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Walter E. Fernald 
State School 

Waverley, Massachusetts 

^ \^ — 








XX - ^ /^ 


^ 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 


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 


I 9 I I 

RiCHAKD Clay and Sons, Limited, 



H, W. W. 


Digitized by the Internet Archive 

in 2011 with funding from 

Boston Library Consortium Member Libraries 


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- 


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 


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 

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 


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 


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. 








THE FEEBLE MIND . . . • 70 










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 


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 


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 


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 


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. 


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 

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. 






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 

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 



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. 


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 

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 


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 

2 H. Head, W. H. R. Rivers and J. Sherren, The Afferent Nervous 
System from a New Aspect, Brain, Nov. 1903, p. iii. 


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 

(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 


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." 


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 


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 

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 


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 


for the affected ideas which are comprised in 

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. 


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 


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. 


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 

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 


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 


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 


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. 


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. 


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. 


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 


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. 


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 : 















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 

We employ yet another device to facilitate the 

1 W. McDougall, op. cit. 


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« 


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 


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 


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- 


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. 


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 


" 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. .' 


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. 


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 


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. 


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. 



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. 



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 


action part of the brain interferes to a corre- 
sponding extent with the development of mental 

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 


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. 


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. 


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. 


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. 


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 


extent, by supposing that the diversity exists rather 
in the observer's points of view than in the thing 

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. 


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 


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. 


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 

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 


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. 


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, 


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 — 


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. 


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 

" 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 



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. 


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 


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. 


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 

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 


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 

Neither phylogenetically, i.e. by study of the 
evolution of the human race, nor ontogenetically, 


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 


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," 


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 


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 

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. 


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. 


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- 

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 

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 


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, 


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 


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 

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. 


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 


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. 



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 




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? 





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 




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 


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. 



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 


''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 


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, 


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 

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 


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 


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. 


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 


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 


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, 


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 


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 

(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. 


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 



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 

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 


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 

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 


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. 


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 

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 


accounts, being those of C. J. Thomas^ and J. H. 

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. 


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 


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. 


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 

Whatever may be the causes producing defective 
development of the nervous system, it would appear 


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. 


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. 


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. 



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 



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. 


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 

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. 


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 

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. 


(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 

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. 


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 | 

[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 



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. 


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 

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 

In one case of series A, the right cerebral hemi- 
sphere weighed 6f ozs., the left i7f ozs., while the 

II 2 


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. 


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 


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 

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 


{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. 


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. 


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 

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 


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 

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. 


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 ... 



2. Pyramidal 



3. Granular 



4. Inner fibres 



5. Polymorphic cell ... 



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 

(d) The connections of the nerve-cells. — In the 
chapter on the basis of the normal mind reference has 

^ J. S. Bolton, loc, cit. 


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 


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. 


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- 


elation In the value of the brain as an organ of 

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 


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 

(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. 


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 

9. Epilepsy of moderately severe type : slight 

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, 


month : marked sclerosis, especially at the right 

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 

14. Epilepsy of moderate severity : slight 

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 

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 


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 

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 


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 


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 


l8 2 I 


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 : — 


Unequal pupils 





In addition all grades of defective vision were 

Males (400). 

Females (250). 














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). 


Wide and flat 

Narrow and high 


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 










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 

" 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 


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 

(K) Maximum parieto-squamous diameter. 

The cephalic index, which is obtained by multi- 
plying the measurement ^ by 100 and dividing the 


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 


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 

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 :: — 


(/) Length of head from glabella to occipital 

{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. 

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." 



1 45 '4 





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 

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. 


of the brain in the last two classes to be approxi- 

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 


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 


Increased both sides .. 
Diminished both sides., 
Greater on right side . , 
Greater on left side 



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- 


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. 


Average weight in ozs. 
(50 cases). 

Normal weight in ozs. 







Kidney (loo). 







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. 


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. 


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, 


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 

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 


2.— I :25 

3-— I 


4.— I 



6.— I 


7.— 1 


8.— I : 34 

9.— I 


10. — I 



12. — I 


13.— I 



15.— I 


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 


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 

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- 



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. 


Mean weight of brain. 

Mean stature. 



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- 

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 


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 

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 


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. 


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. 


** 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. 



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. 


(d) Environment favourable to normal develop- 

(/3) Environment unfavourable to normal develop- 

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 

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 


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. 


virtue of its hereditary relation to parents and 
ancestors." These definitions express with sufficient 
clearness the connotation of the words as here 

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 


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 


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. 


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. 


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. 


bioplasm, they naturally characterise the descendants 

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. 


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. 


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 


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. 


(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 

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 


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- 


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. 


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 

(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. 


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. 


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. 


(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 

(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 


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, 


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- 

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. 


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 


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. 


in the stock of the same individual has not been 

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. 





Defective children 

Normal children ... 






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. 


^ B. Booth, Report of Roy. Com7n, on Feeble- Minded, vol. 2, p. 


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. 




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. 





Both sane 

One insane 

Both insane 









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. 


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 

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. 



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. 


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 

(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 


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. 


responsible for the development of feeble-mlndedness 
in the children whose nutrition is thus interfered 

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. 


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. 


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 

(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. 


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. 


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 

{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. 


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. 


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. 


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. 


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 

It is interesting to note that the cause most 




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. 





^Hereditary defect.. 





Family history of 







Family history of 







Maternal impres- 






Consanguinity ... 






Acute disease of, 
or injury to, the 

the mother 





^Parental syphiHs... 





S ^^' r Primogeniture... 





pq !& ^."S J Prolonged labour 




Q-^"^ [Premature birth 





'Convulsions soon 

after birth 





Acute infectious 







■-tj J-i 

Meningitis and 






.^ B 







Ill-treatment and 





Head injuries 









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- 

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. 


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, 

2 Report of Roy. Coimn. on the Feeble- Minded, vol. 8, p. 185. 


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. 



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. 


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 



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 


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 

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 


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. 


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 

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 


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 

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^ 


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 

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 


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 

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 


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 :— ' 


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- 

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 


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 

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. 


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. 


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 


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 


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 

(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. 



(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 


the exploits which he has performed during his 

(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 


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. 


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 : 


\ immoral 7^ 

/Sexually \ 
( immoral : J (^ 
\ Drunkard/ 



$ (Procuress) 

I / Sexually \ 




\ Drunkard 



(Drunkard) (^- 


? (Prostitute) 

— ? (Immoral) 



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, 


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 

'* 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. 


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 


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 

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. 


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 


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 


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." 


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 


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 

The picture has, of course, its shadows ; the more 


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- 


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 


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. 


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 


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. 


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 ; 

Deformity of thorax, knock-knee, flat-foot. Hands 
and feet broad ; digits thick and webbed ; thumb 



and little finger short, and the latter abnormally 
curved ; second toe relatively too long. 

Laxity of ligaments and hyperextensibility of 

Congenital, and other, forms of heart disease. 

Abdomen large and tumid ; umbilical hernia ; 

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 


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 


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 

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 


Fig. 15. — The microcephalic idiot whose brain is shown 
in Figs. 16, 17, 18. 

[Face page 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 


of mother at Recorded 

in family 

birth of child by 


Only child ... 




2nd of 2 


40 - 

Dr. G. A. Sutherland 


3rd of 3 



Last but one of large family 


2nd of 3 


Dr. F. J. Poynton 


3rd of 3 ... 



Only child ... 
loth of II ... 



Dr. F. Langmead 


1st of 2 



loth of 10 ... 


Dr. H. M. Fletcher 


4th of 5 



7th of 7 


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 


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. 


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. 


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 : 



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 


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. 

2 O. Berkhan, tjber den angebore7ten oder friih sick zeige?iden 
Wasserkopf dr^c. Die Ki7iderfehler. '] Jahrgang p. 49. 


children, o'5 to i cm., and, for adults, 2 to 2*5 cm., 

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 


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. 


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. 


\ '" 

f -. 



^^^K ■ 






r ^ 










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. 


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 

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. 


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 


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 

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 

\_Face page 220. 


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 


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 


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. 


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. 


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. 


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 



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. 


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 


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. 



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 


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. 


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 

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 


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, 


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. 


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« 


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. 


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 


'* 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 


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. 


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, 


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 

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 


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 


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. 



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- 

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 


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 

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. 

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 





15 years 
6 years 




9 years 
19 years 





14 years 
9 years 
8 years 




17 years 
6 years 


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 


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. 


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 


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." 


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. 


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. 


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. 


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. 


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 


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 


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 

Chronic meningo-encephalitis, which seems to be 
the basis of general paralysis whether it occurs in 
children or in adults, produces similar changes in 


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. 


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 


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 

(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. 


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 

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. 


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. 



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 

(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. 


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. 


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 


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 

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. 


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 



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 



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 


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 

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 


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 

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- 


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 

Some persons with a smattering of biological 
knowledge are inclined to preach a war of exter- 
mination against the inefficient, believing that in so 


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 


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. 


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 


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 


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 


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 

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 

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 


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 

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 


periodical re-certlficatlon has proved an obstacle In 

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 


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 

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 


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 


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 

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 


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, 


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. 


Male and Female Store-keepers. 

Store, Hall, and General Porters, 


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- 

An Engineer with his subordinates. 

A Farm Bailiff with the necessary farm and garden 

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.] 



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. 




1 1 
1 1 




1 1 




1 1 

1 1 




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1 1 


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'1 q/' O' r 

V^ivf \\ Ok 



j J 

1 1 


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'n r 


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 » 


250 » 


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 


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 


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. 


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 

'' an order under the hand of a justice having 
jurisdiction in the place where the workhouse Is 

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 

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 


*' 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 

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- 


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, 


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 

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 


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. 


(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. 



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 


previous history and those relating to his present 

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 




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 



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 

I Half -sisters of A 





Insanity Feeble- 



Fig. 23. 

€ 3 

Neruous Alcoholism 

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 

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 


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 

I . Examination of the physical condition. 

This serves several purposes, e.g. : 

{a) It discloses any evidence of neglect or ill- 

{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 

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. 


(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 


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 

(A) Sensitiveness to stimulation. 

The various senses may be tested thus. — 

(i) Sight 


(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 ,-/ //// / // r rj ri 

'/'"'' > 

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 

{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 


(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 

(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. 


(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 .-^ 


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 


by Miss Mason for instruction in the art of reading 
may be utilised for the purpose.^ 

(6) Explain the purpose of some unfamiliar 

(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 

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 

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. 


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 


ultimately followed. They may be thus sum- 

(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 


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 

(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, 


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 


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 

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 


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, 


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 

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 


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. 


ministered more or less systematically by the social 

(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- 

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. 


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. 


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 


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- 


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 


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 

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 


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 

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. 


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, 

Affective tone, 6 

Agrammatism, 84 

Agyria, 104 

Alcoholic diathesis, 162 

Alcoholism, 161, 162, 169, 170, 171, 

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, 

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 


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 




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 


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 



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, 

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, 

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 


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 


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, 

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 



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 


Judgment, 13, 14, 29, 76 

rudimentary, 29 
Juvenile form of general paralysis, 

pathology of, 253 


Kalmuck type of feeble-minded- 
ness, 208, 209 

Keller, Helen, case of, 167 

Kidney, tumours of, 238 

Kidney, weight of in feeble-minded, 

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, 

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 


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, 

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 



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 


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 



Pseudo-instincts, 21 
Pseudologia phantastica, 194 
Pseudo-querulanten, 196 
Psychical cerebroplegia, 250 
Psycho-physiological parallelism, 

" Psycho-physischen Wechselwirk- 
ung," 36 


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, 

Sagitta, 179 

Scalp, hypertrophy of, 116, 217, 

Scanning, 82 

Sclerose hypertrophique, 235 
Sclerosis, 104, iii, 228 

hypertrophic, 236 

of cornu Ammonis, 112 

tuberose, 112, 236, 239, 241, 242, 
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, 

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 


Volition, 14, 17, 49, 65 


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, 

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 


Xenia, 153 

Variation, 142, 144, 156, 177 
Verbigeration, 85 

Ziehen's method of testing memory, 

Y 2 


Abricossoff, A. J., 238 
Adami, J. G., 50, 140, 144 
Aeby, 216 

Ariens-Kappers, C. U., 58, 59 
Ashby, H., 25, 210, 215, 228 


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, 

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 


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 



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 


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, 

Isserlin, M., 75 


James, W., 10, 19, 22, 28, 33 
Jansky, J., 257 
Jennings, H. S., 142 
Jolly, 242 


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 


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 



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 


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, 

Spencer, H., 40, 46, 50, 52, 53, 139, 

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 


Vierordt, 25 
Virchow, 216 



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 


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. 



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