B3^:"in^^i
Ju&Ti}:;i'fVij:i'i^i-siii,^-;:i4^3jj;!Jl2^,i^^
LIBRARY
Walter E. Fernald
State School
Waverley, Massachusetts
No.
^ \^ —
THE FEEBLE-MINDED
MACMILLAN AND CO., Limited
LONDON , BOMBAY . CALCUTTA
MELBOURNE
THE MACMILLAN COMPANY
NEW YORK . BOSTON . CHICAGO
ATLANTA . SAN FRANCISCO
THE MACMILLAN CO. OF CANADA. Ltu
TORONTO
XX - ^ /^
THE
FEEBLE- MINDED
^ Guide to Study and Practice
Massachusetts School
for Feeble Minded*
E. B. SHERLOCK, M.D., B.Sc. lond., D.P.H.
Barrister-at-Law, formerly S2cperintendent of the Belmont Asylum
for Idiots, and Lectttrer on Biology in the Westminster
Hospital Medical School
WITH AN INTRODUCTORY NOTE BY
Sir H. B. DONKIN, M.D. Oxon., F.R.C.P. Lond.
Medical Adviser to the Prison Commissioners, Member of the Prisons Board, Consulting
Physician to Westminster Hospital, late Member of the Royal Commission
on the Care and Control of the Feeble-Minded
MACMILLAN AND CO., LIMITED
ST. MARTIN'S STREET, LONDON
I 9 I I
RiCHAKD Clay and Sons, Limited,
BREAD STREET HILL, E.G., AND
BUNGAY, SUFFOLK.
TO
H, W. W.
AS A TOKEN OF ESTEEM
Digitized by the Internet Archive
in 2011 with funding from
Boston Library Consortium Member Libraries
http://www.archive.org/details/feeblemindedguidOOsher
PREFACE
One meets in the world with many human beings
who do not appear to have attained to the average
intellectual level of their social class. For the
condition of such persons no very satisfactory
designation is available, the terms actually employed
being all open to objection either because they are
indefinite or because, being definite, they are inac-
curate. " Degeneracy " implies the falling from a
higher estate, whereas it is the failure to reach the
normal one which is the more obvious characteristic.
" Amentia " errs in the other direction. It suggests
that the defect observed is entirely due to laggard
development ; a suggestion which, as will be seen later,
is not particularly well founded. Moreover, the term
" Amentia " is widely used to denote states of
confusional insanity. " Mental Deficiency " is too
comprehensive, while ''Idiocy" and "Imbecility"
are too restricted in their application. One might,
perhaps, speak of a " Psychical Hypotrophy " or
utilise the Greek word '' ficopla/' which, whatever it
may have meant originally, has now so few associa-
viii PREFACE
tions that any desired signification might be attached
to it. On the whole, however, it seems best to
follow the lead of a recent Royal Commission and
employ the term '' Feeble- Mindedness." Without
attempting a too rigid definition, then, it may be
said that for the purposes of this book, '' The
Feeble-Minded " are the persons with whose " care
and control " the Royal Commission just mentioned
concerned itself.
Between feeble-mindedness and sanity there Is no
clear line of demarcation. To say, as a recent
writer does, that " the two conditions do not merge
into one another and between the lowest normal and
the highest ament a great and impassable gulf is
fixed " is, to say the least of It, misleading. A more
accurate statement of the position is that in the
report of the Departmental Committee on Defective
and Epileptic Children, 1898, which runs: —
'' From the normal child down to the lowest idiot
there are all degrees of deficiency of mental power :
and It is only a difference of degree which dis-
tinguishes the feeble-minded children referred to In
our enquiry on the one side from the backward
children who are found in every ordinary school and
on the other side from the children who are too
deficient to receive proper benefit from any teaching
which the school authorities can give."
This book does not profess to be more than an
PREFACE ix
introduction to the subject with which it deals. Its
original aim was more ambitious, but the clearer per-
ception of the magnitude and complexity of the
problems presented by the feeble-minded which has
resulted from its preparation has engendered in the
author a more modest estimate of its utility.
The earlier chapters are concerned with psychology
and with the anatomical and physiological facts
which are believed to be correlated with psychological
happenings. Such facts as belong more particularly
to those special departments of biology which are
known as pathology, etiology and taxonomy are then
dealt with, and finally the subject is considered in its
legal, medical and educational bearings. Taken as
a whole the treatment may be best described as
sociological.
Since it has proved to be impossible to discuss
fully, within the limits of a small book, the numerous
debatable topics to which reference has had to be
made, the author has contented himself with drawing
what appear to him to be the practically important
conclusions legitimately deducible from the evidence
before him. He confidently anticipates that his
efforts will have resulted in his giving cause for dis-
satisfaction to numerous worthy people. Thus the
psychological scheme adopted will doubtless be
regarded by professed psychologists as unconven-
tional. The author hopes, however, that it may at
X PREFACE
least prove intelligible, and therefore free from a
defect which has vitiated a good deal of psycho-
logical teaching in the past. Take, again, the views
on heredity which are propounded. So far as these
are capable of being allocated to any particular
school, they have something in common with the
hypotheses of Nageli and Weismann, but to as-
sociate anybody's name with them more definitely
than this would probably give rise on the one hand
to indignant repudiations and on the other to pro-
tests as to disregarded claims. To disciples of
Weismann the teaching here given will appear con-
taminated with the pestilent neo-Lamarcklan heresy,
while the Mutatlonists, the Mendellans, and the
Biometriclans will doubtless be prepared to sink
their differences in order to join in a chorus of con-
demnation. The lore of heredity is open to the
reader, and he may well study it for himself. One
may, perhaps, be allowed to throw out the sugges-
tion that he will find the memorial volume Darwin
and Modern Science of the greatest service, and that
he should not overlook the recent works of Dr. G.
Archdall Reid and Mr. Charles E. Walker.
As will be gathered from the bibliographical
references, the literature of the subject has been
freely consulted, and it Is hoped that adequate
acknowledgment has been made in all cases. Some
portion of the notes on the admission of cases of
PREFACE xi
feeble-mindedness to workhouses and asylums has
appeared in the Lancet, and is reproduced by the
kind permission of the editor of that journal. Some
of the photographs of brains are taken from a thesis
submitted to the University of London, and have
been used to illustrate a paper on " The Pathology
of Epileptic Idiocy," which is to be found in the
Annual Report of the Metropolitan Asylums Board
for 1907.
The author is under a special obligation to
Sir H. B. Donkin, who, besides contributing an
Introductory Note, has offered many helpful critic-
isms. He desires also to place on record his
indebtedness to the Medical Superintendents of the
Leavesden, Darenth, and Caterham Asylums; to
Dr. J. F. Powell ; and to Dr. A. K. Maclachlan for
help in the preparation of the indexes.
CONTENTS
CHAPTER I
PAGE
THE NATURE OF MIND I
CHAPTER II
THE BASIS OF MIND • • • 33
CHAPTER III
THE FEEBLE MIND . . . • 70
CHAPTER IV
THE BASIS OF THE FEEBLE MIND ....... 92
CHAPTER V
THE CAUSATION OF FEEBLE-MINDEDNESS . . . . -135
CHAPTER VI
THE VARIETIES OF FEEBLE-MINDED PERSONS .... 180
CHAPTER VII
THE HANDLING OF THE FEEBLE-MINDED 262
LIST OF ILLUSTRATIONS
Fig. i^ — Diagrams illustrating different conceptions of the
Relations of the " Centres " concerned in Speech Page 67
Fig. 2 „ 68
Fig. 3 . . ,,87
Fig. 4 — Design in coloured threads on a layer of
cotton-wool. Made by an idiot, without
tuition To face page 91
Fig. 5 — Brain of an epileptic idiot aged 18 ; weight
of left hemisphere 17! oz., of the right
hemisphere 6f oz. The opacity of the
pia-arachnoid is well shown ... „ 91
Fig. 6 — The same brain as in Fig. 5. The hemi-
spheres are separated and placed so
as to emphasise the difference in size . „ 100
Fig. 7 -Brain of an epileptic idiot seen from the
front . The right hemisphere weighed 1 9f
oz. The left 1 3 oz. Note the opacity of the
pia-arachnoid over the left hemisphere . „ 100
Fig. 8 — Parietal region of the right hemisphere of
an idiot boy aged 17, showing microgyria „ 102
Fig. 9 — Left hemisphere of the brain of an idiot,
showing a condition of true porencephaly „ 102
Fig. 10 — The right hemisphere of the brain repre-
sented in Fig. 9, showing, instead of a
perforation of the ventricular wall, a de-
pressed area with irregular convolutions . „ 103
Fig. II — Brain showing the condition known as
pseudo-porencephaly „ 103
Fig. 12 — Right hemisphere of the brain of an idiot,
showing microgyria . . , . . „ 112
Fig, 13 — A MongoHan imbecile „ 112
xvi LIST OF ILLUSTRATIONS
Fig. 14 — Lateral aspect of the left hemisphere of the
brain of a Mongolian idiot .... To face page 213
Fig. 15 — The micro-cephalic idiot whose brain is
shown in Figs. 16, 17, 18 . , . . „ 213
Fig. 16 — Lateral aspect of the right hemisphere of
a micro-cephalic brain .... „ 218
Fig. 17. — Lateral aspect of the left hemisphere of a
micro-cephalic brain „ 218
Fig. 18 — Mesial aspect of the hemispheres shown in
Figs. 16 and 17 „ 219
Fig. 19 — Lateral aspect of the left cerebral hemi-
sphere of a micro-cephalic idiot. The
pari eto -occipital region is represented by
a sac of which the cavity is continuous
with that of the lateral ventricle . . „ 219
Fig. 20 — Left lateral aspect of the brain of a female
micro-cephalic idiot „ 220
Fig. 21 — An epileptic idiot with well-marked
adenoma sebaceum ..... „ 220
Fig. 22 — Plan of Industrial Colony for 2,000 Persons „ 280
Fig. 23 „ 292
Fig. 24 „ 292
Fig. 25 — Apparatus for Testing Acuity of Perception of Light „ 296
Fig. 26 — Ziehen's 5-Angled Figure „ 298
Fig. 27 — Examples of Heilbronner's Figures . . . . „ 299
INTRODUCTORY NOTE
In justification of this response to a request for some
words of introduction to Dr. Sherlock's book I claim
only my great interest in the subject matter, to which
I have given thought during many years ; my long
work as a member of the recent Royal Commission on
the Care and Control of the Feeble-Minded ; and my
special and personal experience of the considerable
number of mentally defective persons who are found
in our prisons.
Both the plan and execution of this book give
evidence that the author has attacked his subject after
laborious study and thought and with a rich equipment
of practical knowledge. He has produced a work
which, in my judgment, is by far the most scientific
and useful of all that have as yet appeared on the
confessedly important matter which is now creating so
wide an interest. The book, as a whole, is marked by
a rare absence of prejudice, and a wholesome refusal
to accept without adequate proof any doctrine, how-
ever seemingly favourable it might be to conclusions
to which the author might incline. A study of the
first five chapters will, I think, fully bear out these
remarks, and justify the author's view that a scientific
consideration of the nature of mind in general is a
xviii INTRODUCTORY NOTE
necessary preliminary to any useful discussion of the
subject of mental defect.
It may possibly be deemed by some that the author
might have struck a somewhat more certain note when
dealing with the still-vexed question of the inheritance
of mental defect. But in a book of this scope, with
an eminently practical bearing on the question of the
best methods of controlling the large body of mentally
defective persons, both children and adults, who are
now a source of fruitless expense and many dangers
to the community, a final pronouncement on the exact
nature and causation of feeble-mindedness is not
necessary, even if it were possible. The positive
harm which is demonstrably caused now by many
" mental defectives " whom the existing laws cannot
control, and the certain prospect of large numbers of
mentally defective children being permanently unable
to shift for themselves and very liable to take to a life
of misery to themselves and multiform evil to others,
are sufficient reasons in themselves for legislative
enactments on the lines recommended by the Royal
Commission and worked out in some detail by Dr.
Sherlock in the final chapter of this book. Proper
control of the feeble-minded, which is so necessary for
these reasons alone, will go far towards satisfying the
requirements of all such persons as may hold that the
primary necessity and justification for the means pro-
posed is to be found in the hereditary nature and
consequent propagation of mental defect.
In this context a few words must be said on the
very luminous Chapter in this book which treats of
the *' Varieties of Feeble-Minded Persons." Dr.
Sherlock here comments trenchantly on many existing
INTRODUCTORY NOTE xix
classifications. He justly points out where they fail,
both for scientific and practical purposes ; while at the
same time he admits the almost insuperable difficulty
of establishing a system of classification which would
effectively compass both of these objects. He states
his opinion that the best classification on practical lines
is that suggested by the Royal College of Physicians
of London, and adopted for confessed purposes of
utility by the Royal Commission ; while he shows
quite clearly that were it intended to be a scientific or
clinical classification, it would be open to similar,
charges of defect.
In proposing a really excellent combination of
classificatory systems which, as he says, '' appears to
give the most generally useful arrangement " he
enumerates nine sub-divisions, eight of which are
marked, clinically, by saliently different characteristics ;
while the ninth, and far largest, sub-division of all, he
terms '' Residual." He further shows that each of these
sub-divisions will supply instances of the three grades
of mental defect which may be called, respectively,
'' Idiocy," '' Imbecility," and ^' Weak-Mindedness."
In this '' residual " group which constitutes much the
largest proportion of the total number of the " feeble-
minded," and a much larger proportion of those who
are the subjects of the slighter forms of defect, are
included most of those who cannot now be legally
controlled, and who form, essentially, the class of
persons whom it is sought to control on account of the
harm they do and the evils from which they suffer.
Among these are the children who in large numbers
become paupers, criminals, and prostitutes, and are
constantly a source of wasteful public expenditure.
XX INTRODUCTORY xNOTE
Members of this group, says Dr. Sherlock, may show
"all kinds of physical abnormalities," but these are
not of a nature to help in the differentiation of
distinct types of disease. " For sociological purposes,"
he adds, ''it does not seem necessary to attempt any
more elaborate classification than that into cases of
'idiocy,' 'imbecility,' and 'weak-mindedness' already
utilised."
It will thus be seen that for the practical purpose of
deciding as to the proper forms of control and treat-
ment needed in most cases, Dr. Sherlock is in accord with
the description given in the Report of the Royal Com-
mission. The merely verbal difference of nomenclature
which is shown in his use of the word " weak-minded "
instead of " feeble-minded " in this context is, of course,
of no special consequence. In common with many, espec-
ially American, writers the author uses the word " feeble-
minded " generically, to include all grades of so-called
"congenital" mental defect; while the Commissioners
used this word in the sense, more prevalent in
England, of a less marked grade of defect than is
commonly described by the terms "idiotic" or
"imbecile." Hence the word "weak-minded" in this
book represents the word "feeble-minded" as techni-
cally employed by the Commission.
H. B. DONKIN.
THE FEEBLE-MINDED
h
^ CHAPTER I
THE NATURE OF MIND
To speak of '' feeble-mindedness " is to imply, in the
first place, that such a thing as " Mind " exists and,
in the second, that mind is capable of existing in
other than a normal condition. As a necessary
preliminary to arriving at a conception of what
normal and abnormal minds consist in one must
therefore endeavour to envisage " Mind" as it is in
itself.
There is perhaps no other branch of science which
a student approaches with the same misgivings as
preoccupy him in the case of psychology. The
matters towards which his thoughts are directed are
here intangible, vague and elusive facts of an un-
accustomed order and his difficulties are increased
by the apparently irreconcilable diversities in the
descriptions of the facts, which confuse him as he
turns from one source of instruction to another.
Momentarily re-assured by sight of the comparatively
solid ground of reaction-time experiments, plethysmo-
graphic records of emotional expression, and the
B
2 THE FEEBLE-MINDED chap.
other data of the practical psychologist, he soon finds
these are but slippery rocks from which he is again
plunged more deeply than before into the sea of
metaphysical speculation. In such an emergency a
chart, even of the most imperfect kind, which may
serve as a guide to smoother waters, will be of value
and in the following pages an attempt is made to
supply one.
''Observation of the mind," says Huxley,^ ''makes
us acquainted with nothing but certain events, facts,
or phenomena (whichever name be preferred) which
pass over the inward field of view in rapid and, as it
may appear on careless inspection, in disorderly
succession like the shifting patterns of a kaleido-
scope." These events, facts, or phenomena we call
mental processes and we classify them under various
headings as thoughts, sensations, ideas, feelings and
so on ; mind at any given instant being the sum
total of the mental operations proceeding at that
instant. For all practical purposes Consciousness is
the same thing as Mind.
Contemplation of the number and complexity of
the mental processes with which we are familiar can
hardly fail to inspire in us a hope that on analysis
they may be_reduced to simpler elements and this is
to a great extent the case.
Certain of our mental processes show a direct
relation to the conditions of our environment : they
constitute, indeed, our sole source of knowledge of
that environment. Apart from them the environ-
ment has, for us, no existence. This, of course, is
quite other than saying that the universe has no
1 T. H. Huxley, Hume and Berkeley, Collected Works, Vol. 6.
1 THE NATURE OF MIND 3
existence outside our consciousness. The fact that
we do not see a thing or do not see it clearly is
no proof that it does not exist.
Such knowledge as we have acquired about the
world outside ourselves has been obtained through
the instrumentality of our sense organs and it
resolves itself into mental presentations arising in
consequence of the application of stimuli to those
sense organs.
We are familiar in nature with a capacity, on the
part of both inanimate and animate bodies, for
responding to stimulation. The study of explosives
introduces us to bodies in which chemical reactions
of great magnitude can be initiated by apparently
trivial stimuli : a mere touch, for example, will cause
such a body as iodide of nitrogen to explode. A
mere touch similarly, may cause a reaction in a
living creature. The resemblance between the
results obtained in the two cases has not unnaturally
suggested a chemical basis for both, but too much
stress must not be laid on this analogy.
In the particular case where the organisms
concerned are our own bodies we observe that the
reaction is accompanied by an effect on consciousness,
i.e. not only do we respond to stimulation but we
know that we are so responding. We do not credit
the inanimate body which reacts with this capacity
for knowledge and we are uncertain as to the exact
stage in the evolution of living beings at which it
appears.
So far then we have three factors to consider :
(i) the application of a stimulus, giving rise to (2) a
reaction, which is accompanied by (3) a mental
B 2
4 THE FEEBLE-MINDED chap.
process corresponding to that reaction. Departing
somewhat from conventional terminology we will
call the reaction a "Sensation" and the associated
mental process a " Presentation," thus establishing a
convenient distinction between the physical fact,
stimulation : the physiological fact, sensation : and
the psychological fact, presentation/
Sensations may have their origin in the parts of
the nervous system associated with the organs of
special sense or in other parts which are not so
obviously specialised, e,g, the terminations of the
nerves connected with the bones, muscles, joints, and
viscera. To this second group of sensations the
designation ''organic" is sometimes applied.
The list of physiological reactions is a fairly long
one : it includes —
(i) Cutaneous sensations, of two kinds, the
'' protopathic " and the "epicritic." These systems
were differentiated by Messrs. H. Head, W. H. R.
Rivers, and J. Sherren ^ and are described in their
^ The distinction between physical and physiological is an arbitrary
one, but between the physical and the physiological on the one hand
and the psychological on the other there is a gulf which cannot be
bridged over in the way so often attempted ; that is to sa^^, by a loose
employment of the term Sensation. According to the Dictionary oj
Philosophy and Psychology, Sensation is " that mode of consciousness
which can only be accounted for by the present operation of an ex-
ternal stimulus upon the nervous system, or some equivalent condi-
tion." Here it is proposed to define a mental process by the help of
physical criteria which are not commensurate with it. The use of the
term " Sensation " in a purely psychological sense as denoting a unit
of experience would be quite legitimate, but since it leaves us without
a convenient word to express the physiological conditions of a mental
presentation and is superfluous as a synonym for such a presentation,
it seems preferable to employ the term in the sense adopted in the
text.
2 H. Head, W. H. R. Rivers and J. Sherren, The Afferent Nervous
System from a New Aspect, Brain, Nov. 1903, p. iii.
I THE NATURE OF MIND 5
paper, which appeared in Brain for November, 1905.
The protopathic system is " capable of responding to
painful cutaneous stimuli, and to the extremes of
heat and cold. This is the great reflex system,
producing a rapid widely diffused response un-
accompanied by any definite appreciation of the
locality of the spot stimulated." By means of the
epicritic system we " gain the power of cutaneous
localisation, of the discrimination of two points, and
of the finer grades of temperature, called cool and
warm."
(2) Visceral sensations.
(3) Auditory sensations.
(4) Labyrinthine and motor sensations. These
are concerned in the maintenance of muscular tone
and in the co-ordination of movements. The motor
sensations are those known as " kinaesthetic," but
the labyrinthine are also, in a sense, kinaesthetic.
(5) Visual sensations.
(6) Gustatory sensations. These are of four
kinds corresponding to the qualities ''sweet,"
''bitter," "salt," and "sour."
(7) Olfactory sensations. The varieties of these
have not been determined with certainty. Zwaarde-
maker's classification runs thus ; —
[a) Ethereal, {b) Aromatic, {c) Balsamic, (d)
Amber-musk. {e) Allyl-cacodyl. (/) Burning.
i^g) Caprylic. {Ji) Repulsive, (i) Nauseating.
On examining a presentation more closely we
discover in it certain features or qualities which call
for description.
{a) In the first place we notice that a presentation
which has been called up by a sensation is not
6 THE FEEBLEMINDED chap.
henceforth a constant part of consciousness. With
removal of the stimulus the presentation fades away.
But experience shows us that it may re-appear in
consciousness without the repetition of the stimulus :
there may, in fact, be a re-presentation. This
species of spontaneous reproduction is called
"perseverance." The particular mental process
which is involved in the re-appearance of a presenta-
tion is called Memory, and as it seems impossible to
resolve it into any simpler constituents, we must
accept it as a further "element of mind." What
becomes of the presentations until they are re-
presented we can only surmise. If it is any help to
the student, he may suppose, with Binet,^ that
they " prolong their existence while they are not
being thought in the same way and for the same
motive that material bodies continue theirs while
they are not being perceived."
(b) Another characteristic which we may observe
a presentation to exhibit is that of being pleasant or
unpleasant ; of being, in the language of the
psychologists, "affected." There are, according to
Professor E. B. Titchener,^ " three possible views of
elementary affective process. The affection may be
an attribute of sensation — an ' affective tone ' of
sensation.-^ Or the affection may be a mental
element distinct from, and co-ordinate with, sensation.
Or lastly the affection may be itself a sensation, a
sensation of a special kind like a visual or the
^ A. Binet, The Mind and the Brain, 1907? P- 126.
- E. B. Titchener, Lectures on the Elementary Psychology of
Feeling and Attention^ 1908.
^ " Sensation " is here used in the sense of " presentation."
1 THE NATURE OF MTND 7
kinaesthetic." As he dismisses somewhat contempt-
uously the first view and devotes a considerable
amount of space to demolishing the third, we may
regard the second as the one which meets with his
approval. The only objection to this view is that it
hardly lays sufficient stress on the dependence of
affection on the idea, for without presentations or
re-presentations affection is non-existent, although
the converse statement, viz., that without affection
ideas are non-existent, does not appear to be true.
We may note that a more elaborate scheme of sub-
division of the affective process than the one here
adopted is employed by some psychologists, e,g, by
Wundt, who recognises three pairs of antithetical
affective qualities, pleasantness — unpleasantness ;
excitement — tranquillisation ; tension — relaxation.
Representations differ from presentations in no
important respects save that of being later in time,
and we may conveniently include the two classes
under the denomination " Ideas." The appearance
and re-appearance of Ideas in consciousness we may
call '' Ideation." Our mental outfit, then, so far as
we have got, consists of Ideas, Memory, and Affec-
tion, and we must now proceed to enquire what are
the possibilities in the way of mental architecture
which this outfit furnishes us with.
Although for the purposes of elucidation we
regarded Ideas as isolated events in consciousness, a
survey of our minds shows them to be woven into
innumerable and ever-varying combinations of
different grades of complexity. As I write, my
organs of sight and hearing are being assailed by
stimuli emanating from an object lying within my
8 THE FEEBLE-MINDED chap.
field of view. My consciousness contains ideas
corresponding to the colours black, white, and yellow,
and to a noise of short duration. The ideas are
simply there and have no connecting link beyond
their simultaneous presence. But connecting links
can be added by memory. The ideas of colour and
noise, if previously experienced in connection with
other ideas, will recall those other ideas. I remember,
for instance, that the object has other sides than the
one I see, that it is tangible, that it is made up of
many parts, and so on, and my mind consequently
becomes occupied by a group of ideas which are not
only present together now, but which, in my experi-
ence, have been present together many times
previously, and which therefore I have learned to
regard as having some firmer bond of union than
mere simultaneity. I am, that is to say, not only
aware of the presence of sensations, but I perceive
that they are referable to a particular object to which
I have been taught to attach the name '' watch."
A group of ideas which can be thus referred is a
Percept.
It has been usual for psychologists to apply the
term percept only to the special case of grouping
which I have taken as an example, i.e. the case in
which both presentations and re-presentations are con-
cerned. There seems, however, to be no sufficient
ground for this distinction, and the term will
be used in this work as equally applicable to a group
of re-presentations only when these are referable
to a particular species, as opposed to a genus, of
natural phenomena.
For the purpose of arriving at the definition of a
T THE NATURE OF MIND 9
percept, we have considered ideas apart from the
special quality of affection. If we now include within
our purview this aspect of ideas also, we are able
to take a further step. An idea or percept which is
appreciably affected, or, if another way of putting it is
preferred, the idea or percept with which an affection
is associated, is called a Feeling.
But we are able to observe in our minds affected
processes which seem to be much more complex
than Feelinois. These are what we call Emotions.
The term connotes a "moving out" or "expression"
as distinct from the " impression " which we have so
far considered, and we must now deal with the new
factor which appears to be introduced.
It constantly happens that the effects of stimula-
tion, instead of being confined to the development
of a sensation, become evident as action, and action
will have its equivalent in consciousness in so far as
it provides a stimulus to the sense organs. Such
equivalents are called Kinsesthetic Ideas. Now
emotion involves action, and it would appear to be
the ideas arising from this activity which, added to
a Feeling, convert it into an Emotion. The
Emotion will thus comprise what may be described
as primary and secondary groups of ideas. Emotions
are numerous and diverse, but for our present purpose
we need not proceed further with the classification
of them than to indicate that they can all be
referred to two, still more easily to six, categories
of affection, the more detailed differences between
them being dependent on their ideational rather
than their affective content. It is generally taught
that '' organic " sensations are mainly responsible
10 THE FEEBLEMINDED char
for the affected ideas which are comprised in
emotion.
A prolonged emotion of no great intensity we
call a Mood, while we speak of one which is brief
but intense as a Passion.
For a long time there has been in progress
between psychologists a discussion as to the relation
subsisting between an emotion and its expression.
At first sight it certainly appears that the sequence
of events is that we feel an emotion and then
proceed to its expression ; but Lange, James, and
others, take up the position that we feel an emotion
because we are expressing it, not that we express an
emotion because we are feeling it. Appeal is made
for confirmation of this view to the experience of
persons whose business or amusement it is to express
emotions, and actors are quoted as having testified
that when they are representing emotions effectively,
they actually experience them in their own conscious-
ness. That emotion may be generated by an effort
of the will is borne out by the interesting experi-
ments alluded to by Sir Francis Galton,^ in which
he succeeded in developing in his mind a fear of
espionage and a reverence for the figure of Punch by
allowing himself to dwell upon those topics. On
the other side of the account we may, however, set
the evidence of no less distinguished an actor than
the late M. Coquelin ain6, who, in an interview
reported in the Daily Graphic for Jan. 28th, 1909,
said, *' I go to a theatre for a first performance
entirely without emotion, knowing exactly what I
am going to do and exactly how I mean to do it.
^ F. Galton, Memories of My Life.
I THE NATURE OF MIND 11
Everything that the actor does on the stage should
be an act of his voHtion and not the result of
a blind impulse of emotion." The apparent dis-
crepancy is perhaps to be explained by supposing
that in some cases the primary and in others
the secondary group of ideas is the one more
strongly affected.
It will be seen that the definitions of emotion and
its modifications which have been given imply more
than the mere existence of ideas, affected or un-
affected. If we search our consciousness, we
discover that we are aware of something more about
ideas than that they simply are ; we observe that
they have certain relations to each other. The
ingredients of natural phenomena can be distributed
among at least four categories — those of matter,
force, time, and space. Perhaps the first two may
be taken together and expressed simply by the term
motion. As to the existence of these categories
outside the limits of human experience we know
nothing : they exist for us because we think that
they do ; they are the projections of our conscious-
ness against the background of the universe. Force
and matter (or motion) have, as we conceive of
them, a quality of substantiality which is lacking
from time and space. Now ideas are the psycho-
logical equivalents of motion, but since we are
aware also of the existence of time and space, these
must also have some equivalents in consciousness.
The essence of our conception of time and space is
an awareness of succession — of the occupying,
by motion, of successive positions in time and
space. Our psychological equivalent of succession
12 THE FEEBLE-MINDED chap.
is something different from an idea in that it is not
directly referable to any sensation.
Introspection will tell us that our minds contain
products of ideation which are much more complex
than, though probably derived from, percepts.
Psychologists have been accustomed to describe
four modes of combination of ideas. These may be
arranged in pairs according to whether the associa-
tion is determined by (a) the co-existence or the
succession of the ideas ; or (d) the similarity or
dissimilarity of the ideas.
The presentations and re-presentations in a
percept form a natural group of ideas between
which there is the relation of simultaneous associa-
tion. When for any reason one of the ideas in the
group is revived, the rest tend to be revived also.
The groups of ideas in consciousness are ever
changing, but before those in one group have passed
away others may have entered consciousness and
so become associated with the original group.
One of these new ideas may serve to revive the
original group and we have then a case of succes-
sive association or association by contiguity. An
entirely new group of ideas may contain one which
had already occurred in the previous group. This
idea, when presented in the new grouping, may
reproduce the former grouping. Association by
similarity occurs in this way : it is thus, as Semon ^
has pointed out, only a special case of simultaneous
association. Contrast association also may be
accounted for on a basis of simultaneous association
if we remember how we are trained in childhood
^ R. Semon, Die mnemischen Empfindungen^ 1909? Chap. X.
I THE NATURE OF MIND 13
to think of contrasted objects or qualities together.
Yet another form of association to which no special
name is applied, but which may also be brought into
the class of simultaneous association, is recognised.
Thus we find that if the ideas x and z have each
been separately associated with the ideajj/, although
neither x nor z alone may suffice to reproduce y,
a combination oi x and z may be effective.
Our processes of analysing and synthesising
groups of ideas may have also a more specific
character, dependent on the circumstance that when
ideas are like each other we can become aware of
the fact. The act of comparing ideas with a view
to learning whether they are alike or not is called a
Judgment.
We are now well within sight of the morass in
which generations of metaphysicians have floundered.
What is it which enables us to observe relations of
succession and similarity and to associate ideas
according to those relations? Is it some ''mental
element " or " process " additional to those already
enumerated, but essentially of the same general
character, or does it, perhaps, belong to a higher
order of mentation ? Frankly, we do not know, and
if we have the scientific spirit we admit as much.
Let us, therefore, accept provisionally the existence
of a something which, in accordance with precedent,
we will call the Ego and proceed with our examin-
ation of ideas.
We have seen that ideas may be " affected " ; that
they may be grouped together in various ways ; and
that they have certain relations to each other. They
have yet a further characteristic : they are not all
14 THE FEEBLE-MINDED chap.
equally prominent in consciousness at any one
instant and any one of them or any group of them is
not prominent in consciousness to the same extent at
all times. An idea which is prominent in conscious-
ness is said to be *' attended to," and the condition of
its prominence is called Attention. Ideas may be
prominent in consciousness either because they have
a natural or intrinsic importance, or because the Ego
lends them that importance. Any sufficiently strong
and sudden stimulation of a sense organ will give
rise to a dominating idea in consciousness. A loud
sound or a bright light or a strong smell standing
out from the background of ordinary sounds, sights,
or smells will attract notice : it will be involuntarily
attended to. On the other hand, we may select some
particular idea or group of ideas for notice by a
process of voluntary attention. The faculty of
voluntarily attending is appropriately entitled Volition,
and it is because we have this faculty that Reasoning
is possible, for Volition enables us to abstract from
groups of ideas such ideas as we wish, and we can
then bring these abstracted ideas together in order
to compare them and so establish between them a
relation of similarity or of dissimilarity. Such a
comparison of ideas is, as we have already seen,
called a Judgment. The comparison of judgments
with the same end in view, i.e. in order to ascertain
whether they are like or unlike, is called Reasoning.
One of the simplest results of Reasoning is the
discovery that different groups of ideas may have a
sub-group common to all of them : thus we are
familiar with numerous objects which differ from one
another, but yet have so much in common that we
I THE NATURE OF MIND 15
perceive them all to be watches. The sub-group o^
ideas which is thus common to several percepts
constitutes a Concept. It is unfortunate that we
should have to indicate this generic idea-group by
the same term, viz. " watch " as was applied to the
specific idea-groups or percepts from which it was
derived. For this the defective analytical faculties
of the minds in which our language was evolved must
be held responsible.
But the faculty of attention does not merely
supply us with judgments. We have seen that ideas
tend to call back to consciousness the ideas with
which they have previously been associated. By
attending to an idea we may, therefore, enrich our
minds with new ideas which in turn may lead us on
to yet others. This is Recollection, a special case
of that capacity for re-presentation which we have
admitted to the status of a " mental element " under
the designation Memory. If it were not for the fact
of association it is inconceivable that we could
remember anything by an effort of will since no
amount of attention to other ideas could bring to
consciousness one not there. Having obtained our
recollections, however, there is nothing to prevent
our associating them together in novel combinations
and the process of doing this we call Imagination.
Some of the ideas present in our minds are, we
have seen, *' affected." A judgment dealing with
affected ideas is a Sentiment and, like the emotions,
the sentiments can be, ultimately, referred to two
main classes according as the affection of pleasure or
pain predominates.
A further sub-division of the sentiments often
16 THE FEEBLE-MINDED chap.
employed is that based on the interests to which they
refer. We have thus four groups of sentiments — the
intellectual, the aesthetic, the religious, and the
social, and it is the last of these which is of the most
importance from the psychiatrical standpoint.
As with so many other psychological terms, the
word "sentiment" is used by different writers with
different meanings. Since a certain prominence has
lately been given to his views, mention should be
made of Mr. A. F. Shand's conception of a senti-
ment as ''an organised system of emotional dis-
positions centred about the idea of some object." ^
The notion of mental constitution which we have
now attained to is that of a collection of ideas which
may be attended to by an Ego, and the attributes of
that Ego may be sketched in the words which Lloyd
Morgan applies to volition, which is, in effect, the
Ego in operation. It is *'an activity, selective and
synthetic, which is neither energy nor consciousness,
which has not been evolved, but through the action
of which evolution has been rendered possible :
which is neither subject nor object, but underlies and
is common to both."
It would be wearisome to enter at length into the
dispute which has raged as regards the necessity for
accepting the Ego as an entity transcending
consciousness, but since we have, for the sake of
convenience, so accepted it, we must in fairness
point out that the necessity is not so urgent as may
appear. We recognise that, apart from our volition,
ideas can return to consciousness after leaving it.
This return, further, seems to depend on laws of
^ W. McDougall, An Inlroduction to Social Psychology^ p. 466.
I THE NATURE OF MIND 17
association which are also quite independent of
volition. Again, the prominence of the ideas in
consciousness, as in the case of involuntary attention,
may not be determined by volition. It is at least
conceivable that all the conditions are in some way
referable to alterations in the environment. What
we observe in consciousness is simply that ideas are
there, our assumption of an Ego is merely an
attempt to explain their presence in a special case,
and since in other cases we do not require meta-
physical explanations, there does not appear to be
any very sound reason why we should do so in this.
The exercise of volition is accompanied by what
has been called a ''sense of effort" or "Conation"
and it is essentially this feature which marks off
voluntary from involuntary mental activity. But
this "awareness" of what is toward does not appear
to differ from an idea, and that fact in itself suggests
that the difference between involuntary and voluntary
processes is simply that the latter have, as compared
with the former, a greater ideational content.
There is about volition an apparent independence
of circumstances which is regarded as elevating it to
a higher plane than that occupied by the mental
elements so far discussed. This is what is meant
by Free Will. But the assumption that the Ego
acts irrespectively of the subject's state of conscious-
ness at the time of the action is not well established.
If we consider our activities we find them to be
conditioned in some measure by the degree of
affection characterising the ideas which give rise to
them. As Mercier^ puts it " Volition depends upon
^ C. A. Mercier, Psychology^ Normal and Morbid, p. 466.
18 THE FEEBLE-MINDED chap.
affection. When affection is neutral there is no
Volition. Pleasurable affection determines Volition
to continue the existing state of action or passion.
Painful affection determines Volition to change the
existing state of action or passion." -^ Our '' motives "
then are simply strongly affected ideas.
It is held by some psychologists that volition, that
is to say, the faculty of voluntarily attending, is
dependent only upon affection. If this be so, the
hypothesis of an Ego is superfluous. It would seem,
however, that the intensity of the affective colouring
of an idea is not a measure of the prominence of the
idea in consciousness : it is rather a measure of the
utility of the idea as a factor in the adaptation of the
individual to his environment. Nor is this the only
consideration bearing upon the matter. In order to
appreciate the position more accurately we must now
turn to an important aspect of the working of the
mind which was incidentally touched on when the
formation of concepts was under review. It is the
faculty which our minds display of taking short cuts.
If we refer to our experience of the way in which
we become cognisant of things, we find that our
appreciation of a proposition does not require a
detailed knowledge of all the trains of thought to
which the proposition can give rise. When, in
consequence of leaning against the edge of my
writing table, I am reminded that I have a watch in
my pocket, the mental picture of the watch is in the
highest degree indistinct. In proportion to the
' Sollier makes a similar statement. " We may," he says, "regard
attention as the result of an affective state, putting into play the motor
power," while Ribot describes spontaneous attention as " caused by
emotional states.
T THE NATURE OF MIND 19
degree of attention which the circumstances require
me to devote to the watch, it becomes more and
more clearly defined in my consciousness. But for
many purposes of life, the less distinct image will
serve sufficiently well. Similarly, a passage in a
book may be at once intelligible even though one
does not pause to think out all that it involves. In
imitation of an experience recorded by Professor
James, I have just taken up a book near at hand and
having opened it at random, have placed a finger on
the page and have then read the words to which my
attention has been thus directed. They are : —
" The total amount of carbonic acid exhaled would
be about 12,000 grains."
The sentence presents no mystery, its purport is at
once obvious ; but if I proceed to analyse what has
been conveyed to my mind by it, I find that the
apprehension of it involves various series of facts in
relation to chemistry, physiology and mathematics
which were certainly not present as separate factors
of consciousness when I read and "understood" the
words. It seems then that in the processes of
thinking we are able to utilise a complex idea by
restricting our attention to some of its components.
But if this is true for the receptive side of our
minds, it is no less so for the emissive side. The
ideas corresponding to our activities exhibit the
same tendency towards short-circuiting. The school-
girl steadily plodding through her '' five-finger
exercises " will be only too unhappily conscious of
which note follows which, while her teacher will
rattle off the various sequences without a thought as
to the movements of his hands, though probably he
c 2
20 THE FEEBLE-MINDED chap.
began in the same laborious fashion as his pupil.
This faculty of acting with only the merest shred of
attention is called ''Automatism," and when, proceed-
ing a stage further, the activity of the organism has
no obvious counterpart in consciousness capable of
beinof attended to at all, we call the condition a
''reflex" one. Reflex movements may, however,
be attributable to an undeveloped, rather than to
a specially modified mind, and those of the lowest
living forms seem to be of this type.
According to the teaching of some psychologists
the important series of activities which we call
"instinctive," and which are characterised by in-
attention both to the end in view and the means of
attaining that end, are essentially automatic, i.e.
they were originally associated with clearly defined
mental concomitants which have, in the course of
transmission through many generations, gradually
faded away. " Evidemment," says Th. Ribot,^ "a
I'origine, tout instinct, simple ou complexe, a ete una
forme quelconque de I'activite psychique ; mais, grdce
a des repetitions perpetuelles chez I'individu et ses
descendants, il s est etabli dans le systeme nerveux
de I'animal des dispositions permanentes, des con-
nexions stables entre divers elements anatomiques :
I'instinct s'est enregistre, organise."
Professor Titchener ^ takes up a somewhat similar
position. "I believe, with Cope," he says, "that
even the automatic involuntary movements of the
heart, intestines, reproductive systems, etc., were
organised in successive states of consciousness."
^ Th. Ribot, LHiriditd Psychologiqucy 1902, p. 19.
'^ E. B. Titchener, op. cit. p. 300.
I THE NATURE OF MIND 21
There is considerable difference of opinion among
psychologists as to the part which instinct plays in
human affairs, but there can be little doubt that
inherited tendencies control our conduct to an
extent which is not always sufficiently allowed for.
McDougall, in particular, has laid stress on the
importance of these innate dispositions. The
analogy of volition would lead us to expect that
instincts, as springs of action, should have a well-
marked affective tone, and this experience shows to
be the case. In his analysis of the subject,
McDougall ^ correlates the principal instincts with
what he regards as the primary emotions of man, as
shown in the following scheme :
Instinct
Emotion
Flight
Fear
Repulsion
Disgust
Curiosity
Wonder
Pugnacity
Anger
Self-abasement
Subjection
Self-assertion
Elation
Protection of offspring Tenderness
Other instincts with less well-defined emotional
attributes are the reproductive, the gregarious,
the acquisitive, and the constructive, while among the
innate tendencies which are of too general a nature
to be classed as instincts are what McDougall calls
the "pseudo-instincts," suggestion, imitation, and
sympathy.
We employ yet another device to facilitate the
1 W. McDougall, op. cit.
22 THE FEEBT.E MINDED chap.
working of our minds. It is the scheme of symbols
which we call language. Let us consider, for example,
the word ''exhaled" in the passage quoted above.
The actual presentations in consciousness which set
my mind at work were simply ideas of some light
and dark areas on a sheet of paper, and had no
intrinsic relation to the physiology of respiration.
That I should regard them as having such a relation
is due to the fact that I have accepted a convention,
subscribed by all English-speaking persons, which
decrees that the particular arrangement of differently
coloured surfaces which I have just been looking at
shall signify a particular phase of a particular form
of organic activity. In our mental processes, then,
we utilise not only simple (and complex) ideas of
things themselves, but ideas of symbols — words —
which we have made to stand for those things.
Very largely we think in words. In describing the
working of his own mind, Professor William James ^
says : "I am sure that my own current thinking has
words for its almost exclusive subjective material,
words which are made intelligible by being referred
to some reality that lies beyond the horizon of direct
consciousness, and of which I am only aware as of a
terminal mo7'e existing in a certain direction to which
the words might lead, but do not lead yet."
The substitution of abbreviations and symbols for
original ideas will involve among its consequences
such an obscuring of the native affective colouring of
those ideas, that the dependence of the activities
referable to the ideas upon affection may no longer
be obvious. We are thus supplied with a reason
^ W. James, The Mea?iing of Truths 1909? P- 3i«
I THE NATURE OF MIND 28
why motives, even if they were originally of a kind
to compel attention, may have ceased to attain to
prominence in consciousness.
Speech plays so large a part in mental develop-
ment that, although the subject bristles with
difficulties, its psychology must be studied by anyone
who wishes to obtain more than a superficial know-
ledge of the nature of mind. There is no lack of
material for the purpose, but since the greater part
of it falls into the hands of biased or uncritical
observers, its educative possibilities are rarely
exploited to the full. In this field we are precluded
from employing the introspective method except to
a very limited extent. Even the most efficient
memory is incapable of re-presenting to the mind
those early stages of the struggle for expression
which constituted the dominant interest of the first
few years of life. Later we can examine the ways
in which we acquire new words or lose old ones, the
dependence of our mental capital of words on the
physical peculiarities of our vocal organs, the
unattended to association which makes us use the
same word or root several times in a short passage,
and kindred topics ; but our acquaintance with the
contents of the infant mind is purely objective, and
so easy is it to misinterpret what we see that the
utmost reserve must be employed in advancing any
propositions relating to the subject. Just as the
wondrous feats of intelligence attributed to cats and
dogs can practically always be reduced to the
simplest psychological elements, so the scintillae of
wisdom which emanate from the infant brain lose
their brilliance at once when subjected to the cold
24 THE FEEBLE-MINDED chap.
light of reason. The writer knows of a child which,
at the age of six months, frequently enunciated
distinctly the syllables ** dad-da" and ''dad-dy," but
a very brief study of the case served to show that
these excursions into phonetics had no relation to
the presence of its male progenitor, or, indeed, to any
distinguishable feature of the environment, but were
merely an accidental result of that playful exercise
which the mechanism of speech shares with the rest
of the muscular apparatus. As Rzesniezek puts it,
"the child amuses itself by the hour with its own
private articulation-concert." That the '' accidental
result " should take a form so closely allied to
voluntary speech is not without its significance from
the standpoint of heredity. It certainly suggests
that since the particular faculty of intelligible, even
if not intelligent, expression thus exhibited had not
been acquired by the individual, it had been inherited
from the ancestors who acquired it.
The elements of speech are apparently derived
from two sources, i.e, some of them are inherited and
some acquired. By a process of evolution which
can be observed during the first few months, the
reflex cry of the period immediately following birth
passes through phases of differentiation correlated
with the incidence of such varying stimuli as pain,
pleasure, hunger, repletion, or other bodily condition,
until it becomes the rudimentary speech which has
been spoken of above as ''accidental" How far
progress in this direction can occur is doubtful, but
some indications are afforded by children who are
deaf from their earliest infancy. Thus Ashby and
I THE NATURE OF MIND 25
Wright ^ record the case of a child who at the usual
time babbled such syllables as ''mam," ''dad," and
" am," but eventually proved to be quite deaf. Too
much stress must not be laid upon such an excep-
tional case as this, because one may suppose that in
the absence of auditory stimuli the inherent capacity
for articulation was not fully developed. It seems
probable that quite a considerable amount of vocal
" raw material " is accumulated before the child
begins to imitate sounds spoken before him, and that
this original material is of a kind differing from that
acquired later. Children may employ speech sounds,
e.g. clicks and gutturals, which adults do not —
unless, indeed, they be adults belonging to certain
savage tribes — give utterance to, and later in life
they may apply to objects about them names which
find no place in the conventional scheme of language,
and which they seem to have evolved quite in-
dependently of, and perhaps in spite of, efforts at
instruction by their elders. It has been noted too
by Vierordt and others that children sometimes
have a difficulty in voluntarily imitating sounds
which they have spontaneously used, and Meumann
endorses the observation of Schmiedel that a
temporary dumbness sometimes marks the transition
from the spontaneous lalling of infancy to the formal
imitation of spoken speech. Even when there is
not this abrupt break, a stage is passed through in
which it is to be inferred from the child's behaviour
that he responds to words addressed to him although
he makes no attempt to use them. One must be
^ H. Ashby and G. A. Wright, The Diseases of Childreii^ iQ^S? P- 573-
26 THE FEEBLE-MINDED chap.
careful not to fall into the error of exaggerating the
significance of this response. It Involves nothing
more than an association of ideas of the most prim-
itive kind. Take, for instance, such a case as this : —
The child's attention has been directed to a certain
object while, contemporaneously, the word "gee-
gee " has been uttered. Subsequently, on again
hearing the word, the child may, by looking towards
the animal, indicate that there has been established
in his mind an association between the auditory and
the visual ideas. But there is something more.
Since the idea complex has given rise to movement,
we must suppose it not to have been indifferent but
to have had an affective colouring. Whether that
colouring is dependent on the idea of the word
spoken, or on the idea of the object formerly seen,
or on some ingredient contributed to the idea com-
plex by inheritance, may be doubtful, and indeed it
becomes henceforth increasingly difficult to distin-
guish instinctive and acquired activities, so that
there is wide difference of opinion among psycholo-
gists as to the scope of the former.
For the activities involved in speech an affective
prompting is, it would appear, just as necessary as for
movement of other kinds. This seems to have been
most clearly recognised by Meumann ^ whose well-
marked critical faculty has prevented his adopting
the 07nne igno turn pro magnifico attitude of so many
other philologists, and whose teachings as to the
ontogenetic evolution of language bear upon them the
stamp of common sense. For him the active speech
^ E, Meumann, Die Eiitstehung der ersten Wo7'tbedeiiiiingeii beim
Kinde, 1902.
I THE NATURE OF MIND 27
of a child begins with a stage which he calls the
*' emotional- volitional," or stage of the expression of
desire. To the child, he says, " the world of his
wishes and desires, of his feelings and affections, and
not that outer world accessible to the intellect, is his
world." The words which a child first learns to
speak are those connected with objects which appeal
to him, and he employs a single word to indicate a
variety of things, not because he has formed a concept
under which those things can be subsumed, but be-
cause he wants them all or is dissatisfied with them
all. Experience will shortly teach him the inexped-
iency of, for example, applying indiscriminately to
things which are too hot or too cold the single term
" 'ot " as in the case described by Tracy, or of saying
" nein " when he means '' ja," as Preyer records, and
thus will be initiated what Meumann calls the "in-
tellectualisirung " of the hitherto emotional speech.
In the absence of any introspective method of
investigation, the subsequent stages in the acquisition
by the child of a vocabulary are likely to remain
enveloped in mystery. We are confronted with the
problem of deciding why, in the first place, the
sounds of words should have any meaning at all, and,
further, why they should have acquired the specific
meaning actually attached to them. A review of the
different theories dealing with the point is beyond
the scope of this work, but allusion may be made to
the chief ones. There is, to begin with, the imita-
tive, or objective, or onomatopoetic, or " bow-wow "
theory, which derives names for things or events
from sounds which are associated with those things
or events : there is the subjective or interjectional or
28 THE FEEBLE-MINDED chap.
" pooh-pooh " theory, which refers our initial attempts
at speech to the exclamatory outbursts which form
part of the expression of the emotions ; and there is
the compromise between these explanations which is
to be found in Noire s modification of the onomato-
poetic theory to which the name of the '* yeo-he-ho "
theory has been applied.
One thing is clear, though it is apt to be overlooked.
A child does not necessarily understand or mean by
any given word what is in the mind of the person
who teaches it to him. Usually, it appears, his
interpretation of it is originally much wider than that
of his tutor. What, for the latter, is merely the
name of a thing, may connote for the former innumer-
able predicates relating to that and other things
which have in common no more than some interest
which, though of the first importance to the child, is
unintelligible to the observer. But while in one
plane the dimensions of a child's thought are so wide,
in another they are quite restricted. The literalness
of children is, in its way, just as striking as the in-
definiteness of their ideas. James recalls that at the
age of eight he thought, in reading " Lord Ullin's
Daughter," that ''the staining of the heather by the
blood was the evil chiefly dreaded, and that when the
boatman said
' I'll row you o'er the ferry.
It is not for your silver bright
But for your winsome lady. . .'
he was to receive the lady for his pay." It was
doubtless a child of a larger growth who regarded
the words
" books in the running brooks
Sermons in stones. .'
r THE NATURE OF MIND 29
as a misprint which could be set right by inter-
changing the positions of the words '' books " and
"stones." How foolish to the schoolboy is Virgil's
famous phrase '* Sunt lachrimse rerum," and how
little does he appreciate, as he will in after life, the
true inwardness of
" O Fortunati ! quorum jam moenia surgunt,"
At what stage in development the spoken word
may be construed as symbolical of a judgment is a
matter in regard to which much diversity of opinion
exists. Sully ^ speaks of '' rudimentary judgments "
as occurring at the age of one year, and gives as an
example the naming and pointing at an object, e.£:
a dog. As expressed in speech, ''judgments " (with-
out qualification) are first noted in the second half
of the second year. Even according to Sully's
own definition : ''We judge," he says, "whenever
we go through any mental process which ends in
an affirmation or negation of something " — such
" rudimentary judgments " are hardly worthy of the
name of judgments at all, and it seems preferable
to regard them with Meumann as simple results of
association involving no processes of analysis or
synthesis. The first steps in reasoning are probably
not taken for a considerable time after such a display
of " intelligence " as this becomes possible. By
learning new words and extending the meaning of
the old ones, the child makes progress in knowledge
but since the feeble minded are, ex hypothesi
restrained from attempting the higher flights in this
sphere of activity, we need not devote more space to
^ J. Sully, The Teacher^ s Handbook of Psychology ^ 1909, p. 298.
30 THE FEEBLE-MINDED chap.
the topic. The reader will find it treated of at
length in Romanes' Mental Evolution in Man and
kindred works.
Exception may perhaps be taken to the view ot
Mind and Consciousness expressed above. It is
very generally held by psychologists that the term
" Mind " embraces certain processes which appear
to go on in a mysterious sub-personality, of which
the Ego takes no account except on those occasions
when for some not very obvious reason the sub-
personality thrusts itself upon consciousness. Thus
we meet with such cases as the following :
Glancing in a casual way over a sheet of an
evening paper, my eye was arrested by a paragraph
referring to the death of a certain Member of
Parliament. The name was unfamiliar and the
particulars given contained no allusion to the
political views of the deceased gentleman, yet I
found in my mind a clearly defined idea of the party
to which he had belonged. I had no recollection of
reading anything on this point and I therefore read
the paragraph again only to find that, as I had
supposed, it contained nothing bearing on the matter.
Then I noticed that the article, of which I had only
read a portion, was headed " Death of a Unionist
M.P.," words which it is clear I must unwittingly
have read before.
From such comparatively trivial instances of what
has been called '' unconscious memory " we may
pass to the more complex questions of hypnotism
and multiple personality. It is true that the
hypothesis of a sub-conscious personality affords a
I THE NATURE OF MIND 31
simple explanation of the phenomena observed.
But it does not follow that such an hypothesis is
valid. Professor H. Munsterberg/ for example,
will have none of it. ''The story of the sub-
conscious mind," he says, "can be told in three
words : there is none." He explains the current
mistaken teachings thus.
"Facts are referred to the sub-conscious mind
which do not belong to the mind at all, neither to a
conscious nor to a sub-conscious one, but which are
simply processes in the physical organism : and
secondly facts are referred to the sub-conscious mind
which go on in the conscious mind, but which are
abnormally connected. Thus the sub-conscious
mental facts are either not mental but physiological,
or mental but not sub-conscious."
The case of " unconscious memory " given above
belongs to the latter category : an idea correspond-
ing to the word " Unionist " was present in
consciousness, but was not being attended to.
" Multiple personality " may be explained on either
basis : there may be '' co-conscious " groups of
contents which appear to be independent since they
have no common content, or when any particular
personality is present to consciousness, a simultaneous
manifestation of another personality may occur
which has simply a physiological significance, i.e, is
unattended by mental concomitants.
In his book just cited. Professor Munsterberg
proceeds to an interesting analysis of consciousness,
which he defines as "the presupposition for the
^ H. Munsterberg, Psychotherapy^ 1909, pp. 125 and 130.
32 THE FEEBLE-MINDED ch. i
existence of the psychical objects." It is the
'' subject of awareness " of the ideas which constitute
mind, but since it has no existence apart from its
content (which is the sum of those ideas) we seem
justified in the proposition already advanced that
consciousness and mind are, for all practical purposes,
the same thing.
CHAPTER II
THE BASIS OF MIND
It may be noted that throughout the foregoing
analysis of mind it has been tacitly taken for granted
that the conclusions which a particular individual
has come to about his own mind may be applied to
the minds which he assumes other persons to possess.
This proceeding is justified for any individual so
long as nothing in his experience invalidates it.
It is futile to raise the objection that we do not know
that other minds are constituted like our own.
This is to claim for knowledge a transcendental
character which removes it from the sphere of
utility. Absolute truth has no existence for us
except as a maximum of probability, to which there
are many degrees of approximation. Truth,
according to Prof. W. James, means ''that ideas
(which themselves are but parts of our experience)
become true just in so far as they help us to get into
satisfactory relation with other parts of our ex-
perience." Or as he puts it in another place, ''true
ideas are those that we can assimilate, validate,
corroborate, and verify."^
^ W. James, Pragmatism^ 190?} PP- 5 8 and 201.
D
34 THE FEEBLE-MINDED chap.
We have regarded mental processes as facts, i.e,
as phenomena which have so invariably been found
on examination of the mind that it is incredible that
they should not always reward introspection. The
resemblance which we observe between ourselves
and other persons makes it incredible that this state-
ment should not apply to them also. If, for example,
one invites a number of persons to write down the
ideas suggested to their minds by a particular set of
terms, it will be found that those ideas have been
derived from associations of similarity or contiguity
just in the same way as one's own are.
This capacity in ideas for being treated objectively
as well as subjectively opens up a new field of in-
vestigation for the psychologist, for he is placed in a
position to observe (what no amount of introspection
would have told him) that ideas are not merely
shadowy and elusive entities aimlessly floating
through infinity, but that some, perhaps all, of them
are linked by an indissoluble bond to material things ;
he perceives that in some obscure fashion mind is a
function of matter. The particular kind of matter
with which he learns to connect a manifestation of
mind is that which is called nervous, and the
existence of the bond between them is demonstrated
to him by the constancy, in his experience, of their
association. That brain is the organ of mind is to
be gathered from the fact that, in a general way, the
two things vary directly. Animals displaying more
intelligence have relatively larger brains (though
size of brain is not the only criterion of intelligence)
than those displaying less. Removal of the brain
eliminates mind, and any agency which puts out of
II THE BASIS OF MIND 35
action part of the brain interferes to a corre-
sponding extent with the development of mental
processes.
It seems unnecessary to labour this point since the
teaching of the dependence of mentation on the
integrity of the brain is universally accepted. As to
the nature of that dependence there is, however, by
no means the same unanimity and it is perhaps
worth while, in order to view the matter in its proper
perspective, to summarise what has been said about
it by the almost innumerable philosophers who have
exercised their intellectual faculties upon it.
The speculations as to the relation of mind and
body may be divided into two main groups according
as attention is paid to the respective characteristics
of mind and of body as such, or the causal relations
of one to the other are considered. From the first
standpoint we may, under the guidance of our
predilection or our educational bias, see mind and
body as totally distinct entities or as modes of
existence of a common entity. In the former case
we subscribe to the doctrines of Dualism, in the
latter to those of Monism. As dualists we may
conceive of mind as a ** soul-substance " with or
without limitations, i.e. as restricted to the sphere
which is occupied also by material things, or as an
infinite something which only comes within our ken
at its points of contact with matter. As monists we
may regard the common entity as of a purely
physical nature, e.g., as some form of motion capable
of presenting itself to us under different disguises.
This is materialism. On the other hand, we may
conclude that since consciousness is the only entity
D 2
36 THE FEEBLE-MINDED chap.
of which we have direct knowledge, nothing except
consciousness exists. This is idealism.
But we may, from a second standpoint, see mind
and body as not merely co-existent, but as inter-
dependent, i. e. as having a causal relation to one
another. " We may, " says J. S. Mill, '' define the
cause of a phenomenon to be the antecedent or
the concurrence of antecedents upon which it is
invariably and unconditionally consequent."^ There
is between mind and body an "■ invariable and un-
conditional " association which suggests a causal
relation, though whether mind or body is antecedent
is a matter which we are not in a position to decide.
Three possibilities may occur to us in this connection.
We may suppose that body in some way produces
mind, or, conversely, that mind produces body ; or
we may combine the two hypothetical processes and
assume that, not only does the mind control the
activities of the body, but that at the same time
these activities influence the course of psychic
events. Only the third of these possibilities seems
to have been seriously regarded by metaphysicians,
who have incorporated it in a theory of reciprocal
interaction or, as the Germans call it, '* psycho-
physischen Wechselwirkung."
Various objections can be urged against these
different views. If mind and body are quite distinct
entities, as the dualists teach, why should the relation
between them be so intimate and so uniform ? To
take an old difficulty, which is pointed out by Eisler,^
''from whom descends the soul of a child, from the
1 J. S. Mill, A Syste7}L of Logic ^ Book 3, Chap. 5.
^ R. Eisler, Leib und Seele^ 1906, p. 28.
II THE BASIS OF MIND 37
father or from the mother or from both ? and if the
latter is the case how can two soul-substances beget
a third when they do not even become inter-
mingled ? "
Materialists have now discarded the crude concep-
tion of mind as a " secretion " of the brain, which
was suggested by Cabanis and by C. Vogt. Lotze's
argument against such a view seems unanswerable.
'*If," he says, *' mind is secreted by the brain, it
must be in the brain in some form before that
process takes place ; if it is there in a psychic form
it does not become psychic as the result of the
brain's activity, and if it is there in a physical form
we have no explanation as to how the facts of its
being secreted can convert it into something
psychic." ^ The notion that we have to deal rather
with a special case of the conservation of energy,
'* physical " motion being converted into an
equivalent amount of ''psychical" motion, though
plausible enough at first sight, is equally open to
criticism. Our conception of physical energy
involves also that of space in which, and from a
determined region of which, it acts : physical energy
again has the capacity of doing work, mechanical or
chemical. An idea has no such properties. Which
of us by taking thought can add one cubit unto his
stature ? The physical and the psychical are not
commensurate : they cannot be expressed in the
same terms.
For idealism no better case can be made out : its
only legitimate development is into that apotheosis
of vanity which is called "solipsism." It involves
^ R. Eisler, op. cit., p. 44.
38 THE FEEBLE-MINDED chap.
the ignoring of physical as distinct from psychical
realities, and the futility of attempting to act In this
way has been abundantly demonstrated by the
followers of what is called Christian Science. There
Is, however, about idealism, considered merely as an
academic proposition, a specious plausibility, the
refutation of which has taxed the Ingenuity of many
generations of philosophers. The difficulty was
familiar, for example, to John Locke, and In his
*' Essay concerning Human Understanding " he
deals with it at length, but without disposing of it
altogether satisfactorily.
The case Is stated very fairly by Professor E.
Lugaro^ who admits that *'the existence of a
reality outside consciousness Is a pure hypothesis."
He proceeds to point out, however, that the
hypothesis Is very firmly established since " there Is
no experience which does not support It. . . It
therefore not only Imposes Itself on consciousness
but Its negation is inconceivable." Very pertin-
ently he asks, *'if consciousness Is the only reality,
what signification can the terms error and illusion
possess when applied to the same data of conscious-
ness ? '^
Some of the existing conflict of opinion as to the
necessity of deriving our ideas from contact with a
material universe is no doubt due to a misunder-
standing of what, for psychologists, is meant by
''Reality." Professor Munsterberg ^ states the
position concisely when he says that ** physical
^ E. Lugaro, Moder?t Problems in Psychiatry^ Trans, by D. Orr and
R. G. Rows, 1909, pp. 48 and 40.
2 H. Miinsterberg, Psychotherapy^ 1909, p. 133.
II THE BASIS OF MIND 39
objects are those which are possible objects of
awareness for every subject : psychical objects are
those which are possible objects of awareness for
one subject only."
Mr. R. B. Haldane^ holds a similar view. ''All
men," he says, ''must see and feel in such a fashion
that the universals in which their descriptions are
recorded are the same, if the impression is to be
given the title of real." A little later he mentions
what he calls a threefold test of what we mean by
reality : Agreement furnished by (i) our own
present senses of every kind ; (2) our past sense
experience ; and (3) the sense experience of others.
" These throw light upon what we mean by reality
and unreality in human knowledge, or, for that
matter, in human perception. It means the
assignment of the phenomenon to its proper place
in the context of experience."
Accepting "reality," we are in a position to
accept also Professor W. Mitchell's ingenious
explanation of the relations of mind and brain.
*'It is an error," he says, "to speak of mental and
physical facts as co-ordinate. . . A mind and its
experiences are realities that are presentable to
sense as the brain and its action." ^
Against the hypothesis of reciprocal interaction is
advanced the difficulty of imagining how such an
interaction could take place between entities which,
according to our experience of them, have no
attributes in common. Further, it is urged that the
^ R. B. Haldane, The Pathway to Reality^ 1903, Vol. I., pp. 71
and ']'],
2 W. Mitchell, Structure and Growth of the Mind^ 190/) p. 23.
40 THE FEEBLE-MINDED chap.
scheme of physical causation is complete in itself
and leaves no gap at which psychical agencies can
be introduced, and that, mutatis mutandis, the same
is true for psychical causation. (Prinzip der
Geschlossenheit der Kausalitat.)
Philosophers have endeavoured to make good the
defects in the various hypotheses above mentioned
by the introduction of a tertium quid. To bring
matter, with its properties of form, mobility, and
extent, within the sphere of action of an entity lack-
ing those attributes, seemed to Descartes and the
school of the Occasionalists to require divine inter-
vention. Leibniz assumed the existence of a "pre-
established harmony." A host of writers from
Spinoza to Wundt have adopted some modification
of the " Identity Theory," a form of Monism which
holds that mind and body are different aspects of
some common Being, as mutually dependent on, and
indispensable to, each other as the concavity and the
convexity of an arc of a circle. The '' Ding an
sich " or " Noumenon " of Kant ; the " Absolute " of
Schelling ; the " Wirklichkeit " of Paulsen and
others ; the *' Unknowable " of Spencer, are examples
of the hypothetical entities of which the existence
has been postulated. These entities tend to fall
into one or the other of two categories according
as they are assumed to approximate to a material
substance on the one hand, or to an idealistic
abstraction on the other. Again the old difficulty
crops up : how can we conceive of anything which
can be endowed with such diverse attributes as
mind and body, which attributes are not even of the
same order of natural events ? It is met, to some
Ti THE BASIS OF MIND 41
extent, by supposing that the diversity exists rather
in the observer's points of view than in the thing
itself.
With some show of reason it has been doubted
whether the association of mind and body is so
universal as has been assumed. If mind is reofarded
as co-extensive with consciousness, it follows that all
nervous tissue has not the same functions since it is
possible to have nervous phenomena without con-
sciousness. We might suppose that mind is a
function of a special or ultra-nervous tissue, but there
is no histological evidence of this. Again it has
been seriously argued that it is impossible to assign
to a physical basis of neuronic intercommunications
the apparently endless variety of combinations of
which our ideas are capable. Why, for instance,
should it not be credible that a certain stock of ideas
having been supplied by physiological means to our
minds, those ideas may undergo an independent
process of evolution ?
Fortunately we need not attempt to decide
questions like these. None of the views above
referred to is sufficiently well established to serve as
a guide in the adjustment of our social relations.
Whatever they may eventually lead to, the most
abstruse speculations of the metaphysicians have as
yet no more practical bearing on the right conduct
of life than has, for example, master play at chess.
For our present purpose we have only to record our
experience that mind and body are intimately related,
and we require no more elaborate doctrine than one
of a psycho-physiological parallelism such as we
assumed at the outset.
42 THE FEEBLE-MINDED chap.
It is desirable now to study the range of this
(psycho-physical) parallelism in order to define the
province of mind more accurately. The extent to
which consciousness is the concomitant of physio-
logical processes is obscure, because in the case of
our own processes we are not agreed as to what is
meant by consciousness, and in the case of the
processes we observe in others we have the further
difficulty that, even if we were agreed as to what
consciousness is, we could only infer that it ac-
companied physiological activity.
In what follows it will be assumed, as is now
generally believed, that the physiological is only a
special case of the physical, by which is meant that
the group of phenomena which are called physio-
logical can be expressed in terms of matter, of the
forces which act upon matter, and of the changes
which matter undergoes.
We can probably best obtain a clear conception
of what the position actually is by applying the
results of biological observation and speculation to
the question of how the nervous system has reached
its present stage of complexity. The capacity of
responding to stimulation is not restricted to living
things, but the kind of response which living things
exhibit is different from that displayed by inanimate
matter, the essential distinction being found in the fact
that living substance has, in a high degree, the power
of making good the losses of motion which are in-
volved in its manifestations of activity, while that
power is defective in non-living matter.
For our present purpose nothing is gained by
harking back to a stage anterior to the appearance
II THE BASIS OF MIND 43
in evolution of the material which we call bioplasm
and which we postulate as the indispensable basis
of vital characteristics. As to the nature of the
most primitive form of bioplasm there are certain
hypotheses. Ray Lankester ^ believes that its nutri-
tion was effected rather on the lines of that of
animals than in the fashion typical of plants. He
thinks that '' it very probably fed in the first few
aeons of its existence on the masses of proteid-like
material which, it may be supposed, were formed in
no small quantity as antecedents to the final evolution
of living matter." In its simplest form bioplasm
may have been characterised by a condition of
stable equilibrium, the amount of motion supplied to
it by intrinsic and extrinsic sources of energy being
exactly equivalent to the amount which it expended
in the production of vital manifestations. But bio-
plasm of such a kind, in view of the destructive
agencies to which it would always be subjected,
would tend to diminish steadily in amount and to
become eventually extinct. Bioplasm has, however,
survived and this is apparently to be explained by
assuming that the motion supplied to it has not
been, and is not now, quantitatively or qualitatively,
exactly equivalent to that which it has lost or is
losing. The expression of this lack of corres-
pondence in the processes of receiving and emitting
motion is found in the cardinal attributes of bioplasm
— its growth and variability — and it is on account
of its possession of these attributes that bioplasm is
able to perform its chief duty, which is to go on
^ Ray Lankester, A Treatise o?i Zoology^ Part I., ist Fasc, 1909,
p. XV.
44 THE FEEBLE-MINDED chap.
living. The capacity for growth enables a reserve
of bioplasm to be provided against the local
catastrophes which would otherwise destroy the
organism : while variability is the quality which
makes adaptability possible and is therefore the sine
qua non of evolution.
Why bioplasm should have undertaken the task
of growing and adapting itself at all we have no
sort of notion, unless we assume that *' through the
ages one increasing purpose runs," but as to how
growth and adaptation take place we have, by
general agreement, a choice between two views ;
according to one of which these manifestations of
vitality are spontaneous, that is, of unknown origin,
while according to the other they are a response to
stimulation.
The mechanism by means of which stimulation
may be supposed to produce its effects has been
studied by many workers, particularly by the
German biologist Richard Semon, whose main con-
tentions may be indicated here. By "stimulation"
Semon understands a change in what he calls the
" energetische Situation " of an organism. A
stimulus causes a corresponding change in the
condition of the organism stimulated, and we observe,
not the change, but the results of that change.
These results he calls the ''reaction." Stimuli may
be exogenous or endogenous (enzymes) ; thus in
Hering's theory of vision the sensation of ''white"
is exogenous, while that of "black" is endogenous.
The principle of the conservation of energy does not
appear to apply to the results of stimulation, owing
to the number and complexity of the internal factors
II THE BASIS OF MIND 45
which a stimulus calls into operation, and, moreover,
those results may be manifested in all provinces of
organic happenings — chemical, morphological, psy-
chical. On the removal of a stimulus, the organism
which has been stimulated may return to its former
state as regards the obvious reaction, but its capacity
for reacting has been permanently modified. To
this modification he applies the term " Engramm "
to express the idea that something has been, so to
speak, ''inscribed" or "written upon" the organism.
The capacity of the organism for being thus
modified is the " Mneme," and nervous tissue is
especially endowed with '' Mneme." The existence
of an engraphic change is demonstrated by the fact
that the original reaction can now be produced by
other than the original influences ; for instance, after
a dog has been hurt by a stone thrown at him, the
sight of a raised hand holding a stone will suffice to
revive in him an idea of the blow. Influences which
act in this way are said to be "ekphoric." Semon
develops an ingenious hypothesis to account for the
occurrence of successive association by distinguishing
between what he calls the *'synchrone" and
"akoluthe" phases of stimulation, and he explains
the inheritance of mental characteristics by supposing
that the reproductive cells, before separation, have
shared the " Mneme " of the parents and have
consequently received engraphic impressions which
duly become evident when the appropriate ekphoric
stimuli occur.^
^ For an exposition of Semon's philosophy the reader is referred to
his works, Die Mneme^ 2nd edit., 1908 ; and Die mnemischen Emp-
findungen^ 1909.
46 THE FEEBLE-MINDED chap.
The simplest forms of bioplasm of which we have
experience as constituting distinct individuals is, it
would seem, of a higher grade of development than
has so far been assumed, though the differences are
morphological rather than functional and do not
affect the considerations as to the effects of stimu-
lation which have just been set forth. There may-
have been, at some stage of evolution, bioplasm of the
non-nucleated primitive type for which E. van
Beneden suggested the name '' Plasson." But such
a form of bioplasm appears no longer to exist. The
group of lowly organisms which bears the name of
Proteomyxa includes forms with no defined nucleus,
but there are reasons for thinking that nuclear
substance is nevertheless present. It is, indeed, a
matter of the greatest difficulty to decide which of
existing Protozoa must be regarded as showing the
smallest amount of departure from the hypothetical
primitive bioplasm, for adaptation does not of neces-
sity involve increase in structural complexity. Thus
the Gregarines, which Spencer took as illustrating
the lowest level of development, are now regarded
as having been degraded from a higher order through
the adoption of a parasitic mode of life, and similar
considerations apply to some of the simplest vege-
table forms, e.g. Bacteria. Ray Lankester regards
the group known as the Mastigophora as being the
one from which the other classes of Protozoa and the
earliest plants — Protophyta — have been derived, and
the Mastigophora represent a considerable advance
upon the '' Plasson " stage.
Between the various unicellular animals, there is,
IT THE BASIS OF MIND 47
from the point of view of the psychologist, little to
choose and we may, for the purpose of study, take one
of the most familiar forms, such as Amoeba, without
regard to its taxonomic position. Amoeba consists
of bioplasm of which a portion retains characters
comparable with those of *' Plasson," while other
portions are differentiated to form, respectively, a
nucleus and an ectoderm. There is no obviously
differentiated nervous system, and in the production
of '' nervous phenomena " the animal reacts as a
whole. The vitality of Amoeba is expressed in
various ways. In the first place the animal has the
power of responding to stimuli — it will, for instance,
retract its pseudopodia and assume a more or less
spherical shape when touched or shaken, and it can
throw out pseudopodia in the direction of foreign
bodies which chance to be in its vicinity. It does
not, however, act in this way towards all foreign
bodies. If the bodies are particles of food material
the reaction takes place : if they are innutritious they
are left alone. Considering the movements of
Amoeba as a whole, we observe that they are of such
a character as to facilitate (i) its coming into contact
with a more favourable environment or (2) its escape
from an unfavourable one.
We find in the above facts an explanation of the
genesis of the mental element which we have called
'* affection " and an indication of the way in which
the activities of the organism are dependent on
affection. In its incipient state, affection is thus not
so much a matter of pleasure and pain in the usual
connotation of those words, but of gains and losses —
48 THE FEEBLE-MINDED chap.
of conditions promoting or opposing nutrition — of
anabolic and katabolic phases of metabolism/
Certain other members of the great group of the
Protozoa present even more striking phenomena.
According to the observations of E.G. Balbiani the
organism known as Didinhim nasutum distinguishes
between two species of Paramoecium, attacking one
but not the other : moreover, it distinguishes them
at a distance and begins the attack by throwing
trichocysts at its prey, so that it may be credited
with powers of orientation.^ Various species of
Technitella, to take another example, exercise the
nicest choice among the building materials available
to them and form a ''test" of quite distinctive
character. Thus, according to Heron- Allen and
Earland,^ Technitella melo employs only sponge
spicules, selecting those which are of the correct
length for the position to be filled. T. legumen
constructs from spicules and fine mud a two-layered
shell, in the outer layer of which the spicules lie
parallel to the long axis of the test, while in the
inner " the spicular fragments are much shorter and
^ This view is not universally accepted, thus H. R. Marshall has
suggested that : — " Pleasure and Pain are determined by the relation
between the energy given out and the energy received at any moment
by the physical organs which determine the content of that moment ;
Pleasure resulting when the balance is on the side of the energy given
out, and Pain when the balance is on the side of the energy received.
Where the amounts received and given are equal, then we have the
state of Indifference." {Mind, Vol. XVI., 1891, p. 470.)
One may note also that in a complicated organisation, such as that
of the human mind, no simple relation between metabolism and affec-
tion may be discoverable : it is unpleasant to be bored by an oft-told
tale, but not obviously injurious.
^ A. Binet, The Psychic Life of Micro-organisins, 1903-
^ E. Heron-Allen and A. Earland, On a Neiv Species of Technitella^
b^c.^Journ. of the (2,uekett Microscopical Club, April, 1909.
II THE BASIS OF MIND 49
are laid at right angles to the outer layer." A new
species, T, thompsoni, is even more remarkable, for
it builds an extremely neat test of echinoderm plates
only, although in the two regions where the creature
has so far been found such plates " form an infini-
tesimal percentage of the material as dredged, and
their presence would be almost unobserved unless
especially searched for."
Here then we seem to have to do with something
very like volition. But to speak of affection and
volition as occurring among the Protozoa is to endow
those creatures with minds. We have no desire to
prejudice the issue in such a way. It is possible to
regard mind either as a universal attribute of matter
or as having no existence except in a misinterpreta-
tion of physiological facts. In this book the question
is left open and no attempt is made to dispose of a
problem which is as old as the mind itself, and
apparently as far from solution as it was in the
beginning.
" Some dim form of discrimination is the germ
from which the spreading tree of mind shall
develop," says Lloyd Morgan/ and on this view
the Protozoa seem to be endowed with minds of a
fairly advanced order. But the facts are explicable
on the special physical lines which are called physio-
logical. A simple response to stimulation may be a
purely physical process : this we infer from the fact
that it may take place in admittedly non-living
substance. But, as shown more particularly by Prof.
Bose,^ response in the inanimate may exhibit a very
^ C. Lloyd Morgan, Animal Life and Intelligence.
^ J. C. Bose, Respo7ise i7i the Living a?id Non- Living., 1902.
.ac'ausetts o^MxA
THE FEEBLE-MINDED chap
Feeby
high degree of complexity, so high indeed that, to
quote Prof. Adami,^ ** In the nature of its responses
to stimuh*, Hving matter differs at most in degree, and
not in kind, from non-Hving." Amoeba's '* discrim-
ination" between nutritious and innutritious particles
may therefore be regarded as merely two different
responses to two different stimuli. The selective
power of lowly organisms may be due, as Spencer ^
puts it, to '' the setting up of an assimilative process
when assimilable matter is brought in contact " with
them. We have here, it would seem, the rudiment
of the sense of taste. A greater elaboration of the
capacity for selecting, such as is displayed by
Didinium, seems to involve also a rudimentary sense
of smell, but between taste and smell there is no
essential difference, indeed, as Spencer points out, in
aquatic creatures smell and taste can be but degrees
of the same faculty corresponding to dilute and con-
centrated solutions of nutritive substance. In the
case of Technitella the problem is more complicated
since the matter is apparently not one of simple
nutrition, but an explanation on physical lines can
easily be supplied without exceeding the limits of
legitimate speculation if we accept Spencer s dictum
that ''all forms of sensibility to external stimuli are,
in their nascent shapes, nothing but the modifica-
tions which those stimuli produce in that duplex
process of integration and disintegration which con-
stitutes the primordial life, physiologically con-
sidered."^ At some stage in evolution there
^ J. G. Adami, T/ie Principles of Pathology^ 19095 P- 90.
2 H. Spencer, Principles of Psychology^ 1870, Vol. I, p. 308.
^ H. Spencer, op. cif.^ p. 312.
II THE BASIS OF MIND 51
appeared organs susceptible to the influence of
mechanical impacts. This may be regarded as the
genesis of both tactile and auditory sensations, since,
as Sherrington^ puts it, the cochlea is essentially
''a group of glorified 'touch spots.'" On similar
lines a variation which gave rise to an organ capable
of appreciating radiant energy would provide the
germ of the apparatus for producing sensations of
heat, cold, and light.
In Amoeba the physical basis of affection would
appear to be supplied by the whole of its bioplasm,
but we may suppose, with Titchener,^ that the
evolution of higher types has been marked by the
appearance of a special mechanism of affection com-
parable with that which we regard as the basis of
presentation. He conceives of the affections as
''mental processes of the same general kind as
sensations," and suggests that "the 'peripheral
organs' of feeling are the free afferent nerve-endings
distributed to the various tissues of the body." If
we accept Wundt's scheme of six affective conditions
we must assume a greater specialisation in the
afferent nerve-endings than if only two forms of
affection are postulated, but otherwise the position is
unchanged, since three pairs of aspects of nutritional
phenomena can be pictured as readily as one pair.
Movement of a seemingly voluntary character
also admits of being referred to a process of stimul-
ation. As we have seen above, the existing para-
sitic Protozoa are probably not the least evolved
' C. S. Sherrington, The Integrative Action of the Nervous System^
1906, p. 324.
2 E. B. T'ltcheneYj Lectures on the Elemetitary Psychology of Feeling
and Attention^ 1908.
£ 2
52 THE FEEBLE-MINDED chap.
members of the group, but their degraded state may
perhaps be reversionary and we may therefore
regard as still plausible Spencer's hypothesis as to
the mode of origin of motility, which is as follows : —
The earliest organisms evolved lived in constant
contact with supplies of nutriment ; motility is an
adaptation to existence in a medium (salt or fresh
water) which, while it everywhere yields a sufficient
supply of oxygen, has nutriment irregularly scattered
so that search has to be made for it. On the lines
of Semon's teaching, we may regard this adaptation
as of the nature of an "engramm" impressed upon
the bioplasm by the change in its ''energische
Situation " which occurred when its environment
was changed.
The activities of a protozoon are not, therefore,
necessarily those of a free agent, but may be
directly referable to the stimuli brought to bear
upon it. Even if the stimuli known to us seemed
inadequate to account for the animal's varied move-
ments, we should have to remember that there may
be involved physical agencies not cognisable by us
because of a kind outside the limited range of our
sense-organs either temporarily or permanently.
It appears, however, that we need not appeal to any
unknown forces : the known influences of the
environment are sufficient.
We have seen that, whatever may be the reason
for such a condition of affairs, the first duty of
bioplasm is to continue in existence, and to that end
it displays powers of growth and of variation. But
in so far as these powers are utilised, the organism
is compelled to take upon itself new responsibilities.
II THE BASIS OF MIND 53
Let us consider first how the mere increase in bulk
affects the position. As pointed out by Spencer,
an individual consisting of a fragment of bioplasm
will, according to mathematical laws, necessarily
display a certain ratio between its mass and its
surface, and since on the extent of its surface
depends its capacity for taking in food, any alteration
of that ratio will affect its nutrition. Assuming that
the organism does not undergo any change of form,
the ratio of surface to mass will get steadily less
as the mass increases, and consequently growth will
lead to a diminution in the food supply and so be
automatically checked.
There is probably also another factor for which
allowance must be made. The unit of bioplasm
which we meet with in practice is the cell, and this
has reached a stage in evolution at which we can
distinguish a more highly specialised portion of
the bioplasm — the nucleus — from a less highly
specialised portion — the cytoplasm. The cytoplasm
provides an environment for the nucleus in the same
way as the medium in which the cell is living
constitutes its environment, and we may therefore
suppose that growth is dependent, not only on the
relationship between the medium and the cytoplasm
but also on that between the cytoplasm and the
nucleus.
The necessary adjustments can be made in various
ways. By spreading itself into a sheet or a reticulum
the organism maintains the ratio between mass and
surface which is necessary to it. But to do this
defeats to a great extent the main purpose of
growth. A large mass of bioplasm is little better
54 THE FEEBLE-MINDED chap.
protected against circumscribed disasters than is a
small mass. A more satisfactory result will be
obtained if the organism, on reaching the limit of
growth under the prevailing conditions, divides into
two (or more) daughter organisms of form like its
own, or cuts off successive parts of its substance as
fresh individuals. Complete separation of the
daughter organisms may not, however, be necessary
to meet the nutrition difficulty, and it would seem
that the undiminished risk of total destruction that
the organism runs is now more than counter-
balanced by the increased capacity for variation
which the multicellular state confers upon it. In
the multicellular organism the capacity for variation
show^s itself morphologically as differentiation of the
bioplasm into various tissues subserving different,
but apparently equally essential, functions in the
maintenance of the organism as a living thing.
But one of these tissues, from the nature of its
peculiar function, has a special relation to the rest
of the tissues. The mechanisms which respectively
seize upon food materials, convert them into an
assimilable form, assimilate them, integrate them,
and cast out the waste materials which result from
them, could be of little service to the organism il
their actions were not co-ordinated, and it is the
business of ''nervous tissue" to effect the necessary
co-ordination. We find, as the above considerations
would lead us to expect, that nervous tissue comes
into intimate association with all other forms of
tissue.
Neither phylogenetically, i.e. by study of the
evolution of the human race, nor ontogenetically,
II THE BASIS OF MIND 55
i.e. by study of the development of individual
human beings, have we as yet arrived at a satis-
factory explanation of the way in which this
association is brought about. We do not know
that any one of the various types of animals which
now intervene between the Protozoa and Man
closely resembles a stage which Man has actually
passed through in the course of his evolution, and
our histological data are insufficient to justify a
confident statement on embryological grounds.
There are two possibilities to be considered : the
connection between nerve-cells and other cells may
be due to the fact that the separation which results
from cell division is incomplete, strands of bioplasm
remaining to constitute permanent links between
the daughter cells ; or it may be brought about by
the nerve cells having come into relation secondarily
with the remaining cells. Which of these lines has
actually been followed is, and has long been, a
matter in regard to which physiologists differ. It
would seem that in plants and in some invertebrate
animals the connection between the nerve cells and
between a nerve cell and the cell which it controls
is effected by direct continuity of bioplasm. In the
higher animals, even though, as the observations
of Szily and Held suggest, such continuity occurs,
it is difficult to explain the degree of complexity to
which the nervous system attains without assuming
that secondary relations are also established. If
what is called the ''neurone theory" is discredited
the generally accepted teaching as to the mechanism
of conduction of nervous impulses will require
revision, for the existence of "synapses," or regions
56 THE FEEBLE-xMINDED chap.
where the terminations of nerve cell processes come
into proximity merely, is essential to the stability
of modern theories of nervous activity.
The earliest stage in the differentiation of nervous
tissue is theoretically one in which all the rest of the
cells making up the individual are connected with
the special one which sub-serves the function of co-
ordination. As the number of cells increased there
would need to be a corresponding Increase in the
size of the co-ordinating cell, unless, by the intro-
duction of some new device, the same object could
be attained in another way. Except in rare instances,
e.£', in the electric cat-fish, the nerve cells do not
show any tendency to increase in bulk with the
demands made upon them and it may be supposed
that, as a result of natural selection, a better way ot
meeting the necessities of the case has been evolved.
This better way is the provision of nerve cells of
different orders, situated at different physiological
''levels," and so arranged that nerve cells controlling
each a small portion of the body are themselves
brought into correlation by "higher" nerve cells, and
these by still higher nerve cells. Thus the activity
of the cells giving rise to the fibres constituting an
anterior spinal nerve root will produce movement in
a limited part of the body, but cells of several
anterior cornua can be prompted to act in the pro-
duction of an elaborate co-ordinated movement by
means of cells in what Is called the " motor area " of
the cerebral hemispheres, and the functional activity of
these cells, in turn, can be controlled by cells in the
parts of the brain which Flechslg described as
''association centres,"
II THE BASTS OF MIND 57
So much uncertainty attends the interpretation of
the nervous phenomena of invertebrate animals that,
until we reach the base of the vertebrate division, the
appearances observed are not sufficiently like those
in Man to be of any use in providing a key to the
latter. Described in the most general terms, what
seems to happen in the development of the central
nervous system is this. A majority of the nerve
cells come to occupy a position in the median plane
which admits of the corresponding parts of the body
being arranged symmetrically about them. They
are collected in such a way as to form, with the
tissue which serves to bind them together, a tube
running along the greater part of the length of the
body beneath the dorsal surface. In the tube the
cells are arranged around the cavity with their fibres
constituting the outer part of the wall. A distinction
between internal grey matter and external white
matter is thus instituted. The tube varies in calibre
and in the sizes of the aggregates of cells at different
parts of its length, in accordance with the import-
ance to the animal of the particular region on the
exterior of the body with which the cells are in
connection. At its anterior end the tube is en-
larged, partly in proportion to the degree of develop-
ment of the animal's senses of smell and taste, and
partly in dependence on other considerations. A
little further back a region becomes specialised as a
centre for vision, while behind that again an auditory
centre is established. A capacity for acting as an
organ for touch is Inherent in practically every part
of the animal's exterior, so that no definite touch
centre is to be expected ; but the anterior end of the
58 THE FEEBLE-MINDED chap.
body is peculiarly the region where, in a motile
organism, appeal is likely to be made to the tactile
sense and, consequently, one finds that the anterior
end of the nervous tube is especially associated with
the development of the sense of touch. To bring
into co-operation the various centres mentioned some
further centre is required, and this appears to be
supplied by the development of collections of cells
in the anterior portion of the tube, the consequent
enlargement of that region giving rise to the
cerebral hemispheres. In the words of Professor
Elliot Smith,^ '' the higher organisation of the brain
is brought about by the extension of all the sensory
paths up to the cerebrum and the evolution within
the hemisphere of mechanisms for receiving and
blending the various impressions of an object so as
to awaken a consciousness of all its properties as they
appeal to the senses of smell, taste, touch, sight and
hearing."
The first stage in the process seems to be marked
by the appearance of a primitive cortex, called by
Ariens-Kappers the ''palaeo-cortex," which receives
fibres from a region of the original grey matter
devoted to the olfactory sense. In the earliest
vertebrates this sense seems to have had a special
predominance and the evolution of sensory capacity
seems to have taken place especially in connection
with it. From the anatomical standpoint the result
of that evolution was the appearance, first, it is said,
in the group of animals known as Amphibia, of a
cortex — the " archi-cortex " — having a tertiary
^ G. Elliot Smith, Some Problems Relating to the Evolution of the
Brain, Arris and Gale Lectures, v. lancet, Jan. 5, 1910, p. 151.
II THE BASIS OF MIND 59
connection with the organ of smell by way of the
palaeocortex. In this way there are laid down a
palseopallium and an archi-pallium, corresponding
respectively to the pyriform lobe and the hippocampal
region of the brain/
As evolution proceeded, the convergence of
sensory paths upon the cerebrum became more and
more marked, and the importance of that organ as a
co-ordinating apparatus became proportionally more
pronounced. New collections of cells provided the
basis for this extension of function, and there
appeared, somewhere about the level of the Reptiles,
a new anatomical formation, the neo-pallium, con-
sisting of cortex intercalated between the palaeo- and
the archi-cortex, and divisible into areas correspond-
ing to the different sense organs. In the lowliest
mammals, according to Professor Elliot Smith, such
a neo-pallium is present and it is through the growth
and differentiation of this structure that we are
provided with the various mechanisms which we
believe to underlie and make possible the processes
of thought.
Without attempting to follow the evolution of the
neo-pallium in detail, as is done by Professor Elliot
Smith in the lectures alluded to, we may notice three
of its salient features. In the first place, a part of
the cortex devoted to the reception of tactile
impressions becomes modified in such a way that its
cells, when stimulated, induce contraction of muscles
in various parts of the body. This is the genesis of
what is known as the "motor area." Secondly, we
^ C. U. Ariens-Kappers, The Phylogenesis of the Palceo-Cortex and
Archi-Cortex^ dr'c., Archives of Neurology aiid Psvchiatry^ 1909? P- 161.
60 THE FEEBLE-MINDED chap.
find in each neo-pallial area a differentiation of cells
into two groups ; the one central and concerned
with the reception of sensory impressions, and the
other peripheral and concerned with the elaboration
of those impressions into idea-complexes. By the
extension of these peripheral portions of the various
areas, their sensory portions come to be widely
separated by what are known as ''association areas."
Finally, we observe that the increase of the neo-
pallium takes place almost entirely in two dimensions,
its thickness remaining practically constant. As a
consequence of this, folding occurs, and Professor
Elliot Smith maintains that, although the fact
becomes obscured in the course of the brain's
development, the folding follows the lines of separa-
tion of the functionally distinct areas in the neo-
pallium.
The distinction of a neo-pallium from the rest of
the cerebrum is somewhat artificial, as shown by the
want of agreement among comparative anatomists
as to the stage of the evolution of the brain at which
this structural feature is recognised. Its individuality
seems to be insisted on mainly because it is thought
to be peculiarly the " organ of mind," but the
boundaries of mind are too indefinite to justify our
limiting the application of the principle of psycho-
physical parallelism to a portion only of the nervous
apparatus.
By turning from phylogeny to ontogeny we do
not obtain very substantial additions to our fund of
knowledge. The early stages in the development
of the functions of the human nervous system are
practically unknown. Our study of foetal brains
II THE BASIS OF MIND 61
and nerves is based on dead tissues only. We
cannot begin to experiment on a child's brain until
the child is born and even then the scope of our
proceedings is strictly limited. In so far as our
investigations might involve interference with the
child's comfort, we are confined to such accidental
opportunities of confirming or disproving results
obtained with lower animals as chance puts in
our way.
It would appear from the researches of Flechsig,
Ambronn and Held, Soltmann, the Westphals, and
various other workers, that in the case of the
medullated fibres, which constitute so large a pro-
portion of the nervous system, the specific function
of the fibre is not capable of being performed until
the fibre has received its medullary sheath.
Stoddart^ proposes to apply this fact in explaining
the difference between instinctive and volitional
activities. True voluntary acts, he considers, do not
make their appearance until the age of seventeen
months, i.e. at the time when the fibres of the
pyramidal tracts have received their sheaths, while
instinctive movements occur from birth, and do so
because of their dependence on the cortico-rubro-
spinal system of fibres which is myelinised at birth.
Whatever may be the anatomical basis of the
condition, we find, as a matter of observation, that
the various sensation mechanisms already mentioned
do not all get into working order at the same stage
of the child's growth. Cutaneous sensibility to
touch, heat, cold, and pain, is present at birth, though
^ W. H. B. Stoddart, On Instinct^ Jour7i. oj Mental Science^ July,
1906.
62 THE FEEBLE-MINDED chap.
the last is probably little developed. A distinction
between the protopathic and epicrltic systems seems
hardly feasible in the circumstances. Visceral
sensations, e.g. those of hunger and thirst, are also of
very early appearance. The sense of hearing seems
to be the last to develop, and it is difficult to say
when auditory vibrations are differentiated from
those appealing to the sense of touch, which usually
accompany them. There is said, however, to be
evidence of audition on the fourth day. The pupil
reacts to light, according to Kussmaul, within an
hour after birth. In the second week the child may
seem to notice a lighted candle, while at five weeks,
according to Raehlmann, it will fix an object which
happens to be in Its line of sight, and at five months
It Is able to get its bearings by means of vision. A
capacity for distinguishing sweet tastes from bitter
is said to be present on the first day, as also a
momentary appreciation of powerful odours.
In the case of an infant, the reception of
kinaesthetic impressions is not accompanied by
objective phenomena of such a kind as would lead
to Its ready recognition by an observer, but from
another point of view it has its own special Interest
in that it occurs In the cerebellum which, as Myers ^
puts It, " Is the great centre where afferent impulses,
alike from the labyrinthine and motor apparatus, are
gathered together."
With the recognition of phylogenetically separable
regions of the cerebrum, a step is taken in the
direction of defining the ''levels" at which the
different stages of co-ordination take place. The
' C. S. Myers, A Teii-Buok of Experimental Psychology^ 1909, p. 75
II THE BASIS OF MIND 63
number of levels which can be identified is, indeed,
largely a question of definition, and the levels are
not anatomically susceptible of clear delimitation,
for the neo-cortex contains cells of many types and
the groups of cells subserving particular functions
are not collected in special convolutions, but are
distributed throughout considerable extents of
cortex.
Fully developed cortex exhibits, under the
microscope, a lamination dependent on the presence
in it of nerve fibres and nerve cells of different sizes
and forms. The cortex is not everywhere alike and
there is not universal agreement as to the number
of layers which are to be distinguished, but a very
general practice is to recognise five, according to the
following scheme, in which the strata are enumerated
from the surface inwards :
1. The layer of superficial fibres. In addition to
the fibres, this layer contains also what are called
the '^ cells of Cajal.''
2. The layer of pyramidal cells.
3. The layer of granules.
4. The inner layer of fibres. Here are found,
too, in different regions, what are known as ** Betz
cells " and " solitary cells of Meynert."
5. The layer of polymorphic cells.
J. S. Bolton^ and G. A. Watson^ have in-
dependently worked out the relation of the cells of
the different layers to mental processes. According
J. S. Bolton, T/ie Histological Basis of A7nentia and Dementia^
Archives of Neurology^ Vol. II., 1903, p. 424.
^ G. A. Watson, The Mammalian Cerebral Cortex^ &^c.^ Archives
of Neurology^ Vol. III., 1907, p. 49.
64 THE FEEBLE-MINDED chap.
to the former, the fifth layer is the first to appear
and it probably subserves '' the lower voluntary
functions of the animal economy." He associates
the layer of granules, which appears next, with
'* the reception or immediate transformation of
afferent impressions whether from the sense organs
or from other parts of the cerebrum." The
pyramidal layer is the last to appear, and since its
extent varies with the range of the higher mental
processes, it may be regarded as subserving *' the
' psychic ' or associational functions of the cerebrum."
Watson's conclusions agree in the main with those
of Bolton, although he classifies the layers some-
what differently, calling the pyramidal' layer the
"supra-granular" and applying the term "infra-
granular " to the combined fourth and fifth layers.
This infra-granular region he believes to be con-
cerned especially " with the associations necessary
for the performance of the instinctive activities, i.e,
all those which are innate and require for their
fulfilment no experience or education." The supra-
granular layer he regards as subserving " the higher
associations, the capacity for which is shown by the
educability of the animal."
Whatever doubt there may be as to the details,
we may take it as well established that the cerebral
cortex is the seat of chemical and physical changes
which, in some mysterious way, express themselves
as mental phenomena.
According as its activities involve the building up
or the breaking down of the nervous tissue, so, it is
taught, will affections of pleasure or pain arise. In
the previous chapter we noted the inter-dependence
II THE BASIS OF MIND 65
of affection, volition, and attention, so that we may
expect to find near at hand a physical explanation
of the last mentioned factor, and also of volition if
we decline to accept the hypothesis of a transcen-
dental '' Ego." The unit of nervous activity, so far
as we can study it objectively, is the reflex, and
according to Sherrington:^ — ''The interference of
unlike reflexes and the alliance of like reflexes in
their action upon their common paths seem to lie at
the very root of the great psychical process of
' attention.' "
Without going at length into the question of the
human being's psychical growth we may note, in
addition to the appearance of volition already
referred to, a couple of striking phases. One is the
development of the consciousness of self or of the
idea of the Ego, which seems to depend mainly on
the specialisation of the apparatus for tactile and
organic sensations : the other is the differentiation of
the centres for language.
The functioning of the mechanism of speech is of
predominant importance as a source of psychical
events. Just as the introduction of a practice of
exchanging counters made possible the growth of
our present commercial system from the primitive
methods of barter, so the development of the faculty
of language has been the chief factor in the
intellectual evolution of the human race. The
acquisition of language has enabled the race, in
accordance with the principle '' to him that hath
shall be given," to obtain an ever increasing lead in
the contest for the headship of the animal kingdom
^ C. S. Sherrington, oj^. cit.
F
66 THE FEEBLE-MINDED chap.
and has, indeed, already established so wide a gulf
between Man and his competitors that their respec-
tive mental states are hardly comparable.
A round unvarnish'd tale setting forth the extent
of our acquaintance with the nervous mechanisms
concerned in speech will probably prove rather dis-
appointing, but no useful purpose is served by
slurring over the difficulties of the subject, and until
the gaps in our knowledge are clearly recognised,
they are not likely to be filled.
Let us begin with the simplest case and consider
only the reception and emission of vocal sounds.
Vibrations of the air set up in the larynx of the
speaker fall upon the tympanic membrane of the
hearer. Modified in accordance with the physical
limitations of the materials along which they are
conveyed, they pass to the endings of the cochlear
division of the eighth cranial nerve. Since the
transmission of nerve impulses involves something
other than simple vibration, the energy of the aerial
vibrations has to be converted into some new form
before it can produce its appropriate effect on the
sensorium. Through devious channels, consisting
of nerve fibres interrupted at one knows not how
many synapses and cell exchanges, some portion of
the energy eventually reaches the '' auditory centre,"
which is believed to exist in the grey matter of the
first temporal convolution of the left cerebral hemi-
sphere. This region is apparently in direct communi-
cation with a "centre," situated somewhere about
the hinder end of the inferior frontal convolution
and the adjacent part of the ascending frontal con-
volution, which, when stimulated, will in turn prompt
II
THE BASIS OF MIND
67
the muscles of articulation to activity. That we
have not even in this comparatively simple case to
do merely with a reflex act is evident, since the
muscles of articulation may or may not react, and
the reaction, if it does occur. Is not always the same ;
there must, consequently, be some Intervening agency
^A M?
Lichtheim.
Kussmaul.
Storring.
Fig.
I. — Diagrams illustrating different conceptions of the
Relations of the "Centres" concerned in Speech.
M= Motor centre.
Auditory centre.
Conceptual " centre.
M and A are ' ' cortical " ; regions central to Af and A are * ' trans-cortical " ;
regions peripheral to A/ and A are " sub-cortical." Lesions of M A cause
"conduction" aphasia. Seven types of aphasia — t.e., motor and sensory
forms of cortical, trans-cortical, and sub-cortical aphasia; and "conduction"
aphasia — are thus theoretically possible.
and this we take to be a third ''centre " of even less
certain localisation than the others. As to the mode
of connection of these three centres with one another,
opinions differ. The diagrammatic representations
given in Fig. i, which illustrate the views of the
three writers whose names are appended, are all
equally plausible.
A word spoken in the circumstances just ex-
pounded would, however, be practically valueless : it
would mean nothing — be simply vox et fr^terea nihil.
Only by the contemporaneous reception of sense
F 2
68
THE FEEBLE-MINDED
CHAP.
Impressions through other channels does a word
acquire a meaning, and there are, besides words, the
other channels of expression — gesture and writing
— to be allowed for. Moreover, we believe all
muscular movements to be sources of kinaesthetic
impressions. Therefore, in trying to indicate by
Fig. 2.
s, s', Organs of special sense, pi, m', Muscular mechanisms of expression.
S, Combined sensory projection, association and memory centres for auditory
impressions. S', Similar centres for visual and other impressions. M, Kinses-
thetic and psycho-motor centre for articulation. M', Kinaesthetic and psycho-
motor centres for movements of writing and gesture. C, Controlling or
co-ordinating centre or centres in the prefrontal cortex.
means of a diagram the course of the nerve impulses
concerned In speech, we must Introduce symbols
corresponding to these other factors.
Fig. 2, which is sufficiently complex, represents
these conditions in their simplest terms. The various
'' centres," the nature of which is shown in the
II THE BASIS OF MIND 69
diagram, are supposed to be situated at the angles
of a quadrangular pyramid, but this arrangement Is a
purely speculative one. To represent language
which Is merely thought and not spoken, and without
such use of language thought Is probably Impossible,
the diagram may be modified by omitting the lines
sS dind / S\ and disregarding the projection elements
in the centres S S\
This elaborate machinery may break down at any
point and some day we may be in a position to locate
the fault with the same precision as In the case of a
trans-oceanic cable. At present we can only decide
with some degree of probability whether the defect
is sensory, motor, or psychic. Further reference to
this topic, in so far as It concerns the feeble-minded,
will be made in a subsequent chapter.
CHAPTER III
THE FEEBLE MIND
The preceding description of *' Mind " will apply
to Minds of all kinds. It is therefore necessary to
investigate the characteristics special to the feeble
mind and this can only be done by erecting a
standard of the normal mind for purposes of com-
parison. The normal mind is not, however, itself
susceptible of accurate definition. It is a mind
arbitrarily selected by each observer as representing
the average mind of the community at large. No
simple numerical formula will express the number,
the affective tone, the degree of prominence in con-
sciousness, and so on, of the ideas which make up a
normal mind ; but nevertheless it can be recognised
that departure from the normal constitution of mind
does occur, and feeble-mindedness is one of the
modes of this departure. Its specific characters are,
however, rather temporal than psychical, that is to
say, it is distinguished rather by the time at which
it appears than by its innate peculiarities. There
are no mental phenomena accompanying the pro-
cesses of cerebral degeneration which may not find
their counterpart in defective development of the
brain, and the legal employment of the term
CH. Ill THE FEEBLE MIND 71
''lunatic" as including "an idiot or person of un-
sound mind " is justified by experience. In all forms
of insanity we find abnormalities in the various
departments of mind which we have enumerated
above, and in proceeding to consider these abnor-
malities as they appear in feeble-mindedness, we
must remember that they do not, by themselves,
afford a distinctive picture of that condition.
The analysis of the mental characteristics of the
feeble-minded has not yet attained to any great
degree of perfection, but it leads us to suppose that
we have not to deal with any psychical elements in
addition to those already enumerated. A paucity of
presentations ; an imperfect memory ; anomalies of
the affective process and limitation of the faculty of
attention are the ground-work of mental incom-
petence. If, further, we admit the existence of an
Ego distinct from the manifestations of mind which
have an objective reality, we provide ourselves with
a means of escape from any difficulties which the
employment of the more limited scheme may involve
us in.
It is desirable to distinguish, among the factors of
mind, such as constitute the initial capital of the
individual before personal experience has come into
play. This is by no means easy, but a review of the
whole position suggests that the only thing trans-
mitted from one generation to another is that
capacity for being modified by stimuli which Semon
calls the " mneme." As a mere potentiality this can
have no counterpart in consciousness until stirred
into activity by the incidence of sensations. Without
sensations the mind does not begin to be at all
72 THE FEEBLE-MINDED chap.
This is in accordance with the results of observation.
We know that permanent impairment of even one
sense, especially of sight or hearing, is a serious
obstacle to normal intellectual development, and a
person whose channels of communication with the
outside world are extensively restricted does not rise
beyond the lowest depths of idiocy.
Inherited capacity, or, as it has been called,
" educability," probably differs in different persons,
and a well-developed "mneme" will offset a poorly
developed sensory apparatus. We need not, there-
fore, be surprised that in certain cases, e.g., the
famous ones of Laura Bridgman and Helen Keller,
a painstaking effort on the part of tutors to utilise to
the utmost the defective sensory channels has been
rewarded by the production of a comparatively high
degree of intelligence.
To appreciate fully the importance of sensation in
the evolution of the individual mind, it must be re-
membered that the opening up of communication
with the outside world does not begin at birth, but
that for a long time prior to that event the
mechanism of organic, and perhaps of tactile, sensi-
bility may have been in operation.
The peculiarities of presentation, memory,
cilfection, and attention above mentioned constitute
the psychical, as distinct from the physical, symptoms
of feeble-mindedness. Let us consider them in a
little more detail : —
(i) Paucity of Presentations. This may be
assumed when there is obviously defective sensibility,
but it is difficult to demonstrate it directly, because a
consciousness containing only isolated ideas, such,
Ill THE FEEBLE MIND 73
for example, as that imagined by Condillac in his
conception of a statue endowed, step by step, with
sense impressions, is unknown to us.
(2) Imperfection of Memory. Dependent on
memory are :
(a) The amount of the mental capital. Since the
majority of the ideas in consciousness at any given
time are re-presentations, the total content of the
mind will be determined very largely by that
property of the memory which is called '' persever-
ance " {cf. p. 6).
(f) The faculty of association. An idea, as we
have seen, can cause to be reproduced another
with which it has been previously associated
either simultaneously or after a short interval of
time.
Defects of memory, then, whether as regards
perseverance or the scope of the associations
permitted, will have a most important bearing on
the mental status. Those of the former kind give
rise to abnormalities of perception, chiefly in the
direction of insufficiency. Hallucinations and
illusions are not conspicuous features of feeble-
mindedness, so far as an observer is in a position
to judge, though their existence may sometimes be
inferred. Marked limitation of the field of associa-
tion is a familiar symptom of idiocy. We meet, for
instance, with children who are clearly hungry but
who make no attempt to consume food placed before
them since the ideas set up in their minds by it are
not associated with the idea of satisfying hunger.
We meet, too, with the burnt child who does not
dread the fire or who, however frequently the
74 THE FEEBLE-MINDED chap.
information has been imparted, cannot remember
what letter comes after ''a."
(3) Anomalies of the Affective Process. These
may include :
{a) Quantitative abnormalities.
There is a certain parallelism between the grada-
tions of the emotional state observable in the feeble-
minded and the stages of affective evolution through
which the normal mind passes. Idiots of the lowest
grade seem to have no feelings at all. At a some-
what higher level they show signs of distinguishing
a condition of repletion from one of hunger and
thirst ; they may appear to derive some sort of
gratification from sensations of colour, tone or
sapidity ; and they respond to what, for the normal
organism, are unpleasant stimuli in a way which
suggests that they also find such stimuli displeasing.
Anger and resentment occur at a still higher plane
of development, and from this stage onward there
may be found in increasing degree, joy and sorrow,
hope and fear, like and dislike, and so on through
the whole gamut of emotion. The excessive
emotional reaction which the feeble-minded some-
times display does not necessarily indicate a more
pronounced affective colouring of the ideas con-
stituting the emotion, but is rather to be explained
by a deficiency of those relatively neutral ideas
which in the normal mind serve, if one may so put
it, to ''dilute" the emotion.
Owing to the relation which exists between the
two we may appropriately pass from a consideration
of the emotions to that of the instinctive activities.
Many of our actions have an easily recognisable
instinctive foundation even though it may be difficult
Ill THE FEEBLE MIND 75
to decide where foundation gives place to super-
structure. On account of this fundamental character
defect in the sphere of instinct may be of crucial
importance. The idiot with no instinct to seek
food must lead a precarious existence. With no
instinct of cleanliness it can never be other than
a social outcast. With no instinct of imitation it is
debarred from intellectual progress.
[b) A want of harmony between the affection and
the idea with which it is connected.
If, as has been suggested, affections are "mental
elements " distinct from and separable from ideas,
they may be capable of reproduction in new com-
binations independently of the original ideas with
which they were in relation. Such a capacity would
impart a considerable degree of elasticity to the
mental structure and to that extent render more
intelligible the apparent want of harmony between
idea and affection which is sometimes observable
in the feeble-minded. Examples of the condition
are afforded by the cases in which stimuli, of a kind
to give pleasure to the normal individual, produce
pain ; or those in which, as in filth eating or other
depravity of appetite, noxious substances are
accepted as beneficial.
This possibility of a dissociation of idea and
" affect " seems to lie at the root of the teachings
of Professor Sigmund Freud,^ though it is more
particularly in connection with hysteria, neurasthenia,
^ For an account of Freud's theories reference may be made to,
among other works, his books, Selected Papers on Hysteria and Other
Psychoneuroses, translated by A. A. Brill, 1909, and to Zur Psycho-
pathologie des Alitagslebens, 1907 ; or to Die psychoanalytische
Methode Freuds^ by M. Isserlin in Zeitscrift fur die gesamte
Neurologic und Psychiatrie, Bd. i, Mar., 1910.
76 THE FEEBLE-MINDED chap.
impulsive insanity, and dementia praecox that his
views have been promulgated. The field in which
such dissociation is especially prone to occur is,
according to Freud, that of the sexual life. A study
of the lower animals shows us that the interest in
reproduction may be as pronounced as the interest
in nutrition. Although, as regards human beings,
we are accustomed to ignore the influence of the
reproductive instinct on conduct until the stage of
sexual maturity is reached, the different phases of
development through which that instinct has been
passing since the organism acquired individuality
may have left their impress on the mind's evolution,
and it is conceivable that these forgotten factors may,
in the case of certain feeble-minded persons, be
supplying ** affects" which, by coming into relation
with ideas to which they did not originally belong,
are responsible for the abnormalities displaye'd.
(4) Limitation of the Faculty of Attention,
It will have been gathered from the study of the
mind, entered upon in a preceding chapter, that the
degree of prominence of ideas in consciousness
decides the lines on which the evolution of the mind
shall proceed. Any limitation of the power of
attending may, consequently, act as a restraining
influence in the various departments of thought
to which are given the names Judgment, Reasoning,
Imagination, and Sentiment. In cases of feeble-
mindedness the limitation may appear either (a) as
a deficiency in the process of attention itself, or
{b) in the consequences flowing from that deficiency.
{a) Indifference to stimuli which, in the case of
the ordinary person, would compel attention is
Ill THE FEEBLE MIND 77
observed in idiots, and such indifference is only-
intelligible as an abnormality of the receptive
apparatus. Presentations vary in clearness with the
quality and intensity of the sensations which
originated them and with the state of the sense
organs and of their central connections. For any
particular stimulus, only the second factor, which
Titchener calls the ''psychophysical disposition," has
to be taken into account. Sometimes the difficulty
seems to arise in the province of voluntary attention.
We meet with a class of feeble-minded persons
whose salient characteristics are versatility and super-
ficiality. Before one stimulus can be appreciated
another is sought ; nothing is retained because
nothing is allowed to produce the necessary impres-
sion. Perceptions are not developed, because their
fundamental ideas have not time to arouse the
appropriate concomitants.
In another set of cases the prominent feature is a
condition of apathy or torpor which seems to
nullify the effort of attention. Here the mental
inertia is so great that the will is powerless to over-
come it, and therefore ideas never attain to that
degree of prominence in consciousness which is
required for the arousing of associations.
(d) Attention plays its part behind the scenes to
so great an extent that the appearances on the
psychic stage which we have so far noted represent
but a small proportion of its activities. It is to the
prominence of re-presentations rather than of pre-
sentations that we must look for an explanation of
the higher mental processes. If the feeble-minded
person does not reason, it is because he cannot
78 THE FEEBLE-MINDED chap.
abstract and bring to the focus of his mental vision
the particular elements of his idea complexes which
it is necessary for him to compare. If he have " no
imagination," it is because he cannot fix and sort
out from the idea complexes those ideas, or groups
of ideas, which are capable of being recombined
into something approximately true to nature. If he
be without sentiment, it is because not even feelings
are capable of occupying a prominent place in his
consciousness. Nor are these all the paths along
which he can go astray. He may be wrong in his
judgments, because he cannot envisage the ideas
which he regards as alike sufficiently clearly to
enable him to see that they are not alike. His
imagination runs riot, as in dreams, because he
cannot compare the new groupings which he has
evoked with the standard of things as they are
supplied to normal minds by experience. His
sentiments are vicious because he has not light
enough to enable him to choose the better part.
There are also other cases in which the ideas,
which expediency would suggest should be prominent
in consciousness, fail to occupy that position. In
these, probably because they are marked by more
of the phenomena which we have learned to
associate with exercise of the will, the condition is
usually described as due to defective volition. The
most obvious case is that in which the supplanting
of instincts by voluntarily controlled activities does
not occur, or occurs only incompletely ; and, in
consequence, the adjustment of the individual to his
environment is more or less imperfect. Of some-
what similar character are the instances of obsession,
Ill THE FEEBLE MIND 79
or imperative idea in which the will is powerless to
dethrone one idea from its seat at the focus of
attention by attending to other ideas.
Ill-regulated instincts supply perhaps the largest
group of symptoms observed in the feeble-minded.
The instinct to feed may be displayed irrespective
of times and seasons : the instinct of cleanliness may
find channels of expression which involve much
social inconvenience : the instinct of imitation may
be incapable of direction only to profitable ends.
Instinctive movements are not schooled into an
orderly sequence of purposive activities, but show
themselves as aimless wandering or the various
swaying, nodding, twisting, and other movements
embraced under the denomination "tics." In later
life the instincts of curiosity, acquisitiveness, destruc-
tiveness, amativeness, and so on, will each require
guidance by the will and, failing it, may give rise to
various anti-social disorders of conduct.
The instinct for the employment of vocal or other
signs in language is, perhaps, from a psychological
standpoint, the one of most importance in the
inherited mental outfit, although, without the develop-
ment which education occasions, it would play but
an insignificant part in the individual's life. Idiots
find vent for their emotions in a vocabulary limited
to cries of different pitch, timbre, and loudness,
comparable with the variations in a dog's bark when
the animal is hungry, angry, or frightened. Profit-
able development is dependent on the individual's
power to form concepts. This is often overlooked
by teachers of the feeble-minded, who do not realise
that the parrot-like repetition of set phrases which
80 THE FEEBLE-MINDED chap.
they proudly adduce as evidence of growing intelli-
gence connotes no higher intellectual gifts than
those of a parrot. It is because, on the one hand,
we may find speech not based on reasoning and, on
the other, reasoning unable, on account of a
defective mechanism, to find expression in speech,
that the mere ability to say certain words does not
afford us, as Esquirol too hastily concluded, a satis-
factory criterion in estimating mental capacity.
Feeble-minded persons display practically every
form of abnormality of speech which is known to
exist. Of these, such as have their origin in defec-
tive development are peculiar to the class, but since
the genesis of the morbid condition is often doubtful,
this fact is not of much value for purposes of classi-
fication. The most convenient arrangement seems
to be one on the basis of the distinction between
the main divisions of the linguistic apparatus, and
we may therefore recognise three chief groups of
speech defect, which do not, however, exclude one
another.
(a) Those dependent on abnormality of the
sensory apparatus : — To the child deaf from birth
or from an early age there is available only the
vocal material which has come to it by inheritance,
and this limited capital, which is quite inadequate to
the child's needs, is generally allowed to remain
unutilised, the child consequently becoming dumb
or only making occasional unintelligible noises eked
out by gestures. In such cases it may be possible,
by means of other channels, to impart some form of
sign language in the use of which the child may
attain to a quite remarkable facility.
Ill THE FEEBLE MIND 81
Blindness which is congenital or of early occurrence
need not, of course, affect the reception or emission
of sounds, but it will affect their connotation and
it will limit considerably inter-communication by
means of the symbols which represent words, only
such as can be appreciated also by the sense of
touch being of any service.
(^) Those dependent on abnormality of the motor
apparatus : — -The machinery of gesture is so exten-
sive and the scope of its employment so restricted
that interference with this means of expression is of
relatively little importance. Writing involves a
smaller range of muscles and its utility is much
greater than that of gesture, but even it can be so
completely replaced by vocal speech that only the
latter calls for notice at any great length. It may,
however, be mentioned in passing, that peculiarities
of the script analogous to stammering and stuttering
are exhibited by the feeble-minded.
To such disturbances of the faculty of speaking
as fall within the boundaries of the class under con-
sideration the general term ''dysarthria" may be
applied. The originating lesion may be in the
muscles of articulation, as in trophic or inflammatory
changes ; or in the nerves supplying those muscles,
as in section or toxic neuritis ; or in the grey matter
from which issue the impulses necessary to set the
muscles in motion, as in wasting of the bulbar
nuclei ; or in the pyramidal tract ; and any of these
lesions may serve as the exciting cause of the rest.
There may, further, be structural defect of the
accessory vocal apparatus, e.g., cleft palate or dental
malformation. Frequently it is not possible to
G
82 THE FEEBLE-MINDED chap.
indicate the precise nature and position of the lesions,
and consequently, it is impossible to exclude the
psychic element, but, somewhat arbitrarily, we may
regard the following as attributable rather to in-
competence of the organs of expression than to lack
of intelligence.
1. Aphonia. — This is a quantitative, not a
qualitative, defect of speech. The voice is so low
as to be almost inaudible, or the patient speaks in a
whisper, or with an amount of effort quite dispro-
portionate to the effect produced.
2. Stammering and stuttering. — These terms are
applied indiscriminately by many English writers to
conditions in which there is a difficulty in beginning
to speak or a sudden interruption of speech, or a
repetition of consonantal sounds in speaking. Even
though these conditions are usually associated, it is
convenient to describe spasmodic interruptions of
speech as stammering and the reduplicative anomaly
as stuttering.
3. Slurring, scanning, the stumbling over syllables,
and the omission of syllables go to form a third
group, in which lisping should, perhaps, also be
included.
4. Aphthongla. — A rare condition in which an
incapacitating spasm of the muscles of articulation
occurs when speech is attempted.
5. Bradylalia ; bradylogia ; bradyglossia ; brady-
phasia ; bradyphrasia ; are terms which have been
applied in an indiscriminate fashion to various dis-
orders of speech having in common the feature of
slowness of utterance.
(c) Psychic or intellectual defects. — These are
Ill THE FEEBLE MIND 83
characterised by an absence or a disorder of the
mental concomitants of speech. A child may not
speak because he has nothing to say, or he may speak
in some abnormal fashion because his mental pro-
cesses are in confusion. Such defects as these have,
we must suppose, just as definite a physical basis as
the sensory and motor ones already described, and
since that basis is not capable of isolation from the
sensory and motor apparatus, the recognition of a
" psychic " group of morbid states is simply a matter
of convenience. This consideration will justify the
allocation to the present category of the conditions
comprised under the name ''aphasia," in which the
lack of the power of exact expression is due to
inadequacy of the receptive or the emissive mechan-
ism, and also those which have their origin in
retarded intellectual development and which Heller^
entitles *' dyslogic." The antithesis between aphasic
and dyslogic forms is brought out, according to
Heller, by the fact that in the latter the speech
defect is secondary to the mental one, while in the
former it is the limitation of mental power which is
secondary.
Clinically, evidence of the existence of psychic
defect of speech is afforded by : —
1. Noise-making. Some idiots make an endeavour
to express their wants by crying, shouting, or
shrieking noises which can hardly be dignified with
the title of language.
2. Lalling. As we have seen, primitive efforts at
articulate speech are made in early life, apparently
as a result of inherited tendencies. This condition
^ T. Heller, Grundriss der Heilpddagogik^ 1904, p. 86.
G 2
84 THE FEEBLE-MINDED chap.
may persist into later life, the child failing to acquire
speech of the ordinary kind and contenting itself
with mere babbling.
3. Idioglossia. This is a development of lalling,
in which the person uses a private and peculiar
language, omitting difficult consonants, or substitut-
ing for them easy ones, with fantastic results.
4. Agrammatism. With the limited vocabulary
which alone is at his disposal in his earliest years,
the child has to make single words do duty for
many purposes. For him there is naturally no such
thing as syntax, and the distinctions of noun and
verb, adjective and adverb, preposition and con-
junction, are refinements of which he knows nothing.
The power of inflecting words, and arranging them
to form sentences is acquired slowly, and the process
of acquisition may be interrupted at any stage if the
development of the brain ceases. Liebmann^
describes three forms of agrammatism as met with
in the feeble-minded. In the first, only what may
be called "key-words" are employed. Thus the
word "gee-gee" may be applied to anything which
moves, and may indicate the presence of that thing,
or any emotion which its appearance has aroused.
In the second, the key- words are put together to
make the skeleton of a sentence, e.g., " Nana milk
give," while in the third, the differentiation of the
grammatical classes of words causes this skeleton to
be filled out so as to make a sentence of bizarre
construction, as in the examples quoted by Liebmann
— " Milk get we for the cow butter," " She drinks
1 A. Liebmann, v. Art. " Agranimatismus," in Enzyklopddisches
Handbuch der Heilpddagogik, 1909.
Ill THE FEEBLE MIND 85
the woman on the glass." It would appear that in
these cases the mental limitation is not so marked as
might be expected from the attempts at speech, for
the persons concerned may be found to understand
much more complicated sentences than they them-
selves give utterance to.
5. Echolalia. Normal children sometimes repeat
what is said to them, apparently with the object of
assisting apprehension by strengthening their
auditory impressions with kinaesthetic ones, and a
somewhat similar practice Is occasionally observed
among the feeble-minded, though it is perhaps
more characteristic of some forms of primary
dementia.
6. Verbigeration. This also is most frequently
met with, in a well-marked form, as a symptom of
primary dementia, but idiots will sometimes occupy
themselves for long periods with the repetition of
some word or sound, which conveys no meaning to
the hearer, and, so far as can be judged, has no
significance for the utterer.
7. Word-blindness and word-deafness. In child-
ren of a higher grade than the Imbecile, there are
met with certain intellectual defects of limited extent
which take the form of inability to learn to read, or
of incapacity to apprehend the significance of spoken
words. These conditions, known respectively as
word-blindness, and word-deafness, are said to be
dependent on definite anatomical abnormalities,
referable either to developmental defect, or to a
lesion, which may be found in particular regions of
the cerebrum. Cases of the kind have been
described by many writers, among the most recent
86 THE FEEBLE-MINDED chap.
accounts, being those of C. J. Thomas^ and J. H.
Fisher.^
There is one manifestation of abnormal tendency
in the employment of language which has acquired,
in the popular conception of idiocy, a prominence
attributable to its curious character rather than to its
value as a guide to the mental state. This is what
is called " Mirror Writing." One finds rather
widely prevalent, the notion that a distinctive
characteristic of idiocy is that whereas the normal
person writes from left to right and with the right
hand, the idiot writes from right to left, with the
left hand. What really does happen is, on the face
of it, sufficiently remarkable : in certain cases the
attempts at writing which the feeble-minded person
makes, result in the production of a script which is
meaningless until it is held before a mirror, when one
is able to decipher it in just the same way as one can
decipher the marks on a piece of blotting-paper
which has been used to dry ordinary script. Good
examples of this kind of writing are rare, at any rate
in this country ; for idiots either do not write at all,
or they produce a scrawl which demands the use of
a good deal of ingenuity, in addition to a mirror, if
anything is to be made of it. The example given,
which is the best that the writer has been able to
obtain, will bear out this statement (Fig. 3).
Mirror writing occurs in idiots who are capable of
a limited degree of caligraphic attainment but In-
capable of learning to write properly. The explan-
^ C. J. Thomas, The Aphasias of Childhood a?id Educational
Hygie?ie^ Public Health, May, 1908.
2 J. H. Fisher, Lancet^ May 14th, 19 10, p. 1348.
Ill THE FEEBLE MIND 87
ation of its occurrence is probably to be found, as
suggested by Heller ^ and Wegener, in the natural
tendency of movements at one side of the body to be
accompanied by symmetrical movements at the other
side. In mirror writing, for some reason, the
Cr^U5K?(>
Fig. 3.
attention is directed to what should be the subsidiary
movement, i.e., that of the left hand ; and the idea of
this movement, in consequence, becomes the more
prominent one and therefore controls the form which
the activity takes. Ambidexterity, as we shall see,
is commoner in idiots than in normal persons and
the particular accomplishment which we are consider-
ing seems to be merely a special case of it.
1 T. Heller, op. czL, p. ii8.
88 THE FEEBLE-MINDED chap.
Having provisionally accepted the hypothesis of
an Ego distinct from, and capable of controlling,
consciousness, we may as well utilise it to account
for the existence of certain mental abnormalities
which, while having points of contact with the four
groups above enumerated, cannot be easily referred
to any one of them. These are the phenomena
known as delusions, of which the most prominent
characteristic is their dependence on the " Self."
The term self is employed with various connotations^
but the most intelligible, if not necessarily the most
accurate, use of the word is as a name for the
assumed entity, which has the relation of subject to
the various objective manifestations of mind — the
entity which experiences, remembers, imagines,
reasons, and wills, in short, thinks ; as distinct from
the group of Ideas and affections which constitute
the raw material of the process. The aberrations
of the self in thinking may be temporary and, con-
sequently, of only transient effect, or they may be of
such a character as to indicate a permanent " set " in
the direction of falsity. In the latter case we get
that persistent failure to adapt the mental workings
to the conditions imposed by the environment which
constitutes delusion. The more highly organised
the mind, the greater Is the scope for a mischievous
self to play pranks with it, and since deficient organ-
isation is the essence of feeble-mlndedness, there is
no large field for the production of delusions, which
are. In fact, an insignificant feature of the undeveloped
mind.
Whatever may be the causes producing defective
development of the nervous system, it would appear
Ill THE FEEBLE MIND 89
that their incidence on all parts of that system need
not be the same. It is possible, consequently, to
have one portion of the apparatus proceeding to
attain maturity, while other systems lag behind to a
greater or less extent. When this happens, we get
ability in some particular field standing out con-
spicuously against a background of unintellectuality.
The contrast is sometimes so striking as to give the
impression of phenomenal capacity as regards the
department of knowledge concerned, but this
appearance is probably misleading. In their own
special lines, the '' idiots savants," as persons exhibit-
ing the features under consideration are called, are
not superior to persons whose general mental level
is normal. The exceptional ability of the feeble-
minded shows itself more especially in the provinces
of mathematics and the arts. Many instances of
this kind have now been placed on record. Heller^
mentions the case of a child of ten whose sole
interest in life was to count. When out walking he
counted the passing men, horses, and vehicles ; the
windows and doors of the houses ; the number of
men with brown or with black boots ; those with
moustaches ; those with whiskers ; and so on.
Books appealed to him as affording facilities for
enumeration, he counted the pages, the words and
the letters. Other feeble-minded persons show a
noteworthy aptitude for remembering dates, and
Sengelmann ^ has reported the case of an imbecile
who learned the names and corresponding numbers
^ T. Heller, op. cit., p. 143.
^ Quoted from Handbuch der Schwachsinnigenfiirsorge^ by
H. Bosbauer, L, Miklas and H. Schiner, 1909, p. 43.
90 THE FEEBLE-MINDED chap.
of more than 1 50 scholars whom he had never seen
and for whom the identity of the numbers with the
persons was so complete that when he saw the
numbers of the hymns on the board in the church
which he attended he would say " To-day Meyer's,
Muller's, Schroder's songs have been sung."
Of the feats referred to, the first would not, of
course, be beyond the power of any normal ten-year
old child who was silly enough to attempt it, and as
regards the others they have been surpassed by
apparently sane persons. A correspondent of The
Daily Telegraph, for example, has drawn attention
to the doings of the youthful son of a well-known
American physician, who is said to have been
admitted to Harvard University at the age of eleven
years and to have been lecturing on advanced
mathematics a few months later. Again, as Heller
points out, while the famous arithmeticians Zacharius
Dase, Buxton, Frankl, and Zaneboni were more or
less imbecile, this could not be said of Gauss,
Ampere, and Bidder, who were not inferior to them
in mathematical gifts. Heller regards Colburn also
as having been feeble-minded, but the evidence is
hardly sufficient to warrant him in this. In music
a similar state of things is met with. Before the
Royal Commission on the Feeble-Minded, Mr. W.
H. Illingworth^ described, in the following words,
the capabilities of a blind and mentally defective
child under his care, '' if one sitting at a pianoforte,
tuned high or tuned low pitch, strikes as many keys
as he can, let it be the finest chord or most ear-
^ W. H. Illingworth, Rep. of the Roy. Comm. on the Care and
Control of the Feeble-Minded., vol. 2, p. 276.
Fig. 4. — Design in coloured threads on a layer of cotton-wool. Made by an
idiot, without tuition.
Fig. 5. — Brain of an epileptic idiot aged 18 ; weight of left hemisphere lyf oz.,
of the right hemisphere 64 oz. The opacity of the pia-arachnoid is
well shown.
{Face page 91.
Ill THE FEEBLE MIND 91
splitting discord, this boy will name every note
struck without the smallest slip or error." There
have been sane musicians who could do as much,
and probably Mozart, at the same age, could have
done a good deal more in the way of contributing
to musical knowledge.
Notable aptitude for sketching, for caricaturing,
for drawing plans, and for modelling, has been
recorded by various observers. An idiot formerly
under the writer's care used to amuse himself for
hours by preparing elegant designs in coloured
wools. A copy of one of these is shown in the
accompanying illustration (Fig. 4) which does not,
however, do full justice to it, since the different
colours are not shown in the photograph. The
strands of wool drawn out from any articles of
clothing or decoration which happened to fall into
the boy's hands are arranged on a pad of cotton
wool obtained from the attendant in charge. Dr.
Tredgold ^ has described at length the case of a
patient at Earlswood Asylum who displayed a con-
siderable amount of artistic and mechanical skill.
1 A. F. Tredgold, Mental Deficiency^ 1908, p. 275.
CHAPTER IV
THE BASIS OF THE FEEBLE MIND
The exposition of the physical conditions
associated with feebleness of the mind will be
facilitated if, as the result of a preliminary survey,
the outlines of a scheme of more detailed study
be sketched. Let us begin then by considering the
salient features of feeble-minded persons, and so
arrive at a series of categories into which the
particular facts observed and any additions to them
may be distributed.
Well-marked cases of mental defect will provide
the best introduction to the subject. If one
observes a group of idiots, one finds that they
display bodily abnormalities in great variety and in
much higher proportion than would a group of
persons of corresponding social status and of sound
mind. Poor general development ; deformities of
head, trunk, and limbs ; irregularities of muscular
action, e.g., paralysis, spasm, or inco-ordination ;
defects of the organs of special sense and of speech,
are common. After death the viscera may be found
to be of less than normal weight and to present
structural differences from the organs of healthy
92
CH.iv BASIS OF THE FEEBLE MIND 98
persons. The brain in particular may display,
in some cases to the unaided eye and in some cases
under the microscope, wide departures from the
standard of normality which anatomy has provided
us with.
To the interpretation of these appearances some
postulates are necessary. Let it be granted that the
existence of mind is conditioned by the existence
of nervous tissue. Let it be granted, further,
that the units of nervous tissue are cells with
processes. '' I am sometimes tempted to ask,"
says Dr. W. W. Ireland, '* Is the assumption correct
that we have reached through the highest power
of the microscope the ultimate elements of the
brain ? " -^ The question is interesting, but as no
satisfactory answer is forthcoming from Dr. Ireland
or from anyone else we need not let it prevent our
accepting the above dicta. For an explanation
of mental abnormality we must look then to the
state of the nerve cells. But man does not consist
of nerve cells alone, and the health of the nerve
cells is dependent, to an extent which we cannot as
yet exactly define, on the integrity of cells in other
parts of the body.
The development of an individual human being
from a fertilised egg-cell is the resultant of certain
obscure forces which can be roughly classified with
the help of the evolutionary hypothesis. Primitive
bioplasm has a power of responding to stimulation
which becomes more marked as differentiation in
the direction of nervous tissue takes place, but is not
lost even when the differentiation is in some other
1 w. W. Ireland, The Mental Affections of Children^ 1900, p. 72.
94 THE FEEBLE-MINDED chap.
direction. The state of any particular cell and,
consequently, of any aggregate of cells such as that
constituting a tissue in a highly organised type like
Man, will depend on its intrinsic power of response ;
on the mysterious control of its nutrition which we
ascribe to the trophic influence of the nervous
system ; and on the control of its functional activity
which may be exercised by the nervous vSystem.
Nervous and non-nervous cells are thus mutually
dependent and w^e need not therefore be surprised
to find that one system does not suffer without
involving the other in its misfortunes.
The physical factors of feeble-mindedness are
to be sought then in the following fields.
(i) The nature and relations of the nerve cells.
(2) The nature and relations of non-nervous
elements.
Since in any given case it may be, and probably
will be, impossible to assign the pathological
condition observed to its exact position in the above
scheme, the suggested fields must be regarded as
overlapping to a greater or less extent.
In preparing this account of the pathology of
feeble-mindedness, use has been made of several
series of cases at some time under the writer's care.
Different aspects of the subject have been under
review at the times when the different series were
worked over, so that the total number of cases is
not available as a basis for statistics in regard
to each point dealt with. The various groups which
have supplied data will, however, be sufBciently
indicated in connection with the special points they
serve to illustrate.
IV BASIS OF THE FEEBLE MIND 95
The notes on the post-mortem appearances,
i.e.^ on what is ordinarily included under patho-
logical anatomy, are derived from the study of the
bodies of the patients comprised in the following
series : —
A. One hundred males between the ages of
sixteen and forty-nine years. These patients were
all idiots or imbeciles, so that the degree of mental
impairment exhibited during life was considerable.
No cases diagnosed during life as general paralysis
of the insane are included.
A'. One hundred males corresponding in the
main to series A, but modified so as to comprise fifty
epileptic and fifty non-epileptic patients.
B. A number of persons of all ages and both
sexes in regard to whom the reports of the autopsies
are less complete.
An investigation of the abnormalities observable
during life was conducted with the help of the
following material : —
C. A series of 150 male patients at the Belmont
Asylum. The ages of these ranged from sixteen
to fifty years.
D. A series of 250 male children and 250
female children between the ages of five and sixteen
years.
E. A series of 100 males between the ages
of sixteen and forty years who were subjected
to a special craniometric examination by Dr.
R. J. Gladstone.
The cases in series D and E were inmates
of the Darenth Industrial Colony and Training
School for Imbeciles.
96 THE FEEBLE-MINDED chap.
(i) The nahire and relations of the nerve-cells. —
These may be observed directly or may be inferred
from the results of the activities of the nerve cells.
They may be conveniently studied from three points
of view.
(a) The number of the nerve- cells, — Pathologists
are very generally of opinion that a normal mind is
never found associated with a brain of less than a
\ certain weight, e.g., 36 ozs. for an adult human
being. Above the limit mentioned there is no
simple relation between the weight of the brain and
the degree of mental capacity, but it is worthy of
note that the mean weight of the brain in mentally
defective persons is definitely below the mean weight
of normal brains. In series A the brains ranged
from a maximum of 55 ozs. to a minimum of 1 5^ ozs.^
giving a mean of about 42 ozs., whereas the average
weight of the brain in mentally normal male adults,
as ascertained for me by Dr. Braxton Hicks, was
49 ozs., an estimate agreeing with that generally
accepted.
A paucity of nerve cells such as is here suggested
may be due to the fact that an adequate supply has
never been provided or to the loss of cells formerly
present, and the mere absence of cells does not throw
any light on the matter. There is, however, reason
to think that both factors play their parts in the
production of the "feeble" brain. An obvious gap
in a layer of nerve-cells such as some of my prepara-
tions have shown, affords strong evidence that cells
^ ^ This brain had been preserved in formalin, a method which,
according to Harper {v. Archives of Neurology, vol. iii., 1907,
p. 202), adds 10% to the weight.
IV BASIS OF THE FEEBLE MIND 97
once present have been replaced by something else. \
That ''something" is usually the neuroglia and this 1
aspect of the lack of cells can be dealt with more \
satisfactorily when that tissue is being considered. ':
It appears, however, that in the brains of the feeble-
minded there is an actual non-development of
nerve-cells. This, at any rate, is the deduction ;
from his careful measurements of the cortical layers I
which was made by Dr. J. S. Bolton whose paper in !
the Archives of Neurology^ is worthy of careful |
study.
[d) The quality of the nerve-cells, — The normal
histology of the brain has hardly, as yet, been
worked out with sufficient thoroughness to render
practicable a correct interpretation of the appear-
ances observed when the nerve-cells of defective
brains are studied microscopically. Bevan Lewis
and Tredgold have described an embryonic type
of cell with few processes, large ovoid nucleus, and
rounded contour as specially characteristic of mental
deficiency. By the former these cells were thought j
to occur only in cases complicated by epilepsy, but '
the latter observer does not agree with this view.
Tredgold ^ has described pigmentation of the cortical
nerve cells and the writer's own preparations from
other regions of the brain have afforded instances of
a similar condition. Of the cases in series A,
fifteen were examined microscopically after staining
by Nissl's method, the regions from which sections
were taken being usually the hippocampal gyrus and
1 J. S. Bolton, "The Histological Basis of Amentia and Dementia,"
Archives of Neurology^ vol. 2, 1903, p. 424.
\A. F. Tredgold, Mental Deficiency, 1908, p. 58
H
98 THE FEEBLE-MINDED chap.
the red nucleus. In most of the brains there was
evidence of nerve-cell degeneration, which amounted
in the slighter cases to chromatolysis and in the more
advanced to loss of the cell processes, swelling of the
nucleus, and disintegration.
(c) The proportion of the different types of cells. —
While admitting that nerve-cells are the physical
basis of mind, one has to recognise that, apparently,
all nerve cells are not of equal importance in the
production of psychical manifestations. The physio-
logical activity of some of the nerve cells does not
appear to affect consciousness perceptibly, while that
of others commands instant attention. As a result
of piecing together odd fragments of knowledge
acquired in the course of ages, we have come to
regard the cells in the cortex of the cerebral hemi-
spheres as especially endowed with the function of
** mentation," and as the amount of white matter in
the hemispheres is dependent on the amount of grey,
we might expect that the mass of the hemispheres,
as compared with that of the whole brain, would be
proportionately less than in normal brains. *'The
statistics of various observers," says W. Ford
Robertson, ''appear to prove that the smaller average
weight of the brain of the insane as compared with
those of the mentally sound is dependent upon the
cerebral hemispheres alone." ^ In order to discover
whether the principle so enunciated applied to the
brains of the feeble-minded the ratio of the weight
of the cerebrum to that of the whole encephalon was
1 W. Ford Robertson, A Text-book of Pathology in Relation to
Mental Diseases^ 1900, p. 279.
IV BASIS OF THE FEEBLE MIND 99
worked out for the brains in series A. The pro-
portion varied widely in the different cases, ranging
from a maximum of 92% to a minimum of "J^jj^, the
mean of the 100 brains being '^'jy^. On the strength
of observations made by Huschke, the ratio of the
cerebrum to that of the whole brain in normal
persons has also been stated as 87 to 100. Dr.
Braxton Hicks, Assistant Pathologist to the
Westminster Hospital, has supplied me with a set
of figures derived from the brains of twenty-five
mentally sound male patients for comparison with
those obtained from the idiot and imbecile patients
in series A. The ratio of cerebrum to whole brain
varied from 89% to 82%, i.e., not nearly so widely as
in the case of the mentally defective persons, but
the mean ratio was only 85-5%. ix., 1*5% below the
mean for series A. We get therefore no corrobora-
tion of the view that in idiots and imbeciles the
cerebrum is relatively less developed than in the
sane, indeed the evidence points in the opposite
direction.
A common feature of idiot and imbecile brains, ^
which may be conveniently dealt with here, \^
Asymmetry, shown particularly by a difference in
weight of the cerebral hemispheres with which is
associated a difference in the opposite direction
between the weight of the lateral lobes of the
cerebellum. Differences of this kind occur
also in normal persons, but rarely to a marked
extent.
In one case of series A, the right cerebral hemi-
sphere weighed 6f ozs., the left i7f ozs., while the
II 2
100 THE FEEBLE-MINDED chap.
right lobe of the cerebelkim weighed 2^ ozs. and
the left if ozs. ; in another the weights were :
Right hemisphere igf ozs.
Left hemisphere 13 ozs.
right lobe ... 2 ozs.
left lobe .... 24- ozs.
Cerebellum -!
These were the brains shown In Figs. 5, 6 and 7.
The relation of asymmetry to the mental state is
not always clear. In the most marked cases there are
usually associated with it sensory and motor defects
of one half of the body which are not, apparently, of
great psychical moment. There must be, however,
in addition, a disturbance of the psychical equili-
brium which may have far-reaching consequences.
The frequency with which epileptic seizures were
known to have occurred in patients exhibiting cere-
bral asymmetry led the writer to enquire to what
extent this relation was to be regarded as merely
accidental. For this purpose a series of a hundred
brains corresponding in part to series A, but
selected so as to comprise the brains of fifty
epileptic and fifty non-epileptic idiots and Im-
beciles (series A^) was weighed and the difference
between the weights of the two hemispheres noted.
Among the epileptics there v/as no difference in
fourteen cases ; In three of the remaining thirty-six
the differences recorded were respectively 1 1 ozs.,
9f ozs., and 6f ozs., and the mean difference for the
whole fifty brains was i'iq ozs. Of the non-
epileptic brains, one, a case of cerebral tumour, had
the right hemisphere weighing 6f ozs. more than
the left, but apart from this the greatest difference
Fig. 6. — The same brain as in Fig. 5. The hemispheres are separated and
placed so as to emphasise the difference in size.
Fig. 7. — Brain of an epileptic idiot seen from the front. The right hemisphere
weighed 19! oz. ; the left, 13 oz. Note the opacity of the pia-
arachnoid over the left hemisphere.
{Face pa^e 100.
IV BASIS OF THE FEEBLE MIND 101
observed was 3 ozs. (in two cases). In twenty-one
cases there was no difference, and the mean difference
for the whole series was '59 oz. Too much stress
must not be laid on the curious fact that the ratio of
the two means is almost exactly 2:1, but it certainly
appears that, as detected by weighing, asymmetry
occurs in the brains of epileptic idiots and imbeciles
to a much greater extent than in non-epileptics of
the same class.
The cerebrum may also show departures from the
normal condition as regards the folds into which the
cortical region is thrown. The term "normal" in
this connection is sufficiently elastic to cover a good
deal of variety in the arrangement of the cerebral
convolutions, but healthy brains do not show such
extreme diversity as is found in the brains of
mentally defective persons of low grade. The
difficulty of correlating the observed abnormalities
with the peculiarities of the mental state prevents
our attaching great importance to the convolutional
pattern of the brain. It will suffice to call attention
to the most striking features of idiot brains from the
topographical standpoint.
The cerebral hemispheres, as met with in persons
of normal development, though presenting numerous
differences in detail, conform to a certain standard
as regards the disposition of the chief folds and
furrows which the surface exhibits. The fissures of
Sylvius and Rolando and those fissures or sulci
known as the parieto-occipital, the calcarine, the
intra-parietal, the parallel and the collateral, to name
only the chief, have a fairly constant relation to each
other in the brains of the sane. This convolutional
102 THE FEEBLE-MINDED chap.
pattern is, however, often departed from in the
brains of idiots and imbeciles, especially when the
brain is very small. The brain depicted in
Figs. 1 6 — 1 8 affords a good example of such an
abnormality. At both sides the parieto-occipital
fissure is confluent with the intra-parietal, while at
the right side the fissures of Sylvius and Rolando
are merged in a single furrow. Apart from such
striking anomalies as these, it was noted that very
generally the brains in series A showed, as com-
pared with the normal brain, a simplicity in the
convolutional arrangement suggestive of the con-
ditions found in animals of a much lower grade than
that attained to by Man.
Apparently any region of the cerebrum may dis-
play convolutions which are much larger or much
smaller than the average size for the brain. The
former condition, called macrogyria,-^ is rarely pro-
nounced, and the large convolutions seem to be due
simply to a more or less perfect fusion of ordinary
convolutions.
Microgyria, in which some of the convolutions are
unduly small, is of more frequent occurrence. Two
types of it can be recognised. In the first, which is
illustrated in Fig. 8, there appears to be a simple
under-development of some particular portion of the
cortex. In the second, which will be better dealt
with later, the smallness of the convolutions is to be
explained as the result of atrophic changes.
Marked disturbance of the arrangement of the
convolutions is found also in the condition known as
^ Schwalbe {Die Morphologic der Missbildungen des Me7tsche7t und
der Tiere) follows Oekonomakis in preferring the term " pachygyria."
Fig. 8. — Parietal region of the right hemisphere of an idiot boy aged 17,
showing microgyria.
Fig. 9. — Left hemisphere of the brain of an idiot, showing a condition of true
porencephaly.
{Face page 102.
Fig. io. — The right hemisphere of the brain represented in Fig. 9, showing,
instead of a perforation of the ventricular wall, a depressed area
with irregular convolutions.
Fig. II. — Brain showing the condition known as pseudo-porencephaly.
{Face page 103.
IV BASIS OF THE FEEBLE MIND 103
porencephaly, in which there is a gap in one or both
of the cerebral hemispheres, the resulting cavity, in
a well-defined case, being continuous with the lateral
ventricle. As in the case of microgyria, two forms
of porencephaly are met with. Both seem to own a
vascular origin, but in the first the defect is develop-
mental and to be attributed to a want of growth of
certain parts owing to the absence of a sufficient
supply of blood to them, while in the second it is
consequent on a breaking down of tissue in the
affected part following thrombosis or embolism of the
vessels leading to it. In the former type the region
affected is usually that supplied by the middle cere-
bral artery, so that the perforation is found either
about the posterior part of the Sylvian fissure, as in
the brain shown in Fig. 9, or along the whole length
of the normal site of that fissure, as in the case
described and figured by Conolly Norman and Alec
Frazer.-^ As will be seen from Fig. 9 the occurrence
of this type of porencephaly is associated with a
radial arrangement of the convolutions about the
cavity which makes the ordinary nomenclature in-
applicable. This brain was from an infant female
idiot not included in series A. One case in the
series, that of a male aged at death '^'] years, showed
a condition of porencephaly affecting the greater
part of the middle and lower frontal convolutions at
the right side. In both cases the remaining hemi-
sphere was also abnormal, though there was no
perforation (v. Fig. 10). Fig. 11 shows the second
type of porencephaly. The brain was that of a
^ Conolly Norman and Alec Frazer, " A Case of Porencephaly,''
Journal of Mental Science^ Oct., 1894.
104 THE FEEBLE-MINDED chap.
female who died at the age of 73 years in a de-
mented condition. In this instance the mental
defect was probably not congenital, but, as illus-
trating a point in pathological anatomy, the case
will serve.
The cerebrum is not the only part of the brain to
exhibit abnormality ; both the cerebellum and the
spinal cord may be involved in the morbid conditions
which have given rise to mental defect. In addition
to the asymmetry and the relative smallness as com-
pared with the cerebrum which have been already
referred to, the cerebellum may show complete
failure of development of one or other hemisphere,
sclerosis, microgyria, agyria, or heterotopia (v. infra).
A moulding of the hinder region to the shape of the
foramen magnum was several times observed in
association with hydrocephalus, apparently owing to
the increase in the intra-cranial pressure, and there
are on record cases in which this process of com-
pression has advanced so far that the fourth ventricle
has been obliterated or the cerebellum has been
flattened out over the upper part of the spinal
cord.
The medulla oblongata has been found deformed,
especially in the direction of a more or less complete
splitting into two lateral portions, and similar division
of the cord has been noted. One of seven cords
examined from series A showed a condition of
hydromyelia, and heterotopia occurs in the cord just
as in other parts of the central nervous system. It
has been laid down by Flechsig and others that
nerve fibres of the medullated order do not become
efficient until the medullary sheath is developed
IV BASIS OF THE FEEBLE MIND 105
Certain of the nerve fibres, ^.^., those of the pyra-
midal tract, do not ordinarily become medullated
until after birth, and it appears that the acquisition of
voluntary control proceeds pari passu with the
myelination of the fibres of those tracts. It might,
consequently, be expected that the defective volition
of idiots would be associated with a want of develop-
ment of the pyramidal tract fibres. This anticipation
is not fully realised. Sections of the spinal cord in
idiots show areas of degeneration corresponding to
gross cerebral lesions, but there does not seem to be
in cases of congenital mental defect characterised by
volitional incapacity a persistence of the primitive
condition of non-myelination such as would explain
the patients' deficiency in this respect. In seven
cords from cases in series A no very definite
features which could be correlated with the mental
state were observed, but, in several, degenerated
nerve fibres were found scattered through the white
matter.
As was noted when the basis of the normal mind
was under consideration, the nerve cells in the cere=
brum have not all the same function. A dispro-
portion, as compared with the ratio observed in the
normal brain, in the cortical areas corresponding to
sensorimotor and associational functions is often
observable in the brains of idiots, but it follows no
simple rule, and its relation to the character of the
mental defect is not usually obvious. Sometimes, as
in several of the brains figured, the distinction between
the lobes is so much obscured that it is difficult to
decide what regions are to be compared with normal
sensorimotor and association areas.
106 THE FEEBLE-MINDED chap.
If, proceeding a stage further, we try to Infer the
kind or degree of mental defect from the proportions
of small, medium and large pyramidal cells, to say
nothing of the other varieties of nerve cells, in a
particular portion of the cortex of an idiot's brain, our
ignorance of the respective functions of these differ-
ent types of cells in the normal cortex prevents our
arriving at very definite conclusions. Some valu-
able information on the subject has, however, been
contributed by J. S. Bolton,^ who has measured in a
number of brains the thickness of the different
cortical layers. Four imbecile brains examined by
him showed marked reduction in this respect as
compared with the normal brain. This appears from
the following table, in which, the whole thickness of
the normal cortex being represented by loo, the
average thickness of each of the various layers was
approximately as stated.
No. of layer.
Normal brain.
Imbecile brain.
I. Superficial fibres ...
14-5
13-5
2. Pyramidal
44
35*5
3. Granular
13
10
4. Inner fibres
12-5
IO-5
5. Polymorphic cell ...
16
i4'5
100 84
It is interesting to note that the ratio of the
different kinds of cells in the brain of the imbecile
when estimated by this method does not differ in
any significant way from the ratio in the healthy
brain.
(d) The connections of the nerve-cells. — In the
chapter on the basis of the normal mind reference has
^ J. S. Bolton, loc, cit.
IV BASIS OF THE FEEBLE MIND 107
already been made to the conflicting views which
are held by rival schools of anatomists as to the
nature of the connection between the nerve-cells.
Such connection is admittedly effected by means of
the processes given off from the cells, but whether
the processes are actually continuous with one
another or not remains in doubt. The neuronic
doctrine which assumes the existence of gaps or
'* synapses" between the processes has something
to recommend it in that it greatly facilitates the
explanation of the way in which the nerve-cells
interact. At any rate it is clear that undue
separation of nerve-cells, or rather of their processes,
would involve serious interference with the proper
performance of their functions, and it is possible that
this is one of the ways in which the overgrowth of
neuroglia, which diseased brains sometimes show,
produces its injurious effects.
The particular conformation of the central
nervous system with which we are familiar, although
no doubt determined by efficient if not very
intelligible forces, does not appear theoretically to be
essential to the proper performance of its functions.
A given mass of nerve-cells might conceivably be
arranged in different ways without interruption of
the communicating channels between the cells.
Abnormality in the relative distribution of grey and
white matter in the brain may consequently be of
little or much significance from a psychic standpoint.
Heterotopia, as this condition is called, occasionally
occurs in association with mental defect. The few
cases known exhibit considerable diversity as to
form. Von Monakow described six types, and later
108 THE FEEBLE-MINDED chap.
H. Vogt arranged the recorded cases in five groups.
A review of their respective schemes is given by
Schwalbe.-^ For a detailed study of a case reference
may be made to the paper by H. G. Stewart^ in the
Archives of Neurology and Psychiatry. Another
rare abnormality is absence of the corpus callosum.
Of this condition there was one instance in series A,
the hemispheres being connected dorsally to the
third ventricle only by a thin band of tissue
continuous with the lining of the lateral ventricles.
(2) The 7iature and relations of non-nervous cells.
— It is something more than an accidental circum-
stance that, as recorded in every description of the
feeble-minded which aims at completeness, bodily
defects should occupy so prominent a place in the
clinical picture. A section on the '' physical " charac-
teristics or " bodily symptoms " is a recognised
institution in the preparation of a text-book dealing
with the feeble-minded, and it would be improper to
disregard this aspect of the subject. It would be
well, however, to adopt a somewhat more critical
attitude than is usually taken up in assigning to the
'' stigmata" of feeble-mindedness, as they are called,
their correct place as diagnostic criteria. In
speaking of the cells other than nerve cells which
may be implicated in cerebral defects they will only,
except in special cases, be considered in the mass as
constituting tissues and organs, for the process of
physiological analysis has not yet reached such a
1 E. Schwalbe, Die Morphologic der Missbildungeii des Menschen
und der Tiere. 3 Teil^ 1909.
2 H. G. Stewart, "A Description of the Brain of an Epileptic
Imbecile, Showing Extensive Heterotopia of the Grey Matter,"
Archives of Neurology a7id Psychiat?y^ 1909, P- 289.
IV BASIS OF THE FEEBLE MIND 109
degree of thoroughness as to supply data of other
than the most general character. Abnormalities of
non-nervous cells are here only of interest in so far
as they are associated with nerve-cell defects. The
relation between the two kinds of cells is twofold, in
that the changes in either may be secondary to
changes in the other. Of the peculiarities which
the bodies of the feeble-minded display, some may
be regarded as due to nerve-cell lesions, while others
are to be looked upon as causes and not as conse-
quences of nerve defects. The paralysis and
wasting of a limb which follow on a cerebral
haemorrhage are of the former variety, while the
degeneration of nerve cells which follows an intra-
uterine amputation of that limb, or the rupture
during the act of birth of the nerves supplying it,
belongs to the latter. In general there is an inter-
action of the two sets of conditions which makes it
useless to attempt to designate one of them as a cause
in opposition to the other. Take, for instance, the
sequence of events which Ford Robertson describes
as occurring in cerebral degeneration. As a result
of "more metabolism In the cerebral tissues," or of
**a morbid condition of the blood from which the
fluid is derived," the cerebro-spinal fluid becomes
abnormal. In this condition it produces changes,
those in the dura mater being of special importance,
which result in lymphatic obstruction. This
obstruction causes disturbances of the Intra-cranlal
pressure and progressive contamination of the
cerebro-spinal fluid which, of course, react injuriously
on the nutrition of the nerve cells. Thus a vicious
circle is set up which promotes steady depre-
110 THE FEEBLE-MINDED chap.
elation In the value of the brain as an organ of
mind.
In describing abnormalities of the non-nervous
cells, tissues, or organs, one may begin with those in
the most intimate anatomical relationship with the
purely nervous elements.
I. First in importance comes the internal support-
ing and connective tissue of the central nervous
system. This, according to Ford Robertson, is
derived from two sources, the one being the
primitive external layer of the body, the epiblast,
from which the nerve cells also are derived, and the
other the primitive middle layer or mesoblast. He
reserves the name neuroglia for the first type
of tissue, and designates the second mesoglia.
Although the two forms are said to be present in
about equal proportions, it is apparently the
neuroglia in which take place the changes associated
with abnormality of the nerve cells. To the mesoglia
elements Ford Robertson refers the formation of
amyloid bodies, and the colloid bodies found in some
of the writer's preparations may perhaps have a
similar origin.
{a) The neuroglia is, it would appear, susceptible
of a general or local overgrowth (gliosis), which may
or may not be followed by a shrinking of the over-
grown tissue leading to induration. We may
consider these conditions under the following heads.
I. General hypertrophy. Of the brains in series
A some exceeded in weight the average of the
normal brain. The heaviest weighed 55 ozs., while
others were respectively 52^ ozs., 5i|- ozs., and
51 ozs., while much heavier brains, e.g., one weighing
TV BASIS OF THE FEEBLE MIND 11]
71 ozs. from a patient formerly under the writer's
care, have been from time to time recorded. That
It should be possible to have brains of such magni-
tude Identified with obvious defect of Intelligence Is
to be explained by supposing that the excess In
weight Is due to other than nervous tissue, and a
relative excess of neuroglia Is demonstrable In such
cases under the microscope.
II. Localised hypertrophy. In nine of the cases in
series A the walls of the lateral ventricles and of
the fourth ventricle showed a condition of granula-
tion, while in six others the change was confined to
the fourth ventricle. These granulations are
generally held to be due to an Irregular overgrowth
of the neuroglia, and perhaps one should Include as
due to the same cause the appearance of granulation
of the cerebral cortex which was noted in five cases
of the series, and a peculiar "cross-hatching" of the
upper ends of the ascending frontal and ascending
parietal convolutions which was observed In one
case.
(d) Sometimes as a result of contraction of the
neuroglia, and sometimes without there being diminu-
tion In the bulk of the affected part, the brain sub-
stance is found to display Increased resistance to
pressure or to the knife. A certain amount of
Induration seems also to characterise the hyper-
trophy above mentioned. To such a change the
term sclerosis is applied. The sclerotic process,
like the gllotic, may Involve much or little of the
cerebral structure. To It are to be referred the
most marked Instances of asymmetry, as for example
that shown in Fig. 5.
112 THE FEEBLE-MINDED chap.
The forms of secondary microgyria, as illustrated
by Fig. 12, are also attributable to sclerosis. A
third and quite distinct variety unaccompanied by
contraction is the '' tuberose " which will be con-
sidered in greater detail subsequently.
Prominence has been given by various writers to
a reputed connection between epilepsy and a
sclerosis of the part of the brain known as the
cornu Ammonis. In order to test the correctness
of an Idea so generally prevalent the writer examined
microscopically sections from the hippocampal region
of fifteen brains. These comprised eleven from
cases of Idiocy and imbecility complicated by
epilepsy ; three from cases of non-epileptic Idiocy ;
and one from a case of general paralysis of the
insane. The results obtained may be stated briefly
thus : —
1. Non-epileptic : cornu normal at both sides.
2. Non-epileptic : extensive degeneration, but no
marked sclerosis.
3. Non-epileptic : right cornu sclerotic.
4. Epilepsy of exceptionally severe character :
slight sclerosis.
5. Epilepsy of mild character : slight sclerosis.
6. Epilepsy of medium character : degeneration,
but no definite sclerosis.
7. Like 6.
8. Epilepsy — patient had only one fit In eighteen
months : there was extreme sclerosis at the right
side.
9. Epilepsy of moderately severe type : slight
sclerosis.
10. Epilepsy of mild type — about two fits per
Fig. 12.— Right hemisphere of the brain of an idiot, showing microgyria.
Fig. 13, — A Mongolian imbecile.
{Face pa^e 112,
IV BASIS OF THE FEEBLE MIND 113
month : marked sclerosis, especially at the right
side.
11. Epilepsy of mild type^about one fit per
month : moderate sclerosis both sides.
12. Epilepsy of mild type — about one fit per
month : marked sclerosis, especially at the right side.
13. Epilepsy of severe character : sclerosis both
sides.
14. Epilepsy of moderate severity : slight
sclerosis.
15. General paralysis : no sclerosis.
There was thus no simple relation between the
frequency or the severity of the epileptic seizures
and the degree of sclerosis observed, though there
was some sort of proportion between the amount of
sclerosis and the intensity of the mental defect
exhibited.
2. The ependyma, — The cavities of the brain and
cord are lined by a delicate epithelial layer, which
does not usually show any obvious abnormality in
defective brains, for the granulations sometimes
visible upon its surface are probably, as mentioned
above, to be referred to the neuroglia. In the brain
which was found to lack a corpus callosum, the
ependyma of the lateral ventricle was so thick and
tough that it could be stripped off as a definite
membrane. In another case the aqueduct of
Sylvius was occupied by a strand of white tissue
which appeared to spring from a point in the
ependyma at the upper part of the opening of the
aqueduct into the third ventricle. This might have
been regarded as a clot formed from the cerebro-
spinal fluid but for the fact that the cerebro-spinal
114 THE FEEBLE-MINDED chap.
fluid is not known to clot. The case of porencephaly
illustrated in Fig. 9 showed the apparently normal
ependyma of the ventricle thickened around the
inner orifice of the perforation, and gradually acquir-
ing the characters of the abnormal pia-arachnoid
which lined the more superficial parts of the
opening.
3. The vascular system. — Gross lesions of the
intra-cranial blood-vessels were not a conspicuous
feature of the brains in series A, although irregular-
ities in the distribution of the arteries supplying the
brain were observed in association with the
encephalic deformities already mentioned. One
case showed the remains of a small haemorrhage in
the corpus striatum, while another had a larger one
in the left lobe of the cerebellum. In two others
there were patches of softening in various parts of
the hemispheres, and in a third the choroid plexuses
were cystic. The most significant feature in this
connection was, however, the prevalence of a con-
dition characterised by a superabundance of cerebro-
spinal fluid. In forty-eight of a hundred cases
there was definite excess of cerebro-spinal fluid as
compared with the normal state, and in thirty-six of
the cases the excess was pronounced. Thirteen of
the last mentioned cases had one or both lateral
ventricles definitely enlarged with associated
thinning of the hemisphere wall and flattening of the
convolutions, but in the remaining cases the ac-
cumulation of fluid had occurred chiefly between the
dura and the surface of the brain.
4. The meninges.
(a) The pia-arachnoid. Opacity, localised or
IV BASIS OF THE FEEBLE MIND 115
general, increase in thickness and an exaggerated
toughness are the morbid conditions which are most
commonly displayed by the pia-arachnoid. These
changes proceed along approximately parallel lines
and are usually attributed by pathologists to de-
generative processes affecting the membrane. They
were present together in twenty-four cases belong-
ing to series A, while of the rest fifteen displayed
opacity without any special thickening and in nine
the pia-arachnoid, though thick and tough, was not
noticeably opaque. The condition was usually most
marked over the frontal lobe. In nine of the forty-
eight cases just mentioned the pia-arachnoid was
adherent to the convolutions. Adhesion of the
adjacent faces of the hemispheres was common and
the membrane covering one of the spinal cords
examined showed a large number of osteoid plates.
In two cases there were adhesions between the pia-
arachnoid and the dura mater. Illustrations of
thickened and opaque pia-arachnoid are shown in
Figs. 5 and 7.
{b) The dura mater. The morbid conditions
observed in this structure may be summed up as
follows :
Unduly adherent to the skull 5%
Increased in thickness ... ... ... ... 6%
Studded with tubercles 1%
Subdural false membrane 1%
In one of the cases showing increased thickness it
was noted that the dura was soft and easily separ-
able into layers.
5. The skull-cap. — Abnormalities of varied char-
acter are found in connection with mental defect.
I 2
116 THE FEEBLE-MINDED chap.
Those recorded in this section are in regard to
thickness and density. They may be thus arranged
for series A.
Normal density. Softening. Hardening.
Normal thickness
— — I
Thinning
l8 2 I
Thickening
12 — lO
These figures, which include all degrees of the
condition, were obtained by rough and ready
methods, the only standard of comparison being the
observer's mental picture, at the time, of the state
of the normal skull-cap. Although no examples
occurred in this series, softening is sometimes found
associated with both thickening and normal thick-
ness of the bone.
6. The scalp.- — One instance of the rare and
rather striking condition known as hypertrophy, in
which the scalp is raised into a number of antero-
posterior folds as though it were too big for the
underlying skull, occurred in the series. The case
was that of the microcephalic idiot whose brain is
shown in Fig. 19.
7. The sense-organs, — A cursory inspection of the
cases in series C and D revealed the following
abnormalities in the organs of sight and hearing.
The eyes : —
Blindness
Unequal pupils
Squint
Ptosis
Nystagmus
Cataract
In addition all grades of defective vision were
found.
Males (400).
Females (250).
5
6
24
3
IS
II
10
—
6
4
4
I
IV BASIS OF THE FEEBLE MIND 117
The ears : —
Males (400). Females (250).
Different in shape, size, or
prominence ... ... ... 26 4
Different in position =9 —
Large and prominent 15 3
Deafness of all degrees was also noted.
8. The 1no^Uh. — This may be considered as
regards :
{a) The palate. From time to time a good deal
of stress has been laid on the supposed connection
between mental and palatal abnormalities. Without
committing ourselves to any statement as to their
significance we may note that defects of the bony
palate do, in fact, occur fairly frequently among the
feeble-minded. There is endless diversity in regard
to the forms of defect found, but for the purpose of
classification the scheme employed in the following
table will prove convenient.
Males (400). Females (250).
Normal
Wide and flat
Narrow and high
Deformed
400 250
In the writer's experience, if there be any one of
these types which is especially characteristic of
idiocy it is the second, which, so far as he is aware,
has not previously had attention directed to it.
(U) The teeth. The teeth of idiots and imbeciles
are often defective, but anything like a complete
description of the conditions found would occupy far
too much space. Undue crowding or separation
and other irregularities of arrangement, together
with abnormalities as regards size, shape, or the
206
136
43
43
no
63
41
8
118 THE FEEBLE-MINDED chap.
state of the enamel, are met with. SolHer described
as peculiar to idiots a condition in which the mouth
cannot be completely closed, the hindmost molars
alone coming into apposition.
The following notes, which have been kindly contributed by
Mr. C. Edward Wallis, will be of interest in this connection.
" An experience of many years in attending to the mouths and teeth
of imbecile and epileptic children shows clearly that the statements
that are copied from one text-book to another as to maxillary and
dental deformities are devoid of any appreciable foundation.
" Speaking broadly, one finds far more well-shaped jaws among these
children than among the so-called normal children to be seen in
everyday life, whether in public elementary schools or in private
practice amongst the better classes.
"The mistake has perhaps arisen in the past from a want of dis-
crimination on the part of medical examiners between deformities of
the jaws which are real and deformities which are apparent ; that is
to say, in which the maxilla appear to be too high or perhaps
asymmetrical owing to a general irregularity produced by misplaced
teeth, the result of neglect in childhood.
"A detailed examination of some thousands of these children over
a long period leads me to think that, as compared with the ordinary,
epileptic and imbecile children have, as a class, exceedingly well-
developed jaws, and are above the average as regards freedom from
caries.
" In Mongolian imbeciles one not infrequently finds an hypertrophy
of the mucous membrane of the sides of the palate leading to the
appearance of a high, narrow palatine arch, whereas the actual bony
arch may be exceedingly well-shaped."
For some time past Mr. Wallis has been making
observations on the subject of the " torus palatinus "
or palatine ridge, and he has come to the conclusion
that in bad cases of imbecility this ridge is more
pronounced than among less advanced cases, though
as to the genesis of this " torus " we are completely
in the dark at present.
As regards the lower jaw Mr. Wallis notes that
"the mandible is seldom deformed in imbeciles
though here and there, owing to an imperfect
IV BASIS OF THE FEEBLE MIND 119
development of the maxilla, the lower teeth may
bite in front of the upper ones and produce the
deformity known as underhung jaw or ' inferior
protrusion. ' "
9. The head as a whole, — {a) Asymmetry : —
Note was made in reviewing the cases in series C
and D as to the presence or absence of unlikeness
between the right side and the left so far as the head
was concerned. Such asymmetry as was due to
differences in the regions of attachment of the ears
or to optical defects has been already referred to.
Other forms are grouped together according to their
degree in the following table.
Slight. Well-marked.
Males (400) 47 22
Females (250) ii i6
(by Head measurements : — For the notes in this
connection series C and E were employed. The
measurements in the first group were made by my-
self while those in the second were made with some-
what greater exactitude by Dr. Gladstone. In both
series, since the patients were living, the thickness
of the scalp has to be taken into consideration.
Series C. — The following measurements were
taken to the nearest \ cm.
{c) Circumference along a line passing in front
just above the upper margins of the orbits and behind
over the occipital protuberance.
(/) Distance from the glabella to the occipital
point.
(K) Maximum parieto-squamous diameter.
The cephalic index, which is obtained by multi-
plying the measurement ^ by 100 and dividing the
120 THE FEEBLE-MINDED chap
product by /, was estimated in each of the 1 50 cases.
Details are given in a contribution to the Annual
Report of the Metropolitan Asylums Board, 1907, but
a summary of the results will suffice for our present
purpose. Indices ranging from 88*8 to 71*42 were
obtained, the average being 7 7 "9. The greatest
circumference noted was 65 cm. and the least 48 cm.,
the average being 53*69 cm.
Dr. Ford Robertson gives as average measure-
ments of the normal British skull,
Cephalic Index, 78 ; Circumference, 503 to 534 mm.
Allowance beinor made for the thickness of the
o
skull, which would affect more particularly the
circumference, the evidence indicates that so far as
the circumference and the cephalic index are con-
cerned, idiots and imbeciles depart very little from the
normal.
Series E. — During the course of an enquiry which
he was conducting into the relation of the size and
shape of the head to mental ability, Dr. R. J.
Gladstone measured the heads of 100 patients at
Darenth Asylum. Two groups were selected for
him, care being take to exclude any cases displaying
striking abnormalities such as microcephaly or
hydrocephaly. The first group consisted of 50 males
between 20 and 40 years of age who were capable of
doing useful work under supervision and who were
employed in workshops on the premises as tailors,
shoemakers, carpenters, etc. The second comprised
50 males of similar age to those in group i, but
incapable of doing any useful work and of a distincdy
lower grade of intelligence than were the patients in
group 1 . The measurements taken were :: —
IV BASIS OF THE FEEBLE MIND 121
(/) Length of head from glabella to occipital
point.
{b) Breadth of head, i.e., maximum transverse
diameter, above the level of the zygomatic arches.
(h) Height of head, i.e., the vertical distance from
the biauricular line to the bregma.
Dr. Gladstone has kindly placed at my disposal
the following figures which he obtained. The
measurements are expressed in millimetres.
Length of head.
Maximum.
Workers ... 209
Non-workers ... ... 203*5
Breadth of head.
Workers ., 171
Non-workers 165*5
Height of head.
Workers 144*1
Non-workers ... ... 150*7
''It will be observed," he says, "on comparing the
mean diameter of the heads of the workers with
that of the non-workers that there is a diminution in
each of the principal dimensions amounting to 2 mm.
in the longitudinal diameter, i mm. in the transverse,
and 2*1 mm. in the vertical. It will also be noticed
that there is a very considerable difference between
the maximum and minimum diameters in both
classes which far exceeds that which would be
present in an equal number of sane individuals of the
same age and sex. This greater variability in the
size of the head in imbeciles as compared with the
sane may be readily seen by comparing the tables
given above with a table showing the same measure-
ments in normal individuals."
Average.
186*5
184-5
Minimum.
156
165
1 45 '4
144*4
126
129
127*8
125*7
112
112
122 THE FEEBLE-MINDED chap.
For comparison with the above figures the
following table, which shows the corresponding
measurements for a group of 230 adult males, mostly
of the Professional class, was prepared by Dr.
Gladstone : —
Maximum. Average. Minimum.
Length of head 210 197 183
Breadth of head 163 153 138
Height of head 155 138 121
Two facts appear from the above data. In the
first place the mean diameters of the head are
considerably greater in the normal individuals than
in the imbeciles, and in the second, the variability in
size of the heads of the imbeciles exceeds that of
the sane individuals to quite a marked degree. It
is worthy of notice that owing to the process of
selection which Dr. Gladstone's cases underwent, the
differences between the maximum and minimum
diameters, although considerable, are even less than
in the cases measured by me, which were taken as
they came.
Dr. Gladstone worked out the '' index of size" ^ of
the different groups together with that of a further
group consisting of 50 male inmates of a London
workhouse and found them to have the following
ratios.
Professional class 4,219
Workhouse inmates 35933
Workers (Darenth Asylum) 35465
Non-workers (Darenth Asylum) ... ... ... 3,347
From these figures he estimated the mean weight
1 The " index of size" is the number of cubic centimetres contained
in a rectangular solid having the same diameters as the average
length, breadth and height of the heads in the different groups.
IV BASIS OF THE FEEBLE MIND 123
of the brain in the last two classes to be approxi-
mately
Workers 1,247 grms.
Non-workers 1,218 „
It is interesting to compare with the last figure the
average weight, obtained directly, of the 100 brains
derived from a somewhat similar class of patients in
series A, which worked out at about 1,193 grms. If
the cephalic index be estimated from Dr. Gladstone's
figures it will be found to be for
Workers 77'96
Non-workers ... ... ... ... ... 78'26
Mean 78-1
which approximates closely to the normal and to
the result of the measurement in series A.
10. The remaining farts of the body. — Of these
we may take first the muscular system which
is peculiarly the medium for the expression of
mental activity. Defect in the muscular apparatus
may take the form of inco-ordination, weakness, or
over-action, though it may be difficult to decide as
to the precise share of each of these morbid
conditions in the production of the observed
phenomena. Inco-ordination is probably responsible
for some of the forms of imperfect speech which
occur in the feeble-minded. Paralysis is a common
feature of the class : the subjoined table will give
some idea of the frequency of its occurrence.
Type. Males (400). Females (250)
Alllimbs 8 12
Hemiplegia 27 6
Paraplegia 25 18
Facial 10 —
Over-action of muscles, apart from the occurrence
124 THE FEEBLE-MINDED chap.
of definite epileptiform seizures, becomes obvious
chiefly in the erratic movements called ''tics."
Using the term in its widest sense to cover all forms
of swaying, nodding, tapping, picking and other
motions which idiots indulge in, tics were observed
in 64 of the 400 males and 47 of the 250 females
above referred to.
Reflexes. There may be mentioned in this con-
nection the subject of reflexes. In series C the
condition as regards knee-jerk, ankle-clonus, and the
Babinski phenomenon was noted with the following
result : —
Knee jerk : —
Normal 50
58
Increased both sides ..
Diminished both sides.,
Greater on right side . ,
Greater on left side
30
6
6
150
In five, cases ankle-clonus was obtained at both sides
and in three at one side only, while the Babinski
reflex was obtained at both sides in fivQ cases and at
one side in six cases.
Left handedness. An attempt was made to
estimate the degree of prevalence of left-handedness
in the 650 cases already alluded to. Excluding
cases of paralysis, it was found that 32 of the males
and 8 of the females exhibited this condition pretty
definitely, but the results obtained were in many
cases so ambiguous that no particular value attaches
to these figures. It was, however, noticeable that
ambidexterity, which may here be taken to signify
equal degrees of helplessness of the hands, was much
more commonly found than among normal indi-
IV BASIS OF THE FEEBLE MIND 125
viduals. This experience agrees with that of Dr.
W. W. Ireland/
The thoracic and abdominal viscera. As a rule
the idiot or imbecile is physically a poor creature
and the thoracic and abdominal viscera share in the
bodily shortcomings. This is shown by the follow-
ing figures collected for the heart, liver, and spleen
from 50 cases, among those in series A, which did
not exhibit gross disease of one or other organ. ^
As regards the kidneys, a larger proportion of the
cases conformed to this requirement and the list of
100 was obtained by the substitution from other
sources of a few to replace those that had to be
excluded. Disease of the lungs, on the contrary,
was so general that it seemed hopeless to get figures
for this organ which would be of the least value, and
the lung weights are therefore disregarded.
Organ.
Average weight in ozs.
(50 cases).
Normal weight in ozs.
Heart
6-25
30-3
3'4
II
Liver
50-60
6-7
Spleen
Kidney (loo).
Right.
3-45
Left.
3-55
Right.
5-25
Left.
5'5
Any physical abnormality traceable to develop-
mental errors which is known to occur in the
mentally sound may be looked for among the feeble-
minded, with the confident anticipation that it is
even more likely to be discoverable in this class
^ W. W. Ireland, loc. cit., p. 329.
2 Sollier, in his article in Twentieth Century Practice^ says that
idiots are peculiarly susceptible to abscess of the liver. The writer
has not found anything in his cases to corroborate this statement.
126 THE FEEBLE-MINDED chap.
than it was in the former. The index of any
treatise on pathological anatomy may be turned to
for a summary of the appearances met with and
recorded by various observers. All that have any
value as pathognomonic signs have been already
mentioned or will be alluded to in the descriptions
of the chief clinical types. In estimating that value,
a critical attitude must be maintained in view of the
uncertainty surrounding even the most widely
accepted facts. Our postulate as to the supreme
importance of the nerve cells, for example, may be
called in question. It may be, as suggested by
Lugaro and others, that the neuroglia plays an
important part in controlling the nutrition and
consequent efficiency of the nerve cells by neutral-
ising toxic agents which are either brought to the
nerve cell by the blood or result from the katabolism
of the nerve cell. We are, again, in doubt as to the
interpretation of the changes which nerve cells
undergo. " Modifications in Nissl's substance," says
Lugaro, '' do not constitute an index of functional
variation, but rather of modifications in the state of the
nervous elements' nutrition. These morphological
modifications are compatible within certain limits
with complete functional integrity even when they
are quite obvious under the microscope." ^ Similarly,
there is no simple and clear connection between
functional disturbance and morphological alteration
in the neurofibrils. As we have seen, the condition
of pyramidal tract fibres as regards myelination is
not such as to suggest that a persistent infantil-
ism is responsible for the defective volition of the
1 E. Lugaro, Modern Problems in Psychiatry^ 1909, p. 124.
IV BASIS OF THE FEEBLE MIND 127
feeble-minded. Of the mode in which nerve cells
affect each other, we are too ignorant to be able to
estimate the part played by conduction or induction
in promoting or inhibiting, accelerating or restrain-
ing the quasi-electrical '' fluid " which is the vehicle
for the conveyance of nervous impressions. Still
less do we know of that intimate physico-chemistry
of the nerve cells which conditions the "mneme"
and on which depends the faculty of memory.
In assigning to the observations recorded in this
chapter their due meed of importance, it must be
borne in mind that the personal equation of the
observer has to be allowed for. Opacity of the
pia-arachnoid, hardness of the skull-cap, excess of
cerebro-spinal fluid, and so on, exhibit degrees which
do not admit of being stated with any great precision,
partly because no ordinary pathological laboratory
is supplied with the elaborate physical apparatus
which would be necessary, and partly because of the
absence of any clearly defined standard of com-
parison. We are in little better case when trying to
use the data provided by the balance or the
measuring tape. Height and weight, which are
regarded as affording some basis of comparison
between diflerent individuals, are not always in
practice ascertainable with any great approximation
to accuracy. It is not usually feasible to weigh a
dying person or even a corpse, so that the proportion
of the body weight which is constituted by the
weight, obtained at an autopsy, of some viscus will
not be capable of exact statement. The height of
an individual does not vary so much as his weight,
but in the case of an idiot suffering, as many do,
128 THE FEEBLE-MINDED chap.
from deformity of some kind, the measurement of the
height is often no simple matter. For the reason
just given the following figures, though of interest
from the unexpectedness of the conclusions to which
they lead, need not be taken too seriously.
A. The relation of brain weight to that of the
body.
In the normal man, according to Dubois, the brain
weight has to the body weight the ratio i : 46. For
fifteen cases of idiocy and imbecility taken at random
the ratios were : —
I. — I
22
2.— I :25
3-— I
30
4.— I
30
5.-1:32
6.— I
32
7.— 1
33
8.— I : 34
9.— I
35
10. — I
38
11.-1:39
12. — I
•39
13.— I
40
14.-1:41
15.— I
46
giving an average of i : 34, which is equivalent to
an assertion that the Jdiot or imbecile has more
brain to the unit of body weight than the normal
person can lay claim to. How little importance
attaches to this ratio may be judged by a com-
parison of the figures obtained for various animals.
Warncke has compiled a lengthy record of the
ratios found in the animal kingdom. These vary
from I : 105 71 in one of the whales to i : 23 in the
insectivore Sorex vulgaris. Even within the limits
of the Primates the range is from 1:213 to
I : 26I.
The following consideration would lead us to
anticipate that no simple relation between brain
weight and intellectual capacity is likely to be estab-
lished : there is as great a gap mentally between an
Idiot and a person of average intelligence as between
the latter and a genius. Now a genius of the first
IV BASIS OF THE FEEBLE MIND 129
rank has been estimated to be, perhaps, a hundred
times more capable than the ordinary man. We
might, then, expect to find that the brain of a
genius weighed ten thousand times as much as that
of an idiot — a condition of things so completely-
Inconsistent with our experience as to savour of the
ludicrous.
The weight of the brain is dependent on at least
two groups of factors ; the somatic, i.e., the mass of
tissue which has to be centrally represented, and the
psychical, i.e., the degree of mental development.
As regards the former it may be noted that all parts
of the body are not equally innervated. It has
been suggested that the chief determining factor of
the mass of the brain is the extent of the surface of
the body, and that the greater magnitude of the
brain of man as compared with that of the ape Is In
a measure to be accounted for by the comparatively
hairless condition of man and the consequent greater
development in him of a tactile sense. Estimates
of the proportion of the somatic and psychical
elements in various animals have been made by
Dubois, Warncke,^ and others, who have deduced
from their results a ''cephallsatioji factor" which
they believe to indicate the respective degrees of
intelligence of the animals concerned. It is no
doubt satisfactory to find that Homo sapiens comes
out at the top of the list.
B. The relation of brain weight to height.
In connection with an investigation already
1 Paul Warncke, Mitteilung neuer Gehirn unci K'drpergeiuichts-
bestinunungen bet Sdugern, etc. Festschrift su Forels Sechzigstem
Geburtstag. Journal filr Psychologie unci Neurologie, Bd. 13, 1908,
P- 355-
K
130 THE FEEBLE-MINDED char
alluded to, Dr. R. J. Gladstone worked out the
relation between the (estimated) brain weights and
the heights of the fifty ''workers" and fifty "non-
workers " seen by him at Darenth Asylum, as
shown in the following table.
Class.
Mean weight of brain.
Mean stature.
Workers
Non-workers
1,247 grms.
1,218 „
1,609 ^ni-
1,505 »
From these figures It appears that the non-workers
averaged slightly more brain to the unit height than
did the workers.
What appears to be brought out most clearly by
the investigations recorded is the limitation of the
statistical method. Owing to the different, and fre-
quently opposite, directions in which departures from
the normal occur, the effect of striking averages is
to obscure rather than to elucidate the differences
which experience shows to exist. Thus the
extremes in the way of cranial abnormality which
were displayed by different patients among the 250
measured by myself and Dr. Gladstone cancel out
so as to give a ''cephalic index" which is almost
exactly normal. The existence of a high degree of
variability is established by the data so far available,
but we find nothing to justify the separation of a
distinctive type characteristic of feeble-minded-
ness.
A large number of data on the lines of those
given in this chapter have now been accumulated,
and, though they are not without scientific value,
their abundance, unfortunately, serves to obscure
the fact that cerebral pathology Is yet In Its earliest
infancy. About the raw material of mind, those
IV BASIS OF THE FEEBLE MIND 131
sensory phenomena which are the results of the
action of the environment on the individual, a good
deal is now known, but the processes of manufac-
ture, the methods by which sense impressions are
reproduced and rearranged, remain enshrouded in
darkness.
As considered more fully in the chapter on
Causation, abnormalities of the brain may be
referred to innate defect of development or to the
influence of an unfavourable environment. The
distinction is of practical value, though the first
named factor may be regarded as only a special case
of the second. Developmental error may, it is
taught, occur in one of three forms. There may be
simple retardation, there may be a return to a more
primitive type of organisation, or there may be
progress in a new direction. These various forms
are not, however, independent either of one another
or of the environment. We may, for example,
meet with what the Germans call *' Korrektur-
bildung," a condition in which, owing to deficient
development of the phylogenetically younger parts,
the phylogenetically older undergo compensatory
hypertrophy, and this may be complicated by the
lack of normal resistive power against injurious
agents which imperfectly developed tissues exhibit.
A similar compensatory activity of unimplicated
regions may follow localised injury to any part of
the nervous system and may involve such an inter-
ference with the normal functions of the hyper-
trophied part that the initial defect is not simply
compensated for, but replaced by one of a new
character. But we have to take into consideration
K 2
132 THE FEEBLE-MINDED chap.
also another biological factor, the tendency of the
organism to a specialisation and delimiting of an
affected region owing to the development of
antagonistic Influences which strive to nullify its
evil effects.
Taking into account only the broad distinction
between developmental and acquired abnormalities,
it is of interest to note that the evidence obtained
from the cases in series A points to a greater
prominence of the latter forms than might have
been anticipated. In 48 per cent, of the cases
there was excess of cerebro- spinal fluid, a condition
clearly pointing to degenerative changes in the
brain. *' I think," says W. Ford Robertson,^ "it may
be affirmed that an excess of cerebro-spinal fluid is
generally compensatory for brain atrophy, and that
it only rarely has any other significance." J. S.
Bolton^ has stated that he ''cannot too strongly
emphasise the Importance of excess of intra-cranlal
fluid in the pathology of dementia," and in the same
article he expressed the opinion that " dilation of
the lateral ventricle is ... . evidence of loss of
cerebral tissue." The opacity and thickening
of the pia-arachnold observed in 24 per cent, of the
cases point in the same direction, for one can hardly
attribute such features to errors of development in
view of the frequency of their occurrence in the
brains of sufferers from general paralysis and senile
dementia. The brains of idiots have, indeed, in
many Instances, much in common with those of
^ W. Ford Robertson, loc. cit., p. 310.
2 j_ s. Bolton, " Amentia and Dementia," Journal of Mental
Science^ 1905, PP- 326-7.
IV BASIS OF THE FEEBLE MIND 133
general paralytics and differ from those of senile
dements chiefly in the absence of the gross changes
in the cerebral vessels which occur so conspicuously
in the latter. One is led to the conclusion that the
mental defect which dates from birth or from an
early age may be characterised by a large
element of *' dementia" as distinct from what is
called '* amentia," that is to say, the idiot brain has
undergone a process of degeneration and has not
merely been arrested in its growth.
Series A comprised, as already mentioned, brains
from persons who had displayed very limited
intelligence. To what extent deductions drawn
from a study of these brains apply to those of
persons exhibiting only slight degrees of feeble-
mindedness is uncertain. Eminent Continental
psychiatrists have taken up different attitudes in
regard to this matter. According to Tanzi,^
*' imbecility is congenital, while idiocy is acquired,
it may be, in the earliest stages of existence." He
reserves the term idiot for *'all those cases of
deficiency that do not present the clinical picture
of mental degeneration but that of the infantile
cerebro-pathies, notwithstanding the occasionally
very slight degree of their deficiency." His concep-
tion of idiocy thus appears to be one of a *' nervous "
disease which happens to be complicated by
** mental" symptoms. Sollier's view is that *'all
idiots present cerebral lesion, while imbeciles have
none." ^ On the whole it seems most satisfactory to
follow Ziehen, Herfort, and others, in holding that
^ E. Tanzi, A Text-book of Me?tfal Diseases, 1909, pp. 747-8.
2 P. Sollier, Art. " Idiocy" in XXth Century Practice, 1897, p. 264.
134 THE FEEBLE-MINDED ch. iv
** a congenital weak-mindedness of purely functional
nature, that Is to say, with an anatomically Intact
cerebral cortex, does not exist," ^ though with our
present Imperfect methods of research, the defect
may not always be demonstrable.
The Investigation of the physical substrata of
aberrant complex mental processes presents much
greater difficulty than the recording of abnormalities
of the sensory or motor apparatus, which is all that
most workers among the feeble-minded have oppor-
tunity for. All departments of biology — embry-
ology ; normal and morbid anatomy both human and
comparative ; physiology and psychology must be
called upon if further progress is to be made, and
it is a dawning perception of this fact which is the
most significant as well as the most hopeful feature
of modern tendencies in the investigation of the
pathology of mind.
^ K. Herfort, Die pathologische Anatomie der Idiotie^ Eos. 1908.
CHAPTER V
THE CAUSATION OF FEEBLE-MINDEDNESS
Of the causes which lead to incomplete psychical
development extremely little is known with certainty.
It is, however, undisputed that feeble-mindedness is
often associated with obvious imperfection or arrest
of cerebral development. As to the nature of this
association, something has been said in Chap. IV.
Even when the application of current scientific
methods fails to supply definite information, we
cannot exclude the possibility that what are called
** errors of metabolism " are the responsible agents.
Whatever theory of the relation of mind and
brain is adopted, the problem of the origin of mental
defect resolves itself into an investigation of the
circumstances in which the development of the
brain is injuriously interfered with.
There are, it would appear, two chief sets of
factors in development : —
(i) The innate tendency to develop.
(2) The influences of the environment.
And theoretically these may be further subdivided
as follows : —
(a) Normal tendency.
(a) Abnormal tendency.
136 THE FEEBLE-MINDED chap.
(d) Environment favourable to normal develop-
ment.
(/3) Environment unfavourable to normal develop-
ment.
Of these (a) and (a) are mutually exclusive and so
are (d) and (l3), so that the possible combinations are
reduced to four, viz., (a) {b) ; [a) (/3) ; (a) {b) ; (a) {0) ;
but the combination (a) (b) represents the condition
of normal development, so that in the production of
abnormal conditions we have to do with the three
sets of relations which are expressed by the formulae
(a) (/3) ; (a) {6) ; (a) (^).
We seem, therefore, to have three groups of cases
to consider : —
(i) Those in which the innate developmental
tendency is normal, but is modified by the influence
of an unfavourable environment.
{2) Those in which an abnormal innate tendency
gives rise to pathological conditions although the
environment exercises no unfavourable influence.
(3) Those in which the innate tendency and the
environment combine to produce pathological
conditions.
Observed facts are not, however, readily suscep-
tible of classification in accordance with this simple
scheme, and in order to understand what modifications
it may require, to bring it into accordance with
those facts, we must consider briefly what the terms
''innate tendency" and ''environment" really
signify. To begin with, we may note that they are
not factors of quite the same order, although we
may suppose both to have a physical basis. While
it is conceivable that an innate tendency might,
without the intervention of any other agency, control
V CAUSATION OF FEEBLE MIND 137
the development of a germinal cell, we have in
actual practice no knowledge of such a state of
things. We only know the tendency in so far as its
expression is conditioned by its environment. We
have assumed that innate tendency and environment
may vary independently, and, on reviewing such
facts as are accessible to us, this seems to be the
more convenient hypothesis, but it is open to anyone
to suggest that the differences which individuals
display, whether they belong to the same or success-
ive generations, are determined solely by the
influence of the environment. The suggestion
becomes the more plausible when we recognise, with
Dr. Archdall Reid,^ that much of what is regarded
as '* innate " is really attributable to the effects of the
stimuli which are incidental to the processes of
nutrition. For the purposes of this chapter, it will
suffice to divide the cases of defective cerebral
development into two groups, in one of which the
innate tendency is believed to be the important
factor, while in the other a preponderating influence
is attributed to the environment.
(A) Innate tendency Predominant.
We enter here upon the domain of Heredity and
are at once faced by difficulties arising from the con-
fusion which exists as to the significance of that term.
Heredity, according to Professor J. A. Thomson,^ is
*' just a name for the reproductive or genetic relation
between parents and offspring," while Inheritance
is '* all that the organism is or has to start with in
1 G. Archdall Reid, The Laws of Heredity. 1910.
^ J. A. Thomson, Heredity^ 1908, p. 68 and p. 517.
138 THE FEEBLE-MINDED chap.
virtue of its hereditary relation to parents and
ancestors." These definitions express with sufficient
clearness the connotation of the words as here
employed.
The salient feature of Inheritance is the existence
of some degree of resemblance between parent
and offspring, and a distinction must at the outset
be drawn between uniformity of type in the in-
dividuals themselves, and uniformity of type in
their environment. A son Is said to "inherit"
peculiarities of form and disposition from his father ;
he is also said to *' inherit " the social conditions with
which the father has surrounded himself. In regard
to the second use of the term. It may be argued
that, although Professor Thomson's definition might
be strained so as to cover It, there Is no *' inheritance "
in the strict sense ; and that the case is one in which
the influence of the environment is paramount. The
discussion of this point may conveniently stand over
for the time being, since certain considerations bear-
ing upon It will be more readily intelligible when the
cases more directly referable to the existence of an
Innate tendency have been mentioned.
To return then to the instances in which uniformity
of type as regards morphological features is the
expression of the Inheritance. The question im-
mediately arises : Why should the child resemble the
parent at all ?
The simplest explanation is that the two have a
common origin. Let us see if by the light of
evolution we can arrive at some conception of where
that origin is to be found. The exposition which
follows may or may not be correct, but It has sufficient
V CAUSATION OF FEEBLE MIND 139
plausibility to serve to connect together in an
intelligible way the admitted facts about heredity.
Starting with a primitive bioplasmic mass (some
organism, we may suppose, of the nature of the
lowly creature we call Amoeba) we may reasonably
postulate for it a power of growing. We may then
be prepared to find, in view of Spencer's law, that
the mass divides and that each part grows to the
original size, and again divides. Each generation
will be lost in its descendants, but the original
bioplasm does not cease to exist. At a somewhat
higher zoological level, e.g., in the case of Par-
amoecium, there is such a degree of specialisation
of various regions that the two organisms resulting
from the process of fission are at first dissimilar.
Each, however, develops the features in which it is
lacking, so that when the process is completed the
resulting individuals are similar to each other.
As one proceeds upwards through the ranks of
more and more complex organisms, the process of
fission becomes more and more obscured by the
circumstances attending it, so that, by the time the
mammalia are reached, it is at first difficult to corre-
late the special germinal cells with the portion of
bioplasm separated off from Amoeba or Paramoecium
to produce a new individual. We must, however,
regard what are called the ''organs " of the higher
animals as adventitious growths superposed upon a
structure of specialised bioplasm which, it would
appear, is of relatively small amount and of uncertain
distribution in the organism. From this specialised
bioplasm fragments are separated off at intervals,
and these fragments, having, like the mass from
140 THE FEEBLE-MINDED chap.
which they sprang, the potentiaHties of generating
the organs which serve to distinguish the individual,
grow into forms resembhng the parent as closely as
the conditions of growth will allow.
Biologists are in the main agreed that the capacity
for transmitting characteristics which bioplasm dis-
plays is dependent on the presence in its substance
of certain definite elements/ Herbert Spencer
postulated ''physiological" or "constitutional" units
— " ultimate life bearing elements intermediate
between the chemical molecules and the cell." For
Weismann^ these elements are "very small individual
particles, far below the limits of microscopic visibility,
vital units which feed, grow, and multiply by division."
These he calls "determinants." The "gemmules"
of Darwin and the " pangens " of de Vries
appear to be much the same thing as determinants
although a different origin is assumed for them.
Bateson's conception of the units which serve as
vehicles for the transmission of heritable charac-
ters is that of bodies which, in some cases
at least, have the power of producing ferments.
Bateson^ differs from the majority of biologists in
supposing that the elementary bodies are not
necessarily confined to the nuclei of the cells
containing them, and this to some extent meets the
objection urged by Adami * that the various theories
referred to above involve the assumption of physical
1 J. A. Thomson, op. cit.., p. 455.
2 A. Weismann, " The Selection Theory," in Darwin and Modern
Science.^ 1909, p. 36.
3 W. Bateson, " Heredity and Variation in Modern Lights," in
Darwin and Modern Science., 1909.
^ J. G. Adami, The Principles of Pathology^ 1909, p. 121.
V CAUSATION OF FEEBLE MIND 141
impossibilities since '' determinants," for example,
must be molecular groupings of a size which makes
the packing of a sufficient number of them into
a nucleus quite inconceivable. Loeb ^ attaches so
much importance to the influence of the environment
in controlling the development of bioplasm that he
does not postulate for the germ anything more than
the transmission of *' a certain form of Irritability."
On the whole, we seem justified in accepting
Thomson's^ dictum that *' everything points to the
conclusion that there is a definite hereditary
material"; and It Is convenient to accept also the
view that this material consists of "vital units" or
''bioplasm," without attempting to define these with
any great pretence of accuracy.^
Apart from conditions of growth, heredity
involves differences between parent and offspring
which are no less Important than the resemblances
with which we have so far been concerned. Let
us take again the primitive organism. Some par-
ticular descendant may display a new feature. Let
us suppose It exhibits a cillum. If its descendants
also exhibit each a cilium this will indicate that
a new character has been impressed upon the
original bioplasm. Change In the direction of more
cilia may follow, a new variety of bioplasm thus
coming into existence. A fragment of the new
variety, endowed with the potentiality of developing
^ J. Loeb, " Experimental Study of the Influence of Environment on
Animals," in Darwin and Modern Scie7tce, 1909.
2 J. A. Thomson, op. cit.^ p. 431.
^ For a review of the various theories as to the constitution of
bioplasm, see Darwi7iism To-day^ by Professor Vernon L. Kellog'g,
1907, pp. 214-228.
142 THE FEEBLE-MINDED chap.
many cilia though actually at the outset bearing
none, may be separated and grow up. On these
lines the possibility of endowing a germ with huge
potentialities is conceivable. Thus some portion
of the bioplasm which has now been converted
into a many-cilia-bearing kind may become so
changed as to be capable of developing a pigment
spot from which an organ of vision may be evolved,
and so the process may go on to higher and higher
degrees of complexity. Alteration from generation
to generation proceeding in some such way as this
has been observed to occur in the case of Para-
mcecium,^ and the fact affords us an illustration
of the evolutionary principle which all modern
biologists accept as explaining how living creatures
came to be as they are.
The bioplasmic basis, it would appear, is sus-
ceptible of changes of at least two kinds. There
may be : —
(a) Slight alterations affecting some existing
attribute. These are not of a permanent character
unless fixed by natural or artificial selection. Such
changes are called Variations. What is loosely
called '' The Law of Healthy Birth " (a matter to
which we shall again refer), which lays down the
principle that organisms tend to return to the normal,
is merely a statement that variations are sometimes
not so fixed by selection.
{b) Slight or great alterations involving the
appearance of a new attribute. These are called
Mutations and, being permanent changes in the
1 H. S. Jennings, " Heredity, Variation and Evolution in Protozoa,"
Jou7'n. of Exper. Zoology, 1908, p. 577.
V CAUSATION OF FEEBLE MIND 143
bioplasm, they naturally characterise the descendants
also.
The definitions just given are such that in all
probability they will not be accepted without criticism
by any biologist, but they seem to include what little
is common to the innumerable conflicting views
respecting the method of evolution. Dr. A. Reld,
one of the most recent writers on the subject,
regards variations as additions to or abbreviations
of the recapitulation of parental development which
in their own development offspring exhibit. He
does not attempt to define precisely what is to be
understood by mutations, but for him they are
apparently large and '' discontinuous " variations
which can hardly advance the process of evolution,
since to be effective they require numerous co-adapted
mutations, and since, too, they must almost of
necessity overshoot the mark because of the initial
adaptation to the environment which species display.
Why changes take place in the bioplasm at all is
a question which has not yet been satisfactorily
answered. Weismann supposes that the deter-
minants vary with variations in the amount of
nutriment they receive, and, having varied, may
have so become endowed with a capacity for con-
trolling their own nutrition which renders them
independent of the circumstances which initiated the
variation. The '' hereditary individual variation "
so arising will therefore be permanent. As to the
causation of the alterations in nutrition he can only
say that they occur " by chance, that is, for reasons
unknown to us,"^ and Bateson is equally unillumi-
^ A. Weismann, " The Selection Theory," p. 37.
144 THE FEEBLE-MINDED chap.
nating in regard to the causes which determine the
mode of segregation of his " unit-characters." Pro-
fessor J. Loeb is unable to convince himself of the
validity of the claims to have succeeded in pro-
ducing mutations by physico-chemical means which
certain authors make. Professor George Klebs,
however, admits the possibility that '' sudden and
special disturbances in the relations of the cell
substances have a directive influence on the inner
organisation of the sexual cells, so that not only
inconstant but also constant varieties will be
formed," ^ while Professor Adami holds that " it is
impossible to arrive at any other conclusion than
that variation originates primarily in the action of
modified environment upon the labile bioplasm."^
Dr. Archdall Reid insists on the insusceptibility of
germ-plasm to environmental influences and holds
that practically all variations are spontaneous. The
tendency to vary *' is itself an adaptation which
is subject to variations," and, like all other adapta-
tions, it ''results from the Natural Selection of
favourable variations. " ^
But in the vast majority of animals and plants,
the germ from which a new individual springs is a
combination of bioplasm from two separate sources.
An additional factor in the production of dif-
ferences between parent and offspring is thus
introduced, for we have now to take into account
1 G. Klebs, " The Influence of the Environment on the Forms of
Plants," in Darwin and Modern Science^ I909) P- 246.
2 J. G. Adami, op. cit. p. 171 ; cf. also the Art. "The Direct
Influence of Environment," by D. T. MacDougal in Fifty Years of
Dar'wi?iism^ 1909.
9 G. Archdall Reid, op. cii.^ p. 436.
V CAUSATION OF FEEBLE MIND 145
not only the variability which may depend on
environmental conditions, but also possibilities in the
way of blending which the two different kinds of
bioplasm admit of. It is, however, so difficult to
distinguish between the respective effects of these
separate factors that we must perforce consider
them together as responsible for the departures
from the parent type. The need for such a wide
definition of heredity as is implied in saying that it
is simply *' the genetic relation between parents and
offspring " becomes intelligible when we regard the
diversity which that relation may exhibit. The
various grades of inheritance may be grouped in
the following scheme, the artificiality of which must
be excused by its convenience.
(i) Cases in which the resemblance of off spring to
parents is the prevailing characteristic.
In his Law of Ancestral Inheritance, Sir Francis
Galton laid down the proposition that the contri-
butions from successive generations of ancestors, i.e.,
parents, grand-parents, great-grand-parents, and so
on, to the characters of the individual are, respec-
tively, in the proportions of \, \, ■§-, ^V ^^^-^ the
whole inheritance, represented by the figure i,
being the sum of the contributions from an
indefinite series of ancestors. Modifications of the
law have been advanced as expressing the situation
more accurately, but the general principle, which is
all that we are now concerned with, appears to be
conformed to in some cases at least.
The shares contributed by father and mother,
whatever those shares may be, do not always
146 THE FEEBLE-MINDED chap.
become evident in the same way, the following
varieties of inheritance being met with.
(a) Sometimes the paternal and maternal charac-
ters are so intimately intermingled that the offspring
exhibits what may be described as a compromise
between the parents, as in the case of the mule.
This may be called " Blended Inheritance."
(d) Sometimes the offspring display paternal
characters in one part of the body and maternal in
another. This is called *' Particulate Inheritance."
In the special case where the characters from the
respective sources are distributed widely and in
small groups, we get one of the forms to which the
term '' Mosaic Inheritance " has been applied.
(c) As regards certain factors, the contribution of
one parent may be not at all evident, so that the
offspring conspicuously resemble one parent only.
This is what is called '* Exclusive Inheritance." It
may, of course, be regarded as another special case
of particulate inheritance, since in that also the
presence of a particular paternal or maternal
character involves the absence of the corresponding
maternal or paternal character. But the use of the
term "exclusive" is generally restricted to certain
varieties of inheritance which are of sufficient
importance to deserve separate notice.
(a) Sexual Dimorphism. When the paternal and
maternal character are mutually so antagonistic that
anything in the way of compromise between them
would defeat the purposes of their existence one will
exclude the other in inheritance. This is peculiarly
the condition of affairs in regard to the organs which
mark the distinction of sex.
V CAUSATION OF FEEBLE MIND 147
(0) Sex Limitation. Certain characters seem to
be in some mysterious way bound up in sex although
they are not obviously what would be called
"sexual" in the ordinary acceptation of the term.
It is, for example, a familiar fact that certain diseases,
e.£'.f pseudo-hypertrophic muscular paralysis, haemo-
philia, and colour-blindness only appear in males :
a fact which does not become any less remarkable
when we note that they appear to be transmitted
only by females.
(7) Of late years the attention of biologists has
been concentrated on some experiments in breeding
plants and animals which were made about half a
century ago by Gregor Johann Mendel, Abbot of
Brlinn. The literature dealing with this matter is
now very extensive and easily accessible, and in any
case a detailed account of Mendel's teachings would
be out of place here, but a brief notice of them is
demanded owing to the importance which they have
assumed.
Before the fire in the room where this is being
written there lies a commonplace '' tabby " cat.
That she is commonplace is, however, when one
stops to think of it, perhaps the most surprising
thing about her. Of '' pedigree " in the conventional
connotation of that word she has none. Natural
selection has doubtless played some part in her
production, but of artificial selection — that process
of controlled breeding by which we endeavour to fix
types — there is no evidence. She is just a casual
product of the promiscuous intercourse in which the
domestic cat indulges when allowed to wander at
large. Yet she has perfectly distinctive characters
L 2
148 THE FEEBLE-MINDED chap.
which relegate her to one of the two distinctive
classes into which *' tabby" cats can be divided.
Throughout the indiscriminate breeding which has
been taking place for countless generations, certain
features of colouration and marking have been
transmitted unchanged to the exclusion of other
characters which some ancestor must have
possessed. There has been no blending of the
particular character with others. We have here,
according to Mr. R. J. Pocock,^ an example of
Mendelian inheritance. Mendel's own experiments
were, in the main, conducted with the edible pea.
He crossed individuals having distinctive characters,
e.g., those yielding smooth round seeds with those
yielding angular wrinkled seeds, and found that the
offspring yielded only seeds of the former kind. To
characters thus transmitted at the expense of corre-
sponding characters he applied the name ''dominant."
i Further, he found that when the plants so obtained
I were bred amongst themselves, the new generation
Icontained individuals of which some displayed, the
dominant character, which was alone present in their
parent form, while others produced the angular
wrinkled seeds absent from the parental form, but
found in one of the grand-parental forms. This
grand-parental character, which had been temporarily
suppressed, he called '' recessive."
At the present day attempts are being made by a
particular school of biologists to bring within the
scope of Mendelian rules peculiarities of hereditary
transmission of all kinds. It will be time enough to
1 R. J. Pocock, " On English Domestic Cats," Proc. Zool Soc. of
London^ iQo?? P- i43-
V CAUSATION OF FEEBLE MIND 149
deal with these when they have passed the bounds
of controversy and when their general acceptance
makes a study of their applicability to practical
questions imperative. We may, however, notice
one interesting development, since it bears upon a
matter — that of sexual dimorphism — to which
allusion has been made above. Professor W.
Bateson, the great protagonist of Mendelism in this
country, has stated that he feels little doubt that
we shall succeed in proving that in Vertebrates and
in some other types, '' femaleness is a definite
Mendelian factor absent from the male and following
the ordinary Mendelian rules." ^
Dr. Archdall Reid's way of accounting for the
above forms of resemblance between parents and
offspring has elements of novelty which claim atten-
tion. His views may be thus summarised, though
it is desirable that the reader should study them
as expounded in Dr. Reid's own book in order to
get a thorough grasp of them. Parental characters
ordinarily blend in the offspring — indeed, the object
of conjugation is to secure this blending. But of
mutually incompatible characters, since these cannot
blend, one or other becomes latent. Mendelism
has concerned itself with characters of this class,
which includes the sexual characters and some others.
" The apparent non-blending of the sexual and
Mendelian characters" is *'due to the fact that the
patent set from the one parent blends with the latent
set from the other." Instead, therefore, of sexual
dimorphism being a special case of Mendelian
inheritance, we are to regard Mendelian reproduction
* W. Bateson, The Method and Scope of Genetics^ 1908, p. 39.
150 THE FEEBLE-MINDED chap.
as *' an anomaly of sexual reproduction whereby
non-sexual characters are reproduced and blended
in the same mode as sexual characters, one of each
allelomorphic pair being patent and the other
latent."^
(2) Reversion. We have now to consider a group
of cases in which the inheritance is said to be
'' reversionary." The cases have little in common
beyond the fact that such resemblance as exists
between the individual and his ancestors is of a kind
from which, as regards the special features under
notice, the immediate ancestors, i.e,, the parents,
are excluded. Professor A. Thomson ^ makes the
term '' reversion " cover *' all cases where, through
inheritance, there reappears in an individual some
character or combination of characters which was
not expressed in his immediate lineage, but which
had occurred in a remoter, but not hypothetical
ancestor." Bateson's definition is somewhat more
elastic. He uses the term to signify ''that particular
addition or subtraction which brings the total of the
elements back to something it had been before in
the history of the race."^
We may note, incidentally, that evolution is
twofold. In developing from the fertilised ovum,
the individual passes through a certain series of
phases which together constitute the ontogeny.
But the race to which the individual belongs has
similarly passed through a series of phases —
constituting the phylogeny — of which the onto-
1 G. Archdall Reid, op. cit., p. 437.
2 J. A. Thomson, op. cit.^ p. 123.
^ W. Bateson, The Method mid Scope of Genetics., 1908, p. 48.
V CAUSATION OF FEEBLE MIND 151
genetic series is only, according to modern views,
an imperfect reiteration. Theoretically, therefore,
the individual may " revert " to a stage in either
series and on this basis a distinction between
'' reversion " and " atavism " has been founded.
This distinction is, however, of no practical value
and may be disregarded.
Variations, as we have seen, are considered by
Dr. Archdall Reid to be either progressive or
retrogressive alterations of recapitulation, and the
retrogressive variations, which are correlated with
cessation of selection, give rise to one of the two
forms of reversion, the other being the reproduction
of a *' dormant ancestral trait." It follows from the
occurrence of retrogression that '' ancestors are
represented by the individual, not en masse, but in
orderly succession." ^
How difficult it is to arrive at a satisfactory
conception of what is meant by reversion will appear
when one reflects that Professor Thomson's definition
will embrace all the cases to which either Galton's
Law of Ancestral Inheritance, or Mendel's principles
apply. It is, however, convenient to restrict the
use of the term to Instances in which the characters
drawn from the stock comprised in the series of
contributions, one-quarter, one-eighth, one-sixteenth,
etc., which together make up the one-half of the
inheritance not directly referable to the parents,
are especially prominent. Cases in point are,
doubtless, those which Galton himself described
as examples of what he calls the Law of Filial
Regression, which may be regarded as probably the
1 G. Archdall Reid, op. at., p. 208.
152 THE FEEBLE-MINDED chap.
scientific equivalent of the Law of Healthy Birth,
to which allusion has already been made. A
conception of what is meant by filial regression may
be arrived at in this way : — Every individual is
represented in the past by a multitude of ancestors,
the number being directly proportional to the
number of generations through which we count back
and inversely proportional to the amount of inter-
breeding which has taken place between the
ancestors. Thus if one counted only a dozen
generations back, and assumed that the branches
of the genealogical tree had never intertwined,
any particular individual would have behind him
an army of 4096 persons. Exactly what the
number is in any given case is, however, a secondary
matter. It suffices that the number is large and
that, in consequence, the *' mean " of the ancestors
will be approximately that of the general population.
Now since the individual is a mosaic of ancestral
characters he also will tend to approximate to
the mean of the general population. There will,
that is to say, be a tendency for offspring to
" regress " towards the average in respect of any
character with which the parents are specially
endowed or in regard to which they are conspicu-
ously deficient.
(3) Anomalous cases. These have little obvious
application to human beings and they are mentioned
chiefly for the sake of completeness. At the same
time they may serve to indicate directions in which,
with the help afforded by the scientific use of the
imagination, the mysteries of heredity may be
further probed.
V CAUSATION OF FEEBLE MIND 153
(a) Telegony. This term is used to denote "the
supposed influence of a previous sire on offspring
subsequently borne by the same female to a different
sire." The widespread belief in the occurrence
of phenomena of this kind seems to have so slender
a basis that, failing more convincing evidence, we
need not dwell upon it.
(d) Metagenesis. In certain plants and animals
the offspring is altogether different in type from its
parent. Thus the plant which develops from the
spore produced by an ordinary bracken fern is
wholly unlike that fern ; and the freely swimming
organism — the medusa — to which a hydrozoan
zoophyte gives rise, bears no resemblance to that
zoophyte. To these new creatures succeed forms
unlike them but like the forms of the first generation.
We have, that is to say, an alternation of generations.
The significant difference between the alternating
forms is that they are, respectively, asexual and
sexual as regards their mode of giving rise to the
succeeding generation. Something in the nature
of alternation of generations can be traced in the
highest plants, and attempts have been made to
interpret certain features of the reproductive process
even in Man himself on similar lines. Still more
complicated examples of alternation are familiar
to the zoologist. One need only allude, in illus-
tration, to the life histories of liver flukes and plant
lice.
(c) Xenia. This is a form of inheritance
dependent on a process of double fertilisation,
which has been observed in some species of maize.
Not only is the egg-cell fertilised, but a second
154 THE FEEBLE-MINDED chap.
nucleus from the pollen tube unites with the polar
nuclei extruded from the egg-cell in maturation
to give rise to the endosperm.
(d) Psedogenesis. The Mexican Axolotl is a
lacustrine gilled amphibian, which, under conditions
favourable to the change, can shed its gills and
continue life as a terrestrial form (called Amblystoma)
so different from the Axolotl that for a long time
the relationship between the two was not recognised,
since the Axolotl bred freely and gave rise to forms
similar to itself In the light of its subsequent
history it is obvious then that Amblystoma is
capable of reproduction while still in the larval
stage of its development.
(e) Seasonal Dimorphism. Welsmann long ago
drew attention to the fact that certain butterflies
of apparently different species were in reality
summer and winter forms of the same species, it
being possible, by employing a suitable temperature,
to convert the winter form into the summer one,
though in ordinary circumstances the two forms
alternated according to the season at which they
appeared. Both this case and that of the Axolotl
are described in Weismann's Stttdies in the Theory of
Desce7it, and it is interesting to note that Welsmann
regarded them as Instances of reversion.
As we saw above, the application of the term
** Inheritance " Is not usually restricted to the
manifestations of innate tendency of which we have
so far been speaking, and it would appear that the
legal and other uses of the word are themselves not
without biological significance. As Darwin pointed
out. Inheritance involves not only the transmission,
V CAUSATION OF FEEBLE MIND 155
but the development of characters. This develop-
ment is conditioned by the environment, but the cases
which we are now considering are not, therefore, to
be relegated to the second of our primary classes,
for while the expression of inheritance is dependent
on the circumstances in which development takes
place, its possibility is to be explained by reference
to the innate tendency which is the essential
characteristic of the first class of cases.
It is a fact of common observation that latent
characters are being continually brought to the light
of day by the changing conditions of life. The
humdrum citizen, suddenly faced for the first time
by a critical situation, may display qualities of courage
or cowardice, promptness or vacillation, delicacy or
boorishness, of which he had previously given no
sign. An epidemic of disease will bring out the
fact that different persons have exhibited and have
presumably inherited different degrees of suscepti-
bility to its influence. Instincts which ordinarily
cease in early life to be of value to the individual
may persist to years of maturity if the special
conditions which abrogate them are not forth-
coming.
We can only judge of heredity by the way in
which it manifests itself, and, in so far as factors in
the environment have to do with the manifestation,
we may legitimately regard them as factors of
inheritance. All the elements which go to make up
the special kind of environment which is conven-
tionally described as '' inherited " are not necessarily
factors of this kind, but it is peculiarly among those
elements that factors are to be found.
156 THE FEEBLE-MINDED chap.
Having now obtained some notion of what is
meant by inheritance, we may proceed to enquire
what innate tendencies have to do with the causa-
tion of feeble-mindedness. Very little can be done
in the way of allocating to its particular category
any case of defectiveness which is admitted to be
hereditary, since the psychical elements which afford
the means of comparison are not very clearly
definable. Moreover, although it may be admitted
that the psychical elements have anatomical sub-
strata, the admission is, as yet, of no particular value,
for we do not know, except in the most general
way, what psychical phenomena are associated with
particular anatomical features, and if we should
discover this we might find that the anatomical
features themselves were not sufficiently distinctive
to lend us any assistance.
All that we seem justified in asserting is that the
bioplasmic basis, or (to employ the terminology of
Weismann) the germ-plasm, derived from either
parent, may, '* for reasons unknown to us," exhibit in
the offspring changes in the nature of variation or
mutation. In this way an unsound stock may be
derived from a sound one and, conversely, a sound
from an unsound one. On the lines laid down
above, a character of unsoundness may be transmitted
so as to appear as an example of one or other of the
modes of inheritance which have been mentioned.
By a ** character of unsoundness" is meant, in the
circumstances with which we are at present con-
cerned, what is called the " Insane Diathesis," for
there is practically no evidence that particular
mental defects are heritable quantities, although this
V CAUSATION OF FEEBLE MIND 157
fact may simply be an expression of the deficiency
of trustworthy information bearing upon the matter.
Certainly, as far as feeble-mindedness is in question,
unless the relationship to it, in heredity, of insanity,
epilepsy, hysteria, neurasthenia, and even gross
cerebral lesions were admitted, the case for inherit-
ance would be a weak one.
Even in regard to the insane diathesis there is a
plentiful lack of reliable data. Speaking during the
course of a discussion on " The Influence of Heredity
on Disease," Dr. C. Mercier ^ expressed the opinion
that the '' compilation of the statistics of inheritance
which appear in the Report of the Commissioners in
Lunacy is a gigantic waste of time and labour.
The statistics are of no value at all for any practical
or scientific purpose." Somewhat more satisfactory
are the records compiled by individual observers in
special instances to demonstrate the ''effects of
heredity," but from the statistical standpoint these
records also are to a great extent vitiated by the
absence of a standard of normal heredity with which
to compare them.
Mr. David Heron,^ whose studies in this connec-
tion are among the few which have been conducted
on scientific lines, has stated that "the whole of the
medical data hitherto published on the subject seem
lacking in the precision needful to give a logical
proof. . . . Heredity is over and over again
recorded as a principal or contributory cause of
insanity, although the average number of the insane
^ C. Mercier, Proc. Royal Society of Medicine^ Jan. 1909, p. 45.
2 D. Heron, A First Study of the Statistics of Insanity and the
Inheritance of the Insane Diathesis^ 190?? p- 21.
158 THE FEEBLE-MINDED chap.
in the stock of the same individual has not been
discussed."
We may, however, quote some of the more recent
figures which have been collected, in circumstances
which eliminate to a great extent the purely specula-
tive element. In his evidence before the Royal
Commission on the Care and Control of the Feeble-
Minded, Dr. W. A. Potts ^ tendered the following
tables as summarising the results of an enquiry
which he had made : —
Insane, Feeble-Minded, and Epileptic Heredity.
—
Direct.
Collateral.
Total.
Defective children
Normal children ...
28-4%
io%
12%
38-4%
22%
From figures given by Mrs. Bramwell Booth,^ it
appears that of 205 children born to feeble-minded
women 25 were " of average intellect (so far as it
was possible to tell) " ; 6"] were '' mentally weak " ;
while about the remaining 113 there was *'no in-
formation." Assuming that the proportion of
''mentally weak" children among the 113 was the
same as among the 92 in regard to whom particulars
could be ascertained, this would mean that over
70 per cent, of the children of feeble-minded mothers
are mentally defective.
A few cases quoted in the 13th Annual Report
(1909) of the National Association for the Feeble-
Mlnded hardly bear out the view. "A careful
^ W. A. Vo\Xs^ Rep07't of Roy. Comm. o?t Feeble-Minded, vol. 2, p.
474.
^ B. Booth, Report of Roy. Com7n, on Feeble- Minded, vol. 2, p.
572.
V CAUSATION OF FEEBLE MIND 159
examination of the children at the North Finchley
Home," it is stated, showed that ''2 out of 12
children of 12 mothers, all of whom are definitely
feeble-minded, can at present be considered mentally
defective." This works out at less than 17 per cent,
but in regard to both sets of figures much more in-
formation is required before they can be satis-
factorily compared.
Dr. A. Eichholz,^ in his evidence before the
Royal Commission, contended that the influence of
heredity is not to be expressed in such simple
fashion as this. '*' Apart from the associated con-
ditions of physical degeneracy which," he says, '* are
responsible for a considerable proportion of the
feeble-minded, it ma}^ be said that the chances of
mentally defective offspring reside evenly among the
whole population, and that they do not pertain to
any particular type of parent. This is a direct
result of the operation of heredity in virtue of which
the physical inheritance of the individual is derived
from a very far-reaching line of ancestors, the large
majority of whom are normal." Dr. Eichholz, it
would appear, applies rather too absolutely the
principle of filial regression.
Mr. Heron's conclusions, which, from the nature
of the methods employed, have a special value, are
that *'The insane diathesis is inherited with at least
as great an intensity as any physical or mental
character in man. It forms, considering the
difficulties and assumptions of the investigation,
probably no exception to an orderly system of
^ A. Eichholz, Report of Roy. Conim. on Feeble-Minded^ vol. i,
p. 206.
160
THE FEEBLE-MINDED
CHAP.
inheritance in man, whereby on an average about
half of the mean parental character, whether physical,
mental, or pathological, will be found in the child.
It is accordingly highly probable that it is in the
same manner as other physical characters capable of
selection or elimination by unwise or prudential
mating in the course of two or three generations."^
Mental characters thus appear to conform to Galton's
Law of Ancestral Inheritance as far as the parents
are concerned. Whether the Law is of more ex-
tended application remains to be seen.
A subsidiary result obtained by Mr. Heron is also
worthy of notice. He found that there is "no
reduction in, possibly rather an augmentation of,
the fertility of insane stocks, when compared with
that of sane stocks." ^
Attempts have been made to account for the
inheritance of mental unsoundness on Mendelian
principles, insanity being regarded as the recessive
character, and sanity as the dominant one, but this
interpretation is not borne out by Mr. Heron's
figures, as is shown, for example, by the following
table given by him : — ^
Nature of parents as
Total Offspring.
Percentage Offspring.
to insanity.
Insane.
Sane.
Insane.
Sane.
Both sane
One insane
Both insane
314
93
4
1,179
299
4
21
24
50
79
76
50
Possibly the '' insane diathesis " may eventually
admit of being split up into a number of diatheses each
1 D. Heron, op. cit.^ p. 21. 2 jj^id,^ p. 32.
3 Ibid.^ P- 17.
V CAUSATION OF FEEBLE MIND 161
capable of recognition as a specific hereditary and
perhaps MendeHan character.
Sir E. Ray Lankester^ would place the facts of
inheritance, as regards mental defect, in yet another
category. *' There is," he says, '' no reason whatever
to suppose that true feeble-mindedness is anything
but a congenital condition, due to heredity and to
nothing else ; a reversion of the brain to an earlier
level of development."
In cases of mental deficiency we may find, as
associated conditions, other forms of hereditary
defect, and much confusion has resulted from the
gratuitous assumption that the latter have a causal
relation to the want of intellectual capacity. Fairly
definitely in the case of alcohol ; less so in the case
of tubercle ; and only doubtfully as regards syphilis
and other toxic agencies, we can recognise that the
injurious effects of these agents are contributed to by
the lack of resistive power in the organism. But in
this fact there lies no justification for assuming that
the particular defect which the bioplasm may display
is capable of engendering defect of some other kind.
Therefore, when we find that the forebears of a
mentally defective person are alcoholic or tuberculous
we have not sufficient ground for inferring that
alcohol or tubercle was responsible for his intellectual
shortcomings.
Such evidence as there is for associating tuber-
culosis and insanity lies in the fact that the incidence
of tuberculosis upon the insane is relatively high ;
but this association may be indirect in that the
1 E. Ray Lankester, Report of Roy, Com7n. on Feeble- Minded, vol.
5, p. 246.
M
162 THE FEEBLE-MINDED chap.
existence of insanity may Involve the acquiring of
characters in the way of defective nutrition which
render the individual more susceptible to the action
of the tubercle bacillus, apart from any Innate weak-
ness in that direction. If there be, as Mr. Heron
maintains, '' a close correspondence between the
inheritance of the insane diathesis and that of
pulmonary tuberculosis," -^ this must be taken to
mean that the different pathological conditions are
inherited on parallel lines, and not that one condition
is convertible into another. Even parallelism to
this extent is not without its confusing aspect, for
while the tubercular diathesis (if it exists at all) ^
denotes a capacity for reacting with abnormal ease
to the influence of only one particular toxin, the
insane diathesis would appear to involve a many-
sided weakness expressed as susceptibility to many
and various toxins, to say nothing of mechanical and
even more obscure agencies.
Alcoholism is on a somewhat different footing,
since it is, theoretically at least, under the control of
the will. The germinal defect involved in alcoholism
may therefore be either a special susceptibility to
the action of the toxin — an alcoholic diathesis — or a
paresis of volition which brings the organism within
the sphere of action of the toxin — a form of the
insane diathesis.
The part which consanguinity plays in the
causation of weak-mindedness becomes intelligible
in the light of our conception of heredity. If the
^ D. Heron, op. cit., p. 32.
2 See in regard to this point the discussion on Heredity reported in
Proc. Roy. Sac. of Medici?ie, Jan., 1909.
V CAUSATION OF FEEBLE MIND 163
bioplasmic stock from which the closely related
persons come Is of the kind which generates defective
brains, the chance of the occurrence of two inde-
pendent parental variations which would be
necessary to eliminate this quality is so small that
the transmission of the quality by one or both lines
of descent is probable. If the stock is free from
this peculiarity, it is no more likely to vary in the
direction of producing It than any other healthy
stock.
(B) Environmental Influences Predominant.
In the first set of cases the environment was seen
to play a part apparently insignificant and certainly
obscure ; here, on the other hand, we suppose It to
have special Importance. As far as the human race
Is concerned, natural selection has become greatly
restricted,-^ and artificial selection has been carried on
either haphazard or with a view to the perpetuation
of other qualities than the Intellectual. The mean
Intellectual level of the community Is apparently no
higher than, for example, In the Elizabethan period ;
indeed, there are reasons for regarding It as lower :
and yet we have advanced since those days. It has
been pointed out by Lloyd Morgan and others that
present-day evolution Is rather of the environment
than of the race. The children start where the
fathers left off, not only because they have Inherited
^ " The present progressive evolution of man, at any rate of civilised
man, is chiefly, if not exclusively, against disease, which is apparently
the only selective agency acting on him sufficiently stringent to do
more than merely maintain characters previously evolved." — G. Arch-
dall Reid, The Laws of Heredity^ 1910, p. 438.
M 2
164 THE FEEBLE-MINDED chap.
the favourable mutations and variations of bioplasm
which the father experienced, but because they have
come Into the store of favourable conditions which
successive generations have accumulated.
During recent years some remarkable results
have been obtained by Professor J. Loeb ^ in his
investigations of the effects which temperature,
light, gravitation, and chemical agencies, acting
upon the germ, have In modifying both the bodily
form and the Instinctive reactions of animals.
Although his experiments have little direct bearing
upon human development, they open up fields of
interesting possibilities which may eventually be
productive of valuable contributions to embryo-
logical science. So far as our present knowledge
goes, the environmental factors which have the most
obvious relation to the production of mental defect
may be thus classified : —
(i) Mental and physical strains and stresses. —
These may be considered either in connection
with their Influence on the parent before the
separate existence of the child or as acting on
the child directly. It appears, on the face of It,
reasonable to suppose that an insanitary milieu and
want of suitable food may prejudicially affect Intra-
uterine development. We have for Instance the
figures given by Legrand du Saulle as to the "siege
children" In Paris. Of 92 conceived during the
siege of 1870-71 not one was thoroughly healthy,
and 29 of them displayed symptoms of mental
disorder. There is also some evidence that
attempts to procure abortion are occasionally
^ J. Loeb, op. cit.
V CAUSATION OF FEEBLE MIND 165
responsible for the development of feeble-mlndedness
in the children whose nutrition is thus interfered
with.
On the subject of ''maternal impressions," to
which allusion will no doubt be expected, the
remark which seems appropriate is that we should
keep an open mind, in the hope that some day
there may be forthcoming more conclusive evidence.
The presumption is, however, against the view that
maternal impressions can have important effects
in controlling the development of the foetus if only
for the following reason. In spite of the intimacy
of the relation which exists between mother and
child during gestation, there is not ordinarily a pre-
ponderance of maternal characteristics over paternal.
As compared with the influence which the mother is
bringing to bear during a prolonged period, the
incidence of an isolated and temporary emotion
might reasonably be expected to be trivial, and
since it appears that the former is of no particular
moment, we may regard the latter as of very little
consequence indeed.
The incidents of birth afford ample scope for the
intervention of injurious agencies, but the topic is
one that need not detain us, since the possibilities in
this regard are such as anyone may readily think
out for himself. Reference is, however, permissible
to the work of Little,^ since his name has been
applied to a condition in which certain accidents at
birth may be associated with feeble-mindedness.
Some degree of paralysis was observable in Little's
cases, but it has been suggested that a form of
1 W. J. Little, Trans, of the London Obstetrical Society^ 1861, p. 293.
166 THE FEEBLE-MINDED chap
infantile '' cerebroplegia," which is not accompanied
by paralysis, may occur.
A view very generally approved, ^.^., by Heller,^ is
that first-born children are more likely to be mentally
defective than those afterwards born to the same
parents. This is said to be due to the fact that first
labours are usually more prolonged and difficult
than subsequent ones. Dr. Tredgold ^ maintains
the contrary opinion. "As a matter of fact," he
says, " I believe the statement that an undue pro-
portion of idiots are first-born children is decidedly
open to question, and my own experience is to the
effect that it is more common for the later-born, and
not the first-born, to be affected." It may be noted
in this connection that Mr. Heron, in the research
already alluded to, found that '' the incidence of
insanity does not appear to be equally distributed
over the family, but to fall more heavily on the
elder members." ^ Mr. Heron does not suggest, and
probably would not accept the suggestion, that the
explanation of his results is to be found in the
mechanical conditions of parturition.
After birth the child is still exposed to the
influences of strains and stresses, though from these
we must arbitrarily exclude, out of respect to the
scheme of classification adopted in this book, such
as do not act at "an early age." Of special im-
portance are the ones which, for any reason, e.^-., by
causing abnormalities of sense-organs or by limiting
educational opportunities, result in the child's not
^ T. Heller, Grimdriss der Heiipddagogik^ I904) P- i68.
2 A. F. Tredgold, Mental Deficiency^ 1908, p. 30.
^ D. Heron, op. cit.^ p. 32.
V CAUSATION OF FEEBLE MIND 167
acquiring the necessary capital of sense-impressions. /
To the instances of mental defect arising in this way
Ireland and others apply the name Idiocy by
Deprivation, and the class includes cases like those
of Laura Bridgman and Helen Keller on the one
hand, and on the other, the " wild boys " and '' wolf
children " who formerly attracted so much attention.
We may notice, in passing, Griesinger s ^ sugges-
tion that an injurious state of cerebral congestion
may be produced in children by keeping their heads
too closely wrapped up or by allowing them to sleep
in too close proximity to a stove.
The importance to be attached to psychical stresses
will depend somewhat on our interpretation of what
constitutes *'an early age." Very young children
are not sufficiently appreciative of their surroundings
to find in them occasion for the development of
profound emotions. Heller ^ quotes instances in
which children of, respectively, six and eight years
of age, previously of normal intelligence, became
permanently weak-minded in consequence of severe
frights. For practical purposes such cases might
well be included among the '' feeble-minded," though
it might be argued that our definitions do not cover
them.
(2) Toxic Agencies. — These might, of course, be
brought under the heading "strains and stresses"
just given above, but it is more convenient to take
them separately. They may be applied directly to
the individual ; thus the child may be given alcohol,
^ H. Bosbauer, L. Miklas and H. Schiner, Hafidbuch der Schwach-
sinnigenfiirsorge, 1909, p. 87.
2 T. Heller, op. cit.^ pp. 14 and 15.
168 THE FEEBLE-MINDED chap.
or may acquire syphilis, malaria, or one of the acute
infections at a sufficiently early age to bring It within
the limits of our conception of feeble-mindedness as
a condition dating " from birth or from an early age."
In general, however, they influence the child via the
parent. The most important ones are, it would
appear :
[a) Syphilis. — The degree of probability that
syphilis is the cause of the mental defect observed Is
fairly high in a case where one finds, as one some-
times does find, a gumma in the brain ; or where,
after a definite history of infection, parent and child
alike suffer from general paralysis (using that term
in its specific sense). With this justification for
assuming some connection between syphilis and
feeble-mindedness, an Investigation was conducted
as carefully as circumstances would permit Into the
family history of 90 patients over 16 years of age.
In 13 of these cases, i.e., 14 '4%, there was satis-
factory evidence that one or other of the parents
had had syphilis. If it be remembered how wide-
spread this disease Is among the general public, it
seems probable that if one took children who were
not mentally defective and investigated their family
history as thoroughly, one would find quite as much
parental syphilis — the normal children taken might
indeed very well be the brothers and sisters of the
idiots In the first batch of cases. The Wassermann
reaction provides a more satisfactory means of
diagnosing the existence of syphilitic infection than
is afforded either by Inspection or by inquiries into
the history of the person concerned. Dean^ has
t ^ H. R. Dean, " An Examination of the Blood Serum of Idiots by the
Wassermann Reaction," Lancet^ July 23, 1910, p. 227.
V CAUSATION OF FEEBLE MIND 169
recorded the results of an examination, by Wasser-
mann's method, of blood serum from 330 cases of
idiocy. He found that in 51, i.e., i5'4%, a positive
reaction was obtained. Included among the 51
cases were 7 with definite signs of syphilis and 3 or
4 in which syphilis might have been suspected. It
is interesting to note how closely Dean's figures
approximate to those quoted above, which were
yielded by an investigation of the family history.
(K) Tuberctilosis. — This disease is perhaps more
widely spread than syphilis, and its association with
feeble-mindedness proves nothing in the absence of
figures to show that the association is really more
frequent than the occurrence of a family history of
phthisis in the sane. It is, however, quite con-
ceivable that tuberculosis in the mother may interfere
with the nutrition of the embryo as suggested by
Weygandt.-^
{c) Alcohol, — The argument from association of
conditions is even more feeble in this case than in
the preceding. In the great majority of the com-
pilations of statistics dealing with this subject no
attempt is made to show the percentage of cases in
which there is a direct or indirect action of alcohol
on the healthy embryo. It is, however, credible
that alcohol in such circumstances would be in-
jurious, and that the brain might suffer as well as
other parts of the body. Some confirmatory
evidence on this point is afforded by Dr. G. Schenker,^
Director of the Biberstein Asylum, near Aarau in
1 W. Weygandt, Die Beha7tdlung idiotischer und imbeciller Kinder^
1900, p. 8.
2 G. Schenker, Beobachttmgen an schwachsinjiigen Kindern^ 1899,
p. 7.
170 THE FEEBLE-MINDED chap.
Switzerland. *' Before the Introduction of the
alcohol monopoly," he says, ''there were certain
towns and districts where the consumption of brandy
was excessive. The physical and psychical state of
the people In these regions was such that frequently
hardly a third of them would be considered fit for
military service. A large number of idiotic and
semi-idiotic children were there produced. Alcohol-
ism was chiefly responsible for these, for in other
districts where alcohol was little indulged in, and a
more rational mode of living was observed, strong,
well-built and mentally well-developed persons were
the rule."
Of the same purport Is the statement made by
Mr. R. J. Parr,^ Director of the National Society
for the Prevention of Cruelty to Children, in his
evidence before the Royal Commission on the Care
and Control of the Feeble- Minded. He submitted
a list of 13 Inebriate women in regard to whom
it was noted that ''the younger children born
during the period of the women's Inebriety " were
weak-minded, while those born prior to that period
were sound.
Against the view that there is any such simple
dependence of feeble-mlndedness in the offspring
on alcoholism In the parent must be set the ex-
perience of Miss E. M. Elderton and Professor
Karl Pearson, as recorded in No. 10 of the Eugenics
Laboratory Memoirs. As a result of analysing two
series of statistics, collected, the one by the Edin-
burgh Charity Organisation Society and the other
by Miss Mary Dendy of Manchester, no marked
^ R. J. Parr, Rep. of Roy. Conmi. on Feeble- Minded-, vol. 2, pp.
138 and 147.
V CAUSATION OF FEEBLE MIND 171
relation was found "between the intelligence,
physique or disease of the offspring and parental
alcoholism in any of the categories investigated " ;
and the opinion is expressed that ''the danger of
alcoholic parentage lies chiefly in the direct and
cross-hereditary factors of which it is the outward
or somatic mark." It has been pointed out in
regard to these contentions: (i) that the influence
of parental alcoholism might have become obvious
if the children concerned had been examined at a
later age ; and (2) that no information is supplied as
to whether the parents' alcoholism existed prior to
the birth of the children.^ Both these criticisms
seem legitimate and due weight must be assigned
to them in arriving at a conclusion on the matter.
As to the pernicious influence of alcohol when
given to the child directly there is little question.
In this country alcohol is administered to children
by careless or vicious parents with deplorable fre-
quency, while among the lower classes in Germany
it is said to be customary to reduce infants to a
state of torpor by dipping the teats of their feeders
in brandy or by rubbing that liquid into their faces.
Bournevllle and Baumgarten^ have recorded a
case of alcoholism in a child of 4 years. It appears too
that sufficient alcohol may be excreted In the milk
of nursing mothers to produce pernicious effects on
the infant. Thus in his work " Le Nourisson,"
Professor Pierre Budin relates the story of a woman
who, while suckling her child, was advised by her
^ Vide Communications by Dr. Maurice Craig and Dr. W. C
Sullivan in the Lajtcet for June 25th and July 2nd, 1910.
2 Bourneville and Baumgarten, Alcoolisme chez un enfant de 4 ans.
Recherches sur LEpilepsie^ etc.^ 1887, p. 142.
172 THE FEEBLE-MINDED chap.
doctor to take quinine wine and who added thereto
bordeaux, champagne, beer, and liqueurs on her own
responsibility. At the age of 5 weeks the child
had two convulsions after having been for several
days " nervous " with disturbed sleep. A third and
subsequent severe convulsions led to the discon-
tinuance of the mother s milk and the child then
speedily recovered.
[d) Other Toxic Agents. — Heller ^ refers to
three cases in which the mothers of feeble-minded
children suffered from malaria during pregnancy.
Seguin ^ states, as a matter of personal observation,
that idiocy is common in the class of artisans who
work in copper, while, according to Roque and
others, idiocy, imbecility, and epilepsy occur with
abnormal frequency in the children of workers in
lead. It is suggested also that the widely spread
practice of giving soothing syrups and similar opiates
to children has perhaps contributed in some measure
to the imperfect cerebral evolution of those children.
There are to be found in the various English and
foreign works treating of idiocy and its congeners
numerous statistical tables setting forth the per-
centage of cases in which the different agencies
above enumerated, and possibly others, have been
credited with ''causing" feeble-mindedness.
Unless we are in a position to judge of the
competence of an observer and of his disinter-
estedness we cannot estimate correctly the worth of
any evidence he may submit and there can be no
question that the raw material of the statistics of
1 T. Heller, op. cit., p. 163.
2 E. Seguin, Traitement Morale Hygiene et Education des Idiots.,
etc., 1846, p. 182.
V CAUSATION OF FEEBLE MIND 173
etiology is to a great extent furnished by persons
who are neither capable nor free from bias.
Information supplied by the relatives and friends
of the feeble-minded may require to be discounted
very considerably before its true value can be
arrived at, and it is not always clear that this
process has been properly carried out. Sufficient
proof of the need for the adoption of an attitude of
scepticism in regard to the explanation of their
relatives' condition proffered by the common people
is to be found in the following table, taken from the
Report of the Commission on the Care and Control
of the Feeble- Minded. Here the causes are stated
just as they were given, in apparent good faith,
by various relatives.
(a) Conditions affecting the mothers : —
Mental shock during gestation 14 cases.
Physical injury ... 4 ,,
Accidents of parturition ... 5 „
(d) Conditions affecting the patient only : —
Physical injury, usually a fall ... ... ... 12 cases.
"Fits" 6 „
Frights 4 5,
Rupture, vaccination, rickets, and scarlet fever ; of
each 2 „ '
" Brain fever," " brain affection," " closing of the
skull," hydrocephalus, operation for adenoids,
removal of the tonsils, heart disease, teething,
measles, typhoid fever, eczema, pain in the
back, and dog-bite ; of each i „
In only one case was there any suggestion that
inheritance had played a part. The reply ran —
'' Have no idea unless it is taken through the
family."
It is interesting to note that the cause most
174
THE FEEBLE-MINDED
CHAP.
frequently given was ''maternal impressions" and
that alcoholism is not once mentioned.
The necessity for maintaining a critical attitude
being realised we may venture to study the statistical
data to which allusion has been made. Of these
the English ones are readily accessible, and our
illustrations may therefore be drawn more profitably
from foreign sources. At Lucerne in 1903 there
was laid before the 4th Swiss Conference on Idiocy
by Direktor Friedrich Kolle, of Zurich, a compilation
from the sources indicated in the following table.
Name of Recorder.
Volker.
Schwenk.
Piper.
Zeitschrift.
^Hereditary defect..
53%
31%
27%
18%
Family history of
tubercle
22-9%
—
23%
—
fcJD^
Family history of
•!i^
alcoholism
21%
io-3%
10%
9-5%
Maternal impres-
sions
io-3%
7%
10%
3-6%
Consanguinity ...
47%
3-5%
3%
5%
0^
Acute disease of,
or injury to, the
the mother
3-1%
—
2.5%
—
^Parental syphiHs...
1%
—
5%
—
S ^^' r Primogeniture...
23-2%
29%
32%
35%
pq !& ^."S J Prolonged labour
97%
2%
6%
Q-^"^ [Premature birth
o-6%
3%
2%
13%
'Convulsions soon
after birth
33-1%
34-3%
—
31-3%
Acute infectious
^■s
diseases
11%
12%
27%
6%
■-tj J-i
Meningitis and
apoplexy
8%
6%
9%
22%
.^ B
Rickets
3-9%
13%
9%
4%
0 ^
Ill-treatment and
neglect
5-4%
—
7%
Head injuries
37%
4%
20%
11%
^Scrofula
o-i%
2%
V CAUSATION OF FEEBLE MIND 175
The total number of cases, upon which the per-
centages given are based, was thus made up : —
Volker 2037 (except in section " B," where it was
332). Schwenk 175. Piper 416.
Zeitschrift fUr die Behandlung Schwachsinniger
und Epileptiker 1287.
It is obvious that there exists among those con-
cerned with the care of the feeble-minded some
considerable diversity of opinion in regard to the
relative importance in etiology of the cardinal factors,
innate and environmental, which v/e have been
studying. As already mentioned this is no doubt
primarily due to the lack of precise information on
the point, but it seems to indicate also a regrettable
want of the scientific spirit on the part of those who
make confident pronouncements on the matter.
As a set-off to the views already ventilated, and
without any pretence of assuming other than a
strictly neutral position, we may quote an opinion
expressed by G. Archdall Reid.-^ *' We have,"
he says, ''no option but to believe that medical men
are mistaken in supposing that morbid conditions
affecting parents tend to render offspring degen-
erate."
We must note also the results obtained by
workers in the Galton Laboratory of the University />
of London. Statistical inquiry was made into
(among other things) : (a) The influence of drink
in the parents on the height, weight, general health,
and intelligence of the children ; and (/S) The
influence of overcrowding, bad economic condition
^ G. Archdall Reid, Rep. of Roy, Comm. on the Feeble-Minded^
vol. 5, p. 248.
176 THE FEEBLE-MINDED chap.
of the home, and the moral and physical condition of
the parents on the intelligence, eyesight, glands, and
hearing of the children.
The investigations, so far as they have gone,
** show clearly the small influence of environment."
The various conditions enumerated appear to have
exercised practically no effect on the intelligence of
the children or, for that matter, on any of the
qualities mentioned.^
It v^ould seem then, on reviewing the whole
position, that we may accept as most in accordance
with modern ideas the conclusion of the Commission
on the Feeble-Minded : —
'' That both on the grounds of fact and theory
there is the highest probability that feeble-
mindedness is usually spontaneous in origin— that
is, not due to influences acting on the parent — and
tends strongly to be inherited." ^
Before the subject of etiology is dismissed the
vexed question of what is called "the transmission
of acquired characters " maybe briefly noticed. In
the light of the theory of heredity here adopted it
does not present any special difficulty. We have
seen that the portions of bioplasm which are separ-
ated off for the purpose of reproduction may exhibit
variations or mutations, arising "spontaneously" or
as the result of some unknown environmental
influence, which may persist and be handed down
from generation to generation. To this extent, then,
acquired characters are transmitted. In the second
1 E. M. Elderton, The Relative Strength of Nurture and Nature,
1909.
2 Report of Roy. Coimn. on the Feeble- Minded, vol. 8, p. 185.
V CAUSATION OF FEEBLE MIND 177
group of cases with which we have just been deaUng
we had, again, Hving matter altering under the action
of various forces. But of this Hving matter the
bioplasm which is the basis of continuity forms only
a small part. The process of alteration may there-
fore not reach it at all. The lopping off of a limb, or
similar mutilation, could hardly affect the germinal
substance and it is inconceivable that such a " modi-
fication," as a biologist would term it, should be
transmitted. If, however, the germinal substance is
reached by an injurious agent, e.g., a poison circu-
lating in the blood, it may respond by undergoing
either a ''variation," which, like other variations, will
be permanent or not according as it is fixed by
natural or artificial selection; or a "mutation" which
will remain as a permanent character. Again, a modi-
fication may act indirectly by making an opening for
the appearance of a variation or mutation, and in
the former case its continued operation during many
generations may become evident in heredity through
the appearance of what is seemingly a mutation.
As this matter of the handing on of acquirements
is one to which Dr. Archdall Reid ^ has devoted
special attention, it will be fitting to give a summary
of his views on the point. '' Living beings," he says,
*' develop mainly under the influence of three distinct
kinds of stimuli — nutriment, use, and injury." What
are ordinarily called " acquirements " are characters
arising under the stimulus of use or injury. The
capacity to develop " acquirements " is present "only
in structures where it is useful, to the extent to which
it is useful, and during the time it is useful." Al-
1 G. Archdall Reid, The Laws of Heredity, 1910.
N
178 THE FEEBLE-MINDED chap.
though the " power of responding to the stimulus of
injury is clearly allied to, and is derived from, the
power of responding to the stimulus of nutriment,"
there is so great a difference between them that In
order to explain the appearance of ''acquirements"
in offspring we should have to assume not so much a
** transmission " as a " transmutation " of characters
in the sense that features which were evoked in the
case of the parent by means of the stimulus of injury
would be called forth In the offspring by nutritional
stimuli. This consideration applies equally to the
effects of use, which, however, come less frequently
into the question, since the capacity for responding
to the stimulus of use is more limited than that of
responding to the stimulus of Injury.
The need for the doctrine of the transmission of
acquirements depends on the view taken as to the
adequacy of Natural Selection in accounting for
evolution, and since Dr. Reid finds in Natural Selec-
tion a sufficient explanation of the phenomena, the
Lamarckian hypothesis is for him superfluous, to say
the least of it.
But all biologists are not satisfied that Natural
Selection is the only method of evolution, and there
are cases in which the supposition that characters
acquired by a parent can be transmitted to offspring
involves fewer difficulties than the view that only
the weeding-out process of the struggle for existence
has been in operation. A recent statement of the
case for the transmission of acquired characters is
that of Professor R. Meyer.^
1 R. Meyer, " Gibt es Vererbung erworbener Eigenschaften ?
Deutsche Medizinische Wochenschrift, June 9, 19 10, p. 1086.
V CAUSATION OF FEEBLE MIND 179
It is the conception of the isolation of the germ-
plasm as the sole vehicle for inheritance which puts
out of court even the most plausible story of the
handing on of an acquirement. But if that isolation
is not complete; if, that is, some portion of "so-
matic," as distinct from ''germ," plasm goes to the
formation of a new individual, the case for " acquire-
ments " is greatly strengthened. Dr. Paul Buchner ^
has described such a condition of affairs as actually
existing in the organism known as Sagitta, where,
according to his observations, chromatin from an
epithelial cell wanders into the "ovocyte " and plays
a part in the subsequent development of the egg.
^ P. Buchner, " Kelmbahn und Ovogenese von Sagitta," Anafo-
mischer Anzeiger^ Bd. 35, Jan. 1910, p. 433.
N 2
CHAPTER VI
THE VARIETIES OF FEEBLE-MINDED PERSONS
Since no two cases of feeble-mlndedness are alike,
the making of a classification involves the acceptance
of certain conventions. There must be agreement
as to the respects in which likeness exists, and as to
the degree of likeness, in any particular respect,
which is to be regarded as constituting similarity.
Classification is akin to the formation of concepts.
Its aim is to render a mass of facts more easily
handled by substituting one for many, and its utility
will depend on the amount of information which the
type form supplies as to the characteristics of the
group for which it stands.
In drawing up a scheme of classification many
interests, some of them conflicting, have to be
consulted. We shall get a notion of the difficulties
which arise by considering what are the features
which a good classification should exhibit.
1. It should be based on matters of fact rather
than of opinion.
2. It should be complete and exclusive. A
division of human beings into those with red hair,
those who subscribe to The Times, and those who
take sugar in their tea will at once be seen to leave
1 80
CH. VI VARIETIES OF FEEBLE-MINDED 181
much to be desired ; yet on such lines as these are
some of the existing systems drawn up. Take, for
instance, Dr. Ireland's familiar classification of idiots
into genetous, microcephalic, hydrocephalic, eclamp-
sic, epileptic, paralytic, traumatic, inflammatory,
sclerotic, and syphilitic varieties, to which are added
cretins and idiots by deprivation. Here the cases
are arranged in sections, of which the distinguishing
features are now anatomical, now physiological, now
etiological. This objection is to be met by
introducing a further consideration in regard to
classification.
3. It should have, at any rate for groups at the
same level, a constant determining factor. In Dr.
Ireland's arrangement the principle of uniformity is
not carried out even to the extent of providing a
common grammatical form for the terminology.
This criticism is not offered with any desire to
belittle Dr. Ireland's work. The defects of his
system are, to a great extent, inherent in the subject,
as will be appreciated if one attempts to devise a
better scheme. No single aspect of feeble-minded-
ness has been studied with sufficient thoroughness
to provide an adequate foundation for the satisfactory
erection of species, genera, and orders. In the
present state of our knowledge a classification on
strictly anatomical, etiological, or even psychological,
lines would be as artificial and as little indicative of
the number of points of contact between different
forms as is the Linnean system in its application to
plants. Thus schemes based on head measure-
ments ; or on assumed modes of causation ; or, as in
Esquirol's case, on the power of speech ; would
182 THE FEEBLE-MINDED chap.
bring together cases having nothing In common
except the arbitrarily selected factor. It would be
pedantic, then, to insist too strongly upon uniformity
of plan in a taxonomic arrangement of which the
chief raison d'etre Is convenience.
4. It should be based on definitions of universal
acceptance. The value of any convention, con-
sidered qua convention, Is proportional to the
number of persons who subscribe to it. However
much ingenuity may have been expended on a
scheme Its utility will be small if nobody employs it
but Its author.
5. It should be authoritative. There is, on their
merits, so little to choose between the different
systems which have been proposed by various
writers that the selection of a particular one by some
acknowledged authority supplies a strong argument
for employing It to the exclusion of others.
Keeping these considerations before us we may
briefly review some of the almost innumerable
suggestions for classifying the feeble-minded which
have been propounded. Fanciful analogies, such as
that which gave us Brephoid, Therold, and Ethnoid
types, or that underlying the distinction of Kalmuck,
Aztec, Papuan, etc., types, have no more than some
slight historical interest. On the basis of his studies
In pathological anatomy Bourneville distinguished
forms of Idiocy marked by the following conditions :
1. Meningitis.
2. Meningo-encephalitis.
3. Simple arrest of development.
4. Atrophic sclerosis.
5. Hypertrophic sclerosis.
VI VARIETIES OF FEEBLE-MINDED 183
6. Primary porencephaly.
7. Secondary porencephaly.
8. Hydrocephaly,
9. Cretinism.
10. Microcephaly.
Although this arrangement has merit, in that it
serves as a reminder of the chief forms of cerebral
defect found at post-mortem examinations of Idiots,
it is open to objection as being of little use during
life, as assigning to the different conditions enumer-
ated a fictitious independence, and as leaving
undifferentiated all except the most marked cases of
feeble-mlndedness.
In the section dealing with causation reasons
were adduced for recognising innate and environ-
mental etiological factors. This distinction supplies
the foundation for various systems, e.g., those of
Heller and Tredgold, in which the first step in
classification is the separation of a group of
primary or inherent mental defects from a group
of secondary or acquired defects. Such systems are
practically valueless. The uncertainty attending
the mode of origin of cerebral abnormalities leaves
us with no test which is applicable to the great
majority of cases. Tredgold admits that the so-
called congenital cases may be either '' primary " or
" secondary," and his tabular statement of the
" primary " and '' secondary " types shows a marked
absence of those differentia which he charges other
authors with neglecting.
Since we are admittedly concerned with a disorder
of the mind, a classification on the lines of psychology
would appear to be most rational. This thought
184 THE FEEBLE-MINDED chap.
has occurred to many, and has resulted in the pro-
duction of a number of schemes, some of which are
purely academic, while others aim at being practical.
Sollier measured the degree of mental defect by
noting the extent to which the faculty of attention
was impaired. He made three classes : —
1. Absolute idiocy : complete absence and im-
possibility of attention.
2. Simple idiocy : weakness and difficulty of
attention.
3. Imbecility : instability of attention.
Wildermuth attempted to define various grades
of idiocy by comparing them with stages of the
development of normal persons on the assumption
that idiocy was simply the result of an arrest of the
processes of growth. This attempt is chiefly of
interest in that its failure serves as a reminder of
the complexity of the etiological problem.
Voisin and Weygandt have regarded the idiot's
capacity for being educated as affording the most
useful criterion, though, as Heller shrewdly remarks,
this depends not only on the mental state of the
taught but also on the skill and experience of the
teacher. Weygandt's arrangement is as follows.^
1. Idiots incapable of being taught.
2. Idiots capable of being taught
a. Apathetic type.
b. Excitable type.
3. Imbeciles.
a. Apathetic type.
b. Excitable type.
^ W. Weygandt, Die Behandlimg idioHscher und imbeciller Kinder^
1900.
VI VARIETIES OF FEEBLE-MINDED 185
In Germany this distinction of apathetic (apath-
ische) and excitable (erethische) forms is very
generally accepted. It is adopted, for example, by
Kraepelin in his classical treatise on insanity.
Heller, however, holds that most weak-minded
children cannot be relegated to one or the other
group with certainty, and this accords with the
present writer's experience. A rough distinction
can be drawn between the superficial, shallow minds
which, within the narrow limits of their powers,
learn easily, to forget as easily, and minds which,
being impressed only with difficulty yet retain the
impression made for a relatively long period. This
latter distinction, which has practically no taxonomic
value, seems to depend on the affective reaction to
stimuli.
The best classification on practical lines is that
suggested by the Royal College of Physicians of
London and adopted from considerations of utility
by the Royal Commission on the Feeble- Minded.
It is no worse than those quoted above as regards
the first four criteria mentioned and it has, since it
represents the considered judgment of a body of
able persons, the merit of being authoritative. The
following groups are recognised : —
Idiots, i.e., persons so deeply defective in mind
from birth or from an early age that they are unable
to guard themselves from common physical dangers,
such as in the case of young children would prevent
their parents from leaving them alone.
LnbecileSy i.e., persons who are capable of guard-
ing themselves against common physical dangers
but who are incapable of earning their own living
186 THE FEEBLE-MINDED chap.
by reason of mental defect existing from birth or
from an early age.
Feeble- Minded, i.e., persons who may be capable
of earning a living in favourable circumstances, but
are incapable from mental defect existing from
birth or from an early age : (a) of competing on
equal terms with their normal fellows ; or {b) of
managing themselves and their affairs with ordinary
prudence.
Moral Imbeciles, i.e., persons who from an early
age display some mental defect coupled with strong
vicious or criminal propensities on which punishment
has little or no deterrent effect.
Criticism has been directed at the above scheme
on the ground that no definition is given of what
constitutes '' an early age," and, further, that the
test of capacity for w^ork is not applicable to the
children who form a large proportion of the feeble-
minded. As regards the latter of these contentions
it may be said that for practical purposes the
difficulty is not a serious one, and that it could be
met by reading " learning to earn " for '* earning,'*
wherever necessary. There is, unquestionably,
about the phrase '* an early age " a want of explicit-
ness which detracts from the value of the definition
of which it forms part. The Commissioners in
Lunacy have tried to avoid this pitfall in the defini-
tions of the kinds of unsoundness of mind recognised
by them, by speaking of a " congenita) or infantile
mental deficiency (Idiocy or Imbecility) occurring as
early in life as it can be observed." By common
agreement " congenital " means, in the language of
the Standard Dictionary, '' born with us : existing
VI VARIETIES OF FEEBLE-MINDED 187
from birth." But the term ''infantile" cannot be so
easily disposed of. '' Infancy " from a chronological
standpoint may be taken to signify the first few
months of life, which is the way in which medical
men employ the description, or the word may
be used in one of its legal bearings to denote
periods expiring at the age of seven, or fourteen, or
twenty-one years. If the first mentioned interpreta-
tion is to be accepted, it must not be lost sight of
that certain mental qualities do not appear till long
after the first year of life and, consequently, any
aberration involving them, occurring "as early in
life as it can be observed " cannot be either
'' congenital "or " infantile."
Another objection to the scheme of the Royal
Commission on the Feeble-MInded Is that it does
not go far enough, since it takes no heed of obvious
differences between the members of each primary
grouping, and therefore fails to convey so much in-
formation about the individuals concerned as an
ideal classification should. We cannot, then, dis-
pense, as yet, with the old empirical principles, and
in order to cover the ground more completely we
must combine the scheme of the Commissioners
with a preliminary subdivision of the cases on clinical
lines by picking out from the aggregate such as
have distinctive points of resemblance, even though
these points are not all of the same order.
A combination of the different systems mentioned
would appear to give the most generally useful
arrangement. Taking the whole range of persons
of unsound mind we may distinguish two '* sub-
kingdoms " thus :— '
188 THE FEEBLE-MINDED chap.
1. The Feeble-Minded : — In whom the defect
dates from *'as early in life as it can be observed."
2. The Insane : — In whom the defect occurs
" later in life." We are concerned only with the
former group, which includes —
la. The morally feeble-7ninded\ those who display
incorrigible criminal propensities.
\b. The intellectually feeble-minded \ those in
whom the defect is, primarily, one of intelligence.
In this latter class there can be distinguished,
clinically, families, the members of which, in view of
their salient characteristics, may be described,
respectively, as —
A. Ateleiotic.
B. Mongolian.
C. Microcephalic.
D. Macrocephalic.
E. Cretinous.
F. Epiloiac.
G. Plegic.
H. Progressive.
I. Residual.
Each of these groupings will supply instances of
three grades of mental defect which may be called,
respectively, ** Idiocy," "Imbecility," and ''Weak-
Mindedness."
Details of the above scheme of classification will
be more conveniently considered under the different
headings, but before proceeding further some
remarks are called for on the position which is to be
assigned to epilepsy. From the point of view of
treatment the existence of epilepsy is of great
VI VARIETIES OF FEEBLE-MINDED 189
moment, but its manifestations are so widely spread
among the feeble-minded that they do not afford
much assistance in classification. We may note
however that, in spite of this fact, according to the
scheme approved by the Commissioners in Lunacy,
cases of congenital intellectual deficiency are divided
into those complicated by epilepsy and those not so
complicated.
Moral Feeble-Mindedness
The distinction which has been drawn, for the
purposes of classification, between moral and intel-
lectual defect is, perhaps, an artificial one, and the
propriety of making it calls for some discussion
before its adoption is approved. It is easy to
understand why, as common experience teaches,
obvious intellectual defects are accompanied by
moral ones, for no individual can be expected to
follow rules of life which are incomprehensible to
him, but whether moral defect can exist apart from
intellectual is more difficult to decide.
In his treatise on psychiatry Kraepelin^ expresses
the view that in cases of moral feeble-mindedness
one never fails to find some diminution of the
reasoning faculty, and, as already noted, the Com-
mission on the Feeble-Minded include in their
definition of moral imbecility the phrase "some
mental defect." On the other hand, Maier,^ after
reviewing the whole position, comes to the con-
1 E. Kraepelin, Psychiatrie^ 1904, Bd. 2, p. 817.
^ ^ H. W. Maier, " Uber moralische Idiotic. Festschrift zu Forels
Sechzigstem Geburtstag," Journal fiir Psychologic und Neurologic^
Bd. XIII, 1908, p. 57.
190 THE FEEBLE-MINDED chap.
elusion that " there is a congenital moral defect, that
is to say, a want of appreciation of the moral
conditions of the environment, associated with
normal intellectual tendencies." Cramer,^ again,
gives it as his opinion that ''there is only one
certain clinical sign of moral idiocy and that is a
more or less well-marked ethical defect."
If the intellectual sentiments were of earlier
evolution than the ethical, the existence of a purely
moral defect would be intelligible, and the possibility
that such may be the case is not excluded by the
fact that some dull people are virtuous, while some
clever ones are not, for a certain grade of miorality
is appropriate to every intellectual level, and its
failure to appear at that level might be due to
arrested development. We get some indication of a
process of this kind in the cases to which Sir James
Crichton Browne ^ referred in his evidence before the
Royal Commission on the Feeble-Minded. " Many
nervous children in good circumstances," he re-
marked, **at certain epochs of development, sud-
denly take to motiveless and systematic lying or
stealing. Wisely treated they soon get over it and
return to the paths of rectitude."
From the psychical standpoint moral defect seems
to be due to a failure of development in the affective
sphere. We have seen already that to the primitive
organism the maintenance of its nutrition is the first
consideration and that closely bound up with the
question of nutrition is that of reproduction. Such
^ A. Cramer, Gerichtliche Psychiatrie^ IQOS) P- 352.
2 J. Crichton Browne, Rep. of the Roy. Comin. on the Feeble-
Minded., vol. I, p. 333.
Yi VARIETIES OF FEEBLE-MINDED 191
acts as further these interests are fundamentally
pleasant and therefore tend to determine the will in
the direction of continuing them. The acts which
are opposed to nutrition and reproduction are funda-
mentally unpleasant and tend to be discontinued.
The various functions involved in obtaining and
assimilating food, excreting waste products and pro-
pagating the species have thus an inherent pleasur-
able quality, which constitutes them the dominating
motives of the organism, but to render them of
maximum advantage they require to be exercised with
due regard to the environmental conditions, some
present sacrifice being counterbalanced by a greater
future gain. The primitive idea thus becomes
associated with other ideas in a complex of which
the affective tone may be different from that of the
original motive and the resulting activity will be
modified accordingly. It is an inability to associate
affected ideas, expressing itself as defect in the
evolution of the sentiments, which chiefly character-
ises the immoral mind. The defect may show itself
on the aesthetic side, which is not a matter of great
practical moment ; or on the logical side, as seems
to be the case in what is called pathological lying.
Particularly, however, it becomes manifest in regard
to the sentiment of expediency. But, as we have
seen, the sentiments involve judgments, and, that
being so, it is difficult to see how the exclusion of
an '' intellectual " element from moral feeble-minded-
ness is to be justified. The discussion as to the
possible existence of a purely moral defect has,
indeed, turned to a very great extent on the meaning
attached to the term ''intellectual." It is merely
192 THE FEEBLE-MINDED chap.
because we do, in practice, meet with cases In which,
though there is obvious immorality, the ordinary
methods of examination fail to detect any intellectual
shortcomings ; or in which the moral deficiency is so
much more in evidence than the intellectual ; that it
is convenient to establish a special class for the
reception of such cases.
Clinically the signs of moral feeble-mlndedness are,
in a typical case, those of unqualified viciousness, by
which is meant that the activities of the individual
are designed to satisfy his present desires without
any reference to the bearing of such a course on
himself or others. Judged by the accepted standard
of morals, he is purely selfish. He has no affection
for his relatives, no sense of personal or family
honour, and no reverence for family ties ; and he
will commit an offence against a member of his
family as readily as against a stranger : there is thus
not even a rudiment of the social instinct. In his
relations with the world at large, he shows an entire
lack of sympathy with man and beast, and may even
be actively cruel. Altruism Is entirely foreign to his
nature ; he is untruthful, obscene, lustful, unstable,
restless, devoid of discretion, and unregulated as to
his imagination. He makes no friends, and is
averse from doing any work ; he knows neither
gratitude, shame, nor repentance, and Is, as Maier
found in a well-marked case, so completely im-
pervious to reproaches and appeals that they produce
in him no obvious emotional reaction, whether as
regards facial expression, bodily movement, the
pulse and respiration rates, or speech. To the law
he is known as thief, train-wrecker, incendiary, or
VI VARIETIES OF FEEBLE-MINDED 193
murderer ; or as addicted to assaults, and sexual
offences of all kinds.
Grades of moral feeble-mindedness designated as
moral idiocy, moral imbecility, and moral debility,
have been distinguished, but, since the criteria
employed in the differentiation are not the capacity
for avoiding ''common physical dangers" and the
ability to earn a livelihood, this mode of classification
is unsuitable. As met with in practice, members of
the class under consideration may show a special
prominence of some only of the moral failings
above enumerated, so that it is possible to dis-
tinguish at least the following types, individual
examples of which may exhibit any stage between
mere brutishness and a shallow but audacious
cunning.
(i) The Unstable. — In this group are included
many of the anti-social individuals whom we call
" the unemployable." These are the people who
when they can be made to work are laggards in
beginning but prompt in discontinuance : such
imagination as they possess is employed in finding
excuses for resting ; the hours are too long, the pay
is too small, they have no tools, the work demanded
of them is such as should be assigned to some other
craftsman, and so on : they suffer frequently from
minor ailments of an elusive but seriously disabling
character and require lengthy periods for recupera-
tion : they are well content to live at the expense of
their relatives or of the community, and if the path
of intemperance is open to them they will follow it
to the end. Other members of the group are beggars,
vagrants, and prostitutes.
O
194 THE FEEBLE-MINDED chap.
(2) The Mendacioits. — Most people who move
about in the world have made acquaintance with
persons "whose word no man relies on " : they give
promises which they make no attempt to keep ; they
borrow money which they have no intention of
returning ; they treat with disdain the accepted
canons of honour and probity ; " good form " has no
meaning for them, and they have no reverence for
the, it must be admitted, rather quaint fetich which
men call '' sportsmanship." In more extreme cases
they are thieves or swindlers or romancers, whose
inaccuracy of statement is so phenomenal that it has
been dignified by Delbriick and others with the
imposing name of ' ' pseudologia phantastica. " From
time to time, through the intermediation of the
sensational reporter, public sympathies are harrowed
by a tale of woe unfolded in the police court by
some youthful offender. With an appearance of
truthfulness which carries conviction to all except
the most experienced minds, the small boy (or girl)
tells how he has been driven into his present pre-
dicament through oppression on the part of cruel
parents or relatives, and the hearers are raised to
heights of righteous indignation from which they
fail to detect little inconsistencies or contradictions.
Inquiries are set on foot and it soon appears that
the statements made are untrue in every material
particular. Harassed parents or guardians, whose
good faith is clearly beyond question, appear to
remove the delinquent and he enlivens the journey
home with an account of the abuses of which he has
been the victim while in the hands of the police, and,
being restored to his original circle, brags about
VI VAUIETIES OF FEEBLE-MINDED 195
the exploits which he has performed during his
absence.
(3) The Sexual. — In these cases there is more
evidence of physiological abnormality than in the
others, for not only is the sexual instinct irregular
in its mode of manifestation but it exhibits a
precocity of development which points to a definitely
pathological state of the organs involved. No
lengthy account of sexual aberrations is needed, for
the topic is one which runs no risk of being over-
looked so long as an enterprising press continues to
regale us with columns of information respecting its
various forms. The exposition of the subject is
not, of course, confined to our newspapers, and there
is a vast fund of literature on more scientific lines
now available. Whether the fact that such literature
is mainly Continental is to be regarded as evidence
that in our own country the moral level is higher
may perhaps be doubted. One caution is necessary
in regard to this matter. It is peculiarly in the
province of ethics which deals with questions re-
lating to the instinct of sex that the difficulty of
forming a correct judgment as to the expediency of
actions is met with. The canon of sexual propriety
varies with the latitude, and in all latitudes is more
or less obsolete, since nowhere is it established on
biological principles. One redeeming feature of the
ventilation which sexual matters have received of
late years is a partial blowing away of the mists of
ignorance, prejudice, and superstition which made
anything like a rational philosophy of the re-
productive process impossible. So long as the
scientific spirit actuates those who carry on the
o 2
196 THE FEEBLE-MINDED chap.
work of investigation, nothing but benefit to society
at large can result from a critical study of our
conceptions of sexual morality.
(4) The Contentious. — Kraepelin^ has described
a group of morally defective persons to whom he
applies the name '' pseudo-querulanten." They are
unduly sensitive in regard to their own interests and
violently resent any real or fancied interference
with what they esteem to be their rights. They
accept, without proof, any statement which is in
accordance with their prejudices and refuse to listen
to anything of contrary tenor. They hug their
grievances and devote themselves to revenge, pursu-
ing those whom they believe to be opposed to them
with malicious stories, molestation, abusive language,
slander, and legal process, in which they do not
hesitate to commit perjury. Their persistence brings
them into conflict with all sorts of people on whom
they try to vent their ill-will until at last every man's
hand is against them and the exhaustion of their
resources reduces them to impotent anger. Accord-
ing to Kraepelin, this type of moral defect is quite
distinct from the cases of insanity with delusions of
persecution : it represents a temperamental peculiarity
dating back to early life and therefore to be classified
as a manifestation of feeble-mindedness.
There Is but little to be said as regards the
pathology and the etiology of moral feeble-minded-
ness. Kraepelin refers to two cases in which Nissl
found evidence of chronic changes in the cortical
cells. Cramer remarks that there may be no
discoverable anatomical lesion to account for the
^ E. Kraepelin, op. cit., p. 836.
VI VARIETIES OF FEEBLE-MINDED 197
condition in cases of this kind. Bodily abnormalities
of all kinds may occur just as in the other groups of
the feeble-minded, but there is about these nothing
definitive. As regards etiology it is to be noted
that the persons under consideration generally come
of demonstrably bad stocks.
The family histories ascertained by Maier in three
of the cases which he describes at length are shown
in the following diagrams :
(I)
\ immoral 7^
/Sexually \
( immoral : J (^
\ Drunkard/
(Patient)
I
$ (Procuress)
I / Sexually \
(jUnimoral/
S
(Thief)
?
(Immoral)
(2)
/Weak-minded
\ Drunkard
■y
(3)
I
(Patient)
(Drunkard) (^-
I
(Patient)
? (Prostitute)
(Weak-minded)
— ? (Immoral)
I
?
(Normal)
In the fourth case the paternity of the child was
doubtful though there was good ground for be-
lieving him to be the son of a moral idiot with a bad
family history.
The differential diagnosis of moral feeble-minded-
ness has to be considered under two aspects, the
medical and the legal. We have to distinguish, on
the one hand, moral insanity, and on the other,
198 THE FEEBLE-MINDED chap.
criminality. The former task is relatively un-
important : all that need be said is that cases of
*' acquired " immorality do not differ in their general
character from those of ''developmental" origin,
and that the history of any given case will afford
the most satisfactory means of defining it. The
second topic supplies one of the most prolific sources
of disagreement between the medical and the legal
professions — the question of criminal responsibility.
So much confusion has resulted from the dis-
cussion as to what is the true test of responsibility
for wrongful actions that in practice every judge is, to
a great extent, a law unto himself. There are, how-
ever, well recognised underlying principles derived
from the famous '' Answers of the Judges " in the
MacNaghten case. The following summary of these
is taken from Dr. Oppenheimer's recent work.^
'' To establish a defence on the ground of insanity
it must be proved that at the time of committing
the act, the accused was prevented by disease
affecting his mind from knowing the nature and
quality of his act, or from knowing that the act was
wrong."
'* A person labouring under specific delusions but
in other respects sane shall not be allowed to benefit
by the plea of insanity unless the delusions caused
him to believe in the existence of some state of
things which, if it existed, would justify or excuse
his act."
Whether '' wrong " means either '' morally wrong "
or '* illegal," or both, is still in dispute. One may
^ H. Oppenheimer, Tke Criminal Responsibity of Lunatics^ I909)
P- 19.
VI VARIETIES OF FEEBLE-MINDED 199
comparatively easily define, in terms of the common
law or of the statute law, what constitutes illegality,
but to decide whether a thing is immoral or not is a
much more difficult matter. It is felt by many
persons that to adopt a purely legal interpretation
of the word ''wrong" is inexpedient. A person
suffering from chorea who destroys the sight of
another by an involuntary movement set up by some
unexpected stimulus can hardly be absolved from
the legal consequences of his act on the ground that
he was prevented "by disease affecting his mind
from knowing the nature and quality of his act or
from knowing that the act was wrong," and Sir
James Stephen is doubtful whether there should not
be added to the above statement of the law a clause
excusing him who is prevented '' from controlling
his own conduct unless the absence of the power of
control has been produced by his own default." In
his book on *' Criminal Responsibility " Mercier ex-
haustively considerswhat constitutes wrong-doing and
he concludes that '' to incur responsibility by a harm-
ful act the actor must will the act : intend the harm :
desire primarily his own gratification. Furthermore,
the act must be unprovoked and the actor must
know and appreciate the circumstances in which the
act is done." This teaching certainly shows a truer
appreciation of the problem than did the answers of
the judges, but it is admittedly not an exposition of
the law as it is. One deduction may, for our present
purpose, be profitably drawn from these various
dicta : it is that in each case the test is an
'' intellectual " and not a '' moral " one, and that to
regard '' moral feeble-mindedness " as involving no
200 THE FEEBLE-MINDED chap.
intellectual defect is to drag those displaying it from
the sanctuary of irresponsibility.
A similar attitude is taken up by the criminal law
of Germany, under which, as Cramer^ remarks,
'' accountability for moral defect is only excluded
when that defect is due to pathological disturbance."
It may be noted in this connection that the English
law, unlike that of Scotland, Denmark, Greece,
Italy, Sweden, and some of the Swiss Cantons, does
not provide for mitigation of punishment by formally
recognising grades of responsibility, although its
indefiniteness leaves to the judges a fairly free
hand.
Mercier's analysis of " responsibility," though not
perhaps intended to do so, raises doubts as to
whether the law relating to crime is not funda-
mentally unsound. A responsible person is, accord-
ing to him, one who is " liable to punishment on
grounds that appear fair and just to the ordinary
man when they are explained to him — grounds that
commend themselves as equitable and right, not to
the faddist, the pedant, or enthusiast, but to the
common sense of the common man of this time and
this country." The arbiter of the destinies of
society is thus to be '' the man in the street." To a
great extent this is the case already. The criminal
law is an idol which men have fashioned with their
own hands and have set up in a high place. To it
they have dedicated temples and for the adornment
of its priests they have fabricated robes of silk and
ermine. Deceived by the pretences with which they
have themselves surrounded the god, they forget that
^ A. Cramer, op. cit.^ p. 353.
VI VARIETIES OF FEEBLE-MINDED 201
his voice is but that of the people and that the
utterances which appear to proceed from his Hps
are but echoes of the cries for vengeance in which
their crude passions express themselves. Is this
the best which philosophy can do for us ? Can it
not provide us with some more practical ideal than
the satisfaction of that primitive instinct of
retaliation which was appropriate to a long past
stage of evolution ? Let us desist from the pursuit
of that ignis fatuus, a criterion of ''responsibility,"
and realise that the interest of society in any
member of its community, good or bad, sane or
insane, consists, primarily, not in speculating as to
his moral worth, but in devising schemes for turning
to the best account such powers as he possesses.
Intellectual Feeble-Mindedness
Feeble-mindedness of what has been distinguished
as the "intellectual," as opposed to the "moral,"
form exhibits no less diversity than marks the
latter. The infirmity of mind ranges from mere
defect of educability to degradation of such an
extreme type as almost to remove the subject of it
from the pale of human sympathy. Examples of
the slighter degrees of feeble-mindedness are
provided by the children who, in spite of the most
skilful teaching, cannot keep pace with their fellows
at school. Later in life the deficient capacity will
be expressed in different ways according to the sex
and the social status of the individual. If a worse
fate does not befall her, the girl of the lower classes
will become a slatternly drudge, while the one born
202 THE FEEBLE-MINDED chap.
in the purple will, perhaps, after suffering many
things at the hands of parents and tutors engaged
upon the task of moulding her to the conventional
pattern of her class, cut the Gordian knot by leaving
home with the footman or the chauffeur. The boy,
if compelled to earn his own living, will be the butt
of his workshop, and will never be able to carry out
other than the roughest forms of unskilled labour.
With a suitable environment, he may become a
hooligan, or a thief, or a deserter. Aided by the
numerous advantages which the possession of
adequate pecuniary resources confers, he may be
able to enter upon a business or professional career,
which in due course may lead him to the almshouse,
or the penitentiary ; or, if no attempt has been
made to turn his energies into profitable channels,
he becomes a wastrel and a prodigal, distributing
his means among the hoard of rascals who will have
attached themselves to him.
At the other end of the scale occur cases,
fortunately few in comparison, which are such pain-
ful caricatures of humanity that members of the
general public, seeing them for the first time, usually
suggest the establishment of a lethal chamber, as
affording the only feasible method of dealing with
them. Entering a ward in one of our asylums for
idiots, one may observe huddled up on a bed, since
it can neither stand nor sit, a piece of life's flotsam
with mis-shapen head, deformed chest,, twisted spine,
and distorted limbs. Its hands are claws, and if it
exhibits only two complicated forms of club-foot,
that is, apparently, because the circumstances do
not permit of more. At intervals it shrieks in an
VI VARIETIES OF FEEBLE-MINDED 203
uncanny way for the food with which it is unable to
feed itself and over which it would choke but for the
care of the attendant. Saliva dribbles from its
mouth as it gnaws at the bed-clothes, and its
excretory organs perform their functions without
control. The expressionless features twitch gro-
tesquely and from time to time the ungainly frame
is racked by convulsions.^
As illustrating an intermediate type we may take
those cases, usually classed, without special reference
to the definition of the Commission on the Feeble-
Minded, as '' imbeciles," which one meets with in
such institutions as asylums. For these the world
is a very small stage. The trivial round, the
common task, furnish them with sufficient interests
and about those few interests their feelings are as
keen, if not as enduring, as those of the normal
person. There is, in fact, little of that limitation in
the affective sphere which is peculiarly characteristic
of moral feeble-mindedness. Their want of experi-
ence makes them easily misled, but they have no
^ The following description of idiots as Dr. Pariset saw them long
ago is worth rescuing from the comparative obscurity of Seguin's
Traitement Morale Hygiene et Educatio?i des Idiots^ published in
1846 ; " Quel spectacle ! I'un s'agite en forcene, vocif^re et crie ;
I'autre se tient accroupi dans le silence et I'immobilitd d'un automate ;
le premier a qui vous adressez la parole se sauve en ricanant ; le
second vous envoie k profusion des salutations et des baise-mains ; un
troisieme se couvre de signes de croix ; un quatriem.e se couche k terre ;
un cinqui^me se mord .les doigts en riant d'un rire insense. Aux
questions que vous leur faites, pas un ne fait une rdponse intelligible,
tant leur langue est embarrassde, tant leur voix est sourde, confuse et
inarticulde. ... lis ont des yeux qui voient et qui ne regardent pas ;
des oreilles qui entendent et qui n'ecoutent pas. S'ils ont des jambes
inhabiles a la station, a I'equilibre, a la marche, au saut, ^ la course,
leurs mains incertaines sont egalement inhabiles a toucher, a saisir, a
mouvoir, a deplacer les corps."
204 THE FEEBLE-MINDED chap.
inherent prejudice against virtue, and are quite
willing to be as good as they know how to be.
When their simple wants in the way of food and
clothing are satisfied they are cheerful and contented
and quite ready to devote themselves to the tasks
assigned to them, until their small fund of energy
is exhausted. They are apt to be impolite and
uncouth, disdaining distinctions of rank, and
recognising no order of precedence except that
which gives them the first place ; but their failings,
unlike those of the morally feeble-minded, are
almost entirely due to Ignorance and are easily
eradicated by suitable training. Indeed, they tend
under tuition to go to extremes in the other direc-
tions : they will say *' Good Morning " at whatever
hour or however frequently one meets them, and
the males will indulge in amusingly extravagant
parodies of the salutes with which the attendants
acknowledge the presence of superior officers, while
the females may become great sticklers for the
proprieties and may show themselves eager to dis-
play their familiarity with what they esteem to be
the rules of etiquette. ''Why do you stick your
little finger out like that ? " was asked of an imbecile
girl who was lifting her teacup with much empresse-
ment, " That's manners ! " was the reply, in a tone
expressing surprise at the questioner's ignorance of
correct social usage. Among the females, too, the
love of finery Is strongly pronounced, though the
decorative effect achieved Is sometimes a little
bizarre. The incapacity for adapting means to ends,
which is a prominent feature of imbecility, comes
out, perhaps, in no more striking fashion than in the
Yi VARIETIES OF FEEBLE-MINDED 205
playing of games. At football, for instance, the sole
principle recognised is to kick the ball hard.
Nothing in the way of combination occurs, and the
ball will pass to and fro in the middle of the field
throughout the whole of the game unless some
enthusiast kicks it through his own goal ; a pro-
ceeding, by the way, which earns for him loud
applause from the rest of his side. Cricket is
conducted on similar lines. Unless prevented by
those in charge the spectators squat around the
wicket, undeterred by the imminent probability of
" wides " or of a batsman's vigorous swipes, resulting
in the despatch among them of both ball and bat.
The ball is chased by half the field ; easy catches
are muffed ; wild shies are made in all directions ;
and, finally, unless the contingency has been guarded
against, the result of the match may remain in doubt
owing to the scorer's having placed all the runs for
both teams to the credit of the first man whose name
happens to have caught his eye.
A sense of humour, which is, after all, mainly a
sense of proportion, is hardly to be expected among
imbeciles, but obvious jokes and the antics of the
knock-about comedian are rewarded with hearty
laughter. Displays of primitive passion appeal to
their sympathies, and the instinctive tendency to
find gratification in the misfortunes of others is not
kept in check. Naive allusions to sexual matters
may be made, and in view of the difficulties attend-
ing the subject, it is not surprising to find that
quaint interpretations are put upon the teachings of
religion.
The picture has, of course, its shadows ; the more
206 THE FEEBLE-MINDED chap.
so since the earlier years of an imbecile's life are
often passed in circumstances which provide him
with abundant experience of vice. Many imbeciles
are mischievous and prone to outbreaks of temper
which may lead to violence : they may fight with
one another, or smash windows and table-ware :
they may use obscene and abusive language, or
indulge in sexually immoral conduct : they may
steal food or anything else which excites their
cupidity : they may set fire to the ward in which
they live, or generally, they may give trouble in any
of the score of ways which those in charge of them
usually include under the generic term " playing-
up."
ATELEIOTIC FORMS
It Is a moot point whether feeble-mindedness Is
ever a purely quantitative and not a qualitative
defect of mental capacity. Theoretically, there is no
difficulty in supposing that the process of normal
development may simply stop when a certain stage
has been reached, leaving the individual concerned
in a state of permanent infantilism or juvenility, but
in practice it Is rare to find a case which can be
confidently accounted for in this way. Infantile
characteristics are common enough among the
feeble-minded, but they are almost always closely
Interwoven with signs which suggest that the
current of growth has been deflected at some point
from its proper course. We do, however, occasion-
ally meet with what may be described as ''minds in
miniature," which may perhaps be associated with
bodies of the same order. The sensory apparatus
VI VARIETIES OF FEEBLE-MINDED 207
is efficient but limited in the range of its utility.
Memory is of the ordinary type, so far as it goes,
there being neither the gross incapacity nor the
one-sidedness which the ''qualitatively" feeble-
minded may exhibit. Ideas are associated in a
normal way. Judgments, if few, are sound, and
conclusions, if they are drawn at all, are logically
deducible from their premises. Most important
of all, presentations and representations have
the affective colouring which is in harmony with
the experience of the majority, and which must,
therefore, be regarded as the natural one. The
emotions are not, however, strongly pronounced, and
they do not supply any very powerful incentives ;
thus the sexual instinct may remain in abeyance to
a great extent. Speech may show the defects due
to a lack of grasp of grammatical principles. Such
unprofitable forms of industry as playing with dolls
collecting the numbers of passing motor-cars, string-
ing used postage stamps into the semblance of a
serpent, or other of the futile employments which
children ordinarily grow out of, may occupy the
years which should be devoted to more serious
labours. There may be a disinclination to leave
the mother's apron-strings. Irresolution, depend-
ence, suggestibility, and want of tenacity of purpose,
may make persons of this class a prey to the
pernicious influence of some stronger mind, but the
activities in which their thought expresses itself are
never wilfully anti-social. On the physical side also
there may be persistence of juvenile characteristics,
e.g., a childish voice ; ill-developed sexual organs
and want of union of epiphyses.
208 THE FEEBLE-MINDED chap.
In another group of cases a condition of infantilism
seems to be dependent on disease of some particular
organ, e.g., the pancreas, the liver, the adrenal, or
the pituitary ; or to be a sequel to some general
disease, e.g., congenital syphilis.
When the retardation of development is so marked
as to be accepted as pathological, there may con-
veniently be used for it the term '* Ateleiosis "
{aTe\r)s, not arriving at perfection), which seems to
have been originally employed, with a somewhat
narrower signification than is here given to it, by
H. Gilford.^
A good example of "Ateleiosis" was recently
brought before the Royal Society of Medicine by
Dr. F. Parkes Weber.^ This was the case of a man
aged 42 years, whose development seemed to have
ceased at about the age of 9 or 10 years, though in
some respects the proper attributes of his age were
recognisable.
THE MONGOLIAN, KALMUCK OR TARTAR TYPE
Custom has for so long sanctioned the application
of the name ''Mongolian" to the group of feeble-
minded persons about to be described, that it is
convenient to retain the designation, even though
its meaning is vague and its suggestion of a
resemblance to any of the Chinese types of physi-
ognomy is largely fanciful. The physical pecu-
^ H. Gilford, "Ateleiosis, a Disease characterised by Conspicuous
Delay of Growth and Development," Med.-Chir. Trans. ^ 1902, p. 305.
■J- F. Parkes Weber, "Ateleiosis in a Man aged 42," Proc. of the
Royal Society of Medicine, June, 1910.
VI VARIETIES OF FEEBLE-MINDED 209
liarities of Mongolism are nevertheless sufficiently
distinctive, in most cases, and make up a clinical
ense^nble which renders diagnosis easy, although no
one feature can be regarded as pathognomonic.
A consideration of the various abnormalities which
have been noted by different writers, shows how
numerous are the morbid appearances which may
be exhibited. Stated briefly, the signs of Mongolism
may include any or all of the following conditions,
which are arranged according to the requirements of
clinical convenience and without reference to their
relative significance, since that is decidedly obscure.
(Fig- ^3-)
Head small, with high cephalic index owing to the
depression of the glabella and the want of promin-
ence of the occipital region. The cephalic index
has been recorded as having reached loo, i.e., the
antero-posterior and transverse diameters of the
head were equal.
Eyes wide apart, with the palpebral fissures
sloping upwards and outwards, the lids displaying
the condition of epicanthus, and bearing few lashes ;
unilateral ptosis, and strabismus, nystagmus, and a
speckled condition of the iris ; chronic blepharitis
going on to corneal opacity, ectropion, and epiphora.
Nose short, nostrils looking forward. Adenoids.
Ears small and rounded.
Tongue large and fissured, protruding from mouth
if very large.
Skin of face red, of hands thick and wrinkled ;
chilblains.
Deformity of thorax, knock-knee, flat-foot. Hands
and feet broad ; digits thick and webbed ; thumb
p
210 THE FEEBLE-MINDED chap.
and little finger short, and the latter abnormally
curved ; second toe relatively too long.
Laxity of ligaments and hyperextensibility of
joints.
Congenital, and other, forms of heart disease.
Abdomen large and tumid ; umbilical hernia ;
constipation.
Of these signs the most characteristic are, perhaps,
the redness and flatness of the face, the state of the
tongue and the obliquity of the eyes ; which last,
though responsible for the name given to the type, is
by no means invariably present. Epicanthus is an
hereditary character not peculiar to Mongolism,
since, as Ashby showed, it occurs among the
relatives of Mongols as frequently as among the
Mongols themselves, and it is also met with in
families which show no trace of Mongolism. All
the remaining morbid conditions may be encountered
in cases of feeble-mindedness which do not in other
respects conform to the Mongolian type.
It is not surprising that the considerable degree of
abnormality which the head displays in Mongolism
should obliterate the numerous, but individually
unimportant, differences which serve to distinguish
human beings of the same race, and that, con-
sequently, well-marked cases of Mongolism should
resemble each other so closely that they look like
members of the same family. Taken together, the
signs of Mongolism suggest that the condition is due
to some definite, if unknown, disorder of nutrition,
and the morbid process may be far-reaching in Its
effects or of but limited extent. The mental
symptoms show, as might be anticipated, a certain
VI VARIETIES OF FEEBLE-MINDED 211
parallelism with the physical, and all grades of defect
are found from simple weakness of mind to complete
idiocy. There are, however, certain features of the
mental state which may be noted. When sufficiently
intelligent to be capable of such manifestations
Mongols often show an imitativeness and an appre-
ciation of rhythm which are rather striking. They
are good tempered as a rule, though infants showing
the condition may be subject to storms of passion,
willing and submissive to authority. They show
an interest in what is going on about them, and
sometimes they are lively, talkative and restless.
There is a marked immunity from epilepsy, but they
may simulate epileptic fits if they are in wards
which provide them with models to copy. It may
be that the early death which overtakes most
Mongols is in some measure accountable for the
absence of epilepsy among them. Of the six cases
referred to below, one, a woman of twenty-five, has
had several apparently genuine epileptic fits in
addition to the imitation ones with which she
sometimes favours observers, while another had, at
the age of twenty-three, a series of slight and
transient convulsions affecting only the left side of
the body. As with other diseases there is an inverse
ratio between the severity of the symptoms and the
duration of life. Dividing the cases according to
their powers of taking care of themselves and of
doing useful work, we find that the idiots die young,
the imbeciles probably break down before reaching
middle life, while the weak-minded, if suitably cared
for, may attain a fairly advanced age. In the milder
cases the state of puberty is duly arrived at though,
P 2
212 THE FEEBLE-MINDED chap.
perhaps, a little late ; thus in six female Mongols, of
ages ranging from twenty to thirty-nine years, under
the writer's care, menstruation is normal except in
the case of the eldest one who suffers from
menorrhagia.
The proportion of Mongols to the whole body of
the feeble-minded at any age is difficult to ascertain
accurately. Shuttleworth states that they consti-
tuted about 5% of 2900 admissions to the Royal
Albert Asylum and that the condition is commoner
in the north of England than in the south. Among
250 male feeble-minded children, between the ages
of 5 and 16 years, the writer found 6 Mongols, and
among a similar group of female children, 8, i.e.,
taking the sexes together, nearly 3% ; while among
600 females over the age of 16 there were 5 cases.
Both the institutions from which the figures were
obtained are in the south of England. According to
H. Vogt, Mongolism is much less common in Ger-
many than in England, supplying only 1% of the
cases of feeble-mindedness.
As regards the causation of Mongolism there is
little to be added to what has been said on the
general subject of etiology in Chapter V. Several
observers have tried, with some success, to connect
the development of this form of feeble-mindedness,
in the child, with a state of impaired nutrition, in
the mother, during pregnancy. The children have
certainly, in many cases, been the last members of
large families so that the mothers at the time of
conception were approaching the age of decline of
the reproductive powers. That some other factor
besides the age and exhaustion of the mother has
Fig. 14.^ — Lateral aspect of the left hemisphere of the brain of a Mongolian
idiot.
Fig. 15. — The microcephalic idiot whose brain is shown
in Figs. 16, 17, 18.
[Face page 213.
VI VARIETIES OF FEEBLE-MINDED 213
to be taken into account is shown by the following
table of the family history of twelve of the most
recently reported cases. The first eleven are from
the Proceedings of the Royal Society of Medicine
for May 1909, the last from the Lancet for January
ist, 1 9 10.
Position of child
Age
of mother at Recorded
in family
birth of child by
I.
Only child ...
...
43]
2.
2nd of 2
...
40 -
Dr. G. A. Sutherland
3-
3rd of 3
...
4-
Last but one of large family
40]
2nd of 3
~\
Dr. F. J. Poynton
6.
3rd of 3 ...
-J
7.
8.
Only child ...
loth of II ...
261
39)
Dr. F. Langmead
9.
1st of 2
40]
10.
loth of 10 ...
44
Dr. H. M. Fletcher
II.
4th of 5
32/
12.
7th of 7
43
Dr. J. P. Cullen
Mongolism being a comparatively rare condition
the number of cases in which an examination of
the brain after death has been made is small. Fig.
14, which is a photograph of the brain of a Mon-
golian idiot, aged about 6 years, shows no very
striking peculiarities except the smallness of the
superior temporal convolution. The roundness and
shortness of the hemisphere and the concavity of
the orbital surface are to be correlated with the
shape of the skull, though which is to be regarded
as cause and which as effect is open to discussion.
The right hemisphere weighed 1 5f ozs. and the left
15 ozs., while the cerebellum, pons, and medulla
together weighed 2>2 ^^^-^ ^^^ cerebrum thus con-
stituting 8978% of the whole encephalon. The
ratio of the several parts of the brain undergoes
change during growth, and in the absence of statistics
214 THE FEEBLE-MINDED chap.
relating to normal brains of males at the age of this
case, it is impossible to say to what extent this
particular brain is exceptional, but if Huschke's
figures giving the weight of the cerebrum as 93%
of the total brain weight at birth and '^'jj^ at
maturity be correct there is little indication here of
the abnormal smallness of the cerebellum which has
been described as a feature of the Mongolian brain. ^
On the whole it seems most satisfactory to regard
Mongolism as a distinct pathological entity referable,
as, for example, cretinism is, to a disturbance of
the function of some glandular structure of which
the physiology is as yet but imperfectly known.
Bufe ^ found that Mongols excrete lime salts to
only a slight extent in the urine, but that a much
larger amount than in normal children of the same
age is excreted in the faeces. The disease has thus
some points of contact with osteomalacia and he
suggests that its occurrence depends on an abnormal
trophic action of the sexual glands.
MICROCEPHALIC TYPE
The cases of feeble-mindedness which fall into
this category form a less natural grouping than
those just described since the establishment of
the class is conditioned by the arbitrary selection of
one particular anatomical feature instead of having
reference, as in Mongolism, to a number of such
characters. Opinions differ so much as to what
Ix ^ Paul Biach, " Zur Kenntnis des Zentralnervensystems beim
Mongolismus," Deutsche Zeitschr. ^. Nervenheilk, Bd. ^7^ H. 1-2,
p. 7.
V ^ E. Bufe, Die mo7igoloide Fonjt der Idiotie. Zeitschr. f. drztl.
Praxis^ No. 3.
VI VARIETIES OF FEEBLE-MINDED 215
constitutes a small head that it becomes necessary
to agree upon a standard of measurement. Ireland
includes all cases having crania with a maximum
circumference of 17 inches or less, and his ruling
is generally followed in this country. In Germany,
Schwalbe's plan of fixing the maximum circum-
ference at 45 cm. or the maximum brain weight at
900 grms. is more usually adopted. Something, of
course, depends on the age of the patient. Accord-
ing to Ashby and Wright ^ the average circum-
ference of the normal head is 18 in. at i year, 20 in.
at 2 years, 21 in. at 4 years, and 21^ at 10 years.
They state the position thus :
" If a child's head is 3 in. under the average cir-
cumference for its age the child will be an imbecile.
If 2 in. under the average the child will probably be
feeble-minded in more or less degree. Thus a child
from seven to ten years with a head measurement of
19 in. or under, and at the same time fairly well-grown
for his age, is almost certain to be of weak intellect."
Berkhan ^ gives the following as the average
measurements, for males, of the circumference of the
skull at the ages mentioned :
Age
Measurement
6 months
40 cm.
I year
45-5 cm.
2 years
47'5 cm.
5 years
50 cm.
10 years
52 cm.
15 years
54 cm.
20 years
55
to 55-5 cm.
in the case of females the measurements are, for
1 H. Ashby and G. A. Wright, The Diseases of Childre7i^ 1905, p.
584.
2 O. Berkhan, tjber den angebore7ten oder friih sick zeige?iden
Wasserkopf dr^c. Die Ki7iderfehler. '] Jahrgang p. 49.
216 THE FEEBLE-MINDED chap.
children, o'5 to i cm., and, for adults, 2 to 2*5 cm.,
less.
Apart from the small size of the head there is
clinically so little which is distinctive about micro-
cephaly that the interest of the condition is mainly
pathological. The well-marked abnormality which,
as a rule, the microcephalic brain exhibits has opened
up a fertile field for theorists, although the total
number of brains studied is as yet so small that
definite conclusions as to the fundamental causes of
the defect can hardly be arrived at. Biassed in their
judgment by the study of particular instances which
have fallen into their hands, different writers have
propounded hypotheses which, as a wider survey
shows, are individually inadequate. Speculation
upon the genesis of pathological states of the nervous
system takes three principal directions. The abnor-
mality may be due to causes, such as mechanical
interference or infection, which produce gross lesions
of the growing organ ; it may represent a return to
an earlier stage in the development of the organism,
i.e.y it may be reversionary ; or thirdly, it may be
explicable as a more or less irregular curtailment
of those vital activities which result in growth.
Explanations of microcephaly on all three of these
lines have been advanced from time to time. With
the first hypothesis the name of VIrchow is particu-
larly associated ; with the second that of K. Vogt ;
with the third that of Aeby.
The notion, ascribed to VIrchow and to Baillarger,
that a small brain was to be accounted for by pre-
mature synostosis of the bones of the skull, received
some support from the occasional occurrence among
VI VARIETIES OF FEEBLEMINDED 217
microcephalic idiots of hypertrophied scalps which
seemed to be intended to cover larger skulls than
actually bore them. It led to operative procedures
which, however useless they may have been in other
respects, served to dispel confidence in a seductive,
but entirely unwarranted assumption. Traumatism,
obstruction of blood-vessels, and inflammatory pro-
cesses may, however, be responsible for a maiming
of the brain which may prevent its reaching the
normal size and weight.
In 1867, when Vogt published his paper, biologists
were engaged in a lively discussion of the evolu-
tionary theory which Darwin had promulgated a
few years before, and an intemperate zeal led the
adherents of the new school of thought to conclude,
somewhat rashly, that microcephalic idiots repre-
sented a return to the simian stage in the genealogy
of human beings — a view which Darwin himself
seems to have accepted. Although it soon became
apparent that this explanation was not particularly
well founded, there can be little doubt that develop-
mental errors play their part in the production of
the small brains of microcephalic idiots, though to
what extent those errors are due to a process of
reversion remains open to question. In a case
which he investigated with great thoroughness,
G. Mingazzini^ found what he regarded as evidence
of two distinct series of anomalies, one due to
arrested growth, the other to ''true atavistic retro-
gression." Cunningham and Telford-Smith ^ ex-
Cr^i G. Mingazzini, Beitrag zum klinisch-anatomzscken Studimn der
Mikrocephalie. Monatssch. f. Psychiat, u. Neurol. Bd. 7, 1900, p. 429.
,J- D. J. Cunningham and T. Telford-Smith, "The Brain of the
Microcephalic Idiot," Trans, of the Roy, Dublin Soc, vol. 5, 1895.
218 THE FEEBLE-MINDED chap.
amined in much detail the brains of two micro-
cephaHcs, *'Fred" and ''Joe," and their report shows
a distinct leaning towards the ** atavistic " hypothesis.
In regard to the brain of '' Fred " they say : — '' We
do not think that it is possible to avoid the con-
clusion that we are dealing with a case of partial
atavism or a case in which the brain, so far as its
convolutionary condition is concerned, has reverted
wholly or partially to a condition in which it existed
in an early stem-form." They consider that the
brain of "Joe" also displayed ''simian features."
That no simple solution of the problems of
microcephaly is likely to be found becomes in the
highest degree probable when the wide differences
in type which small brains may display is clearly
recognised. A comparison of several brains which
have passed through the writer's hands will
demonstrate this, and since there are still but few
records of such brains, a brief description of each
will not be superfluous.
H. H : — male, aged at death 28 years. (See Figs,
15 to 18.)
Weight of right cerebral hemisphere 5| ozs.'
» „ left „ „ 6 ozs./^^*[-i5 ozs.
„ „ cerebellum, pons, and medulla
,.. 5|ozs.| ^^
,.. 6 ozs./^^4l
... 3f ozs. J
These weights were taken after stripping and
after the brain had been preserved in ten per cent,
formalin for several months. In such circumstances
brains are said to gain ten per cent, in weight, so
that the weight in the fresh state would be less than
14 ozs. The convolutions are reduced in number
rather than in size, and there are considerable
differences between the two sides. At the right side
Fig. 1 6. — Lateral aspect of the right hemisphere of a microcephalic brain.
Fig. 17. — Lateral aspect of the left hemisphere of a microcephalic br
[Face page 21
Fig. 1 8. — Mesial aspect of the hemispheres shown in Figs. i6 and ij.
■1
\ '"
f -.
^^B
/-
^^^K ■
J
V
\
*«^J^^^H
^^^^^B
r ^
^^
J
^^^^H
HHJC
j:^
^p
^^^^^^^H
^^H
1
Fig. 19. — Lateral aspect of the left cerebral hemisphere of a microcephalic
idiot. The parieto-occipital region is represented by a sac of which
the cavity is continuous with that of the lateral ventricle.
[Face page 219.
VI VAKIETIES OF FEEBLE-MINDED 219
the fissures of Sylvius and Rolando are directly
continuous with each other, forming a single furrow-
running from the dorsal to the ventral aspect, while
the parallel sulcus is separated by a narrow gyrus
from the intra-parietal which, in its hinder part,
forms the boundary of an operculum overlapping the
occipital convolutions. At the left side the Sylvian
fissure is slightly more normal in its arrangement,
and, while the parallel sulcus is carried far back,
there is no definite operculum. In both hemi-
spheres the parieto-occipital fissure runs well out
over the outer face of the hemisphere and joins the
intra-parietal.
E. G. : — male : died at age of 26 years. (See
Fig. 19.)
Weight of right cerebral hemisphere ... ... 9| ozs.
„ J, left „ „ I2f ozs./^'^s [-29I0ZS.
„ 5, cerebellum, pons, and medulla ... 7 ozs.
}22il
In the right hemisphere the mid-frontal con-
volution only extends half-way to the apex of the
lobe ; the ascending parietal convolution is divided
about the middle by a gap which contained an
arachnoid cyst one inch in diameter ; behind the
post-central sulcus a single convolution represents
the only normal portion of the parietal lobe : the
parallel sulcus runs up into the Sylvian fissure ; the
calloso-marginal sulcus is continuous with the post-
central and from the junction a groove runs across
the ventral aspect of the hemisphere to the middle
temporal sulcus. At the left side the fissure of
Rolando joins the end of the Sylvian ; there are no
normal convolutions behind the ascending frontal ;
the calloso-marginal ends blindly and a sulcus
220 THE FEEBLE-MINDED chap.
parallel to its hinder part runs across the ventral
aspect as on the right side.
In each hemisphere the parietal and occipital
regions are represented by a sac with walls about
-| in. in thickness which show an indefinite arrange-
ment of grey and white matter.
This case exhibited in a marked degree the
hypertrophy of the scalp above alluded to, a series
of antero-posterior ridges and furrows suggesting
the arrangement of the ranks of bristles in a
brush.
F.W. : — female : died at age of 32 years. (See
Fig. 20.)
Weight of right cerebral hemisphere 6| ozs.l A
» » left „ „ 7 ozsJ^3?li8Jozs
„ „ cerebellum, pons and medulla ... 4^ ozs. J
As will be seen from the photograph this case is
marked by a deficiency in the size rather than in the
number of the convolutions, considerable areas of
the cortex showing only the slightest differentiation
into folds. In the left hemisphere the frontal and
occipital regions are comparatively normal in
appearance except for the small size of the convolu-
tions, but the parietal and the hinder portion of the
temporal region present the aspect of an irregularly
tuberculated surface with some trace of mis-shapen
radiating convolutions in the upper part. The
whole motor area, with the fissure of Rolando, Is
reduced to a shrivelled sclerosed plate, the central
lobe being exposed. On the mesial aspect the
marginal convolution is very narrow, and the calloso-
marginal fissure terminates opposite the middle of
the corpus callosum. The parieto-occipital fissure,
Fig. 20. — Left lateral aspect of the brain of a female microcephalic idiot.
Fig. 21. — An epileptic idiot with well-marked adenoma
sebaceum.
\_Face page 220.
VI VARIETIES OF FEEBLE-MINDED 221
which extends for a long distance over the outer
surface of the hemisphere, is separated from a double
calcarine fissure by a small gyrus. At the right
side normally convoluted regions occur In the
anterior part of the frontal lobe, the posterior part
of the occipital, and the middle part of the parietal,
the Intervening areas, together with the middle
temporal convolution, being poorly developed and
showing the tuberculated appearance already men-
tioned. The central lobe Is even more completely
exposed on this side than on the other, owing to
the small size of the various opercula which ordinarily
overlie it. Mesially the condition is much like that
at the left side, except that the doubling of the
calcarine fissure is less obvious. Comparison of
the type of deformity which the brain exhibits with
that shown by the case of porencephaly figured in
the photographs 9 and 10 suggests a mode of
origin common to both, and the brain under notice
did in fact show traces of hollowing In connection
with a cyst of the pla-arachnoid In the posterior part
of the frontal region at the right side.
Accepting Schwalbe's standard of 900 grms.
(roughly 2 lbs.) as denoting the weight which
constitutes the upper limit of microcephaly, the
porencephalic brain just mentioned, which weighed
31 ozs., must be regarded as an example of the
condition. There were also, In addition to that of
H. H., two brains below 32 ozs. in weight among
the 100 cases referred to in an earlier chapter as
series A. Of these one, which weighed 31^ ozs.,
presented no very striking features beyond opacity
of the pia-arachnoid and excess of cerebro-spinal
222 THE FEEBLE-MINDED chap.
fluid, while the other, which weighed only 28|- ozs.,
is shown in Fig. 5. Its abnormality is expressed
mainly in the want of development of the right
hemisphere, which weighed only 6f ozs., the weight
of the left being 1 7f ozs.
In view of the anatomical differences which the
brains of microcephalics exhibit, it is not surprising
that the mental symptoms show little indication of
belonging to a distinctive type. As with most of
the other groups of the feeble-minded, a high degree
of abnormality in the brain connotes a low degree of
intelligence. All the cases with heads measuring
less than 17 inches in circumference have been, in
the writer's experience, such as would be classed as
idiots, but many small-headed persons are to be found
in the ranks of the imbeciles and the weak-minded.
The patient H.H., whose skull was found at the
post-mortem examination to have a maximum cir-
cumference of I5|- inches, was of faulty habits
and of destructive disposition. He made attempts
at speech but never said anything intelligible. He
learnt to feed and dress himself after a fashion and
on occasion would do a little work, e.g.^ dusting
or polishing in his ward.
E. G. was also faulty In habits and even more
incapable of looking after himself than H. H. Thus
he had to be fed since, even when supplied with a
spoon and a basin of food, he did not seem to know
what to do with them. Yet he would ask for food,
saying, e,g., ''Teddy like milk" and would call
attention to the fact that he had wet himself. He
obviously had some notion of his own personality
since he would come when called. It Is worth
VI VAUIETIES OF FEEBLE-MINDED 223
noting that, notwithstanding the condition of his
occipital lobes, he was apparently not blind though
his sight was doubtless very defective. He could
find his way about the ward and airing-court,
avoiding obstacles, and seemed to recognise those
who had charge of him. It Is recorded of him that
he liked to stand facing the sun, which suggests that
he could perceive light but that his retinae were not
very sensitive.
The female patient F. W. could make Inarticulate
noises but was unable to talk. Owing, In part at
any rate, to deformity of the feet, she was unable to
walk and she had to be dressed and undressed and
fed, while she never acquired even the rudiments of
the art of attending to her personal cleanliness.
In two cases of microcephaly brought before
the Royal Society of Medicine, Carpenter^ found
changes in the fundus oculi which, though not
specially characteristic of the condition, are worthy
of notice. A female child aged 2^ years, with a head
1 5 inches in circumference, showed In the central
region of the left retina a large patch of choroidal
atrophy believed to be due either to a coloboma
or to syphilitic choroiditis ; while another female
child of five months, whose head measured 14
Inches, showed a dense ring of black pigment round
the right optic disc.
MACROCEPHALIC TYPE
Just as there are to be found among the feeble-
minded a certain number whose heads are unduly
^^ G. Carpenter, "Two Cases of Microcephaly: Changes in the Fundus
OcuH," Froc. Roy. Soc. of Medicine., Nov. 1908.
224 THE FEEBLE-MINDED chap.
small, so it is possible to pick out others with heads
exceeding, sometimes by a relatively large amount,
the normal dimensions. The group of large-headed
or, as they are often called, Macrocephalic cases is a
distinctly artificial one, since no standard of maxi-
mum size for normal heads has been agreed upon.
Moreover, whereas a small skull is clearly incom-
patible with a large brain, the converse of this state-
ment is not necessarily true, for a large skull affords
no evidence whatever of an accumulation of nervous
tissue. As to the size which heads may attain, it is
very rare for a circumference of 30 inches to be
exceeded, though Seguin speaks of a girl, aged
seventeen years, whose head measured thirty-seven
inches and Millard^ has recorded a case in which the
circumference was ninety cm., and the distance from
ear to ear over the vertex, 75 cm.
The feeble-minded, probably even more than the
mentally sound, are liable to the diseases of skeletal
structures known as rickets, acromegaly, leontiasis
ossia, achondroplasia, osteitis deformans, and syphi-
litic osteitis ; and still more frequently do they
show enlargement of the skull due to its expansion
under the pressure of contained fluid, as occurs in
hydrocephalus. When all these conditions can be
excluded, the presumption is that the large head
contains a large brain, but even so the probabilities
are all in favour of the view that only a small propor-
tion of the encephalic mass is of functional value
from the psychological standpoint.
A subdivision of the class of macrocephalics on
U'l K. Millard, " An Extraordinary Case of Hydrocephalus," Jour7i. of
America7i Med, Associatio?t^Yo\. 51, No. 2, p. 128.
VI VARIETIES OF FEEBLE-MINDED 225
the anatomical lines just laid down will supply the
most convenient arrangement of the cases. As in
the case of microcephalics, it Is not feasible to estab-
lish a classification on a purely psychological basis,
but such distinctions as can be drawn in regard to
the mental state will be duly noted. To each group
the test of social capacity can be applied as with the
other types, and groups of idiots, imbeciles, and the
weak-minded established.
(i) Cases in which the large size of the head is
referable to disease of the bone. The attendant mental
defect is in these cases apparently a mere accident.
Large and badly shaped heads are quite consistent
with soundness of mind, but they occur among the
feeble-minded with a relatively greater frequency
than among ordinary individuals. Rickets seems to
be the most prolific source of the abnormality. It
results in the production of a skull irregularly thickened
and perhaps asymmetrical, with bosses on the
frontal and parietal bones. The cranial vault is
flattened and the forehead bulgy, while the fontanelles
may not be completely closed.
(2) Cases In which there is an excess of fluid
within the cranial cavity. These are examples of
the condition known as hydrocephalus. Not all
hydrocephalics are large-headed, and therefore a
certain number of cases in which hydrocephalus is
associated with feeble-mindedness must, owing to
the lack of distinctive clinical features, be relegated
to the residuary group ; but when the, as yet, not
fully known conditions which give rise to accumula-
tion of cerebro-splnal fluid act in early life, there
takes place an expansion of the skull, affecting more
Q
226 THE FEEBLE-MINDED chap.
particularly the thinner and less firmly united bones
of the vault, which in a well-marked case results in
the production of a sub-globular cranium of char-
acteristic shape. How rapidly the enlargement may
take place is illustrated by a case recorded by E.
Schneider,^ in which the measurement of a child's
head increased from 44 cm. to 71 cm. in less than
4 months.
Although there is no simple ratio between the
dimensions of the skull and the degree of mental
defect, the higher measurements are associated with
considerable impairment on both the sensory and
the motor sides. Apparently as the result of the
stretching of the optic and auditory nerves, sight
and hearing may be greatly interfered with. There
is general muscular weakness, and this, taken in
conjunction with the weight of the contained fluid,
causes the patient to seek support for the head either
on a pillow or on the back or arm of his chair. In
the bed-ridden cases, partly from a disturbance of
the cerebral functions and partly from want of
exercise, atrophy of the muscles and contracture
occur, though movement may be induced from time
to time through the onset of epileptic seizures. It
is perhaps the being, so to speak, tied down by the
head which makes hydrocephalics lethargic and
docile, at any rate they rarely indulge in the rest-
lessness and ill-temper which some of the feeble-
minded display.
About the pathology of hydrocephalus there is
^ E. Schneider, Ein Fall von aussergewohnlicher Grosse eines
kindlichen Wasserkopfes ; v. Jahresbericht liber die Lelstungen und
Fortschrltte auf dem Geblete der Neurologle und Psychlatrle^ 1909,
p. 505.
VI VARIETIES OF FEEBLE-MINDED 227
little to be said, except by way of surmise. The
accumulation of fluid usually takes place in the lateral
ventricles of the cerebrum, causing a dilatation which
flattens out the convolutions against the inner aspect
of the skull and reduces the wall of the hemisphere
to the thickness of a few millimetres. There is
evidence of increased intra-cranial pressure so that
some more potent force than that of simple transud-
ation from blood-vessels is called into play, but it is
not clear whether the choroid plexuses actively
secrete the cerebro-spinal fluid against an increasing
resistance, or whether the conditions are such, owing
for instance to the presence in the ventricles of some
soluble substance, that an abnormal osmotic flow
from the blood-vessels is determined. When, as in
cases of cerebellar tumour, there is obstruction of
the veins of Galen, the state of affairs sufficiently
resembles that found in some forms of ascites to
render the pouring out of fluid from the congested
choroid plexus intelligible, but this explanation is
only rarely available. An inflammatory process set
up, for instance, by the meningo-coccus or the tubercle
bacillus can, it would seem, be held responsible in
other cases. There remains, however, a large pro-
portion of cases to account for which no adequate
hypothesis has so far been advanced, for the proposal
to lay the onus on congenital syphilis can hardly be
accepted in view of the fact that in three (and those
the best marked) of four cases of chronic hydro-
cephalus Knoepfelmacher and Lehndorff^ obtained
ij 1 W. Knoepfelmacher und H. Lehndorff, Hydrocephalus chronicus
internus coftgenitus und Lues; v. Jahresbericht Uber die Leistimgen^
&-C., 1909, p. 504.
Q 2
228 THE FEEBLE-MINDED chap.
a negative reaction when employing the method of
Wassermann, while Dean^ obtained a positive
reaction in only four out of fourteen cases.
(3) Cases in which there is enlargement of the
brain (megalencephaly). Several workers among
the feeble-minded have attempted to differentiate
from the rest of the large-headed cases a section
presenting certain characteristic symptoms, to wit,
general muscular weakness, headache and epileptic
seizures. Whatever justification there may be for
erecting a special clinical category, there is no doubt
that at autopsies brains are sometimes found which
considerably exceed the average in weight and
which, since they have belonged to mentally defective
persons, are presumably defective in some way. A
definite overgrowth of neuroglia, in some instances
accompanied by sclerosis, has been observed in con-
nection with brains of this class, while in other cases,
as, for example, in one recorded by v. Hansemann^
where the brain weighed i860 grams, no histological
abnormality was discovered. Ashby and Wright ^
speak of having found a cerebral hypertrophy of the
kind mentioned in association with rickets, and so
lend some colour to the popular conception of
rickets as a cause of feeble-mindedness ; but the
matter must, at present, be regarded as undecided.
V-^ 1 H. R. Dean, " An Examination of the Blood Serum of Idiots by
the Wassermann Reaction," Lancet^ July 23, 1910, p. 227.
*' 2 D. V. Hansemann, Uber echte Megalencephalie : Berline)' klin
Wochenschr. 1908, No. i, p. 7.
^ H. Ashby and G. A. Wright, The Diseases of Children, 1905, p.
21Q.
VI VARIETIES OF FEEBLE-MINDED 229
CRETINISM.
One of the most striking features of feeble-
mindedness, when considered from the historical
standpoint, is the way in which Cretinism has gradu-
ally ceased to occupy its originally prominent
position. On the Continent of Europe, to which the
available literature chiefly relates, the distinctive
peculiarities of cretins, and in some regions the large
proportion of them among the inhabitants, caused
cretinism to be regarded as constituting, to the
exclusion of less conspicuous abnormalities, an
essential characteristic of the more severe grades of
mental defect.
Practically all the earliest institutions, e.g., that
founded by Guggenmoos at Salzburg in 1828 ; that
of Haldenwang at Wildberg in 1835 ; and the still
more famous one established by Guggenbtihl on the
Abendberg in 1841, were designed for cretins, with
whom, no doubt, were included the '' Mongolians "
of that day. Griesinger's dictum that while every
cretin is an idiot, every idiot is not a cretin, has now
quite lost its application, for in this country, at any
rate, the cretin is becoming a clinical curiosity,
though there is no lack of idiots. Among the 500
feeble-minded children under 16 years of age, to
whom reference has frequently been made, only
three presented signs of cretinism, while of 600
females over 16, only one was an example of the
condition. The introduction of the treatment by
means of thyroid gland preparations has revolu-
tionised the position, and, since every private
practitioner is only too glad to gain the kudos
230 THE FEEBLE-MINDED chap.
associated with the transformation of a youthful
monstrosity into the fairer semblance of a normal
child, the admission of a cretin into an institution for
idiots is comparatively rare/
Just as in the case of Mongolian idiocy, well-
marked cretinism involves so many departures from
the normal, that minor racial characteristics are
obliterated and a certain uniformity of type, which
has caused it to be said that "to see one is to see
all," is created. This compendious statement must
not, however, be accepted too confidently. In a
typical case there are bodily and mental symptoms
of a pronounced character. The stature is short and
there may be deformity of the limb bones, which,
taken in conjunction with the clumsy hands and
feet, interferes with walking, or the pursuit of any
manual employment. The skin is rough and
thickened, with few and coarse hairs, and is cold and
clammy to the touch ; over the face its redundancy
causes the obliteration of the ordinary folds and
wrinkles, and lends a stolid aspect to the expression ;
the upper eyelids are thickened, the lower baggy ;
an enormous tongue protrudes between the swollen
lips, which cover carious and irregular teeth ; large
collections of fat fill in the supra-clavicular fossae, and
1 In some parts of Europe, however, cretinism is, even at the present
day, a social factor of the first importance. Thus, speaking of the
cretins in the Valley of Aosta, F. Ferrero says "many roam freely
in the villages and importune strangers, begging with the most obdurate
insistence and forcing into evidence their horrid bodies " : and again
" the cretin still wanders aimlessly about emitting uncanny sounds from
his distorted mouth, a clouded intelligence in a useless body — a
horrible example of the miseries that flourish by the side of the divine
glory of the great mountains."
The Valley of Aosia^ 1910, pp. 49 and 51.
VI VARIETIES OF FEEBLE-MINDED 231
the pendent abdomen frequently shows a hernial
bulging in the umbilical region : there may or may
not be enlargement of the thyroid gland. In some
cases the incidence of the disease seems to be chiefly
upon the nervous system, a condition resembling
that in cerebral diplegia resulting. Many of the
cases are deaf and dumb, the deafness being
apparently due, in some measure, to myxomatous
thickening of the mucous membrane of the middle
ear ; and cutaneous sensibility is so much diminished
that there is indifference to what would, ordinarily,
be painful impressions.
Mentally there is marked apathy with sluggish
reaction to stimuli. Cretins are generally timorous,
shy, and retiring, but they resent interference and
are liable to outbreaks of anger if not let alone. Their
appetites, so far as these exist at all, are depraved,
leading them to filth-eating and other offences against
good manners, and the more active of them are
prone to vagabondage and deeds of wanton mischief.
Considering the extent of the literature relating to
cretinism, it is remarkable how little information of
scientific value is available in regard to the condition.
The following brief exposition, however, appears to
summarise the present state of our knowledge of the
subject.
For the maintenance of life there is necessary the
harmonious co-operation of various systems of organs
which are concerned with the acquisition, the absorp-
tion, and the assimilation of food materials, and the
elimination of waste matter. The necessary control
is exercised by the nervous system and might, con-
ceivably, have its origin in some psychic agency
232 THE FEEBLE-MINDED chap.
capable of effecting the desired co-ordination. But
it is, in fact, so largely unconscious that a physical
source for the provision of adequate determinants
must be sought. Of such sources there appear to be
several, though only one, the thyroid gland, is of
immediate interest. An interference with the
functions of the thyroid — expressing itself in
deficiency of the thyroid secretion — gives rise to a
series of pathological changes in the body generally,
which vary with the age and with other less easily
ascertained circumstances, but which mainly follow
two directions, one being the accumulation of a
mucoid substance and the other the disablement of
nervous tissue. If the deficiency occurs in early life
the processes of growth are seriously disorganised
and cretinism results. It appears from the observa-
tions of Captain McCarrison^ that in the Chitral
and Gilgit Valleys of the Himalayas two types of
cretinism, the '' myxcedematous " and '' the nervous,"
characterised by a predominance of one or the other
group of symptoms, are clearly recognisable.
This comparatively simple proposition is, however,
complicated by sundry factors which call for notice.
In the first place, a deficiency of thyroid secretion
may be associated with an apparent hypertrophy of
the thyroid gland, and it is a familiar fact that
cretinous individuals frequently exhibit a goitrous
swelling of the neck. Thus among McCarrison's
203 cases of cretinism there were 88 in which a
goitre was present.
Ireland, expressing the view which is generally
V 1 R. McCarrison, "Observations on Endemic Cretinism in the
Chitral and Gilgit Valleys," Proc. Rov. Soc. of Med., Nov. 1908,
VI VARIETIES OF FEEBLE-MINDED 283
held and which on the face of it seems most
plausible, speaks of the goitre as '' being the begin-
ning of the disease," but it appears from McCar-
rison's studies that the thyroid enlargement is not
the cause of cretinism, since its occurrence is sub-
sequent, and not prior, to the development of cretinic
symptoms. Cretinism and goitre seem to have a
common origin, which is, according to McCarrison,
''defective thyroid function in the mother." He
found that in 86 per cent, of his cases the mother
was certainly goitrous and that in only 4 per cent,
could goitre be definitely excluded, and he suggests
that it is the consequent toxicity of the mother's
blood which, by its action on the developing thyroid
of the unborn child, determines cretinism. The
hereditary element in the disease, which may perhaps
follow Mendelian lines in transmission, is thus
accounted for, but there is such overwhelming
evidence that cretinism is to some extent dependent
on topical conditions that its etiology cannot be said
to be fully elucidated until an explanation of the
influence of those conditions is forthcoming. So far
we have failed to discover the mysterious agency
which converts some regions of the earth's surface
into hot-beds of the disease, and we can only picture
it as a ** miasm" which, as E. and H. Bircher claim
to have shown, follows in its distribution certain
sedimentary rocks (being apparently a decompos-
ition product of organic matter), and is introduced
into the body by means of drinking water. Professor
Wilms ^ of Basle has brought forward evidence in
'"^ M. Wilms, Expermientelle Erzeugung und Ursache des Kropfesj
Deutsche Medizinische Wochenschrift^ Mar. 31, 19 10.
234 THE FEEBLE-MINDED chap.
support of the view that the " miasm " is in reality
a soluble toxin or ferment which cannot be filtered
out, but which can be rendered innocuous by heating
the water.
The fact that cases of cretinism occasionally
appear in places far removed from the districts
where the disease is rife has led to a distinction
between "endemic" and "sporadic" forms which,
while generally insisted upon by authors, appears to
have little practical value, since clinically the two
conditions are similar. The suggestion that the
former type is distinguished by the presence, the
latter by the absence, of a goitre, seems to be quite
unsubstantiated. Tanzi ^ says of sporadic cretinism,
*' It is not even a family disease : the subject of
sporadic cretinism always represents a solitary case
of the disease in his family, and commonly has
brothers and sisters who are perfectly normal."
But this diagnostic character appears to be as
untrustworthy as the one already mentioned, for
Stevens ^ has recorded four cases of sporadic
cretinism, all with enlarged thyroids, occurring in a
family which did not live and had not lived in a
district where cretinism is endemic.
It has been customary in the past to distinguish
three grades of mental defect associated with
cretinism and to describe these as the "cretin," the
"semi-cretin," and the "cretinoid," according to the
severity of the symptoms. Weygandt,^ in a recent
1 E. Tanzi, A Text-book of Mental Diseases^ trans, by W. Ford
Robertson and T. C. Mackenzie, 1909, p. 377.
^ ^ V>.C Stevens, " Four Cases of Sporadic Cretinism in One Family,"
Lancet^ June 18, 19 10, p. 1684.
3 W. Weygandt : v. Art. "Kretinismus," in Enzyklopddisches Hand-
buck der Heilpddagogik.^ I909«
VI VARIETIES OF FEEBLE-MINDED 235
contribution to the literature of the subject, adversely
criticises this arrangement. In harmony with the
classification adopted in this work, it will be more
convenient to subdivide the cases into three groups,
to which the terms " idiotic," " imbecilic," and
''weak-minded" may, respectively, be applied.
In practice it is often difficult to distinguish with
certainty between the Mongolian and the cretinous
type of the feeble-minded, and no test other than
the administration of preparations of the thyroid
gland is of much value for the purpose of differential
diagnosis. Sometimes a partial recovery, which
serves to bring into relief the previously obscured
Mongolian elements of the picture, renders it
probable that we have to do with a combination of
the two disease processes. At other times, especially
when the exhibition of the remedy has not been
undertaken sufficiently early, obvious signs of
cretinism remain in spite of treatment, being
apparently too firmly fixed to be eradicated.
Whether, as has been suggested, there is a
distinct disease having some features common to both
Mongolism and cretinism, is a question calling for
further elucidation.
EPILOIAC TYPE.
In the scheme of classification, based on
considerations of morbid anatomy, adopted by
Bourneville, a place is assigned to cases ex-
hibiting after death the condition which he has
called '* sclerose hypertrophique," and which is
widely known to English speaking pathologists as
236 THE FEEBLE-MINDED chap.
'* tuberose " or " hypertrophic " sclerosis. Bourne-
ville's first case, which was pubHshed in the
Archives de Neurologie for 1880, showed, at the
autopsy, striking changes in the brain and kidneys.
In the former organ, there were, to quote his
own words, '' lesions consistant en Hots arrondis
formant saillie, de volume variable, dune coloration
blanchatre, opaque, d'une densite bien superieure
aux parties avoisinantes et faisant partie des circon-
volutions. II s'agit, en un mot, d'une sorte de
sclerose hypertrophique de portions plus ou moins
grandes des circonvolutions." The kidneys, he says,
presented " masses blanchatres, mamelonnees, dures,
formant une saillie de 3 a 5 millimetres. " Shortly
afterwards Bourneville described, in conjunction with
E. Brissard, a further case in which similar appear-
ances had been observed. Both cases were subject
during life to epileptiform convulsions.
This combination of pathological characters was
met with at intervals in the practice of the Bicetre
Hospital and accounts of the cases were given by
Bourneville in his annual reports. A summary of
them appears in the '' Compte-rendu du Service de
Bicetre" for 1898, where allusion is made to ten
cases observed up to that time. In the same year,
Sailer directed attention to an instance of what he
called " hypertrophic nodular gliosis " occurring in a
boy who died of exhaustion from epilepsy at the
age of fifteen years. There were indurated areas in
the cerebral cortex and nodules projecting into the
lateral ventricles from the basal ganglia ; the right
kidney ''contained a huge tumour-like mass" and
there were smaller growths in the left. Sailer's
VI VARIETIES OF FEEBLE-MINDED 237
article makes allusion to thirty other cases, including
five from Bourneville's clinic, but the descriptions
given are not always complete enough to make
the exact nature of the cases clear. The more
recent literature, in English, contains reports by
A. W. Campbell,^ M. B. Dobson,^and Messrs. Fowler
and Dickson,^ while Ch. de Montet ^ has described a
French case, and R. Bonfigli,^ has added particulars
of two Italian ones. In a lengthy paper published
in 1908, H. Vogt^ reviews thirty cases, including
three of his own.
Campbell's paper contains a detailed account of the
minute anatomy of the condition. He found in the
affected regions of the brain a neuroglial proliferation
ranging from a diminution of nerve cells and fibres
with substitution of glia cells of peculiar character
to the formation, at the centres of the indurated areas,
of "a. matrix composed of a dense network of indefinite
structure, a tissue showing neither nuclei nor distinct
fibres." Sub-ependymal growths of the lateral ven-
tricles were composed of a " coarse fibrous tissue "
and contained "an abundance of corpora arenacea."
In connection with the cortical sclerosis he observed
"giant" or "ganglion" nerve cells and curious
A'^ A. W. Campbell, "Cerebral Sclerosis," Brain^ Feb. 1906.
*^2 M. B. Dobson, " A Case of Epileptic Idiocy associated with
Tuberose Sclerosis of the Brain," Lancet^ Dec. 8, 1906.
^3 J. s. Fowler and W. E. C. Dickson, "Tuberose Sclerosis," Proc*
Edi7i. Med.-Chir. Soc. v. La?tcet, May 14, 19 10, p. 1351.
Q,'^ Ch. de Montet, Reciter ches sur la sclerose tubereuse. DEjicephale 3
Anne'e, No. 2, p. 97.
i^ ^ R. Bonfigli, Uber tuberose Sklerosej Monatssch. f. Psychiat. und
Neurol. Bd. 27, 19 10, p. 395.
. 6 H. Vogt, "Zur Pathologic und pathologischen Anatomic der
¥erschicdenen Idiotieformen," Monatssch. f. Psych, u. Neur. Bd. 24,
1908, p. 106.
238 THE FEEBLE-MINDED chap.
structures resembling tubular glands. Somewhat
similar appearances are described by de Montet and
the observations are supported by a study of the
writer s own preparations, though as these were made
from material which reached him in a badly pre-
served state, they do not afford very conclusive
evidence. In a case described by Geitlin and quoted
by Vogt, two of the tuberose masses in the occipital
region contained small cysts, there was a condition
of heterotopia, and the ventricular tumours contained
embedded in them bodies described as '' corpora
amylacea " which apparently correspond to the
" corpora arenacea " of Campbell. Geitlin noted
also the presence of rounded concentrically arranged
structures which he regarded as derived from blood-
vessels and which perhaps have affinities with the
" tubular glands " mentioned by Campbell. Vogt
finds reason for thinking that the giant cells are of
two kinds, some being related to ganglion cells and
others to neuroglia elements.
The tumours in the kidneys are said by Geitlin
to be allied to those which appear in the lateral
ventricles ; other writers detect in them a resem-
blance to adrenal gland tissue. They show,
sometimes, a tendency to malignancy and may be
the immediate cause of death. Occasionally there
have been observed tumours in the heart muscle,
usually at the right side and of the nature of a
rhabdomyoma.-^ That such neoplasms are not
described more frequently is attributed by Vogt to
Kj 1 A. J. Abricossoff, " Ein Fall von multiplem Rhabdomyom des
Herzens und gleichzeitiger herdformiger kongenitaler Sklerose des
Gehirns," Bez'tr. zur pathol. A7iat.^ Bd. 45, H. 3, p. 376,
VI VARIETIES OF FEEBLE-MINDED 239
the fact that they would be Hkely to cause early
death so that the subjects of them would never come
under the notice of alienists. Still more rarely new
growths have been noted in the liver, the spleen,
the thyroid, the thymus, the duodenum, or the
skin.
As to the general pathology of the condition,
Campbell's hypothesis is that the morbid processes
giving rise to it originate in the vascular system of
the affected parts. Vogt, however, makes out a
case for regarding the widespread incidence of the
disease as resulting from errors of development, a
view taken also by Geitlin and de Montet.
It will be seen that there is nothing in the above
descriptions to justify the separation of tuberose
sclerosis as a clinical entity. Bourneville seems to
have observed during the lifetime of his cases noth-
ing which he regarded as pathognomonic. Writing
in the Twentieth Century Practice, P. Sollier says
that " while atrophic sclerosis may be diagnosed in
a certain number of cases, the recognition of the
hypertrophic form is absolutely impossible, in my
opinion at least, not only because it has no charac-
teristic symptom, but also because being such a rare
condition we are seldom led to think of it at all."
Of late years, however, there has accumulated a
considerable amount of evidence in favour of the
view that some at any rate of the cases of tuberose
sclerosis may be diagnosed during life, owing to the
co-existence with the cerebral and renal conditions
of the peculiar skin affection known as adenoma
sebaceum. For a complete description of the state
of the skin in adenoma sebaceum one of the larger
240 THE FEEBLE-MINDED chap.
text-books of dermatology may be consulted ; it will
suffice here to give briefly the principal features.
Over all parts of the body the skin may be found
to exhibit small nodules or thickenings apparently of
a fibrous character. On the face the nodules are
generally, as shown in the accompanying figure,
arranged fairly symmetrically across the nose and
cheeks giving rise to one of the forms of " butter-
fly rash " and, owing to an association with the
nodules of dilated blood-vessels, there is usually
well-marked redness. Elsewhere the fibrotic change
is much more irregular both in distribution and
character, so that structures resembling raised
scars and warty growths may be found anywhere on
the trunk and limbs (Fig. 21).
In recording the results of the routine examina-
tion of his cases Bourneville makes mention of
dermatological conditions to which he obviously
attached no importance, though in the light of our
present knowledge there can be little doubt that
what he observed was the symptom referred to
above. His first case showed what he calls ''acne
rosacee et pustuleuse de la face ; — de plus, eruption
vesiculo-papuleuse confluente du nez, des joues, du
front ; nombreux petits molluscums a la nuque et sur
les parties du cou." Of another case he says " La
peau du visage presente de nombreuses rides, avec
une teint pale ; il existe quelques productions de
nature verruqeuse sur les joues " ; while a third
displayed an '' eruption erythemateuse a la base du
nez ; pointille plus rouge sur la face, a la joue
gauche en particulier ; petites saillies oflrant
Tapparence de naevi." A similar association has
VI VARIETIES OF FEEBLE-MINDED 241
been noted on several occasions at the Darenth
Asylum for feeble-minded persons : it is recorded in
the papers by Campbell, Dobson, and H. Vogt to
which allusion has already been made, and by
Volland,^ while Hornowski and Rudzki ^ seem to
have met with it also.
It is difficult to believe that if a skin condition so
distinctive as that in adenoma sebaceum had been
present in all ten of the cases observed by Bourneville
that keen pathologist would have failed to note the
fact, and the remark is equally true of other skilled
workers who make no mention of such a striking
dermatologlcal peculiarity. Bonfigli, indeed, states
explicitly that it was absent from his cases.
Assuming the existence of an association between
tuberose sclerosis and adenoma sebaceum to have
been definitely established in certain instances no
special importance attaches to the occurrence of the
former condition without the latter. That some
particular element of a clinical syndrome should be
wanting in cases conforming otherwise to the type
is no uncommon experience, and the cases in point
are susceptible of various explanations. There may
be, for example, more than one form of tuberose
sclerosis, or the skin changes may appear only at a
particular stage in the development of the disease.
Serious interference with the excretory functions
of the kidneys may occur : thus in two of Vogt's
1 Volland, " Weitere Beitrage zum Krankheitsbild der tuberosen
Sklerose," Zeitsch.f. die Erforsch. u. Behandl. d. jugendl. Schwachs.^
Bd. 3, H. 3, p. 245.
2 Hornowski und Rudzki, Sclerose tubdreuse {Bourneville) : cf.
Jahresbericht iiber die Leistungen und Fortschritte auf dein Gebiete der
Neurologie und Psychiatrie, 1910, p. 249.
R
242 THE FEEBLE-MINDED chap.
cases death resulted from dropsy, while In one of
those recorded by Bonfigli it was preceded by
uraemic symptoms. Sometimes, also, the renal
tumours have been large enough to be detected
during life. Morbid states of the urine are not, in
the writer's experience, especially connected with
the presence of adenoma sebaceum. Except for a
tendency to the formation of a deposit of triple
phosphate crystals, which the urine from one case
exhibited, the writer has not observed anyabnormality
discoverable by the ordinary tests in the samples
which he has had an opportunity of examining. A
colleague has, however, met with a trace of albumin.
In the great majority, if not in all, of the cases
which, after death, have been found to exhibit a
condition of tuberose sclerosis, there, has been a
history of epileptiform seizures. These may have
been of the types met with In '' major," '* minor," or
"Jacksonlan" epilepsy, or they may have had
affinities with syncopal attacks or uraemic con-
vulsions.
It would appear, then, that in favourable circum-
stances it may be possible to differentiate clinically
a group of cases of feeble-mlndedness having the
characters above dealt with, and, this being so,
there arises a need for a name based on clinical
rather than pathological considerations. Some
years ago, the writer proposed as a convenient
designation the term ''Anoia." This word has,
however, been applied by Jolly to cases of acute
dementia, and by Herfort to an imperfectly defined
form of congenital mental defect. The term
" Epiloia," coined for the purpose, and having, the
VI VARIETIES OF FEEBLE-MINDED 243
writer believes, no existing connotation, is therefore
suggested as being more suitable. It has, at any
rate, some of the features which, according to Dr.
Pye-Smith, characterise a good name : it is short,
unmeaning, distinctive, and capable of forming an
adjective.
The writer's earlier experience of " Epiloia," led
him to regard the condition as one involving grave
risk to life, mainly on account of the severity of the
fits which occur. In twelve cases of the disease
which have died in Darenth Asylum the apparent
cause of death was as stated in the following
table :—
No. Sex. Age at death. Circumstances attending death.
1 M 27 years Supervention of " pneumonia " while
having 20 to 40 fits a day.
2 F 23 years Status epilepticus for 2 days with temper-
ature reaching 105 F.
3 F 13 years Status epilepticus. The temperature
reached 107.4 shortly before death.
Status epilepticus.
Vomiting and convulsive twitchings
lasting for 3 days.
Status epilepticus lasting 3 days.
Status epilepticus ; death occurred after
46 fits.
Pneumonia.
Malignant disease of skin.
Died suddenly 20 minutes after an
epileptic fit.
Status epilepticus.
Died in one of the " syncopal attacks "
to which he was subject.
A more extended acquaintance with the disease,
however, has taught him that while no known
treatment produces any definite amelioration of the
symptoms, the cases are not necessarily progressive.
Nine cases are at present known to him, and
although they have not been continuously under his
care, he has been in touch with eight of them for
R 2
4
5
F
M
15 years
6 years
6
7
F
F
9 years
19 years
8
9
10
F
M
M
14 years
9 years
8 years
II
12
F
M
17 years
6 years
244 THE FEEBLE-MINDED chap.
the past five years, and with the ninth for three
years. A short account of these cases may not be
devoid of interest.
1. H. C. This is the patient of whom a photo-
graph is appended. She came under notice at the
age of eight years, and is now eighteen. Adenoma
sebaceum was observed on admission and has been
getting worse pretty steadily since. There are
many fibroid nodules in the skin of the trunk. In
October 1904, she had a series of fits spreading
over three days, which left her in an exhausted
state, and fits have been of frequent occurrence
since. Thus during the first six months of 1907
there were recorded :
1907 Jan. Feb. Mar. Apr. May June
70 62 40 6 21 19
During the corresponding period in 1910 the
numbers were :
1910 Jan. Feb. Mar. Apr. May June
13 2 4 6 I 2
a diminution which has not, however, been
accompanied by any improvement in the mental
state. The girl is unable to walk without a good
deal of assistance, is faulty in her habits, and has to
be dressed and fed. Usually she sits quietly with
her head hanging, but at times she rotates the head
slowly. She appears to understand nothing of what
is said to her, though occasionally when she is
spoken to a faint smile seems to denote that she is
not wholly impervious to auditory impressions.
2. P. F. A rash was noted on the face at the
age of five years, but there is no evidence to show
VI VARIETIES OF FEEBLE-MINDED 245
how long it had been present at that time. It is
now most marked over the malar bones and is slight
over the bridge of the nose, and there is a small
confluent area in the right frontal region. There
are small fibrous nodules scattered over the arms
and the upper part of the trunk, in addition to larger
collections over the lower part of the abdomen and
the inner surface of the right thigh. The first fit
occurred in February 1900, when the boy was seven
years old, and since then the fits have not averaged
more than one a year, but the mental state has
slowly deteriorated and the patient is now an idiot
of faulty habits.
3. M. L. S. This girl has been subject to
epileptic fits since the age of three years, but since
1890, when she was described as having them
" nearly every week," they have been becoming less
frequent and none has occurred for a long but rather
uncertain period. The condition of adenoma seba-
ceum is not pronounced and the patient might be
described as an imbecile, for her mental capacity has
proved sufficient to enable her to become, under
supervision, a useful laundry worker.
4. A. S. The facial eruption was first noticed in
1903, when the patient was ten years old, and has
never been strongly marked. There are some
fibrous nodules scattered over the trunk, back and
front. In April 1899, this patient was recorded as
having frequent attacks of petit mal with major fits,
of no great severity, about once a week. The fits
then became much rarer ; thus there has been only
one noted during the past two years, but the boy
suffers from periodic attacks of vomiting.
246 THE FEEBLE-MINDED chap.
5. E. B. There have been occasional severe fits
but none of recent occurrence. The patient, who is
now twenty-six years of age, exhibits fair intelHgence.
He can talk and give a sensible' account of himself,
and he is a good ward worker.
6. H. W. A boy of sixteen. The skin affection
is not pronounced and does not appear to get worse.
No definite epileptiform seizure, unless ''fits when
teething " are to be regarded as of this nature, has
so far been recorded. Mentally, the condition is
one of imbecility.
7. S. W. This boy came under observation, at
the age of twelve years, in April 1905. In November
of that year it was noted that he was having severe
fits and occasionally series of fits. A further batch
of fits was recorded in March 1906. During the
early months of 1907, it was noted that the fits
became entirely nocturnal in character and averaged
three per month. The boy is fairly intelligent and
does not appear to be getting more demented.
8. F. V. S. A girl eight years old. There is
at present no history of epilepsy, and she appears to
be fairly bright, but she is uncleanly in her habits.
9. A. D. Female, aged 24 years. There is on
the face a symmetrical eruption which is confluent
over the cheeks and the bridge of the nose, but
discrete elsewhere. Fibro-vascular nodules are
present over the upper part of the chest, and there
are fibrous patches in the skin over the abdomen.
Cases like these supply a means of transition to
the ones which remain within the province of the
dermatologist, although these latter, as is now
generally admitted, usually present some signs of
VI VARIETIES OF FEEBLE-MINDED 247
mental defect. So long ago as 1890, J. J. Pringle ^
noted that '' the subjects of the disease (adenoma
sebaceum) appear to be generally intellectually
below par." H. Radcliffe Crocker ^ speaks of the
majority of the cases as passing '' unrecognised into
the hands of the neurologists," and agrees that ''all
the marked cases show intellectual infirmity, a large
proportion being chronic epileptics or imbeciles."
PLEGIC FORMS.
Some degree of paralysis is one of the commonest
symptoms of the more severe grades of feeble-
mindedness. A reference to the sections on
pathology will provide illustrative figures. The
type of paralysis, taken in conjunction with the
history of its development, will serve as a basis for
the isolation of a set of cases which may be
collected into a clinical group marked off from the
others, in the scheme of classification adopted in
this work, by the fact that the special differentia of
the other subdivisions are wanting. By assigning
to the group conveniently elastic limits it may be
made to comprise all those cases of feeble-
mindedness in which a more or less extensive
cerebral lesion gives rise to a deficient muscular
activity ; whether this involves many muscles or
few, or whether the lesion is in the sensory or the
motor part of the cerebral pathway which impulses
traverse during their transition from the afferent to
1 J. J. Pringle, " A Case of Congenital Adenoma Sebaceum," BrU,
Joiirn. of Dermatology^ Jan. 1890.
2 H. Radcliffe Crocker, Diseases of the Skin^ 1903, p. 922.
248 THE FEEBLE-MINDED chap.
the efferent phase. We may, consequently, meet
with monoplegia or diplegia ; hemiplegia or para-
plegia ; ophthalmoplegia or laryngoplegia and so
on ; with visual, auditory, tactile, or other sensory
anomalies which indirectly express themselves in
muscular activities of various kinds ; or with word-
deafness, word-blindness, or other species of the
genus *' aphasia."
The lesions display as much variety in their mode
of origin as in their mode of manifestation. They
may be of that indeterminate character which we
call "inherent" or they may be explicable on
ordinary physical principles as the result of the
action of disruptive or toxic agents.
A description of these pathological states has
been given in Chap. IV. Affections of the cerebral
or meningeal vessels are the chief source of trouble.
There may be rupture, embolism, or thrombosis
occurring at birth or later. There may be the
inflammatory process in the cerebral grey matter,
due to the conveyance thither by the blood vessels
of toxic bodies, which is said to give rise to infantile
hemiplegia. There may be sclerotic changes of the
atrophic type which, from their distribution, appear
to have a vascular origin even though the exact
modus operandi is not clear. The somewhat in-
definite clinical grouping of cases of paraplegia and
diplegia dating back to birth or early infancy and
known as Little's disease will be included here though
it Is worthy of note that many French writers accept
a definition of Little's disease which would exclude it
from this category. Thus Ballet ^ distinguishes a
1 G. Ballet, Trait e de Pathologie Meftiale, 1903, p. 1217.
VI VARIETIES OF FEEBLE-MINDED 249
form of diplegia, to which he applies the name
** maladle de Little," which is especially characterised
by the absence of '' troubles intellectuels graves,"
though there may be an " air d'imbecillite."
Hemiplegic forms of paralysis usually occur some
little time after birth. They affect the whole of one
side of the body, including the face, and pass through
a phase of flaccidity followed, on the one hand, by
some measure of functional restoration, on the other,
by spasm and contracture and by atrophic processes
which may involve not only the muscles but also the
bony and other structures of the paralysed limb.
Among the diplegic forms there may be recognised,
according to Freud (as quoted by Tanzi ^), the
varieties enumerated below : —
(i) General Rigidity.
(2) Paraplegic Rigidity.
(3) True Paraplegic Paralysis.
(4) Bilateral Hemiplegia.
(5) General Chorea.
(6) Double Athetosis.
Morbid states of the central nervous system more
subtle in their nature — perhaps impossible of detec-
tion by ordinary histological methods and dependent
on physical and chemical conditions, as yet beyond
the range of analysis— may be at the bottom of the
cases in which there is no definite paralysis, but in
which the abnormalities of the muscular apparatus
take the shape of localised wasting, hypo- or
hyper-tonus, exaggerated or diminished reflexes,
^ E. Tanzi, oj^. df., p. 463.
250 THE FEEBLE-MINDED chap.
epileptiform or choreiform movements, tremors,
inco-ordination, or the tics.
Of some interest is the reputed occurrence of cases
of what has been called ''psychical cerebroplegia " in
which a gross cerebral anomaly is overlooked during
the sufferer's lifetime owing to the absence or in-
conspicuousness of other than psychical defects. With
our present views on the structure of the encephalon
it is not difficult to imagine such a state of things as
this, for we may suppose that only the "higher"
cortical regions are affected, and how widely the
brain may depart from the normal without serious
interference with motor functions may be gathered
from the case of an imbecile who suffered from
frequent epileptic fits but whose physical condition
was good, there being no paralysis or deformity such
as might be expected from the cerebral condition.
He died at the age of twenty-six years. At the
post-mortem examination the right cerebral hemi-
sphere, which showed much wasting and sclerotic
change in the occipital lobe and the hinder portion
of the parietal and temporal lobes, was found to
weigh only 13 ozs., while the left weighed 24 ozs.
and appeared to be of normal structure. The left
side of the cerebellum was, as is customary in such
cases, rather smaller than the right.
PROGRESSIVE FORMS.
In the clinical types so far dealt with, while the
expectation of life has been low, there has not,
except, perhaps, in some of the cases of tuberose
sclerosis, been any evidence that the patient was
VI VARIETIES OF FEEBLE-MINDED 251
steadily tending to an early death. It is, however,
possible to distinguish a group of cases in which a
rapidly progressive deterioration as regards both
mental and physical characters is the outstanding
feature. The relationship of the members of the
group is by no means clear and any scheme of sub-
division which may be adopted is liable to adverse
criticism, but one may differentiate with some degree
of confidence the following forms :
(i) General Paralysis.
Of late years it has been recognised that children
are subject to a form of progressive paralytic
dementia resembling in its symptoms and course
the disease which in adults is usually known as
general paralysis of the insane. The "juvenile"
type, like that of adults, seems to have its origin in
syphilis but differs in that this disorder has not been
acquired by direct infection but has been transmitted
by one or both parents. The stage of growth at
which the influence of the syphilitic taint becomes
manifest, so far as the mental state is concerned, is
variable ; thus the child may appear healthy up to
the time of puberty or may exhibit mental defect
from infancy. The propriety of including cases of
the former kind under the description of feeble-
mindedness may, in view of the definition given at
the beginning of this chapter, be questioned, but it
may be argued that the defect, though not at first
apparent, is really congenital, and in any case it is
convenient to consider together all the varieties of
juvenile general paralysis which are met with.
Definite symptoms of paralytic dementia have been
noted as early as the eighth year, but such symptoms
252 THE FEEBLE-MINDED chap.
are sometimes preceded by conditions of idiocy
which in the light of the subsequent history may be
regarded as prodromal.
A close parallelism between the symptoms of
''juvenile" and " adult " general paralysis is hardly
to be looked for, since in the child the field for the
development of possible abnormalities is smaller ;
but the classical features of a progressive paralysis
leading to atrophy and contracture of the muscles,
convulsive seizures, and a steady diminution in
mental capacity with loss of emotional control and
an exaggerated bien etre are present. Any or all
of such signs as abnormal pupillary reactions ;
irregular knee-jerks ; grinding of the teeth ; lingual,
labial, and facial tremors ; inco-ordination; disordered
speech ; irregular pyrexia ; a ravenous appetite ; and
trophic disturbances may occur. Of the different
types of the disease that known as the ** dementing "
is the one with which the juvenile form has most in
common, but expansive delusions may be met with,
as in a case recorded by H. Vogt. The usual history
is of a gradual physical and mental deterioration
occurring at school age, whereby a perhaps bright
and intelligent child becomes increasingly dull,
stupid, and helpless, eventually losing control of the
bladder and rectum and being confined to bed with
contracted limbs, inability to converse or swallow
food, and rapidly progressive emaciation, until some
intercurrent disorder or simple inanition ends the
scene.
Chronic meningo-encephalitis, which seems to be
the basis of general paralysis whether it occurs in
children or in adults, produces similar changes in
VI VARIETIES OF FEEBLE-MINDED 253
both classes though in both different cases exhibit
considerable diversity in detail. The best account
of the pathological anatomy of juvenile general
paralysis is that of Watson,^ who examined the
brains of twelve cases finding in all evidence of a
chronic degeneration of the nerve cells in the shape
of chromatolysis, shrinking of the cells, displacement
of nuclei, and breaking down of cytoplasm. In some
of the cases there was also acute degeneration of at
least two types : —
(a) Swelling of the cell and chromatolysis with
sometimes vacuolation.
(d) Coagulative necrosis.
A further important contribution to the pathology
of juvenile general paralysis is that of Rondoni.^
In a patient formerly under the writer's care, who
presented during life typical signs of the disease and
died at the age of twenty years, the dura mater was
found to be very thick and adherent in places to the
pia-arachnoid, which was opaque and thickened
irregularly. There was an excessive amount of
cerebro-spinal fluid. The right cerebral hemisphere
weighed i8 ozs. the left i6|- ozs. a decidedly low
weight for the brain of a male originally of good
physique and intelligence. The father of this
patient, in regard to whom there was a definite
history of syphilitic infection, had himself died of
general paralysis. In another patient, a female who
died at the age of nineteen years and in whom also
1 G. A. Watson, " The Pathology and Morbid Histology of Juvenile
General Paralysis," Archives of Neurology^ vol. 2, 1903, p. 621.
c..^2 pietro Rondoni, " Beitrage zum Studium der Entwickelungskrank-
heiten des Gehirns," Archiv.f. Psychiatrie^ Bd. 45, H 3, p. 1004.
254 THE FEEBLE-MINDED chap.
the condition during life had been such as to justify
a confident diagnosis of general paralysis, the brain,
as observed at the post-mortem examination, could
not be regarded as displaying typical signs of that
disease ; indeed its most distinctive character was a
patchy induration having some analogy with that of
tuberose sclerosis. In this instance the family
history afforded no evidence of the existence of
syphilitic infection.
(2) Familial Forms.
We turn now to an ill-defined group of cases of
progressive bodily and mental enfeeblement, of
which the salient features are some or all of the
following characters.
(a) An incidence, suggesting transmission of some
parental defect, upon several members of the same
generation of a family.
(d) Affections of vision.
(c) Peculiar anatomical changes in the central
nervous system. Some few of the members of this
group are so closely allied, as regards (i) etiology,
(2) course, and (3) pathology, that they may be placed
in a special class. The remainder are not sufficiently
clearly outlined to admit of classification with the
same precision and at present their relationships
remain in doubt. There is some confusion as to
terminology, but the most convenient arrangement
seems to be to include all the cases under the
designation "amaurotic family idiocy," which is
now too widely employed to be ignored, and to
differentiate two types of this disease.
A. Infantile type.
The chief characteristics of this disease, which is
Yi VARIETIES OF FEEBLE-MINDED 255
known also by the names of the earHest students of
it, Mr. Waren Tay and Dr. B. Sachs, may be briefly
considered under the three heads just mentioned.
(i) Etiology. — As a rule the patients are of Jewish
extraction. Whether the rule is absolute is a little
uncertain. From time to time, one finds in the
literature references to cases which are said to have
occurred in Gentiles, but it is possible that these
belong rather to the second of the classes here
accepted. Syphilis, apparently, has nothing to do
with the matter ; the blood and the cerebro-spinal
fluid have been found not to give Wassermann's
reaction.^
(2) Course. — The disease begins at about the end
of the third month. There is a rapidly increasing
general muscular weakness, which may be associated
at first with a well-nourished condition, and a
rapidly diminishing acuity of vision. Wasting and
rigidity, with blindness due to optic atrophy, result,
and death takes place after an illness of about two
years' duration.
(3) Pathology. — Until the later stages supervene
there is recognisable, in addition to the signs above
mentioned, a distinctive condition of the retina. In
the region of each macula lutea, a whitish patch
with the position of the fovea centralis marked as a
cherry-red spot is observable. In some cases, at
any rate, this appearance is " due to the chorio-
capillaris showing through a thin, if not perforated
retina." There is a consensus of opinion that the
disease is primarily an affection of the nervous
^^ F. J. Poynton, " Amaurotic Family Idiocy," Bri^. Med. Journ.^
May 8, 1909, p. 1106.
256 THE FEEBLE-MINDED chap.
elements. Poynton, Parsons, and Holmes^ found
in their detailed study of three cases that the cells
in all parts of the central nervous system were
swollen and showed eccentric nuclei, loss of *' tigroid
masses," vacuolated protoplasm, and breaking up of
neuro-fibrils, together with loss of nerve fibres and
a secondary increase of neuroglia. Mott ^ records
similar changes in two cases and notes that the cells
of the sympathetic ganglia are also affected. As
the result of a chemical investigation, he found a
diminution of nucleo-proteid and an increase ot
simple proteid which he correlates with the dis-
appearance of Nissl substance and the increase
of glia fibrils. Schaffer ^ also agrees with the
conclusions of Foynton and his fellow-workers, and
Sachs* expresses the view that *'the morbid process
in the disease affects primarily, or at least to a great
extent, the entire grey matter of the brain and of
the spinal cord." In cases examined by Sachs the
cortical changes had given rise to such a degree
of hardness, that ''the knife grated as it passed
through."
B. Juvenile type.
Sachs recognises a form of amaurotic family idiocy
which is not restricted to Hebrews, and the duration
^1 F. J. Poynton, J. H. Parsons, and G. Holmes, "A Contribution to
the Study of Amaurotic Family Idiocy," Brain^ June, 1906.
U ^ F. W. Mott, "Two Cases of Amaurotic Dementia (Idiocy) and a
Correlation of the Microscopic Changes in the Central Nervous System,
with the Results of a Chemical Analysis of the Brain," Archives of
Neurology^ vol, 3, 1907.
t ^ ^ K. Schaffer, " Uber die Pathohistologie eines neueren Falles (viii)
von Sachsscherfamiliar-amaurotischer l^xoixt^^ Journ.fur PsychoL und
Neurol.^ Bd. 10, 1907, p. 121.
* B. Sachs, " On Amaurotic Family Idiocy," Jour?t. of Nerv. and
'\Me7ital Dis., Jan., 1903.
VI VARIETIES OF FEEBLE-MINDED 257
of which extends over a number of years. H.
Vogt^ has described a "family" disease marked by
mental defect, blindness, and paralysis with bulbar
symptoms, which he regards as belonging to the
same category. Several cases have now been
recorded: thus Jansky^ has given an account of a
boy, healthy up to the fourth year of his age, who
became the subject of a progressive dementia with
blindness, general hypersesthesia, spastic diplegia,
increased knee-jerk, and hyperakusis, dying at the
age of six. This boy was one of a family of eight,
of whom three died with similar symptoms between
the ages of four and six years. Brooks ^ has also
described three cases of somewhat allied character
occurring in a family of seven children, and Mayou *
has given an account of a family containing seven
members, of whom four have been affected in a
similar way.
As yet cases of the familial form of idiocy are too
few for a satisfactory determination of their taxo-
nomlc position to be made, and It Is possible that
with increasing knowledge the boundaries of the
group may become less, rather than more, sharply
delimited. Several years ago Sachs expressed the
opinion that " there Is a close anatomical relationship
between amaurotic family Idiocy and other cerebral
V 1 H. Vogt, " Uber familiare amaurotische Idiotie und verwandte
Krankheitsbilder," Mo?tatssch. f. Psychiat. it. Neur.^ Bd. i8.
2 j^ Jansky, " Uber einen bisher nicht publizierten Fall von familiarer
amaurotischer Idiotie &c." v. Jahresbericht uber die Leistungen &^c.,
1909, p. 1025.
W 3 H. Brooks, "Amaurotic Family Idiocy," Journ. of Nefv. and
Me?tt. Dis.^ April 19 lo, p. 251,
* M. S. Mayou, v. papers in Proc. Ophthalmological Society .^ 1904,
p. 142 ; and Proc. Roy. Soc. of Medicine^ July 1908.
S
258 THE FEEBLE-MINDED chap.
diseases of childhood, which are dependent on an
arrest of, or at least a disturbance in, the normal
development of the central nervous system," and
recently Huismans^ has published the following
conclusions to which he has been led by his study of
the subject.
(a) Amaurotic family idiocy of the kind described
by Waren Tay and Sachs cannot be isolated as a
definite morbid entity because all the clinical
features, even the macular spot, may occur singly
or together in other familial and hereditary as well
as heterogeneous diseases of the central nervous
system.
(d) Amaurotic family idiocy belongs to the great
province of familial and hereditary diseases of the
central nervous system, and is a variety of Little's
disease or cerebral diplegia.
Residual Forms
While the types of mentally defective persons
described in the preceding pages are, from the
clinical and pathological standpoints, the most
interesting cases which we have to consider, they
constitute, taken together, quite a small proportion
of the total number of the feeble-minded. Thus of
the 500 cases alluded to as series D {v. p. 95)
a large number could not be included under any
of the above headings, and among the class of
persons exhibiting the slighter forms of defect,
\j 1 L. Huismans, " Kurze Bemerkungen zur Tay-Sachsschen familiaren
amaurotischen IdioUe" /ourn. f. Psychol, u. Neurol.^ Bd. lo, 1908, p.
282.
VI VARIETIES OF FEEBLE-MINDED 259
such for instance as are not certified under the
Idiots Act of 1886, or the Lunacy Act of 1890,
but attend special schools, the percentage is still
higher. We are left then with a large residual group
requiring, for its complete subdivision, a more
minute analysis than has so far been employed.
Clinically the members of the group show all kinds
of physical abnormalities, but these are of too
moderate extent and too irregular distribution to
help in the differentiation of distinct types of disease.
For sociological purposes, however, it does not
seem to be necessary to attempt any more elaborate
classification than the one into cases of idiocy,
imbecility, and weak-mindedness already utilised.
Epilepsy
It has been usual for writers on mental defect
to distinguish as a group co-ordinate with other
clinical groups those cases, or some of them, in
which epileptic seizures occur. Such a distinction
is essentially unsound, for convulsions which cannot
be described otherwise than as epileptiform occur in
diverse types of feeble-mindedness. It will be
better, therefore, to consider this symptom in relation
to the different forms of defect recognised in this
chapter, without accepting it as in itself a criterion
for purposes of clinical classification. We note then
that in Mongolism there is a conspicuous freedom
from epileptiform seizures, while, on the other hand,
such seizures are one of the most striking and
constant features of tuberose sclerosis. In the cases
which have been included under the headings
s 2
260 THE FEEBLE-MINDED chap.
microcephalic, macrocephalic, and plegic, the ratio
of epileptics to non-epileptics Is high. It is not,
however, true that all paralysed idiots are epileptic.
Thus in a series of 150 cases, half being epileptic,
the following condition as regards paralysis was
observed.
All limbs Rt. hemiplegia Lt. hemiplegia Paraplegia
Epileptics 6 4 10 9
Non-epileptics 11 19
These figures may be compared with those given
by Bourneville. At the end of December 1904, he
had under his care fifty-nine mentally defective
patients suffering from hemiplegia. In thirty-two
of these the affection was at the left side, in twenty-
seven at the right. Of the former nineteen suffered
from epilepsy, and of the latter twelve. As to the
relationship of epilepsy and cretinism there is some
doubt. McCarrlson obtained a history of convulsive
seizures in a few of his cases of the " nervous " type
of cretinism, which has points of contact with
cerebral diplegia, but such seizures appear to be
rare in the myxoedematous type. On the other
hand. Stern ^ has noted the rarity of epilepsy as a
complication of Graves' disease and believes that
there exists a certain antagonism between thyroldism
and epilepsy. Thus he found that a slight enlarge-
ment of the thyroid was associated with improvement
in the condition of two-thirds of the patients in a
series kept under observation. The cases here
grouped under the heading '' progressive " differ as
regards the occurrence of convulsive attacks, these
^ R. Stern, " Zur Prognose der Epilepsie," Jahrbiicher fiir
Psychiatrie und Neurologie^ Bd. 3, 1909, p. i.
VI VARIETIES OF FEEBLE-MINDED 261
being a common symptom of juvenile general
paralysis, but not of the familial forms. A consider-
able percentage of cases of epilepsy is found in the
** residual " group.
Among 500 feeble-minded children under sixteen
years of age (250 of each sex), examined in an
asylum, there were 142 suffering from epilepsy,
while, in another set of asylum cases, of 500 males
and 600 females over sixteen there were, respec-
tively, 128 and 196 epileptics, a total of 324.
These figures give a grand total of 466 cases among
1,600 certified idiots and imbeciles, i.e,, approxi-
mately, 29%. Since epileptics call for closer
supervision than non-epileptics the distinction
between the two, though it may be clinically little,
is, for asylum administration, of great importance.
It is, doubtless, for this reason that the Com-
missioners in Lunacy have given prominence to
epilepsy in the scheme of classification approved by
them.
CHAPTER VII
THE HANDLING OF THE FEEBLE-MINDED
According to the estimate of the Royal Com-
mission on the Care and Control of the Feeble-
Minded there are, approximately, 150,000 " mentally
defective " persons, apart from certified lunatics, in
England and Wales. Of these some 66,000 are not
suitably provided for either as regards their own
well-being or that of the public generally. Clinically,
some of these defectives would not be embraced
even by the wide definition of feeble-mindedness
accepted in this work, but this is of no importance
from the sociological standpoint. The figures, too,
may be, to some extent, inaccurate. An incomplete
census, taken by investigators equipped with
different standards of what constitutes ** mental
defect," will not, in the nature of things, give
entirely trustworthy results. This also is not, for
our present purpose, a matter of great consequence.
The essential thing is that there are in the com-
munity, to use the Commissioners' own words,
** numbers of mentally defective persons whose
training is neglected, over whom no sufficient
control is exercised, and whose wayward and
irresponsible lives are productive of crime and
misery ; of much injury and mischief to themselves
and to others ; and of much continuous expenditure
262
VII HANDLING OF FEEBLE-MINDED 263
wasteful to the community and to individual
families " ; and that there is urgent need of a satis-
factory scheme for dealing with them.
Difficulties of two kinds are met with in attempting
to satisfy this demand. Not only have we to select
the scheme which is theoretically the best, but we
have also to consider how it can be carried out.
The interests of ihe feeble-minded and of society in
general may be, and apparently are, in some measure
conflicting, and the decision as to what is expedient
will only inspire confidence in so far as it is founded
on the widest possible survey of the position.
Our study of the subject will, then, begin appro-
priately with a consideration of the point of view
from which we are to regard it.
A. The Point of View.
So long as there have been human beings on the
face of the earth these beings have, we may assume,
exhibited inequality as regards their mental status,
some falling so far short of the work-a-day require-
ments of communal life as to be necessarily pre-
cluded from entering into the social organisation of
their day on the ordinary footing. There are in-
dications that the average man has, at all stages in
history, looked at his abnormal contemporaries with
mixed feelings. They have appealed now to his
selfishness, now to his altruism ; gusts of pity and
repugnance ; reverence and contempt ; fear and
amusement ; have in turn passed over the surface of
his abysmal ignorance : guiding the weaker vessels
towards a haven of sympathy and forbearance, or
264 THE FEEBLE-MINDED chap.
overwhelming them in storms of cruelty and oppres-
sion. Sometimes, doubtless, the cruelty has been
well-intentioned and has been designed to exorcise
the evil spirits which were thought to have taken
possession of the sufferer, and the responsibility for
the resulting inhumanity must rest on the shoulders
of the priests and teachers of the community rather
than upon the ordinary citizen. Even in these
later days we are not far advanced in the matter
of dealing with the feeble-minded in a philosophic
spirit : we have learnt a little and are more tolerant,
but we still fall short of Bacon's ideal of "employing
the Divine gift of reason to the use and benefit of
mankind."
It is idle to blink the fact that popular prejudice
is one of the most potent of the forces which have
to be reckoned with in any scheme of reform. The
spirit of opposition to changes in accepted usage as
regards the treatment of mental diseases, which one
finds in civilised communities, does not differ in
essence from that which the Indian native displays
in the matter of plague.
Probably only those who are brought into direct
contact with the feeble-minded appreciate the social
force behind them. They are not isolated person-
alities to be considered on their merits. Nearly
every one of them has such far-reaching ramifications
of relationship penetrating the body politic that any
shock applied to the individual may be transmitted
in an ever widening wave which causes a vast social
upheaval. Every British asylum medical officer has
had experience of the stupidity, the unfairness, the
suspicion, the untruthfulness, of the relatives of his
VII HANDLING OF FEEBLE-MINDED 265
patients. In Germany things are no better ; indeed,
according to Dr. M. Fischer,^ they are even worse
than with us. Nor is it merely the illiterate who
are guilty of such questionable conduct. An
American work entitled " The Lunacy Law of the
World," by J. A. Chaloner, Counsellor-at-Law, which
is in the writer's possession, indulges in the wildest
charges of corruption against asylum authorities,
impugning even the good faith of our own Lunacy
Commission and employing language of a character
so extravagant as to be ludicrous to anyone having
practical knowledge of lunacy law. Thus in regard
to the Idiots Act of 1886 we are told: —
" All that is required to incarcerate a person upon
the possibly false charge of idiocy or imbecility is
the action of his parents or guardians or ' any person
undertaking and performing towards him the duty
of a parent or guardian ' supported by a medical man
upon whose bare allegation, unsupported by affidavit,
the alleged idiot or imbecile may be imprisoned for
life."
And it is not only the antagonism born of ignor-
ance and superstition which the reformer has to
meet. Behind this is a more subtle sentiment, which
doubtless has its roots in the primitive struggle for
existence, that of shirking responsibility ; of leaving
others to bear the brunt. No scheme yet devised
by man for the amelioration of the conditions which
result from the existence of feeble-minded persons
fails to demand some immediate self-sacrifice on the
part of individual members of society even though
it offers them, in compensation, an ultimate advantage
^ M. Fischer, Laienwelt unci Geisteskranke^ 1903-
266 THE FEEBLE-MINDED chap.
much greater than that which they have foregone.
It is not disputed by the vast majority of persons
that the segregation of the feeble-minded, so far as
it has been effected, has been of benefit to the com-
munity, but that segregation has involved some
interference with social amenities in the places where
the feeble-minded have been collected and has been
bitterly complained of in consequence. Further, it
is not disputed that by following such industries as
are within the limited compass of their abilities the
feeble-minded have lightened the burden of the
community ; yet workers not handicapped by mental
infirmity, instead of turning their attention to the
higher branches for which, presumably, their greater
capacity fits them, resent the intrusion of the feeble-
minded and place such obstacles as they can in the
way of their employment. Equally indifferent to
the duties of citizenship are those parents who,
under the pretence of family affection, try to exploit,
for their own private ends, the labours of the feeble-
minded ; and who utilise the privileges which
society has conferred upon them in respect of their
relationship in order to defeat the fundamental
purpose of those concessions.
A conscientious desire to do one's best for the
feeble-minded does not, however, remove one beyond
the risk of falling into errors of judgment, as is
shown by the existence of conflicting suggestions,
all of which have been advanced in entire good
faith.
Some persons with a smattering of biological
knowledge are inclined to preach a war of exter-
mination against the inefficient, believing that in so
VII HANDLING OF FEEBLE-MINDED 267
doing they are conforming to the natural law of the
survival of the fittest. Glib suggestions of the
erection of lethal chambers are common enough,
being, indeed, the ordinary sequel to the first
introduction of the unthinking to cases of profound
idiocy. Apart from the difficulty that the provision
of lethal chambers is impracticable in the existing
state of the law, the scope of the procedure is so
restricted that it promises no more, as a set-off to
outraged feelings of humanity than the saving of
the relatively small sum which the housing and
feeding of a few short-lived idiots costs society.
Such cases as could alone be dealt with in this way are
not the ones which breed feeble-mindedness, simply
because they do not breed at all, and the removal of
them would do practically nothing towards solving
the chief problem which the mentally defective set :
that of the persistence of the obnoxious stock.
For asexualisation by surgical means a more
plausible case may, perhaps, be made out, but the
conditions under which this method would be
feasible are rare. It might be practised under
suitable control in those cases where an ungoverned
sexual instinct leads to crimes against the person.
Here it would probably prove advantageous, not
only to society at large but also to the offender as
removing him from the sway of impulses and
obsessions which, besides being dangerous to those
about him, are sources of misery to himself.
At the other extreme of opinion are the persons
who see in the feeble-minded only channels for the
outpourings of a lively emotionalism. Their as-
piration is the moulding of defective minds to the
268 THE FEEBLE-MINDED chap.
conventional pattern of thought and conduct to
which they themselves endeavour to conform. It
involves, as a necessary corollary, that the greater
the mental abnormality, the greater the effort which
should be made to correct it. But our social
resources are limited, and from the standpoint of the
national interest it is desirable that they should
be invested where they are most likely to produce
some return.
That the matter of dealing with the feeble-minded
has not, so far, been managed in a business-like
way, seems to be due in great part to its having
been so generally left in the hands of women. It was,
of course, a perfectly natural development that the
care of those who, in many respects, remain children,
should rest with the customary guardians of child-
hood. There were also such considerations as the
catholicity of feminine sympathies, feminine patience
with unpleasant and discouraging conditions, and,
perhaps, though to mention it savours of anti-
climax, the cheapness of feminine labour. So long
as the scholastic interest is predominant this state of
things is likely to continue. Thus in his evidence
before the Royal Commission Dr. J. J. Flndlay,^
Professor of Education in the University of
Manchester, said : " It maybe taken for granted that
although men (physicians and teachers both) may
do in the future as in the past much of the work
of research and of organisation, the daily task of train-
ing defectives will fall to women teachers." The
trouble Is that men have hitherto done so little '*of
^ J. J. Findlay, Rep. of Roy. Comm, on the Feeble- Minded., vol. "5,
p. 249.
VII HANDLING OF FEEBLE-MINDED 269
the work of research and organisation," and have
accepted women's services as trainers without con-
sidering what purpose the training should be
adapted to forward.
Some enhghtenment on this point may be derived
from a consideration of the way in which education
seems to have evolved. We may suppose that the
newly-appeared human animal would instruct his
offspring in the means of satisfying the primitive
needs of his day. Information as to the ways of
escaping danger and of obtaining food, with perhaps
some guidance in sexual matters, would be first
imparted. It would then be realised by the teacher
that the energies of the taught need not be wholly
absorbed in satisfying the wants of the latter and he
would endeavour to direct some portion of those
energies into channels profitable to himself. A
reverence for authority would have to be inculcated
to replace the feeling of dependence on parents
which the developing mind of the child would tend
to outgrow, and an appeal to supernatural sanctions
would be an obvious expedient for compelling that
deference for which, on purely mundane grounds,
there would be little apparent justification. With
the establishment of extraneous social relations new
obligations for both teacher and taught would arise
and the scheme of education would require modifica-
tion accordingly. As political interests predominated
over personal ones there would be initiated two
tendencies, one in the direction of society's depriving
the parent of the option of educating and the other
towards dictating the form which education should
take.
270 THE FEEBLE-MINDED chap.
The State is, indeed, gradually assuming towards
individual members of society a position similar to
that which we have attributed to the parents of an
earlier age. It endeavours to control education in
the interests of the individual and in its own interests,
and it does not scruple to claim, in order to justify
Its action, familiarity with the laws which govern
the universe. As yet It Is not strong enough to
ignore completely Individual predilections. In this
country, at any rate, the sentiment of nationality is
not so robust as to lead to the willing sacrifice of
Immediate personal interests, and the iniquity of
taxation, the Immorality of learning to bear arms,
and the Indecency of applying physiological know-
ledge, still afford themes for eloquent protest ; while
religious teachers of all denominations are aggrieved
because their particular conceptions of the eternal
verities are not at once recognised as the only
legitimate ones.
If the body politic is not to be subjected to per-
petual disruptive strains and stresses, It must be
founded on an equivalence of demands and obliga-
tions. Society should know nothing of rights and
duties in the abstract : It should admit the claims of
any Individual only In so far as these are counter-
balanced by services rendered. This principle
applies to feeble-minded persons as to others, but
the matter Is complicated In this special case by the
difficulty In the way of placing the issue clearly
before both parties to the bargain. As a set-off to
the charges which the community must bear on his
account the mentally defective offers his capacity
for labour and for engendering those pleasing
VII HANDLING OF FEEBLE-MINDED 271
emotions of righteousness, which, whether they
originate in the maternal instinct or in that of self-
assertion are sources of gratification to our souls.
If in both these respects the capacity of the feeble-
minded person is small, so are his needs few, and if
the return which he makes by affording opportunities
for the practice of altruism is inadequate, the balance
must be adjusted by getting more profitable work
out of him. There is no inhumanity in this, for the
things in his repertory which he can do best are the
things which, from the social standpoint, he ought
to do. That this fact is only now being recognised
is due to the darkening of counsel which has resulted
from leaving a biological problem to be solved by
pedagogues and particularly by female pedagogues.
The case of the feeble-minded who do not, on
account of their defect, become directly or indirectly
a charge upon the public purse presents special
features which alter the position.
** It is not intended," say the Commissioners, in
the Preamble to their Recommendations, " that the
maintenance at public expense of the mentally
defective or epileptics not mentally defective should
be extended to those who, either at their own cost
or at that of their relatives or friends, can be other-
wise suitably and sufificiently provided for." Society's
interest in this group of persons is simply to make
it relatively as large as possible by increasing the
facilities for obtaining suitable and sufficient provision
at such cost as falls within the means of the par-
ticular person or his relatives or friends. If the
relatives or friends accept nothing from Society
they need not consult its wishes, and they are at
272 THE FEEBLE-MINDED chap.
liberty to arrange the lives of their feeble-minded
dependents on any lines which are not actually anti-
social. Training in accordance with the ordinary
scholastic ideals may in such cases be legitimate
enough, though, if the ordinary scholastic methods
are employed, it may be productive of but little
result.
B. The Method.
When a dozen eminent Commissioners have
devoted nearly four years of earnest study and
discussion to a subject it may reasonably be
regarded as having been thrashed out as thoroughly
as is practicable, and no personal predilections would
justify a rejection of the conclusions reached even
if they did not, as the Recommendations of the
Royal Commission do, carry conviction to the minds
of the most prejudiced. What follows will be
largely an exposition of the views of the Com-
missioners with such comments, amplifications, and
minor criticisms, as the writer's experience seems to
warrant.
Stated concisely, the principles which in the view
of the Commissioners should guide attempts to
adjust the relations of the feeble-minded to the rest
of the community are that : —
1. Suitable special protection of the feeble-
minded should be provided by the State.
2. Not the poverty or the crime but the mental
incapacity of the feeble-minded should supply the
motive for the interference of the State.
Corollaries of these are the considerations that
since feeble-mindedness is a lifelong condition the
VII HANDLING OF FEEBLE-MINDED 273
protection afforded should be of lifelong duration ;
that the persons to be protected must first be
identified ; and that the machinery of protection
would be most satisfactorily controlled by a central
authority.
Special protection can only be provided by the
establishment of appropriate institutions and the
Commissioners discuss in their report the various
expedients available. They speak with approval of
the system of " boarding out " or family guardian-
ship, when practised under suitable conditions,
and they advocate the introduction of large farm
colonies on the lines of those which are to be found
in the United States and Canada.
" Boarding out " has the great merit of cheapness,
but there is always the risk that in aiming at cheap-
ness economy may be sacrificed. Thus against
the fact that cases are being maintained at a low
rate must be set the probability that the earning
capacity of those cases is not being utilised to the
full. It is not easy also to find the necessary
combination of a good house and a good house-
holder. A working man of the better class, for
example, does not want an idiot always about the
house, especially if he has children of his own, and
anything like adequate inspection is likely to be
resented. The risks that the feeble-minded person
may injure himself or another, or may give way to
drunkenness or sexual malpractices, naturally vary
inversely as the supervision exercised over him and
a check is given to scientific investigation if only
unskilled observers are ordinarily at hand. More-
over, under the existing lunacy law the need for
274 THE FEEBLE-MINDED chap.
periodical re-certlficatlon has proved an obstacle In
practice.
In England the scope of ''boarding out" Is likely
to be restricted except It be combined In some
such way as mentioned below with the opening of
Industrial colonies. All the Indications point to
these latter as the most hopeful agencies In
remedying the social Ills for which the feeble-
minded are responsible, although our experience of
such establishments Is, as yet, so slight that any
action taken In providing them would be to a large
extent experimental. The Commissioners were of
opinion that a " farm colony in England would be
of the greatest service both directly and Indirectly,"
and as some enterprising local authority may be
desirous of putting the matter to the test a little
space may be devoted to a consideration of what is
feasible In this regard.
Although the term '* farm colony " Is used by the
Commissioners, what they had in mind would be
better designated an "industrial colony," since other
Industries besides farming would be followed. The
cases for which accommodation is needed, being
those not at present under supervision, are generally
those showing the slighter degrees of mental defect,
and since such cases, whatever else they may lack,
are likely to have a fair capacity for work the Ideal
of a self-supporting institution may be approached.
The mutual disabilities which sane and insane
persons impose and experience are largely a matter
of elbow room and therefore the colony should be
as far from the hives of human activity as is
consistent with economical working. A ''model
VII HANDLING OF FEEBLE-MINDED 275
village" of special type seems to be what should be
aimed at. In Fig. 22 is shown a plan for such a
village, though of course many alterations in detail
might be rendered necessary by the conformation
of the ground selected, and with the help of the
ensuing description the reader may be able to
envisage the place as it would be in working
order.
A site of 200 acres is required. Anywhere within
easy reach of London the land would probably cost
;^ioo per acre, but elsewhere this amount would
cover also the cost of draining. There should be a
good supply of water; preferably of such a character
that it could be used for power generation, in which
case the problem of lighting would incidentally be
solved. By road, rail, river, or canal there should be
convenient access to some commercial centre. The
soil should be fertile and of a kind suitable for
cultivation by manual labour. Experience at Alt-
Scherbitz and elsewhere has shown how superfluous
is the costly wall which usually surrounds institu-
tions for those of unsound mind, and with inmates of
the class now under consideration there would be
even less need than in the case of an ordinary
asylum for mural enclosure. The precautions
necessary to prevent the escape of patients and to
protect the property of the institution from theft
can be carried out by less cumbrous means than the
erection of barricades.
Accommodation is designed for 2000 of the
feeble-minded and for the staff, say 200, who would
be required to control them. The number 2000 is
selected as representing the total beyond which
T 2
276 THE FEEBLE-MINDED chap.
economy In capital expenditure is counteracted by-
increased cost of administration,
Such a collection of buildings as that shown could,
probably, be provided at the cost of ;^ioo per bed
if due care were devoted to the selection of the site
and to the elimination of superfluous architectural
features. The East Harling and Ackworth re-
formatories, described in the Report of the Royal
Commission, are examples of how much can be done
with ;^ioo if it be judiciously expended. Economy
can be effected by proceeding gradually with the
work of providing accommodation, admitting first
such persons as can learn to render assistance in
further preparation. Thus, if, to begin with, pro-
vision were made for sane epileptics, a number of
comparatively skilled workers could be got together
and their labours could be turned to account with
much profit to the Institution.
Failing any special indications as to the class to
be provided for we may assume that the total will
include looo males and looo females, each group
being subdivided Into, say :—
500 Children.
400 Adults ; Including 40 of the immoral or
Intemperate type requiring special supervision.
50 Infirmary Cases.
50 Sane Epileptics.
These would be housed In separate buildings,
arranged, as shown in the plan. In convenient
proximity to the workshops and the administrative
departments. The buildings would differ In detail
according to the requirements of the different
groups into which it might be found necessary
VII HANDLING OF FEEBLE-MINDED 277
to divide the inmates. Since the plan given is only-
intended to embody a general idea no attempt is
made to indicate these minor features.
For the staff there would be required a certain
number of houses for married men, and suitable
staff blocks for women. Cottages for the employees
of subordinate rank should be of sufficient size to
enable the occupier to take in as a lodger some
unmarried officer or, in special circumstances, a
patient. It would be necessary also to assign
rooms in the patients' blocks to some of the
attendants.
The controlling authority which, if the recom-
mendations of the Royal Commission are adopted,
would be a Statutory Committee of the County
Council with co-opted members, of whom at least
one would be a woman, might also with advantage
be entrusted with powers which would enable it
to sell or let on lease to persons not in its employ,
but attracted to the site by business or other
considerations, such land as might be suitable for
the purpose ; and to enter into contracts with such
persons for the boarding out of patients. Further,
it might appropriately supply and control those
products of civilisation, the post-office, the police
station, and the public-house, without which no
community can be expected to be happy.
As head of the establishment would be installed
a resident Director, preferably a medical man ; for
medical men, as they have frequently shown, are
capable administrators, inspiring respect in their
subordinates by their professional status and supple-
menting their technical knowledge of mental disease
278 THE FEEBLE-MINDED chap.
by broad views of human nature. Such a Director,
having been appointed with due deliberation by
the Statutory Committee, should be allowed to
direct. Committees are apt to lose sight of the
fact that they are concerned rather with results than
with methods and that the man on the spot,
especially when he brings to bear upon his duties
the experience born of years of service, will probably
be able to deal single-handed with administrative
details. Farming operations, in particular, cannot
be carried on satisfactorily if at every stage of the
cultivation of the soil, the purchase of stock, and the
disposal of produce, a specific authorisation has to
be obtained from a committee meeting only once a
fortnight and perhaps failing to constitute a quorum
at critical moments. The Director would maintain
discipline by means of suitable rewards and punish-
ments and it would probably be advisable to confer
upon him the powers of a Justice of the Peace.
In many respects the staffing of a colony of the
kind here described would differ from that of an
ordinary asylum. The bulk of the colonists would
be actual or potential workers and the chief purpose
of the colony would be the utilisation of their
labour. Immediately subordinate to the Director
there would be the following officers each in charge
of a special department.
A Senior Assistant Medical Officer.
A Steward.
A Craftsmaster.
A Craftsmistress.
And in addition to these there would be an officer,
VII HANDLING OF FEEBLE-MINDED 279
not necessarily resident, who would make arrange-
ments for the provision of religious instruction. To
the officers just mentioned would be assigned duties
appropriate to their several positions, as thus :
The Senior Assistant Medical Officer, He would
in the absence of the Director assume the func-
tions of that officer. Ordinarily he would have
control of the medical treatment, including the
nursing of the colonists, and he would be looked to
for the development of that scientific aspect of
feeble-mindedness which has hitherto been so greatly
neglected. He would be assisted by
A Junior AssistantMedical Officer.
A Superintendent Nurse, supervising Charge and
Ordinary Nurses.
Mortuary Attendants.
The Steward. Stated briefly the duties of the
Steward would be to keep all books and accounts
and produce them for inspection or audit when
required ; to submit estimates for, purchase, receive,
examine, and issue, all goods ; to conduct corre-
spondence and supply information to duly authorised
persons ; to receive and pay out all moneys ; to
arrange for the admission, transfer, discharge, and
interment of the colonists ; and to protect from
theft, wanton destruction, or improper use the
property of the colony. The officers in his depart-
ment would include
An Assistant Steward.
Clerks.
Male and Female Store-keepers.
Store, Hall, and General Porters,
280 THE FEEBLE-MINDED chap.
A Fire Brigade.
The Craftsmaster, This officer would be
responsible for the control of all the male colonists
who could be usefully employed. He would have
charge of them both while they w^ere at work and
while they were at leisure and would endeavour,
generally, so to order their lives as to make them
happy and useful members of the community. His
lieutenants would be
A Chief Industrial Attendant (Male), at the head
of a staff of industrial trainers and ordinary attend-
ants.
An Engineer with his subordinates.
A Farm Bailiff with the necessary farm and garden
labourers.
The Craftsmistress. Many of the duties usually
attached to the post of a matron would fall to this
officer, but as nursing would not be one of them she
would not require to have had special training in
that art. She would hold in relation to the female
colonists a position similar to that of the craftsmaster
and would have under her
A Chief Industrial Attendant (Female), with
industrial and ordinary attendants.
A Cook, with her helpers in the kitchen.
A Laundress, with her staff.
To enter in any detail into the question of the
salaries which should be paid to the officers above
mentioned is beyond the scope of this book, the
more so since the matter is one which would be
controlled to a large extent by local conditions.
Taking the current rates of remuneration in poor
law and asylum service as a guide the cash pay-
[Fig. 33.]
PLAN OF INDUSTRIAL COLONY
FOR 2,000 PERSONS.
REFERENCE.
A. Rouses fm Members of Subordinate Staff.
B. Farm Buildings.
C. Church.
D. Isolation Hospital.
E. House for Craftsmistress.
F. Female Staff Block.
0. Blocks for ChAld/ren : each to accommodate SO.
H. Combined Training School and Recreation Hall.
1. House for Craftamasier.
J. Blocks for Adult Patients. These might be
planned on the lines of the blocks figured in the
account of the Rev. H. W. Burden's Colony Scheme
which appears in tlte Report of tlie Royal Comm.
on the Feehle-Minded, vol. 5. Each block would
hold 40 patients and cost .approMmately, £2,000.
K. Mortuary.
L. Fire Station.
M. Pumping Machinery.
N. Wood Shed.
0. Workshops for Women.
P. Lamidry with Drying Ground.
Q. Engines ; Boilers ; Chimney Shaft ; Water Tower.
B. Coal Store.
S. Workshops for Men.
T. Kitchen.
V. Steward's Stores.
V. Steward's House.
W. Nurses' House.
X. Receiving Wards.
Y. Blocks for Scne Epileptics.
Z. Admimistrati/oe and Infirmary Block.
1. House for Senior Assistant Medical Officer.
2. House for Director.
\
u!
|U
1 1
1 1
1
D'
'n
1 1
j
4
io-
1 1
1 1
j
D|
]n
1 1
IE
F
ID
L
.__iilL
'D
1 1
n
1 <^
1
1
// ^^ / \
G "^ \
HFj
1
1
'1 q/' O' r
V^ivf \\ Ok
4]'d
c
j J
1 1
f^M""
1 =
"-
J 1 1
1
1
) P
p
9
R
D
1 "^
'i^
i
1 b
tL--"
T
u
1 L
:--"'l
,^
J
"
J / /
H
'n r
VII HAl^DLING OF FEEBLE-MINDED 281
ments to the principal officers might be somewhat
as follows :
^Director ....
£600 per annum
■^Senior Assistant Medical Officer .
ZSo »
Junior Assistant Medical Officer .
175 »
•^Steward ....
250 »
*Craftsmaster
250 »
Craftsmistress
150 »
To which would be added various emoluments, e.g.
unfurnished houses, with coals, light, and washing,
in the case of those marked with an asterisk, who
would probably be married, and furnished quarters
with rations, etc., for the other two.
It will be noted that no provision in the way of
school teachers of the ordinary type is made. Such
elementary instruction in reading, writing, and
arithmetic as would be required would be given by
the attendants in charge of the colonists. To have
the school life and the home life under separate
control not only adds to the difficulties of administra-
tion, but introduces into the training a discontinuity
which embarrasses the feeble-minded person.
The Obtaining of Control.
Adequate control and supervision are the urgent
needs of the feeble-minded and in order that these
may be supplied there must be some interference
with the ''liberty of the subject." When this is
effected by private individuals in regard to those
having a familiar relation to them, the public con-
science is not touched and no difficulty arises, but it
is otherwise when society at large takes action.
This is in no way surprising because there is involved
in it an antagonism between the stronger and more
282 THE FEEBLE-MINDED chap.
primitive instincts of family life and the weaker
secondary tendencies which bind separate families
into a community. Private enterprise has provided
sundry schools, homes, asylums, and kindred insti-
tutions for the feeble-minded and, under the existing
law, these can be utilised by anybody who is pre-
pared to pay for the privilege ; such legal sanction
for detention as is found necessary being afforded by
the Idiots Act of 1886.
When, however, there comes into the question the
exercise of compulsion by the State, the matter
assumes quite another aspect. Two categories of
cases may be recognised, according as the interven-
tion of the State does or does not involve pauperism
on the part of the recipients of State aid.
(A) Taking the latter category first, we find that
under the Elementary Education (Defective and
Epileptic Children) Act, 1899, modified by the
amending Act of 1903, education authorities may
make a certain limited provision for the feeble-
minded. The limitations are in part directly imposed
by the Act and in part are due to practical difficulties
in working it. Their effect may be thus sum-
marised :■--
1. The supervision is restricted to school hours,
except in the few instances in which boarding houses
have been established.
2. The Act applies only to such children as are
between the ages of seven and sixteen years. Of
the two classes named, the "defective" includes only
those who ** not being imbecile and not merely dull
and backward are by reason of mental or physical
defect incapable of receiving proper benefit from the
instruction in the ordinary public elementary schools
VII HANDLING OF FEEBLE-MINDED 283
but are not incapable by reason of such defect of
receiving benefit from instruction in such special
classes or schools as are in this Act mentioned " ;
while the ''epileptic" comprises those who "not
being idiots or imbeciles are unfit by reason of
severe epilepsy to attend the ordinary public
elementary schools."
3. The necessity of distinguishing the forms of
mental disorder referred to in paragraph two opens
up the way for disputes as to certification in which
the medical officer of the education authority,
unattached medical practitioners, the parents of the
child, and the magistrate to whom appeal is eventu-
ally made, join. Messrs Garbutt and Crowley,^ in
their evidence before the Royal Commission, noted
the objections raised by parents who think their child
mentally sound, or who do not want it to attend the
** Silly School," or who want it to go to work, or
who are alarmed by the formalities of admission to
the special school and by the number of persons
present to carry them out.
4. Minor difficulties are the religious question,
the distance of the special school from the homes of
the children, and the supply of teachers.
(B) The machinery for dealing with feeble-minded
persons of the pauper class is as intricate as it is
ineffective. Guardians of the poor may, under
certain conditions, utilise the provisions of the Idiots
Act, 1886, in obtaining for such idiots and imbeciles
as are '' capable of deriving benefit from the treat-
ment to be received "the necessary care and control,
but it is questionable whether the detention author-
ised could be maintained in opposition to the wishes
^ Garbutt and Crowley, Rep. of Roy, Comm., vol. 2, p. 121.
284 THE FEEBLE-MINDED chap.
of the parent, guardian, or other approved person
who took the Initiative In procuring It. The accom-
modation available Is also too scanty and too expen-
sive to meet the public needs.
When the degree of Idiocy or Imbecility Is
sufficiently marked to justify the Institution of pro-
ceedings under Section 24 of the Lunacy Act, 1890,
which relates to "lunatics In workhouses," there Is,
on theoretical grounds, no particular difficulty, but, in
practice, the procedure is very cumbrous. The case
may reach the workhouse either by transfer from an
asylum under Sections 25 and 26 of the Act, or
directly. A perusal of Section 24 will show that
for permanent detention In the workhouse there Is
necessary,
'' an order under the hand of a justice having
jurisdiction in the place where the workhouse Is
situate,"
which order
''may be made upon the application of a
relieving officer of the union to which the
workhouse belongs supported by a medical
certificate under the hand of a medical prac-
titioner not being an officer of the workhouse
and by the certificate under the hand of the
medical officer of the workhouse hereinbefore
mentioned."
Two medical certificates, respectively, in Forms 8
and 10 in the Schedule to the Act, are thus
apparently required, but the number is really three,
for Form 11, according to which the justice makes
his order, winds up with the words
VII HANDLING OF FEEBLE-MINDED 285
*' and, if the workhouse medical officer shall
certify it to be necessary to detain the said A.B.
as a patient in your workhouse,"
and the law officers of the Crown have given it
as their opinion that
" the certificate must be obtained before any
detention against the will of the patient takes
place."
The Commissioners in Lunacy do not regard the
order in which the two medical certificates mentioned
in Section 24 (4) are given as of any importance, but
it may be noted that whereas the certificate given by
the workhouse medical officer is alone sufficient
authority for detaining the patient for not more than
14 days, that given by the outside practitioner has
not the same effect. A correct chronological relation
between the justice's order and the certificates and
statement of particulars upon which it is based is
however essential to the validity of the first-named
document. The words '' not being an officer of the
workhouse " have given rise to a good many
difficulties : thus the Commissioners in Lunacy have
had occasion to decide that "a member of a board
of guardians is not an officer of the workhouse within
the meaning of Section 24 (4) of the Lunacy Act,
1890." It is curious that no fee is payable to the
medical officer of the workhouse under this section
though he is entitled to one if he certifies the patient
as suitable for detention in an asylum.
In London the position is complicated by the fact
that the institutions referred to in the Lunacy Act of
1890 as "workhouses" are of two distinct kinds.
There are, on the one hand, the ordinary "work-
286 THE FEEBLE-MINDED chap.
houses " maintained by the separate boards of
guardians and, on the other, the ''asylums" main-
tained by the MetropoHtan Asylums Board. The
latter establishments do not receive patients directly
from the outer world, but only through the ordinary
workhouses or occasionally through other asylums.
A special set of formalities to control this transfer
has been devised by the Local Government Board,
but since these formalities do not replace the
procedure for detention under the Lunacy Act, 1890,
this has to be utilised just as in the case of the
provincial workhouses. The imposing dossier which
accompanies a feeble-minded person to one of the
" asylums " which, under the Metropolitan Poor
Act, 1867, the Metropolitan Asylums Board has
provided, includes, then, the following documents.
1. Application by relieving officer to a justice
having jurisdiction in the place where the workhouse
is situate for an order for the detention of the case
in the workhouse of the parish or union to which he
is chargeable.
2. Statement of particulars by the relieving officer
to accompany the application.
3. Certificate by the medical officer of the work-
house under Section 24 of the Lunacy Act, 1890.
4. Certificate by an outside medical practitioner
under the same section.
5. The medical certificate referred to in Form 1 1
of the Schedule to the Lunacy Act, 1890.
6. Order for detention made by the justice under
Section 24.
7. Order for the admission of the patient to one
of the asylums of the Metropolitan Asylums Board,
VII HANDLING OF FEEBLE-MINDED 287
signed by the clerk to the guardians of the parish or
union from which the patient proceeds.
8. Certificate by a medical officer of the parish
or union to which the patient is chargeable, to the
effect that the patient is *' a chronic and harmless
lunatic, idiot, or imbecile " suitable, and physically
fit for removal. This certificate differs in several
respects from the certificate referred to in paragraph
3 supra, though its general purport is the same, and
it is usually given by the same medical officer. The
chief difference seems to be that it may include
'* facts communicated by others."
9. A report " signed by the chairman or vice-
chairman of the board of guardians of the parish or
union to which the pauper is chargeable or by some
member of the visiting committee of such board of
guardians."
10. A second medical certificate as to the patient's
bodily condition is frequently necessary for the
following reasons. The admission order mentioned
in paragraph 7 supra, is, according to the Order of
the Local Government Board of Feb. loth, 1875,
which regulates admissions to the asylums here
considered, to be signed by the clerk by direction
of the board of guardians and it is further laid
down that '' such direction shall not be given until
the certificate and report above mentioned (cf. 8
and 9 supra) have been laid before the board of
guardians." The medical certificate must, there-
fore, be anterior in date to the admission order,
and, as this is available for seven days, it sometimes
happens that the statement of the medical ofificer as
to the patient's physical fitness for removal has been
288 THE FEEBLE-MINDED chap.
made so long before the removal to the asylum
actually takes place as to afford no satisfactory
evidence about the patient's condition at that time.
In the case of children admitted to ** the Asylum for
Children at Darenth" the admission order is available
for fourteen days and the force of the objection just
noted, to having the medical certificate as to fitness
for removal given several days before such removal,
is recognised by the Local Government Board,
which, by an Order dated May 5th, 1890, requires
that the certificate should be given on the day of
the removal or on the day immediately preceding.
Since December, 1907, the Metropolitan Asylums
Board has been able to admit into its asylums
patients at any age above 3 years. Such cases
as do not appear to require certification under
Section 24 of the Lunacy Act, 1890, are received
into certain homes and schools which are under the
control of the Board, but in which detention is not
authorised. These last mentioned cases, if received
before reaching the age of 16 years, remain until
they are 21. Detention is, however, of the essence
of control and it may be of interest to note briefly
what authority outside the purview of the Lunacy
Act, 1890, is available for the purpose. The
detention of a lunatic is said to be justifiable at
common law if necessary for his safety and the
safety of others. For the rest, feeble-minded
persons are on the same footing as ordinary persons.
Guardians of the poor have limited powers under : —
(1) The Children Act, 1908. (8 Edw. 7, c. 67.)
Parts 2, 4, and 5. This Act repeals much of the
Prevention of Cruelty to Children Act, 1904.
VII HANDLING OF FEEBLE-MINDED 289
(2) The Pauper Inmates Discharge and Regu-
lation Act, 1871. (34 and 35 Vict. c. 108.)
(3) The Poor Law Act, 1899. (62 and 6^ Vict.
c. 37.)
(4) Art. 115 of the General Consolidated Order,
July 24th, 1847.^
The sum total of these falls far short of the
needs of the position.
In order to simplify the procedure, the Royal
Commission on the Feeble- Minded have made a
series of Recommendations which they, and others,
hope to see embodied in an Act of Parliament.
These Recommendations are set out at length in
vol. 8 of their Report, but it will be convenient to
give here the gist of such of them as apply to the
question of detention. By eliminating the word
''pauper" and replacing the word ''lunatic" by
the words "mentally defective person" in sundry
sections of the Lunacy Act, 1890, the scope of that
measure would be largely increased with a minimum
of disturbance of the existing machinery : important
results would be that Sections 24 to 27, which
apply to "workhouses," would become unnecessary:
Section 206, which refers to lunatics cared for
without charge by their friends or in some charitable
establishment, would become applicable to the feeble-
minded : Sections 4 to 8, dealing with Reception
Orders on Petition, might be utilised : and Sections
II to 23, which lay down the procedure for obtaining
Urgency and Summary Reception Orders, would
become available. Similarly, it Is proposed to
extend the provisions of the Idiots Act, 1886, so as to
1 V. Notes in Glen's Poor Lmv Orders^ 1898, p. 312.
U
290 THE FEEBLE-MINDED chap.
cover, without limit of age, seven of the nine classes
into which the Commissioners divide " mentally
defective" persons. These 7 classes are '' Idiots" ;
'' Imbeciles " ; '' the Feeble-Minded " : *' Moral
Imbeciles " ; and mentally defective persons who
are " Epileptics," " Inebriates," or *' Deaf and Dumb,
or Blind," the remaining two classes, to be dealt with
under the revised Lunacy Act of 1890, being
*' persons of unsound mind " and '' persons mentally
infirm." Mentally Defective and Epileptic children,
as defined by the Elementary Education (Defective
and Epileptic Children) Act, 1899, would no longer
be affected by that statute, but ample powers for
dealing with them would be assigned to the local
authority. Finally, Recommendations are made as
to the control of mentally defective criminals and
inebriates and of epileptics not mentally defective.
The Procedure on Admission.
Having obtained control of the feeble-minded
individual, we are confronted with the problem of
deciding the use to which he shall be put, the ideal
being, as already indicated, such employment as
shall be congenial to him and profitable to society.
To this end it is desirable that the individual con-
cerned should be examined with some thoroughness,
not with a view to bolstering up some obsolete
theory of etiology, but in order to learn the nature
and extent of his capabilities. This examination
will appropriately embrace the customary two sets
of conditions : those bearing on the person's
VII HANDLING OF FEEBLE-MINDED 291
previous history and those relating to his present
state.
The information respecting the former would be
best contributed by the medical man who certified
the case as suitable for admission. Being brought
into immediate contact with the patient's environ-
ment, he is in a much better position to record
such features of it as are noteworthy than is the
medical officer at an asylum, perhaps miles away,
whose sole means of eliciting facts is the questioning
of untrustworthy relatives. This principle is acted
upon in various parts of Germany, where the
*' Kreisarzt " furnishes, by means of a series of
**Arztliches Gutachten," ample particulars of the
cases he certifies. It is proposed by the Royal
Commission that there should be appointed by each
local authority a special advisory medical officer
and a sufficient number of " certifying medical
practitioners " so that the method suggested would
be feasible. The record should be arranged in such
a form that it can be filed without transcription into
" case books," such transcription Involving much
clerical labour of an unprofitable sort which usually
devolves upon the medical officers of the institution
into which the case is received. It does not appear
that anything Is gained by having the enquiries
made and the results of them recorded according to
a set form : a wide discretion as to what is worth
reporting may^be given to the certifying practitioner.
One of the points on which stress may, however, be
laid, in view of the uncertainty surrounding It^ is the
family history in so far as this bears upon the
presumed Inheritance of the mental defect. As a
u 2
292
THE FEEBLE-MINDED
CHAP.
convenient means of registering facts in this con-
nection the form shown in Figs. 23 and 24 is
Male Cousins of A) „
Female Cousins of A i^'-oif'^'^
Male Cousins of A) si^fg^g
Female Cousins ofAi
Half -brothers of A-i
Half-sisters of A i
A = the person under examination.
j Father
\\ Mother
Uncles
Aunts
Uncles
Aunts
Nephews, g^^^,,^^^
Nieces )
Sisters i A'epAeu/s
I Nieces
(Male Cousins of A
^'-°*''^''^\Feniale Cousins of A
Sistersi '^"'^ Cousins of A
'"^^^'^^X Female Cousins of A
fHalf-brothersofA
I Half -sisters of A
Females
O
9
o
Insanity Feeble-
mindedness
Epilepsy
Fig. 23.
€ 3
Neruous Alcoholism
Disease
A numeral before the symbol, e.g. 3 $ , indicates the number conforming
to a particular type ; in the example given, 3 epileptic females of the same
degree of relationship to A.
Only those persons in regard to whom reliable information is obtainable are
inserted.
The sign © indicates that reference should be made to a marginal note.
recommended. Fig. 23 is a key diagram showing
the relationships which can be indicated and the
Fig. 24.
symbols which are employed, while Fig. 24 shows
an actual family history recorded with the help of
VII HANDLING OF FEEBLE-MINDED 293
the diagram. It is also desirable to ascertain, as
the writer believes is done at Earlswood Asylum,
whether the census return relating to the patient
was properly filled up.
Ignoring for the moment the consideration that
all the characters capable of investigation have,
presumably, a physical basis, we may follow the
usual convention which distinguishes between
physical and mental attributes and divide the
examination on admission into two parts, one dealing
with the former group and the other with the
latter.
I . Examination of the physical condition.
This serves several purposes, e.g. :
{a) It discloses any evidence of neglect or ill-
treatment.
{b) It gives opportunity for the detection of any
conditions, e.g., infectious disease, which would make
rejection necessary.
{c) It supplies data for subsequent identification
in case of escape.
(d) It affords information as to the nature and
amount of the work which may properly be
demanded.
The examination may be conducted on the
ordinary lines familiar to medical men. In order
to save time and labour line diagrams of the various
parts of the body may be employed freely, in
conjunction with the customary abbreviations and
signs. The notes may be conveniently made on
the back of a card bearing a stereoscopic portrait
of the case, the portraits being filed in accordance
with one of the systems now in vogue.
294 THE FEEBLE-MINDED chap.
(2) Examination of the mental condition.
Motives of economy are likely to prevent the
provision in working colonies of an elaborate
equipment for pursuing psycho-physiological methods
in the examination of the residents. Moreover, in
the present state of our knowledge, the results yielded
by reaction time experiments ; the exact deter-
mination of differences in visual, auditory, or tactile
sensibility ; or the measurement of emotional
reactions ; have no immediate applicability to social
problems and the collection of them must be left in
the hands of persons not primarily concerned with
administrative details.
It is necessary, however, to obtain such a
familiarity with the mental state of the defective
person as will enable us to place him under the
most favourable conditions for profitable develop-
ment, and this is done by asking him questions and
inviting him to perform sundry exercises. A certain
discretion must be displayed in these procedures in
order to obtain information of value. In the first
place allowance must be made for the examinee's
opportunities of acquiring knowledge. Thus a set
of questions suitable for testing the intelligence of a
country-bred child might give very misleading
results if employed for one who had never previously
left a London slum. Then it must be remembered
that people whose mental gifts are up to, or above,
the average may be unobservant or '' absent-
minded " and may consequently fail to answer
correctly simple questions. It is a common practice
to test the intelligence of a child by asking it to
name the day of the month or describe what it had
VII HANDLING OF FEEBLE-MINDED 295
for dinner on the previous day, questions which, on
occasion, the examiner himself would probably fail
to answer off-hand. It is advisable also to avoid
questions which admit of only a limited choice of
answers, since the less scope there is in this respect
the greater is the chance that the right answer may
be given by accident. If one tells a child to pick
up one of two coloured beads lying before him he
may easily select the right one even though colour-
blind. In the performance of exercises, too, the
opposing effects of practice and fatigue must be duly
set off against each other.
The following scheme is designed to elicit such
general information as to the capabilities of a feeble-
minded person as will enable the examiner to classify
him with sufficient accuracy for the purposes of
an industrial colony. Many of the questions and
exercises could doubtless be replaced by others
equally serviceable, but it is desirable to stick as
far as possible to one system in order to facilitate
comparison and the compiling of the necessary
statistics. Further, since mind must be regarded
not as a fixed conglomerate of the elements which,
in the first chapter, we believed ourselves to have
discovered In it, but rather as a flowing stream of
ever-varying constitution, we cannot, in fact, cut it
up into the various sections enumerated below,
although it is convenient to gather together the
data obtained under the different headings there
mentioned.
(A) Sensitiveness to stimulation.
The various senses may be tested thus. —
(i) Sight
296 THE FEEBLE-MINDED chap.
(a) Light perception : — Bring up gradually behind
a screen of ground glass, or of ordinary glass
covered with translucent paper, lighted from behind,
some object of simple outline, e. g. a pencil, and note
the distance between object and screen at which the
shadow is detected. An apparatus consisting of a
graduated rod along which the object can slide
between the fixed screen and the source of light, as
in Fig. 25, can be constructed at trifling cost.
-7 ,-/ /////// rrjri
'/'"''>
A B C
A. Source of Light. B. Rod on sliding base. C. Screen.
Fig. 25. — Apparatus for Testing Acuity of Perception of Light.
(d) Distance of distinct vision. The ordinary
test-types can be employed for children who know
their letters ; for others some familiar and attractive
object, e. g, a piece of toffee or an orange, will be
preferable.
{c) From a number of brightly coloured wooden
beads let those of similar colour be sorted out.
(2) Hearing. Two tuning forks of different pitch
are required. The person is asked if there is any
difference between the sounds of them, and, one of
them being sounded, he is to say when he ceases to
hear it.
(3) Taste. Two powders one of starch mixed
with a little saccharin and the other of starch with
a little quinine sulphate are to be discriminated
between.
VII HANDLING OF FEEBLE-MINDED 297
(4) Smell. Fluids consisting the one of olive oil
containing oil of cloves and the other of olive oil
and oil of peppermint will serve.
(5) Cutaneous sensibility. Test reaction to
temperature by tubes containing hot and cold water
respectively ; susceptibility to pain by pricking with
a needle ; touch by wooden blocks of different
shapes, sizes, and degrees of superficial roughness ;
pressure by means of similar rubber balls, some
empty, others solid or filled with a hard substance,
e.g., plaster.
(B) Attention.
The testing of the sense organs will have sup-
plied much information in regard to this. Further
evidence will be afforded by the subjoined
exercises.
(i) Mix two packs of ordinary playing cards and
note the time taken in sorting them out, {a) into two
groups by the pattern on the back ; (b) into suits ;
[c) into cards of the same denomination.
(2) Bourdon's Method. Hand to the person a
piece of printed matter and tell him to underline or
otherwise mark all the examples of a particular
letter present. The letter "n" which is likely to be
mistaken for '' u " is perhaps the most suitable for
the purpose. Note the number of mistakes and the
time taken.
(3) Kraepelln's Method. Numerals printed in
columns are added up In pairs, the time taken to
complete a certain number being noted. Suitable
sheets of figures are published by the Unlversitats-
Buchdruckerel von J. Horning, of Heidelberg, and
can be obtained at the cost of a few pence.
298 THE FEEBLE-MINDED chap.
(C) Memory.
(i) Method of Ebblnghaus. A number, 6 to 12,
of disconnected monosyllabic words is read by or to
the person until it can be repeated without mistake.
The number of readings necessary for learning will
be a measure of the memory, as will also be the
amount forgotten after an interval.
(2) Copying from memory Ziehen's 5-angled
figure (v. Fig. 26).
Fig. 26. — Ziehen's 5-Angled Figure.
Note that the base-line is not horizontal, and that the sides and angles are
all unequal. (From Ziehen's Die Prinzipien und Methoden der Intelligenz-
prufungy 1908.)
(3) Description from memory of the furniture in
the room where the examination is taking place.
(4) Familiar articles are shown and questions
are asked about their names and uses. For the
lowest grades a spoon is suitable, while for patients
of somewhat greater intelligence an article of
clothing, a coin, a clock, a key, and a compass
constitute a convenient ascending series.
(5) Questions are asked about matters of common
knowledge, e.g, :
What is the day of the week, the month, the
season, the year, the century .-^
VII HANDLING OF FEEBLE-MINDED 299
What is the name of the King, your own country,
some other country ?
What things are used in washing, cooking,
mending ?
What is to be seen on a farm, in a street, at a
railway station ?
(D) Reasoning.
Such tests as the following may be employed.
(i) Untie a knot of simple design.
(2) Put on a coat of which the sleeves have been
turned inside out.
(3) Explain purport of a picture post-card and
fit together the portions of it when it has been
cut up.
(4) Identify objects from drawings showing
different degrees of detail. The simple figures
designed by Heilbronner, one set of which is shown
in the accompanying illustration (Fig. 27), will
Fig. 27. — Examples of Heilbronner's Figures.
These particular ones are taken from Cimbal's Tasckenbtcck, but a variety of
others on the same lines are given in Heilbronner's original paper, " Zur
klinisch-psychologischen Untersuchungstechnik," in Monatssch. f. Psych, u.
Neur.^ Bd. 17, 1905.
serve for cases of low capacity ; for more intelligent
persons a series of photographs of some scene
showing some feature with gradually increasing
clearness is a convenient device.
(5) Supply a missing word. The cards designed
300 THE FEEBLE-MINDED chap.
by Miss Mason for instruction in the art of reading
may be utilised for the purpose.^
(6) Explain the purpose of some unfamiliar
object.
(7) Describe common dangers and the way of
avoiding them.
(E) Morals.
(i) Instances of virtuous and vicious practices
are to be recognised and named.
(2) Inquiry is to be made as to the person's
ideals.
Instinctive and emotional activities, habits, and
powers of work cannot be thoroughly investigated
at the first sitting. A note in regard to them may
be made at the expiration of, say, one month from
admission.
The Training to be Given.
'' Education" says Professor J. Sully ^ ''is an art
and as such needs to have a clear idea of its end.
We cannot begin to educate intelligently until we
know what we are aiming at. " The end is, however,
''plainly something large and complex" and to
define it we must have recourse to Ethics, Sociology,
Logic, Esthetics, and Psychology. Even when it
is defined our approach to it can only be asympto-
tical, for it is undergoing an evolution which must
render our pursuit of it interminable. So far as it
is capable of exact statement our ideal is the "intel-
ligent, refined and good person. " Now for the
1 Published at 56 Romola Road, Heme Hill, S.E.
^ J. Sully, The Teacher's Handbook of Psychology^ 1909, p. 11.
VII HANDLING OF FEEBLE-MINDED 301
realisation of this ideal there is necessary at least a
normal capacity for development, which, ex hypo-
thesis the feeble-minded individual has not. To
some extent feeble-mindedness appears to be a
reversion, though opinions differ as to the degree to
which this is the case. The evolution of the
individual follows that of the race sufficiently closely
to lead us to expect that if a simple failure of
development were the cause of idiocy we should find
more marked resemblances than in fact exist between
idiots on the one hand and savages or the lower
animals on the other in respect of mental capacity.
But the parallelism is close enough to suggest that
the fields of activity — economic or moral — open to
the feeble-minded will correspond to those of living
beings at the various stages to which retrogression
has occurred and that It Is consequently idle to
attempt to reach the standard set by Professor
Sully. Obviously, then, as we must cut our coat
according to our cloth, a more modest conception of
the end in view must be accepted. Our aim must
be to provide the feeble-minded person, in so far as
he Is capable of receiving them, with a fund of ideas
of such a character that the exercise of his limited
capacity for associating them will result in the pro-
duction of activities as little detrimental to the
interests of society as is possible.
Two distinct ideals, which may be designated,
respectively, the ornamental and the useful, are met
with, and the former is the one which In the past
teachers have usually kept before them and have set
their course by. The preliminary steps in training
will, however, be the same whichever line is to be
302 THE FEEBLE-MINDED chap.
ultimately followed. They may be thus sum-
marised.
(i) Procedures for attracting and retaining the
attention of the pupil. Without these no progress is
possible, and failure at this stage denotes that the
case Is unimprovable. It seems probable that the
mentally defective, like normal persons, belong to
different Ideational types — visual, auditory, kinaes-
thetlc, etc., and the best results are therefore likely to
be obtained by stimulating that part of the sensory
apparatus which is of chief Importance for the initia-
tion of mental processes.
(2) Exercise of the sense-organs and of the
mechanism of memory. It is a moot point whether,
strictly speaking, any development of the senses or
of the memory can take place as a result of such
exercise. Acuteness of sensibility and the capacity
for reproducing Ideas are probably dependent on
Innate, or as Dr. Archdall Reld would have It,
nutritional conditions of the germ-plasm which are
only modifiable by use In so far as use affords a field
for their expression. Thus a person may learn to
distinguish between sights or sounds which at first
were alike to him not because his visual or auditory
acuity has Increased but because of an alteration in
the circumstances attending the perception of them ;
and he may acquire a larger store of facts not
because his memory has improved but because the
facts have been presented In such a way as to link
up with the Ideas already present In his mind and so
come within the scope of the laws governing the
association of Ideas. The procedure for improving
sensation Is, in the main, an application of the
VII HANDLING OF FEEBLE-MINDED 303
principle of contrast, while In the case of the
memory rhythm is largely utilised.
(3) Exercise of muscles. Voluntary control with
co-ordination may be encouraged in three ways — by
passive movement, by imitation, and by play. It
should, as soon as practicable, be rendered purposive,
i.e. the pupil should be taught to walk and to
minister to his own wants. Incidentally, a check
should be placed on bad habits by the acquisition of
good ones. Various devices have been employed
for teaching suitable movements, and apparatus
on the lines of that used by Frankel in cases
of tabes has been suggested, but such measures
call for a degree of intelligent co-operation on
the part of the pupil which usually puts them
out of court. Even the familiar walking-frame Is
condemned by Heller ^ who mentions a case in
which a child walked with the aid of one for three
years without learning to walk alone. For tuition in
walking he advises that one person should lead the
child by the hands while another places the feet In
the proper positions from behind. The movements
of conveying food to the mouth and of dressing and
undressing are among the most Important which a
child has to learn, but the list can be indefinitely
extended by the teacher in accordance with the
necessities and the possibilities of each individual
case.
(4) Object lessons. This generic term will
Include all the methods by which the pupil Is taught
to associate names and properties with things as a
preliminary to using those things. It comprises the
^ T. Heller, Grundriss der Heilpddagogik, 1904, p. 225,
304 THE FEEBLE-MINDED chap.
distinguishing of objects as observed in nature, as
figured in models, and as represented in pictures ; the
distinction of the properties of objects, i.e. their form,
colour, size, material, and so on ; the development
of the concepts of time and space ; and the use of
signs as representing things.
(5) The development of speech by exercises in
articulation, reading, and writing ; and of the
concept of number by exercises in arithmetic. This
brings us to the parting of the ways and it becomes
necessary to decide whether education is to proceed
on conventional lines or whether utilitarian ideals are
to prevail.
The arts popularly known as the "three Rs "
require from their practitioners quite a high degree
of intelligence and they are completely beyond the
range of many feeble minds though teachers are
slow to admit the fact. By employing devices for
memorising it is possible to invest the mentally
defective person with a pretence of erudition which
may deceive the inexperienced observer but which
will not bear a moment's critical investigation.
Thus with the help of a rhythmic arrangement of
the letters it is possible for an idiot child, after
prolonged tuition, to repeat the alphabet. When
prompted to display this accomplishment the child
may recite in a sing-song manner : —
a' b c' d e' f g'
h' i j' k I' m-n-o p'
r m-n-o p' q r' s t'
u' V w' X y' z'
but he will probably be unable to say what letter
comes before or after another taken at random, or
VII HANDLING OF FEEBLE-MINDED 305
what is the last letter, without running through the
whole series. It may, perhaps, be questioned
whether committing the alphabet to memory is the
best preliminary to learning to read even in the case
of normal children, but to regard the process as an
end in itself is obviously futile. Taught in this way
the idiot merely accepts the alphabet as a finished
piece of mentation, not as a collection of tools by
means of which new products of the mind are
to be fashioned, and, since it has no application to
the circumstances of his daily routine, he speedily
forgets it. In a similar way an idiot who has
learned to count up to ten with the aid of his fingers
may be unable to say how many toes he has. He
may be able to quote large sections of the
multiplication table and yet not know how many
beans there will be in five groups of five each, or be
able to do the simplest problems in addition or
subtraction.
It is not either a wise or a kind thing to deprive
the developing mind of such mental nutriment as it
can assimilate, but it is still less wise and kind to
persist for years in a policy of stuf^ng indigestible
data into a mind incapable of dealing with them.
Quite a short time will suffice to make clear in any
particular case the intellectual limitations which
make progress on the ordinary scholastic lines
impossible, and the attempt to make a silk purse out
of a sow's ear should be promptly given up so that
no time may be lost in discovering such aptitudes
as may happen to exist.
The immediate purpose in teaching a child to
read and write is to open up channels for conveying
306 THE FEEBLE-MINDED chap.
Instruction. Attempts on these lines proving
unsuccessful one must employ the channels provided
by the child's primitive impulses to imitate or to
play, and correct ideas of conduct may be imparted
by supplying correct models of behaviour for
imitation and by suitably directing the movements of
play. The case of the feeble-minded person is
sufficiently similar to make these methods applicable
to it also. Imitation, in particular, affords a means
of supplying ideas of a useful kind. A mentally
defective child sent out with a party engaged in
picking up stones, or chopping wood, or dusting
furniture, will readily join in the work and, being
successively tried with duties involving more and
more skill, will soon find a niche to suit him.
Placed there patient and repeated demonstrations
on the part of a sympathetic instructor may
gradually convert him into a craftsman of quite
surprising dexterity in the art of brush-making,
basket-weaving, or cobbling.
In general the feeble-minded are willing workers,
and if their work is so arranged as not to impose too
prolonged a strain on their attention their industry
leaves little to be desired. Many of them are open
to the stimulus of emulation and many, too, take so
great a pride in what they turn out that any
evidence of its being appreciated supplies a strong
inducement to continued efforts at improvement.
Almost all forms of manual labour are available
for the feeble-minded, who, it must not be forgotten,
embrace a great variety of mental types. The
occupations usually followed are, for the males,
farm-work, wood-chopping, the mending of boots,
Yii HANDLING OF FEEBLE-MINDED 307
chair-caning, basket-making, brush-making, mat-
making, tailoring, painting, carpentry, book-binding,
and printing ; for the females needlework, laundry-
work, and the making of the lighter kinds of mats,
baskets, and brushes. For both sexes toy-making
offers a field as yet practically unexploited in this
country.
If for any reason, as in the case of children who
are not and are not likely to become a charge on the
community, it is deemed advisable to try to mould
the feeble mind to the orthodox scholastic pattern
a prolonged course of tuition in the rudiments of
grammar, arithmetic, and social observances may be
undertaken with a view to hiding, as completely as
may be, the state of intellectual emptiness. Since
society's demands in this respect are not high it may
be possible to make a person with only a moderate
degree of mental defect pass muster if expense is no
object. In such cases the procedure will follow the
same general lines as are adapted for normal
children, advantage being taken of modern develop-
ments in the way of kindergarten methods. Every
case must be treated on its merits, so that it is im-
possible to lay down a course of study of universal
application. One element is, however, essential.
It is the possession by the teacher of a strong but
sympathetic disposition, so that the interest of the
pupil may be aroused, his attention held, and his
tendency to take up an attitude of opposition over-
borne. As evidence of technical skill on the part of
the teacher such certificates as those of the National
Froebel Union would be acceptable.
So far we have considered only the economic side
X 2
308 THE FEEBLE-MINDED chap.
of the activities of the feeble-minded, but the moral
aspect is of no less importance though one approaches
it with fear and trembling. Religious training is
universally regarded as an integral portion of the
education of the feeble-minded, but little attempt is
made to adapt it to the special circumstances.
Feeble-minded persons include all grades up to the
normal in intelligence, and it would seem then that a
corresponding graduation of ethical teaching is called
for. If we consider the diversity exhibited by
persons reputed to be of sound mind as regards their
manifestations of the religious sentiment, we find an
inverse ratio between the development of the reason-
ing powers and the demonstrativeness of the form
of religion which appeals. The appetite for signs
and wonders diminishes as the mental horizon
broadens : fervour no longer demands confirmatory
miracles nor is conviction intensified by the banging
of a big drum or the singing of a hymn out of tune.
It seems a legitimate deduction from this line of
argument that a progressive crudity should mark the
ministrations provided for the mentally defective as
one proceeds from the slighter degrees of imbecility
into the deeps of idiocy.
Looking at the matter from the ethical standpoint
McDougalP recognises four levels of conduct, which
may be thus described : —
(i) Instinctive behaviour modified only by the
influence of the pains and pleasures that are in-
cidentally experienced.
(2) Operation of the instinctive impulses modified
by the influence of rewards and punishments ad-
^ W. McDougall, An Introduction to Social Psychology.
VII HANDLING OF FEEBLE-MINDED 309
ministered more or less systematically by the social
environment.
(3) Control in the main by the anticipation of
social praise and blame.
(4) Regulation by an ideal of conduct which
prompts to act as seems right, regardless of the
praise or blame of the immediate social environ-
ment.
This highest plane is one which the feeble-minded
cannot be expected to reach, and the religious teach-
ing provided for them must be of a kind not appeal-
ing to non-existent powers of reasoning, but offering a
scheme in which the relation of rewards to virtuous
acts and of punishments to misdeeds is as direct as
possible. At an early stage of development the
promise of a dainty is the most potent influence for
good, and the prospect of receiving a rap across the
knuckles will have a greater deterrent effect than
will the fear of incurring the wrath of the Almighty.
Since sectarianism belongs to the fourth level it can
have no place in the instruction of the feeble-minded,
and there can consequently be no need to provide a
whole set of teachers armed with different dogmas
as part of the equipment of an industrial colony.
The formal presentation of a feeble-minded person
for reception into any church is a proceeding reflect-
ing discredit both on the church and on the priest
who adopts this reprehensible way of serving it.
The practice of assembling the feeble-minded for
public worship has its merits. As Dr. Needham ^
has expressed it, ''the absolute self-control which is
requisite to be maintained by these people during
1 Rep. of Roy. Comm. on the Feeble- Minded^ vol. 2, Q. 15463.
310 THE FEEBLE-MINDED chap.
an entertainment and during the chapel services
Is very Important discipline In their treatment."
Moreover, the people like to attend divine service
since it provides a break In the monotony of their
daily lives. There Is here no question of religious
enthusiasm, for the services are welcomed as
heartily by the nominal opponents of the doctrines
taught as by the professed supporters of them.
Indeed, care has constantly to be exercised In an
institution for the mentally defective to see that
patients do not attend the services of some de-
nomination other than that to which they are
accredited, their tolerance In such matters not being
shared by relatives and pastors. Much of the
utility of the services is lost if they are made the
occasion for disquisitions on abstruse tenets ; they
should rather be enlivened by music and pictures
and confined to the exposition of those practical
distinctions between right and wrong which are at
the root of the social scheme and which are accepted
by all denominations. Even in the use of pictures
care must be exercised, for, as Heller^ points out,
the apparently innocent picture books of children
may suggest undesirable ideas. Thus he thinks
that the adventures of the naughty Frederick, as
recorded in the familiar Struwelpeter chronicle, are
calculated to excite sympathy with, rather than
aversion from, mis-doing, since it Is only towards the
end of his Immoral career that retribution overtakes
the hero.
1 T. Heller, op. cit.^ p. 250.
VII HANDLING OF FEEBLE-MINDED 311
Medical and Surgical Treatment.
Except in those comparatively rare cases, e.g.,
cretinism and some traumatic conditions, in which the
causation of mental defect is obvious and amenable
to simple medical or surgical procedures, we are too
much in the dark in regard to the etiology of feeble-
mindedness to be able to attempt with any hope of
success the repair of the damaged brain. Such
indications for treatment as seem to be present have
so far, owing to our limited knowledge, proved more
misleading than helpful. Thus the operations of
craniectomy in cases of microcephaly and of para-
centesis in cases of hydrocephaly have proved
valueless since the root of the trouble lies deeper
than they can reach. Similarly in the case of drugs
the indications for treatment are almost always too
obscure to be intelligible. We have hitherto failed
to interpret them correcdy and the shots we have
made have been wide of the mark. In view of the
diversity which abnormalities of the brain exhibit it
seems unreasonable to expect to discover any single
remedial agent which shall be of universal application.
On the other hand we need not take up the
pessimistic attitude of some writers and accept it as
a settled fact that we never shall be able to influence
cerebral development favourably, even though the
results achieved so far have been in the highest
degree discouraging.
But although the cure of feeble-mindedness is, in
the vast majority of cases, beyond our power, we
can do a good deal in the way of patching up the
312 THE FEEBLE-MINDED chap.
defective machinery so that its efficiency may be
increased. On the surgical side the profitable field
is chiefly that in which work the orthopaedic surgeons.
Paralysed limbs may have their deformities corrected
and some degree of mobility imparted to them
by means of tenotomy, transplantation of tendons,
excisions of joints, nerve transference, and the like.
In special cases operations of considerable magnitude,
e.g., Foerster's excision of portions of the lumbar and
sacral posterior nerve roots in cerebral diplegia,
may be undertaken with advantage to the patient.
The correction of optical and auditory defects, the
removal of adenoids, attention to the teeth, and
circumcision are other procedures which may be
indicated. It must, however, be borne in mind
that feeble-minded persons are not able to give
the surgeon that assistance without which many
otherwise desirable operations become inadmissible,
and regard must be paid not only to the need
for operation but also to the possibility of providing
adequate after-care.
The scope of medical, as distinct from surgical,
treatment is also restricted. Suitable feeding, the
proper working of the excretory organs, the checking
of outbursts of excitement, the combating of sleep-
lessness, all require attention. Many idiots have
not wit enough to feed themselves and for this
reason, or on account of the presence of palatal
deformities or paralytic conditions of the muscles
of the throat, have to be fed by an attendant.
Others eat too fast or too indiscriminately if left to
themselves, or involve themselves in strife by
gnatching food from their fellows. Want of con-
VII HANDLING OF FEEBLE-MINDED 313
trol over the bowel and the bladder is a common
trouble with them, and is met to a limited extent
by education in habits of cleanliness, but more
particularly by frequent changes of garments and
the protection of the beds by means of waterproof
sheeting. In large wards noisiness may be a
source of great annoyance to other patients and
may call for isolation of the case as far as is
practicable. Some idiots scream or cry almost con-
tinuously, no doubt on account of suffering some
discomfort which they are not able to explain.
Before medicinal agents are resorted to in such
cases it is well to try the effect of greater warmth
and additional food. Undue restlessness and want
of sleep will need to be treated by hypnotics. In
the way of sedative drugs the best is paraldehyde in
doses of m. xxx to 3 j- Rarely is a larger dose called
for, and it is always worth while to begin with the
small one since that may prove quite sufficient.
Paraldehyde is nasty, but this does not seem to trouble
idiots very much; indeed some of them appear to
like the drug.
Of special importance is the treatment of epilepsy.
Perhaps because in many cases the seizures which
occur among the feeble-minded have their origin in
gross cerebral defect they are peculiarly insusceptible
to medical treatment. A routine employment of
bromide of potassium is not always advisable, indeed
sulphate of magnesium will often prove more to the
purpose. On occasion a powerful purgative such as
croton oil is needed., and, though its effects are apt
to be unpleasantly drastic, patients will sometimes
ask for it owing to the relief it affords them from
314 THE FEEBLE-MINDED chap.
states of acute irritability. In the status epilepticus,
too, better results are likely to be obtained by
keeping the bowels open and administering, by
nasal tube if necessary, a liberal supply of nourishing
liquid food than by poisoning the patient with large
doses of chloral hydrate or opium. Constant super-
vision by night as well as by day is the first require-
ment in the care of epileptics. Fanciful procedures,
such as the use of pillows stuffed with hay to prevent
suffocation in case the subject turns over in a fit, are
a poor substitute for watchfulness on the part of
nurses and attendants.
On account of the success which has followed the
employment, in cases of cretinism, of preparations of
the thyroid gland they have been tried in many
other forms of feeble-mindedness. The results
obtained have not been particularly satisfactory.
One meets even with old-standing cases of what is
apparently cretinism which receive no obvious
benefit from the drug. Some observers have
described an amelioration in the condition of
epileptics as due to the use of thyroid extract, but
its efficacy in this respect is not universally
admitted.
In the absence of conclusive data it is hard to say
to what extent, if at all, the feeble-minded are more
susceptible to infection than normal personsv Cer-
tainly diseases of an infectious character are rife
among them when they are segregated, but this may
be due not so much to a lack of natural immunity as
to the difficulty of getting the cases to conform to
sanitary laws. Apart from the state of the brain
there is nothing particularly characteristic about the
vii HANDLING OF FEEBLE-MINDED 315
forms of disease from which they suffer, but asylum
dysentery and the chronic blepharitis which is so
frequently associated with Mongolism are to some
extent special to them. In tubercular disease of the
lung the foci are apt to be more widely distributed
through the organ than in the sane, thus adding to
the difficulty of diagnosis, and tubercular ulceration
of the small intestine is relatively common, apparently
because the patients swallow their sputum instead of
expectorating.
As on the surgical side the mental state places
obstacles in the way both of examination and of
treatment. The prognosis in ophthalmia, for
example, cannot be regarded as good when the
patient takes every opportunity of rubbing dirt into
the eye, and it is of little use to prescribe a scanty
liquid diet for an idiot suffering from enteric fever
unless at the same time one takes measures to pre-
vent his eating the bed-clothes.
There remains a factor of which the importance
is apt to be overlooked. The wonders performed
by medical and surgical art are rendered possible by
the capacity for repair with which organisms are
endowed. Like other manifestations of vitality, the
processes of regeneration are under the influence of
the nervous system, and while, in the normal person,
the mode of operation of the vis medicatrix naturce
is obscure enough, the potentialities of a nervous
apparatus which is out of gear are such as to baffle
the ingenuity of the most acute mind.
INDEX
Abbreviations, 22
Abortion, 164
Ackworth Reformatory, 276
Acquired characters, transmission
of, 176
Adenoma sebaceum, 239
Affection, 6, 47, 51
Affection and moral defect, 190
Affection in feeble-mindedness, 74,
.75
Affective tone, 6
Agrammatism, 84
Agyria, 104
Alcoholic diathesis, 162
Alcoholism, 161, 162, 169, 170, 171,
174
Alphabet, 304
Alternation of generations, 153
Alt-Scherbitz, 275
Amaurotic family idiocy, 254
infantile type, 254
juvenile type, 256
Ambidexterity, 87, 124
Amblystoma, 154
Amentia, 133
Amoeba, 47, 51, 139
Amphibia, 58
Amyloid bodies, no
Ankle-clonus in the feeble-minded,
124
Anoia, 242
Answers of the Judges, 198
Aphasia, 83, 248
Aphonia, 82
Aphthongia, 82
Archi-cortex, 58
Archi-pallium 59
Artificial selection, 163
Artistic capacity in the feeble-
minded, 90, 91
Asexualisation, 267
Association areas, 60
Association centres, 56
Association in feeble-mindedness,
Asymmetry and epilepsy, 100
cerebral, 1 1 1
of brain, 99
of head, 119
Atavism, 151
Ateleiosis, 206
Attention, 14, 15, 65, 302
in feeble-mindedness, 76, 'j'j
involuntary, 14
tests for, 297
voluntary, 14
Auditory centre, 66
Automatism, 20
Axolotl, 154
B
Babinski reflex, 124
Belmont Asylum, 95
Bioplasm, 43, 46, 52, 139, 140, 141,
164, 177
Birth, incidents of, 165
Blended inheritance, 146
Blindness, 81
Blood-vessels, intra-cranial, 114
Boarding out, 273
Bourdon's method of testing atten-
tion, 297
Bradylalia, 82
Brain, as organ of mind, 34
317
818
INDEX
Brain of " Fred," 218
Brain of " Joe," 218
Brain, weight of, 96
in the feeble-minded, no
Brain, weight of in relation to body
weight, 127, 128, 129
height, 127, 129, 130
Bridgman, Laura, case of, 167
CephaHc index, 119, 130
Cerebellum, 62
abnormality of, 104
Cerebral congestion as cause of
feeble-mindedness, 167
Cerebral cortex, 98
functions of, 63
measurements of, 106
structure of, 63
Cerebral degeneration, 109
Cerebral levels, 62
Cerebroplegia, 166
Cerebro-spinal fluid, 114
excess of, 132
Cerebrum, relative weight of, 98
convolutional pattern of, loi
Children Act, 1908, 288
Classification, principles of, 180
systems of, 181
Colloid bodies, no
Conation, 17
Concept, 15
Conduct, levels of, 308
Consanguinity, 162
Consciousness, 2, 16, 30
Conservation of energy, 37, 44
Control of the feeble-minded, 281
Copper-workers andfeeble-minded-
ness, 172
Corpora amylacea, 238
Corpora arenacea, 237, 238
Corpus callosum, absence of, 108
Cortico-rubro-spinal system, 61
Craniectomy, 311
Cretinism, 181, 183, 229, 260, 314
and goitre, 233
and Mongolism, 235
endemic forms, 234
myxoedematous form, 232
nervous form, 232
sporadic form, 234
thyroid preparations in, 229
Cretins, asylums for, 229
Criminal responsibility, 198
Cutaneous sensibility, tests for, 297
D
Darenth Asylum, 95, 120, 241, 288
Definitions adopted by the Royal
Commission on the Feeble-
Minded, 185
Degeneration, cerebral, 109
Delusion, 88
Dementia, 132, 133
Determinants, 140
Developmental errors, forms of, 131
Development, factors in, 135
Didinium, 48, 50
Dimorphism, seasonal, 154
sexual, 146
Diplegia, 248, 258, 312
Diplegic forms of feeble-minded-
ness, 249
Discrimination, 49
Dominant characters, 148
Duahsm, 35
Dura mater, 115
Dysarthria, 81
Dyslogic speech defects, 83
Ears, peculiarities of, among the
feeble-minded, 117
East Harling Reformatory, 276
Ebbinghaus' method of testing
memory, 298
Echolalia, 85
Educability, 72
Education, 269, 300, 305
Ego, 13, 16, 17, 18, 30, 65, 71, 88
Elementary Education (Defective
and Epileptic Children) Act,
1899, 282, 290
Emotion, 9, 21, 74
expression of, 10
" Energetische Situation," 44
Engramm, 45, 52
Environment, 144
influence of, 135, 136, 163, 164
Ependyma, 113
Epicanthus, 209, 210
Epicritic system, 4
INDEX
319
Epilepsy, i88, 259, 313
and sclerosis, 1 12
in Mongolism, 211
relation of to paralysis, 260
Epileptiform seizures in epiloia, 242
Epiloia, 242
epileptiform seizures in, 242
prognosis in, 243
renal conditions in, 241
Epiloiac type of feeble-mindedness,
235
Exclusive inheritance, 146
Exercise of muscles, 303
Eyes, peculiarities of, among the
feeble-minded, 116
Familial forms of feeble-minded-
ness, 254
Family history, 291
Farm colonies, 274
Feeble-minded, examination of
mental condition in the, 294
physical, 293
medical and surgical treatment
of the, 311
number of the, 262
procedure on admission to in-
dustrial colony, 290
workhouses, 284
religious training of the, 308
Feeble-mindedness, apathetic forms
of, 185
causes of popularly assigned, 174
excitable forms of, 185
forms of as recognised by the
Royal Commission, 185
nature of, 70
primary and secondary types of,
183
table of alleged causes of, 174
Feeling, 9
Fertility of insane stocks, 160
Free will, 17
Fright as cause of feeble-minded-
ness, 167
Gemmules, 140
General paralysis, 168, 251
Germ-plasm, 156, 179
Gesture, 81
Gliosis, no
Goitre and cretinism, 233
Granulation, in
Graves' disease, 260
Gregarines, 46
H
Head measurements, 119, 215
Hearing, tests for, 296
Heart, weight of in the feeble-
minded, 125
Height in relation to brain weight,
127, 129, 130
Heilbronner's method of testing
the reasoning powers, 299
Hemiplegia, 248, 249
Heredity, 137
in feeble-mindedness, 157
Heterotopia, 104, 107, 238
Hydrocephalus, 104, 224, 225, 311
pathology of, 227
Hydromyelia, 104
Hypertrophic nodular gliosis, 236
Hypertrophy of scalp, 217, 220
I
Idea, 7
Idea considered objectively, 34
Idealism, 36, 37
Ideas, association of, 12
Ideas, kinaesthetic, 9
Ideation, 7
Identity theory, 40
Idiocy by deprivation, 167, 181
Idioglossia, 84
Idiots Act, 1886, 259, 265, 282, 283,
289
Idiots savants, 89
Imagination, 15, 76
Inco-ordination, 123
Index of size, 122
Industrial colonies, 274
administration of, 276
duties of craftsmaster, 280
craftsmistress, 280
director, 277
medical officers, 279
steward, 279
Infantilism, 206
320
INDEX
Inferior protrusion, 119
Inheritance, 137, 138, 154
blended, 146
exclusive, 146
mosaic, 146
particulate, 146
Innate tendency, 135, 136
Insane diathesis, 156, 160, 162
Instinct, 21, 78, 79
Instinctive activities, 20, 61, 74
Instinct, varieties of, 21
Intellectual feeble-mindedness, 201
" Intellectualisirung," 27
J
Judgment, 13, 14, 29, 76
rudimentary, 29
Juvenile form of general paralysis,
251
pathology of, 253
K
Kalmuck type of feeble-minded-
ness, 208, 209
Keller, Helen, case of, 167
Kidney, tumours of, 238
Kidney, weight of in feeble-minded,
125
Knee-jerk in feeble-minded, 124
' Korrekturbildung," 131
Kraepelin's method of testing
attention, 297
Lalhng, 83
Language, 22, 65
Law of ancestral inheritance, 145
151, 160
Law of filial regression, 151
Law of healthy birth, 142, 152
Lead-workers and feeble-minded-
ness, 172
Left-handedness, 124
Lethal chambers, provision of, 267
Lisping, 82
Little's disease, 165, 248, 258
Liver, weight of, in feeble-minded,
125
Local Government Board Orders,
286, 287, 288
Lunacy Act, 1890, 259, 284, 285,
286, 288, 289, 290
Lunacy Commission, 157, 186, 189,
261, 285
Lunatics in workhouses, 284
M
MacNaghten case, 198
Macrocephalic type of feeble-
mindedness, 223, 260
Macrocephaly due to bone-disease,
224, 225
Macrogyria, 102
Malaria, 172
Mastigophora, 46
Materialism, 35
Maternal impressions, 165, 174
Mathematical capacity in feeble-
mindedness, 89, 90
Megalencephaly, 224, 228
Memory, 6, 15, 302
in the feeble-minded, 72, 73
tests for, 298
unconscious, 30, 31
Mendehan inheritance, 147, 149,
160
Meninges, 114
Meningo-encephalitis, 252
Mentally defective persons, classes
of, 290
Mesoglia, no
Metagenesis, 153
Metropolitan Asylums Board, 120,
286, 288
Metropolitan Poor Act, 1867, 286
Microcephalic type of feeble-
mindedness, 214, 260
Microcephaly, 311
pathology of, 216
Microgyria, 102, 104, 112
Mind and brain, 39
Mind as a secretion, 37
Mirror writing, 86, 87
Mneme, 45, 71, 127
Model village, scheme of, 275
Modification, 177
Mongolian imbeciles, 118
Mongolian type of feeble-minded
ness, 208
Mongolism, 259, 315
INDEX
321
Mongolism and cretinism, 235
and epilepsy, 211
pathology of, 212
signs of, 208
Monism, 35, 40
Mood, 10
Moral, as distinct from intellectual,
defects, 189
Moral capacity, examination of, 300
Moral defect and affection, 190
Moral defect in children, 190
Moral feeble-mindedness, 1 89
characters of, 192
contentious type of, 196
diagnosis of, 197
etiology of, 196
forms of, 193
mendacious type of, 194
pathology of, 196
sexual type of, 195
unstable type of, 193
Mosaic inheritance, 146
Motility, origin of, 52
Motor area, 56, 59
Mouth, condition of, in the feeble-
minded, 117
Multiple personality, 30, 31
Muscular abnormalities in the
feeble-minded, 123
Mutation, 142, 156, 177
Myehnation, 104, 126
N
National Froebel Union, 307
Natural Selection, 144, 163, 178
Neo-pallium, 59, 60
Nerve cells, embryonic type, 97
nature and relation of, 96
Nervous system, development of, 57
Nervous tissue, 54
Neuroglia, 97, no
contraction of, in
hypertrophy of, no
Neurone theory, 55
NissFs substance, 126
Noird's theory, 28
Object lessons, 303
Ontogeny, 150
Opiates as cause of feeble-minded-
ness, 172
Organs, nature of, 139
Origin of speech, 27
Osteoid plates in spinal pia-
arachnoid, 115
Pachygyria, 102
Paedogenesis, 154
Pain, 48, 64
Palaeo-cortex, 58
PaliEO-pallium, 59
Palate, condition of, in the feeble-
minded, 117
Pangens, 140
Paracentesis, 3n
Paraldehyde, use of, 313
Paralysis, 123, 312
forms of, among the feeble-
minded, 248
relation of, to epilepsy, 260
Paramoecium, 48, 139, 142
Particulate inheritance, 146
Passion, 10
Pathological lying, 191
Pauper Inmates Discharge and
Regulation Act, 1871, 289
Percept, 8, 15
Perseverance, 6, ']2i
Phylogeny, 150
Physical characters of the feeble-
minded, 92
Pia-arachnoid, 114
Pigmentation of nerve cells, 97
Plasson, 46
Pleasure, 48, 64
Plegic forms of feeble-mindedness,
247, 260
Poor Law Act, 1899, 289
Porencephaly, 103, 114, 221
Pre-established harmony, 40
Presentation, 4
in feeble-mindedness, 72
Prevention of Cruelty to Children
Act, 1904, 288
Progressive forms of feeble-minded-
ness, 250
Proteomyxa, 46
Protopathic system, 4
Protophyta, 4
Protozoa, 46, 48, 51, 55
322
INDEX
Pseudo-instincts, 21
Pseudologia phantastica, 194
Pseudo-querulanten, 196
Psychical cerebroplegia, 250
Psycho-physiological parallelism,
" Psycho-physischen Wechselwirk-
ung," 36
R
Reaction, 44
Reality, 38, 39
Reasoning, 14, 29, 76
Reasoning, tests for, 299
Recessive characters, 148
Recollection, 15
Reflex activity, 20, 65
Reflexes in the feeble-minded, 124
Renal conditions in epiloia, 241
Re-presentation, 6
in feeble-mindedness, 73
Reptiles, 59
Residual forms of feeble-minded-
ness, 258, 261
Responsibility, criminal, 198
Reversion, 150
Rhabdomyoma, 238
Rickets in the feeble-minded, 228
Royal Commission on the Care
and Control of the Feeble-
Minded, 90, 158, 159, 161,
170, 173, 175, 176, 185, 187,
189, 190, 262, 268, 271, 272,
273, 274, 276, 277, 283, 289,
290
Sagitta, 179
Scalp, hypertrophy of, 116, 217,
220
Scanning, 82
Sclerose hypertrophique, 235
Sclerosis, 104, iii, 228
hypertrophic, 236
of cornu Ammonis, 112
tuberose, 112, 236, 239, 241, 242,
259
Seasonal dimorphism, 154
Selection, artificial, 163
Selection, natural, 163, 178
Self, 88
Self-consciousness, 65
Sensation, 4
auditory, 5, 51
cutaneous, 4, 61
epicritic, 4
gustatory, 5
kinaesthetic, 5
labyrinthine, 5
motor, 5
olfactory, 5
organic, 4, 9
protopathic, 4
tactile, 51
visceral, 5, 62
visual, 5
Sense organs, 302
in the feeble-minded, 116
Sensitiveness to stimulation, tests
for, 297
Sentiment, 15, 76, 191
Sexual dimorphism, 146, 149
Sex limitation, 147
Sight testing, 295
Simian characters in microcephaly,
218
Skull-cap, 115
Slurring, 82
Smell, tests for, 297
Solipsism, 37
Soul-substance, 35
Speech, 23, 65, 79, 80, 304
centres, 66, 67, 68
emotional — volitional, 27
motor defects of, 83
origin of, 27
psychic defects of, 82
sensory defects of, 8^
Spinal cord, abnormality of, 104
Spleen, weight of, in the feeble-
minded, 125
Stammering, 82
Status epilepticus, 314
Stigmata, 108
Stimulation, 3, 44
ekphoric, 45
Strains and stresses in relation to
feeble-mindedness, 164, 166
Stuttering, 82
Sub-consciousness, 30, 31
Symbols, 22
Synapse, 55, 107
Syphilis, 168
INDEX
Volition, 14, 17, 49, 65
323
Tartar type of the feeble-minded,
208 W
Taste, tests for, 296
Technitella, 48, 50
Teeth, condition of, in the feeble- Wassermann reaction, 168, 228
minded, 117 Weight of body in relation to brain
Telegony, 153 _ weight, 127, 128, 129
Thyroid gland, condition of, in Wild boys, 167
cretmism, 231
Tics, 79, 124
Torus palatinus, 118
Toxic agencies, 167
Transmission of acquired characters,
176
Truth, definition of, 33
Tubercular diathesis, 162
Tuberculosis, 169
in the feeble-minded, 315
Tuberose sclerosis, 112, 236, 239,
241, 242, 259
Wolf children, 167
Word blindness, 85
Word deafness, 85
Workhouses in London, 285
Writing, 81
X
Xenia, 153
Variation, 142, 144, 156, 177
Verbigeration, 85
Ziehen's method of testing memory,
298
Y 2
INDEX OF AUTHORS
Abricossoff, A. J., 238
Adami, J. G., 50, 140, 144
Aeby, 216
Ariens-Kappers, C. U., 58, 59
Ashby, H., 25, 210, 215, 228
B
Baillarger, 216
Balbiani, E. G., 48
Ballet, G., 248
Bateson, W., 140, 143, 149, 150
Baumgarten, 171
van Beneden, E., 46
Berkhan, O., 215
Biach, P., 214
Binet, A., 6, 48
Bircher, E., 233
Bircher, H., 233
Bolton, J. S., 63, 97, 106, 132
Bonfigli, R., 237, 241, 242
Booth, B., 158
Bosbauer, H., 89, 167
Bose, J. C., 49
Bourdon, 297
Bourneville, 171, 182, 235, 236, 239,
240, 241, 260
Brill, A. A., 75
Brissard, E., 236
Brooks, H., 257
Browne, J. Crichton, 190
Buchner, P., 179
Budin, P., 171
Bufe, E., 214
Campbell, A. W., 237, 238, 239,
241
Carpenter, G., 223
Chaloner, J. A., 265
Cimbal, 299
Condillac, 73
Coquelin, 10
Craig, M., 171
Cramer, A., 190, 200
Crocker, H. Radcliffe, 247
Crowley, 283
Cullen, J. P., 213
Cunningham, D. J., 217
D
Darwin, C, 140, 154, 217
Dean, H. R., 168, 228
Delbriick, 194
Dendy, M., 170
Descartes, R., 40
Dickson, W. E. C, 237
Dobson, M. B., 237, 241
Dubois, 128, 129
Earland, A., 48
Ebbinghaus, 298
Eichholz, A., 159
Eisler, R., 36, '},']
Elderton, E. M., 170, 176
Esquirol, 80, 181
INDEX OF AUTHORS
325
Ferrero, F., 230
Findlay, J. J., 268
Fischer, M., 265
Fisher, J. H., 86
Flechsig, P., 56, 61, 104
Fletcher, H. M., 213
Fcerster, 312
Fowler, J. S., 237
Frankel, 303
Frazer, A., 103
Freud, S., 75, 76, 249
Galton, F., 10, 145, 151
Garbutt, 283
Geitlin, 238, 239
Gilford, H., 208
Gladstone, R. J., 95, 119, 120, 121,
122, 123, 130
Glen, 289
Griesinger, 167, 229
H
Haldane, R. B., 39
V. Hansemann, D., 228
Harper, 96
Head, H., 4
Heilbronner, 299
Heller, T., 83, 87, 89, 90, 166, 167,
172, 183, 184, 185, 303, 310
Herfort, K., 133, 134, 242
Heron-Allen, E., 48
Heron, D., 157, 159, 160, 162, 166
Hicks, J. A. Braxton, 96, 99
Holmes, G., 256
Hornowski, 241
Huismans, L., 258
Huschke, 99, 214
Huxley, T. H., 2
Illingworth, W. H., 90
Ireland, W. W., 93, 125, 181, 215,
232
Isserlin, M., 75
J
James, W., 10, 19, 22, 28, 33
Jansky, J., 257
Jennings, H. S., 142
Jolly, 242
K
Kant, I., 40
Kellogg, V. L., 141
Klebs, G., 144
Knoepfelmacher, W., 227
Kolle, F. 174
Kraepelin, E., 185, 189, 196, 297
Kussmaul, 62, 67
Lange, 10
Langmead, F., 213
Lankester, E. Ray, 43, 46 161
Legrand du SauUe, 164
Lehndorff, H., 227
Leibniz, G. W., 40
Lewis, Bevan, 97
Lichtheim, 67
Liebmann, 84
Little, W. J., 165, 248, 249
Locke, J., 38
Loeb, J., 141, 144, 164
Lotze, R. H., 37
Lugaro, E., 38, 126
M
MacDougal, D. T., 144
Mackenzie, T. C., 234
Maier, H. W., 189, 192, 197
Marshall, H. R., 48
Mason, 300
Mayou, M. S., 257
McCarrison, R., 232, 233, 260
McDougall, W., 16, 21, 308
Mendel, G. J., 147
Mercier, C. A., 17, 157, 199, 200
Meumann, E., 25, 26, 27, 29
Meyer, R., 178
Miklas, L., 89, 167
Mill, J. S., 36
Millard, K., 224
326
INDEX OF AUTHORS
Mingazzini, G., 217
Mitchell, W., 39
V. Monakow, 107
de Montet, Ch., 237, 238, 239
Morgan, C. Lloyd, 16, 49, 163
Mott, F. W., 256
Miinsterberg, H., 31, 38
Myers, C. S., 62
N
Needham, F., 309
Nissl, 196
Norman, Conolly, 103
Oekonomakis, 102
Oppenheimer, H., 198
Pariset, 203
Parr, R. J., 170
Parsons, J. H., 256
Paulsen, F., 40
Pearson, K., 170
Piper, 174, 175
Pocock, R. J., 148
Potts, W. A., 158
Poynton, F. J., 213, 255, 256
Preyer, W. T., 27
Pringle, J. J., 247
Raehlmann, 62
Raid, G. Archdall, 137, 143, 144,
149, 151, 163, 175, 177, 302
Ribot, Th., 18, 20
Rivers, W. H. R., 4
Robertson, W. Ford, 98, 109, no,
120, 132, 234
Romanes, G. J., 30
Rondoni, P., 253
Roque, 172
Rudzki, 241
Rzesniezek, 24
Sachs, B., 255, 256, 257, 258
Sailer, J., 236
S chaffer, K., 256
SchelHng, F. W. J., 40
Schenker, G., 169
Schiner, H., 89, 167
Schmiedel, 25
Schneider, E., 226
Schwalbe, E., 102, 108, 215, 221
Schwenk, 174, 175
Seguin, E., 172, 203, 224
Semon, R., 12, 44, 45, 52, 71
Sengelmann, 89
Shand, A. F., 16
Sherren, J., 4
Sherrington, C. S., 51, 65
Shuttleworth, G. E., 212
Smith, G. Elhot, 58, 59
Sollier, P., 18, 118, 125, 133, 184,
239
Spencer, H., 40, 46, 50, 52, 53, 139,
140
Spinoza, B. de, 40
Stephen, J. F., 199
Stern, R., 260
Stevens, B. C., 234
Stewart, H. G., 108
Stoddart, W. H. B., 61
Storring, 67
Sullivan, W. C., 171
Sully, J., 29, 300, 301
Sutherland, G. A., 213
Tanzi, E, 133, 234, 249
Tay, Waren, 255, 258
Telford-Smith, T., 217
Thomas, C. J., 86
Thomson, J. A., 137, 138, 140, 141,
150, 151
Titchener, E. B., 6, 20, 51, T]
Tracy, F. 27
Tredgold, A. F., 91, 97, 166, 183
V
Vierordt, 25
Virchow, 216
INDEX OF AUTHORS
327
Vogt, H., io8, 212, 237, 238, 239,
241, 252, 257
Vogt, K., 37, 216, 217
Voisin, 184
Volker, 174, 175
Volland, 241
de Vries, H., 140
Weber, F. Parkes, 208
Wegener, H., 87
Weismann, A., 140, 143, 154, 156
Weygandt, W., 169, 184, 234
Wildermuth, 184
Wilms, M., 233
Wright, G. A., 25, 215, 228
Wundt, W., 7, 40, 51
W
Warncke, P., 128, 129
Watson, G. A., 63, 253
Ziehen, 133, 298
Zwaardemaker, 5
Richard Clay and Sons, Limited,
bread street hill, e.g., ast)
bungay, suffolk.
MACMILLAN ^ CO.'S
NEW MEDICAL WORKS
DISEASE IN BONES AND ITS DETEC-
TION BY THE X-RAYS. By Edward W. H. Shenton,
L.R.C.P., M.R.C.S., Sen.-Surg. Radiographer, Guy's Hos-
pital. Illustrated. 8vo.
DISEASES OF THE EAR. By William
MiLLiGAN, M.D., and Wyatt Wingrave, M.D. With
Illustrations. 8vo.
AN INTRODUCTION TO THERAPEU-
TIC INOCULATION. By D. W. Carmalt-Jones, M.A.,
M.B., etc. Crown 8vo.
A SYSTEM OF MEDICINE. By Many
Writers. Second Edition. Edited by Sir Clifford
Allbutt, K.C.B., M.D., and H. D. Rolleston, M.D.
Vol. IX. (concluding the work). Diseases of the Skin.
Svo, 255. net.
DEFORMITIES. A TREATISE ON
ORTHOPAEDIC SURGERY, INTENDED FOR
PRACTITIONERS & ADVANCED STUDENTS. By
Alfred H. Tubby, M.S. New Edition, revised and enlarged.
Illustrated. 2 vols. Svo.
TEXT-BOOK OF HUMAN PHYSIOLOGY.
By Dr. LuiGi Luciani. Translated by Frances A. WELBY,and
Edited by Dr. M. Camis, Institute of Physiology, University
of Pisa. With a Preface by Prof. J. N. Langley, F.R.S.
Illustrated. In 4 vols. Vol. I. Circulation. Svo.
ALCOHOL AND THE HUMAN BODY.
An Introduction to the Study of the Subject, and a Contri-
bution to National Health. By Sir Victor Horsley, F.R.S.,
and Mary D. Sturge, M.D. With a Chapter by Arthur
Newsholme, M.D. New Edition. Svo. 53-. net.
Popular Edition. Globe Svo. Cloth, i^. net.
MACMILLAN AND Co., Ltd., LONDON.
A SYSTEM OF MEDICINE
BY MANY WRITERS.
8vo.
SECOND EDITION.
Edited by
Sir CLIFFORD ALLBUTT, K.C.B., M.D.,
and HUMPHRY DAVY ROLLESTON, M.D.
Vol. I. Prolegomena and Infectious Diseases. 2 5J-. net.
II. Part I. Infectious Diseases {continued)^ Intoxications.
255-. net.
II. Part II. Tropical Diseases and Animal Parasites. 25j-.net.
III. Certain General Diseases, Diseases of the Alimentary
Canal and Peritoneum. 25J-. net.
IV. Part I. Diseases of the Liver, Pancreas, Ductless Glands,
and Kidneys. 255-. net.
IV. Part II. Diseases of the Nose, Pharynx, Larynx, and Ear.
253-. net.
V. Diseases of the Respiratory System, Disorders of the
Blood. 255-. net.
VI. Diseases of the Heart and Blood- Vessels. 255-. net.
VII. Diseases of the Muscles, The Trophoneuroses, Diseases of
the Nerves, Vertebral Column, and Spinal Cord.
25^-. net.
VIII. Diseases of the Brain and Mental Diseases. 2 5J". net.
IK. Diseases of the Skin. 2^s. net.
SECOND EDITION.
A SYSTEM OF GYNECOLOGY. By many
Writers. Edited by Sir Clifford Allbutt, K.C.B., M.D.,
W. S. Playfair, M.D., and Thomas Watts Eden, M.D.
8vo, 2^s. net.
MACMILLAN AND CO., Ltd., LONDON.
A SYSTEM OF MEDICINE
SOME PRESS OPINIONS.
LANCET. — "A work which must undoubtedly rank as a fore-
most treatise on the scientific medicine of to-day. It contains
contributions from those whose qualifications for the task imposed
on them are of the highest order, so that the reader can feel certain
to find in its pages the most recent as well as the most valuable
information that exists on these matters."
BRITISH MEDICAL JOURNAL. — "■ P^ work which must
rank as one of the most important standard books of medical reference
in the English, or indeed any language, that has appeared for many
years. It may be regarded as the successor, and as occupying the
same authoritative position that Reynolds' System did . . . Records the
high-water mark of contemporary medical progress and opinion . . .
The articles are each provided by their authors with a selected
bibliography, which adds greatly to the value and practical utility
of the work,"
EDINBURGH MEDICAL JOURNAL.— '' It is impossible
to study its pages without being struck by the exhaustive character
of the articles, contributed by physicians entitled to speak with
authority upon the subjects entrusted to them. The articles, therefore,
reflect fully the most advanced knowledge and the best fruits of
experience, many of the subjects being those in which pathological
inquiry has been of recent years most active."
MEDICAL MAGAZINE.— ''The present work is pre-eminently
a book of reference, a complete guide, for professional men in what-
ever department their practice lies. This applies equally to the
specialist as to the general physician. Unless a man is working
specially at some particular point either in the laboratory or in an
hospital ward, we know of no more authoritative or complete work
from which his professional knowledge can be culled and his
treatment guided."
NA TURE. — " This System of Medicine will form a lasting
monument of the high place which British medicine holds at the
present time."
SCOTTISH MEDICAL AND SURGICAL JOURNAL.— '' It is
impossible in the short hmits of this review to attempt to do justice
to the great value of Dr. Allbutt's System. Every article which it
contains is worthy of a prolonged consideration. We can only
conclude by wishing the second edition the same success which has
been so signally attained by the first, and by suggesting that even
those who possess the first edition will do well to secure the second,
which, as we have endeavoured to show, is to all intents and purposes
a new book."
MACMILLAN AND CO., Ltd., LONDON.
3
A SELECTION
OF MEDICAL WORKS
MENTAL AFFECTIONS: AN INTRO-
DUCTION TO THE STUDY OF INSANITY. By
John Macpherson, M.D., F.R.C.P.E. Illustrated. 8vo,
I2S. net.
SOME POINTS IN THE SURGERY OF
THE BRAIN AND ITS MEMBRANES. By Charles
A. Ballance, M.V.O., M.S. Illustrated. Second Edition.
8vo, 15^-. net.
THE HEALING OF NERVES. By Charles
A. Ballance, M.S., and Purves Stewart, M.A., M.D.
With Plates. 4to, 12s. 6d. net.
EPILEPSY: A STUDY OF THE IDIO-
PATHIC DISEASE. By W. Aldren Turner, M.D.
8vo, los. net.
STUDIES IN CLINICAD PSYCHIATRY.
By Lewis C. Bruce, M.D. 8vo, los. dd. net.
A MANUAL OF MEDICINE.
Edited by
Sir W. H. ALLCHIN, M.D. (Lond.), F.R.C.P., F.R.S.E.
In 5 Vols. Extra Crown 8vo.
Vol. I. General Diseases, yj-. dd. net.
II. General Diseases — continued, p. 6d. net.
III. Diseases of the Nervous System, yj-. 6d. net.
IV. Diseases of the Respiratory and of the Circulatory
Systems, "js. 6d. net.
V. Diseases of the Digestive System and of the Liver —
Diseases of the Peritoneum and of the Vessels of the
Abdomen — Diseases of the Kidneys — Diseases of
the Ductless Glands. 10s. net.
MACMILLAN AND CO., Ltd., LONDON.
4
Massachusetts ScHmI
for Feeble MlmiBik