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LIBRARY 

Walter  E.  Fernald 
State  School 


Waverley,  Massachusetts 
No. 


^  \^  — 


THE    FEEBLE-MINDED 


MACMILLAN  AND   CO.,    Limited 

LONDON  ,  BOMBAY  .  CALCUTTA 
MELBOURNE 

THE   MACMILLAN   COMPANY 

NEW  YORK   .    BOSTON   .    CHICAGO 
ATLANTA   .    SAN   FRANCISCO 

THE  MACMILLAN   CO.  OF   CANADA.    Ltu 

TORONTO 


XX  -    ^  /^ 
THE 

FEEBLE-  MINDED 

^  Guide   to   Study   and  Practice 


Massachusetts  School 
for  Feeble  Minded* 


E.  B.  SHERLOCK,  M.D.,  B.Sc.  lond.,  D.P.H. 

Barrister-at-Law,  formerly  S2cperintendent  of  the  Belmont  Asylum 

for  Idiots,  and  Lectttrer  on  Biology  in  the  Westminster 

Hospital  Medical  School 


WITH  AN  INTRODUCTORY  NOTE  BY 

Sir  H.  B.  DONKIN,  M.D.  Oxon.,  F.R.C.P.  Lond. 

Medical  Adviser  to  the  Prison  Commissioners,  Member  of  the  Prisons  Board,  Consulting 

Physician  to   Westminster  Hospital,  late  Member  of  the  Royal  Commission 

on  the  Care  and  Control  of  the  Feeble-Minded 


MACMILLAN   AND    CO.,   LIMITED 
ST.    MARTIN'S   STREET,   LONDON 

I  9  I  I 


RiCHAKD  Clay  and  Sons,  Limited, 

BREAD   STREET   HILL,    E.G.,    AND 
BUNGAY,    SUFFOLK. 


TO 

H,  W.  W. 

AS   A   TOKEN    OF   ESTEEM 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

Boston  Library  Consortium  Member  Libraries 


http://www.archive.org/details/feeblemindedguidOOsher 


PREFACE 

One  meets  in  the  world  with  many  human  beings 
who  do  not  appear  to  have  attained  to  the  average 
intellectual  level  of  their  social  class.  For  the 
condition  of  such  persons  no  very  satisfactory 
designation  is  available,  the  terms  actually  employed 
being  all  open  to  objection  either  because  they  are 
indefinite  or  because,  being  definite,  they  are  inac- 
curate. "  Degeneracy  "  implies  the  falling  from  a 
higher  estate,  whereas  it  is  the  failure  to  reach  the 
normal  one  which  is  the  more  obvious  characteristic. 
"  Amentia  "  errs  in  the  other  direction.  It  suggests 
that  the  defect  observed  is  entirely  due  to  laggard 
development ;  a  suggestion  which,  as  will  be  seen  later, 
is  not  particularly  well  founded.  Moreover,  the  term 
"  Amentia "  is  widely  used  to  denote  states  of 
confusional  insanity.  "  Mental  Deficiency  "  is  too 
comprehensive,  while  ''Idiocy"  and  "Imbecility" 
are  too  restricted  in  their  application.  One  might, 
perhaps,  speak  of  a  "  Psychical  Hypotrophy "  or 
utilise  the  Greek  word  ''  ficopla/'  which,  whatever  it 
may  have  meant  originally,  has  now  so  few  associa- 


viii  PREFACE 

tions  that  any  desired  signification  might  be  attached 
to  it.  On  the  whole,  however,  it  seems  best  to 
follow  the  lead  of  a  recent  Royal  Commission  and 
employ  the  term  '' Feeble- Mindedness."  Without 
attempting  a  too  rigid  definition,  then,  it  may  be 
said  that  for  the  purposes  of  this  book,  ''  The 
Feeble-Minded  "  are  the  persons  with  whose  "  care 
and  control  "  the  Royal  Commission  just  mentioned 
concerned  itself. 

Between  feeble-mindedness  and  sanity  there  Is  no 
clear  line  of  demarcation.  To  say,  as  a  recent 
writer  does,  that  "  the  two  conditions  do  not  merge 
into  one  another  and  between  the  lowest  normal  and 
the  highest  ament  a  great  and  impassable  gulf  is 
fixed  "  is,  to  say  the  least  of  It,  misleading.  A  more 
accurate  statement  of  the  position  is  that  in  the 
report  of  the  Departmental  Committee  on  Defective 
and  Epileptic  Children,  1898,  which  runs: — 

''  From  the  normal  child  down  to  the  lowest  idiot 
there  are  all  degrees  of  deficiency  of  mental  power  : 
and  It  is  only  a  difference  of  degree  which  dis- 
tinguishes the  feeble-minded  children  referred  to  In 
our  enquiry  on  the  one  side  from  the  backward 
children  who  are  found  in  every  ordinary  school  and 
on  the  other  side  from  the  children  who  are  too 
deficient  to  receive  proper  benefit  from  any  teaching 
which  the  school  authorities  can  give." 

This  book  does  not  profess  to  be  more  than  an 


PREFACE  ix 

introduction  to  the  subject  with  which  it  deals.  Its 
original  aim  was  more  ambitious,  but  the  clearer  per- 
ception of  the  magnitude  and  complexity  of  the 
problems  presented  by  the  feeble-minded  which  has 
resulted  from  its  preparation  has  engendered  in  the 
author  a  more  modest  estimate  of  its  utility. 

The  earlier  chapters  are  concerned  with  psychology 
and  with  the  anatomical  and  physiological  facts 
which  are  believed  to  be  correlated  with  psychological 
happenings.  Such  facts  as  belong  more  particularly 
to  those  special  departments  of  biology  which  are 
known  as  pathology,  etiology  and  taxonomy  are  then 
dealt  with,  and  finally  the  subject  is  considered  in  its 
legal,  medical  and  educational  bearings.  Taken  as 
a  whole  the  treatment  may  be  best  described  as 
sociological. 

Since  it  has  proved  to  be  impossible  to  discuss 
fully,  within  the  limits  of  a  small  book,  the  numerous 
debatable  topics  to  which  reference  has  had  to  be 
made,  the  author  has  contented  himself  with  drawing 
what  appear  to  him  to  be  the  practically  important 
conclusions  legitimately  deducible  from  the  evidence 
before  him.  He  confidently  anticipates  that  his 
efforts  will  have  resulted  in  his  giving  cause  for  dis- 
satisfaction to  numerous  worthy  people.  Thus  the 
psychological  scheme  adopted  will  doubtless  be 
regarded  by  professed  psychologists  as  unconven- 
tional.    The  author  hopes,  however,  that  it  may  at 


X  PREFACE 

least  prove  intelligible,  and  therefore  free  from  a 
defect  which  has  vitiated  a  good  deal  of  psycho- 
logical teaching  in  the  past.  Take,  again,  the  views 
on  heredity  which  are  propounded.  So  far  as  these 
are  capable  of  being  allocated  to  any  particular 
school,  they  have  something  in  common  with  the 
hypotheses  of  Nageli  and  Weismann,  but  to  as- 
sociate anybody's  name  with  them  more  definitely 
than  this  would  probably  give  rise  on  the  one  hand 
to  indignant  repudiations  and  on  the  other  to  pro- 
tests as  to  disregarded  claims.  To  disciples  of 
Weismann  the  teaching  here  given  will  appear  con- 
taminated with  the  pestilent  neo-Lamarcklan  heresy, 
while  the  Mutatlonists,  the  Mendellans,  and  the 
Biometriclans  will  doubtless  be  prepared  to  sink 
their  differences  in  order  to  join  in  a  chorus  of  con- 
demnation. The  lore  of  heredity  is  open  to  the 
reader,  and  he  may  well  study  it  for  himself.  One 
may,  perhaps,  be  allowed  to  throw  out  the  sugges- 
tion that  he  will  find  the  memorial  volume  Darwin 
and  Modern  Science  of  the  greatest  service,  and  that 
he  should  not  overlook  the  recent  works  of  Dr.  G. 
Archdall  Reid  and  Mr.  Charles  E.  Walker. 

As  will  be  gathered  from  the  bibliographical 
references,  the  literature  of  the  subject  has  been 
freely  consulted,  and  it  Is  hoped  that  adequate 
acknowledgment  has  been  made  in  all  cases.  Some 
portion  of  the  notes  on  the  admission  of  cases  of 


PREFACE  xi 

feeble-mindedness  to  workhouses  and  asylums  has 
appeared  in  the  Lancet,  and  is  reproduced  by  the 
kind  permission  of  the  editor  of  that  journal.  Some 
of  the  photographs  of  brains  are  taken  from  a  thesis 
submitted  to  the  University  of  London,  and  have 
been  used  to  illustrate  a  paper  on  "  The  Pathology 
of  Epileptic  Idiocy,"  which  is  to  be  found  in  the 
Annual  Report  of  the  Metropolitan  Asylums  Board 
for  1907. 

The  author  is  under  a  special  obligation  to 
Sir  H.  B.  Donkin,  who,  besides  contributing  an 
Introductory  Note,  has  offered  many  helpful  critic- 
isms. He  desires  also  to  place  on  record  his 
indebtedness  to  the  Medical  Superintendents  of  the 
Leavesden,  Darenth,  and  Caterham  Asylums;  to 
Dr.  J.  F.  Powell  ;  and  to  Dr.  A.  K.  Maclachlan  for 
help  in  the  preparation  of  the  indexes. 


CONTENTS 


CHAPTER    I 

PAGE 

THE  NATURE  OF   MIND I 

CHAPTER    II 

THE  BASIS   OF   MIND •  •  •        33 

CHAPTER    III 

THE   FEEBLE   MIND  .  .         .         • 70 

CHAPTER    IV 

THE   BASIS   OF  THE   FEEBLE  MIND      .......       92 

CHAPTER   V 

THE  CAUSATION   OF   FEEBLE-MINDEDNESS        .  .  .  .  -135 

CHAPTER   VI 

THE   VARIETIES   OF    FEEBLE-MINDED   PERSONS        ....      180 

CHAPTER   VII 

THE   HANDLING   OF  THE   FEEBLE-MINDED 262 


LIST    OF    ILLUSTRATIONS 


Fig.   i^ — Diagrams  illustrating  different  conceptions  of  the 

Relations  of  the  "  Centres  "  concerned  in  Speech    Page  67 

Fig.  2 „      68 

Fig.  3      .       . ,,87 

Fig.  4 — Design  in  coloured  threads  on  a  layer  of 
cotton-wool.  Made  by  an  idiot,  without 
tuition To  face  page      91 

Fig.  5 — Brain  of  an  epileptic  idiot  aged  18  ;  weight 
of  left  hemisphere  17!  oz.,  of  the  right 
hemisphere  6f  oz.  The  opacity  of  the 
pia-arachnoid  is  well  shown        ...  „  91 

Fig.  6 — The  same  brain  as  in  Fig.  5.  The  hemi- 
spheres are  separated  and  placed  so 
as  to  emphasise  the  difference  in  size       .  „  100 

Fig.  7 -Brain  of  an  epileptic  idiot  seen  from  the 
front .  The  right  hemisphere  weighed  1 9f 
oz.  The  left  1 3  oz.  Note  the  opacity  of  the 
pia-arachnoid  over  the  left  hemisphere     .  „  100 

Fig.  8 — Parietal  region  of  the  right  hemisphere  of 

an  idiot  boy  aged  17,  showing  microgyria  „  102 

Fig.  9 — Left  hemisphere   of  the  brain  of  an  idiot, 

showing  a  condition  of  true  porencephaly  „  102 

Fig.  10 — The  right  hemisphere  of  the  brain  repre- 
sented in  Fig.  9,  showing,  instead  of  a 
perforation  of  the  ventricular  wall,  a  de- 
pressed area  with  irregular  convolutions  .  „  103 

Fig.    II — Brain   showing  the   condition  known   as 

pseudo-porencephaly „  103 

Fig.  12 — Right  hemisphere  of  the  brain  of  an  idiot, 

showing  microgyria      .        .        ,        .        .  „  112 

Fig,  13 — A  MongoHan  imbecile „  112 


xvi         LIST  OF   ILLUSTRATIONS 

Fig.  14 — Lateral  aspect  of  the  left  hemisphere  of  the 

brain  of  a  Mongolian  idiot  ....  To  face  page  213 

Fig.  15 — The   micro-cephalic  idiot  whose   brain   is 

shown  in  Figs.  16,  17,  18     .        ,        .        .  „  213 

Fig.  16 — Lateral  aspect  of  the  right  hemisphere  of 

a  micro-cephalic  brain  ....  „  218 

Fig.  17. — Lateral  aspect  of  the  left  hemisphere  of  a 

micro-cephalic  brain „  218 

Fig.  18 — Mesial  aspect  of  the  hemispheres  shown  in 

Figs.  16  and  17 „  219 

Fig.  19 — Lateral  aspect  of  the  left  cerebral  hemi- 
sphere of  a  micro-cephalic  idiot.  The 
pari eto -occipital  region  is  represented  by 
a  sac  of  which  the  cavity  is  continuous 
with  that  of  the  lateral  ventricle         .        .  „  219 

Fig.  20 — Left  lateral  aspect  of  the  brain  of  a  female 

micro-cephalic  idiot „  220 

Fig.  21 — An     epileptic      idiot     with     well-marked 

adenoma  sebaceum      .....  „  220 

Fig.  22 — Plan  of  Industrial  Colony  for  2,000  Persons  „  280 

Fig.  23 „  292 

Fig.  24 „  292 

Fig.  25 — Apparatus  for  Testing  Acuity  of  Perception  of  Light  „  296 

Fig.  26 — Ziehen's  5-Angled  Figure „  298 

Fig.  27 — Examples  of  Heilbronner's  Figures   .        .        .        .  „  299 


INTRODUCTORY  NOTE 

In  justification  of  this  response  to  a  request  for  some 
words  of  introduction  to  Dr.  Sherlock's  book  I  claim 
only  my  great  interest  in  the  subject  matter,  to  which 
I  have  given  thought  during  many  years  ;  my  long 
work  as  a  member  of  the  recent  Royal  Commission  on 
the  Care  and  Control  of  the  Feeble-Minded  ;  and  my 
special  and  personal  experience  of  the  considerable 
number  of  mentally  defective  persons  who  are  found 
in  our  prisons. 

Both  the  plan  and  execution  of  this  book  give 
evidence  that  the  author  has  attacked  his  subject  after 
laborious  study  and  thought  and  with  a  rich  equipment 
of  practical  knowledge.  He  has  produced  a  work 
which,  in  my  judgment,  is  by  far  the  most  scientific 
and  useful  of  all  that  have  as  yet  appeared  on  the 
confessedly  important  matter  which  is  now  creating  so 
wide  an  interest.  The  book,  as  a  whole,  is  marked  by 
a  rare  absence  of  prejudice,  and  a  wholesome  refusal 
to  accept  without  adequate  proof  any  doctrine,  how- 
ever seemingly  favourable  it  might  be  to  conclusions 
to  which  the  author  might  incline.  A  study  of  the 
first  five  chapters  will,  I  think,  fully  bear  out  these 
remarks,  and  justify  the  author's  view  that  a  scientific 
consideration  of  the   nature  of  mind  in  general   is  a 


xviii  INTRODUCTORY   NOTE 

necessary  preliminary  to  any  useful  discussion  of  the 
subject  of  mental  defect. 

It  may  possibly  be  deemed  by  some  that  the  author 
might  have  struck  a  somewhat  more  certain  note  when 
dealing  with  the  still-vexed  question  of  the  inheritance 
of  mental  defect.      But  in  a  book  of  this  scope,  with 
an  eminently  practical  bearing  on  the  question  of  the 
best  methods  of  controlling  the  large  body  of  mentally 
defective  persons,  both  children  and  adults,  who  are 
now  a  source  of  fruitless  expense  and  many  dangers 
to  the  community,  a  final  pronouncement  on  the  exact 
nature    and    causation    of    feeble-mindedness    is    not 
necessary,    even    if   it   were   possible.     The   positive 
harm    which    is    demonstrably  caused    now  by  many 
"  mental  defectives "  whom  the  existing  laws  cannot 
control,  and  the  certain  prospect  of  large  numbers  of 
mentally  defective  children  being  permanently  unable 
to  shift  for  themselves  and  very  liable  to  take  to  a  life 
of  misery  to  themselves  and  multiform  evil  to  others, 
are   sufficient    reasons    in    themselves   for    legislative 
enactments  on  the  lines  recommended  by  the  Royal 
Commission  and  worked  out  in  some  detail   by  Dr. 
Sherlock  in  the  final   chapter  of  this  book.     Proper 
control  of  the  feeble-minded,  which  is  so  necessary  for 
these  reasons  alone,  will  go  far  towards  satisfying  the 
requirements  of  all  such  persons  as  may  hold  that  the 
primary  necessity  and  justification  for  the  means  pro- 
posed is    to  be  found  in    the  hereditary  nature   and 
consequent  propagation  of  mental  defect. 

In  this  context  a  few  words  must  be  said  on  the 
very  luminous  Chapter  in  this  book  which  treats  of 
the  *'  Varieties  of  Feeble-Minded  Persons."  Dr. 
Sherlock  here  comments  trenchantly  on  many  existing 


INTRODUCTORY   NOTE  xix 

classifications.  He  justly  points  out  where  they  fail, 
both  for  scientific  and  practical  purposes  ;  while  at  the 
same  time  he  admits  the  almost  insuperable  difficulty 
of  establishing  a  system  of  classification  which  would 
effectively  compass  both  of  these  objects.  He  states 
his  opinion  that  the  best  classification  on  practical  lines 
is  that  suggested  by  the  Royal  College  of  Physicians 
of  London,  and  adopted  for  confessed  purposes  of 
utility  by  the  Royal  Commission ;  while  he  shows 
quite  clearly  that  were  it  intended  to  be  a  scientific  or 
clinical  classification,  it  would  be  open  to  similar, 
charges  of  defect. 

In  proposing  a  really  excellent  combination  of 
classificatory  systems  which,  as  he  says,  ''  appears  to 
give  the  most  generally  useful  arrangement "  he 
enumerates  nine  sub-divisions,  eight  of  which  are 
marked,  clinically,  by  saliently  different  characteristics  ; 
while  the  ninth,  and  far  largest,  sub-division  of  all,  he 
terms  ''  Residual."  He  further  shows  that  each  of  these 
sub-divisions  will  supply  instances  of  the  three  grades 
of  mental  defect  which  may  be  called,  respectively, 
''  Idiocy,"  ''  Imbecility,"  and  ^' Weak-Mindedness." 

In  this  ''  residual  "  group  which  constitutes  much  the 
largest  proportion  of  the  total  number  of  the  "  feeble- 
minded," and  a  much  larger  proportion  of  those  who 
are  the  subjects  of  the  slighter  forms  of  defect,  are 
included  most  of  those  who  cannot  now  be  legally 
controlled,  and  who  form,  essentially,  the  class  of 
persons  whom  it  is  sought  to  control  on  account  of  the 
harm  they  do  and  the  evils  from  which  they  suffer. 
Among  these  are  the  children  who  in  large  numbers 
become  paupers,  criminals,  and  prostitutes,  and  are 
constantly  a  source    of  wasteful    public   expenditure. 


XX  INTRODUCTORY   xNOTE 

Members  of  this  group,  says  Dr.  Sherlock,  may  show 
"all  kinds  of  physical  abnormalities,"  but  these  are 
not  of  a  nature  to  help  in  the  differentiation  of 
distinct  types  of  disease.  "  For  sociological  purposes," 
he  adds,  ''it  does  not  seem  necessary  to  attempt  any 
more  elaborate  classification  than  that  into  cases  of 
'idiocy,'  'imbecility,'  and  'weak-mindedness'  already 
utilised." 

It  will  thus  be  seen  that  for  the  practical  purpose  of 
deciding  as  to  the  proper  forms  of  control  and  treat- 
ment needed  in  most  cases,  Dr.  Sherlock  is  in  accord  with 
the  description  given  in  the  Report  of  the  Royal  Com- 
mission. The  merely  verbal  difference  of  nomenclature 
which  is  shown  in  his  use  of  the  word  "  weak-minded  " 
instead  of  "  feeble-minded  "  in  this  context  is,  of  course, 
of  no  special  consequence.  In  common  with  many,  espec- 
ially American,  writers  the  author  uses  the  word  "  feeble- 
minded "  generically,  to  include  all  grades  of  so-called 
"congenital"  mental  defect;  while  the  Commissioners 
used  this  word  in  the  sense,  more  prevalent  in 
England,  of  a  less  marked  grade  of  defect  than  is 
commonly  described  by  the  terms  "idiotic"  or 
"imbecile."  Hence  the  word  "weak-minded"  in  this 
book  represents  the  word  "feeble-minded"  as  techni- 
cally employed  by  the  Commission. 

H.    B.    DONKIN. 


THE    FEEBLE-MINDED 


h 

^  CHAPTER    I 


THE    NATURE    OF    MIND 

To  speak  of ''  feeble-mindedness  "  is  to  imply,  in  the 
first  place,  that  such  a  thing  as  "  Mind  "  exists  and, 
in  the  second,  that  mind  is  capable  of  existing  in 
other  than  a  normal  condition.  As  a  necessary 
preliminary  to  arriving  at  a  conception  of  what 
normal  and  abnormal  minds  consist  in  one  must 
therefore  endeavour  to  envisage  "  Mind"  as  it  is  in 
itself. 

There  is  perhaps  no  other  branch  of  science  which 
a  student  approaches  with  the  same  misgivings  as 
preoccupy  him  in  the  case  of  psychology.  The 
matters  towards  which  his  thoughts  are  directed  are 
here  intangible,  vague  and  elusive  facts  of  an  un- 
accustomed order  and  his  difficulties  are  increased 
by  the  apparently  irreconcilable  diversities  in  the 
descriptions  of  the  facts,  which  confuse  him  as  he 
turns  from  one  source  of  instruction  to  another. 
Momentarily  re-assured  by  sight  of  the  comparatively 
solid  ground  of  reaction-time  experiments,  plethysmo- 
graphic   records    of   emotional    expression,   and   the 

B 


2  THE   FEEBLE-MINDED         chap. 

other  data  of  the  practical  psychologist,  he  soon  finds 
these  are  but  slippery  rocks  from  which  he  is  again 
plunged  more  deeply  than  before  into  the  sea  of 
metaphysical  speculation.  In  such  an  emergency  a 
chart,  even  of  the  most  imperfect  kind,  which  may 
serve  as  a  guide  to  smoother  waters,  will  be  of  value 
and  in  the  following  pages  an  attempt  is  made  to 
supply  one. 

''Observation  of  the  mind,"  says  Huxley,^  ''makes 
us  acquainted  with  nothing  but  certain  events,  facts, 
or  phenomena  (whichever  name  be  preferred)  which 
pass  over  the  inward  field  of  view  in  rapid  and,  as  it 
may  appear  on  careless  inspection,  in  disorderly 
succession  like  the  shifting  patterns  of  a  kaleido- 
scope." These  events,  facts,  or  phenomena  we  call 
mental  processes  and  we  classify  them  under  various 
headings  as  thoughts,  sensations,  ideas,  feelings  and 
so  on  ;  mind  at  any  given  instant  being  the  sum 
total  of  the  mental  operations  proceeding  at  that 
instant.  For  all  practical  purposes  Consciousness  is 
the  same  thing  as  Mind. 

Contemplation  of  the  number  and  complexity  of 
the  mental  processes  with  which  we  are  familiar  can 
hardly  fail  to  inspire  in  us  a  hope  that  on  analysis 
they  may  be_reduced  to  simpler  elements  and  this  is 
to  a  great  extent  the  case. 

Certain  of  our  mental  processes  show  a  direct 
relation  to  the  conditions  of  our  environment :  they 
constitute,  indeed,  our  sole  source  of  knowledge  of 
that  environment.  Apart  from  them  the  environ- 
ment has,  for  us,  no  existence.  This,  of  course,  is 
quite  other   than    saying    that  the  universe  has  no 

1  T.  H.  Huxley,  Hume  and  Berkeley,  Collected  Works,  Vol.  6. 


1  THE   NATURE   OF   MIND  3 

existence  outside  our  consciousness.  The  fact  that 
we  do  not  see  a  thing  or  do  not  see  it  clearly  is 
no  proof  that  it  does  not  exist. 

Such  knowledge  as  we  have  acquired  about  the 
world  outside  ourselves  has  been  obtained  through 
the  instrumentality  of  our  sense  organs  and  it 
resolves  itself  into  mental  presentations  arising  in 
consequence  of  the  application  of  stimuli  to  those 
sense  organs. 

We  are  familiar  in  nature  with  a  capacity,  on  the 
part  of  both  inanimate  and  animate  bodies,  for 
responding  to  stimulation.  The  study  of  explosives 
introduces  us  to  bodies  in  which  chemical  reactions 
of  great  magnitude  can  be  initiated  by  apparently 
trivial  stimuli  :  a  mere  touch,  for  example,  will  cause 
such  a  body  as  iodide  of  nitrogen  to  explode.  A 
mere  touch  similarly,  may  cause  a  reaction  in  a 
living  creature.  The  resemblance  between  the 
results  obtained  in  the  two  cases  has  not  unnaturally 
suggested  a  chemical  basis  for  both,  but  too  much 
stress  must  not  be  laid  on  this  analogy. 

In  the  particular  case  where  the  organisms 
concerned  are  our  own  bodies  we  observe  that  the 
reaction  is  accompanied  by  an  effect  on  consciousness, 
i.e.  not  only  do  we  respond  to  stimulation  but  we 
know  that  we  are  so  responding.  We  do  not  credit 
the  inanimate  body  which  reacts  with  this  capacity 
for  knowledge  and  we  are  uncertain  as  to  the  exact 
stage  in  the  evolution  of  living  beings  at  which  it 
appears. 

So  far  then  we  have  three  factors  to  consider  : 
(i)  the  application  of  a  stimulus,  giving  rise  to  (2)  a 
reaction,   which    is    accompanied    by    (3)    a    mental 

B    2 


4  THE   FEEBLE-MINDED         chap. 

process  corresponding  to  that  reaction.  Departing 
somewhat  from  conventional  terminology  we  will 
call  the  reaction  a  "Sensation"  and  the  associated 
mental  process  a  "  Presentation,"  thus  establishing  a 
convenient  distinction  between  the  physical  fact, 
stimulation  :  the  physiological  fact,  sensation  :  and 
the  psychological  fact,  presentation/ 

Sensations  may  have  their  origin  in  the  parts  of 
the  nervous  system  associated  with  the  organs  of 
special  sense  or  in  other  parts  which  are  not  so 
obviously  specialised,  e,g,  the  terminations  of  the 
nerves  connected  with  the  bones,  muscles,  joints,  and 
viscera.  To  this  second  group  of  sensations  the 
designation  ''organic"  is  sometimes  applied. 

The  list  of  physiological  reactions  is  a  fairly  long 
one  :  it  includes — 

(i)  Cutaneous  sensations,  of  two  kinds,  the 
'' protopathic  "  and  the  "epicritic."  These  systems 
were  differentiated  by  Messrs.  H.  Head,  W.  H.  R. 
Rivers,  and  J.  Sherren  ^  and  are  described  in  their 

^  The  distinction  between  physical  and  physiological  is  an  arbitrary 
one,  but  between  the  physical  and  the  physiological  on  the  one  hand 
and  the  psychological  on  the  other  there  is  a  gulf  which  cannot  be 
bridged  over  in  the  way  so  often  attempted  ;  that  is  to  sa^^,  by  a  loose 
employment  of  the  term  Sensation.  According  to  the  Dictionary  oj 
Philosophy  and  Psychology,  Sensation  is  "  that  mode  of  consciousness 
which  can  only  be  accounted  for  by  the  present  operation  of  an  ex- 
ternal stimulus  upon  the  nervous  system,  or  some  equivalent  condi- 
tion." Here  it  is  proposed  to  define  a  mental  process  by  the  help  of 
physical  criteria  which  are  not  commensurate  with  it.  The  use  of  the 
term  "  Sensation  "  in  a  purely  psychological  sense  as  denoting  a  unit 
of  experience  would  be  quite  legitimate,  but  since  it  leaves  us  without 
a  convenient  word  to  express  the  physiological  conditions  of  a  mental 
presentation  and  is  superfluous  as  a  synonym  for  such  a  presentation, 
it  seems  preferable  to  employ  the  term  in  the  sense  adopted  in  the 
text. 

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


I  THE   NATURE   OF   MIND  5 

paper,  which  appeared  in  Brain  for  November,  1905. 
The  protopathic  system  is  "  capable  of  responding  to 
painful  cutaneous  stimuli,  and  to  the  extremes  of 
heat  and  cold.  This  is  the  great  reflex  system, 
producing  a  rapid  widely  diffused  response  un- 
accompanied by  any  definite  appreciation  of  the 
locality  of  the  spot  stimulated."  By  means  of  the 
epicritic  system  we  "  gain  the  power  of  cutaneous 
localisation,  of  the  discrimination  of  two  points,  and 
of  the  finer  grades  of  temperature,  called  cool  and 
warm." 

(2)  Visceral  sensations. 

(3)  Auditory  sensations. 

(4)  Labyrinthine  and  motor  sensations.  These 
are  concerned  in  the  maintenance  of  muscular  tone 
and  in  the  co-ordination  of  movements.  The  motor 
sensations  are  those  known  as  "  kinaesthetic,"  but 
the  labyrinthine  are  also,  in  a  sense,  kinaesthetic. 

(5)  Visual  sensations. 

(6)  Gustatory  sensations.  These  are  of  four 
kinds  corresponding  to  the  qualities  ''sweet," 
''bitter,"  "salt,"  and  "sour." 

(7)  Olfactory  sensations.  The  varieties  of  these 
have  not  been  determined  with  certainty.  Zwaarde- 
maker's  classification  runs  thus  ; — 

[a)  Ethereal,  {b)  Aromatic,  {c)  Balsamic,  (d) 
Amber-musk.  {e)  Allyl-cacodyl.  (/)  Burning. 
i^g)  Caprylic.     {Ji)  Repulsive,     (i)  Nauseating. 

On  examining  a  presentation  more  closely  we 
discover  in  it  certain  features  or  qualities  which  call 
for  description. 

{a)  In  the  first  place  we  notice  that  a  presentation 
which    has   been    called  up  by  a  sensation  is   not 


6  THE    FEEBLEMINDED  chap. 

henceforth  a  constant  part  of  consciousness.  With 
removal  of  the  stimulus  the  presentation  fades  away. 
But  experience  shows  us  that  it  may  re-appear  in 
consciousness  without  the  repetition  of  the  stimulus  : 
there  may,  in  fact,  be  a  re-presentation.  This 
species  of  spontaneous  reproduction  is  called 
"perseverance."  The  particular  mental  process 
which  is  involved  in  the  re-appearance  of  a  presenta- 
tion is  called  Memory,  and  as  it  seems  impossible  to 
resolve  it  into  any  simpler  constituents,  we  must 
accept  it  as  a  further  "element  of  mind."  What 
becomes  of  the  presentations  until  they  are  re- 
presented we  can  only  surmise.  If  it  is  any  help  to 
the  student,  he  may  suppose,  with  Binet,^  that 
they  "  prolong  their  existence  while  they  are  not 
being  thought  in  the  same  way  and  for  the  same 
motive  that  material  bodies  continue  theirs  while 
they  are  not  being  perceived." 

(b)  Another  characteristic  which  we  may  observe 
a  presentation  to  exhibit  is  that  of  being  pleasant  or 
unpleasant ;  of  being,  in  the  language  of  the 
psychologists,  "affected."  There  are,  according  to 
Professor  E.  B.  Titchener,^  "  three  possible  views  of 
elementary  affective  process.  The  affection  may  be 
an  attribute  of  sensation — an  '  affective  tone '  of 
sensation.-^  Or  the  affection  may  be  a  mental 
element  distinct  from,  and  co-ordinate  with,  sensation. 
Or  lastly  the  affection  may  be  itself  a  sensation,  a 
sensation  of  a   special    kind    like   a    visual    or   the 

^  A.  Binet,  The  Mind  and  the  Brain,  1907?  P-  126. 
-  E.     B.    Titchener,    Lectures  on   the   Elementary  Psychology   of 
Feeling  and  Attention^  1908. 

^  "  Sensation  "  is  here  used  in  the  sense  of  "  presentation." 


1  THE   NATURE   OF   MTND  7 

kinaesthetic."  As  he  dismisses  somewhat  contempt- 
uously the  first  view  and  devotes  a  considerable 
amount  of  space  to  demolishing  the  third,  we  may 
regard  the  second  as  the  one  which  meets  with  his 
approval.  The  only  objection  to  this  view  is  that  it 
hardly  lays  sufficient  stress  on  the  dependence  of 
affection  on  the  idea,  for  without  presentations  or 
re-presentations  affection  is  non-existent,  although 
the  converse  statement,  viz.,  that  without  affection 
ideas  are  non-existent,  does  not  appear  to  be  true. 
We  may  note  that  a  more  elaborate  scheme  of  sub- 
division of  the  affective  process  than  the  one  here 
adopted  is  employed  by  some  psychologists,  e,g,  by 
Wundt,  who  recognises  three  pairs  of  antithetical 
affective  qualities,  pleasantness  —  unpleasantness  ; 
excitement — tranquillisation  ;  tension — relaxation. 

Representations  differ  from  presentations  in  no 
important  respects  save  that  of  being  later  in  time, 
and  we  may  conveniently  include  the  two  classes 
under  the  denomination  "  Ideas."  The  appearance 
and  re-appearance  of  Ideas  in  consciousness  we  may 
call  ''  Ideation."  Our  mental  outfit,  then,  so  far  as 
we  have  got,  consists  of  Ideas,  Memory,  and  Affec- 
tion, and  we  must  now  proceed  to  enquire  what  are 
the  possibilities  in  the  way  of  mental  architecture 
which  this  outfit  furnishes  us  with. 

Although  for  the  purposes  of  elucidation  we 
regarded  Ideas  as  isolated  events  in  consciousness,  a 
survey  of  our  minds  shows  them  to  be  woven  into 
innumerable  and  ever-varying  combinations  of 
different  grades  of  complexity.  As  I  write,  my 
organs  of  sight  and  hearing  are  being  assailed  by 
stimuli  emanating  from  an  object  lying  within  my 


8  THE   FEEBLE-MINDED         chap. 

field  of  view.  My  consciousness  contains  ideas 
corresponding  to  the  colours  black,  white,  and  yellow, 
and  to  a  noise  of  short  duration.  The  ideas  are 
simply  there  and  have  no  connecting  link  beyond 
their  simultaneous  presence.  But  connecting  links 
can  be  added  by  memory.  The  ideas  of  colour  and 
noise,  if  previously  experienced  in  connection  with 
other  ideas,  will  recall  those  other  ideas.  I  remember, 
for  instance,  that  the  object  has  other  sides  than  the 
one  I  see,  that  it  is  tangible,  that  it  is  made  up  of 
many  parts,  and  so  on,  and  my  mind  consequently 
becomes  occupied  by  a  group  of  ideas  which  are  not 
only  present  together  now,  but  which,  in  my  experi- 
ence, have  been  present  together  many  times 
previously,  and  which  therefore  I  have  learned  to 
regard  as  having  some  firmer  bond  of  union  than 
mere  simultaneity.  I  am,  that  is  to  say,  not  only 
aware  of  the  presence  of  sensations,  but  I  perceive 
that  they  are  referable  to  a  particular  object  to  which 
I  have  been  taught  to  attach  the  name  ''  watch." 
A  group  of  ideas  which  can  be  thus  referred  is  a 
Percept. 

It  has  been  usual  for  psychologists  to  apply  the 
term  percept  only  to  the  special  case  of  grouping 
which  I  have  taken  as  an  example,  i.e.  the  case  in 
which  both  presentations  and  re-presentations  are  con- 
cerned. There  seems,  however,  to  be  no  sufficient 
ground  for  this  distinction,  and  the  term  will 
be  used  in  this  work  as  equally  applicable  to  a  group 
of  re-presentations  only  when  these  are  referable 
to  a  particular  species,  as  opposed  to  a  genus,  of 
natural  phenomena. 

For  the  purpose  of  arriving  at  the  definition  of  a 


T  THE    NATURE   OF   MIND  9 

percept,  we  have  considered  ideas  apart  from  the 
special  quality  of  affection.  If  we  now  include  within 
our  purview  this  aspect  of  ideas  also,  we  are  able 
to  take  a  further  step.  An  idea  or  percept  which  is 
appreciably  affected,  or,  if  another  way  of  putting  it  is 
preferred,  the  idea  or  percept  with  which  an  affection 
is  associated,  is  called  a  Feeling. 

But  we  are  able  to  observe  in  our  minds  affected 
processes  which  seem  to  be  much  more  complex 
than  Feelinois.  These  are  what  we  call  Emotions. 
The  term  connotes  a  "moving  out"  or  "expression" 
as  distinct  from  the  "  impression  "  which  we  have  so 
far  considered,  and  we  must  now  deal  with  the  new 
factor  which  appears  to  be  introduced. 

It  constantly  happens  that  the  effects  of  stimula- 
tion, instead  of  being  confined  to  the  development 
of  a  sensation,  become  evident  as  action,  and  action 
will  have  its  equivalent  in  consciousness  in  so  far  as 
it  provides  a  stimulus  to  the  sense  organs.  Such 
equivalents  are  called  Kinsesthetic  Ideas.  Now 
emotion  involves  action,  and  it  would  appear  to  be 
the  ideas  arising  from  this  activity  which,  added  to 
a  Feeling,  convert  it  into  an  Emotion.  The 
Emotion  will  thus  comprise  what  may  be  described 
as  primary  and  secondary  groups  of  ideas.  Emotions 
are  numerous  and  diverse,  but  for  our  present  purpose 
we  need  not  proceed  further  with  the  classification 
of  them  than  to  indicate  that  they  can  all  be 
referred  to  two,  still  more  easily  to  six,  categories 
of  affection,  the  more  detailed  differences  between 
them  being  dependent  on  their  ideational  rather 
than  their  affective  content.  It  is  generally  taught 
that   ''  organic  "   sensations    are    mainly  responsible 


10  THE   FEEBLEMINDED         char 

for    the    affected    ideas    which    are    comprised    in 
emotion. 

A  prolonged  emotion  of  no  great  intensity  we 
call  a  Mood,  while  we  speak  of  one  which  is  brief 
but  intense  as  a  Passion. 

For  a  long  time  there  has  been  in  progress 
between  psychologists  a  discussion  as  to  the  relation 
subsisting  between  an  emotion  and  its  expression. 
At  first  sight  it  certainly  appears  that  the  sequence 
of  events  is  that  we  feel  an  emotion  and  then 
proceed  to  its  expression  ;  but  Lange,  James,  and 
others,  take  up  the  position  that  we  feel  an  emotion 
because  we  are  expressing  it,  not  that  we  express  an 
emotion  because  we  are  feeling  it.  Appeal  is  made 
for  confirmation  of  this  view  to  the  experience  of 
persons  whose  business  or  amusement  it  is  to  express 
emotions,  and  actors  are  quoted  as  having  testified 
that  when  they  are  representing  emotions  effectively, 
they  actually  experience  them  in  their  own  conscious- 
ness. That  emotion  may  be  generated  by  an  effort 
of  the  will  is  borne  out  by  the  interesting  experi- 
ments alluded  to  by  Sir  Francis  Galton,^  in  which 
he  succeeded  in  developing  in  his  mind  a  fear  of 
espionage  and  a  reverence  for  the  figure  of  Punch  by 
allowing  himself  to  dwell  upon  those  topics.  On 
the  other  side  of  the  account  we  may,  however,  set 
the  evidence  of  no  less  distinguished  an  actor  than 
the  late  M.  Coquelin  ain6,  who,  in  an  interview 
reported  in  the  Daily  Graphic  for  Jan.  28th,  1909, 
said,  *'  I  go  to  a  theatre  for  a  first  performance 
entirely  without  emotion,  knowing  exactly  what  I 
am  going  to  do  and  exactly  how  I   mean  to  do  it. 

^  F.  Galton,  Memories  of  My  Life. 


I  THE   NATURE   OF   MIND  11 

Everything  that  the  actor  does  on  the  stage  should 
be  an  act  of  his  voHtion  and  not  the  result  of 
a  blind  impulse  of  emotion."  The  apparent  dis- 
crepancy is  perhaps  to  be  explained  by  supposing 
that  in  some  cases  the  primary  and  in  others 
the  secondary  group  of  ideas  is  the  one  more 
strongly  affected. 

It  will  be  seen  that  the  definitions  of  emotion  and 
its  modifications  which  have  been  given  imply  more 
than  the  mere  existence  of  ideas,  affected  or  un- 
affected. If  we  search  our  consciousness,  we 
discover  that  we  are  aware  of  something  more  about 
ideas  than  that  they  simply  are  ;  we  observe  that 
they  have  certain  relations  to  each  other.  The 
ingredients  of  natural  phenomena  can  be  distributed 
among  at  least  four  categories — those  of  matter, 
force,  time,  and  space.  Perhaps  the  first  two  may 
be  taken  together  and  expressed  simply  by  the  term 
motion.  As  to  the  existence  of  these  categories 
outside  the  limits  of  human  experience  we  know 
nothing  :  they  exist  for  us  because  we  think  that 
they  do  ;  they  are  the  projections  of  our  conscious- 
ness against  the  background  of  the  universe.  Force 
and  matter  (or  motion)  have,  as  we  conceive  of 
them,  a  quality  of  substantiality  which  is  lacking 
from  time  and  space.  Now  ideas  are  the  psycho- 
logical equivalents  of  motion,  but  since  we  are 
aware  also  of  the  existence  of  time  and  space,  these 
must  also  have  some  equivalents  in  consciousness. 
The  essence  of  our  conception  of  time  and  space  is 
an  awareness  of  succession — of  the  occupying, 
by  motion,  of  successive  positions  in  time  and 
space.     Our  psychological  equivalent  of  succession 


12  THE   FEEBLE-MINDED         chap. 

is  something  different  from  an  idea  in  that  it  is  not 
directly  referable  to  any  sensation. 

Introspection  will  tell  us  that  our  minds  contain 
products  of  ideation  which  are  much  more  complex 
than,  though  probably  derived  from,  percepts. 
Psychologists  have  been  accustomed  to  describe 
four  modes  of  combination  of  ideas.  These  may  be 
arranged  in  pairs  according  to  whether  the  associa- 
tion is  determined  by  (a)  the  co-existence  or  the 
succession  of  the  ideas ;  or  (d)  the  similarity  or 
dissimilarity  of  the  ideas. 

The  presentations  and  re-presentations  in  a 
percept  form  a  natural  group  of  ideas  between 
which  there  is  the  relation  of  simultaneous  associa- 
tion. When  for  any  reason  one  of  the  ideas  in  the 
group  is  revived,  the  rest  tend  to  be  revived  also. 
The  groups  of  ideas  in  consciousness  are  ever 
changing,  but  before  those  in  one  group  have  passed 
away  others  may  have  entered  consciousness  and 
so  become  associated  with  the  original  group. 
One  of  these  new  ideas  may  serve  to  revive  the 
original  group  and  we  have  then  a  case  of  succes- 
sive association  or  association  by  contiguity.  An 
entirely  new  group  of  ideas  may  contain  one  which 
had  already  occurred  in  the  previous  group.  This 
idea,  when  presented  in  the  new  grouping,  may 
reproduce  the  former  grouping.  Association  by 
similarity  occurs  in  this  way  :  it  is  thus,  as  Semon  ^ 
has  pointed  out,  only  a  special  case  of  simultaneous 
association.  Contrast  association  also  may  be 
accounted  for  on  a  basis  of  simultaneous  association 
if  we  remember  how  we  are  trained    in  childhood 

^  R.  Semon,  Die  mnemischen  Empfindungen^  1909?  Chap.  X. 


I  THE   NATURE   OF   MIND  13 

to  think  of  contrasted  objects  or  qualities  together. 
Yet  another  form  of  association  to  which  no  special 
name  is  applied,  but  which  may  also  be  brought  into 
the  class  of  simultaneous  association,  is  recognised. 
Thus  we  find  that  if  the  ideas  x  and  z  have  each 
been  separately  associated  with  the  ideajj/,  although 
neither  x  nor  z  alone  may  suffice  to  reproduce  y, 
a  combination  oi  x  and  z  may  be  effective. 

Our  processes  of  analysing  and  synthesising 
groups  of  ideas  may  have  also  a  more  specific 
character,  dependent  on  the  circumstance  that  when 
ideas  are  like  each  other  we  can  become  aware  of 
the  fact.  The  act  of  comparing  ideas  with  a  view 
to  learning  whether  they  are  alike  or  not  is  called  a 
Judgment. 

We  are  now  well  within  sight  of  the  morass  in 
which  generations  of  metaphysicians  have  floundered. 
What  is  it  which  enables  us  to  observe  relations  of 
succession  and  similarity  and  to  associate  ideas 
according  to  those  relations?  Is  it  some  ''mental 
element  "  or  "  process  "  additional  to  those  already 
enumerated,  but  essentially  of  the  same  general 
character,  or  does  it,  perhaps,  belong  to  a  higher 
order  of  mentation  ?  Frankly,  we  do  not  know,  and 
if  we  have  the  scientific  spirit  we  admit  as  much. 
Let  us,  therefore,  accept  provisionally  the  existence 
of  a  something  which,  in  accordance  with  precedent, 
we  will  call  the  Ego  and  proceed  with  our  examin- 
ation of  ideas. 

We  have  seen  that  ideas  may  be  "  affected  "  ;  that 
they  may  be  grouped  together  in  various  ways  ;  and 
that  they  have  certain  relations  to  each  other.  They 
have  yet  a  further  characteristic  :  they  are  not  all 


14  THE   FEEBLE-MINDED         chap. 

equally  prominent  in  consciousness  at  any  one 
instant  and  any  one  of  them  or  any  group  of  them  is 
not  prominent  in  consciousness  to  the  same  extent  at 
all  times.  An  idea  which  is  prominent  in  conscious- 
ness is  said  to  be  *'  attended  to,"  and  the  condition  of 
its  prominence  is  called  Attention.  Ideas  may  be 
prominent  in  consciousness  either  because  they  have 
a  natural  or  intrinsic  importance,  or  because  the  Ego 
lends  them  that  importance.  Any  sufficiently  strong 
and  sudden  stimulation  of  a  sense  organ  will  give 
rise  to  a  dominating  idea  in  consciousness.  A  loud 
sound  or  a  bright  light  or  a  strong  smell  standing 
out  from  the  background  of  ordinary  sounds,  sights, 
or  smells  will  attract  notice  :  it  will  be  involuntarily 
attended  to.  On  the  other  hand,  we  may  select  some 
particular  idea  or  group  of  ideas  for  notice  by  a 
process  of  voluntary  attention.  The  faculty  of 
voluntarily  attending  is  appropriately  entitled  Volition, 
and  it  is  because  we  have  this  faculty  that  Reasoning 
is  possible,  for  Volition  enables  us  to  abstract  from 
groups  of  ideas  such  ideas  as  we  wish,  and  we  can 
then  bring  these  abstracted  ideas  together  in  order 
to  compare  them  and  so  establish  between  them  a 
relation  of  similarity  or  of  dissimilarity.  Such  a 
comparison  of  ideas  is,  as  we  have  already  seen, 
called  a  Judgment.  The  comparison  of  judgments 
with  the  same  end  in  view,  i.e.  in  order  to  ascertain 
whether  they  are  like  or  unlike,  is  called  Reasoning. 

One  of  the  simplest  results  of  Reasoning  is  the 
discovery  that  different  groups  of  ideas  may  have  a 
sub-group  common  to  all  of  them  :  thus  we  are 
familiar  with  numerous  objects  which  differ  from  one 
another,  but  yet  have  so  much   in  common  that  we 


I  THE   NATURE   OF   MIND  15 

perceive  them  all  to  be  watches.  The  sub-group  o^ 
ideas  which  is  thus  common  to  several  percepts 
constitutes  a  Concept.  It  is  unfortunate  that  we 
should  have  to  indicate  this  generic  idea-group  by 
the  same  term,  viz.  "  watch  "  as  was  applied  to  the 
specific  idea-groups  or  percepts  from  which  it  was 
derived.  For  this  the  defective  analytical  faculties 
of  the  minds  in  which  our  language  was  evolved  must 
be  held  responsible. 

But  the  faculty  of  attention  does  not  merely 
supply  us  with  judgments.  We  have  seen  that  ideas 
tend  to  call  back  to  consciousness  the  ideas  with 
which  they  have  previously  been  associated.  By 
attending  to  an  idea  we  may,  therefore,  enrich  our 
minds  with  new  ideas  which  in  turn  may  lead  us  on 
to  yet  others.  This  is  Recollection,  a  special  case 
of  that  capacity  for  re-presentation  which  we  have 
admitted  to  the  status  of  a  "  mental  element  "  under 
the  designation  Memory.  If  it  were  not  for  the  fact 
of  association  it  is  inconceivable  that  we  could 
remember  anything  by  an  effort  of  will  since  no 
amount  of  attention  to  other  ideas  could  bring  to 
consciousness  one  not  there.  Having  obtained  our 
recollections,  however,  there  is  nothing  to  prevent 
our  associating  them  together  in  novel  combinations 
and  the  process  of  doing  this  we  call  Imagination. 

Some  of  the  ideas  present  in  our  minds  are,  we 
have  seen,  *' affected."  A  judgment  dealing  with 
affected  ideas  is  a  Sentiment  and,  like  the  emotions, 
the  sentiments  can  be,  ultimately,  referred  to  two 
main  classes  according  as  the  affection  of  pleasure  or 
pain  predominates. 

A   further  sub-division    of   the  sentiments  often 


16  THE   FEEBLE-MINDED  chap. 

employed  is  that  based  on  the  interests  to  which  they 
refer.  We  have  thus  four  groups  of  sentiments — the 
intellectual,  the  aesthetic,  the  religious,  and  the 
social,  and  it  is  the  last  of  these  which  is  of  the  most 
importance  from  the  psychiatrical  standpoint. 

As  with  so  many  other  psychological  terms,  the 
word  "sentiment"  is  used  by  different  writers  with 
different  meanings.  Since  a  certain  prominence  has 
lately  been  given  to  his  views,  mention  should  be 
made  of  Mr.  A.  F.  Shand's  conception  of  a  senti- 
ment as  ''an  organised  system  of  emotional  dis- 
positions centred  about  the  idea  of  some  object."  ^ 

The  notion  of  mental  constitution  which  we  have 
now  attained  to  is  that  of  a  collection  of  ideas  which 
may  be  attended  to  by  an  Ego,  and  the  attributes  of 
that  Ego  may  be  sketched  in  the  words  which  Lloyd 
Morgan  applies  to  volition,  which  is,  in  effect,  the 
Ego  in  operation.  It  is  *'an  activity,  selective  and 
synthetic,  which  is  neither  energy  nor  consciousness, 
which  has  not  been  evolved,  but  through  the  action 
of  which  evolution  has  been  rendered  possible : 
which  is  neither  subject  nor  object,  but  underlies  and 
is  common  to  both." 

It  would  be  wearisome  to  enter  at  length  into  the 
dispute  which  has  raged  as  regards  the  necessity  for 
accepting  the  Ego  as  an  entity  transcending 
consciousness,  but  since  we  have,  for  the  sake  of 
convenience,  so  accepted  it,  we  must  in  fairness 
point  out  that  the  necessity  is  not  so  urgent  as  may 
appear.  We  recognise  that,  apart  from  our  volition, 
ideas  can  return  to  consciousness  after  leaving  it. 
This  return,  further,   seems  to  depend   on  laws  of 

^  W.  McDougall,  An  Inlroduction  to  Social  Psychology^  p.  466. 


I  THE   NATURE   OF   MIND  17 

association  which  are  also  quite  independent  of 
volition.  Again,  the  prominence  of  the  ideas  in 
consciousness,  as  in  the  case  of  involuntary  attention, 
may  not  be  determined  by  volition.  It  is  at  least 
conceivable  that  all  the  conditions  are  in  some  way 
referable  to  alterations  in  the  environment.  What 
we  observe  in  consciousness  is  simply  that  ideas  are 
there,  our  assumption  of  an  Ego  is  merely  an 
attempt  to  explain  their  presence  in  a  special  case, 
and  since  in  other  cases  we  do  not  require  meta- 
physical explanations,  there  does  not  appear  to  be 
any  very  sound  reason  why  we  should  do  so  in  this. 

The  exercise  of  volition  is  accompanied  by  what 
has  been  called  a  ''sense  of  effort"  or  "Conation" 
and  it  is  essentially  this  feature  which  marks  off 
voluntary  from  involuntary  mental  activity.  But 
this  "awareness"  of  what  is  toward  does  not  appear 
to  differ  from  an  idea,  and  that  fact  in  itself  suggests 
that  the  difference  between  involuntary  and  voluntary 
processes  is  simply  that  the  latter  have,  as  compared 
with  the  former,  a  greater  ideational  content. 

There  is  about  volition  an  apparent  independence 
of  circumstances  which  is  regarded  as  elevating  it  to 
a  higher  plane  than  that  occupied  by  the  mental 
elements  so  far  discussed.  This  is  what  is  meant 
by  Free  Will.  But  the  assumption  that  the  Ego 
acts  irrespectively  of  the  subject's  state  of  conscious- 
ness at  the  time  of  the  action  is  not  well  established. 
If  we  consider  our  activities  we  find  them  to  be 
conditioned  in  some  measure  by  the  degree  of 
affection  characterising  the  ideas  which  give  rise  to 
them.     As  Mercier^  puts  it  "  Volition  depends  upon 

^  C.  A.  Mercier,  Psychology^  Normal  and  Morbid,  p.  466. 


18  THE    FEEBLE-MINDED         chap. 

affection.  When  affection  is  neutral  there  is  no 
Volition.  Pleasurable  affection  determines  Volition 
to  continue  the  existing  state  of  action  or  passion. 
Painful  affection  determines  Volition  to  change  the 
existing  state  of  action  or  passion."  -^  Our  ''  motives  " 
then  are  simply  strongly  affected  ideas. 

It  is  held  by  some  psychologists  that  volition,  that 
is  to  say,  the  faculty  of  voluntarily  attending,  is 
dependent  only  upon  affection.  If  this  be  so,  the 
hypothesis  of  an  Ego  is  superfluous.  It  would  seem, 
however,  that  the  intensity  of  the  affective  colouring 
of  an  idea  is  not  a  measure  of  the  prominence  of  the 
idea  in  consciousness  :  it  is  rather  a  measure  of  the 
utility  of  the  idea  as  a  factor  in  the  adaptation  of  the 
individual  to  his  environment.  Nor  is  this  the  only 
consideration  bearing  upon  the  matter.  In  order  to 
appreciate  the  position  more  accurately  we  must  now 
turn  to  an  important  aspect  of  the  working  of  the 
mind  which  was  incidentally  touched  on  when  the 
formation  of  concepts  was  under  review.  It  is  the 
faculty  which  our  minds  display  of  taking  short  cuts. 
If  we  refer  to  our  experience  of  the  way  in  which 
we  become  cognisant  of  things,  we  find  that  our 
appreciation  of  a  proposition  does  not  require  a 
detailed  knowledge  of  all  the  trains  of  thought  to 
which  the  proposition  can  give  rise.  When,  in 
consequence  of  leaning  against  the  edge  of  my 
writing  table,  I  am  reminded  that  I  have  a  watch  in 
my  pocket,  the  mental  picture  of  the  watch  is  in  the 
highest    degree    indistinct.       In    proportion    to    the 

'  Sollier  makes  a  similar  statement.  "  We  may,"  he  says,  "regard 
attention  as  the  result  of  an  affective  state,  putting  into  play  the  motor 
power,"  while  Ribot  describes  spontaneous  attention  as  "  caused  by 
emotional  states. 


T  THE   NATURE   OF   MIND  19 

degree  of  attention  which  the  circumstances  require 
me  to  devote  to  the  watch,  it  becomes  more  and 
more  clearly  defined  in  my  consciousness.  But  for 
many  purposes  of  life,  the  less  distinct  image  will 
serve  sufficiently  well.  Similarly,  a  passage  in  a 
book  may  be  at  once  intelligible  even  though  one 
does  not  pause  to  think  out  all  that  it  involves.  In 
imitation  of  an  experience  recorded  by  Professor 
James,  I  have  just  taken  up  a  book  near  at  hand  and 
having  opened  it  at  random,  have  placed  a  finger  on 
the  page  and  have  then  read  the  words  to  which  my 
attention  has  been  thus  directed.     They  are  : — 

"  The  total  amount  of  carbonic  acid  exhaled  would 
be  about  12,000  grains." 

The  sentence  presents  no  mystery,  its  purport  is  at 
once  obvious  ;  but  if  I  proceed  to  analyse  what  has 
been  conveyed  to  my  mind  by  it,  I  find  that  the 
apprehension  of  it  involves  various  series  of  facts  in 
relation  to  chemistry,  physiology  and  mathematics 
which  were  certainly  not  present  as  separate  factors 
of  consciousness  when  I  read  and  "understood"  the 
words.  It  seems  then  that  in  the  processes  of 
thinking  we  are  able  to  utilise  a  complex  idea  by 
restricting  our  attention  to  some  of  its  components. 

But  if  this  is  true  for  the  receptive  side  of  our 
minds,  it  is  no  less  so  for  the  emissive  side.  The 
ideas  corresponding  to  our  activities  exhibit  the 
same  tendency  towards  short-circuiting.  The  school- 
girl steadily  plodding  through  her  ''  five-finger 
exercises  "  will  be  only  too  unhappily  conscious  of 
which  note  follows  which,  while  her  teacher  will 
rattle  off  the  various  sequences  without  a  thought  as 
to  the  movements  of  his  hands,  though  probably  he 

c  2 


20  THE   FEEBLE-MINDED         chap. 

began  in  the  same  laborious  fashion  as  his  pupil. 
This  faculty  of  acting  with  only  the  merest  shred  of 
attention  is  called  ''Automatism,"  and  when,  proceed- 
ing a  stage  further,  the  activity  of  the  organism  has 
no  obvious  counterpart  in  consciousness  capable  of 
beinof  attended  to  at  all,  we  call  the  condition  a 
''reflex"  one.  Reflex  movements  may,  however, 
be  attributable  to  an  undeveloped,  rather  than  to 
a  specially  modified  mind,  and  those  of  the  lowest 
living  forms  seem  to  be  of  this  type. 

According  to  the  teaching  of  some  psychologists 
the  important  series  of  activities  which  we  call 
"instinctive,"  and  which  are  characterised  by  in- 
attention both  to  the  end  in  view  and  the  means  of 
attaining  that  end,  are  essentially  automatic,  i.e. 
they  were  originally  associated  with  clearly  defined 
mental  concomitants  which  have,  in  the  course  of 
transmission  through  many  generations,  gradually 
faded  away.  "  Evidemment,"  says  Th.  Ribot,^  "a 
I'origine,  tout  instinct,  simple  ou  complexe,  a  ete  una 
forme  quelconque  de  I'activite  psychique  ;  mais,  grdce 
a  des  repetitions  perpetuelles  chez  I'individu  et  ses 
descendants,  il  s  est  etabli  dans  le  systeme  nerveux 
de  I'animal  des  dispositions  permanentes,  des  con- 
nexions stables  entre  divers  elements  anatomiques  : 
I'instinct  s'est  enregistre,  organise." 

Professor  Titchener  ^  takes  up  a  somewhat  similar 
position.  "I  believe,  with  Cope,"  he  says,  "that 
even  the  automatic  involuntary  movements  of  the 
heart,  intestines,  reproductive  systems,  etc.,  were 
organised  in  successive  states  of  consciousness." 

^  Th.  Ribot,  LHiriditd  Psychologiqucy  1902,  p.  19. 
'^  E.  B.  Titchener,  op.  cit.  p.  300. 


I  THE   NATURE   OF   MIND  21 

There  is  considerable  difference  of  opinion  among 
psychologists  as  to  the  part  which  instinct  plays  in 
human  affairs,  but  there  can  be  little  doubt  that 
inherited  tendencies  control  our  conduct  to  an 
extent  which  is  not  always  sufficiently  allowed  for. 
McDougall,  in  particular,  has  laid  stress  on  the 
importance  of  these  innate  dispositions.  The 
analogy  of  volition  would  lead  us  to  expect  that 
instincts,  as  springs  of  action,  should  have  a  well- 
marked  affective  tone,  and  this  experience  shows  to 
be  the  case.  In  his  analysis  of  the  subject, 
McDougall  ^  correlates  the  principal  instincts  with 
what  he  regards  as  the  primary  emotions  of  man,  as 
shown  in  the  following  scheme  : 


Instinct 

Emotion 

Flight 

Fear 

Repulsion 

Disgust 

Curiosity 

Wonder 

Pugnacity 

Anger 

Self-abasement 

Subjection 

Self-assertion 

Elation 

Protection  of  offspring      Tenderness 

Other  instincts  with  less  well-defined  emotional 
attributes  are  the  reproductive,  the  gregarious, 
the  acquisitive,  and  the  constructive,  while  among  the 
innate  tendencies  which  are  of  too  general  a  nature 
to  be  classed  as  instincts  are  what  McDougall  calls 
the  "pseudo-instincts,"  suggestion,  imitation,  and 
sympathy. 

We  employ  yet  another  device  to  facilitate  the 

1  W.  McDougall,  op.  cit. 


22  THE   FEEBT.E  MINDED  chap. 

working  of  our  minds.  It  is  the  scheme  of  symbols 
which  we  call  language.  Let  us  consider,  for  example, 
the  word  ''exhaled"  in  the  passage  quoted  above. 
The  actual  presentations  in  consciousness  which  set 
my  mind  at  work  were  simply  ideas  of  some  light 
and  dark  areas  on  a  sheet  of  paper,  and  had  no 
intrinsic  relation  to  the  physiology  of  respiration. 
That  I  should  regard  them  as  having  such  a  relation 
is  due  to  the  fact  that  I  have  accepted  a  convention, 
subscribed  by  all  English-speaking  persons,  which 
decrees  that  the  particular  arrangement  of  differently 
coloured  surfaces  which  I  have  just  been  looking  at 
shall  signify  a  particular  phase  of  a  particular  form 
of  organic  activity.  In  our  mental  processes,  then, 
we  utilise  not  only  simple  (and  complex)  ideas  of 
things  themselves,  but  ideas  of  symbols — words — 
which  we  have  made  to  stand  for  those  things. 
Very  largely  we  think  in  words.  In  describing  the 
working  of  his  own  mind,  Professor  William  James  ^ 
says  :  "I  am  sure  that  my  own  current  thinking  has 
words  for  its  almost  exclusive  subjective  material, 
words  which  are  made  intelligible  by  being  referred 
to  some  reality  that  lies  beyond  the  horizon  of  direct 
consciousness,  and  of  which  I  am  only  aware  as  of  a 
terminal  mo7'e  existing  in  a  certain  direction  to  which 
the  words  might  lead,  but  do  not  lead  yet." 

The  substitution  of  abbreviations  and  symbols  for 
original  ideas  will  involve  among  its  consequences 
such  an  obscuring  of  the  native  affective  colouring  of 
those  ideas,  that  the  dependence  of  the  activities 
referable  to  the  ideas  upon  affection  may  no  longer 
be  obvious.     We  are    thus  supplied  with  a  reason 

^  W.  James,  The  Mea?iing  of  Truths  1909?  P-  3i« 


I  THE    NATURE    OF   MIND  28 

why  motives,  even  if  they  were  originally  of  a  kind 
to  compel  attention,  may  have  ceased  to  attain  to 
prominence  in  consciousness. 

Speech  plays  so  large  a  part  in  mental  develop- 
ment that,  although  the  subject  bristles  with 
difficulties,  its  psychology  must  be  studied  by  anyone 
who  wishes  to  obtain  more  than  a  superficial  know- 
ledge of  the  nature  of  mind.  There  is  no  lack  of 
material  for  the  purpose,  but  since  the  greater  part 
of  it  falls  into  the  hands  of  biased  or  uncritical 
observers,  its  educative  possibilities  are  rarely 
exploited  to  the  full.  In  this  field  we  are  precluded 
from  employing  the  introspective  method  except  to 
a  very  limited  extent.  Even  the  most  efficient 
memory  is  incapable  of  re-presenting  to  the  mind 
those  early  stages  of  the  struggle  for  expression 
which  constituted  the  dominant  interest  of  the  first 
few  years  of  life.  Later  we  can  examine  the  ways 
in  which  we  acquire  new  words  or  lose  old  ones,  the 
dependence  of  our  mental  capital  of  words  on  the 
physical  peculiarities  of  our  vocal  organs,  the 
unattended  to  association  which  makes  us  use  the 
same  word  or  root  several  times  in  a  short  passage, 
and  kindred  topics  ;  but  our  acquaintance  with  the 
contents  of  the  infant  mind  is  purely  objective,  and 
so  easy  is  it  to  misinterpret  what  we  see  that  the 
utmost  reserve  must  be  employed  in  advancing  any 
propositions  relating  to  the  subject.  Just  as  the 
wondrous  feats  of  intelligence  attributed  to  cats  and 
dogs  can  practically  always  be  reduced  to  the 
simplest  psychological  elements,  so  the  scintillae  of 
wisdom  which  emanate  from  the  infant  brain  lose 
their  brilliance  at  once  when  subjected  to  the  cold 


24  THE   FEEBLE-MINDED  chap. 

light  of  reason.  The  writer  knows  of  a  child  which, 
at  the  age  of  six  months,  frequently  enunciated 
distinctly  the  syllables  **  dad-da"  and  ''dad-dy,"  but 
a  very  brief  study  of  the  case  served  to  show  that 
these  excursions  into  phonetics  had  no  relation  to 
the  presence  of  its  male  progenitor,  or,  indeed,  to  any 
distinguishable  feature  of  the  environment,  but  were 
merely  an  accidental  result  of  that  playful  exercise 
which  the  mechanism  of  speech  shares  with  the  rest 
of  the  muscular  apparatus.  As  Rzesniezek  puts  it, 
"the  child  amuses  itself  by  the  hour  with  its  own 
private  articulation-concert."  That  the  '' accidental 
result "  should  take  a  form  so  closely  allied  to 
voluntary  speech  is  not  without  its  significance  from 
the  standpoint  of  heredity.  It  certainly  suggests 
that  since  the  particular  faculty  of  intelligible,  even 
if  not  intelligent,  expression  thus  exhibited  had  not 
been  acquired  by  the  individual,  it  had  been  inherited 
from  the  ancestors  who  acquired  it. 

The  elements  of  speech  are  apparently  derived 
from  two  sources,  i.e,  some  of  them  are  inherited  and 
some  acquired.  By  a  process  of  evolution  which 
can  be  observed  during  the  first  few  months,  the 
reflex  cry  of  the  period  immediately  following  birth 
passes  through  phases  of  differentiation  correlated 
with  the  incidence  of  such  varying  stimuli  as  pain, 
pleasure,  hunger,  repletion,  or  other  bodily  condition, 
until  it  becomes  the  rudimentary  speech  which  has 
been  spoken  of  above  as  ''accidental"  How  far 
progress  in  this  direction  can  occur  is  doubtful,  but 
some  indications  are  afforded  by  children  who  are 
deaf  from  their  earliest  infancy.     Thus  Ashby  and 


I  THE    NATURE    OF   MIND  25 

Wright  ^  record  the  case  of  a  child  who  at  the  usual 
time  babbled  such  syllables  as  ''mam,"  ''dad,"  and 
"  am,"  but  eventually  proved  to  be  quite  deaf.  Too 
much  stress  must  not  be  laid  upon  such  an  excep- 
tional case  as  this,  because  one  may  suppose  that  in 
the  absence  of  auditory  stimuli  the  inherent  capacity 
for  articulation  was  not  fully  developed.  It  seems 
probable  that  quite  a  considerable  amount  of  vocal 
"  raw  material "  is  accumulated  before  the  child 
begins  to  imitate  sounds  spoken  before  him,  and  that 
this  original  material  is  of  a  kind  differing  from  that 
acquired  later.  Children  may  employ  speech  sounds, 
e.g.  clicks  and  gutturals,  which  adults  do  not — 
unless,  indeed,  they  be  adults  belonging  to  certain 
savage  tribes — give  utterance  to,  and  later  in  life 
they  may  apply  to  objects  about  them  names  which 
find  no  place  in  the  conventional  scheme  of  language, 
and  which  they  seem  to  have  evolved  quite  in- 
dependently of,  and  perhaps  in  spite  of,  efforts  at 
instruction  by  their  elders.  It  has  been  noted  too 
by  Vierordt  and  others  that  children  sometimes 
have  a  difficulty  in  voluntarily  imitating  sounds 
which  they  have  spontaneously  used,  and  Meumann 
endorses  the  observation  of  Schmiedel  that  a 
temporary  dumbness  sometimes  marks  the  transition 
from  the  spontaneous  lalling  of  infancy  to  the  formal 
imitation  of  spoken  speech.  Even  when  there  is 
not  this  abrupt  break,  a  stage  is  passed  through  in 
which  it  is  to  be  inferred  from  the  child's  behaviour 
that  he  responds  to  words  addressed  to  him  although 
he  makes  no  attempt  to  use  them.     One  must  be 

^  H.  Ashby  and  G.  A.  Wright,  The  Diseases  of  Childreii^  iQ^S?  P-  573- 


26  THE   FEEBLE-MINDED  chap. 

careful  not  to  fall  into  the  error  of  exaggerating  the 
significance  of  this  response.  It  Involves  nothing 
more  than  an  association  of  ideas  of  the  most  prim- 
itive kind.  Take,  for  instance,  such  a  case  as  this  : — 
The  child's  attention  has  been  directed  to  a  certain 
object  while,  contemporaneously,  the  word  "gee- 
gee  "  has  been  uttered.  Subsequently,  on  again 
hearing  the  word,  the  child  may,  by  looking  towards 
the  animal,  indicate  that  there  has  been  established 
in  his  mind  an  association  between  the  auditory  and 
the  visual  ideas.  But  there  is  something  more. 
Since  the  idea  complex  has  given  rise  to  movement, 
we  must  suppose  it  not  to  have  been  indifferent  but 
to  have  had  an  affective  colouring.  Whether  that 
colouring  is  dependent  on  the  idea  of  the  word 
spoken,  or  on  the  idea  of  the  object  formerly  seen, 
or  on  some  ingredient  contributed  to  the  idea  com- 
plex by  inheritance,  may  be  doubtful,  and  indeed  it 
becomes  henceforth  increasingly  difficult  to  distin- 
guish instinctive  and  acquired  activities,  so  that 
there  is  wide  difference  of  opinion  among  psycholo- 
gists as  to  the  scope  of  the  former. 

For  the  activities  involved  in  speech  an  affective 
prompting  is,  it  would  appear,  just  as  necessary  as  for 
movement  of  other  kinds.  This  seems  to  have  been 
most  clearly  recognised  by  Meumann  ^  whose  well- 
marked  critical  faculty  has  prevented  his  adopting 
the  07nne  igno turn  pro  magnifico  attitude  of  so  many 
other  philologists,  and  whose  teachings  as  to  the 
ontogenetic  evolution  of  language  bear  upon  them  the 
stamp  of  common  sense.     For  him  the  active  speech 

^  E,  Meumann,  Die  Eiitstehung  der  ersten   Wo7'tbedeiiiiingeii  beim 
Kinde,  1902. 


I  THE    NATURE    OF   MIND  27 

of  a  child  begins  with   a  stage  which   he  calls  the 
*' emotional- volitional,"  or  stage  of  the  expression  of 
desire.     To    the   child,  he  says,  "  the  world  of   his 
wishes  and  desires,  of  his  feelings  and  affections,  and 
not  that  outer  world  accessible  to  the  intellect,  is  his 
world."     The  words  which  a   child    first   learns  to 
speak  are  those  connected  with  objects  which  appeal 
to  him,  and  he   employs  a  single  word  to  indicate  a 
variety  of  things,  not  because  he  has  formed  a  concept 
under  which  those  things  can  be  subsumed,  but  be- 
cause he  wants  them   all  or  is  dissatisfied  with  them 
all.      Experience  will  shortly  teach  him  the  inexped- 
iency of,    for  example,   applying   indiscriminately  to 
things  which  are  too  hot  or  too  cold  the  single  term 
"  'ot  "  as  in  the  case  described  by  Tracy,  or  of  saying 
"  nein  "  when  he  means  '' ja,"  as  Preyer  records,  and 
thus  will  be  initiated  what  Meumann  calls  the  "in- 
tellectualisirung  "  of  the  hitherto  emotional  speech. 

In  the  absence  of  any  introspective  method  of 
investigation,  the  subsequent  stages  in  the  acquisition 
by  the  child  of  a  vocabulary  are  likely  to  remain 
enveloped  in  mystery.  We  are  confronted  with  the 
problem  of  deciding  why,  in  the  first  place,  the 
sounds  of  words  should  have  any  meaning  at  all,  and, 
further,  why  they  should  have  acquired  the  specific 
meaning  actually  attached  to  them.  A  review  of  the 
different  theories  dealing  with  the  point  is  beyond 
the  scope  of  this  work,  but  allusion  may  be  made  to 
the  chief  ones.  There  is,  to  begin  with,  the  imita- 
tive, or  objective,  or  onomatopoetic,  or  "  bow-wow  " 
theory,  which  derives  names  for  things  or  events 
from  sounds  which  are  associated  with  those  things 
or  events  :  there  is  the  subjective  or  interjectional  or 


28  THE   FEEBLE-MINDED         chap. 

"  pooh-pooh  "  theory,  which  refers  our  initial  attempts 
at  speech  to  the  exclamatory  outbursts  which  form 
part  of  the  expression  of  the  emotions  ;  and  there  is 
the  compromise  between  these  explanations  which  is 
to  be  found  in  Noire  s  modification  of  the  onomato- 
poetic  theory  to  which  the  name  of  the  '*  yeo-he-ho  " 
theory  has  been  applied. 

One  thing  is  clear,  though  it  is  apt  to  be  overlooked. 
A  child  does  not  necessarily  understand  or  mean  by 
any  given  word  what  is  in  the  mind  of  the  person 
who  teaches  it  to  him.  Usually,  it  appears,  his 
interpretation  of  it  is  originally  much  wider  than  that 
of  his  tutor.  What,  for  the  latter,  is  merely  the 
name  of  a  thing,  may  connote  for  the  former  innumer- 
able predicates  relating  to  that  and  other  things 
which  have  in  common  no  more  than  some  interest 
which,  though  of  the  first  importance  to  the  child,  is 
unintelligible  to  the  observer.  But  while  in  one 
plane  the  dimensions  of  a  child's  thought  are  so  wide, 
in  another  they  are  quite  restricted.  The  literalness 
of  children  is,  in  its  way,  just  as  striking  as  the  in- 
definiteness  of  their  ideas.  James  recalls  that  at  the 
age  of  eight  he  thought,  in  reading  "  Lord  Ullin's 
Daughter,"  that  ''the  staining  of  the  heather  by  the 
blood  was  the  evil  chiefly  dreaded,  and  that  when  the 
boatman  said 

'  I'll  row  you  o'er  the  ferry. 
It  is  not  for  your  silver  bright 
But  for  your  winsome  lady.  .  .' 

he  was  to  receive  the  lady  for  his  pay."  It  was 
doubtless  a  child  of  a  larger  growth  who  regarded 
the  words 

" books  in  the  running  brooks 

Sermons  in  stones.  .' 


r  THE   NATURE   OF   MIND  29 

as  a  misprint  which  could  be  set  right  by  inter- 
changing the  positions  of  the  words  ''  books  "  and 
"stones."  How  foolish  to  the  schoolboy  is  Virgil's 
famous  phrase  '*  Sunt  lachrimse  rerum,"  and  how 
little  does  he  appreciate,  as  he  will  in  after  life,  the 
true  inwardness  of 

"  O  Fortunati !    quorum  jam  moenia  surgunt," 

At  what  stage  in  development  the  spoken  word 
may  be  construed  as  symbolical  of  a  judgment  is  a 
matter  in  regard  to  which  much  diversity  of  opinion 
exists.  Sully  ^  speaks  of  '' rudimentary  judgments  " 
as  occurring  at  the  age  of  one  year,  and  gives  as  an 
example  the  naming  and  pointing  at  an  object,  e.£: 
a  dog.  As  expressed  in  speech,  ''judgments  "  (with- 
out qualification)  are  first  noted  in  the  second  half 
of  the  second  year.  Even  according  to  Sully's 
own  definition  :  ''We  judge,"  he  says,  "whenever 
we  go  through  any  mental  process  which  ends  in 
an  affirmation  or  negation  of  something  " — such 
"  rudimentary  judgments  "  are  hardly  worthy  of  the 
name  of  judgments  at  all,  and  it  seems  preferable 
to  regard  them  with  Meumann  as  simple  results  of 
association  involving  no  processes  of  analysis  or 
synthesis.  The  first  steps  in  reasoning  are  probably 
not  taken  for  a  considerable  time  after  such  a  display 
of  "  intelligence "  as  this  becomes  possible.  By 
learning  new  words  and  extending  the  meaning  of 
the  old  ones,  the  child  makes  progress  in  knowledge 
but  since  the  feeble  minded  are,  ex  hypothesi 
restrained  from  attempting  the  higher  flights  in  this 
sphere  of  activity,  we  need  not  devote  more  space  to 

^  J.  Sully,  The  Teacher^  s  Handbook  of  Psychology  ^  1909,  p.  298. 


30  THE    FEEBLE-MINDED         chap. 

the  topic.  The  reader  will  find  it  treated  of  at 
length  in  Romanes'  Mental  Evolution  in  Man  and 
kindred  works. 

Exception  may  perhaps  be  taken  to  the  view  ot 
Mind  and  Consciousness  expressed  above.  It  is 
very  generally  held  by  psychologists  that  the  term 
"  Mind  "  embraces  certain  processes  which  appear 
to  go  on  in  a  mysterious  sub-personality,  of  which 
the  Ego  takes  no  account  except  on  those  occasions 
when  for  some  not  very  obvious  reason  the  sub- 
personality  thrusts  itself  upon  consciousness.  Thus 
we  meet  with  such  cases  as  the  following  : 

Glancing  in  a  casual  way  over  a  sheet  of  an 
evening  paper,  my  eye  was  arrested  by  a  paragraph 
referring  to  the  death  of  a  certain  Member  of 
Parliament.  The  name  was  unfamiliar  and  the 
particulars  given  contained  no  allusion  to  the 
political  views  of  the  deceased  gentleman,  yet  I 
found  in  my  mind  a  clearly  defined  idea  of  the  party 
to  which  he  had  belonged.  I  had  no  recollection  of 
reading  anything  on  this  point  and  I  therefore  read 
the  paragraph  again  only  to  find  that,  as  I  had 
supposed,  it  contained  nothing  bearing  on  the  matter. 
Then  I  noticed  that  the  article,  of  which  I  had  only 
read  a  portion,  was  headed  "  Death  of  a  Unionist 
M.P.,"  words  which  it  is  clear  I  must  unwittingly 
have  read  before. 

From  such  comparatively  trivial  instances  of  what 
has  been  called  ''  unconscious  memory "  we  may 
pass  to  the  more  complex  questions  of  hypnotism 
and  multiple  personality.  It  is  true  that  the 
hypothesis  of  a  sub-conscious  personality  affords  a 


I  THE   NATURE   OF  MIND  31 

simple  explanation  of  the  phenomena  observed. 
But  it  does  not  follow  that  such  an  hypothesis  is 
valid.  Professor  H.  Munsterberg/  for  example, 
will  have  none  of  it.  ''The  story  of  the  sub- 
conscious mind,"  he  says,  "can  be  told  in  three 
words  :  there  is  none."  He  explains  the  current 
mistaken  teachings  thus. 

"Facts  are  referred  to  the  sub-conscious  mind 
which  do  not  belong  to  the  mind  at  all,  neither  to  a 
conscious  nor  to  a  sub-conscious  one,  but  which  are 
simply  processes  in  the  physical  organism :  and 
secondly  facts  are  referred  to  the  sub-conscious  mind 
which  go  on  in  the  conscious  mind,  but  which  are 
abnormally  connected.  Thus  the  sub-conscious 
mental  facts  are  either  not  mental  but  physiological, 
or  mental  but  not  sub-conscious." 

The  case  of  "  unconscious  memory  "  given  above 
belongs  to  the  latter  category  :  an  idea  correspond- 
ing to  the  word  "  Unionist "  was  present  in 
consciousness,  but  was  not  being  attended  to. 
"  Multiple  personality  "  may  be  explained  on  either 
basis  :  there  may  be  ''  co-conscious "  groups  of 
contents  which  appear  to  be  independent  since  they 
have  no  common  content,  or  when  any  particular 
personality  is  present  to  consciousness,  a  simultaneous 
manifestation  of  another  personality  may  occur 
which  has  simply  a  physiological  significance,  i.e,  is 
unattended  by  mental  concomitants. 

In  his  book  just  cited.  Professor  Munsterberg 
proceeds  to  an  interesting  analysis  of  consciousness, 
which    he  defines    as  "the  presupposition    for    the 

^  H.  Munsterberg,  Psychotherapy^  1909,  pp.  125  and  130. 


32  THE   FEEBLE-MINDED  ch.  i 

existence  of  the  psychical  objects."  It  is  the 
''  subject  of  awareness  "  of  the  ideas  which  constitute 
mind,  but  since  it  has  no  existence  apart  from  its 
content  (which  is  the  sum  of  those  ideas)  we  seem 
justified  in  the  proposition  already  advanced  that 
consciousness  and  mind  are,  for  all  practical  purposes, 
the  same  thing. 


CHAPTER  II 

THE    BASIS    OF    MIND 

It  may  be  noted  that  throughout  the  foregoing 
analysis  of  mind  it  has  been  tacitly  taken  for  granted 
that  the  conclusions  which  a  particular  individual 
has  come  to  about  his  own  mind  may  be  applied  to 
the  minds  which  he  assumes  other  persons  to  possess. 
This  proceeding  is  justified  for  any  individual  so 
long  as  nothing  in  his  experience  invalidates  it. 
It  is  futile  to  raise  the  objection  that  we  do  not  know 
that  other  minds  are  constituted  like  our  own. 
This  is  to  claim  for  knowledge  a  transcendental 
character  which  removes  it  from  the  sphere  of 
utility.  Absolute  truth  has  no  existence  for  us 
except  as  a  maximum  of  probability,  to  which  there 
are  many  degrees  of  approximation.  Truth, 
according  to  Prof.  W.  James,  means  ''that  ideas 
(which  themselves  are  but  parts  of  our  experience) 
become  true  just  in  so  far  as  they  help  us  to  get  into 
satisfactory  relation  with  other  parts  of  our  ex- 
perience." Or  as  he  puts  it  in  another  place,  ''true 
ideas  are  those  that  we  can  assimilate,  validate, 
corroborate,  and  verify."^ 

^  W.  James,  Pragmatism^  190?}  PP-  5 8  and  201. 

D 


34  THE   FEEBLE-MINDED         chap. 

We  have  regarded  mental  processes  as  facts,  i.e, 
as  phenomena  which  have  so  invariably  been  found 
on  examination  of  the  mind  that  it  is  incredible  that 
they  should  not  always  reward  introspection.  The 
resemblance  which  we  observe  between  ourselves 
and  other  persons  makes  it  incredible  that  this  state- 
ment should  not  apply  to  them  also.  If,  for  example, 
one  invites  a  number  of  persons  to  write  down  the 
ideas  suggested  to  their  minds  by  a  particular  set  of 
terms,  it  will  be  found  that  those  ideas  have  been 
derived  from  associations  of  similarity  or  contiguity 
just  in  the  same  way  as  one's  own  are. 

This  capacity  in  ideas  for  being  treated  objectively 
as  well  as  subjectively  opens  up  a  new  field  of  in- 
vestigation for  the  psychologist,  for  he  is  placed  in  a 
position  to  observe  (what  no  amount  of  introspection 
would  have  told  him)  that  ideas  are  not  merely 
shadowy  and  elusive  entities  aimlessly  floating 
through  infinity,  but  that  some,  perhaps  all,  of  them 
are  linked  by  an  indissoluble  bond  to  material  things  ; 
he  perceives  that  in  some  obscure  fashion  mind  is  a 
function  of  matter.  The  particular  kind  of  matter 
with  which  he  learns  to  connect  a  manifestation  of 
mind  is  that  which  is  called  nervous,  and  the 
existence  of  the  bond  between  them  is  demonstrated 
to  him  by  the  constancy,  in  his  experience,  of  their 
association.  That  brain  is  the  organ  of  mind  is  to 
be  gathered  from  the  fact  that,  in  a  general  way,  the 
two  things  vary  directly.  Animals  displaying  more 
intelligence  have  relatively  larger  brains  (though 
size  of  brain  is  not  the  only  criterion  of  intelligence) 
than  those  displaying  less.  Removal  of  the  brain 
eliminates  mind,  and  any  agency  which  puts  out  of 


II  THE   BASIS    OF    MIND  35 

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

It  seems  unnecessary  to  labour  this  point  since  the 
teaching  of  the  dependence  of  mentation  on  the 
integrity  of  the  brain  is  universally  accepted.  As  to 
the  nature  of  that  dependence  there  is,  however,  by 
no  means  the  same  unanimity  and  it  is  perhaps 
worth  while,  in  order  to  view  the  matter  in  its  proper 
perspective,  to  summarise  what  has  been  said  about 
it  by  the  almost  innumerable  philosophers  who  have 
exercised  their  intellectual  faculties  upon  it. 

The  speculations  as  to  the  relation  of  mind  and 
body  may  be  divided  into  two  main  groups  according 
as  attention  is  paid  to  the  respective  characteristics 
of  mind  and  of  body  as  such,  or  the  causal  relations 
of  one  to  the  other  are  considered.  From  the  first 
standpoint  we  may,  under  the  guidance  of  our 
predilection  or  our  educational  bias,  see  mind  and 
body  as  totally  distinct  entities  or  as  modes  of 
existence  of  a  common  entity.  In  the  former  case 
we  subscribe  to  the  doctrines  of  Dualism,  in  the 
latter  to  those  of  Monism.  As  dualists  we  may 
conceive  of  mind  as  a  **  soul-substance "  with  or 
without  limitations,  i.e.  as  restricted  to  the  sphere 
which  is  occupied  also  by  material  things,  or  as  an 
infinite  something  which  only  comes  within  our  ken 
at  its  points  of  contact  with  matter.  As  monists  we 
may  regard  the  common  entity  as  of  a  purely 
physical  nature,  e.g.,  as  some  form  of  motion  capable 
of  presenting  itself  to  us  under  different  disguises. 
This  is  materialism.  On  the  other  hand,  we  may 
conclude  that  since  consciousness  is  the  only  entity 

D    2 


36  THE   FEEBLE-MINDED         chap. 

of  which  we  have  direct  knowledge,  nothing  except 
consciousness  exists.     This  is  idealism. 

But  we  may,  from  a  second  standpoint,  see  mind 
and  body  as  not  merely  co-existent,  but  as  inter- 
dependent, i.  e.  as  having  a  causal  relation  to  one 
another.  "  We  may,  "  says  J.  S.  Mill, ''  define  the 
cause  of  a  phenomenon  to  be  the  antecedent  or 
the  concurrence  of  antecedents  upon  which  it  is 
invariably  and  unconditionally  consequent."^  There 
is  between  mind  and  body  an  "■  invariable  and  un- 
conditional "  association  which  suggests  a  causal 
relation,  though  whether  mind  or  body  is  antecedent 
is  a  matter  which  we  are  not  in  a  position  to  decide. 
Three  possibilities  may  occur  to  us  in  this  connection. 
We  may  suppose  that  body  in  some  way  produces 
mind,  or,  conversely,  that  mind  produces  body  ;  or 
we  may  combine  the  two  hypothetical  processes  and 
assume  that,  not  only  does  the  mind  control  the 
activities  of  the  body,  but  that  at  the  same  time 
these  activities  influence  the  course  of  psychic 
events.  Only  the  third  of  these  possibilities  seems 
to  have  been  seriously  regarded  by  metaphysicians, 
who  have  incorporated  it  in  a  theory  of  reciprocal 
interaction  or,  as  the  Germans  call  it,  '*  psycho- 
physischen  Wechselwirkung." 

Various  objections  can  be  urged  against  these 
different  views.  If  mind  and  body  are  quite  distinct 
entities,  as  the  dualists  teach,  why  should  the  relation 
between  them  be  so  intimate  and  so  uniform  ?  To 
take  an  old  difficulty,  which  is  pointed  out  by  Eisler,^ 
''from  whom  descends  the  soul  of  a  child,  from  the 

1  J.  S.  Mill,  A  Syste7}L  of  Logic ^  Book  3,  Chap.  5. 
^  R.  Eisler,  Leib  und  Seele^  1906,  p.  28. 


II  THE    BASIS    OF   MIND  37 

father  or  from  the  mother  or  from  both  ?  and  if  the 
latter  is  the  case  how  can  two  soul-substances  beget 
a  third  when  they  do  not  even  become  inter- 
mingled ?  " 

Materialists  have  now  discarded  the  crude  concep- 
tion of  mind  as  a  "  secretion  "  of  the  brain,  which 
was  suggested  by  Cabanis  and  by  C.  Vogt.  Lotze's 
argument  against  such  a  view  seems  unanswerable. 
'*If,"  he  says,  *' mind  is  secreted  by  the  brain,  it 
must  be  in  the  brain  in  some  form  before  that 
process  takes  place ;  if  it  is  there  in  a  psychic  form 
it  does  not  become  psychic  as  the  result  of  the 
brain's  activity,  and  if  it  is  there  in  a  physical  form 
we  have  no  explanation  as  to  how  the  facts  of  its 
being  secreted  can  convert  it  into  something 
psychic."  ^  The  notion  that  we  have  to  deal  rather 
with  a  special  case  of  the  conservation  of  energy, 
'*  physical "  motion  being  converted  into  an 
equivalent  amount  of  ''psychical"  motion,  though 
plausible  enough  at  first  sight,  is  equally  open  to 
criticism.  Our  conception  of  physical  energy 
involves  also  that  of  space  in  which,  and  from  a 
determined  region  of  which,  it  acts  :  physical  energy 
again  has  the  capacity  of  doing  work,  mechanical  or 
chemical.  An  idea  has  no  such  properties.  Which 
of  us  by  taking  thought  can  add  one  cubit  unto  his 
stature  ?  The  physical  and  the  psychical  are  not 
commensurate :  they  cannot  be  expressed  in  the 
same  terms. 

For  idealism  no  better  case  can  be  made  out  :  its 
only  legitimate  development  is  into  that  apotheosis 
of  vanity  which  is  called  "solipsism."     It  involves 

^  R.  Eisler,  op.  cit.,  p.  44. 


38  THE    FEEBLE-MINDED  chap. 

the  ignoring  of  physical  as  distinct  from  psychical 
realities,  and  the  futility  of  attempting  to  act  In  this 
way  has  been  abundantly  demonstrated  by  the 
followers  of  what  is  called  Christian  Science.  There 
Is,  however,  about  idealism,  considered  merely  as  an 
academic  proposition,  a  specious  plausibility,  the 
refutation  of  which  has  taxed  the  Ingenuity  of  many 
generations  of  philosophers.  The  difficulty  was 
familiar,  for  example,  to  John  Locke,  and  In  his 
*'  Essay  concerning  Human  Understanding "  he 
deals  with  it  at  length,  but  without  disposing  of  it 
altogether  satisfactorily. 

The  case  Is  stated  very  fairly  by  Professor  E. 
Lugaro^  who  admits  that  *'the  existence  of  a 
reality  outside  consciousness  Is  a  pure  hypothesis." 
He  proceeds  to  point  out,  however,  that  the 
hypothesis  Is  very  firmly  established  since  "  there  Is 
no  experience  which  does  not  support  It.  .  .  It 
therefore  not  only  Imposes  Itself  on  consciousness 
but  Its  negation  is  inconceivable."  Very  pertin- 
ently he  asks,  *'if  consciousness  Is  the  only  reality, 
what  signification  can  the  terms  error  and  illusion 
possess  when  applied  to  the  same  data  of  conscious- 
ness ?  '^ 

Some  of  the  existing  conflict  of  opinion  as  to  the 
necessity  of  deriving  our  ideas  from  contact  with  a 
material  universe  is  no  doubt  due  to  a  misunder- 
standing of  what,  for  psychologists,  is  meant  by 
''Reality."  Professor  Munsterberg ^  states  the 
position    concisely    when    he    says    that    **  physical 

^  E.  Lugaro,  Moder?t  Problems  in  Psychiatry^  Trans,  by  D.  Orr  and 
R.  G.  Rows,  1909,  pp.  48  and  40. 

2  H.  Miinsterberg,  Psychotherapy^  1909,  p.  133. 


II  THE    BASIS    OF   MIND  39 

objects  are  those  which  are  possible  objects  of 
awareness  for  every  subject :  psychical  objects  are 
those  which  are  possible  objects  of  awareness  for 
one  subject  only." 

Mr.  R.  B.  Haldane^  holds  a  similar  view.  ''All 
men,"  he  says,  ''must  see  and  feel  in  such  a  fashion 
that  the  universals  in  which  their  descriptions  are 
recorded  are  the  same,  if  the  impression  is  to  be 
given  the  title  of  real."  A  little  later  he  mentions 
what  he  calls  a  threefold  test  of  what  we  mean  by 
reality :  Agreement  furnished  by  (i)  our  own 
present  senses  of  every  kind  ;  (2)  our  past  sense 
experience  ;  and  (3)  the  sense  experience  of  others. 
"  These  throw  light  upon  what  we  mean  by  reality 
and  unreality  in  human  knowledge,  or,  for  that 
matter,  in  human  perception.  It  means  the 
assignment  of  the  phenomenon  to  its  proper  place 
in  the  context  of  experience." 

Accepting  "reality,"  we  are  in  a  position  to 
accept  also  Professor  W.  Mitchell's  ingenious 
explanation  of  the  relations  of  mind  and  brain. 
*'It  is  an  error,"  he  says,  "to  speak  of  mental  and 
physical  facts  as  co-ordinate.  .  .  A  mind  and  its 
experiences  are  realities  that  are  presentable  to 
sense  as  the  brain  and  its  action."  ^ 

Against  the  hypothesis  of  reciprocal  interaction  is 
advanced  the  difficulty  of  imagining  how  such  an 
interaction  could  take  place  between  entities  which, 
according  to  our  experience  of  them,  have  no 
attributes  in  common.     Further,  it  is  urged  that  the 

^  R.  B.  Haldane,   The  Pathway  to  Reality^  1903,  Vol.  I.,  pp.  71 
and  ']'], 

2  W.  Mitchell,  Structure  and  Growth  of  the  Mind^  190/)  p.  23. 


40  THE   FEEBLE-MINDED         chap. 

scheme  of  physical  causation  is  complete  in  itself 
and  leaves  no  gap  at  which  psychical  agencies  can 
be  introduced,  and  that,  mutatis  mutandis,  the  same 
is  true  for  psychical  causation.  (Prinzip  der 
Geschlossenheit  der  Kausalitat.) 

Philosophers  have  endeavoured  to  make  good  the 
defects  in  the  various  hypotheses  above  mentioned 
by  the  introduction  of  a  tertium  quid.  To  bring 
matter,  with  its  properties  of  form,  mobility,  and 
extent,  within  the  sphere  of  action  of  an  entity  lack- 
ing those  attributes,  seemed  to  Descartes  and  the 
school  of  the  Occasionalists  to  require  divine  inter- 
vention. Leibniz  assumed  the  existence  of  a  "pre- 
established  harmony."  A  host  of  writers  from 
Spinoza  to  Wundt  have  adopted  some  modification 
of  the  "  Identity  Theory,"  a  form  of  Monism  which 
holds  that  mind  and  body  are  different  aspects  of 
some  common  Being,  as  mutually  dependent  on,  and 
indispensable  to,  each  other  as  the  concavity  and  the 
convexity  of  an  arc  of  a  circle.  The  ''  Ding  an 
sich  "  or  "  Noumenon  "  of  Kant ;  the  "  Absolute  "  of 
Schelling ;  the  "  Wirklichkeit "  of  Paulsen  and 
others  ;  the  *'  Unknowable  "  of  Spencer,  are  examples 
of  the  hypothetical  entities  of  which  the  existence 
has  been  postulated.  These  entities  tend  to  fall 
into  one  or  the  other  of  two  categories  according 
as  they  are  assumed  to  approximate  to  a  material 
substance  on  the  one  hand,  or  to  an  idealistic 
abstraction  on  the  other.  Again  the  old  difficulty 
crops  up  :  how  can  we  conceive  of  anything  which 
can  be  endowed  with  such  diverse  attributes  as 
mind  and  body,  which  attributes  are  not  even  of  the 
same  order  of  natural   events  ?  It  is   met,  to  some 


Ti  THE   BASIS   OF   MIND  41 

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

With  some  show  of  reason  it  has  been  doubted 
whether  the  association  of  mind  and  body  is  so 
universal  as  has  been  assumed.  If  mind  is  reofarded 
as  co-extensive  with  consciousness,  it  follows  that  all 
nervous  tissue  has  not  the  same  functions  since  it  is 
possible  to  have  nervous  phenomena  without  con- 
sciousness. We  might  suppose  that  mind  is  a 
function  of  a  special  or  ultra-nervous  tissue,  but  there 
is  no  histological  evidence  of  this.  Again  it  has 
been  seriously  argued  that  it  is  impossible  to  assign 
to  a  physical  basis  of  neuronic  intercommunications 
the  apparently  endless  variety  of  combinations  of 
which  our  ideas  are  capable.  Why,  for  instance, 
should  it  not  be  credible  that  a  certain  stock  of  ideas 
having  been  supplied  by  physiological  means  to  our 
minds,  those  ideas  may  undergo  an  independent 
process  of  evolution  ? 

Fortunately  we  need  not  attempt  to  decide 
questions  like  these.  None  of  the  views  above 
referred  to  is  sufficiently  well  established  to  serve  as 
a  guide  in  the  adjustment  of  our  social  relations. 
Whatever  they  may  eventually  lead  to,  the  most 
abstruse  speculations  of  the  metaphysicians  have  as 
yet  no  more  practical  bearing  on  the  right  conduct 
of  life  than  has,  for  example,  master  play  at  chess. 
For  our  present  purpose  we  have  only  to  record  our 
experience  that  mind  and  body  are  intimately  related, 
and  we  require  no  more  elaborate  doctrine  than  one 
of  a  psycho-physiological  parallelism  such  as  we 
assumed  at  the  outset. 


42  THE   FEEBLE-MINDED  chap. 

It  is  desirable  now  to  study  the  range  of  this 
(psycho-physical)  parallelism  in  order  to  define  the 
province  of  mind  more  accurately.  The  extent  to 
which  consciousness  is  the  concomitant  of  physio- 
logical processes  is  obscure,  because  in  the  case  of 
our  own  processes  we  are  not  agreed  as  to  what  is 
meant  by  consciousness,  and  in  the  case  of  the 
processes  we  observe  in  others  we  have  the  further 
difficulty  that,  even  if  we  were  agreed  as  to  what 
consciousness  is,  we  could  only  infer  that  it  ac- 
companied physiological  activity. 

In  what  follows  it  will  be  assumed,  as  is  now 
generally  believed,  that  the  physiological  is  only  a 
special  case  of  the  physical,  by  which  is  meant  that 
the  group  of  phenomena  which  are  called  physio- 
logical can  be  expressed  in  terms  of  matter,  of  the 
forces  which  act  upon  matter,  and  of  the  changes 
which  matter  undergoes. 

We  can  probably  best  obtain  a  clear  conception 
of  what  the  position  actually  is  by  applying  the 
results  of  biological  observation  and  speculation  to 
the  question  of  how  the  nervous  system  has  reached 
its  present  stage  of  complexity.  The  capacity  of 
responding  to  stimulation  is  not  restricted  to  living 
things,  but  the  kind  of  response  which  living  things 
exhibit  is  different  from  that  displayed  by  inanimate 
matter,  the  essential  distinction  being  found  in  the  fact 
that  living  substance  has,  in  a  high  degree,  the  power 
of  making  good  the  losses  of  motion  which  are  in- 
volved in  its  manifestations  of  activity,  while  that 
power  is  defective  in  non-living  matter. 

For  our  present  purpose  nothing  is  gained  by 
harking  back  to  a  stage  anterior  to  the  appearance 


II  THE   BASIS    OF   MIND  43 

in  evolution  of  the  material  which  we  call  bioplasm 
and  which  we  postulate  as  the  indispensable  basis 
of  vital  characteristics.  As  to  the  nature  of  the 
most  primitive  form  of  bioplasm  there  are  certain 
hypotheses.  Ray  Lankester  ^  believes  that  its  nutri- 
tion was  effected  rather  on  the  lines  of  that  of 
animals  than  in  the  fashion  typical  of  plants.  He 
thinks  that  ''  it  very  probably  fed  in  the  first  few 
aeons  of  its  existence  on  the  masses  of  proteid-like 
material  which,  it  may  be  supposed,  were  formed  in 
no  small  quantity  as  antecedents  to  the  final  evolution 
of  living  matter."  In  its  simplest  form  bioplasm 
may  have  been  characterised  by  a  condition  of 
stable  equilibrium,  the  amount  of  motion  supplied  to 
it  by  intrinsic  and  extrinsic  sources  of  energy  being 
exactly  equivalent  to  the  amount  which  it  expended 
in  the  production  of  vital  manifestations.  But  bio- 
plasm of  such  a  kind,  in  view  of  the  destructive 
agencies  to  which  it  would  always  be  subjected, 
would  tend  to  diminish  steadily  in  amount  and  to 
become  eventually  extinct.  Bioplasm  has,  however, 
survived  and  this  is  apparently  to  be  explained  by 
assuming  that  the  motion  supplied  to  it  has  not 
been,  and  is  not  now,  quantitatively  or  qualitatively, 
exactly  equivalent  to  that  which  it  has  lost  or  is 
losing.  The  expression  of  this  lack  of  corres- 
pondence in  the  processes  of  receiving  and  emitting 
motion  is  found  in  the  cardinal  attributes  of  bioplasm 
— its  growth  and  variability — and  it  is  on  account 
of  its  possession  of  these  attributes  that  bioplasm  is 
able   to  perform  its  chief  duty,  which   is  to  go  on 

^  Ray  Lankester,  A  Treatise  o?i  Zoology^  Part  I.,  ist  Fasc,   1909, 
p.  XV. 


44  THE   FEEBLE-MINDED         chap. 

living.  The  capacity  for  growth  enables  a  reserve 
of  bioplasm  to  be  provided  against  the  local 
catastrophes  which  would  otherwise  destroy  the 
organism  :  while  variability  is  the  quality  which 
makes  adaptability  possible  and  is  therefore  the  sine 
qua  non  of  evolution. 

Why  bioplasm  should  have  undertaken  the  task 
of  growing  and  adapting  itself  at  all  we  have  no 
sort  of  notion,  unless  we  assume  that  *'  through  the 
ages  one  increasing  purpose  runs,"  but  as  to  how 
growth  and  adaptation  take  place  we  have,  by 
general  agreement,  a  choice  between  two  views  ; 
according  to  one  of  which  these  manifestations  of 
vitality  are  spontaneous,  that  is,  of  unknown  origin, 
while  according  to  the  other  they  are  a  response  to 
stimulation. 

The  mechanism  by  means  of  which  stimulation 
may  be  supposed  to  produce  its  effects  has  been 
studied  by  many  workers,  particularly  by  the 
German  biologist  Richard  Semon,  whose  main  con- 
tentions may  be  indicated  here.  By  "stimulation" 
Semon  understands  a  change  in  what  he  calls  the 
"  energetische  Situation "  of  an  organism.  A 
stimulus  causes  a  corresponding  change  in  the 
condition  of  the  organism  stimulated,  and  we  observe, 
not  the  change,  but  the  results  of  that  change. 
These  results  he  calls  the  ''reaction."  Stimuli  may 
be  exogenous  or  endogenous  (enzymes) ;  thus  in 
Hering's  theory  of  vision  the  sensation  of  ''white" 
is  exogenous,  while  that  of  "black"  is  endogenous. 
The  principle  of  the  conservation  of  energy  does  not 
appear  to  apply  to  the  results  of  stimulation,  owing 
to  the  number  and  complexity  of  the  internal  factors 


II  THE   BASIS   OF   MIND  45 

which  a  stimulus  calls  into  operation,  and,  moreover, 
those  results  may  be  manifested  in  all  provinces  of 
organic  happenings — chemical,  morphological,  psy- 
chical. On  the  removal  of  a  stimulus,  the  organism 
which  has  been  stimulated  may  return  to  its  former 
state  as  regards  the  obvious  reaction,  but  its  capacity 
for  reacting  has  been  permanently  modified.  To 
this  modification  he  applies  the  term  "  Engramm  " 
to  express  the  idea  that  something  has  been,  so  to 
speak,  ''inscribed"  or  "written  upon"  the  organism. 
The  capacity  of  the  organism  for  being  thus 
modified  is  the  "  Mneme,"  and  nervous  tissue  is 
especially  endowed  with  ''  Mneme."  The  existence 
of  an  engraphic  change  is  demonstrated  by  the  fact 
that  the  original  reaction  can  now  be  produced  by 
other  than  the  original  influences  ;  for  instance,  after 
a  dog  has  been  hurt  by  a  stone  thrown  at  him,  the 
sight  of  a  raised  hand  holding  a  stone  will  suffice  to 
revive  in  him  an  idea  of  the  blow.  Influences  which 
act  in  this  way  are  said  to  be  "ekphoric."  Semon 
develops  an  ingenious  hypothesis  to  account  for  the 
occurrence  of  successive  association  by  distinguishing 
between  what  he  calls  the  *'synchrone"  and 
"akoluthe"  phases  of  stimulation,  and  he  explains 
the  inheritance  of  mental  characteristics  by  supposing 
that  the  reproductive  cells,  before  separation,  have 
shared  the  "  Mneme "  of  the  parents  and  have 
consequently  received  engraphic  impressions  which 
duly  become  evident  when  the  appropriate  ekphoric 
stimuli  occur.^ 


^  For  an  exposition  of  Semon's  philosophy  the  reader  is  referred  to 
his  works,  Die  Mneme^  2nd  edit.,  1908  ;  and  Die  mnemischen  Emp- 
findungen^  1909. 


46  THE   FEEBLE-MINDED         chap. 

The  simplest  forms  of  bioplasm  of  which  we  have 
experience  as  constituting  distinct  individuals  is,  it 
would  seem,  of  a  higher  grade  of  development  than 
has  so  far  been  assumed,  though  the  differences  are 
morphological  rather  than  functional  and  do  not 
affect  the  considerations  as  to  the  effects  of  stimu- 
lation which  have  just  been  set  forth.  There  may- 
have  been,  at  some  stage  of  evolution,  bioplasm  of  the 
non-nucleated  primitive  type  for  which  E.  van 
Beneden  suggested  the  name  ''  Plasson."  But  such 
a  form  of  bioplasm  appears  no  longer  to  exist.  The 
group  of  lowly  organisms  which  bears  the  name  of 
Proteomyxa  includes  forms  with  no  defined  nucleus, 
but  there  are  reasons  for  thinking  that  nuclear 
substance  is  nevertheless  present.  It  is,  indeed,  a 
matter  of  the  greatest  difficulty  to  decide  which  of 
existing  Protozoa  must  be  regarded  as  showing  the 
smallest  amount  of  departure  from  the  hypothetical 
primitive  bioplasm,  for  adaptation  does  not  of  neces- 
sity involve  increase  in  structural  complexity.  Thus 
the  Gregarines,  which  Spencer  took  as  illustrating 
the  lowest  level  of  development,  are  now  regarded 
as  having  been  degraded  from  a  higher  order  through 
the  adoption  of  a  parasitic  mode  of  life,  and  similar 
considerations  apply  to  some  of  the  simplest  vege- 
table forms,  e.g.  Bacteria.  Ray  Lankester  regards 
the  group  known  as  the  Mastigophora  as  being  the 
one  from  which  the  other  classes  of  Protozoa  and  the 
earliest  plants — Protophyta — have  been  derived,  and 
the  Mastigophora  represent  a  considerable  advance 
upon  the  ''  Plasson  "  stage. 

Between  the  various  unicellular  animals,  there  is, 


IT  THE   BASIS   OF    MIND  47 

from  the  point  of  view  of  the  psychologist,  little  to 
choose  and  we  may,  for  the  purpose  of  study,  take  one 
of  the  most  familiar  forms,  such  as  Amoeba,  without 
regard  to  its  taxonomic  position.  Amoeba  consists 
of  bioplasm  of  which  a  portion  retains  characters 
comparable  with  those  of  *'  Plasson,"  while  other 
portions  are  differentiated  to  form,  respectively,  a 
nucleus  and  an  ectoderm.  There  is  no  obviously 
differentiated  nervous  system,  and  in  the  production 
of  ''  nervous  phenomena "  the  animal  reacts  as  a 
whole.  The  vitality  of  Amoeba  is  expressed  in 
various  ways.  In  the  first  place  the  animal  has  the 
power  of  responding  to  stimuli — it  will,  for  instance, 
retract  its  pseudopodia  and  assume  a  more  or  less 
spherical  shape  when  touched  or  shaken,  and  it  can 
throw  out  pseudopodia  in  the  direction  of  foreign 
bodies  which  chance  to  be  in  its  vicinity.  It  does 
not,  however,  act  in  this  way  towards  all  foreign 
bodies.  If  the  bodies  are  particles  of  food  material 
the  reaction  takes  place  :  if  they  are  innutritious  they 
are  left  alone.  Considering  the  movements  of 
Amoeba  as  a  whole,  we  observe  that  they  are  of  such 
a  character  as  to  facilitate  (i)  its  coming  into  contact 
with  a  more  favourable  environment  or  (2)  its  escape 
from  an  unfavourable  one. 

We  find  in  the  above  facts  an  explanation  of  the 
genesis  of  the  mental  element  which  we  have  called 
'*  affection  "  and  an  indication  of  the  way  in  which 
the  activities  of  the  organism  are  dependent  on 
affection.  In  its  incipient  state,  affection  is  thus  not 
so  much  a  matter  of  pleasure  and  pain  in  the  usual 
connotation  of  those  words,  but  of  gains  and  losses — 


48  THE   FEEBLE-MINDED         chap. 

of  conditions   promoting  or  opposing  nutrition — of 
anabolic  and  katabolic  phases  of  metabolism/ 

Certain  other  members  of  the  great  group  of  the 
Protozoa  present  even  more  striking  phenomena. 
According  to  the  observations  of  E.G.  Balbiani  the 
organism  known  as  Didinhim  nasutum  distinguishes 
between  two  species  of  Paramoecium,  attacking  one 
but  not  the  other  :  moreover,  it  distinguishes  them 
at  a  distance  and  begins  the  attack  by  throwing 
trichocysts  at  its  prey,  so  that  it  may  be  credited 
with  powers  of  orientation.^  Various  species  of 
Technitella,  to  take  another  example,  exercise  the 
nicest  choice  among  the  building  materials  available 
to  them  and  form  a  ''test"  of  quite  distinctive 
character.  Thus,  according  to  Heron- Allen  and 
Earland,^  Technitella  melo  employs  only  sponge 
spicules,  selecting  those  which  are  of  the  correct 
length  for  the  position  to  be  filled.  T.  legumen 
constructs  from  spicules  and  fine  mud  a  two-layered 
shell,  in  the  outer  layer  of  which  the  spicules  lie 
parallel  to  the  long  axis  of  the  test,  while  in  the 
inner  "  the  spicular  fragments  are  much  shorter  and 

^  This  view  is  not  universally  accepted,  thus  H.  R.  Marshall  has 
suggested  that : — "  Pleasure  and  Pain  are  determined  by  the  relation 
between  the  energy  given  out  and  the  energy  received  at  any  moment 
by  the  physical  organs  which  determine  the  content  of  that  moment ; 
Pleasure  resulting  when  the  balance  is  on  the  side  of  the  energy  given 
out,  and  Pain  when  the  balance  is  on  the  side  of  the  energy  received. 
Where  the  amounts  received  and  given  are  equal,  then  we  have  the 
state  of  Indifference."     {Mind,  Vol.  XVI.,  1891,  p.  470.) 

One  may  note  also  that  in  a  complicated  organisation,  such  as  that 
of  the  human  mind,  no  simple  relation  between  metabolism  and  affec- 
tion may  be  discoverable  :  it  is  unpleasant  to  be  bored  by  an  oft-told 
tale,  but  not  obviously  injurious. 

^  A.  Binet,  The  Psychic  Life  of  Micro-organisins,  1903- 

^  E.  Heron-Allen  and  A.  Earland,  On  a  Neiv  Species  of  Technitella^ 
b^c.^Journ.  of  the  (2,uekett  Microscopical  Club,  April,  1909. 


II  THE   BASIS    OF   MIND  49 

are  laid  at  right  angles  to  the  outer  layer."  A  new 
species,  T,  thompsoni,  is  even  more  remarkable,  for 
it  builds  an  extremely  neat  test  of  echinoderm  plates 
only,  although  in  the  two  regions  where  the  creature 
has  so  far  been  found  such  plates  "  form  an  infini- 
tesimal percentage  of  the  material  as  dredged,  and 
their  presence  would  be  almost  unobserved  unless 
especially  searched  for." 

Here  then  we  seem  to  have  to  do  with  something 
very  like  volition.  But  to  speak  of  affection  and 
volition  as  occurring  among  the  Protozoa  is  to  endow 
those  creatures  with  minds.  We  have  no  desire  to 
prejudice  the  issue  in  such  a  way.  It  is  possible  to 
regard  mind  either  as  a  universal  attribute  of  matter 
or  as  having  no  existence  except  in  a  misinterpreta- 
tion of  physiological  facts.  In  this  book  the  question 
is  left  open  and  no  attempt  is  made  to  dispose  of  a 
problem  which  is  as  old  as  the  mind  itself,  and 
apparently  as  far  from  solution  as  it  was  in  the 
beginning. 

"  Some  dim  form  of  discrimination  is  the  germ 
from  which  the  spreading  tree  of  mind  shall 
develop,"  says  Lloyd  Morgan/  and  on  this  view 
the  Protozoa  seem  to  be  endowed  with  minds  of  a 
fairly  advanced  order.  But  the  facts  are  explicable 
on  the  special  physical  lines  which  are  called  physio- 
logical. A  simple  response  to  stimulation  may  be  a 
purely  physical  process  :  this  we  infer  from  the  fact 
that  it  may  take  place  in  admittedly  non-living 
substance.  But,  as  shown  more  particularly  by  Prof. 
Bose,^  response  in  the  inanimate  may  exhibit  a  very 

^  C.  Lloyd  Morgan,  Animal  Life  and  Intelligence. 

^  J.  C.  Bose,  Respo7ise  i7i  the  Living  a?id  Non- Living.,  1902. 


.ac'ausetts  o^MxA 

THE   FEEBLE-MINDED         chap 


Feeby 


high  degree  of  complexity,  so  high  indeed  that,  to 
quote  Prof.  Adami,^  **  In  the  nature  of  its  responses 
to  stimuh*,  Hving  matter  differs  at  most  in  degree,  and 
not  in  kind,  from  non-Hving."  Amoeba's  '*  discrim- 
ination" between  nutritious  and  innutritious  particles 
may  therefore  be  regarded  as  merely  two  different 
responses  to  two  different  stimuli.  The  selective 
power  of  lowly  organisms  may  be  due,  as  Spencer  ^ 
puts  it,  to  ''  the  setting  up  of  an  assimilative  process 
when  assimilable  matter  is  brought  in  contact "  with 
them.  We  have  here,  it  would  seem,  the  rudiment 
of  the  sense  of  taste.  A  greater  elaboration  of  the 
capacity  for  selecting,  such  as  is  displayed  by 
Didinium,  seems  to  involve  also  a  rudimentary  sense 
of  smell,  but  between  taste  and  smell  there  is  no 
essential  difference,  indeed,  as  Spencer  points  out,  in 
aquatic  creatures  smell  and  taste  can  be  but  degrees 
of  the  same  faculty  corresponding  to  dilute  and  con- 
centrated solutions  of  nutritive  substance.  In  the 
case  of  Technitella  the  problem  is  more  complicated 
since  the  matter  is  apparently  not  one  of  simple 
nutrition,  but  an  explanation  on  physical  lines  can 
easily  be  supplied  without  exceeding  the  limits  of 
legitimate  speculation  if  we  accept  Spencer  s  dictum 
that  ''all  forms  of  sensibility  to  external  stimuli  are, 
in  their  nascent  shapes,  nothing  but  the  modifica- 
tions which  those  stimuli  produce  in  that  duplex 
process  of  integration  and  disintegration  which  con- 
stitutes the  primordial  life,  physiologically  con- 
sidered."^      At    some    stage    in    evolution    there 

^  J.  G.  Adami,  T/ie  Principles  of  Pathology^  19095  P-  90. 
2  H.  Spencer,  Principles  of  Psychology^  1870,  Vol.  I,  p.  308. 
^  H.  Spencer,  op.  cif.^  p.  312. 


II  THE    BASIS    OF   MIND  51 

appeared  organs  susceptible  to  the  influence  of 
mechanical  impacts.  This  may  be  regarded  as  the 
genesis  of  both  tactile  and  auditory  sensations,  since, 
as  Sherrington^  puts  it,  the  cochlea  is  essentially 
''a  group  of  glorified  'touch  spots.'"  On  similar 
lines  a  variation  which  gave  rise  to  an  organ  capable 
of  appreciating  radiant  energy  would  provide  the 
germ  of  the  apparatus  for  producing  sensations  of 
heat,  cold,  and  light. 

In  Amoeba  the  physical  basis  of  affection  would 
appear  to  be  supplied  by  the  whole  of  its  bioplasm, 
but  we  may  suppose,  with  Titchener,^  that  the 
evolution  of  higher  types  has  been  marked  by  the 
appearance  of  a  special  mechanism  of  affection  com- 
parable with  that  which  we  regard  as  the  basis  of 
presentation.  He  conceives  of  the  affections  as 
''mental  processes  of  the  same  general  kind  as 
sensations,"  and  suggests  that  "the  'peripheral 
organs'  of  feeling  are  the  free  afferent  nerve-endings 
distributed  to  the  various  tissues  of  the  body."  If 
we  accept  Wundt's  scheme  of  six  affective  conditions 
we  must  assume  a  greater  specialisation  in  the 
afferent  nerve-endings  than  if  only  two  forms  of 
affection  are  postulated,  but  otherwise  the  position  is 
unchanged,  since  three  pairs  of  aspects  of  nutritional 
phenomena  can  be  pictured  as  readily  as  one  pair. 

Movement  of  a  seemingly  voluntary  character 
also  admits  of  being  referred  to  a  process  of  stimul- 
ation. As  we  have  seen  above,  the  existing  para- 
sitic Protozoa  are  probably  not   the    least   evolved 

'  C.  S.  Sherrington,  The  Integrative  Action  of  the  Nervous  System^ 
1906,  p.  324. 

2  E.  B.  T'ltcheneYj  Lectures  on  the  Elemetitary  Psychology  of  Feeling 
and  Attention^  1908. 

£   2 


52  THE   FEEBLE-MINDED  chap. 

members  of  the  group,  but  their  degraded  state  may 
perhaps  be  reversionary  and  we  may  therefore 
regard  as  still  plausible  Spencer's  hypothesis  as  to 
the  mode  of  origin  of  motility,  which  is  as  follows  : — 
The  earliest  organisms  evolved  lived  in  constant 
contact  with  supplies  of  nutriment  ;  motility  is  an 
adaptation  to  existence  in  a  medium  (salt  or  fresh 
water)  which,  while  it  everywhere  yields  a  sufficient 
supply  of  oxygen,  has  nutriment  irregularly  scattered 
so  that  search  has  to  be  made  for  it.  On  the  lines 
of  Semon's  teaching,  we  may  regard  this  adaptation 
as  of  the  nature  of  an  "engramm"  impressed  upon 
the  bioplasm  by  the  change  in  its  ''energische 
Situation "  which  occurred  when  its  environment 
was  changed. 

The  activities  of  a  protozoon  are  not,  therefore, 
necessarily  those  of  a  free  agent,  but  may  be 
directly  referable  to  the  stimuli  brought  to  bear 
upon  it.  Even  if  the  stimuli  known  to  us  seemed 
inadequate  to  account  for  the  animal's  varied  move- 
ments, we  should  have  to  remember  that  there  may 
be  involved  physical  agencies  not  cognisable  by  us 
because  of  a  kind  outside  the  limited  range  of  our 
sense-organs  either  temporarily  or  permanently. 
It  appears,  however,  that  we  need  not  appeal  to  any 
unknown  forces :  the  known  influences  of  the 
environment  are  sufficient. 

We  have  seen  that,  whatever  may  be  the  reason 
for  such  a  condition  of  affairs,  the  first  duty  of 
bioplasm  is  to  continue  in  existence,  and  to  that  end 
it  displays  powers  of  growth  and  of  variation.  But 
in  so  far  as  these  powers  are  utilised,  the  organism 
is  compelled  to  take  upon  itself  new  responsibilities. 


II  THE    BASIS    OF   MIND  53 

Let  us  consider  first  how  the  mere  increase  in  bulk 
affects  the  position.  As  pointed  out  by  Spencer, 
an  individual  consisting  of  a  fragment  of  bioplasm 
will,  according  to  mathematical  laws,  necessarily 
display  a  certain  ratio  between  its  mass  and  its 
surface,  and  since  on  the  extent  of  its  surface 
depends  its  capacity  for  taking  in  food,  any  alteration 
of  that  ratio  will  affect  its  nutrition.  Assuming  that 
the  organism  does  not  undergo  any  change  of  form, 
the  ratio  of  surface  to  mass  will  get  steadily  less 
as  the  mass  increases,  and  consequently  growth  will 
lead  to  a  diminution  in  the  food  supply  and  so  be 
automatically  checked. 

There  is  probably  also  another  factor  for  which 
allowance  must  be  made.  The  unit  of  bioplasm 
which  we  meet  with  in  practice  is  the  cell,  and  this 
has  reached  a  stage  in  evolution  at  which  we  can 
distinguish  a  more  highly  specialised  portion  of 
the  bioplasm — the  nucleus — from  a  less  highly 
specialised  portion — the  cytoplasm.  The  cytoplasm 
provides  an  environment  for  the  nucleus  in  the  same 
way  as  the  medium  in  which  the  cell  is  living 
constitutes  its  environment,  and  we  may  therefore 
suppose  that  growth  is  dependent,  not  only  on  the 
relationship  between  the  medium  and  the  cytoplasm 
but  also  on  that  between  the  cytoplasm  and  the 
nucleus. 

The  necessary  adjustments  can  be  made  in  various 
ways.  By  spreading  itself  into  a  sheet  or  a  reticulum 
the  organism  maintains  the  ratio  between  mass  and 
surface  which  is  necessary  to  it.  But  to  do  this 
defeats  to  a  great  extent  the  main  purpose  of 
growth.     A  large  mass  of  bioplasm  is  little  better 


54  THE   FEEBLE-MINDED  chap. 

protected  against  circumscribed  disasters  than  is  a 
small  mass.  A  more  satisfactory  result  will  be 
obtained  if  the  organism,  on  reaching  the  limit  of 
growth  under  the  prevailing  conditions,  divides  into 
two  (or  more)  daughter  organisms  of  form  like  its 
own,  or  cuts  off  successive  parts  of  its  substance  as 
fresh  individuals.  Complete  separation  of  the 
daughter  organisms  may  not,  however,  be  necessary 
to  meet  the  nutrition  difficulty,  and  it  would  seem 
that  the  undiminished  risk  of  total  destruction  that 
the  organism  runs  is  now  more  than  counter- 
balanced by  the  increased  capacity  for  variation 
which  the  multicellular  state  confers  upon  it.  In 
the  multicellular  organism  the  capacity  for  variation 
show^s  itself  morphologically  as  differentiation  of  the 
bioplasm  into  various  tissues  subserving  different, 
but  apparently  equally  essential,  functions  in  the 
maintenance  of  the  organism  as  a  living  thing. 
But  one  of  these  tissues,  from  the  nature  of  its 
peculiar  function,  has  a  special  relation  to  the  rest 
of  the  tissues.  The  mechanisms  which  respectively 
seize  upon  food  materials,  convert  them  into  an 
assimilable  form,  assimilate  them,  integrate  them, 
and  cast  out  the  waste  materials  which  result  from 
them,  could  be  of  little  service  to  the  organism  il 
their  actions  were  not  co-ordinated,  and  it  is  the 
business  of  ''nervous  tissue"  to  effect  the  necessary 
co-ordination.  We  find,  as  the  above  considerations 
would  lead  us  to  expect,  that  nervous  tissue  comes 
into  intimate  association  with  all  other  forms  of 
tissue. 

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


II  THE   BASIS    OF   MIND  55 

i.e.  by  study  of  the  development  of  individual 
human  beings,  have  we  as  yet  arrived  at  a  satis- 
factory explanation  of  the  way  in  which  this 
association  is  brought  about.  We  do  not  know 
that  any  one  of  the  various  types  of  animals  which 
now  intervene  between  the  Protozoa  and  Man 
closely  resembles  a  stage  which  Man  has  actually 
passed  through  in  the  course  of  his  evolution,  and 
our  histological  data  are  insufficient  to  justify  a 
confident  statement  on  embryological  grounds. 
There  are  two  possibilities  to  be  considered  :  the 
connection  between  nerve-cells  and  other  cells  may 
be  due  to  the  fact  that  the  separation  which  results 
from  cell  division  is  incomplete,  strands  of  bioplasm 
remaining  to  constitute  permanent  links  between 
the  daughter  cells  ;  or  it  may  be  brought  about  by 
the  nerve  cells  having  come  into  relation  secondarily 
with  the  remaining  cells.  Which  of  these  lines  has 
actually  been  followed  is,  and  has  long  been,  a 
matter  in  regard  to  which  physiologists  differ.  It 
would  seem  that  in  plants  and  in  some  invertebrate 
animals  the  connection  between  the  nerve  cells  and 
between  a  nerve  cell  and  the  cell  which  it  controls 
is  effected  by  direct  continuity  of  bioplasm.  In  the 
higher  animals,  even  though,  as  the  observations 
of  Szily  and  Held  suggest,  such  continuity  occurs, 
it  is  difficult  to  explain  the  degree  of  complexity  to 
which  the  nervous  system  attains  without  assuming 
that  secondary  relations  are  also  established.  If 
what  is  called  the  ''neurone  theory"  is  discredited 
the  generally  accepted  teaching  as  to  the  mechanism 
of  conduction  of  nervous  impulses  will  require 
revision,  for  the  existence  of  "synapses,"  or  regions 


56  THE   FEEBLE-xMINDED         chap. 

where  the  terminations  of  nerve  cell  processes  come 
into  proximity  merely,  is  essential  to  the  stability 
of  modern  theories  of  nervous  activity. 

The  earliest  stage  in  the  differentiation  of  nervous 
tissue  is  theoretically  one  in  which  all  the  rest  of  the 
cells  making  up  the  individual  are  connected  with 
the  special  one  which  sub-serves  the  function  of  co- 
ordination.    As  the  number  of  cells  increased  there 
would  need  to  be  a  corresponding  Increase  in  the 
size  of  the  co-ordinating  cell,  unless,  by  the  intro- 
duction of  some  new  device,  the  same  object  could 
be  attained  in  another  way.    Except  in  rare  instances, 
e.£',  in  the  electric  cat-fish,  the  nerve  cells  do  not 
show   any  tendency  to  increase  in  bulk  with   the 
demands  made  upon  them  and  it  may  be  supposed 
that,  as  a  result  of  natural  selection,  a  better  way  ot 
meeting  the  necessities  of  the  case  has  been  evolved. 
This  better  way  is  the  provision  of  nerve  cells  of 
different  orders,  situated  at  different  physiological 
''levels,"  and  so  arranged  that  nerve  cells  controlling 
each  a  small  portion  of  the  body  are  themselves 
brought  into  correlation  by  "higher"  nerve  cells,  and 
these  by  still  higher  nerve  cells.     Thus  the  activity 
of  the  cells  giving  rise  to  the  fibres  constituting  an 
anterior  spinal  nerve  root  will  produce  movement  in 
a   limited   part   of  the   body,  but    cells  of  several 
anterior  cornua  can  be  prompted  to  act  in  the  pro- 
duction of  an  elaborate  co-ordinated  movement  by 
means  of  cells  in  what  Is  called  the  "  motor  area  "  of 
the  cerebral  hemispheres,  and  the  functional  activity  of 
these  cells,  in  turn,  can  be  controlled  by  cells  in  the 
parts    of    the   brain    which    Flechslg    described    as 
''association  centres," 


II  THE    BASTS    OF   MIND  57 

So  much  uncertainty  attends  the  interpretation  of 
the  nervous  phenomena  of  invertebrate  animals  that, 
until  we  reach  the  base  of  the  vertebrate  division,  the 
appearances  observed  are  not  sufficiently  like  those 
in  Man  to  be  of  any  use  in  providing  a  key  to  the 
latter.  Described  in  the  most  general  terms,  what 
seems  to  happen  in  the  development  of  the  central 
nervous  system  is  this.  A  majority  of  the  nerve 
cells  come  to  occupy  a  position  in  the  median  plane 
which  admits  of  the  corresponding  parts  of  the  body 
being  arranged  symmetrically  about  them.  They 
are  collected  in  such  a  way  as  to  form,  with  the 
tissue  which  serves  to  bind  them  together,  a  tube 
running  along  the  greater  part  of  the  length  of  the 
body  beneath  the  dorsal  surface.  In  the  tube  the 
cells  are  arranged  around  the  cavity  with  their  fibres 
constituting  the  outer  part  of  the  wall.  A  distinction 
between  internal  grey  matter  and  external  white 
matter  is  thus  instituted.  The  tube  varies  in  calibre 
and  in  the  sizes  of  the  aggregates  of  cells  at  different 
parts  of  its  length,  in  accordance  with  the  import- 
ance to  the  animal  of  the  particular  region  on  the 
exterior  of  the  body  with  which  the  cells  are  in 
connection.  At  its  anterior  end  the  tube  is  en- 
larged, partly  in  proportion  to  the  degree  of  develop- 
ment of  the  animal's  senses  of  smell  and  taste,  and 
partly  in  dependence  on  other  considerations.  A 
little  further  back  a  region  becomes  specialised  as  a 
centre  for  vision,  while  behind  that  again  an  auditory 
centre  is  established.  A  capacity  for  acting  as  an 
organ  for  touch  is  Inherent  in  practically  every  part 
of  the  animal's  exterior,  so  that  no  definite  touch 
centre  is  to  be  expected  ;  but  the  anterior  end  of  the 


58  THE   FEEBLE-MINDED         chap. 

body  is  peculiarly  the  region  where,  in  a  motile 
organism,  appeal  is  likely  to  be  made  to  the  tactile 
sense  and,  consequently,  one  finds  that  the  anterior 
end  of  the  nervous  tube  is  especially  associated  with 
the  development  of  the  sense  of  touch.  To  bring 
into  co-operation  the  various  centres  mentioned  some 
further  centre  is  required,  and  this  appears  to  be 
supplied  by  the  development  of  collections  of  cells 
in  the  anterior  portion  of  the  tube,  the  consequent 
enlargement  of  that  region  giving  rise  to  the 
cerebral  hemispheres.  In  the  words  of  Professor 
Elliot  Smith,^  ''  the  higher  organisation  of  the  brain 
is  brought  about  by  the  extension  of  all  the  sensory 
paths  up  to  the  cerebrum  and  the  evolution  within 
the  hemisphere  of  mechanisms  for  receiving  and 
blending  the  various  impressions  of  an  object  so  as 
to  awaken  a  consciousness  of  all  its  properties  as  they 
appeal  to  the  senses  of  smell,  taste,  touch,  sight  and 
hearing." 

The  first  stage  in  the  process  seems  to  be  marked 
by  the  appearance  of  a  primitive  cortex,  called  by 
Ariens-Kappers  the  ''palaeo-cortex,"  which  receives 
fibres  from  a  region  of  the  original  grey  matter 
devoted  to  the  olfactory  sense.  In  the  earliest 
vertebrates  this  sense  seems  to  have  had  a  special 
predominance  and  the  evolution  of  sensory  capacity 
seems  to  have  taken  place  especially  in  connection 
with  it.  From  the  anatomical  standpoint  the  result 
of  that  evolution  was  the  appearance,  first,  it  is  said, 
in  the  group  of  animals  known  as  Amphibia,  of  a 
cortex — the      "  archi-cortex  " — having     a     tertiary 

^  G.  Elliot  Smith,  Some  Problems  Relating  to  the  Evolution  of  the 
Brain,  Arris  and  Gale  Lectures,  v.  lancet,  Jan.  5,  1910,  p.  151. 


II  THE   BASIS    OF   MIND  59 

connection  with  the  organ  of  smell  by  way  of  the 
palaeocortex.  In  this  way  there  are  laid  down  a 
palseopallium  and  an  archi-pallium,  corresponding 
respectively  to  the  pyriform  lobe  and  the  hippocampal 
region  of  the  brain/ 

As  evolution  proceeded,  the  convergence  of 
sensory  paths  upon  the  cerebrum  became  more  and 
more  marked,  and  the  importance  of  that  organ  as  a 
co-ordinating  apparatus  became  proportionally  more 
pronounced.  New  collections  of  cells  provided  the 
basis  for  this  extension  of  function,  and  there 
appeared,  somewhere  about  the  level  of  the  Reptiles, 
a  new  anatomical  formation,  the  neo-pallium,  con- 
sisting of  cortex  intercalated  between  the  palaeo-  and 
the  archi-cortex,  and  divisible  into  areas  correspond- 
ing to  the  different  sense  organs.  In  the  lowliest 
mammals,  according  to  Professor  Elliot  Smith,  such 
a  neo-pallium  is  present  and  it  is  through  the  growth 
and  differentiation  of  this  structure  that  we  are 
provided  with  the  various  mechanisms  which  we 
believe  to  underlie  and  make  possible  the  processes 
of  thought. 

Without  attempting  to  follow  the  evolution  of  the 
neo-pallium  in  detail,  as  is  done  by  Professor  Elliot 
Smith  in  the  lectures  alluded  to,  we  may  notice  three 
of  its  salient  features.  In  the  first  place,  a  part  of 
the  cortex  devoted  to  the  reception  of  tactile 
impressions  becomes  modified  in  such  a  way  that  its 
cells,  when  stimulated,  induce  contraction  of  muscles 
in  various  parts  of  the  body.  This  is  the  genesis  of 
what  is  known  as  the  "motor  area."     Secondly,  we 

^  C.  U.  Ariens-Kappers,  The  Phylogenesis  of  the  Palceo-Cortex  and 
Archi-Cortex^  dr'c.,  Archives  of  Neurology  aiid  Psvchiatry^  1909?  P-  161. 


60  THE   FEEBLE-MINDED         chap. 

find  in  each  neo-pallial  area  a  differentiation  of  cells 
into  two  groups ;  the  one  central  and  concerned 
with  the  reception  of  sensory  impressions,  and  the 
other  peripheral  and  concerned  with  the  elaboration 
of  those  impressions  into  idea-complexes.  By  the 
extension  of  these  peripheral  portions  of  the  various 
areas,  their  sensory  portions  come  to  be  widely 
separated  by  what  are  known  as  ''association  areas." 
Finally,  we  observe  that  the  increase  of  the  neo- 
pallium takes  place  almost  entirely  in  two  dimensions, 
its  thickness  remaining  practically  constant.  As  a 
consequence  of  this,  folding  occurs,  and  Professor 
Elliot  Smith  maintains  that,  although  the  fact 
becomes  obscured  in  the  course  of  the  brain's 
development,  the  folding  follows  the  lines  of  separa- 
tion of  the  functionally  distinct  areas  in  the  neo- 
pallium. 

The  distinction  of  a  neo-pallium  from  the  rest  of 
the  cerebrum  is  somewhat  artificial,  as  shown  by  the 
want  of  agreement  among  comparative  anatomists 
as  to  the  stage  of  the  evolution  of  the  brain  at  which 
this  structural  feature  is  recognised.  Its  individuality 
seems  to  be  insisted  on  mainly  because  it  is  thought 
to  be  peculiarly  the  "  organ  of  mind,"  but  the 
boundaries  of  mind  are  too  indefinite  to  justify  our 
limiting  the  application  of  the  principle  of  psycho- 
physical parallelism  to  a  portion  only  of  the  nervous 
apparatus. 

By  turning  from  phylogeny  to  ontogeny  we  do 
not  obtain  very  substantial  additions  to  our  fund  of 
knowledge.  The  early  stages  in  the  development 
of  the  functions  of  the  human  nervous  system  are 
practically   unknown.     Our    study   of  foetal    brains 


II  THE   BASIS   OF   MIND  61 

and  nerves  is  based  on  dead  tissues  only.  We 
cannot  begin  to  experiment  on  a  child's  brain  until 
the  child  is  born  and  even  then  the  scope  of  our 
proceedings  is  strictly  limited.  In  so  far  as  our 
investigations  might  involve  interference  with  the 
child's  comfort,  we  are  confined  to  such  accidental 
opportunities  of  confirming  or  disproving  results 
obtained  with  lower  animals  as  chance  puts  in 
our  way. 

It  would  appear  from  the  researches  of  Flechsig, 
Ambronn  and  Held,  Soltmann,  the  Westphals,  and 
various  other  workers,  that  in  the  case  of  the 
medullated  fibres,  which  constitute  so  large  a  pro- 
portion of  the  nervous  system,  the  specific  function 
of  the  fibre  is  not  capable  of  being  performed  until 
the  fibre  has  received  its  medullary  sheath. 
Stoddart^  proposes  to  apply  this  fact  in  explaining 
the  difference  between  instinctive  and  volitional 
activities.  True  voluntary  acts,  he  considers,  do  not 
make  their  appearance  until  the  age  of  seventeen 
months,  i.e.  at  the  time  when  the  fibres  of  the 
pyramidal  tracts  have  received  their  sheaths,  while 
instinctive  movements  occur  from  birth,  and  do  so 
because  of  their  dependence  on  the  cortico-rubro- 
spinal  system  of  fibres  which  is  myelinised  at  birth. 

Whatever  may  be  the  anatomical  basis  of  the 
condition,  we  find,  as  a  matter  of  observation,  that 
the  various  sensation  mechanisms  already  mentioned 
do  not  all  get  into  working  order  at  the  same  stage 
of  the  child's  growth.  Cutaneous  sensibility  to 
touch,  heat,  cold,  and  pain,  is  present  at  birth,  though 

^  W.  H.  B.  Stoddart,  On  Instinct^  Jour7i.  oj  Mental  Science^  July, 
1906. 


62  THE   FEEBLE-MINDED         chap. 

the  last  is  probably  little  developed.  A  distinction 
between  the  protopathic  and  epicrltic  systems  seems 
hardly  feasible  in  the  circumstances.  Visceral 
sensations,  e.g.  those  of  hunger  and  thirst,  are  also  of 
very  early  appearance.  The  sense  of  hearing  seems 
to  be  the  last  to  develop,  and  it  is  difficult  to  say 
when  auditory  vibrations  are  differentiated  from 
those  appealing  to  the  sense  of  touch,  which  usually 
accompany  them.  There  is  said,  however,  to  be 
evidence  of  audition  on  the  fourth  day.  The  pupil 
reacts  to  light,  according  to  Kussmaul,  within  an 
hour  after  birth.  In  the  second  week  the  child  may 
seem  to  notice  a  lighted  candle,  while  at  five  weeks, 
according  to  Raehlmann,  it  will  fix  an  object  which 
happens  to  be  in  Its  line  of  sight,  and  at  five  months 
It  Is  able  to  get  its  bearings  by  means  of  vision.  A 
capacity  for  distinguishing  sweet  tastes  from  bitter 
is  said  to  be  present  on  the  first  day,  as  also  a 
momentary  appreciation  of  powerful  odours. 

In  the  case  of  an  infant,  the  reception  of 
kinaesthetic  impressions  is  not  accompanied  by 
objective  phenomena  of  such  a  kind  as  would  lead 
to  Its  ready  recognition  by  an  observer,  but  from 
another  point  of  view  it  has  its  own  special  Interest 
in  that  it  occurs  In  the  cerebellum  which,  as  Myers  ^ 
puts  It,  "  Is  the  great  centre  where  afferent  impulses, 
alike  from  the  labyrinthine  and  motor  apparatus,  are 
gathered  together." 

With  the  recognition  of  phylogenetically  separable 
regions  of  the  cerebrum,  a  step  is  taken  in  the 
direction  of  defining  the  ''levels"  at  which  the 
different  stages    of  co-ordination  take  place.     The 

'  C.  S.  Myers,  A  Teii-Buok  of  Experimental  Psychology^  1909,  p.  75 


II  THE   BASIS    OF   MIND  63 

number  of  levels  which  can  be  identified  is,  indeed, 
largely  a  question  of  definition,  and  the  levels  are 
not  anatomically  susceptible  of  clear  delimitation, 
for  the  neo-cortex  contains  cells  of  many  types  and 
the  groups  of  cells  subserving  particular  functions 
are  not  collected  in  special  convolutions,  but  are 
distributed  throughout  considerable  extents  of 
cortex. 

Fully  developed  cortex  exhibits,  under  the 
microscope,  a  lamination  dependent  on  the  presence 
in  it  of  nerve  fibres  and  nerve  cells  of  different  sizes 
and  forms.  The  cortex  is  not  everywhere  alike  and 
there  is  not  universal  agreement  as  to  the  number 
of  layers  which  are  to  be  distinguished,  but  a  very 
general  practice  is  to  recognise  five,  according  to  the 
following  scheme,  in  which  the  strata  are  enumerated 
from  the  surface  inwards  : 

1.  The  layer  of  superficial  fibres.  In  addition  to 
the  fibres,  this  layer  contains  also  what  are  called 
the  '^  cells  of  Cajal.'' 

2.  The  layer  of  pyramidal  cells. 

3.  The  layer  of  granules. 

4.  The  inner  layer  of  fibres.  Here  are  found, 
too,  in  different  regions,  what  are  known  as  **  Betz 
cells  "  and  "  solitary  cells  of  Meynert." 

5.  The  layer  of  polymorphic  cells. 

J.  S.  Bolton^  and  G.  A.  Watson^  have  in- 
dependently worked  out  the  relation  of  the  cells  of 
the  different  layers  to  mental  processes.     According 

J.  S.  Bolton,  T/ie  Histological  Basis  of  A7nentia  and  Dementia^ 
Archives  of  Neurology^  Vol.  II.,  1903,  p.  424. 

^  G.  A.  Watson,   The  Mammalian  Cerebral  Cortex^  &^c.^  Archives 
of  Neurology^  Vol.  III.,  1907,  p.  49. 


64  THE   FEEBLE-MINDED         chap. 

to  the  former,  the  fifth  layer  is  the  first  to  appear 
and  it  probably  subserves  ''  the  lower  voluntary 
functions  of  the  animal  economy."  He  associates 
the  layer  of  granules,  which  appears  next,  with 
'*  the  reception  or  immediate  transformation  of 
afferent  impressions  whether  from  the  sense  organs 
or  from  other  parts  of  the  cerebrum."  The 
pyramidal  layer  is  the  last  to  appear,  and  since  its 
extent  varies  with  the  range  of  the  higher  mental 
processes,  it  may  be  regarded  as  subserving  *'  the 
'  psychic  '  or  associational  functions  of  the  cerebrum." 
Watson's  conclusions  agree  in  the  main  with  those 
of  Bolton,  although  he  classifies  the  layers  some- 
what differently,  calling  the  pyramidal'  layer  the 
"supra-granular"  and  applying  the  term  "infra- 
granular  "  to  the  combined  fourth  and  fifth  layers. 
This  infra-granular  region  he  believes  to  be  con- 
cerned especially  "  with  the  associations  necessary 
for  the  performance  of  the  instinctive  activities,  i.e, 
all  those  which  are  innate  and  require  for  their 
fulfilment  no  experience  or  education."  The  supra- 
granular  layer  he  regards  as  subserving  "  the  higher 
associations,  the  capacity  for  which  is  shown  by  the 
educability  of  the  animal." 

Whatever  doubt  there  may  be  as  to  the  details, 
we  may  take  it  as  well  established  that  the  cerebral 
cortex  is  the  seat  of  chemical  and  physical  changes 
which,  in  some  mysterious  way,  express  themselves 
as  mental  phenomena. 

According  as  its  activities  involve  the  building  up 
or  the  breaking  down  of  the  nervous  tissue,  so,  it  is 
taught,  will  affections  of  pleasure  or  pain  arise.  In 
the  previous  chapter  we  noted  the  inter-dependence 


II  THE   BASIS    OF   MIND  65 

of  affection,  volition,  and  attention,  so  that  we  may 
expect  to  find  near  at  hand  a  physical  explanation 
of  the  last  mentioned  factor,  and  also  of  volition  if 
we  decline  to  accept  the  hypothesis  of  a  transcen- 
dental ''  Ego."  The  unit  of  nervous  activity,  so  far 
as  we  can  study  it  objectively,  is  the  reflex,  and 
according  to  Sherrington:^ — ''The  interference  of 
unlike  reflexes  and  the  alliance  of  like  reflexes  in 
their  action  upon  their  common  paths  seem  to  lie  at 
the  very  root  of  the  great  psychical  process  of 
'  attention.'  " 

Without  going  at  length  into  the  question  of  the 
human  being's  psychical  growth  we  may  note,  in 
addition  to  the  appearance  of  volition  already 
referred  to,  a  couple  of  striking  phases.  One  is  the 
development  of  the  consciousness  of  self  or  of  the 
idea  of  the  Ego,  which  seems  to  depend  mainly  on 
the  specialisation  of  the  apparatus  for  tactile  and 
organic  sensations  :  the  other  is  the  differentiation  of 
the  centres  for  language. 

The  functioning  of  the  mechanism  of  speech  is  of 
predominant  importance  as  a  source  of  psychical 
events.  Just  as  the  introduction  of  a  practice  of 
exchanging  counters  made  possible  the  growth  of 
our  present  commercial  system  from  the  primitive 
methods  of  barter,  so  the  development  of  the  faculty 
of  language  has  been  the  chief  factor  in  the 
intellectual  evolution  of  the  human  race.  The 
acquisition  of  language  has  enabled  the  race,  in 
accordance  with  the  principle  ''  to  him  that  hath 
shall  be  given,"  to  obtain  an  ever  increasing  lead  in 
the  contest  for  the  headship  of  the  animal  kingdom 

^  C.  S.  Sherrington,  oj^.  cit. 

F 


66  THE   FEEBLE-MINDED  chap. 

and  has,  indeed,  already  established  so  wide  a  gulf 
between  Man  and  his  competitors  that  their  respec- 
tive mental  states  are  hardly  comparable. 

A  round  unvarnish'd  tale  setting  forth  the  extent 
of  our  acquaintance  with  the  nervous  mechanisms 
concerned  in  speech  will  probably  prove  rather  dis- 
appointing, but  no  useful  purpose  is  served  by 
slurring  over  the  difficulties  of  the  subject,  and  until 
the  gaps  in  our  knowledge  are  clearly  recognised, 
they  are  not  likely  to  be  filled. 

Let  us  begin  with  the  simplest  case  and  consider 
only  the  reception  and  emission  of  vocal  sounds. 
Vibrations  of  the  air  set  up  in  the  larynx  of  the 
speaker  fall  upon  the  tympanic  membrane  of  the 
hearer.  Modified  in  accordance  with  the  physical 
limitations  of  the  materials  along  which  they  are 
conveyed,  they  pass  to  the  endings  of  the  cochlear 
division  of  the  eighth  cranial  nerve.  Since  the 
transmission  of  nerve  impulses  involves  something 
other  than  simple  vibration,  the  energy  of  the  aerial 
vibrations  has  to  be  converted  into  some  new  form 
before  it  can  produce  its  appropriate  effect  on  the 
sensorium.  Through  devious  channels,  consisting 
of  nerve  fibres  interrupted  at  one  knows  not  how 
many  synapses  and  cell  exchanges,  some  portion  of 
the  energy  eventually  reaches  the  ''  auditory  centre," 
which  is  believed  to  exist  in  the  grey  matter  of  the 
first  temporal  convolution  of  the  left  cerebral  hemi- 
sphere. This  region  is  apparently  in  direct  communi- 
cation with  a  "centre,"  situated  somewhere  about 
the  hinder  end  of  the  inferior  frontal  convolution 
and  the  adjacent  part  of  the  ascending  frontal  con- 
volution, which,  when  stimulated,  will  in  turn  prompt 


II 


THE   BASIS    OF   MIND 


67 


the  muscles  of  articulation  to  activity.  That  we 
have  not  even  in  this  comparatively  simple  case  to 
do  merely  with  a  reflex  act  is  evident,  since  the 
muscles  of  articulation  may  or  may  not  react,  and 
the  reaction,  if  it  does  occur.  Is  not  always  the  same  ; 
there  must,  consequently,  be  some  Intervening  agency 


^A     M? 


Lichtheim. 


Kussmaul. 


Storring. 


Fig. 


I. — Diagrams    illustrating    different    conceptions    of    the 
Relations  of  the  "Centres"  concerned  in  Speech. 


M=  Motor  centre. 


Auditory  centre. 


Conceptual "  centre. 


M  and  A  are  ' '  cortical "  ;  regions  central  to  Af  and  A  are  * '  trans-cortical "  ; 
regions  peripheral  to  A/  and  A  are  "  sub-cortical."  Lesions  of  M  A  cause 
"conduction"  aphasia.  Seven  types  of  aphasia — t.e.,  motor  and  sensory 
forms  of  cortical,  trans-cortical,  and  sub-cortical  aphasia;  and  "conduction" 
aphasia — are  thus  theoretically  possible. 


and  this  we  take  to  be  a  third  ''centre  "  of  even  less 
certain  localisation  than  the  others.  As  to  the  mode 
of  connection  of  these  three  centres  with  one  another, 
opinions  differ.  The  diagrammatic  representations 
given  in  Fig.  i,  which  illustrate  the  views  of  the 
three  writers  whose  names  are  appended,  are  all 
equally  plausible. 

A  word  spoken  in  the  circumstances  just  ex- 
pounded would,  however,  be  practically  valueless  :  it 
would  mean  nothing — be  simply  vox  et  fr^terea  nihil. 
Only  by  the  contemporaneous    reception    of  sense 

F    2 


68 


THE   FEEBLE-MINDED 


CHAP. 


Impressions  through  other  channels  does  a  word 
acquire  a  meaning,  and  there  are,  besides  words,  the 
other  channels  of  expression — gesture  and  writing 
— to  be  allowed  for.  Moreover,  we  believe  all 
muscular  movements  to  be  sources  of  kinaesthetic 
impressions.     Therefore,    in    trying   to    indicate  by 


Fig.  2. 

s,  s',  Organs  of  special  sense,  pi,  m',  Muscular  mechanisms  of  expression. 
S,  Combined  sensory  projection,  association  and  memory  centres  for  auditory 
impressions.  S',  Similar  centres  for  visual  and  other  impressions.  M,  Kinses- 
thetic  and  psycho-motor  centre  for  articulation.  M',  Kinaesthetic  and  psycho- 
motor centres  for  movements  of  writing  and  gesture.  C,  Controlling  or 
co-ordinating  centre  or  centres  in  the  prefrontal  cortex. 


means  of  a  diagram  the  course  of  the  nerve  impulses 
concerned  In  speech,  we  must  Introduce  symbols 
corresponding  to  these  other  factors. 

Fig.  2,  which  is  sufficiently  complex,  represents 
these  conditions  in  their  simplest  terms.  The  various 
''  centres,"    the    nature    of  which    is    shown    in    the 


II  THE    BASIS    OF   MIND  69 

diagram,  are  supposed  to  be  situated  at  the  angles 
of  a  quadrangular  pyramid,  but  this  arrangement  Is  a 
purely  speculative  one.  To  represent  language 
which  Is  merely  thought  and  not  spoken,  and  without 
such  use  of  language  thought  Is  probably  Impossible, 
the  diagram  may  be  modified  by  omitting  the  lines 
sS  dind  /  S\  and  disregarding  the  projection  elements 
in  the  centres  S  S\ 

This  elaborate  machinery  may  break  down  at  any 
point  and  some  day  we  may  be  in  a  position  to  locate 
the  fault  with  the  same  precision  as  In  the  case  of  a 
trans-oceanic  cable.  At  present  we  can  only  decide 
with  some  degree  of  probability  whether  the  defect 
is  sensory,  motor,  or  psychic.  Further  reference  to 
this  topic,  in  so  far  as  It  concerns  the  feeble-minded, 
will  be  made  in  a  subsequent  chapter. 


CHAPTER  III 

THE    FEEBLE    MIND 

The  preceding  description  of  *'  Mind  "  will  apply 
to  Minds  of  all  kinds.  It  is  therefore  necessary  to 
investigate  the  characteristics  special  to  the  feeble 
mind  and  this  can  only  be  done  by  erecting  a 
standard  of  the  normal  mind  for  purposes  of  com- 
parison. The  normal  mind  is  not,  however,  itself 
susceptible  of  accurate  definition.  It  is  a  mind 
arbitrarily  selected  by  each  observer  as  representing 
the  average  mind  of  the  community  at  large.  No 
simple  numerical  formula  will  express  the  number, 
the  affective  tone,  the  degree  of  prominence  in  con- 
sciousness, and  so  on,  of  the  ideas  which  make  up  a 
normal  mind  ;  but  nevertheless  it  can  be  recognised 
that  departure  from  the  normal  constitution  of  mind 
does  occur,  and  feeble-mindedness  is  one  of  the 
modes  of  this  departure.  Its  specific  characters  are, 
however,  rather  temporal  than  psychical,  that  is  to 
say,  it  is  distinguished  rather  by  the  time  at  which 
it  appears  than  by  its  innate  peculiarities.  There 
are  no  mental  phenomena  accompanying  the  pro- 
cesses of  cerebral  degeneration  which  may  not  find 
their  counterpart  in  defective  development  of  the 
brain,    and    the    legal    employment    of    the    term 


CH.  Ill  THE   FEEBLE   MIND  71 

''lunatic"  as  including  "an  idiot  or  person  of  un- 
sound mind  "  is  justified  by  experience.  In  all  forms 
of  insanity  we  find  abnormalities  in  the  various 
departments  of  mind  which  we  have  enumerated 
above,  and  in  proceeding  to  consider  these  abnor- 
malities as  they  appear  in  feeble-mindedness,  we 
must  remember  that  they  do  not,  by  themselves, 
afford  a  distinctive  picture  of  that  condition. 

The  analysis  of  the  mental  characteristics  of  the 
feeble-minded  has  not  yet  attained  to  any  great 
degree  of  perfection,  but  it  leads  us  to  suppose  that 
we  have  not  to  deal  with  any  psychical  elements  in 
addition  to  those  already  enumerated.  A  paucity  of 
presentations  ;  an  imperfect  memory  ;  anomalies  of 
the  affective  process  and  limitation  of  the  faculty  of 
attention  are  the  ground-work  of  mental  incom- 
petence. If,  further,  we  admit  the  existence  of  an 
Ego  distinct  from  the  manifestations  of  mind  which 
have  an  objective  reality,  we  provide  ourselves  with 
a  means  of  escape  from  any  difficulties  which  the 
employment  of  the  more  limited  scheme  may  involve 
us  in. 

It  is  desirable  to  distinguish,  among  the  factors  of 
mind,  such  as  constitute  the  initial  capital  of  the 
individual  before  personal  experience  has  come  into 
play.  This  is  by  no  means  easy,  but  a  review  of  the 
whole  position  suggests  that  the  only  thing  trans- 
mitted from  one  generation  to  another  is  that 
capacity  for  being  modified  by  stimuli  which  Semon 
calls  the  "  mneme."  As  a  mere  potentiality  this  can 
have  no  counterpart  in  consciousness  until  stirred 
into  activity  by  the  incidence  of  sensations.  Without 
sensations  the  mind    does    not    begin  to  be  at  all 


72  THE   FEEBLE-MINDED  chap. 

This  is  in  accordance  with  the  results  of  observation. 
We  know  that  permanent  impairment  of  even  one 
sense,  especially  of  sight  or  hearing,  is  a  serious 
obstacle  to  normal  intellectual  development,  and  a 
person  whose  channels  of  communication  with  the 
outside  world  are  extensively  restricted  does  not  rise 
beyond  the  lowest  depths  of  idiocy. 

Inherited  capacity,  or,  as  it  has  been  called, 
"  educability,"  probably  differs  in  different  persons, 
and  a  well-developed  "mneme"  will  offset  a  poorly 
developed  sensory  apparatus.  We  need  not,  there- 
fore, be  surprised  that  in  certain  cases,  e.g.,  the 
famous  ones  of  Laura  Bridgman  and  Helen  Keller, 
a  painstaking  effort  on  the  part  of  tutors  to  utilise  to 
the  utmost  the  defective  sensory  channels  has  been 
rewarded  by  the  production  of  a  comparatively  high 
degree  of  intelligence. 

To  appreciate  fully  the  importance  of  sensation  in 
the  evolution  of  the  individual  mind,  it  must  be  re- 
membered that  the  opening  up  of  communication 
with  the  outside  world  does  not  begin  at  birth,  but 
that  for  a  long  time  prior  to  that  event  the 
mechanism  of  organic,  and  perhaps  of  tactile,  sensi- 
bility may  have  been  in  operation. 

The  peculiarities  of  presentation,  memory, 
cilfection,  and  attention  above  mentioned  constitute 
the  psychical,  as  distinct  from  the  physical,  symptoms 
of  feeble-mindedness.  Let  us  consider  them  in  a 
little  more  detail  : — 

(i)  Paucity  of  Presentations.  This  may  be 
assumed  when  there  is  obviously  defective  sensibility, 
but  it  is  difficult  to  demonstrate  it  directly,  because  a 
consciousness  containing  only  isolated   ideas,   such, 


Ill  THE    FEEBLE   MIND  73 

for  example,  as  that  imagined  by  Condillac  in  his 
conception  of  a  statue  endowed,  step  by  step,  with 
sense  impressions,  is  unknown  to  us. 

(2)  Imperfection  of  Memory.  Dependent  on 
memory  are  : 

(a)  The  amount  of  the  mental  capital.  Since  the 
majority  of  the  ideas  in  consciousness  at  any  given 
time  are  re-presentations,  the  total  content  of  the 
mind  will  be  determined  very  largely  by  that 
property  of  the  memory  which  is  called  ''  persever- 
ance "  {cf.  p.  6). 

(f)  The  faculty  of  association.  An  idea,  as  we 
have  seen,  can  cause  to  be  reproduced  another 
with  which  it  has  been  previously  associated 
either  simultaneously  or  after  a  short  interval  of 
time. 

Defects  of  memory,  then,  whether  as  regards 
perseverance  or  the  scope  of  the  associations 
permitted,  will  have  a  most  important  bearing  on 
the  mental  status.  Those  of  the  former  kind  give 
rise  to  abnormalities  of  perception,  chiefly  in  the 
direction  of  insufficiency.  Hallucinations  and 
illusions  are  not  conspicuous  features  of  feeble- 
mindedness, so  far  as  an  observer  is  in  a  position 
to  judge,  though  their  existence  may  sometimes  be 
inferred.  Marked  limitation  of  the  field  of  associa- 
tion is  a  familiar  symptom  of  idiocy.  We  meet,  for 
instance,  with  children  who  are  clearly  hungry  but 
who  make  no  attempt  to  consume  food  placed  before 
them  since  the  ideas  set  up  in  their  minds  by  it  are 
not  associated  with  the  idea  of  satisfying  hunger. 
We  meet,  too,  with  the  burnt  child  who  does  not 
dread    the    fire    or   who,    however    frequently   the 


74  THE   FEEBLE-MINDED  chap. 

information   has  been    imparted,  cannot   remember 
what  letter  comes  after  ''a." 

(3)  Anomalies  of  the  Affective  Process.  These 
may  include  : 

{a)  Quantitative  abnormalities. 

There  is  a  certain  parallelism  between  the  grada- 
tions of  the  emotional  state  observable  in  the  feeble- 
minded and  the  stages  of  affective  evolution  through 
which  the  normal  mind  passes.  Idiots  of  the  lowest 
grade  seem  to  have  no  feelings  at  all.  At  a  some- 
what higher  level  they  show  signs  of  distinguishing 
a  condition  of  repletion  from  one  of  hunger  and 
thirst ;  they  may  appear  to  derive  some  sort  of 
gratification  from  sensations  of  colour,  tone  or 
sapidity ;  and  they  respond  to  what,  for  the  normal 
organism,  are  unpleasant  stimuli  in  a  way  which 
suggests  that  they  also  find  such  stimuli  displeasing. 
Anger  and  resentment  occur  at  a  still  higher  plane 
of  development,  and  from  this  stage  onward  there 
may  be  found  in  increasing  degree,  joy  and  sorrow, 
hope  and  fear,  like  and  dislike,  and  so  on  through 
the  whole  gamut  of  emotion.  The  excessive 
emotional  reaction  which  the  feeble-minded  some- 
times display  does  not  necessarily  indicate  a  more 
pronounced  affective  colouring  of  the  ideas  con- 
stituting the  emotion,  but  is  rather  to  be  explained 
by  a  deficiency  of  those  relatively  neutral  ideas 
which  in  the  normal  mind  serve,  if  one  may  so  put 
it,  to  ''dilute"  the  emotion. 

Owing  to  the  relation  which  exists  between  the 
two  we  may  appropriately  pass  from  a  consideration 
of  the  emotions  to  that  of  the  instinctive  activities. 
Many  of  our  actions  have  an  easily  recognisable 
instinctive  foundation  even  though  it  may  be  difficult 


Ill  THE   FEEBLE   MIND  75 

to  decide  where  foundation  gives  place  to  super- 
structure. On  account  of  this  fundamental  character 
defect  in  the  sphere  of  instinct  may  be  of  crucial 
importance.  The  idiot  with  no  instinct  to  seek 
food  must  lead  a  precarious  existence.  With  no 
instinct  of  cleanliness  it  can  never  be  other  than 
a  social  outcast.  With  no  instinct  of  imitation  it  is 
debarred  from  intellectual  progress. 

[b)  A  want  of  harmony  between  the  affection  and 
the  idea  with  which  it  is  connected. 

If,  as  has  been  suggested,  affections  are  "mental 
elements "  distinct  from  and  separable  from  ideas, 
they  may  be  capable  of  reproduction  in  new  com- 
binations independently  of  the  original  ideas  with 
which  they  were  in  relation.  Such  a  capacity  would 
impart  a  considerable  degree  of  elasticity  to  the 
mental  structure  and  to  that  extent  render  more 
intelligible  the  apparent  want  of  harmony  between 
idea  and  affection  which  is  sometimes  observable 
in  the  feeble-minded.  Examples  of  the  condition 
are  afforded  by  the  cases  in  which  stimuli,  of  a  kind 
to  give  pleasure  to  the  normal  individual,  produce 
pain  ;  or  those  in  which,  as  in  filth  eating  or  other 
depravity  of  appetite,  noxious  substances  are 
accepted  as  beneficial. 

This  possibility  of  a  dissociation  of  idea  and 
"  affect  "  seems  to  lie  at  the  root  of  the  teachings 
of  Professor  Sigmund  Freud,^  though  it  is  more 
particularly  in  connection  with  hysteria,  neurasthenia, 

^  For  an  account  of  Freud's  theories  reference  may  be  made  to, 
among  other  works,  his  books,  Selected  Papers  on  Hysteria  and  Other 
Psychoneuroses,  translated  by  A.  A.  Brill,  1909,  and  to  Zur  Psycho- 
pathologie  des  Alitagslebens,  1907 ;  or  to  Die  psychoanalytische 
Methode  Freuds^  by  M.  Isserlin  in  Zeitscrift  fur  die  gesamte 
Neurologic  und  Psychiatrie,  Bd.  i,  Mar.,  1910. 


76  THE   FEEBLE-MINDED  chap. 

impulsive  insanity,  and  dementia  praecox  that  his 
views  have  been  promulgated.  The  field  in  which 
such  dissociation  is  especially  prone  to  occur  is, 
according  to  Freud,  that  of  the  sexual  life.  A  study 
of  the  lower  animals  shows  us  that  the  interest  in 
reproduction  may  be  as  pronounced  as  the  interest 
in  nutrition.  Although,  as  regards  human  beings, 
we  are  accustomed  to  ignore  the  influence  of  the 
reproductive  instinct  on  conduct  until  the  stage  of 
sexual  maturity  is  reached,  the  different  phases  of 
development  through  which  that  instinct  has  been 
passing  since  the  organism  acquired  individuality 
may  have  left  their  impress  on  the  mind's  evolution, 
and  it  is  conceivable  that  these  forgotten  factors  may, 
in  the  case  of  certain  feeble-minded  persons,  be 
supplying  ** affects"  which,  by  coming  into  relation 
with  ideas  to  which  they  did  not  originally  belong, 
are  responsible  for  the  abnormalities  displaye'd. 
(4)  Limitation  of  the  Faculty  of  Attention, 
It  will  have  been  gathered  from  the  study  of  the 
mind,  entered  upon  in  a  preceding  chapter,  that  the 
degree  of  prominence  of  ideas  in  consciousness 
decides  the  lines  on  which  the  evolution  of  the  mind 
shall  proceed.  Any  limitation  of  the  power  of 
attending  may,  consequently,  act  as  a  restraining 
influence  in  the  various  departments  of  thought 
to  which  are  given  the  names  Judgment,  Reasoning, 
Imagination,  and  Sentiment.  In  cases  of  feeble- 
mindedness the  limitation  may  appear  either  (a)  as 
a  deficiency  in  the  process  of  attention  itself,  or 
{b)  in  the  consequences  flowing  from  that  deficiency. 
{a)  Indifference  to  stimuli  which,  in  the  case  of 
the    ordinary    person,    would    compel    attention    is 


Ill  THE   FEEBLE   MIND  77 

observed  in  idiots,  and  such  indifference  is  only- 
intelligible  as  an  abnormality  of  the  receptive 
apparatus.  Presentations  vary  in  clearness  with  the 
quality  and  intensity  of  the  sensations  which 
originated  them  and  with  the  state  of  the  sense 
organs  and  of  their  central  connections.  For  any 
particular  stimulus,  only  the  second  factor,  which 
Titchener  calls  the  ''psychophysical  disposition,"  has 
to  be  taken  into  account.  Sometimes  the  difficulty 
seems  to  arise  in  the  province  of  voluntary  attention. 
We  meet  with  a  class  of  feeble-minded  persons 
whose  salient  characteristics  are  versatility  and  super- 
ficiality. Before  one  stimulus  can  be  appreciated 
another  is  sought  ;  nothing  is  retained  because 
nothing  is  allowed  to  produce  the  necessary  impres- 
sion. Perceptions  are  not  developed,  because  their 
fundamental  ideas  have  not  time  to  arouse  the 
appropriate  concomitants. 

In  another  set  of  cases  the  prominent  feature  is  a 
condition  of  apathy  or  torpor  which  seems  to 
nullify  the  effort  of  attention.  Here  the  mental 
inertia  is  so  great  that  the  will  is  powerless  to  over- 
come it,  and  therefore  ideas  never  attain  to  that 
degree  of  prominence  in  consciousness  which  is 
required  for  the  arousing  of  associations. 

(d)  Attention  plays  its  part  behind  the  scenes  to 
so  great  an  extent  that  the  appearances  on  the 
psychic  stage  which  we  have  so  far  noted  represent 
but  a  small  proportion  of  its  activities.  It  is  to  the 
prominence  of  re-presentations  rather  than  of  pre- 
sentations that  we  must  look  for  an  explanation  of 
the  higher  mental  processes.  If  the  feeble-minded 
person   does    not  reason,  it   is   because   he  cannot 


78  THE   FEEBLE-MINDED  chap. 

abstract  and  bring  to  the  focus  of  his  mental  vision 
the  particular  elements  of  his  idea  complexes  which 
it  is  necessary  for  him  to  compare.  If  he  have  "  no 
imagination,"  it  is  because  he  cannot  fix  and  sort 
out  from  the  idea  complexes  those  ideas,  or  groups 
of  ideas,  which  are  capable  of  being  recombined 
into  something  approximately  true  to  nature.  If  he 
be  without  sentiment,  it  is  because  not  even  feelings 
are  capable  of  occupying  a  prominent  place  in  his 
consciousness.  Nor  are  these  all  the  paths  along 
which  he  can  go  astray.  He  may  be  wrong  in  his 
judgments,  because  he  cannot  envisage  the  ideas 
which  he  regards  as  alike  sufficiently  clearly  to 
enable  him  to  see  that  they  are  not  alike.  His 
imagination  runs  riot,  as  in  dreams,  because  he 
cannot  compare  the  new  groupings  which  he  has 
evoked  with  the  standard  of  things  as  they  are 
supplied  to  normal  minds  by  experience.  His 
sentiments  are  vicious  because  he  has  not  light 
enough  to  enable  him  to  choose  the  better  part. 

There  are  also  other  cases  in  which  the  ideas, 
which  expediency  would  suggest  should  be  prominent 
in  consciousness,  fail  to  occupy  that  position.  In 
these,  probably  because  they  are  marked  by  more 
of  the  phenomena  which  we  have  learned  to 
associate  with  exercise  of  the  will,  the  condition  is 
usually  described  as  due  to  defective  volition.  The 
most  obvious  case  is  that  in  which  the  supplanting 
of  instincts  by  voluntarily  controlled  activities  does 
not  occur,  or  occurs  only  incompletely ;  and,  in 
consequence,  the  adjustment  of  the  individual  to  his 
environment  is  more  or  less  imperfect.  Of  some- 
what similar  character  are  the  instances  of  obsession, 


Ill  THE   FEEBLE    MIND  79 

or  imperative  idea  in  which  the  will  is  powerless  to 
dethrone  one  idea  from  its  seat  at  the  focus  of 
attention  by  attending  to  other  ideas. 

Ill-regulated  instincts  supply  perhaps  the  largest 
group  of  symptoms  observed  in  the  feeble-minded. 
The  instinct  to  feed  may  be  displayed  irrespective 
of  times  and  seasons  :  the  instinct  of  cleanliness  may 
find  channels  of  expression  which  involve  much 
social  inconvenience  :  the  instinct  of  imitation  may 
be  incapable  of  direction  only  to  profitable  ends. 
Instinctive  movements  are  not  schooled  into  an 
orderly  sequence  of  purposive  activities,  but  show 
themselves  as  aimless  wandering  or  the  various 
swaying,  nodding,  twisting,  and  other  movements 
embraced  under  the  denomination  "tics."  In  later 
life  the  instincts  of  curiosity,  acquisitiveness,  destruc- 
tiveness,  amativeness,  and  so  on,  will  each  require 
guidance  by  the  will  and,  failing  it,  may  give  rise  to 
various  anti-social  disorders  of  conduct. 

The  instinct  for  the  employment  of  vocal  or  other 
signs  in  language  is,  perhaps,  from  a  psychological 
standpoint,  the  one  of  most  importance  in  the 
inherited  mental  outfit,  although,  without  the  develop- 
ment which  education  occasions,  it  would  play  but 
an  insignificant  part  in  the  individual's  life.  Idiots 
find  vent  for  their  emotions  in  a  vocabulary  limited 
to  cries  of  different  pitch,  timbre,  and  loudness, 
comparable  with  the  variations  in  a  dog's  bark  when 
the  animal  is  hungry,  angry,  or  frightened.  Profit- 
able development  is  dependent  on  the  individual's 
power  to  form  concepts.  This  is  often  overlooked 
by  teachers  of  the  feeble-minded,  who  do  not  realise 
that  the  parrot-like  repetition  of  set  phrases  which 


80  THE   FEEBLE-MINDED  chap. 

they  proudly  adduce  as  evidence  of  growing  intelli- 
gence connotes  no  higher  intellectual  gifts  than 
those  of  a  parrot.  It  is  because,  on  the  one  hand, 
we  may  find  speech  not  based  on  reasoning  and,  on 
the  other,  reasoning  unable,  on  account  of  a 
defective  mechanism,  to  find  expression  in  speech, 
that  the  mere  ability  to  say  certain  words  does  not 
afford  us,  as  Esquirol  too  hastily  concluded,  a  satis- 
factory criterion  in  estimating  mental  capacity. 

Feeble-minded  persons  display  practically  every 
form  of  abnormality  of  speech  which  is  known  to 
exist.  Of  these,  such  as  have  their  origin  in  defec- 
tive development  are  peculiar  to  the  class,  but  since 
the  genesis  of  the  morbid  condition  is  often  doubtful, 
this  fact  is  not  of  much  value  for  purposes  of  classi- 
fication. The  most  convenient  arrangement  seems 
to  be  one  on  the  basis  of  the  distinction  between 
the  main  divisions  of  the  linguistic  apparatus,  and 
we  may  therefore  recognise  three  chief  groups  of 
speech  defect,  which  do  not,  however,  exclude  one 
another. 

(a)  Those  dependent  on  abnormality  of  the 
sensory  apparatus  : — To  the  child  deaf  from  birth 
or  from  an  early  age  there  is  available  only  the 
vocal  material  which  has  come  to  it  by  inheritance, 
and  this  limited  capital,  which  is  quite  inadequate  to 
the  child's  needs,  is  generally  allowed  to  remain 
unutilised,  the  child  consequently  becoming  dumb 
or  only  making  occasional  unintelligible  noises  eked 
out  by  gestures.  In  such  cases  it  may  be  possible, 
by  means  of  other  channels,  to  impart  some  form  of 
sign  language  in  the  use  of  which  the  child  may 
attain  to  a  quite  remarkable  facility. 


Ill  THE   FEEBLE  MIND  81 

Blindness  which  is  congenital  or  of  early  occurrence 
need  not,  of  course,  affect  the  reception  or  emission 
of  sounds,  but  it  will  affect  their  connotation  and 
it  will  limit  considerably  inter-communication  by 
means  of  the  symbols  which  represent  words,  only 
such  as  can  be  appreciated  also  by  the  sense  of 
touch  being  of  any  service. 

(^)  Those  dependent  on  abnormality  of  the  motor 
apparatus  : — -The  machinery  of  gesture  is  so  exten- 
sive and  the  scope  of  its  employment  so  restricted 
that  interference  with  this  means  of  expression  is  of 
relatively  little  importance.  Writing  involves  a 
smaller  range  of  muscles  and  its  utility  is  much 
greater  than  that  of  gesture,  but  even  it  can  be  so 
completely  replaced  by  vocal  speech  that  only  the 
latter  calls  for  notice  at  any  great  length.  It  may, 
however,  be  mentioned  in  passing,  that  peculiarities 
of  the  script  analogous  to  stammering  and  stuttering 
are  exhibited  by  the  feeble-minded. 

To  such  disturbances  of  the  faculty  of  speaking 
as  fall  within  the  boundaries  of  the  class  under  con- 
sideration the  general  term  ''dysarthria"  may  be 
applied.  The  originating  lesion  may  be  in  the 
muscles  of  articulation,  as  in  trophic  or  inflammatory 
changes  ;  or  in  the  nerves  supplying  those  muscles, 
as  in  section  or  toxic  neuritis  ;  or  in  the  grey  matter 
from  which  issue  the  impulses  necessary  to  set  the 
muscles  in  motion,  as  in  wasting  of  the  bulbar 
nuclei ;  or  in  the  pyramidal  tract  ;  and  any  of  these 
lesions  may  serve  as  the  exciting  cause  of  the  rest. 
There  may,  further,  be  structural  defect  of  the 
accessory  vocal  apparatus,  e.g.,  cleft  palate  or  dental 
malformation.     Frequently    it    is    not    possible    to 

G 


82  THE   FEEBLE-MINDED  chap. 

indicate  the  precise  nature  and  position  of  the  lesions, 
and  consequently,  it  is  impossible  to  exclude  the 
psychic  element,  but,  somewhat  arbitrarily,  we  may 
regard  the  following  as  attributable  rather  to  in- 
competence of  the  organs  of  expression  than  to  lack 
of  intelligence. 

1.  Aphonia.  —  This  is  a  quantitative,  not  a 
qualitative,  defect  of  speech.  The  voice  is  so  low 
as  to  be  almost  inaudible,  or  the  patient  speaks  in  a 
whisper,  or  with  an  amount  of  effort  quite  dispro- 
portionate to  the  effect  produced. 

2.  Stammering  and  stuttering. — These  terms  are 
applied  indiscriminately  by  many  English  writers  to 
conditions  in  which  there  is  a  difficulty  in  beginning 
to  speak  or  a  sudden  interruption  of  speech,  or  a 
repetition  of  consonantal  sounds  in  speaking.  Even 
though  these  conditions  are  usually  associated,  it  is 
convenient  to  describe  spasmodic  interruptions  of 
speech  as  stammering  and  the  reduplicative  anomaly 
as  stuttering. 

3.  Slurring,  scanning,  the  stumbling  over  syllables, 
and  the  omission  of  syllables  go  to  form  a  third 
group,  in  which  lisping  should,  perhaps,  also  be 
included. 

4.  Aphthongla. — A  rare  condition  in  which  an 
incapacitating  spasm  of  the  muscles  of  articulation 
occurs  when  speech  is  attempted. 

5.  Bradylalia  ;  bradylogia ;  bradyglossia  ;  brady- 
phasia  ;  bradyphrasia  ;  are  terms  which  have  been 
applied  in  an  indiscriminate  fashion  to  various  dis- 
orders of  speech  having  in  common  the  feature  of 
slowness  of  utterance. 

(c)  Psychic    or    intellectual    defects. — These   are 


Ill  THE   FEEBLE   MIND  83 

characterised  by  an  absence  or  a  disorder  of  the 
mental  concomitants  of  speech.  A  child  may  not 
speak  because  he  has  nothing  to  say,  or  he  may  speak 
in  some  abnormal  fashion  because  his  mental  pro- 
cesses are  in  confusion.  Such  defects  as  these  have, 
we  must  suppose,  just  as  definite  a  physical  basis  as 
the  sensory  and  motor  ones  already  described,  and 
since  that  basis  is  not  capable  of  isolation  from  the 
sensory  and  motor  apparatus,  the  recognition  of  a 
"  psychic  "  group  of  morbid  states  is  simply  a  matter 
of  convenience.  This  consideration  will  justify  the 
allocation  to  the  present  category  of  the  conditions 
comprised  under  the  name  ''aphasia,"  in  which  the 
lack  of  the  power  of  exact  expression  is  due  to 
inadequacy  of  the  receptive  or  the  emissive  mechan- 
ism, and  also  those  which  have  their  origin  in 
retarded  intellectual  development  and  which  Heller^ 
entitles  *'  dyslogic."  The  antithesis  between  aphasic 
and  dyslogic  forms  is  brought  out,  according  to 
Heller,  by  the  fact  that  in  the  latter  the  speech 
defect  is  secondary  to  the  mental  one,  while  in  the 
former  it  is  the  limitation  of  mental  power  which  is 
secondary. 

Clinically,  evidence  of  the  existence  of  psychic 
defect  of  speech  is  afforded  by  : — 

1.  Noise-making.  Some  idiots  make  an  endeavour 
to  express  their  wants  by  crying,  shouting,  or 
shrieking  noises  which  can  hardly  be  dignified  with 
the  title  of  language. 

2.  Lalling.  As  we  have  seen,  primitive  efforts  at 
articulate  speech  are  made  in  early  life,  apparently 
as  a  result  of  inherited  tendencies.     This  condition 

^  T.  Heller,  Grundriss  der  Heilpddagogik^  1904,  p.  86. 

G    2 


84  THE  FEEBLE-MINDED  chap. 

may  persist  into  later  life,  the  child  failing  to  acquire 
speech  of  the  ordinary  kind  and  contenting  itself 
with  mere  babbling. 

3.  Idioglossia.  This  is  a  development  of  lalling, 
in  which  the  person  uses  a  private  and  peculiar 
language,  omitting  difficult  consonants,  or  substitut- 
ing for  them  easy  ones,  with  fantastic  results. 

4.  Agrammatism.  With  the  limited  vocabulary 
which  alone  is  at  his  disposal  in  his  earliest  years, 
the  child  has  to  make  single  words  do  duty  for 
many  purposes.  For  him  there  is  naturally  no  such 
thing  as  syntax,  and  the  distinctions  of  noun  and 
verb,  adjective  and  adverb,  preposition  and  con- 
junction, are  refinements  of  which  he  knows  nothing. 
The  power  of  inflecting  words,  and  arranging  them 
to  form  sentences  is  acquired  slowly,  and  the  process 
of  acquisition  may  be  interrupted  at  any  stage  if  the 
development  of  the  brain  ceases.  Liebmann^ 
describes  three  forms  of  agrammatism  as  met  with 
in  the  feeble-minded.  In  the  first,  only  what  may 
be  called  "key-words"  are  employed.  Thus  the 
word  "gee-gee"  may  be  applied  to  anything  which 
moves,  and  may  indicate  the  presence  of  that  thing, 
or  any  emotion  which  its  appearance  has  aroused. 
In  the  second,  the  key- words  are  put  together  to 
make  the  skeleton  of  a  sentence,  e.g.,  "  Nana  milk 
give,"  while  in  the  third,  the  differentiation  of  the 
grammatical  classes  of  words  causes  this  skeleton  to 
be  filled  out  so  as  to  make  a  sentence  of  bizarre 
construction,  as  in  the  examples  quoted  by  Liebmann 
— "  Milk  get  we  for  the  cow  butter,"  "  She  drinks 

1  A.    Liebmann,   v.  Art.    "  Agranimatismus,"    in  Enzyklopddisches 
Handbuch  der  Heilpddagogik,  1909. 


Ill  THE   FEEBLE   MIND  85 

the  woman  on  the  glass."  It  would  appear  that  in 
these  cases  the  mental  limitation  is  not  so  marked  as 
might  be  expected  from  the  attempts  at  speech,  for 
the  persons  concerned  may  be  found  to  understand 
much  more  complicated  sentences  than  they  them- 
selves give  utterance  to. 

5.  Echolalia.  Normal  children  sometimes  repeat 
what  is  said  to  them,  apparently  with  the  object  of 
assisting  apprehension  by  strengthening  their 
auditory  impressions  with  kinaesthetic  ones,  and  a 
somewhat  similar  practice  Is  occasionally  observed 
among  the  feeble-minded,  though  it  is  perhaps 
more  characteristic  of  some  forms  of  primary 
dementia. 

6.  Verbigeration.  This  also  is  most  frequently 
met  with,  in  a  well-marked  form,  as  a  symptom  of 
primary  dementia,  but  idiots  will  sometimes  occupy 
themselves  for  long  periods  with  the  repetition  of 
some  word  or  sound,  which  conveys  no  meaning  to 
the  hearer,  and,  so  far  as  can  be  judged,  has  no 
significance  for  the  utterer. 

7.  Word-blindness  and  word-deafness.  In  child- 
ren of  a  higher  grade  than  the  Imbecile,  there  are 
met  with  certain  intellectual  defects  of  limited  extent 
which  take  the  form  of  inability  to  learn  to  read,  or 
of  incapacity  to  apprehend  the  significance  of  spoken 
words.  These  conditions,  known  respectively  as 
word-blindness,  and  word-deafness,  are  said  to  be 
dependent  on  definite  anatomical  abnormalities, 
referable  either  to  developmental  defect,  or  to  a 
lesion,  which  may  be  found  in  particular  regions  of 
the  cerebrum.  Cases  of  the  kind  have  been 
described  by  many  writers,  among  the  most  recent 


86  THE   FEEBLE-MINDED  chap. 

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

There  is  one  manifestation  of  abnormal  tendency 
in  the  employment  of  language  which  has  acquired, 
in  the  popular  conception  of  idiocy,  a  prominence 
attributable  to  its  curious  character  rather  than  to  its 
value  as  a  guide  to  the  mental  state.  This  is  what 
is  called  "  Mirror  Writing."  One  finds  rather 
widely  prevalent,  the  notion  that  a  distinctive 
characteristic  of  idiocy  is  that  whereas  the  normal 
person  writes  from  left  to  right  and  with  the  right 
hand,  the  idiot  writes  from  right  to  left,  with  the 
left  hand.  What  really  does  happen  is,  on  the  face 
of  it,  sufficiently  remarkable :  in  certain  cases  the 
attempts  at  writing  which  the  feeble-minded  person 
makes,  result  in  the  production  of  a  script  which  is 
meaningless  until  it  is  held  before  a  mirror,  when  one 
is  able  to  decipher  it  in  just  the  same  way  as  one  can 
decipher  the  marks  on  a  piece  of  blotting-paper 
which  has  been  used  to  dry  ordinary  script.  Good 
examples  of  this  kind  of  writing  are  rare,  at  any  rate 
in  this  country  ;  for  idiots  either  do  not  write  at  all, 
or  they  produce  a  scrawl  which  demands  the  use  of 
a  good  deal  of  ingenuity,  in  addition  to  a  mirror,  if 
anything  is  to  be  made  of  it.  The  example  given, 
which  is  the  best  that  the  writer  has  been  able  to 
obtain,  will  bear  out  this  statement  (Fig.  3). 

Mirror  writing  occurs  in  idiots  who  are  capable  of 
a  limited  degree  of  caligraphic  attainment  but  In- 
capable of  learning  to  write  properly.     The   explan- 

^  C.    J.    Thomas,    The  Aphasias  of  Childhood    a?id  Educational 
Hygie?ie^  Public  Health,  May,  1908. 

2  J.  H.  Fisher,  Lancet^  May  14th,  19 10,  p.  1348. 


Ill  THE   FEEBLE   MIND  87 

ation  of  its  occurrence  is  probably  to  be  found,  as 
suggested  by  Heller  ^  and  Wegener,  in  the  natural 
tendency  of  movements  at  one  side  of  the  body  to  be 
accompanied  by  symmetrical  movements  at  the  other 
side.       In    mirror    writing,    for    some    reason,    the 


Cr^U5K?(> 


Fig.  3. 

attention  is  directed  to  what  should  be  the  subsidiary 
movement,  i.e.,  that  of  the  left  hand  ;  and  the  idea  of 
this  movement,  in  consequence,  becomes  the  more 
prominent  one  and  therefore  controls  the  form  which 
the  activity  takes.  Ambidexterity,  as  we  shall  see, 
is  commoner  in  idiots  than  in  normal  persons  and 
the  particular  accomplishment  which  we  are  consider- 
ing seems  to  be  merely  a  special  case  of  it. 

1  T.  Heller,  op.  czL,  p.  ii8. 


88  THE   FEEBLE-MINDED  chap. 

Having  provisionally  accepted  the  hypothesis  of 
an  Ego  distinct  from,  and  capable  of  controlling, 
consciousness,  we  may  as  well  utilise  it  to  account 
for  the  existence  of  certain  mental  abnormalities 
which,  while  having  points  of  contact  with  the  four 
groups  above  enumerated,  cannot  be  easily  referred 
to  any  one  of  them.  These  are  the  phenomena 
known  as  delusions,  of  which  the  most  prominent 
characteristic  is  their  dependence  on  the  "  Self." 
The  term  self  is  employed  with  various  connotations^ 
but  the  most  intelligible,  if  not  necessarily  the  most 
accurate,  use  of  the  word  is  as  a  name  for  the 
assumed  entity,  which  has  the  relation  of  subject  to 
the  various  objective  manifestations  of  mind — the 
entity  which  experiences,  remembers,  imagines, 
reasons,  and  wills,  in  short,  thinks  ;  as  distinct  from 
the  group  of  Ideas  and  affections  which  constitute 
the  raw  material  of  the  process.  The  aberrations 
of  the  self  in  thinking  may  be  temporary  and,  con- 
sequently, of  only  transient  effect,  or  they  may  be  of 
such  a  character  as  to  indicate  a  permanent  "  set  "  in 
the  direction  of  falsity.  In  the  latter  case  we  get 
that  persistent  failure  to  adapt  the  mental  workings 
to  the  conditions  imposed  by  the  environment  which 
constitutes  delusion.  The  more  highly  organised 
the  mind,  the  greater  Is  the  scope  for  a  mischievous 
self  to  play  pranks  with  it,  and  since  deficient  organ- 
isation is  the  essence  of  feeble-mlndedness,  there  is 
no  large  field  for  the  production  of  delusions,  which 
are.  In  fact,  an  insignificant  feature  of  the  undeveloped 
mind. 

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


Ill  THE   FEEBLE   MIND  89 

that  their  incidence  on  all  parts  of  that  system  need 
not  be  the  same.  It  is  possible,  consequently,  to 
have  one  portion  of  the  apparatus  proceeding  to 
attain  maturity,  while  other  systems  lag  behind  to  a 
greater  or  less  extent.  When  this  happens,  we  get 
ability  in  some  particular  field  standing  out  con- 
spicuously against  a  background  of  unintellectuality. 
The  contrast  is  sometimes  so  striking  as  to  give  the 
impression  of  phenomenal  capacity  as  regards  the 
department  of  knowledge  concerned,  but  this 
appearance  is  probably  misleading.  In  their  own 
special  lines,  the  ''  idiots  savants,"  as  persons  exhibit- 
ing the  features  under  consideration  are  called,  are 
not  superior  to  persons  whose  general  mental  level 
is  normal.  The  exceptional  ability  of  the  feeble- 
minded shows  itself  more  especially  in  the  provinces 
of  mathematics  and  the  arts.  Many  instances  of 
this  kind  have  now  been  placed  on  record.  Heller^ 
mentions  the  case  of  a  child  of  ten  whose  sole 
interest  in  life  was  to  count.  When  out  walking  he 
counted  the  passing  men,  horses,  and  vehicles  ;  the 
windows  and  doors  of  the  houses  ;  the  number  of 
men  with  brown  or  with  black  boots  ;  those  with 
moustaches  ;  those  with  whiskers  ;  and  so  on. 
Books  appealed  to  him  as  affording  facilities  for 
enumeration,  he  counted  the  pages,  the  words  and 
the  letters.  Other  feeble-minded  persons  show  a 
noteworthy  aptitude  for  remembering  dates,  and 
Sengelmann  ^  has  reported  the  case  of  an  imbecile 
who  learned  the  names  and  corresponding  numbers 

^  T.  Heller,  op.  cit.,  p.  143. 

^  Quoted     from     Handbuch     der     Schwachsinnigenfiirsorge^     by 
H.  Bosbauer,  L,  Miklas  and  H.  Schiner,  1909,  p.  43. 


90  THE   FEEBLE-MINDED  chap. 

of  more  than  1 50  scholars  whom  he  had  never  seen 
and  for  whom  the  identity  of  the  numbers  with  the 
persons  was  so  complete  that  when  he  saw  the 
numbers  of  the  hymns  on  the  board  in  the  church 
which  he  attended  he  would  say  "  To-day  Meyer's, 
Muller's,  Schroder's  songs  have  been  sung." 

Of  the  feats  referred  to,  the  first  would  not,  of 
course,  be  beyond  the  power  of  any  normal  ten-year 
old  child  who  was  silly  enough  to  attempt  it,  and  as 
regards  the  others  they  have  been  surpassed  by 
apparently  sane  persons.  A  correspondent  of  The 
Daily  Telegraph,  for  example,  has  drawn  attention 
to  the  doings  of  the  youthful  son  of  a  well-known 
American  physician,  who  is  said  to  have  been 
admitted  to  Harvard  University  at  the  age  of  eleven 
years  and  to  have  been  lecturing  on  advanced 
mathematics  a  few  months  later.  Again,  as  Heller 
points  out,  while  the  famous  arithmeticians  Zacharius 
Dase,  Buxton,  Frankl,  and  Zaneboni  were  more  or 
less  imbecile,  this  could  not  be  said  of  Gauss, 
Ampere,  and  Bidder,  who  were  not  inferior  to  them 
in  mathematical  gifts.  Heller  regards  Colburn  also 
as  having  been  feeble-minded,  but  the  evidence  is 
hardly  sufficient  to  warrant  him  in  this.  In  music 
a  similar  state  of  things  is  met  with.  Before  the 
Royal  Commission  on  the  Feeble-Minded,  Mr.  W. 
H.  Illingworth^  described,  in  the  following  words, 
the  capabilities  of  a  blind  and  mentally  defective 
child  under  his  care,  ''  if  one  sitting  at  a  pianoforte, 
tuned  high  or  tuned  low  pitch,  strikes  as  many  keys 
as  he  can,  let  it  be  the  finest  chord  or  most   ear- 

^  W.    H.    Illingworth,    Rep.  of  the  Roy.  Comm.  on  the   Care  and 
Control  of  the  Feeble-Minded.,  vol.  2,  p.  276. 


Fig.  4. — Design  in  coloured  threads  on  a  layer  of  cotton-wool.      Made  by  an 
idiot,  without  tuition. 


Fig.  5. — Brain  of  an  epileptic  idiot  aged  18  ;  weight  of  left  hemisphere  lyf  oz., 
of  the  right  hemisphere  64  oz.  The  opacity  of  the  pia-arachnoid  is 
well  shown. 


{Face  page  91. 


Ill  THE   FEEBLE    MIND  91 

splitting  discord,  this  boy  will  name  every  note 
struck  without  the  smallest  slip  or  error."  There 
have  been  sane  musicians  who  could  do  as  much, 
and  probably  Mozart,  at  the  same  age,  could  have 
done  a  good  deal  more  in  the  way  of  contributing 
to  musical  knowledge. 

Notable  aptitude  for  sketching,  for  caricaturing, 
for  drawing  plans,  and  for  modelling,  has  been 
recorded  by  various  observers.  An  idiot  formerly 
under  the  writer's  care  used  to  amuse  himself  for 
hours  by  preparing  elegant  designs  in  coloured 
wools.  A  copy  of  one  of  these  is  shown  in  the 
accompanying  illustration  (Fig.  4)  which  does  not, 
however,  do  full  justice  to  it,  since  the  different 
colours  are  not  shown  in  the  photograph.  The 
strands  of  wool  drawn  out  from  any  articles  of 
clothing  or  decoration  which  happened  to  fall  into 
the  boy's  hands  are  arranged  on  a  pad  of  cotton 
wool  obtained  from  the  attendant  in  charge.  Dr. 
Tredgold  ^  has  described  at  length  the  case  of  a 
patient  at  Earlswood  Asylum  who  displayed  a  con- 
siderable amount  of  artistic  and  mechanical  skill. 

1  A.  F.  Tredgold,  Mental  Deficiency^  1908,  p.  275. 


CHAPTER  IV 

THE    BASIS    OF    THE    FEEBLE    MIND 

The  exposition  of  the  physical  conditions 
associated  with  feebleness  of  the  mind  will  be 
facilitated  if,  as  the  result  of  a  preliminary  survey, 
the  outlines  of  a  scheme  of  more  detailed  study 
be  sketched.  Let  us  begin  then  by  considering  the 
salient  features  of  feeble-minded  persons,  and  so 
arrive  at  a  series  of  categories  into  which  the 
particular  facts  observed  and  any  additions  to  them 
may  be  distributed. 

Well-marked  cases  of  mental  defect  will  provide 
the  best  introduction  to  the  subject.  If  one 
observes  a  group  of  idiots,  one  finds  that  they 
display  bodily  abnormalities  in  great  variety  and  in 
much  higher  proportion  than  would  a  group  of 
persons  of  corresponding  social  status  and  of  sound 
mind.  Poor  general  development ;  deformities  of 
head,  trunk,  and  limbs  ;  irregularities  of  muscular 
action,  e.g.,  paralysis,  spasm,  or  inco-ordination ; 
defects  of  the  organs  of  special  sense  and  of  speech, 
are  common.  After  death  the  viscera  may  be  found 
to  be  of  less  than  normal  weight  and  to  present 
structural    differences  from    the   organs    of    healthy 


92 


CH.iv  BASIS  OF  THE  FEEBLE  MIND       98 

persons.  The  brain  in  particular  may  display, 
in  some  cases  to  the  unaided  eye  and  in  some  cases 
under  the  microscope,  wide  departures  from  the 
standard  of  normality  which  anatomy  has  provided 
us  with. 

To  the  interpretation  of  these  appearances  some 
postulates  are  necessary.  Let  it  be  granted  that  the 
existence  of  mind  is  conditioned  by  the  existence 
of  nervous  tissue.  Let  it  be  granted,  further, 
that  the  units  of  nervous  tissue  are  cells  with 
processes.  ''  I  am  sometimes  tempted  to  ask," 
says  Dr.  W.  W.  Ireland,  '*  Is  the  assumption  correct 
that  we  have  reached  through  the  highest  power 
of  the  microscope  the  ultimate  elements  of  the 
brain  ? "  -^  The  question  is  interesting,  but  as  no 
satisfactory  answer  is  forthcoming  from  Dr.  Ireland 
or  from  anyone  else  we  need  not  let  it  prevent  our 
accepting  the  above  dicta.  For  an  explanation 
of  mental  abnormality  we  must  look  then  to  the 
state  of  the  nerve  cells.  But  man  does  not  consist 
of  nerve  cells  alone,  and  the  health  of  the  nerve 
cells  is  dependent,  to  an  extent  which  we  cannot  as 
yet  exactly  define,  on  the  integrity  of  cells  in  other 
parts  of  the  body. 

The  development  of  an  individual  human  being 
from  a  fertilised  egg-cell  is  the  resultant  of  certain 
obscure  forces  which  can  be  roughly  classified  with 
the  help  of  the  evolutionary  hypothesis.  Primitive 
bioplasm  has  a  power  of  responding  to  stimulation 
which  becomes  more  marked  as  differentiation  in 
the  direction  of  nervous  tissue  takes  place,  but  is  not 
lost  even  when  the  differentiation  is  in  some  other 

1  w.  W.  Ireland,  The  Mental  Affections  of  Children^  1900,  p.  72. 


94  THE   FEEBLE-MINDED  chap. 

direction.  The  state  of  any  particular  cell  and, 
consequently,  of  any  aggregate  of  cells  such  as  that 
constituting  a  tissue  in  a  highly  organised  type  like 
Man,  will  depend  on  its  intrinsic  power  of  response  ; 
on  the  mysterious  control  of  its  nutrition  which  we 
ascribe  to  the  trophic  influence  of  the  nervous 
system  ;  and  on  the  control  of  its  functional  activity 
which  may  be  exercised  by  the  nervous  vSystem. 
Nervous  and  non-nervous  cells  are  thus  mutually 
dependent  and  w^e  need  not  therefore  be  surprised 
to  find  that  one  system  does  not  suffer  without 
involving  the  other  in  its  misfortunes. 

The  physical  factors  of  feeble-mindedness  are 
to  be  sought  then  in  the  following  fields. 

(i)  The  nature  and  relations  of  the  nerve  cells. 

(2)  The  nature  and  relations  of  non-nervous 
elements. 

Since  in  any  given  case  it  may  be,  and  probably 
will  be,  impossible  to  assign  the  pathological 
condition  observed  to  its  exact  position  in  the  above 
scheme,  the  suggested  fields  must  be  regarded  as 
overlapping  to  a  greater  or  less  extent. 

In  preparing  this  account  of  the  pathology  of 
feeble-mindedness,  use  has  been  made  of  several 
series  of  cases  at  some  time  under  the  writer's  care. 
Different  aspects  of  the  subject  have  been  under 
review  at  the  times  when  the  different  series  were 
worked  over,  so  that  the  total  number  of  cases  is 
not  available  as  a  basis  for  statistics  in  regard 
to  each  point  dealt  with.  The  various  groups  which 
have  supplied  data  will,  however,  be  sufBciently 
indicated  in  connection  with  the  special  points  they 
serve  to  illustrate. 


IV       BASIS  OF  THE  FEEBLE  MIND       95 

The  notes  on  the  post-mortem  appearances, 
i.e.^  on  what  is  ordinarily  included  under  patho- 
logical anatomy,  are  derived  from  the  study  of  the 
bodies  of  the  patients  comprised  in  the  following 
series  : — 

A.  One  hundred  males  between  the  ages  of 
sixteen  and  forty-nine  years.  These  patients  were 
all  idiots  or  imbeciles,  so  that  the  degree  of  mental 
impairment  exhibited  during  life  was  considerable. 
No  cases  diagnosed  during  life  as  general  paralysis 
of  the  insane  are  included. 

A'.  One  hundred  males  corresponding  in  the 
main  to  series  A,  but  modified  so  as  to  comprise  fifty 
epileptic  and  fifty  non-epileptic  patients. 

B.  A  number  of  persons  of  all  ages  and  both 
sexes  in  regard  to  whom  the  reports  of  the  autopsies 
are  less  complete. 

An  investigation  of  the  abnormalities  observable 
during  life  was  conducted  with  the  help  of  the 
following  material  : — 

C.  A  series  of  150  male  patients  at  the  Belmont 
Asylum.  The  ages  of  these  ranged  from  sixteen 
to  fifty  years. 

D.  A  series  of  250  male  children  and  250 
female  children  between  the  ages  of  five  and  sixteen 
years. 

E.  A  series  of  100  males  between  the  ages 
of  sixteen  and  forty  years  who  were  subjected 
to  a  special  craniometric  examination  by  Dr. 
R.    J.    Gladstone. 

The  cases  in  series  D  and  E  were  inmates 
of  the  Darenth  Industrial  Colony  and  Training 
School  for  Imbeciles. 


96  THE   FEEBLE-MINDED  chap. 

(i)  The  nahire  and  relations  of  the  nerve-cells. — 
These  may  be  observed  directly  or  may  be  inferred 
from  the  results  of  the  activities  of  the  nerve  cells. 
They  may  be  conveniently  studied  from  three  points 
of  view. 

(a)  The  number  of  the  nerve- cells, — Pathologists 
are  very  generally  of  opinion  that  a  normal  mind  is 
never  found  associated  with  a  brain  of  less  than  a 
\  certain  weight,  e.g.,  36  ozs.  for  an  adult  human 
being.  Above  the  limit  mentioned  there  is  no 
simple  relation  between  the  weight  of  the  brain  and 
the  degree  of  mental  capacity,  but  it  is  worthy  of 
note  that  the  mean  weight  of  the  brain  in  mentally 
defective  persons  is  definitely  below  the  mean  weight 
of  normal  brains.  In  series  A  the  brains  ranged 
from  a  maximum  of  55  ozs.  to  a  minimum  of  1 5^  ozs.^ 
giving  a  mean  of  about  42  ozs.,  whereas  the  average 
weight  of  the  brain  in  mentally  normal  male  adults, 
as  ascertained  for  me  by  Dr.  Braxton  Hicks,  was 
49  ozs.,  an  estimate  agreeing  with  that  generally 
accepted. 

A  paucity  of  nerve  cells  such  as  is  here  suggested 
may  be  due  to  the  fact  that  an  adequate  supply  has 
never  been  provided  or  to  the  loss  of  cells  formerly 
present,  and  the  mere  absence  of  cells  does  not  throw 
any  light  on  the  matter.  There  is,  however,  reason 
to  think  that  both  factors  play  their  parts  in  the 
production  of  the  "feeble"  brain.  An  obvious  gap 
in  a  layer  of  nerve-cells  such  as  some  of  my  prepara- 
tions have  shown,  affords  strong  evidence  that  cells 

^  ^  This  brain    had  been  preserved  in  formalin,  a  method    which, 

according    to    Harper   {v.   Archives  of  Neurology,   vol.    iii.,    1907, 
p.  202),  adds  10%  to  the  weight. 


IV       BASIS  OF  THE  FEEBLE  MIND       97 

once  present  have  been  replaced  by  something  else.   \ 
That  ''something"  is  usually  the  neuroglia  and  this    1 
aspect  of  the  lack  of  cells  can  be  dealt  with  more    \ 
satisfactorily  when  that  tissue  is  being  considered.     ': 
It  appears,  however,  that  in  the  brains  of  the  feeble- 
minded   there   is   an    actual    non-development    of 
nerve-cells.      This,    at  any    rate,   is  the  deduction  ; 
from  his  careful  measurements  of  the  cortical  layers  I 
which  was  made  by  Dr.  J.  S.  Bolton  whose  paper  in   ! 
the  Archives  of   Neurology^    is  worthy  of  careful   | 
study. 

[d)  The  quality  of  the  nerve-cells, — The  normal 
histology  of  the  brain  has  hardly,  as  yet,  been 
worked  out  with  sufficient  thoroughness  to  render 
practicable  a  correct  interpretation  of  the  appear- 
ances observed  when  the  nerve-cells  of  defective 
brains  are  studied  microscopically.  Bevan  Lewis 
and  Tredgold  have  described  an  embryonic  type 
of  cell  with  few  processes,  large  ovoid  nucleus,  and 
rounded  contour  as  specially  characteristic  of  mental 
deficiency.  By  the  former  these  cells  were  thought  j 
to  occur  only  in  cases  complicated  by  epilepsy,  but  ' 
the  latter  observer  does  not  agree  with  this  view. 
Tredgold  ^  has  described  pigmentation  of  the  cortical 
nerve  cells  and  the  writer's  own  preparations  from 
other  regions  of  the  brain  have  afforded  instances  of 
a  similar  condition.  Of  the  cases  in  series  A, 
fifteen  were  examined  microscopically  after  staining 
by  Nissl's  method,  the  regions  from  which  sections 
were  taken  being  usually  the  hippocampal  gyrus  and 

1  J.  S.  Bolton,  "The  Histological  Basis  of  Amentia  and  Dementia," 
Archives  of  Neurology^  vol.  2,  1903,  p.  424. 
\A.  F.  Tredgold,  Mental  Deficiency,  1908,  p.  58 

H 


98  THE   FEEBLE-MINDED  chap. 

the  red  nucleus.  In  most  of  the  brains  there  was 
evidence  of  nerve-cell  degeneration,  which  amounted 
in  the  slighter  cases  to  chromatolysis  and  in  the  more 
advanced  to  loss  of  the  cell  processes,  swelling  of  the 
nucleus,  and  disintegration. 

(c)  The  proportion  of  the  different  types  of  cells. — 
While  admitting  that  nerve-cells  are  the  physical 
basis  of  mind,  one  has  to  recognise  that,  apparently, 
all  nerve  cells  are  not  of  equal  importance  in  the 
production  of  psychical  manifestations.  The  physio- 
logical activity  of  some  of  the  nerve  cells  does  not 
appear  to  affect  consciousness  perceptibly,  while  that 
of  others  commands  instant  attention.  As  a  result 
of  piecing  together  odd  fragments  of  knowledge 
acquired  in  the  course  of  ages,  we  have  come  to 
regard  the  cells  in  the  cortex  of  the  cerebral  hemi- 
spheres as  especially  endowed  with  the  function  of 
**  mentation,"  and  as  the  amount  of  white  matter  in 
the  hemispheres  is  dependent  on  the  amount  of  grey, 
we  might  expect  that  the  mass  of  the  hemispheres, 
as  compared  with  that  of  the  whole  brain,  would  be 
proportionately  less  than  in  normal  brains.  *'The 
statistics  of  various  observers,"  says  W.  Ford 
Robertson,  ''appear  to  prove  that  the  smaller  average 
weight  of  the  brain  of  the  insane  as  compared  with 
those  of  the  mentally  sound  is  dependent  upon  the 
cerebral  hemispheres  alone."  ^  In  order  to  discover 
whether  the  principle  so  enunciated  applied  to  the 
brains  of  the  feeble-minded  the  ratio  of  the  weight 
of  the  cerebrum  to  that  of  the  whole  encephalon  was 

1  W.  Ford  Robertson,  A    Text-book  of  Pathology  in  Relation  to 
Mental  Diseases^  1900,  p.  279. 


IV       BASIS  OF  THE  FEEBLE  MIND       99 

worked  out  for  the  brains  in  series  A.  The  pro- 
portion varied  widely  in  the  different  cases,  ranging 
from  a  maximum  of  92%  to  a  minimum  of  "J^jj^,  the 
mean  of  the  100  brains  being  '^'jy^.  On  the  strength 
of  observations  made  by  Huschke,  the  ratio  of  the 
cerebrum  to  that  of  the  whole  brain  in  normal 
persons  has  also  been  stated  as  87  to  100.  Dr. 
Braxton  Hicks,  Assistant  Pathologist  to  the 
Westminster  Hospital,  has  supplied  me  with  a  set 
of  figures  derived  from  the  brains  of  twenty-five 
mentally  sound  male  patients  for  comparison  with 
those  obtained  from  the  idiot  and  imbecile  patients 
in  series  A.  The  ratio  of  cerebrum  to  whole  brain 
varied  from  89%  to  82%,  i.e.,  not  nearly  so  widely  as 
in  the  case  of  the  mentally  defective  persons,  but 
the  mean  ratio  was  only  85-5%.  ix.,  1*5%  below  the 
mean  for  series  A.  We  get  therefore  no  corrobora- 
tion of  the  view  that  in  idiots  and  imbeciles  the 
cerebrum  is  relatively  less  developed  than  in  the 
sane,  indeed  the  evidence  points  in  the  opposite 
direction. 

A  common  feature  of  idiot  and  imbecile  brains,  ^ 
which  may  be  conveniently  dealt  with  here,  \^ 
Asymmetry,  shown  particularly  by  a  difference  in 
weight  of  the  cerebral  hemispheres  with  which  is 
associated  a  difference  in  the  opposite  direction 
between  the  weight  of  the  lateral  lobes  of  the 
cerebellum.  Differences  of  this  kind  occur 
also  in  normal  persons,  but  rarely  to  a  marked 
extent. 

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

II  2 


100  THE   FEEBLE-MINDED  chap. 

right  lobe  of  the  cerebelkim  weighed    2^  ozs.  and 
the  left  if  ozs. ;  in  another  the  weights  were  : 

Right  hemisphere igf  ozs. 

Left  hemisphere 13  ozs. 

right  lobe     ...  2  ozs. 

left  lobe  ....  24-  ozs. 


Cerebellum  -! 


These  were  the  brains  shown  In  Figs.  5,  6  and  7. 

The  relation  of  asymmetry  to  the  mental  state  is 
not  always  clear.  In  the  most  marked  cases  there  are 
usually  associated  with  it  sensory  and  motor  defects 
of  one  half  of  the  body  which  are  not,  apparently,  of 
great  psychical  moment.  There  must  be,  however, 
in  addition,  a  disturbance  of  the  psychical  equili- 
brium which  may  have  far-reaching  consequences. 
The  frequency  with  which  epileptic  seizures  were 
known  to  have  occurred  in  patients  exhibiting  cere- 
bral asymmetry  led  the  writer  to  enquire  to  what 
extent  this  relation  was  to  be  regarded  as  merely 
accidental.  For  this  purpose  a  series  of  a  hundred 
brains  corresponding  in  part  to  series  A,  but 
selected  so  as  to  comprise  the  brains  of  fifty 
epileptic  and  fifty  non-epileptic  idiots  and  Im- 
beciles (series  A^)  was  weighed  and  the  difference 
between  the  weights  of  the  two  hemispheres  noted. 
Among  the  epileptics  there  v/as  no  difference  in 
fourteen  cases  ;  In  three  of  the  remaining  thirty-six 
the  differences  recorded  were  respectively  1 1  ozs., 
9f  ozs.,  and  6f  ozs.,  and  the  mean  difference  for  the 
whole  fifty  brains  was  i'iq  ozs.  Of  the  non- 
epileptic  brains,  one,  a  case  of  cerebral  tumour,  had 
the  right  hemisphere  weighing  6f  ozs.  more  than 
the  left,  but  apart  from  this  the  greatest  difference 


Fig.  6. — The  same  brain  as  in  Fig.   5.     The  hemispheres  are  separated  and 
placed  so  as  to  emphasise  the  difference  in  size. 


Fig.  7. — Brain  of  an  epileptic  idiot  seen  from  the  front.  The  right  hemisphere 
weighed  19!  oz.  ;  the  left,  13  oz.  Note  the  opacity  of  the  pia- 
arachnoid  over  the  left  hemisphere. 


{Face  pa^e  100. 


IV       BASIS  OF  THE  FEEBLE  MIND     101 

observed  was  3  ozs.  (in  two  cases).  In  twenty-one 
cases  there  was  no  difference,  and  the  mean  difference 
for  the  whole  series  was  '59  oz.  Too  much  stress 
must  not  be  laid  on  the  curious  fact  that  the  ratio  of 
the  two  means  is  almost  exactly  2:1,  but  it  certainly 
appears  that,  as  detected  by  weighing,  asymmetry 
occurs  in  the  brains  of  epileptic  idiots  and  imbeciles 
to  a  much  greater  extent  than  in  non-epileptics  of 
the  same  class. 

The  cerebrum  may  also  show  departures  from  the 
normal  condition  as  regards  the  folds  into  which  the 
cortical  region  is  thrown.  The  term  "normal"  in 
this  connection  is  sufficiently  elastic  to  cover  a  good 
deal  of  variety  in  the  arrangement  of  the  cerebral 
convolutions,  but  healthy  brains  do  not  show  such 
extreme  diversity  as  is  found  in  the  brains  of 
mentally  defective  persons  of  low  grade.  The 
difficulty  of  correlating  the  observed  abnormalities 
with  the  peculiarities  of  the  mental  state  prevents 
our  attaching  great  importance  to  the  convolutional 
pattern  of  the  brain.  It  will  suffice  to  call  attention 
to  the  most  striking  features  of  idiot  brains  from  the 
topographical  standpoint. 

The  cerebral  hemispheres,  as  met  with  in  persons 
of  normal  development,  though  presenting  numerous 
differences  in  detail,  conform  to  a  certain  standard 
as  regards  the  disposition  of  the  chief  folds  and 
furrows  which  the  surface  exhibits.  The  fissures  of 
Sylvius  and  Rolando  and  those  fissures  or  sulci 
known  as  the  parieto-occipital,  the  calcarine,  the 
intra-parietal,  the  parallel  and  the  collateral,  to  name 
only  the  chief,  have  a  fairly  constant  relation  to  each 
other  in  the  brains  of  the  sane.     This  convolutional 


102  THE   FEEBLE-MINDED  chap. 

pattern  is,  however,  often  departed  from  in  the 
brains  of  idiots  and  imbeciles,  especially  when  the 
brain  is  very  small.  The  brain  depicted  in 
Figs.  1 6 — 1 8  affords  a  good  example  of  such  an 
abnormality.  At  both  sides  the  parieto-occipital 
fissure  is  confluent  with  the  intra-parietal,  while  at 
the  right  side  the  fissures  of  Sylvius  and  Rolando 
are  merged  in  a  single  furrow.  Apart  from  such 
striking  anomalies  as  these,  it  was  noted  that  very 
generally  the  brains  in  series  A  showed,  as  com- 
pared with  the  normal  brain,  a  simplicity  in  the 
convolutional  arrangement  suggestive  of  the  con- 
ditions found  in  animals  of  a  much  lower  grade  than 
that  attained  to  by  Man. 

Apparently  any  region  of  the  cerebrum  may  dis- 
play convolutions  which  are  much  larger  or  much 
smaller  than  the  average  size  for  the  brain.  The 
former  condition,  called  macrogyria,-^  is  rarely  pro- 
nounced, and  the  large  convolutions  seem  to  be  due 
simply  to  a  more  or  less  perfect  fusion  of  ordinary 
convolutions. 

Microgyria,  in  which  some  of  the  convolutions  are 
unduly  small,  is  of  more  frequent  occurrence.  Two 
types  of  it  can  be  recognised.  In  the  first,  which  is 
illustrated  in  Fig.  8,  there  appears  to  be  a  simple 
under-development  of  some  particular  portion  of  the 
cortex.  In  the  second,  which  will  be  better  dealt 
with  later,  the  smallness  of  the  convolutions  is  to  be 
explained  as  the  result  of  atrophic  changes. 

Marked  disturbance  of  the  arrangement  of  the 
convolutions  is  found  also  in  the  condition  known  as 

^  Schwalbe  {Die  Morphologic  der  Missbildungen  des  Me7tsche7t  und 
der  Tiere)  follows  Oekonomakis  in  preferring  the  term  "  pachygyria." 


Fig.    8. — Parietal  region  of  the   right  hemisphere   of  an  idiot   boy  aged  17, 
showing  microgyria. 


Fig.  9. — Left  hemisphere  of  the  brain  of  an  idiot,  showing  a  condition  of  true 

porencephaly. 


{Face  page  102. 


Fig.  io. — The  right  hemisphere  of  the  brain  represented  in  Fig.  9,  showing, 
instead  of  a  perforation  of  the  ventricular  wall,  a  depressed  area 
with  irregular  convolutions. 


Fig.  II. — Brain  showing  the  condition  known  as  pseudo-porencephaly. 


{Face  page  103. 


IV        BASIS  OF  THE  FEEBLE  MIND     103 

porencephaly,  in  which  there  is  a  gap  in  one  or  both 
of  the  cerebral  hemispheres,  the  resulting  cavity,  in 
a  well-defined  case,  being  continuous  with  the  lateral 
ventricle.  As  in  the  case  of  microgyria,  two  forms 
of  porencephaly  are  met  with.  Both  seem  to  own  a 
vascular  origin,  but  in  the  first  the  defect  is  develop- 
mental and  to  be  attributed  to  a  want  of  growth  of 
certain  parts  owing  to  the  absence  of  a  sufficient 
supply  of  blood  to  them,  while  in  the  second  it  is 
consequent  on  a  breaking  down  of  tissue  in  the 
affected  part  following  thrombosis  or  embolism  of  the 
vessels  leading  to  it.  In  the  former  type  the  region 
affected  is  usually  that  supplied  by  the  middle  cere- 
bral artery,  so  that  the  perforation  is  found  either 
about  the  posterior  part  of  the  Sylvian  fissure,  as  in 
the  brain  shown  in  Fig.  9,  or  along  the  whole  length 
of  the  normal  site  of  that  fissure,  as  in  the  case 
described  and  figured  by  Conolly  Norman  and  Alec 
Frazer.-^  As  will  be  seen  from  Fig.  9  the  occurrence 
of  this  type  of  porencephaly  is  associated  with  a 
radial  arrangement  of  the  convolutions  about  the 
cavity  which  makes  the  ordinary  nomenclature  in- 
applicable. This  brain  was  from  an  infant  female 
idiot  not  included  in  series  A.  One  case  in  the 
series,  that  of  a  male  aged  at  death  '^']  years,  showed 
a  condition  of  porencephaly  affecting  the  greater 
part  of  the  middle  and  lower  frontal  convolutions  at 
the  right  side.  In  both  cases  the  remaining  hemi- 
sphere was  also  abnormal,  though  there  was  no 
perforation  (v.  Fig.  10).  Fig.  11  shows  the  second 
type  of  porencephaly.     The    brain    was   that   of  a 

^  Conolly  Norman  and  Alec  Frazer,  "  A  Case  of  Porencephaly,'' 
Journal  of  Mental  Science^  Oct.,  1894. 


104  THE   FEEBLE-MINDED  chap. 

female  who  died  at  the  age  of  73  years  in  a  de- 
mented condition.  In  this  instance  the  mental 
defect  was  probably  not  congenital,  but,  as  illus- 
trating a  point  in  pathological  anatomy,  the  case 
will  serve. 

The  cerebrum  is  not  the  only  part  of  the  brain  to 
exhibit  abnormality  ;  both  the  cerebellum  and  the 
spinal  cord  may  be  involved  in  the  morbid  conditions 
which  have  given  rise  to  mental  defect.  In  addition 
to  the  asymmetry  and  the  relative  smallness  as  com- 
pared with  the  cerebrum  which  have  been  already 
referred  to,  the  cerebellum  may  show  complete 
failure  of  development  of  one  or  other  hemisphere, 
sclerosis,  microgyria,  agyria,  or  heterotopia  (v.  infra). 
A  moulding  of  the  hinder  region  to  the  shape  of  the 
foramen  magnum  was  several  times  observed  in 
association  with  hydrocephalus,  apparently  owing  to 
the  increase  in  the  intra-cranial  pressure,  and  there 
are  on  record  cases  in  which  this  process  of  com- 
pression has  advanced  so  far  that  the  fourth  ventricle 
has  been  obliterated  or  the  cerebellum  has  been 
flattened  out  over  the  upper  part  of  the  spinal 
cord. 

The  medulla  oblongata  has  been  found  deformed, 
especially  in  the  direction  of  a  more  or  less  complete 
splitting  into  two  lateral  portions,  and  similar  division 
of  the  cord  has  been  noted.  One  of  seven  cords 
examined  from  series  A  showed  a  condition  of 
hydromyelia,  and  heterotopia  occurs  in  the  cord  just 
as  in  other  parts  of  the  central  nervous  system.  It 
has  been  laid  down  by  Flechsig  and  others  that 
nerve  fibres  of  the  medullated  order  do  not  become 
efficient    until    the    medullary  sheath  is   developed 


IV        BASIS  OF  THE  FEEBLE  MIND     105 

Certain  of  the  nerve  fibres,  ^.^.,  those  of  the  pyra- 
midal tract,  do  not  ordinarily  become  medullated 
until  after  birth,  and  it  appears  that  the  acquisition  of 
voluntary  control  proceeds  pari  passu  with  the 
myelination  of  the  fibres  of  those  tracts.  It  might, 
consequently,  be  expected  that  the  defective  volition 
of  idiots  would  be  associated  with  a  want  of  develop- 
ment of  the  pyramidal  tract  fibres.  This  anticipation 
is  not  fully  realised.  Sections  of  the  spinal  cord  in 
idiots  show  areas  of  degeneration  corresponding  to 
gross  cerebral  lesions,  but  there  does  not  seem  to  be 
in  cases  of  congenital  mental  defect  characterised  by 
volitional  incapacity  a  persistence  of  the  primitive 
condition  of  non-myelination  such  as  would  explain 
the  patients'  deficiency  in  this  respect.  In  seven 
cords  from  cases  in  series  A  no  very  definite 
features  which  could  be  correlated  with  the  mental 
state  were  observed,  but,  in  several,  degenerated 
nerve  fibres  were  found  scattered  through  the  white 
matter. 

As  was  noted  when  the  basis  of  the  normal  mind 
was  under  consideration,  the  nerve  cells  in  the  cere= 
brum  have  not  all  the  same  function.  A  dispro- 
portion, as  compared  with  the  ratio  observed  in  the 
normal  brain,  in  the  cortical  areas  corresponding  to 
sensorimotor  and  associational  functions  is  often 
observable  in  the  brains  of  idiots,  but  it  follows  no 
simple  rule,  and  its  relation  to  the  character  of  the 
mental  defect  is  not  usually  obvious.  Sometimes,  as 
in  several  of  the  brains  figured,  the  distinction  between 
the  lobes  is  so  much  obscured  that  it  is  difficult  to 
decide  what  regions  are  to  be  compared  with  normal 
sensorimotor  and  association  areas. 


106  THE   FEEBLE-MINDED  chap. 

If,  proceeding  a  stage  further,  we  try  to  Infer  the 
kind  or  degree  of  mental  defect  from  the  proportions 
of  small,  medium  and  large  pyramidal  cells,  to  say 
nothing  of  the  other  varieties  of  nerve  cells,  in  a 
particular  portion  of  the  cortex  of  an  idiot's  brain,  our 
ignorance  of  the  respective  functions  of  these  differ- 
ent types  of  cells  in  the  normal  cortex  prevents  our 
arriving  at  very  definite  conclusions.  Some  valu- 
able information  on  the  subject  has,  however,  been 
contributed  by  J.  S.  Bolton,^  who  has  measured  in  a 
number  of  brains  the  thickness  of  the  different 
cortical  layers.  Four  imbecile  brains  examined  by 
him  showed  marked  reduction  in  this  respect  as 
compared  with  the  normal  brain.  This  appears  from 
the  following  table,  in  which,  the  whole  thickness  of 
the  normal  cortex  being  represented  by  loo,  the 
average  thickness  of  each  of  the  various  layers  was 
approximately  as  stated. 


No.  of  layer. 

Normal  brain. 

Imbecile  brain. 

I.  Superficial  fibres     ... 

14-5 

13-5 

2.  Pyramidal 

44 

35*5 

3.  Granular       

13 

10 

4.  Inner  fibres 

12-5 

IO-5 

5.  Polymorphic  cell     ... 

16 

i4'5 

100  84 

It  is  interesting  to  note  that  the  ratio  of  the 
different  kinds  of  cells  in  the  brain  of  the  imbecile 
when  estimated  by  this  method  does  not  differ  in 
any  significant  way  from  the  ratio  in  the  healthy 
brain. 

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

^  J.  S.  Bolton,  loc,  cit. 


IV        BASIS  OF  THE  FEEBLE  MIND     107 

already  been  made  to  the  conflicting  views  which 
are  held  by  rival  schools  of  anatomists  as  to  the 
nature  of  the  connection  between  the  nerve-cells. 
Such  connection  is  admittedly  effected  by  means  of 
the  processes  given  off  from  the  cells,  but  whether 
the  processes  are  actually  continuous  with  one 
another  or  not  remains  in  doubt.  The  neuronic 
doctrine  which  assumes  the  existence  of  gaps  or 
'* synapses"  between  the  processes  has  something 
to  recommend  it  in  that  it  greatly  facilitates  the 
explanation  of  the  way  in  which  the  nerve-cells 
interact.  At  any  rate  it  is  clear  that  undue 
separation  of  nerve-cells,  or  rather  of  their  processes, 
would  involve  serious  interference  with  the  proper 
performance  of  their  functions,  and  it  is  possible  that 
this  is  one  of  the  ways  in  which  the  overgrowth  of 
neuroglia,  which  diseased  brains  sometimes  show, 
produces  its  injurious  effects. 

The  particular  conformation  of  the  central 
nervous  system  with  which  we  are  familiar,  although 
no  doubt  determined  by  efficient  if  not  very 
intelligible  forces,  does  not  appear  theoretically  to  be 
essential  to  the  proper  performance  of  its  functions. 
A  given  mass  of  nerve-cells  might  conceivably  be 
arranged  in  different  ways  without  interruption  of 
the  communicating  channels  between  the  cells. 
Abnormality  in  the  relative  distribution  of  grey  and 
white  matter  in  the  brain  may  consequently  be  of 
little  or  much  significance  from  a  psychic  standpoint. 
Heterotopia,  as  this  condition  is  called,  occasionally 
occurs  in  association  with  mental  defect.  The  few 
cases  known  exhibit  considerable  diversity  as  to 
form.     Von  Monakow  described  six  types,  and  later 


108  THE   FEEBLE-MINDED  chap. 

H.  Vogt  arranged  the  recorded  cases  in  five  groups. 
A  review  of  their  respective  schemes  is  given  by 
Schwalbe.-^  For  a  detailed  study  of  a  case  reference 
may  be  made  to  the  paper  by  H.  G.  Stewart^  in  the 
Archives  of  Neurology  and  Psychiatry.  Another 
rare  abnormality  is  absence  of  the  corpus  callosum. 
Of  this  condition  there  was  one  instance  in  series  A, 
the  hemispheres  being  connected  dorsally  to  the 
third  ventricle  only  by  a  thin  band  of  tissue 
continuous  with  the  lining  of  the  lateral  ventricles. 

(2)  The  7iature  and  relations  of  non-nervous  cells. 
— It  is  something  more  than  an  accidental  circum- 
stance that,  as  recorded  in  every  description  of  the 
feeble-minded  which  aims  at  completeness,  bodily 
defects  should  occupy  so  prominent  a  place  in  the 
clinical  picture.  A  section  on  the  ''  physical  "  charac- 
teristics or  "  bodily  symptoms "  is  a  recognised 
institution  in  the  preparation  of  a  text-book  dealing 
with  the  feeble-minded,  and  it  would  be  improper  to 
disregard  this  aspect  of  the  subject.  It  would  be 
well,  however,  to  adopt  a  somewhat  more  critical 
attitude  than  is  usually  taken  up  in  assigning  to  the 
''  stigmata"  of  feeble-mindedness,  as  they  are  called, 
their  correct  place  as  diagnostic  criteria.  In 
speaking  of  the  cells  other  than  nerve  cells  which 
may  be  implicated  in  cerebral  defects  they  will  only, 
except  in  special  cases,  be  considered  in  the  mass  as 
constituting  tissues  and  organs,  for  the  process  of 
physiological  analysis  has  not  yet  reached  such  a 

1  E.  Schwalbe,  Die  Morphologic  der  Missbildungeii  des  Menschen 
und  der  Tiere.     3  Teil^  1909. 

2  H.  G.  Stewart,  "A  Description  of  the  Brain  of  an  Epileptic 
Imbecile,  Showing  Extensive  Heterotopia  of  the  Grey  Matter," 
Archives  of  Neurology  a7id  Psychiat?y^  1909,  P-  289. 


IV       BASIS  OF  THE  FEEBLE  MIND     109 

degree  of  thoroughness  as  to  supply  data  of  other 
than  the  most  general  character.  Abnormalities  of 
non-nervous  cells  are  here  only  of  interest  in  so  far 
as  they  are  associated  with  nerve-cell  defects.  The 
relation  between  the  two  kinds  of  cells  is  twofold,  in 
that  the  changes  in  either  may  be  secondary  to 
changes  in  the  other.  Of  the  peculiarities  which 
the  bodies  of  the  feeble-minded  display,  some  may 
be  regarded  as  due  to  nerve-cell  lesions,  while  others 
are  to  be  looked  upon  as  causes  and  not  as  conse- 
quences of  nerve  defects.  The  paralysis  and 
wasting  of  a  limb  which  follow  on  a  cerebral 
haemorrhage  are  of  the  former  variety,  while  the 
degeneration  of  nerve  cells  which  follows  an  intra- 
uterine amputation  of  that  limb,  or  the  rupture 
during  the  act  of  birth  of  the  nerves  supplying  it, 
belongs  to  the  latter.  In  general  there  is  an  inter- 
action of  the  two  sets  of  conditions  which  makes  it 
useless  to  attempt  to  designate  one  of  them  as  a  cause 
in  opposition  to  the  other.  Take,  for  instance,  the 
sequence  of  events  which  Ford  Robertson  describes 
as  occurring  in  cerebral  degeneration.  As  a  result 
of  "more  metabolism  In  the  cerebral  tissues,"  or  of 
**a  morbid  condition  of  the  blood  from  which  the 
fluid  is  derived,"  the  cerebro-spinal  fluid  becomes 
abnormal.  In  this  condition  it  produces  changes, 
those  in  the  dura  mater  being  of  special  importance, 
which  result  in  lymphatic  obstruction.  This 
obstruction  causes  disturbances  of  the  Intra-cranlal 
pressure  and  progressive  contamination  of  the 
cerebro-spinal  fluid  which,  of  course,  react  injuriously 
on  the  nutrition  of  the  nerve  cells.  Thus  a  vicious 
circle    is    set    up    which    promotes    steady    depre- 


110  THE   FEEBLE-MINDED  chap. 

elation  In    the  value  of  the    brain   as  an  organ  of 
mind. 

In  describing  abnormalities  of  the  non-nervous 
cells,  tissues,  or  organs,  one  may  begin  with  those  in 
the  most  intimate  anatomical  relationship  with  the 
purely  nervous  elements. 

I.  First  in  importance  comes  the  internal  support- 
ing and  connective  tissue  of  the  central  nervous 
system.  This,  according  to  Ford  Robertson,  is 
derived  from  two  sources,  the  one  being  the 
primitive  external  layer  of  the  body,  the  epiblast, 
from  which  the  nerve  cells  also  are  derived,  and  the 
other  the  primitive  middle  layer  or  mesoblast.  He 
reserves  the  name  neuroglia  for  the  first  type 
of  tissue,  and  designates  the  second  mesoglia. 
Although  the  two  forms  are  said  to  be  present  in 
about  equal  proportions,  it  is  apparently  the 
neuroglia  in  which  take  place  the  changes  associated 
with  abnormality  of  the  nerve  cells.  To  the  mesoglia 
elements  Ford  Robertson  refers  the  formation  of 
amyloid  bodies,  and  the  colloid  bodies  found  in  some 
of  the  writer's  preparations  may  perhaps  have  a 
similar  origin. 

{a)  The  neuroglia  is,  it  would  appear,  susceptible 
of  a  general  or  local  overgrowth  (gliosis),  which  may 
or  may  not  be  followed  by  a  shrinking  of  the  over- 
grown tissue  leading  to  induration.  We  may 
consider  these  conditions  under  the  following  heads. 

I.  General  hypertrophy.  Of  the  brains  in  series 
A  some  exceeded  in  weight  the  average  of  the 
normal  brain.  The  heaviest  weighed  55  ozs.,  while 
others  were  respectively  52^  ozs.,  5i|-  ozs.,  and 
51  ozs.,  while  much  heavier  brains,  e.g.,  one  weighing 


TV        BASIS  OF  THE  FEEBLE  MIND     11] 

71  ozs.  from  a  patient  formerly  under  the  writer's 
care,  have  been  from  time  to  time  recorded.  That 
It  should  be  possible  to  have  brains  of  such  magni- 
tude Identified  with  obvious  defect  of  Intelligence  Is 
to  be  explained  by  supposing  that  the  excess  In 
weight  Is  due  to  other  than  nervous  tissue,  and  a 
relative  excess  of  neuroglia  Is  demonstrable  In  such 
cases  under  the  microscope. 

II.  Localised  hypertrophy.  In  nine  of  the  cases  in 
series  A  the  walls  of  the  lateral  ventricles  and  of 
the  fourth  ventricle  showed  a  condition  of  granula- 
tion, while  in  six  others  the  change  was  confined  to 
the  fourth  ventricle.  These  granulations  are 
generally  held  to  be  due  to  an  Irregular  overgrowth 
of  the  neuroglia,  and  perhaps  one  should  Include  as 
due  to  the  same  cause  the  appearance  of  granulation 
of  the  cerebral  cortex  which  was  noted  in  five  cases 
of  the  series,  and  a  peculiar  "cross-hatching"  of  the 
upper  ends  of  the  ascending  frontal  and  ascending 
parietal  convolutions  which  was  observed  In  one 
case. 

(d)  Sometimes  as  a  result  of  contraction  of  the 
neuroglia,  and  sometimes  without  there  being  diminu- 
tion In  the  bulk  of  the  affected  part,  the  brain  sub- 
stance is  found  to  display  Increased  resistance  to 
pressure  or  to  the  knife.  A  certain  amount  of 
Induration  seems  also  to  characterise  the  hyper- 
trophy above  mentioned.  To  such  a  change  the 
term  sclerosis  is  applied.  The  sclerotic  process, 
like  the  gllotic,  may  Involve  much  or  little  of  the 
cerebral  structure.  To  It  are  to  be  referred  the 
most  marked  Instances  of  asymmetry,  as  for  example 
that  shown  in  Fig.  5. 


112  THE   FEEBLE-MINDED  chap. 

The  forms  of  secondary  microgyria,  as  illustrated 
by  Fig.  12,  are  also  attributable  to  sclerosis.  A 
third  and  quite  distinct  variety  unaccompanied  by 
contraction  is  the  ''  tuberose "  which  will  be  con- 
sidered in  greater  detail  subsequently. 

Prominence  has  been  given  by  various  writers  to 
a  reputed  connection  between  epilepsy  and  a 
sclerosis  of  the  part  of  the  brain  known  as  the 
cornu  Ammonis.  In  order  to  test  the  correctness 
of  an  Idea  so  generally  prevalent  the  writer  examined 
microscopically  sections  from  the  hippocampal  region 
of  fifteen  brains.  These  comprised  eleven  from 
cases  of  Idiocy  and  imbecility  complicated  by 
epilepsy  ;  three  from  cases  of  non-epileptic  Idiocy  ; 
and  one  from  a  case  of  general  paralysis  of  the 
insane.  The  results  obtained  may  be  stated  briefly 
thus  : — 

1.  Non-epileptic  :    cornu  normal  at  both  sides. 

2.  Non-epileptic  :  extensive  degeneration,  but  no 
marked  sclerosis. 

3.  Non-epileptic  :  right  cornu  sclerotic. 

4.  Epilepsy  of  exceptionally  severe  character  : 
slight  sclerosis. 

5.  Epilepsy  of  mild  character  :  slight  sclerosis. 

6.  Epilepsy  of  medium  character  :  degeneration, 
but  no  definite  sclerosis. 

7.  Like  6. 

8.  Epilepsy — patient  had  only  one  fit  In  eighteen 
months  :  there  was  extreme  sclerosis  at  the  right 
side. 

9.  Epilepsy  of  moderately  severe  type :  slight 
sclerosis. 

10.  Epilepsy    of  mild   type — about  two   fits  per 


Fig.  12.— Right  hemisphere  of  the  brain  of  an  idiot,  showing  microgyria. 


Fig.  13, — A  Mongolian  imbecile. 


{Face  pa^e  112, 


IV       BASIS  OF  THE  FEEBLE  MIND     113 

month  :    marked   sclerosis,  especially   at   the    right 
side. 

11.  Epilepsy  of  mild  type^about  one  fit  per 
month  :  moderate  sclerosis  both  sides. 

12.  Epilepsy  of  mild  type — about  one  fit  per 
month  :  marked  sclerosis,  especially  at  the  right  side. 

13.  Epilepsy  of  severe  character  :  sclerosis  both 
sides. 

14.  Epilepsy  of  moderate  severity :  slight 
sclerosis. 

15.  General  paralysis  :  no  sclerosis. 

There  was  thus  no  simple  relation  between  the 
frequency  or  the  severity  of  the  epileptic  seizures 
and  the  degree  of  sclerosis  observed,  though  there 
was  some  sort  of  proportion  between  the  amount  of 
sclerosis  and  the  intensity  of  the  mental  defect 
exhibited. 

2.  The  ependyma, — The  cavities  of  the  brain  and 
cord  are  lined  by  a  delicate  epithelial  layer,  which 
does  not  usually  show  any  obvious  abnormality  in 
defective  brains,  for  the  granulations  sometimes 
visible  upon  its  surface  are  probably,  as  mentioned 
above,  to  be  referred  to  the  neuroglia.  In  the  brain 
which  was  found  to  lack  a  corpus  callosum,  the 
ependyma  of  the  lateral  ventricle  was  so  thick  and 
tough  that  it  could  be  stripped  off  as  a  definite 
membrane.  In  another  case  the  aqueduct  of 
Sylvius  was  occupied  by  a  strand  of  white  tissue 
which  appeared  to  spring  from  a  point  in  the 
ependyma  at  the  upper  part  of  the  opening  of  the 
aqueduct  into  the  third  ventricle.  This  might  have 
been  regarded  as  a  clot  formed  from  the  cerebro- 
spinal fluid  but  for  the  fact  that  the  cerebro-spinal 


114  THE   FEEBLE-MINDED  chap. 

fluid  is  not  known  to  clot.  The  case  of  porencephaly 
illustrated  in  Fig.  9  showed  the  apparently  normal 
ependyma  of  the  ventricle  thickened  around  the 
inner  orifice  of  the  perforation,  and  gradually  acquir- 
ing the  characters  of  the  abnormal  pia-arachnoid 
which  lined  the  more  superficial  parts  of  the 
opening. 

3.  The  vascular  system. — Gross  lesions  of  the 
intra-cranial  blood-vessels  were  not  a  conspicuous 
feature  of  the  brains  in  series  A,  although  irregular- 
ities in  the  distribution  of  the  arteries  supplying  the 
brain  were  observed  in  association  with  the 
encephalic  deformities  already  mentioned.  One 
case  showed  the  remains  of  a  small  haemorrhage  in 
the  corpus  striatum,  while  another  had  a  larger  one 
in  the  left  lobe  of  the  cerebellum.  In  two  others 
there  were  patches  of  softening  in  various  parts  of 
the  hemispheres,  and  in  a  third  the  choroid  plexuses 
were  cystic.  The  most  significant  feature  in  this 
connection  was,  however,  the  prevalence  of  a  con- 
dition characterised  by  a  superabundance  of  cerebro- 
spinal fluid.  In  forty-eight  of  a  hundred  cases 
there  was  definite  excess  of  cerebro-spinal  fluid  as 
compared  with  the  normal  state,  and  in  thirty-six  of 
the  cases  the  excess  was  pronounced.  Thirteen  of 
the  last  mentioned  cases  had  one  or  both  lateral 
ventricles  definitely  enlarged  with  associated 
thinning  of  the  hemisphere  wall  and  flattening  of  the 
convolutions,  but  in  the  remaining  cases  the  ac- 
cumulation of  fluid  had  occurred  chiefly  between  the 
dura  and  the  surface  of  the  brain. 

4.  The  meninges. 

(a)  The   pia-arachnoid.       Opacity,    localised    or 


IV       BASIS  OF  THE  FEEBLE  MIND     115 

general,  increase  in  thickness  and  an  exaggerated 
toughness  are  the  morbid  conditions  which  are  most 
commonly  displayed  by  the  pia-arachnoid.  These 
changes  proceed  along  approximately  parallel  lines 
and  are  usually  attributed  by  pathologists  to  de- 
generative processes  affecting  the  membrane.  They 
were  present  together  in  twenty-four  cases  belong- 
ing to  series  A,  while  of  the  rest  fifteen  displayed 
opacity  without  any  special  thickening  and  in  nine 
the  pia-arachnoid,  though  thick  and  tough,  was  not 
noticeably  opaque.  The  condition  was  usually  most 
marked  over  the  frontal  lobe.  In  nine  of  the  forty- 
eight  cases  just  mentioned  the  pia-arachnoid  was 
adherent  to  the  convolutions.  Adhesion  of  the 
adjacent  faces  of  the  hemispheres  was  common  and 
the  membrane  covering  one  of  the  spinal  cords 
examined  showed  a  large  number  of  osteoid  plates. 
In  two  cases  there  were  adhesions  between  the  pia- 
arachnoid  and  the  dura  mater.  Illustrations  of 
thickened  and  opaque  pia-arachnoid  are  shown  in 
Figs.  5  and  7. 

{b)  The  dura  mater.  The  morbid  conditions 
observed  in  this  structure  may  be  summed  up  as 
follows  : 

Unduly  adherent  to  the  skull            5% 

Increased  in  thickness             ...         ...         ...         ...  6% 

Studded  with  tubercles            1% 

Subdural  false  membrane       1% 

In  one  of  the  cases  showing  increased  thickness  it 
was  noted  that  the  dura  was  soft  and  easily  separ- 
able into  layers. 

5.  The  skull-cap. — Abnormalities  of  varied  char- 
acter are  found  in  connection  with   mental  defect. 

I  2 


116  THE   FEEBLE-MINDED  chap. 

Those  recorded  in  this  section  are  in  regard  to 
thickness  and  density.  They  may  be  thus  arranged 
for  series  A. 


Normal  density.  Softening.  Hardening. 

Normal  thickness 

—                  —                  I 

Thinning 

l8                           2                         I 

Thickening 

12                         —                      lO 

These  figures,  which  include  all  degrees  of  the 
condition,  were  obtained  by  rough  and  ready 
methods,  the  only  standard  of  comparison  being  the 
observer's  mental  picture,  at  the  time,  of  the  state 
of  the  normal  skull-cap.  Although  no  examples 
occurred  in  this  series,  softening  is  sometimes  found 
associated  with  both  thickening  and  normal  thick- 
ness of  the  bone. 

6.  The  scalp.- — One  instance  of  the  rare  and 
rather  striking  condition  known  as  hypertrophy,  in 
which  the  scalp  is  raised  into  a  number  of  antero- 
posterior folds  as  though  it  were  too  big  for  the 
underlying  skull,  occurred  in  the  series.  The  case 
was  that  of  the  microcephalic  idiot  whose  brain  is 
shown  in  Fig.  19. 

7.  The  sense-organs, — A  cursory  inspection  of  the 
cases  in  series  C  and  D  revealed  the  following 
abnormalities  in  the  organs  of  sight  and  hearing. 

The  eyes : — 

Blindness  

Unequal  pupils 

Squint      

Ptosis       

Nystagmus  

Cataract 

In  addition  all  grades  of  defective  vision  were 
found. 


Males  (400). 

Females  (250). 

5 

6 

24 

3 

IS 

II 

10 

— 

6 

4 

4 

I 

IV        BASIS  OF  THE  FEEBLE  MIND     117 

The  ears  : — 

Males  (400).  Females  (250). 
Different    in     shape,     size,    or 
prominence     ...         ...         ...                    26  4 

Different  in  position      =9  — 

Large  and  prominent 15  3 

Deafness  of  all  degrees  was  also  noted. 

8.  The  1no^Uh. — This  may  be  considered  as 
regards  : 

{a)  The  palate.  From  time  to  time  a  good  deal 
of  stress  has  been  laid  on  the  supposed  connection 
between  mental  and  palatal  abnormalities.  Without 
committing  ourselves  to  any  statement  as  to  their 
significance  we  may  note  that  defects  of  the  bony 
palate  do,  in  fact,  occur  fairly  frequently  among  the 
feeble-minded.  There  is  endless  diversity  in  regard 
to  the  forms  of  defect  found,  but  for  the  purpose  of 
classification  the  scheme  employed  in  the  following 
table  will  prove  convenient. 

Males  (400).    Females  (250). 

Normal 

Wide  and  flat      

Narrow  and  high  

Deformed  

400  250 

In  the  writer's  experience,  if  there  be  any  one  of 
these   types   which    is    especially   characteristic    of 
idiocy  it  is  the  second,  which,  so  far  as  he  is  aware, 
has  not  previously  had  attention  directed  to  it. 

(U)  The  teeth.  The  teeth  of  idiots  and  imbeciles 
are  often  defective,  but  anything  like  a  complete 
description  of  the  conditions  found  would  occupy  far 
too  much  space.  Undue  crowding  or  separation 
and  other  irregularities  of  arrangement,  together 
with  abnormalities  as  regards   size,    shape,    or  the 


206 

136 

43 

43 

no 

63 

41 

8 

118  THE    FEEBLE-MINDED  chap. 

state  of  the  enamel,  are  met  with.  SolHer  described 
as  peculiar  to  idiots  a  condition  in  which  the  mouth 
cannot  be  completely  closed,  the  hindmost  molars 
alone  coming  into  apposition. 

The  following  notes,  which  have  been  kindly  contributed  by 
Mr.  C.  Edward  Wallis,  will  be  of  interest  in  this  connection. 

"  An  experience  of  many  years  in  attending  to  the  mouths  and  teeth 
of  imbecile  and  epileptic  children  shows  clearly  that  the  statements 
that  are  copied  from  one  text-book  to  another  as  to  maxillary  and 
dental  deformities  are  devoid  of  any  appreciable  foundation. 

"  Speaking  broadly,  one  finds  far  more  well-shaped  jaws  among  these 
children  than  among  the  so-called  normal  children  to  be  seen  in 
everyday  life,  whether  in  public  elementary  schools  or  in  private 
practice  amongst  the  better  classes. 

"The  mistake  has  perhaps  arisen  in  the  past  from  a  want  of  dis- 
crimination on  the  part  of  medical  examiners  between  deformities  of 
the  jaws  which  are  real  and  deformities  which  are  apparent  ;  that  is 
to  say,  in  which  the  maxilla  appear  to  be  too  high  or  perhaps 
asymmetrical  owing  to  a  general  irregularity  produced  by  misplaced 
teeth,  the  result  of  neglect  in  childhood. 

"A  detailed  examination  of  some  thousands  of  these  children  over 
a  long  period  leads  me  to  think  that,  as  compared  with  the  ordinary, 
epileptic  and  imbecile  children  have,  as  a  class,  exceedingly  well- 
developed  jaws,  and  are  above  the  average  as  regards  freedom  from 
caries. 

"  In  Mongolian  imbeciles  one  not  infrequently  finds  an  hypertrophy 
of  the  mucous  membrane  of  the  sides  of  the  palate  leading  to  the 
appearance  of  a  high,  narrow  palatine  arch,  whereas  the  actual  bony 
arch  may  be  exceedingly  well-shaped." 

For  some  time  past  Mr.  Wallis  has  been  making 
observations  on  the  subject  of  the  "  torus  palatinus  " 
or  palatine  ridge,  and  he  has  come  to  the  conclusion 
that  in  bad  cases  of  imbecility  this  ridge  is  more 
pronounced  than  among  less  advanced  cases,  though 
as  to  the  genesis  of  this  "  torus  "  we  are  completely 
in  the  dark  at  present. 

As  regards  the  lower  jaw  Mr.  Wallis  notes  that 
"the  mandible  is  seldom  deformed  in  imbeciles 
though    here   and    there,    owing    to    an     imperfect 


IV       BASIS  OF  THE  FEEBLE  MIND     119 

development  of  the  maxilla,  the  lower  teeth  may 
bite  in  front  of  the  upper  ones  and  produce  the 
deformity  known  as  underhung  jaw  or  '  inferior 
protrusion.  ' " 

9.  The  head  as  a  whole, — {a)  Asymmetry  : — 
Note  was  made  in  reviewing  the  cases  in  series  C 
and  D  as  to  the  presence  or  absence  of  unlikeness 
between  the  right  side  and  the  left  so  far  as  the  head 
was  concerned.  Such  asymmetry  as  was  due  to 
differences  in  the  regions  of  attachment  of  the  ears 
or  to  optical  defects  has  been  already  referred  to. 
Other  forms  are  grouped  together  according  to  their 
degree  in  the  following  table. 

Slight.     Well-marked. 

Males  (400)         47  22 

Females  (250) ii  i6 

(by  Head  measurements  : — For  the  notes  in  this 
connection  series  C  and  E  were  employed.  The 
measurements  in  the  first  group  were  made  by  my- 
self while  those  in  the  second  were  made  with  some- 
what greater  exactitude  by  Dr.  Gladstone.  In  both 
series,  since  the  patients  were  living,  the  thickness 
of  the  scalp  has  to  be  taken  into  consideration. 

Series  C. — The  following  measurements  were 
taken  to  the  nearest  \  cm. 

{c)  Circumference  along  a  line  passing  in  front 
just  above  the  upper  margins  of  the  orbits  and  behind 
over  the  occipital  protuberance. 

(/)  Distance  from  the  glabella  to  the  occipital 
point. 

(K)    Maximum  parieto-squamous  diameter. 

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


120  THE   FEEBLE-MINDED  chap 

product  by  /,  was  estimated  in  each  of  the  1 50  cases. 
Details  are  given  in  a  contribution  to  the  Annual 
Report  of  the  Metropolitan  Asylums  Board,  1907,  but 
a  summary  of  the  results  will  suffice  for  our  present 
purpose.  Indices  ranging  from  88*8  to  71*42  were 
obtained,  the  average  being  7  7  "9.  The  greatest 
circumference  noted  was  65  cm.  and  the  least  48  cm., 
the  average  being  53*69  cm. 

Dr.  Ford  Robertson  gives  as  average  measure- 
ments of  the  normal  British  skull, 

Cephalic  Index,  78  ;  Circumference,  503  to  534  mm. 

Allowance  beinor  made  for  the  thickness  of  the 

o 

skull,  which  would  affect  more  particularly  the 
circumference,  the  evidence  indicates  that  so  far  as 
the  circumference  and  the  cephalic  index  are  con- 
cerned, idiots  and  imbeciles  depart  very  little  from  the 
normal. 

Series  E. — During  the  course  of  an  enquiry  which 
he  was  conducting  into  the  relation  of  the  size  and 
shape  of  the  head  to  mental  ability,  Dr.  R.  J. 
Gladstone  measured  the  heads  of  100  patients  at 
Darenth  Asylum.  Two  groups  were  selected  for 
him,  care  being  take  to  exclude  any  cases  displaying 
striking  abnormalities  such  as  microcephaly  or 
hydrocephaly.  The  first  group  consisted  of  50  males 
between  20  and  40  years  of  age  who  were  capable  of 
doing  useful  work  under  supervision  and  who  were 
employed  in  workshops  on  the  premises  as  tailors, 
shoemakers,  carpenters,  etc.  The  second  comprised 
50  males  of  similar  age  to  those  in  group  i,  but 
incapable  of  doing  any  useful  work  and  of  a  distincdy 
lower  grade  of  intelligence  than  were  the  patients  in 
group  1 .     The  measurements  taken  were  :: — 


IV       BASIS  OF  THE  FEEBLE  MIND     121 

(/)  Length  of  head  from  glabella  to  occipital 
point. 

{b)  Breadth  of  head,  i.e.,  maximum  transverse 
diameter,  above  the  level  of  the  zygomatic  arches. 

(h)  Height  of  head,  i.e.,  the  vertical  distance  from 
the  biauricular  line  to  the  bregma. 

Dr.  Gladstone  has  kindly  placed  at  my  disposal 
the  following  figures  which  he  obtained.  The 
measurements  are  expressed  in  millimetres. 

Length  of  head. 
Maximum. 

Workers     ...         209 

Non-workers         ...         ...         203*5 

Breadth  of  head. 

Workers    ., 171 

Non-workers         165*5 

Height  of  head. 

Workers     144*1 

Non-workers         ...         ...         150*7 

''It  will  be  observed,"  he  says,  "on  comparing  the 
mean  diameter  of  the  heads  of  the  workers  with 
that  of  the  non-workers  that  there  is  a  diminution  in 
each  of  the  principal  dimensions  amounting  to  2  mm. 
in  the  longitudinal  diameter,  i  mm.  in  the  transverse, 
and  2*1  mm.  in  the  vertical.  It  will  also  be  noticed 
that  there  is  a  very  considerable  difference  between 
the  maximum  and  minimum  diameters  in  both 
classes  which  far  exceeds  that  which  would  be 
present  in  an  equal  number  of  sane  individuals  of  the 
same  age  and  sex.  This  greater  variability  in  the 
size  of  the  head  in  imbeciles  as  compared  with  the 
sane  may  be  readily  seen  by  comparing  the  tables 
given  above  with  a  table  showing  the  same  measure- 
ments in  normal  individuals." 


Average. 
186*5 
184-5 

Minimum. 
156 
165 

1 45 '4 
144*4 

126 
129 

127*8 
125*7 

112 
112 

122  THE   FEEBLE-MINDED  chap. 

For  comparison  with  the  above  figures  the 
following  table,  which  shows  the  corresponding 
measurements  for  a  group  of  230  adult  males,  mostly 
of  the  Professional  class,  was  prepared  by  Dr. 
Gladstone  : — 

Maximum.  Average.  Minimum. 

Length  of  head  210  197  183 

Breadth  of  head  163  153  138 

Height  of  head 155  138  121 

Two  facts  appear  from  the  above  data.  In  the 
first  place  the  mean  diameters  of  the  head  are 
considerably  greater  in  the  normal  individuals  than 
in  the  imbeciles,  and  in  the  second,  the  variability  in 
size  of  the  heads  of  the  imbeciles  exceeds  that  of 
the  sane  individuals  to  quite  a  marked  degree.  It 
is  worthy  of  notice  that  owing  to  the  process  of 
selection  which  Dr.  Gladstone's  cases  underwent,  the 
differences  between  the  maximum  and  minimum 
diameters,  although  considerable,  are  even  less  than 
in  the  cases  measured  by  me,  which  were  taken  as 
they  came. 

Dr.  Gladstone  worked  out  the  ''  index  of  size"  ^  of 
the  different  groups  together  with  that  of  a  further 
group  consisting  of  50  male  inmates  of  a  London 
workhouse  and  found  them  to  have  the  following 
ratios. 

Professional  class     4,219 

Workhouse  inmates 35933 

Workers  (Darenth  Asylum)  35465 

Non-workers  (Darenth  Asylum)    ...         ...         ...  3,347 

From  these  figures  he  estimated  the  mean  weight 

1  The  "  index  of  size"  is  the  number  of  cubic  centimetres  contained 
in  a  rectangular  solid  having  the  same  diameters  as  the  average 
length,  breadth  and  height  of  the  heads  in  the  different  groups. 


IV        BASIS  OF  THE  FEEBLE  MIND     123 

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

Workers 1,247  grms. 

Non-workers       1,218     „ 

It  is  interesting  to  compare  with  the  last  figure  the 
average  weight,  obtained  directly,  of  the  100  brains 
derived  from  a  somewhat  similar  class  of  patients  in 
series  A,  which  worked  out  at  about  1,193  grms.  If 
the  cephalic  index  be  estimated  from  Dr.  Gladstone's 
figures  it  will  be  found  to  be  for 

Workers 77'96 

Non-workers      ...         ...         ...         ...         ...     78'26 

Mean  78-1 

which  approximates  closely  to  the  normal  and  to 
the  result  of  the  measurement  in  series  A. 

10.  The  remaining  farts  of  the  body. — Of  these 
we  may  take  first  the  muscular  system  which 
is  peculiarly  the  medium  for  the  expression  of 
mental  activity.  Defect  in  the  muscular  apparatus 
may  take  the  form  of  inco-ordination,  weakness,  or 
over-action,  though  it  may  be  difficult  to  decide  as 
to  the  precise  share  of  each  of  these  morbid 
conditions  in  the  production  of  the  observed 
phenomena.  Inco-ordination  is  probably  responsible 
for  some  of  the  forms  of  imperfect  speech  which 
occur  in  the  feeble-minded.  Paralysis  is  a  common 
feature  of  the  class  :  the  subjoined  table  will  give 
some  idea  of  the  frequency  of  its  occurrence. 

Type.  Males  (400).  Females  (250) 

Alllimbs 8  12 

Hemiplegia  27  6 

Paraplegia  25  18 

Facial        10  — 

Over-action  of  muscles,  apart  from  the   occurrence 


124  THE    FEEBLE-MINDED  chap. 

of  definite  epileptiform  seizures,  becomes  obvious 
chiefly  in  the  erratic  movements  called  ''tics." 
Using  the  term  in  its  widest  sense  to  cover  all  forms 
of  swaying,  nodding,  tapping,  picking  and  other 
motions  which  idiots  indulge  in,  tics  were  observed 
in  64  of  the  400  males  and  47  of  the  250  females 
above  referred  to. 

Reflexes.  There  may  be  mentioned  in  this  con- 
nection the  subject  of  reflexes.  In  series  C  the 
condition  as  regards  knee-jerk,  ankle-clonus,  and  the 
Babinski  phenomenon  was  noted  with  the  following 
result : — 

Knee  jerk  : — 

Normal 50 

58 


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


30 
6 
6 


150 

In  five,  cases  ankle-clonus  was  obtained  at  both  sides 
and  in  three  at  one  side  only,  while  the  Babinski 
reflex  was  obtained  at  both  sides  in  fivQ  cases  and  at 
one  side  in  six  cases. 

Left  handedness.  An  attempt  was  made  to 
estimate  the  degree  of  prevalence  of  left-handedness 
in  the  650  cases  already  alluded  to.  Excluding 
cases  of  paralysis,  it  was  found  that  32  of  the  males 
and  8  of  the  females  exhibited  this  condition  pretty 
definitely,  but  the  results  obtained  were  in  many 
cases  so  ambiguous  that  no  particular  value  attaches 
to  these  figures.  It  was,  however,  noticeable  that 
ambidexterity,  which  may  here  be  taken  to  signify 
equal  degrees  of  helplessness  of  the  hands,  was  much 
more    commonly    found   than    among    normal    indi- 


IV        BASIS  OF  THE  FEEBLE  MIND     125 

viduals.      This  experience  agrees  with  that  of  Dr. 
W.  W.  Ireland/ 

The  thoracic  and  abdominal  viscera.  As  a  rule 
the  idiot  or  imbecile  is  physically  a  poor  creature 
and  the  thoracic  and  abdominal  viscera  share  in  the 
bodily  shortcomings.  This  is  shown  by  the  follow- 
ing figures  collected  for  the  heart,  liver,  and  spleen 
from  50  cases,  among  those  in  series  A,  which  did 
not  exhibit  gross  disease  of  one  or  other  organ. ^ 
As  regards  the  kidneys,  a  larger  proportion  of  the 
cases  conformed  to  this  requirement  and  the  list  of 
100  was  obtained  by  the  substitution  from  other 
sources  of  a  few  to  replace  those  that  had  to  be 
excluded.  Disease  of  the  lungs,  on  the  contrary, 
was  so  general  that  it  seemed  hopeless  to  get  figures 
for  this  organ  which  would  be  of  the  least  value,  and 
the  lung  weights  are  therefore  disregarded. 


Organ. 

Average  weight  in  ozs. 
(50  cases). 

Normal  weight  in  ozs. 

Heart    

6-25 
30-3 
3'4 

II 

Liver 

50-60 
6-7 

Spleen  

Kidney  (loo). 

Right. 
3-45 

Left. 
3-55 

Right. 

5-25 

Left. 

5'5 

Any  physical  abnormality  traceable  to  develop- 
mental errors  which  is  known  to  occur  in  the 
mentally  sound  may  be  looked  for  among  the  feeble- 
minded, with  the  confident  anticipation  that  it  is 
even    more  likely  to  be  discoverable    in  this   class 

^  W.  W.  Ireland,  loc.  cit.,  p.  329. 

2  Sollier,  in  his  article  in  Twentieth  Century  Practice^  says  that 
idiots  are  peculiarly  susceptible  to  abscess  of  the  liver.  The  writer 
has  not  found  anything  in  his  cases  to  corroborate  this  statement. 


126  THE   FEEBLE-MINDED  chap. 

than  it  was  in  the  former.  The  index  of  any 
treatise  on  pathological  anatomy  may  be  turned  to 
for  a  summary  of  the  appearances  met  with  and 
recorded  by  various  observers.  All  that  have  any 
value  as  pathognomonic  signs  have  been  already 
mentioned  or  will  be  alluded  to  in  the  descriptions 
of  the  chief  clinical  types.  In  estimating  that  value, 
a  critical  attitude  must  be  maintained  in  view  of  the 
uncertainty  surrounding  even  the  most  widely 
accepted  facts.  Our  postulate  as  to  the  supreme 
importance  of  the  nerve  cells,  for  example,  may  be 
called  in  question.  It  may  be,  as  suggested  by 
Lugaro  and  others,  that  the  neuroglia  plays  an 
important  part  in  controlling  the  nutrition  and 
consequent  efficiency  of  the  nerve  cells  by  neutral- 
ising toxic  agents  which  are  either  brought  to  the 
nerve  cell  by  the  blood  or  result  from  the  katabolism 
of  the  nerve  cell.  We  are,  again,  in  doubt  as  to  the 
interpretation  of  the  changes  which  nerve  cells 
undergo.  "  Modifications  in  Nissl's  substance,"  says 
Lugaro,  ''  do  not  constitute  an  index  of  functional 
variation,  but  rather  of  modifications  in  the  state  of  the 
nervous  elements'  nutrition.  These  morphological 
modifications  are  compatible  within  certain  limits 
with  complete  functional  integrity  even  when  they 
are  quite  obvious  under  the  microscope."  ^  Similarly, 
there  is  no  simple  and  clear  connection  between 
functional  disturbance  and  morphological  alteration 
in  the  neurofibrils.  As  we  have  seen,  the  condition 
of  pyramidal  tract  fibres  as  regards  myelination  is 
not  such  as  to  suggest  that  a  persistent  infantil- 
ism is  responsible  for  the  defective  volition  of  the 

1  E.  Lugaro,  Modern  Problems  in  Psychiatry^  1909,  p.  124. 


IV        BASIS  OF  THE  FEEBLE  MIND     127 

feeble-minded.  Of  the  mode  in  which  nerve  cells 
affect  each  other,  we  are  too  ignorant  to  be  able  to 
estimate  the  part  played  by  conduction  or  induction 
in  promoting  or  inhibiting,  accelerating  or  restrain- 
ing the  quasi-electrical  ''  fluid  "  which  is  the  vehicle 
for  the  conveyance  of  nervous  impressions.  Still 
less  do  we  know  of  that  intimate  physico-chemistry 
of  the  nerve  cells  which  conditions  the  "mneme" 
and  on  which  depends  the  faculty  of  memory. 

In  assigning  to  the  observations  recorded  in  this 
chapter  their  due  meed  of  importance,  it  must  be 
borne  in  mind  that  the  personal  equation  of  the 
observer  has  to  be  allowed  for.  Opacity  of  the 
pia-arachnoid,  hardness  of  the  skull-cap,  excess  of 
cerebro-spinal  fluid,  and  so  on,  exhibit  degrees  which 
do  not  admit  of  being  stated  with  any  great  precision, 
partly  because  no  ordinary  pathological  laboratory 
is  supplied  with  the  elaborate  physical  apparatus 
which  would  be  necessary,  and  partly  because  of  the 
absence  of  any  clearly  defined  standard  of  com- 
parison. We  are  in  little  better  case  when  trying  to 
use  the  data  provided  by  the  balance  or  the 
measuring  tape.  Height  and  weight,  which  are 
regarded  as  affording  some  basis  of  comparison 
between  diflerent  individuals,  are  not  always  in 
practice  ascertainable  with  any  great  approximation 
to  accuracy.  It  is  not  usually  feasible  to  weigh  a 
dying  person  or  even  a  corpse,  so  that  the  proportion 
of  the  body  weight  which  is  constituted  by  the 
weight,  obtained  at  an  autopsy,  of  some  viscus  will 
not  be  capable  of  exact  statement.  The  height  of 
an  individual  does  not  vary  so  much  as  his  weight, 
but  in  the  case  of  an  idiot  suffering,  as  many  do, 


128  THE   FEEBLE-MINDED  chap. 

from  deformity  of  some  kind,  the  measurement  of  the 
height  is  often  no  simple  matter.  For  the  reason 
just  given  the  following  figures,  though  of  interest 
from  the  unexpectedness  of  the  conclusions  to  which 
they  lead,  need  not  be  taken  too  seriously. 

A.  The  relation  of  brain  weight  to  that  of  the 
body. 

In  the  normal  man,  according  to  Dubois,  the  brain 
weight  has  to  the  body  weight  the  ratio  i :  46.  For 
fifteen  cases  of  idiocy  and  imbecility  taken  at  random 
the  ratios  were  : — 


I. — I 

22 

2.— I  :25 

3-— I 

30 

4.— I 

30 

5.-1:32 

6.— I 

32 

7.— 1 

33 

8.— I  :  34 

9.— I 

35 

10. — I 

38 

11.-1:39 

12. — I 

•39 

13.— I 

40 

14.-1:41 

15.— I 

46 

giving  an  average  of  i  :  34,  which  is  equivalent  to 
an  assertion  that  the  Jdiot  or  imbecile  has  more 
brain  to  the  unit  of  body  weight  than  the  normal 
person  can  lay  claim  to.  How  little  importance 
attaches  to  this  ratio  may  be  judged  by  a  com- 
parison of  the  figures  obtained  for  various  animals. 
Warncke  has  compiled  a  lengthy  record  of  the 
ratios  found  in  the  animal  kingdom.  These  vary 
from  I  :  105 71  in  one  of  the  whales  to  i  :  23  in  the 
insectivore  Sorex  vulgaris.  Even  within  the  limits 
of  the  Primates  the  range  is  from  1:213  to 
I  :  26I. 

The  following  consideration  would  lead  us  to 
anticipate  that  no  simple  relation  between  brain 
weight  and  intellectual  capacity  is  likely  to  be  estab- 
lished :  there  is  as  great  a  gap  mentally  between  an 
Idiot  and  a  person  of  average  intelligence  as  between 
the  latter  and  a  genius.     Now  a  genius  of  the  first 


IV        BASIS  OF  THE  FEEBLE  MIND     129 

rank  has  been  estimated  to  be,  perhaps,  a  hundred 
times  more  capable  than  the  ordinary  man.  We 
might,  then,  expect  to  find  that  the  brain  of  a 
genius  weighed  ten  thousand  times  as  much  as  that 
of  an  idiot — a  condition  of  things  so  completely- 
Inconsistent  with  our  experience  as  to  savour  of  the 
ludicrous. 

The  weight  of  the  brain  is  dependent  on  at  least 
two  groups  of  factors  ;  the  somatic,  i.e.,  the  mass  of 
tissue  which  has  to  be  centrally  represented,  and  the 
psychical,  i.e.,  the  degree  of  mental  development. 
As  regards  the  former  it  may  be  noted  that  all  parts 
of  the  body  are  not  equally  innervated.  It  has 
been  suggested  that  the  chief  determining  factor  of 
the  mass  of  the  brain  is  the  extent  of  the  surface  of 
the  body,  and  that  the  greater  magnitude  of  the 
brain  of  man  as  compared  with  that  of  the  ape  Is  In 
a  measure  to  be  accounted  for  by  the  comparatively 
hairless  condition  of  man  and  the  consequent  greater 
development  in  him  of  a  tactile  sense.  Estimates 
of  the  proportion  of  the  somatic  and  psychical 
elements  in  various  animals  have  been  made  by 
Dubois,  Warncke,^  and  others,  who  have  deduced 
from  their  results  a  ''cephallsatioji  factor"  which 
they  believe  to  indicate  the  respective  degrees  of 
intelligence  of  the  animals  concerned.  It  is  no 
doubt  satisfactory  to  find  that  Homo  sapiens  comes 
out  at  the  top  of  the  list. 

B.  The  relation  of  brain  weight  to  height. 

In    connection    with    an    investigation     already 

1  Paul  Warncke,  Mitteilung  neuer  Gehirn  unci  K'drpergeiuichts- 
bestinunungen  bet  Sdugern,  etc.  Festschrift  su  Forels  Sechzigstem 
Geburtstag.  Journal  filr  Psychologie  unci  Neurologie,  Bd.  13,  1908, 
P-  355- 

K 


130  THE   FEEBLE-MINDED  char 

alluded  to,  Dr.  R.  J.  Gladstone  worked  out  the 
relation  between  the  (estimated)  brain  weights  and 
the  heights  of  the  fifty  ''workers"  and  fifty  "non- 
workers  "  seen  by  him  at  Darenth  Asylum,  as 
shown  in  the  following  table. 


Class. 

Mean  weight  of  brain. 

Mean  stature. 

Workers 

Non-workers 

1,247  grms. 
1,218     „ 

1,609  ^ni- 
1,505    » 

From  these  figures  It  appears  that  the  non-workers 
averaged  slightly  more  brain  to  the  unit  height  than 
did  the  workers. 

What  appears  to  be  brought  out  most  clearly  by 
the  investigations  recorded  is  the  limitation  of  the 
statistical  method.  Owing  to  the  different,  and  fre- 
quently opposite,  directions  in  which  departures  from 
the  normal  occur,  the  effect  of  striking  averages  is 
to  obscure  rather  than  to  elucidate  the  differences 
which  experience  shows  to  exist.  Thus  the 
extremes  in  the  way  of  cranial  abnormality  which 
were  displayed  by  different  patients  among  the  250 
measured  by  myself  and  Dr.  Gladstone  cancel  out 
so  as  to  give  a  ''cephalic  index"  which  is  almost 
exactly  normal.  The  existence  of  a  high  degree  of 
variability  is  established  by  the  data  so  far  available, 
but  we  find  nothing  to  justify  the  separation  of  a 
distinctive  type  characteristic  of  feeble-minded- 
ness. 

A  large  number  of  data  on  the  lines  of  those 
given  in  this  chapter  have  now  been  accumulated, 
and,  though  they  are  not  without  scientific  value, 
their  abundance,  unfortunately,  serves  to  obscure 
the  fact  that  cerebral  pathology  Is  yet  In  Its  earliest 
infancy.      About  the  raw  material   of  mind,   those 


IV        BASIS  OF  THE  FEEBLE  MIND     131 

sensory  phenomena  which  are  the  results  of  the 
action  of  the  environment  on  the  individual,  a  good 
deal  is  now  known,  but  the  processes  of  manufac- 
ture, the  methods  by  which  sense  impressions  are 
reproduced  and  rearranged,  remain  enshrouded  in 
darkness. 

As  considered  more  fully  in  the  chapter  on 
Causation,  abnormalities  of  the  brain  may  be 
referred  to  innate  defect  of  development  or  to  the 
influence  of  an  unfavourable  environment.  The 
distinction  is  of  practical  value,  though  the  first 
named  factor  may  be  regarded  as  only  a  special  case 
of  the  second.  Developmental  error  may,  it  is 
taught,  occur  in  one  of  three  forms.  There  may  be 
simple  retardation,  there  may  be  a  return  to  a  more 
primitive  type  of  organisation,  or  there  may  be 
progress  in  a  new  direction.  These  various  forms 
are  not,  however,  independent  either  of  one  another 
or  of  the  environment.  We  may,  for  example, 
meet  with  what  the  Germans  call  *'  Korrektur- 
bildung,"  a  condition  in  which,  owing  to  deficient 
development  of  the  phylogenetically  younger  parts, 
the  phylogenetically  older  undergo  compensatory 
hypertrophy,  and  this  may  be  complicated  by  the 
lack  of  normal  resistive  power  against  injurious 
agents  which  imperfectly  developed  tissues  exhibit. 
A  similar  compensatory  activity  of  unimplicated 
regions  may  follow  localised  injury  to  any  part  of 
the  nervous  system  and  may  involve  such  an  inter- 
ference with  the  normal  functions  of  the  hyper- 
trophied  part  that  the  initial  defect  is  not  simply 
compensated  for,  but  replaced  by  one  of  a  new 
character.     But  we  have  to  take  into  consideration 

K    2 


132  THE   FEEBLE-MINDED  chap. 

also  another  biological  factor,  the  tendency  of  the 
organism  to  a  specialisation  and  delimiting  of  an 
affected  region  owing  to  the  development  of 
antagonistic  Influences  which  strive  to  nullify  its 
evil  effects. 

Taking  into  account  only  the  broad  distinction 
between  developmental  and  acquired  abnormalities, 
it  is  of  interest  to  note  that  the  evidence  obtained 
from  the  cases  in  series  A  points  to  a  greater 
prominence  of  the  latter  forms  than  might  have 
been  anticipated.  In  48  per  cent,  of  the  cases 
there  was  excess  of  cerebro- spinal  fluid,  a  condition 
clearly  pointing  to  degenerative  changes  in  the 
brain.  *'  I  think,"  says  W.  Ford  Robertson,^  "it  may 
be  affirmed  that  an  excess  of  cerebro-spinal  fluid  is 
generally  compensatory  for  brain  atrophy,  and  that 
it  only  rarely  has  any  other  significance."  J.  S. 
Bolton^  has  stated  that  he  ''cannot  too  strongly 
emphasise  the  Importance  of  excess  of  intra-cranlal 
fluid  in  the  pathology  of  dementia,"  and  in  the  same 
article  he  expressed  the  opinion  that  "  dilation  of 
the  lateral  ventricle  is  ...  .  evidence  of  loss  of 
cerebral  tissue."  The  opacity  and  thickening 
of  the  pia-arachnold  observed  in  24  per  cent,  of  the 
cases  point  in  the  same  direction,  for  one  can  hardly 
attribute  such  features  to  errors  of  development  in 
view  of  the  frequency  of  their  occurrence  in  the 
brains  of  sufferers  from  general  paralysis  and  senile 
dementia.  The  brains  of  idiots  have,  indeed,  in 
many    Instances,    much    in    common  with  those  of 

^  W.  Ford  Robertson,  loc.  cit.,  p.  310. 

2  j_    s.   Bolton,    "  Amentia  and   Dementia,"  Journal  of    Mental 
Science^  1905,  PP-  326-7. 


IV       BASIS  OF  THE  FEEBLE  MIND     133 

general  paralytics  and  differ  from  those  of  senile 
dements  chiefly  in  the  absence  of  the  gross  changes 
in  the  cerebral  vessels  which  occur  so  conspicuously 
in  the  latter.  One  is  led  to  the  conclusion  that  the 
mental  defect  which  dates  from  birth  or  from  an 
early  age  may  be  characterised  by  a  large 
element  of  *' dementia"  as  distinct  from  what  is 
called  '*  amentia,"  that  is  to  say,  the  idiot  brain  has 
undergone  a  process  of  degeneration  and  has  not 
merely  been  arrested  in  its  growth. 

Series  A  comprised,  as  already  mentioned,  brains 
from  persons  who  had  displayed  very  limited 
intelligence.  To  what  extent  deductions  drawn 
from  a  study  of  these  brains  apply  to  those  of 
persons  exhibiting  only  slight  degrees  of  feeble- 
mindedness is  uncertain.  Eminent  Continental 
psychiatrists  have  taken  up  different  attitudes  in 
regard  to  this  matter.  According  to  Tanzi,^ 
*'  imbecility  is  congenital,  while  idiocy  is  acquired, 
it  may  be,  in  the  earliest  stages  of  existence."  He 
reserves  the  term  idiot  for  *'all  those  cases  of 
deficiency  that  do  not  present  the  clinical  picture 
of  mental  degeneration  but  that  of  the  infantile 
cerebro-pathies,  notwithstanding  the  occasionally 
very  slight  degree  of  their  deficiency."  His  concep- 
tion of  idiocy  thus  appears  to  be  one  of  a  *'  nervous  " 
disease  which  happens  to  be  complicated  by 
**  mental"  symptoms.  Sollier's  view  is  that  *'all 
idiots  present  cerebral  lesion,  while  imbeciles  have 
none."  ^  On  the  whole  it  seems  most  satisfactory  to 
follow   Ziehen,  Herfort,  and  others,  in  holding  that 

^  E.  Tanzi,  A  Text-book  of  Me?tfal  Diseases,  1909,  pp.  747-8. 

2  P.  Sollier,  Art.  "  Idiocy"  in  XXth  Century  Practice,  1897,  p.  264. 


134  THE   FEEBLE-MINDED  ch.  iv 

**  a  congenital  weak-mindedness  of  purely  functional 
nature,  that  Is  to  say,  with  an  anatomically  Intact 
cerebral  cortex,  does  not  exist,"  ^  though  with  our 
present  Imperfect  methods  of  research,  the  defect 
may  not  always  be  demonstrable. 

The  Investigation  of  the  physical  substrata  of 
aberrant  complex  mental  processes  presents  much 
greater  difficulty  than  the  recording  of  abnormalities 
of  the  sensory  or  motor  apparatus,  which  is  all  that 
most  workers  among  the  feeble-minded  have  oppor- 
tunity for.  All  departments  of  biology — embry- 
ology ;  normal  and  morbid  anatomy  both  human  and 
comparative  ;  physiology  and  psychology  must  be 
called  upon  if  further  progress  is  to  be  made,  and 
it  is  a  dawning  perception  of  this  fact  which  is  the 
most  significant  as  well  as  the  most  hopeful  feature 
of  modern  tendencies  in  the  investigation  of  the 
pathology  of  mind. 

^  K.  Herfort,  Die pathologische  Anatomie  der  Idiotie^  Eos.  1908. 


CHAPTER  V 

THE    CAUSATION    OF    FEEBLE-MINDEDNESS 

Of  the  causes  which  lead  to  incomplete  psychical 
development  extremely  little  is  known  with  certainty. 
It  is,  however,  undisputed  that  feeble-mindedness  is 
often  associated  with  obvious  imperfection  or  arrest 
of  cerebral  development.  As  to  the  nature  of  this 
association,  something  has  been  said  in  Chap.  IV. 
Even  when  the  application  of  current  scientific 
methods  fails  to  supply  definite  information,  we 
cannot  exclude  the  possibility  that  what  are  called 
**  errors  of  metabolism  "  are  the  responsible  agents. 

Whatever  theory  of  the  relation  of  mind  and 
brain  is  adopted,  the  problem  of  the  origin  of  mental 
defect  resolves  itself  into  an  investigation  of  the 
circumstances  in  which  the  development  of  the 
brain  is  injuriously  interfered  with. 

There  are,  it  would  appear,  two  chief  sets  of 
factors  in  development : — 

(i)  The  innate  tendency  to  develop. 

(2)  The  influences  of  the  environment. 
And  theoretically  these  may  be  further  subdivided 
as  follows  : — 

(a)  Normal  tendency. 

(a)  Abnormal  tendency. 


136  THE   FEEBLE-MINDED  chap. 

(d)  Environment  favourable  to  normal  develop- 
ment. 

(/3)  Environment  unfavourable  to  normal  develop- 
ment. 

Of  these  (a)  and  (a)  are  mutually  exclusive  and  so 
are  (d)  and  (l3),  so  that  the  possible  combinations  are 
reduced  to  four,  viz.,  (a)  {b)  ;  [a)  (/3) ;  (a)  {b)  ;  (a)  {0)  ; 
but  the  combination  (a)  (b)  represents  the  condition 
of  normal  development,  so  that  in  the  production  of 
abnormal  conditions  we  have  to  do  with  the  three 
sets  of  relations  which  are  expressed  by  the  formulae 
(a)  (/3)  ;  (a)  {6)  ;  (a)  (^). 

We  seem,  therefore,  to  have  three  groups  of  cases 
to  consider  : — 

(i)  Those  in  which  the  innate  developmental 
tendency  is  normal,  but  is  modified  by  the  influence 
of  an  unfavourable  environment. 

{2)  Those  in  which  an  abnormal  innate  tendency 
gives  rise  to  pathological  conditions  although  the 
environment  exercises  no  unfavourable  influence. 

(3)  Those  in  which  the  innate  tendency  and  the 
environment  combine  to  produce  pathological 
conditions. 

Observed  facts  are  not,  however,  readily  suscep- 
tible of  classification  in  accordance  with  this  simple 
scheme,  and  in  order  to  understand  what  modifications 
it  may  require,  to  bring  it  into  accordance  with 
those  facts,  we  must  consider  briefly  what  the  terms 
''innate  tendency"  and  ''environment"  really 
signify.  To  begin  with,  we  may  note  that  they  are 
not  factors  of  quite  the  same  order,  although  we 
may  suppose  both  to  have  a  physical  basis.  While 
it  is  conceivable  that  an  innate  tendency  might, 
without  the  intervention  of  any  other  agency,  control 


V      CAUSATION  OF  FEEBLE  MIND     137 

the  development  of  a  germinal  cell,  we  have  in 
actual  practice  no  knowledge  of  such  a  state  of 
things.  We  only  know  the  tendency  in  so  far  as  its 
expression  is  conditioned  by  its  environment.  We 
have  assumed  that  innate  tendency  and  environment 
may  vary  independently,  and,  on  reviewing  such 
facts  as  are  accessible  to  us,  this  seems  to  be  the 
more  convenient  hypothesis,  but  it  is  open  to  anyone 
to  suggest  that  the  differences  which  individuals 
display,  whether  they  belong  to  the  same  or  success- 
ive generations,  are  determined  solely  by  the 
influence  of  the  environment.  The  suggestion 
becomes  the  more  plausible  when  we  recognise,  with 
Dr.  Archdall  Reid,^  that  much  of  what  is  regarded 
as  '*  innate  "  is  really  attributable  to  the  effects  of  the 
stimuli  which  are  incidental  to  the  processes  of 
nutrition.  For  the  purposes  of  this  chapter,  it  will 
suffice  to  divide  the  cases  of  defective  cerebral 
development  into  two  groups,  in  one  of  which  the 
innate  tendency  is  believed  to  be  the  important 
factor,  while  in  the  other  a  preponderating  influence 
is  attributed  to  the  environment. 

(A)    Innate  tendency  Predominant. 

We  enter  here  upon  the  domain  of  Heredity  and 
are  at  once  faced  by  difficulties  arising  from  the  con- 
fusion which  exists  as  to  the  significance  of  that  term. 
Heredity,  according  to  Professor  J.  A.  Thomson,^  is 
*' just  a  name  for  the  reproductive  or  genetic  relation 
between  parents  and  offspring,"  while  Inheritance 
is  '*  all  that  the  organism  is  or  has  to  start  with  in 

1  G.  Archdall  Reid,   The  Laws  of  Heredity.  1910. 
^  J.  A.  Thomson,  Heredity^  1908,  p.  68  and  p.  517. 


138  THE   FEEBLE-MINDED  chap. 

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

The  salient  feature  of  Inheritance  is  the  existence 
of  some  degree  of  resemblance  between  parent 
and  offspring,  and  a  distinction  must  at  the  outset 
be  drawn  between  uniformity  of  type  in  the  in- 
dividuals themselves,  and  uniformity  of  type  in 
their  environment.  A  son  Is  said  to  "inherit" 
peculiarities  of  form  and  disposition  from  his  father  ; 
he  is  also  said  to  *'  inherit  "  the  social  conditions  with 
which  the  father  has  surrounded  himself.  In  regard 
to  the  second  use  of  the  term.  It  may  be  argued 
that,  although  Professor  Thomson's  definition  might 
be  strained  so  as  to  cover  It,  there  Is  no  *'  inheritance  " 
in  the  strict  sense  ;  and  that  the  case  is  one  in  which 
the  influence  of  the  environment  is  paramount.  The 
discussion  of  this  point  may  conveniently  stand  over 
for  the  time  being,  since  certain  considerations  bear- 
ing upon  It  will  be  more  readily  intelligible  when  the 
cases  more  directly  referable  to  the  existence  of  an 
Innate  tendency  have  been  mentioned. 

To  return  then  to  the  instances  in  which  uniformity 
of  type  as  regards  morphological  features  is  the 
expression  of  the  Inheritance.  The  question  im- 
mediately arises  :  Why  should  the  child  resemble  the 
parent  at  all  ? 

The  simplest  explanation  is  that  the  two  have  a 
common  origin.  Let  us  see  if  by  the  light  of 
evolution  we  can  arrive  at  some  conception  of  where 
that  origin  is  to  be  found.  The  exposition  which 
follows  may  or  may  not  be  correct,  but  It  has  sufficient 


V      CAUSATION  OF  FEEBLE  MIND     139 

plausibility  to   serve   to    connect    together    in    an 
intelligible  way  the  admitted  facts  about  heredity. 

Starting  with  a  primitive  bioplasmic  mass  (some 
organism,  we  may  suppose,  of  the  nature  of  the 
lowly  creature  we  call  Amoeba)  we  may  reasonably 
postulate  for  it  a  power  of  growing.  We  may  then 
be  prepared  to  find,  in  view  of  Spencer's  law,  that 
the  mass  divides  and  that  each  part  grows  to  the 
original  size,  and  again  divides.  Each  generation 
will  be  lost  in  its  descendants,  but  the  original 
bioplasm  does  not  cease  to  exist.  At  a  somewhat 
higher  zoological  level,  e.g.,  in  the  case  of  Par- 
amoecium,  there  is  such  a  degree  of  specialisation 
of  various  regions  that  the  two  organisms  resulting 
from  the  process  of  fission  are  at  first  dissimilar. 
Each,  however,  develops  the  features  in  which  it  is 
lacking,  so  that  when  the  process  is  completed  the 
resulting  individuals  are  similar  to  each  other. 

As  one  proceeds  upwards  through  the  ranks   of 
more  and  more  complex  organisms,  the  process  of 
fission  becomes  more  and  more  obscured   by  the 
circumstances  attending  it,  so  that,  by  the  time  the 
mammalia  are  reached,  it  is  at  first  difficult  to  corre- 
late the  special  germinal  cells  with  the  portion   of 
bioplasm  separated  off  from  Amoeba  or  Paramoecium 
to  produce  a  new  individual.     We  must,  however, 
regard  what  are  called  the  ''organs  "  of  the  higher 
animals  as  adventitious  growths  superposed  upon  a 
structure  of    specialised    bioplasm  which,  it  would 
appear,  is  of  relatively  small  amount  and  of  uncertain 
distribution  in  the  organism.     From  this  specialised 
bioplasm  fragments  are  separated   off  at  intervals, 
and  these   fragments,  having,   like  the  mass  from 


140  THE   FEEBLE-MINDED  chap. 

which  they  sprang,  the  potentiaHties  of  generating 
the  organs  which  serve  to  distinguish  the  individual, 
grow  into  forms  resembhng  the  parent  as  closely  as 
the  conditions  of  growth  will  allow. 

Biologists  are  in  the  main  agreed  that  the  capacity 
for  transmitting  characteristics  which  bioplasm  dis- 
plays is  dependent  on  the  presence  in  its  substance 
of  certain  definite  elements/  Herbert  Spencer 
postulated  ''physiological"  or  "constitutional"  units 
— "  ultimate  life  bearing  elements  intermediate 
between  the  chemical  molecules  and  the  cell."  For 
Weismann^  these  elements  are  "very  small  individual 
particles,  far  below  the  limits  of  microscopic  visibility, 
vital  units  which  feed,  grow,  and  multiply  by  division." 
These  he  calls  "determinants."  The  "gemmules" 
of  Darwin  and  the  "  pangens "  of  de  Vries 
appear  to  be  much  the  same  thing  as  determinants 
although  a  different  origin  is  assumed  for  them. 
Bateson's  conception  of  the  units  which  serve  as 
vehicles  for  the  transmission  of  heritable  charac- 
ters is  that  of  bodies  which,  in  some  cases 
at  least,  have  the  power  of  producing  ferments. 
Bateson^  differs  from  the  majority  of  biologists  in 
supposing  that  the  elementary  bodies  are  not 
necessarily  confined  to  the  nuclei  of  the  cells 
containing  them,  and  this  to  some  extent  meets  the 
objection  urged  by  Adami  *  that  the  various  theories 
referred  to  above  involve  the  assumption  of  physical 

1  J.  A.  Thomson,  op.  cit..,  p.  455. 

2  A.  Weismann,  "  The  Selection  Theory,"  in  Darwin  and  Modern 
Science.^  1909,  p.  36. 

3  W.    Bateson,    "  Heredity   and   Variation  in  Modern  Lights,"  in 
Darwin  and  Modern  Science.,  1909. 

^  J.  G.  Adami,  The  Principles  of  Pathology^  1909,  p.  121. 


V      CAUSATION  OF  FEEBLE  MIND     141 

impossibilities  since  ''  determinants,"  for  example, 
must  be  molecular  groupings  of  a  size  which  makes 
the  packing  of  a  sufficient  number  of  them  into 
a  nucleus  quite  inconceivable.  Loeb  ^  attaches  so 
much  importance  to  the  influence  of  the  environment 
in  controlling  the  development  of  bioplasm  that  he 
does  not  postulate  for  the  germ  anything  more  than 
the  transmission  of  *' a  certain  form  of  Irritability." 

On  the  whole,  we  seem  justified  in  accepting 
Thomson's^  dictum  that  *' everything  points  to  the 
conclusion  that  there  is  a  definite  hereditary 
material";  and  It  Is  convenient  to  accept  also  the 
view  that  this  material  consists  of  "vital  units"  or 
''bioplasm,"  without  attempting  to  define  these  with 
any  great  pretence  of  accuracy.^ 

Apart  from  conditions  of  growth,  heredity 
involves  differences  between  parent  and  offspring 
which  are  no  less  Important  than  the  resemblances 
with  which  we  have  so  far  been  concerned.  Let 
us  take  again  the  primitive  organism.  Some  par- 
ticular descendant  may  display  a  new  feature.  Let 
us  suppose  It  exhibits  a  cillum.  If  its  descendants 
also  exhibit  each  a  cilium  this  will  indicate  that 
a  new  character  has  been  impressed  upon  the 
original  bioplasm.  Change  In  the  direction  of  more 
cilia  may  follow,  a  new  variety  of  bioplasm  thus 
coming  into  existence.  A  fragment  of  the  new 
variety,  endowed  with  the  potentiality  of  developing 

^  J.  Loeb,  "  Experimental  Study  of  the  Influence  of  Environment  on 
Animals,"  in  Darwin  and  Modern  Scie7tce,  1909. 

2  J.  A.  Thomson,  op.  cit.^  p.  431. 

^  For  a  review  of  the  various  theories  as  to  the  constitution  of 
bioplasm,  see  Darwi7iism  To-day^  by  Professor  Vernon  L.  Kellog'g, 
1907,  pp.  214-228. 


142  THE   FEEBLE-MINDED  chap. 

many  cilia  though  actually  at  the  outset  bearing 
none,  may  be  separated  and  grow  up.  On  these 
lines  the  possibility  of  endowing  a  germ  with  huge 
potentialities  is  conceivable.  Thus  some  portion 
of  the  bioplasm  which  has  now  been  converted 
into  a  many-cilia-bearing  kind  may  become  so 
changed  as  to  be  capable  of  developing  a  pigment 
spot  from  which  an  organ  of  vision  may  be  evolved, 
and  so  the  process  may  go  on  to  higher  and  higher 
degrees  of  complexity.  Alteration  from  generation 
to  generation  proceeding  in  some  such  way  as  this 
has  been  observed  to  occur  in  the  case  of  Para- 
mcecium,^  and  the  fact  affords  us  an  illustration 
of  the  evolutionary  principle  which  all  modern 
biologists  accept  as  explaining  how  living  creatures 
came  to  be  as  they  are. 

The  bioplasmic  basis,  it  would  appear,  is  sus- 
ceptible of  changes  of  at  least  two  kinds.  There 
may  be  : — 

(a)  Slight  alterations  affecting  some  existing 
attribute.  These  are  not  of  a  permanent  character 
unless  fixed  by  natural  or  artificial  selection.  Such 
changes  are  called  Variations.  What  is  loosely 
called  ''  The  Law  of  Healthy  Birth  "  (a  matter  to 
which  we  shall  again  refer),  which  lays  down  the 
principle  that  organisms  tend  to  return  to  the  normal, 
is  merely  a  statement  that  variations  are  sometimes 
not  so  fixed  by  selection. 

{b)  Slight  or  great  alterations  involving  the 
appearance  of  a  new  attribute.  These  are  called 
Mutations   and,   being   permanent   changes    in    the 

1  H.  S.  Jennings,  "  Heredity,  Variation  and  Evolution  in  Protozoa," 
Jou7'n.  of  Exper.  Zoology,  1908,  p.  577. 


V      CAUSATION  OF  FEEBLE  MIND     143 

bioplasm,  they  naturally  characterise  the  descendants 
also. 

The  definitions  just  given  are  such  that  in  all 
probability  they  will  not  be  accepted  without  criticism 
by  any  biologist,  but  they  seem  to  include  what  little 
is  common  to  the  innumerable  conflicting  views 
respecting  the  method  of  evolution.  Dr.  A.  Reld, 
one  of  the  most  recent  writers  on  the  subject, 
regards  variations  as  additions  to  or  abbreviations 
of  the  recapitulation  of  parental  development  which 
in  their  own  development  offspring  exhibit.  He 
does  not  attempt  to  define  precisely  what  is  to  be 
understood  by  mutations,  but  for  him  they  are 
apparently  large  and  ''  discontinuous "  variations 
which  can  hardly  advance  the  process  of  evolution, 
since  to  be  effective  they  require  numerous  co-adapted 
mutations,  and  since,  too,  they  must  almost  of 
necessity  overshoot  the  mark  because  of  the  initial 
adaptation  to  the  environment  which  species  display. 

Why  changes  take  place  in  the  bioplasm  at  all  is 
a  question  which  has  not  yet  been  satisfactorily 
answered.  Weismann  supposes  that  the  deter- 
minants vary  with  variations  in  the  amount  of 
nutriment  they  receive,  and,  having  varied,  may 
have  so  become  endowed  with  a  capacity  for  con- 
trolling their  own  nutrition  which  renders  them 
independent  of  the  circumstances  which  initiated  the 
variation.  The  ''  hereditary  individual  variation  " 
so  arising  will  therefore  be  permanent.  As  to  the 
causation  of  the  alterations  in  nutrition  he  can  only 
say  that  they  occur  "  by  chance,  that  is,  for  reasons 
unknown  to  us,"^  and  Bateson  is  equally  unillumi- 

^  A.  Weismann,  "  The  Selection  Theory,"  p.  37. 


144  THE   FEEBLE-MINDED  chap. 

nating  in  regard  to  the  causes  which  determine  the 
mode  of  segregation  of  his  "  unit-characters."  Pro- 
fessor J.  Loeb  is  unable  to  convince  himself  of  the 
validity  of  the  claims  to  have  succeeded  in  pro- 
ducing mutations  by  physico-chemical  means  which 
certain  authors  make.  Professor  George  Klebs, 
however,  admits  the  possibility  that  ''  sudden  and 
special  disturbances  in  the  relations  of  the  cell 
substances  have  a  directive  influence  on  the  inner 
organisation  of  the  sexual  cells,  so  that  not  only 
inconstant  but  also  constant  varieties  will  be 
formed,"  ^  while  Professor  Adami  holds  that  "  it  is 
impossible  to  arrive  at  any  other  conclusion  than 
that  variation  originates  primarily  in  the  action  of 
modified  environment  upon  the  labile  bioplasm."^ 

Dr.  Archdall  Reid  insists  on  the  insusceptibility  of 
germ-plasm  to  environmental  influences  and  holds 
that  practically  all  variations  are  spontaneous.  The 
tendency  to  vary  *'  is  itself  an  adaptation  which 
is  subject  to  variations,"  and,  like  all  other  adapta- 
tions, it  ''results  from  the  Natural  Selection  of 
favourable  variations.  "  ^ 

But  in  the  vast  majority  of  animals  and  plants, 
the  germ  from  which  a  new  individual  springs  is  a 
combination  of  bioplasm  from  two  separate  sources. 
An  additional  factor  in  the  production  of  dif- 
ferences between  parent  and  offspring  is  thus 
introduced,  for  we  have  now  to  take  into  account 

1  G.  Klebs,  "  The  Influence  of  the  Environment  on  the  Forms  of 
Plants,"  in  Darwin  and  Modern  Science^  I909)  P-  246. 

2  J.  G.  Adami,  op.  cit.  p.  171  ;  cf.  also  the  Art.  "The  Direct 
Influence  of  Environment,"  by  D.  T.  MacDougal  in  Fifty  Years  of 
Dar'wi?iism^  1909. 

9  G.  Archdall  Reid,  op.  cii.^  p.  436. 


V      CAUSATION  OF  FEEBLE  MIND     145 

not  only  the  variability  which  may  depend  on 
environmental  conditions,  but  also  possibilities  in  the 
way  of  blending  which  the  two  different  kinds  of 
bioplasm  admit  of.  It  is,  however,  so  difficult  to 
distinguish  between  the  respective  effects  of  these 
separate  factors  that  we  must  perforce  consider 
them  together  as  responsible  for  the  departures 
from  the  parent  type.  The  need  for  such  a  wide 
definition  of  heredity  as  is  implied  in  saying  that  it 
is  simply  *'  the  genetic  relation  between  parents  and 
offspring  "  becomes  intelligible  when  we  regard  the 
diversity  which  that  relation  may  exhibit.  The 
various  grades  of  inheritance  may  be  grouped  in 
the  following  scheme,  the  artificiality  of  which  must 
be  excused  by  its  convenience. 

(i)  Cases  in  which  the  resemblance  of  off  spring  to 
parents  is  the  prevailing  characteristic. 

In  his  Law  of  Ancestral  Inheritance,  Sir  Francis 
Galton  laid  down  the  proposition  that  the  contri- 
butions from  successive  generations  of  ancestors,  i.e., 
parents,  grand-parents,  great-grand-parents,  and  so 
on,  to  the  characters  of  the  individual  are,  respec- 
tively, in  the  proportions  of  \,  \,  ■§-,  ^V  ^^^-^  the 
whole  inheritance,  represented  by  the  figure  i, 
being  the  sum  of  the  contributions  from  an 
indefinite  series  of  ancestors.  Modifications  of  the 
law  have  been  advanced  as  expressing  the  situation 
more  accurately,  but  the  general  principle,  which  is 
all  that  we  are  now  concerned  with,  appears  to  be 
conformed  to  in  some  cases  at  least. 

The  shares  contributed  by  father  and  mother, 
whatever    those    shares   may   be,    do    not    always 


146  THE  FEEBLE-MINDED  chap. 

become   evident    in    the   same   way,    the    following 
varieties  of  inheritance  being  met  with. 

(a)  Sometimes  the  paternal  and  maternal  charac- 
ters are  so  intimately  intermingled  that  the  offspring 
exhibits  what  may  be  described  as  a  compromise 
between  the  parents,  as  in  the  case  of  the  mule. 
This  may  be  called  "  Blended  Inheritance." 

(d)  Sometimes  the  offspring  display  paternal 
characters  in  one  part  of  the  body  and  maternal  in 
another.  This  is  called  *'  Particulate  Inheritance." 
In  the  special  case  where  the  characters  from  the 
respective  sources  are  distributed  widely  and  in 
small  groups,  we  get  one  of  the  forms  to  which  the 
term  ''  Mosaic  Inheritance  "  has  been  applied. 

(c)  As  regards  certain  factors,  the  contribution  of 
one  parent  may  be  not  at  all  evident,  so  that  the 
offspring  conspicuously  resemble  one  parent  only. 
This  is  what  is  called  '*  Exclusive  Inheritance."  It 
may,  of  course,  be  regarded  as  another  special  case 
of  particulate  inheritance,  since  in  that  also  the 
presence  of  a  particular  paternal  or  maternal 
character  involves  the  absence  of  the  corresponding 
maternal  or  paternal  character.  But  the  use  of  the 
term  "exclusive"  is  generally  restricted  to  certain 
varieties  of  inheritance  which  are  of  sufficient 
importance  to  deserve  separate  notice. 

(a)  Sexual  Dimorphism.  When  the  paternal  and 
maternal  character  are  mutually  so  antagonistic  that 
anything  in  the  way  of  compromise  between  them 
would  defeat  the  purposes  of  their  existence  one  will 
exclude  the  other  in  inheritance.  This  is  peculiarly 
the  condition  of  affairs  in  regard  to  the  organs  which 
mark  the  distinction  of  sex. 


V       CAUSATION  OF  FEEBLE  MIND      147 

(0)  Sex  Limitation.  Certain  characters  seem  to 
be  in  some  mysterious  way  bound  up  in  sex  although 
they  are  not  obviously  what  would  be  called 
"sexual"  in  the  ordinary  acceptation  of  the  term. 
It  is,  for  example,  a  familiar  fact  that  certain  diseases, 
e.£'.f  pseudo-hypertrophic  muscular  paralysis,  haemo- 
philia, and  colour-blindness  only  appear  in  males  : 
a  fact  which  does  not  become  any  less  remarkable 
when  we  note  that  they  appear  to  be  transmitted 
only  by  females. 

(7)  Of  late  years  the  attention  of  biologists  has 
been  concentrated  on  some  experiments  in  breeding 
plants  and  animals  which  were  made  about  half  a 
century  ago  by  Gregor  Johann  Mendel,  Abbot  of 
Brlinn.  The  literature  dealing  with  this  matter  is 
now  very  extensive  and  easily  accessible,  and  in  any 
case  a  detailed  account  of  Mendel's  teachings  would 
be  out  of  place  here,  but  a  brief  notice  of  them  is 
demanded  owing  to  the  importance  which  they  have 
assumed. 

Before  the  fire  in  the  room  where  this  is  being 
written  there  lies  a  commonplace  ''  tabby "  cat. 
That  she  is  commonplace  is,  however,  when  one 
stops  to  think  of  it,  perhaps  the  most  surprising 
thing  about  her.  Of  ''  pedigree  "  in  the  conventional 
connotation  of  that  word  she  has  none.  Natural 
selection  has  doubtless  played  some  part  in  her 
production,  but  of  artificial  selection — that  process 
of  controlled  breeding  by  which  we  endeavour  to  fix 
types — there  is  no  evidence.  She  is  just  a  casual 
product  of  the  promiscuous  intercourse  in  which  the 
domestic  cat  indulges  when  allowed  to  wander  at 
large.     Yet  she  has  perfectly  distinctive  characters 

L  2 


148  THE   FEEBLE-MINDED  chap. 

which  relegate  her  to  one  of  the  two  distinctive 
classes  into  which  *' tabby"  cats  can  be  divided. 
Throughout  the  indiscriminate  breeding  which  has 
been  taking  place  for  countless  generations,  certain 
features  of  colouration  and  marking  have  been 
transmitted  unchanged  to  the  exclusion  of  other 
characters  which  some  ancestor  must  have 
possessed.  There  has  been  no  blending  of  the 
particular  character  with  others.  We  have  here, 
according  to  Mr.  R.  J.  Pocock,^  an  example  of 
Mendelian  inheritance.  Mendel's  own  experiments 
were,  in  the  main,  conducted  with  the  edible  pea. 
He  crossed  individuals  having  distinctive  characters, 
e.g.,  those  yielding  smooth  round  seeds  with  those 
yielding  angular  wrinkled  seeds,  and  found  that  the 
offspring  yielded  only  seeds  of  the  former  kind.  To 
characters  thus  transmitted  at  the  expense  of  corre- 
sponding characters  he  applied  the  name  ''dominant." 
i  Further,  he  found  that  when  the  plants  so  obtained 
I  were  bred  amongst  themselves,  the  new  generation 
Icontained  individuals  of  which  some  displayed,  the 
dominant  character,  which  was  alone  present  in  their 
parent  form,  while  others  produced  the  angular 
wrinkled  seeds  absent  from  the  parental  form,  but 
found  in  one  of  the  grand-parental  forms.  This 
grand-parental  character,  which  had  been  temporarily 
suppressed,  he  called  ''  recessive." 

At  the  present  day  attempts  are  being  made  by  a 
particular  school  of  biologists  to  bring  within  the 
scope  of  Mendelian  rules  peculiarities  of  hereditary 
transmission  of  all  kinds.      It  will  be  time  enough  to 

1  R.  J.  Pocock,  "  On  English  Domestic  Cats,"  Proc.  Zool  Soc.  of 
London^  iQo??  P-  i43- 


V       CAUSATION  OF  FEEBLE  MIND     149 

deal  with  these  when  they  have  passed  the  bounds 
of  controversy  and  when  their  general  acceptance 
makes  a  study  of  their  applicability  to  practical 
questions  imperative.  We  may,  however,  notice 
one  interesting  development,  since  it  bears  upon  a 
matter — that  of  sexual  dimorphism — to  which 
allusion  has  been  made  above.  Professor  W. 
Bateson,  the  great  protagonist  of  Mendelism  in  this 
country,  has  stated  that  he  feels  little  doubt  that 
we  shall  succeed  in  proving  that  in  Vertebrates  and 
in  some  other  types,  ''  femaleness  is  a  definite 
Mendelian  factor  absent  from  the  male  and  following 
the  ordinary  Mendelian  rules."  ^ 

Dr.  Archdall  Reid's  way  of  accounting  for  the 
above  forms  of  resemblance  between  parents  and 
offspring  has  elements  of  novelty  which  claim  atten- 
tion. His  views  may  be  thus  summarised,  though 
it  is  desirable  that  the  reader  should  study  them 
as  expounded  in  Dr.  Reid's  own  book  in  order  to 
get  a  thorough  grasp  of  them.  Parental  characters 
ordinarily  blend  in  the  offspring — indeed,  the  object 
of  conjugation  is  to  secure  this  blending.  But  of 
mutually  incompatible  characters,  since  these  cannot 
blend,  one  or  other  becomes  latent.  Mendelism 
has  concerned  itself  with  characters  of  this  class, 
which  includes  the  sexual  characters  and  some  others. 
"  The  apparent  non-blending  of  the  sexual  and 
Mendelian  characters"  is  *'due  to  the  fact  that  the 
patent  set  from  the  one  parent  blends  with  the  latent 
set  from  the  other."  Instead,  therefore,  of  sexual 
dimorphism  being  a  special  case  of  Mendelian 
inheritance,  we  are  to  regard  Mendelian  reproduction 

*  W.  Bateson,  The  Method  and  Scope  of  Genetics^  1908,  p.  39. 


150  THE   FEEBLE-MINDED  chap. 

as  *'  an  anomaly  of  sexual  reproduction  whereby 
non-sexual  characters  are  reproduced  and  blended 
in  the  same  mode  as  sexual  characters,  one  of  each 
allelomorphic  pair  being  patent  and  the  other 
latent."^ 

(2)  Reversion.  We  have  now  to  consider  a  group 
of  cases  in  which  the  inheritance  is  said  to  be 
''  reversionary."  The  cases  have  little  in  common 
beyond  the  fact  that  such  resemblance  as  exists 
between  the  individual  and  his  ancestors  is  of  a  kind 
from  which,  as  regards  the  special  features  under 
notice,  the  immediate  ancestors,  i.e,,  the  parents, 
are  excluded.  Professor  A.  Thomson  ^  makes  the 
term  ''  reversion  "  cover  *'  all  cases  where,  through 
inheritance,  there  reappears  in  an  individual  some 
character  or  combination  of  characters  which  was 
not  expressed  in  his  immediate  lineage,  but  which 
had  occurred  in  a  remoter,  but  not  hypothetical 
ancestor."  Bateson's  definition  is  somewhat  more 
elastic.  He  uses  the  term  to  signify  ''that  particular 
addition  or  subtraction  which  brings  the  total  of  the 
elements  back  to  something  it  had  been  before  in 
the  history  of  the  race."^ 

We  may  note,  incidentally,  that  evolution  is 
twofold.  In  developing  from  the  fertilised  ovum, 
the  individual  passes  through  a  certain  series  of 
phases  which  together  constitute  the  ontogeny. 
But  the  race  to  which  the  individual  belongs  has 
similarly  passed  through  a  series  of  phases — 
constituting    the    phylogeny — of    which    the    onto- 

1  G.  Archdall  Reid,  op.  cit.,  p.  437. 

2  J.  A.  Thomson,  op.  cit.^  p.  123. 

^  W.  Bateson,  The  Method  mid  Scope  of  Genetics.,  1908,  p.  48. 


V      CAUSATION  OF  FEEBLE  MIND     151 

genetic  series  is  only,  according  to  modern  views, 
an  imperfect  reiteration.  Theoretically,  therefore, 
the  individual  may  "  revert "  to  a  stage  in  either 
series  and  on  this  basis  a  distinction  between 
''  reversion "  and  "  atavism  "  has  been  founded. 
This  distinction  is,  however,  of  no  practical  value 
and  may  be  disregarded. 

Variations,  as  we  have  seen,  are  considered  by 
Dr.  Archdall  Reid  to  be  either  progressive  or 
retrogressive  alterations  of  recapitulation,  and  the 
retrogressive  variations,  which  are  correlated  with 
cessation  of  selection,  give  rise  to  one  of  the  two 
forms  of  reversion,  the  other  being  the  reproduction 
of  a  *'  dormant  ancestral  trait."  It  follows  from  the 
occurrence  of  retrogression  that  ''  ancestors  are 
represented  by  the  individual,  not  en  masse,  but  in 
orderly  succession."  ^ 

How  difficult  it  is  to  arrive  at  a  satisfactory 
conception  of  what  is  meant  by  reversion  will  appear 
when  one  reflects  that  Professor  Thomson's  definition 
will  embrace  all  the  cases  to  which  either  Galton's 
Law  of  Ancestral  Inheritance,  or  Mendel's  principles 
apply.  It  is,  however,  convenient  to  restrict  the 
use  of  the  term  to  Instances  in  which  the  characters 
drawn  from  the  stock  comprised  in  the  series  of 
contributions,  one-quarter,  one-eighth,  one-sixteenth, 
etc.,  which  together  make  up  the  one-half  of  the 
inheritance  not  directly  referable  to  the  parents, 
are  especially  prominent.  Cases  in  point  are, 
doubtless,  those  which  Galton  himself  described 
as  examples  of  what  he  calls  the  Law  of  Filial 
Regression,  which  may  be  regarded  as  probably  the 

1  G.  Archdall  Reid,  op.  at.,  p.  208. 


152  THE   FEEBLE-MINDED         chap. 

scientific  equivalent  of  the  Law  of  Healthy  Birth, 
to  which  allusion  has  already  been  made.  A 
conception  of  what  is  meant  by  filial  regression  may 
be  arrived  at  in  this  way  : — Every  individual  is 
represented  in  the  past  by  a  multitude  of  ancestors, 
the  number  being  directly  proportional  to  the 
number  of  generations  through  which  we  count  back 
and  inversely  proportional  to  the  amount  of  inter- 
breeding which  has  taken  place  between  the 
ancestors.  Thus  if  one  counted  only  a  dozen 
generations  back,  and  assumed  that  the  branches 
of  the  genealogical  tree  had  never  intertwined, 
any  particular  individual  would  have  behind  him 
an  army  of  4096  persons.  Exactly  what  the 
number  is  in  any  given  case  is,  however,  a  secondary 
matter.  It  suffices  that  the  number  is  large  and 
that,  in  consequence,  the  *'  mean  "  of  the  ancestors 
will  be  approximately  that  of  the  general  population. 
Now  since  the  individual  is  a  mosaic  of  ancestral 
characters  he  also  will  tend  to  approximate  to 
the  mean  of  the  general  population.  There  will, 
that  is  to  say,  be  a  tendency  for  offspring  to 
"  regress "  towards  the  average  in  respect  of  any 
character  with  which  the  parents  are  specially 
endowed  or  in  regard  to  which  they  are  conspicu- 
ously deficient. 

(3)  Anomalous  cases.  These  have  little  obvious 
application  to  human  beings  and  they  are  mentioned 
chiefly  for  the  sake  of  completeness.  At  the  same 
time  they  may  serve  to  indicate  directions  in  which, 
with  the  help  afforded  by  the  scientific  use  of  the 
imagination,  the  mysteries  of  heredity  may  be 
further  probed. 


V      CAUSATION  OF  FEEBLE  MIND     153 

(a)  Telegony.  This  term  is  used  to  denote  "the 
supposed  influence  of  a  previous  sire  on  offspring 
subsequently  borne  by  the  same  female  to  a  different 
sire."  The  widespread  belief  in  the  occurrence 
of  phenomena  of  this  kind  seems  to  have  so  slender 
a  basis  that,  failing  more  convincing  evidence,  we 
need  not  dwell  upon  it. 

(d)  Metagenesis.  In  certain  plants  and  animals 
the  offspring  is  altogether  different  in  type  from  its 
parent.  Thus  the  plant  which  develops  from  the 
spore  produced  by  an  ordinary  bracken  fern  is 
wholly  unlike  that  fern  ;  and  the  freely  swimming 
organism — the  medusa — to  which  a  hydrozoan 
zoophyte  gives  rise,  bears  no  resemblance  to  that 
zoophyte.  To  these  new  creatures  succeed  forms 
unlike  them  but  like  the  forms  of  the  first  generation. 
We  have,  that  is  to  say,  an  alternation  of  generations. 
The  significant  difference  between  the  alternating 
forms  is  that  they  are,  respectively,  asexual  and 
sexual  as  regards  their  mode  of  giving  rise  to  the 
succeeding  generation.  Something  in  the  nature 
of  alternation  of  generations  can  be  traced  in  the 
highest  plants,  and  attempts  have  been  made  to 
interpret  certain  features  of  the  reproductive  process 
even  in  Man  himself  on  similar  lines.  Still  more 
complicated  examples  of  alternation  are  familiar 
to  the  zoologist.  One  need  only  allude,  in  illus- 
tration, to  the  life  histories  of  liver  flukes  and  plant 
lice. 

(c)  Xenia.  This  is  a  form  of  inheritance 
dependent  on  a  process  of  double  fertilisation, 
which  has  been  observed  in  some  species  of  maize. 
Not   only  is   the    egg-cell   fertilised,   but   a  second 


154  THE   FEEBLE-MINDED         chap. 

nucleus  from  the  pollen  tube  unites  with  the  polar 
nuclei  extruded  from  the  egg-cell  in  maturation 
to  give  rise  to  the  endosperm. 

(d)  Psedogenesis.  The  Mexican  Axolotl  is  a 
lacustrine  gilled  amphibian,  which,  under  conditions 
favourable  to  the  change,  can  shed  its  gills  and 
continue  life  as  a  terrestrial  form  (called  Amblystoma) 
so  different  from  the  Axolotl  that  for  a  long  time 
the  relationship  between  the  two  was  not  recognised, 
since  the  Axolotl  bred  freely  and  gave  rise  to  forms 
similar  to  itself  In  the  light  of  its  subsequent 
history  it  is  obvious  then  that  Amblystoma  is 
capable  of  reproduction  while  still  in  the  larval 
stage  of  its  development. 

(e)  Seasonal  Dimorphism.  Welsmann  long  ago 
drew  attention  to  the  fact  that  certain  butterflies 
of  apparently  different  species  were  in  reality 
summer  and  winter  forms  of  the  same  species,  it 
being  possible,  by  employing  a  suitable  temperature, 
to  convert  the  winter  form  into  the  summer  one, 
though  in  ordinary  circumstances  the  two  forms 
alternated  according  to  the  season  at  which  they 
appeared.  Both  this  case  and  that  of  the  Axolotl 
are  described  in  Weismann's  Stttdies  in  the  Theory  of 
Desce7it,  and  it  is  interesting  to  note  that  Welsmann 
regarded  them  as  Instances  of  reversion. 

As  we  saw  above,  the  application  of  the  term 
**  Inheritance "  Is  not  usually  restricted  to  the 
manifestations  of  innate  tendency  of  which  we  have 
so  far  been  speaking,  and  it  would  appear  that  the 
legal  and  other  uses  of  the  word  are  themselves  not 
without  biological  significance.  As  Darwin  pointed 
out.  Inheritance  involves  not  only  the  transmission, 


V       CAUSATION  OF  FEEBLE  MIND      155 

but  the  development  of  characters.  This  develop- 
ment is  conditioned  by  the  environment,  but  the  cases 
which  we  are  now  considering  are  not,  therefore,  to 
be  relegated  to  the  second  of  our  primary  classes, 
for  while  the  expression  of  inheritance  is  dependent 
on  the  circumstances  in  which  development  takes 
place,  its  possibility  is  to  be  explained  by  reference 
to  the  innate  tendency  which  is  the  essential 
characteristic  of  the  first  class  of  cases. 

It  is  a  fact  of  common  observation  that  latent 
characters  are  being  continually  brought  to  the  light 
of  day  by  the  changing  conditions  of  life.  The 
humdrum  citizen,  suddenly  faced  for  the  first  time 
by  a  critical  situation,  may  display  qualities  of  courage 
or  cowardice,  promptness  or  vacillation,  delicacy  or 
boorishness,  of  which  he  had  previously  given  no 
sign.  An  epidemic  of  disease  will  bring  out  the 
fact  that  different  persons  have  exhibited  and  have 
presumably  inherited  different  degrees  of  suscepti- 
bility to  its  influence.  Instincts  which  ordinarily 
cease  in  early  life  to  be  of  value  to  the  individual 
may  persist  to  years  of  maturity  if  the  special 
conditions  which  abrogate  them  are  not  forth- 
coming. 

We  can  only  judge  of  heredity  by  the  way  in 
which  it  manifests  itself,  and,  in  so  far  as  factors  in 
the  environment  have  to  do  with  the  manifestation, 
we  may  legitimately  regard  them  as  factors  of 
inheritance.  All  the  elements  which  go  to  make  up 
the  special  kind  of  environment  which  is  conven- 
tionally described  as  ''  inherited  "  are  not  necessarily 
factors  of  this  kind,  but  it  is  peculiarly  among  those 
elements  that  factors  are  to  be  found. 


156  THE   FEEBLE-MINDED         chap. 

Having  now  obtained  some  notion  of  what  is 
meant  by  inheritance,  we  may  proceed  to  enquire 
what  innate  tendencies  have  to  do  with  the  causa- 
tion of  feeble-mindedness.  Very  little  can  be  done 
in  the  way  of  allocating  to  its  particular  category 
any  case  of  defectiveness  which  is  admitted  to  be 
hereditary,  since  the  psychical  elements  which  afford 
the  means  of  comparison  are  not  very  clearly 
definable.  Moreover,  although  it  may  be  admitted 
that  the  psychical  elements  have  anatomical  sub- 
strata, the  admission  is,  as  yet,  of  no  particular  value, 
for  we  do  not  know,  except  in  the  most  general 
way,  what  psychical  phenomena  are  associated  with 
particular  anatomical  features,  and  if  we  should 
discover  this  we  might  find  that  the  anatomical 
features  themselves  were  not  sufficiently  distinctive 
to  lend  us  any  assistance. 

All  that  we  seem  justified  in  asserting  is  that  the 
bioplasmic  basis,  or  (to  employ  the  terminology  of 
Weismann)  the  germ-plasm,  derived  from  either 
parent,  may,  '*  for  reasons  unknown  to  us,"  exhibit  in 
the  offspring  changes  in  the  nature  of  variation  or 
mutation.  In  this  way  an  unsound  stock  may  be 
derived  from  a  sound  one  and,  conversely,  a  sound 
from  an  unsound  one.  On  the  lines  laid  down 
above,  a  character  of  unsoundness  may  be  transmitted 
so  as  to  appear  as  an  example  of  one  or  other  of  the 
modes  of  inheritance  which  have  been  mentioned. 
By  a  ** character  of  unsoundness"  is  meant,  in  the 
circumstances  with  which  we  are  at  present  con- 
cerned, what  is  called  the  "  Insane  Diathesis,"  for 
there  is  practically  no  evidence  that  particular 
mental  defects  are  heritable  quantities,  although  this 


V       CAUSATION  OF  FEEBLE  MIND     157 

fact  may  simply  be  an  expression  of  the  deficiency 
of  trustworthy  information  bearing  upon  the  matter. 
Certainly,  as  far  as  feeble-mindedness  is  in  question, 
unless  the  relationship  to  it,  in  heredity,  of  insanity, 
epilepsy,  hysteria,  neurasthenia,  and  even  gross 
cerebral  lesions  were  admitted,  the  case  for  inherit- 
ance would  be  a  weak  one. 

Even  in  regard  to  the  insane  diathesis  there  is  a 
plentiful  lack  of  reliable  data.  Speaking  during  the 
course  of  a  discussion  on  "  The  Influence  of  Heredity 
on  Disease,"  Dr.  C.  Mercier  ^  expressed  the  opinion 
that  the  ''  compilation  of  the  statistics  of  inheritance 
which  appear  in  the  Report  of  the  Commissioners  in 
Lunacy  is  a  gigantic  waste  of  time  and  labour. 
The  statistics  are  of  no  value  at  all  for  any  practical 
or  scientific  purpose."  Somewhat  more  satisfactory 
are  the  records  compiled  by  individual  observers  in 
special  instances  to  demonstrate  the  ''effects  of 
heredity,"  but  from  the  statistical  standpoint  these 
records  also  are  to  a  great  extent  vitiated  by  the 
absence  of  a  standard  of  normal  heredity  with  which 
to  compare  them. 

Mr.  David  Heron,^  whose  studies  in  this  connec- 
tion are  among  the  few  which  have  been  conducted 
on  scientific  lines,  has  stated  that  "the  whole  of  the 
medical  data  hitherto  published  on  the  subject  seem 
lacking  in  the  precision  needful  to  give  a  logical 
proof.  .  .  .  Heredity  is  over  and  over  again 
recorded  as  a  principal  or  contributory  cause  of 
insanity,  although  the  average  number  of  the  insane 

^  C.  Mercier,  Proc.  Royal  Society  of  Medicine^  Jan.  1909,  p.  45. 
2  D.   Heron,  A  First  Study  of  the  Statistics  of  Insanity  and  the 
Inheritance  of  the  Insane  Diathesis^  190??  p-  21. 


158  THE   FEEBLE-MINDED         chap. 

in  the  stock  of  the  same   individual   has  not  been 
discussed." 

We  may,  however,  quote  some  of  the  more  recent 
figures  which  have  been  collected,  in  circumstances 
which  eliminate  to  a  great  extent  the  purely  specula- 
tive element.  In  his  evidence  before  the  Royal 
Commission  on  the  Care  and  Control  of  the  Feeble- 
Minded,  Dr.  W.  A.  Potts  ^  tendered  the  following 
tables  as  summarising  the  results  of  an  enquiry 
which  he  had  made  : — 

Insane,  Feeble-Minded,  and  Epileptic  Heredity. 


— 

Direct. 

Collateral. 

Total. 

Defective  children 

Normal  children     ... 

28-4% 

io% 

12% 

38-4% 

22% 

From  figures  given  by  Mrs.  Bramwell  Booth,^  it 
appears  that  of  205  children  born  to  feeble-minded 
women  25  were  "  of  average  intellect  (so  far  as  it 
was  possible  to  tell)  "  ;  6"]  were  ''  mentally  weak  "  ; 
while  about  the  remaining  113  there  was  *'no  in- 
formation." Assuming  that  the  proportion  of 
''mentally  weak"  children  among  the  113  was  the 
same  as  among  the  92  in  regard  to  whom  particulars 
could  be  ascertained,  this  would  mean  that  over 
70  per  cent,  of  the  children  of  feeble-minded  mothers 
are  mentally  defective. 

A  few  cases  quoted  in  the  13th  Annual  Report 
(1909)  of  the  National  Association  for  the  Feeble- 
Mlnded    hardly    bear    out    the    view.      "A    careful 

^  W.  A.  Vo\Xs^  Rep07't  of  Roy.  Comm.  o?t  Feeble-Minded,  vol.  2,  p. 

474. 

^  B.  Booth,  Report  of  Roy.  Com7n,  on  Feeble- Minded,   vol.   2,   p. 
572. 


V       CAUSATION  OF  FEEBLE  MIND     159 

examination  of  the  children  at  the  North  Finchley 
Home,"  it  is  stated,  showed  that  ''2  out  of  12 
children  of  12  mothers,  all  of  whom  are  definitely 
feeble-minded,  can  at  present  be  considered  mentally 
defective."  This  works  out  at  less  than  17  per  cent, 
but  in  regard  to  both  sets  of  figures  much  more  in- 
formation is  required  before  they  can  be  satis- 
factorily compared. 

Dr.  A.  Eichholz,^  in  his  evidence  before  the 
Royal  Commission,  contended  that  the  influence  of 
heredity  is  not  to  be  expressed  in  such  simple 
fashion  as  this.  '*'  Apart  from  the  associated  con- 
ditions of  physical  degeneracy  which,"  he  says,  '*  are 
responsible  for  a  considerable  proportion  of  the 
feeble-minded,  it  ma}^  be  said  that  the  chances  of 
mentally  defective  offspring  reside  evenly  among  the 
whole  population,  and  that  they  do  not  pertain  to 
any  particular  type  of  parent.  This  is  a  direct 
result  of  the  operation  of  heredity  in  virtue  of  which 
the  physical  inheritance  of  the  individual  is  derived 
from  a  very  far-reaching  line  of  ancestors,  the  large 
majority  of  whom  are  normal."  Dr.  Eichholz,  it 
would  appear,  applies  rather  too  absolutely  the 
principle  of  filial  regression. 

Mr.  Heron's  conclusions,  which,  from  the  nature 
of  the  methods  employed,  have  a  special  value,  are 
that  *'The  insane  diathesis  is  inherited  with  at  least 
as  great  an  intensity  as  any  physical  or  mental 
character  in  man.  It  forms,  considering  the 
difficulties  and  assumptions  of  the  investigation, 
probably    no    exception   to   an   orderly    system   of 

^  A.  Eichholz,  Report  of  Roy.  Conim.  on  Feeble-Minded^  vol.  i, 
p.  206. 


160 


THE   FEEBLE-MINDED 


CHAP. 


inheritance  in  man,  whereby  on  an  average  about 
half  of  the  mean  parental  character,  whether  physical, 
mental,  or  pathological,  will  be  found  in  the  child. 
It  is  accordingly  highly  probable  that  it  is  in  the 
same  manner  as  other  physical  characters  capable  of 
selection  or  elimination  by  unwise  or  prudential 
mating  in  the  course  of  two  or  three  generations."^ 
Mental  characters  thus  appear  to  conform  to  Galton's 
Law  of  Ancestral  Inheritance  as  far  as  the  parents 
are  concerned.  Whether  the  Law  is  of  more  ex- 
tended application  remains  to  be  seen. 

A  subsidiary  result  obtained  by  Mr.  Heron  is  also 
worthy  of  notice.  He  found  that  there  is  "no 
reduction  in,  possibly  rather  an  augmentation  of, 
the  fertility  of  insane  stocks,  when  compared  with 
that  of  sane  stocks."  ^ 

Attempts  have  been  made  to  account  for  the 
inheritance  of  mental  unsoundness  on  Mendelian 
principles,  insanity  being  regarded  as  the  recessive 
character,  and  sanity  as  the  dominant  one,  but  this 
interpretation  is  not  borne  out  by  Mr.  Heron's 
figures,  as  is  shown,  for  example,  by  the  following 
table  given  by  him  : — ^ 


Nature  of  parents  as 

Total  Offspring. 

Percentage  Offspring. 

to  insanity. 

Insane. 

Sane. 

Insane. 

Sane. 

Both  sane       

One  insane     

Both  insane 

314 
93 

4 

1,179 

299 

4 

21 
24 
50 

79 
76 

50 

Possibly  the  ''  insane  diathesis "   may  eventually 
admit  of  being  split  up  into  a  number  of  diatheses  each 

1  D.  Heron,  op.  cit.^  p.  21.  2  jj^id,^  p.  32. 

3  Ibid.^  P-  17. 


V       CAUSATION  OF  FEEBLE  MIND     161 

capable  of  recognition  as  a  specific  hereditary  and 
perhaps  MendeHan  character. 

Sir  E.  Ray  Lankester^  would  place  the  facts  of 
inheritance,  as  regards  mental  defect,  in  yet  another 
category.  *'  There  is,"  he  says,  ''  no  reason  whatever 
to  suppose  that  true  feeble-mindedness  is  anything 
but  a  congenital  condition,  due  to  heredity  and  to 
nothing  else  ;  a  reversion  of  the  brain  to  an  earlier 
level  of  development." 

In  cases  of  mental  deficiency  we  may  find,  as 
associated  conditions,  other  forms  of  hereditary 
defect,  and  much  confusion  has  resulted  from  the 
gratuitous  assumption  that  the  latter  have  a  causal 
relation  to  the  want  of  intellectual  capacity.  Fairly 
definitely  in  the  case  of  alcohol  ;  less  so  in  the  case 
of  tubercle  ;  and  only  doubtfully  as  regards  syphilis 
and  other  toxic  agencies,  we  can  recognise  that  the 
injurious  effects  of  these  agents  are  contributed  to  by 
the  lack  of  resistive  power  in  the  organism.  But  in 
this  fact  there  lies  no  justification  for  assuming  that 
the  particular  defect  which  the  bioplasm  may  display 
is  capable  of  engendering  defect  of  some  other  kind. 
Therefore,  when  we  find  that  the  forebears  of  a 
mentally  defective  person  are  alcoholic  or  tuberculous 
we  have  not  sufficient  ground  for  inferring  that 
alcohol  or  tubercle  was  responsible  for  his  intellectual 
shortcomings. 

Such  evidence  as  there  is  for  associating  tuber- 
culosis and  insanity  lies  in  the  fact  that  the  incidence 
of  tuberculosis  upon  the  insane  is  relatively  high  ; 
but    this  association  may   be    indirect    in    that    the 

1  E.  Ray  Lankester,  Report  of  Roy,  Com7n.  on  Feeble- Minded,  vol. 
5,  p.  246. 

M 


162  THE   FEEBLE-MINDED  chap. 

existence  of  insanity  may  Involve  the  acquiring  of 
characters  in  the  way  of  defective  nutrition  which 
render  the  individual  more  susceptible  to  the  action 
of  the  tubercle  bacillus,  apart  from  any  Innate  weak- 
ness in  that  direction.  If  there  be,  as  Mr.  Heron 
maintains,  ''  a  close  correspondence  between  the 
inheritance  of  the  insane  diathesis  and  that  of 
pulmonary  tuberculosis,"  -^  this  must  be  taken  to 
mean  that  the  different  pathological  conditions  are 
inherited  on  parallel  lines,  and  not  that  one  condition 
is  convertible  into  another.  Even  parallelism  to 
this  extent  is  not  without  its  confusing  aspect,  for 
while  the  tubercular  diathesis  (if  it  exists  at  all)  ^ 
denotes  a  capacity  for  reacting  with  abnormal  ease 
to  the  influence  of  only  one  particular  toxin,  the 
insane  diathesis  would  appear  to  involve  a  many- 
sided  weakness  expressed  as  susceptibility  to  many 
and  various  toxins,  to  say  nothing  of  mechanical  and 
even  more  obscure  agencies. 

Alcoholism  is  on  a  somewhat  different  footing, 
since  it  is,  theoretically  at  least,  under  the  control  of 
the  will.  The  germinal  defect  involved  in  alcoholism 
may  therefore  be  either  a  special  susceptibility  to 
the  action  of  the  toxin — an  alcoholic  diathesis — or  a 
paresis  of  volition  which  brings  the  organism  within 
the  sphere  of  action  of  the  toxin — a  form  of  the 
insane  diathesis. 

The  part  which  consanguinity  plays  in  the 
causation  of  weak-mindedness  becomes  intelligible 
in  the  light  of  our  conception  of  heredity.     If  the 

^  D.  Heron,  op.  cit.,  p.  32. 

2  See  in  regard  to  this  point  the  discussion  on  Heredity  reported  in 
Proc.  Roy.  Sac.  of  Medici?ie,  Jan.,  1909. 


V       CAUSATION  OF  FEEBLE  MIND     163 

bioplasmic  stock  from  which  the  closely  related 
persons  come  Is  of  the  kind  which  generates  defective 
brains,  the  chance  of  the  occurrence  of  two  inde- 
pendent parental  variations  which  would  be 
necessary  to  eliminate  this  quality  is  so  small  that 
the  transmission  of  the  quality  by  one  or  both  lines 
of  descent  is  probable.  If  the  stock  is  free  from 
this  peculiarity,  it  is  no  more  likely  to  vary  in  the 
direction  of  producing  It  than  any  other  healthy 
stock. 

(B)     Environmental  Influences  Predominant. 

In  the  first  set  of  cases  the  environment  was  seen 
to  play  a  part  apparently  insignificant  and  certainly 
obscure  ;  here,  on  the  other  hand,  we  suppose  It  to 
have  special  Importance.  As  far  as  the  human  race 
Is  concerned,  natural  selection  has  become  greatly 
restricted,-^  and  artificial  selection  has  been  carried  on 
either  haphazard  or  with  a  view  to  the  perpetuation 
of  other  qualities  than  the  Intellectual.  The  mean 
Intellectual  level  of  the  community  Is  apparently  no 
higher  than,  for  example,  In  the  Elizabethan  period  ; 
indeed,  there  are  reasons  for  regarding  It  as  lower  : 
and  yet  we  have  advanced  since  those  days.  It  has 
been  pointed  out  by  Lloyd  Morgan  and  others  that 
present-day  evolution  Is  rather  of  the  environment 
than  of  the  race.  The  children  start  where  the 
fathers  left  off,  not  only  because  they  have  Inherited 

^  "  The  present  progressive  evolution  of  man,  at  any  rate  of  civilised 
man,  is  chiefly,  if  not  exclusively,  against  disease,  which  is  apparently 
the  only  selective  agency  acting  on  him  sufficiently  stringent  to  do 
more  than  merely  maintain  characters  previously  evolved." — G.  Arch- 
dall  Reid,  The  Laws  of  Heredity^  1910,  p.  438. 

M    2 


164  THE   FEEBLE-MINDED         chap. 

the  favourable  mutations  and  variations  of  bioplasm 
which  the  father  experienced,  but  because  they  have 
come  Into  the  store  of  favourable  conditions  which 
successive  generations  have  accumulated. 

During  recent  years  some  remarkable  results 
have  been  obtained  by  Professor  J.  Loeb  ^  in  his 
investigations  of  the  effects  which  temperature, 
light,  gravitation,  and  chemical  agencies,  acting 
upon  the  germ,  have  In  modifying  both  the  bodily 
form  and  the  Instinctive  reactions  of  animals. 
Although  his  experiments  have  little  direct  bearing 
upon  human  development,  they  open  up  fields  of 
interesting  possibilities  which  may  eventually  be 
productive  of  valuable  contributions  to  embryo- 
logical  science.  So  far  as  our  present  knowledge 
goes,  the  environmental  factors  which  have  the  most 
obvious  relation  to  the  production  of  mental  defect 
may  be  thus  classified  : — 

(i)  Mental  and  physical  strains  and  stresses. — 
These  may  be  considered  either  in  connection 
with  their  Influence  on  the  parent  before  the 
separate  existence  of  the  child  or  as  acting  on 
the  child  directly.  It  appears,  on  the  face  of  It, 
reasonable  to  suppose  that  an  insanitary  milieu  and 
want  of  suitable  food  may  prejudicially  affect  Intra- 
uterine development.  We  have  for  Instance  the 
figures  given  by  Legrand  du  Saulle  as  to  the  "siege 
children"  In  Paris.  Of  92  conceived  during  the 
siege  of  1870-71  not  one  was  thoroughly  healthy, 
and  29  of  them  displayed  symptoms  of  mental 
disorder.  There  is  also  some  evidence  that 
attempts     to     procure    abortion     are    occasionally 

^  J.  Loeb,  op.  cit. 


V       CAUSATION  OF  FEEBLE  MIND      165 

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

On  the  subject  of  ''maternal  impressions,"  to 
which  allusion  will  no  doubt  be  expected,  the 
remark  which  seems  appropriate  is  that  we  should 
keep  an  open  mind,  in  the  hope  that  some  day 
there  may  be  forthcoming  more  conclusive  evidence. 
The  presumption  is,  however,  against  the  view  that 
maternal  impressions  can  have  important  effects 
in  controlling  the  development  of  the  foetus  if  only 
for  the  following  reason.  In  spite  of  the  intimacy 
of  the  relation  which  exists  between  mother  and 
child  during  gestation,  there  is  not  ordinarily  a  pre- 
ponderance of  maternal  characteristics  over  paternal. 
As  compared  with  the  influence  which  the  mother  is 
bringing  to  bear  during  a  prolonged  period,  the 
incidence  of  an  isolated  and  temporary  emotion 
might  reasonably  be  expected  to  be  trivial,  and 
since  it  appears  that  the  former  is  of  no  particular 
moment,  we  may  regard  the  latter  as  of  very  little 
consequence  indeed. 

The  incidents  of  birth  afford  ample  scope  for  the 
intervention  of  injurious  agencies,  but  the  topic  is 
one  that  need  not  detain  us,  since  the  possibilities  in 
this  regard  are  such  as  anyone  may  readily  think 
out  for  himself.  Reference  is,  however,  permissible 
to  the  work  of  Little,^  since  his  name  has  been 
applied  to  a  condition  in  which  certain  accidents  at 
birth  may  be  associated  with  feeble-mindedness. 
Some  degree  of  paralysis  was  observable  in  Little's 
cases,    but   it    has  been    suggested   that  a  form  of 

1  W.  J.  Little,  Trans,  of  the  London  Obstetrical  Society^  1861,  p.  293. 


166  THE   FEEBLE-MINDED         chap 

infantile  '' cerebroplegia,"  which  is  not  accompanied 
by  paralysis,  may  occur. 

A  view  very  generally  approved,  ^.^.,  by  Heller,^  is 
that  first-born  children  are  more  likely  to  be  mentally 
defective  than  those  afterwards  born  to  the  same 
parents.  This  is  said  to  be  due  to  the  fact  that  first 
labours  are  usually  more  prolonged  and  difficult 
than  subsequent  ones.  Dr.  Tredgold  ^  maintains 
the  contrary  opinion.  "As  a  matter  of  fact,"  he 
says,  "  I  believe  the  statement  that  an  undue  pro- 
portion of  idiots  are  first-born  children  is  decidedly 
open  to  question,  and  my  own  experience  is  to  the 
effect  that  it  is  more  common  for  the  later-born,  and 
not  the  first-born,  to  be  affected."  It  may  be  noted 
in  this  connection  that  Mr.  Heron,  in  the  research 
already  alluded  to,  found  that  ''  the  incidence  of 
insanity  does  not  appear  to  be  equally  distributed 
over  the  family,  but  to  fall  more  heavily  on  the 
elder  members."  ^  Mr.  Heron  does  not  suggest,  and 
probably  would  not  accept  the  suggestion,  that  the 
explanation  of  his  results  is  to  be  found  in  the 
mechanical  conditions  of  parturition. 

After  birth  the  child  is  still  exposed  to  the 
influences  of  strains  and  stresses,  though  from  these 
we  must  arbitrarily  exclude,  out  of  respect  to  the 
scheme  of  classification  adopted  in  this  book,  such 
as  do  not  act  at  "an  early  age."  Of  special  im- 
portance are  the  ones  which,  for  any  reason,  e.^-.,  by 
causing  abnormalities  of  sense-organs  or  by  limiting 
educational  opportunities,   result  in    the  child's    not 

^  T.  Heller,  Grimdriss  der  Heiipddagogik^  I904)  P-  i68. 
2  A.  F.  Tredgold,  Mental  Deficiency^  1908,  p.  30. 
^  D.  Heron,  op.  cit.^  p.  32. 


V      CAUSATION  OF  FEEBLE  MIND      167 

acquiring  the  necessary  capital  of  sense-impressions.  / 
To  the  instances  of  mental  defect  arising  in  this  way 
Ireland  and  others  apply  the  name  Idiocy  by 
Deprivation,  and  the  class  includes  cases  like  those 
of  Laura  Bridgman  and  Helen  Keller  on  the  one 
hand,  and  on  the  other,  the  "  wild  boys  "  and  ''  wolf 
children  "  who  formerly  attracted  so  much  attention. 

We  may  notice,  in  passing,  Griesinger  s  ^  sugges- 
tion that  an  injurious  state  of  cerebral  congestion 
may  be  produced  in  children  by  keeping  their  heads 
too  closely  wrapped  up  or  by  allowing  them  to  sleep 
in  too  close  proximity  to  a  stove. 

The  importance  to  be  attached  to  psychical  stresses 
will  depend  somewhat  on  our  interpretation  of  what 
constitutes  *'an  early  age."  Very  young  children 
are  not  sufficiently  appreciative  of  their  surroundings 
to  find  in  them  occasion  for  the  development  of 
profound  emotions.  Heller  ^  quotes  instances  in 
which  children  of,  respectively,  six  and  eight  years 
of  age,  previously  of  normal  intelligence,  became 
permanently  weak-minded  in  consequence  of  severe 
frights.  For  practical  purposes  such  cases  might 
well  be  included  among  the  ''  feeble-minded,"  though 
it  might  be  argued  that  our  definitions  do  not  cover 
them. 

(2)  Toxic  Agencies. — These  might,  of  course,  be 
brought  under  the  heading  "strains  and  stresses" 
just  given  above,  but  it  is  more  convenient  to  take 
them  separately.  They  may  be  applied  directly  to 
the  individual ;  thus  the  child  may  be  given  alcohol, 

^  H.  Bosbauer,  L.  Miklas  and  H.  Schiner,  Hafidbuch  der  Schwach- 
sinnigenfiirsorge,  1909,  p.  87. 

2  T.  Heller,  op.  cit.^  pp.  14  and  15. 


168  THE   FEEBLE-MINDED         chap. 

or  may  acquire  syphilis,  malaria,  or  one  of  the  acute 
infections  at  a  sufficiently  early  age  to  bring  It  within 
the  limits  of  our  conception  of  feeble-mindedness  as 
a  condition  dating  "  from  birth  or  from  an  early  age." 
In  general,  however,  they  influence  the  child  via  the 
parent.  The  most  important  ones  are,  it  would 
appear  : 

[a)  Syphilis. — The  degree  of  probability  that 
syphilis  is  the  cause  of  the  mental  defect  observed  Is 
fairly  high  in  a  case  where  one  finds,  as  one  some- 
times does  find,  a  gumma  in  the  brain  ;  or  where, 
after  a  definite  history  of  infection,  parent  and  child 
alike  suffer  from  general  paralysis  (using  that  term 
in  its  specific  sense).  With  this  justification  for 
assuming  some  connection  between  syphilis  and 
feeble-mindedness,  an  Investigation  was  conducted 
as  carefully  as  circumstances  would  permit  Into  the 
family  history  of  90  patients  over  16  years  of  age. 
In  13  of  these  cases,  i.e.,  14 '4%,  there  was  satis- 
factory evidence  that  one  or  other  of  the  parents 
had  had  syphilis.  If  it  be  remembered  how  wide- 
spread this  disease  Is  among  the  general  public,  it 
seems  probable  that  if  one  took  children  who  were 
not  mentally  defective  and  investigated  their  family 
history  as  thoroughly,  one  would  find  quite  as  much 
parental  syphilis — the  normal  children  taken  might 
indeed  very  well  be  the  brothers  and  sisters  of  the 
idiots  In  the  first  batch  of  cases.  The  Wassermann 
reaction  provides  a  more  satisfactory  means  of 
diagnosing  the  existence  of  syphilitic  infection  than 
is  afforded  either  by  Inspection  or  by  inquiries  into 
the  history  of  the  person  concerned.       Dean^  has 

t       ^  H.  R.  Dean,  "  An  Examination  of  the  Blood  Serum  of  Idiots  by  the 
Wassermann  Reaction,"  Lancet^  July  23,  1910,  p.  227. 


V      CAUSATION  OF  FEEBLE  MIND     169 

recorded  the  results  of  an  examination,  by  Wasser- 
mann's  method,  of  blood  serum  from  330  cases  of 
idiocy.  He  found  that  in  51,  i.e.,  i5'4%,  a  positive 
reaction  was  obtained.  Included  among  the  51 
cases  were  7  with  definite  signs  of  syphilis  and  3  or 
4  in  which  syphilis  might  have  been  suspected.  It 
is  interesting  to  note  how  closely  Dean's  figures 
approximate  to  those  quoted  above,  which  were 
yielded  by  an  investigation  of  the  family  history. 

(K)  Tuberctilosis. — This  disease  is  perhaps  more 
widely  spread  than  syphilis,  and  its  association  with 
feeble-mindedness  proves  nothing  in  the  absence  of 
figures  to  show  that  the  association  is  really  more 
frequent  than  the  occurrence  of  a  family  history  of 
phthisis  in  the  sane.  It  is,  however,  quite  con- 
ceivable that  tuberculosis  in  the  mother  may  interfere 
with  the  nutrition  of  the  embryo  as  suggested  by 
Weygandt.-^ 

{c)  Alcohol, — The  argument  from  association  of 
conditions  is  even  more  feeble  in  this  case  than  in 
the  preceding.  In  the  great  majority  of  the  com- 
pilations of  statistics  dealing  with  this  subject  no 
attempt  is  made  to  show  the  percentage  of  cases  in 
which  there  is  a  direct  or  indirect  action  of  alcohol 
on  the  healthy  embryo.  It  is,  however,  credible 
that  alcohol  in  such  circumstances  would  be  in- 
jurious, and  that  the  brain  might  suffer  as  well  as 
other  parts  of  the  body.  Some  confirmatory 
evidence  on  this  point  is  afforded  by  Dr.  G.  Schenker,^ 
Director  of  the  Biberstein  Asylum,   near  Aarau  in 

1  W.  Weygandt,  Die  Beha7tdlung  idiotischer  und  imbeciller  Kinder^ 
1900,  p.  8. 

2  G.  Schenker,  Beobachttmgen  an  schwachsinjiigen  Kindern^  1899, 
p.  7. 


170  THE   FEEBLE-MINDED         chap. 

Switzerland.  *'  Before  the  Introduction  of  the 
alcohol  monopoly,"  he  says,  ''there  were  certain 
towns  and  districts  where  the  consumption  of  brandy 
was  excessive.  The  physical  and  psychical  state  of 
the  people  In  these  regions  was  such  that  frequently 
hardly  a  third  of  them  would  be  considered  fit  for 
military  service.  A  large  number  of  idiotic  and 
semi-idiotic  children  were  there  produced.  Alcohol- 
ism was  chiefly  responsible  for  these,  for  in  other 
districts  where  alcohol  was  little  indulged  in,  and  a 
more  rational  mode  of  living  was  observed,  strong, 
well-built  and  mentally  well-developed  persons  were 
the  rule." 

Of  the  same  purport  Is  the  statement  made  by 
Mr.  R.  J.  Parr,^  Director  of  the  National  Society 
for  the  Prevention  of  Cruelty  to  Children,  in  his 
evidence  before  the  Royal  Commission  on  the  Care 
and  Control  of  the  Feeble- Minded.  He  submitted 
a  list  of  13  Inebriate  women  in  regard  to  whom 
it  was  noted  that  ''the  younger  children  born 
during  the  period  of  the  women's  Inebriety  "  were 
weak-minded,  while  those  born  prior  to  that  period 
were  sound. 

Against  the  view  that  there  is  any  such  simple 
dependence  of  feeble-mlndedness  in  the  offspring 
on  alcoholism  In  the  parent  must  be  set  the  ex- 
perience of  Miss  E.  M.  Elderton  and  Professor 
Karl  Pearson,  as  recorded  in  No.  10  of  the  Eugenics 
Laboratory  Memoirs.  As  a  result  of  analysing  two 
series  of  statistics,  collected,  the  one  by  the  Edin- 
burgh Charity  Organisation  Society  and  the  other 
by  Miss   Mary  Dendy  of  Manchester,   no  marked 

^  R.  J.  Parr,  Rep.  of  Roy.  Conmi.  on  Feeble- Minded-,  vol.    2,  pp. 
138  and  147. 


V      CAUSATION  OF  FEEBLE  MIND      171 

relation  was  found  "between  the  intelligence, 
physique  or  disease  of  the  offspring  and  parental 
alcoholism  in  any  of  the  categories  investigated  "  ; 
and  the  opinion  is  expressed  that  ''the  danger  of 
alcoholic  parentage  lies  chiefly  in  the  direct  and 
cross-hereditary  factors  of  which  it  is  the  outward 
or  somatic  mark."  It  has  been  pointed  out  in 
regard  to  these  contentions:  (i)  that  the  influence 
of  parental  alcoholism  might  have  become  obvious 
if  the  children  concerned  had  been  examined  at  a 
later  age  ;  and  (2)  that  no  information  is  supplied  as 
to  whether  the  parents'  alcoholism  existed  prior  to 
the  birth  of  the  children.^  Both  these  criticisms 
seem  legitimate  and  due  weight  must  be  assigned 
to  them  in  arriving  at  a  conclusion  on  the  matter. 

As  to  the  pernicious  influence  of  alcohol  when 
given  to  the  child  directly  there  is  little  question. 
In  this  country  alcohol  is  administered  to  children 
by  careless  or  vicious  parents  with  deplorable  fre- 
quency, while  among  the  lower  classes  in  Germany 
it  is  said  to  be  customary  to  reduce  infants  to  a 
state  of  torpor  by  dipping  the  teats  of  their  feeders 
in  brandy  or  by  rubbing  that  liquid  into  their  faces. 
Bournevllle  and  Baumgarten^  have  recorded  a 
case  of  alcoholism  in  a  child  of  4  years.  It  appears  too 
that  sufficient  alcohol  may  be  excreted  In  the  milk 
of  nursing  mothers  to  produce  pernicious  effects  on 
the  infant.  Thus  in  his  work  "  Le  Nourisson," 
Professor  Pierre  Budin  relates  the  story  of  a  woman 
who,  while  suckling  her  child,  was  advised  by  her 

^  Vide  Communications  by  Dr.  Maurice  Craig  and  Dr.  W.  C 
Sullivan  in  the  Lajtcet  for  June  25th  and  July  2nd,  1910. 

2  Bourneville  and  Baumgarten,  Alcoolisme  chez  un  enfant  de  4  ans. 
Recherches  sur  LEpilepsie^  etc.^  1887,  p.  142. 


172  THE   FEEBLE-MINDED         chap. 

doctor  to  take  quinine  wine  and  who  added  thereto 
bordeaux,  champagne,  beer,  and  liqueurs  on  her  own 
responsibility.  At  the  age  of  5  weeks  the  child 
had  two  convulsions  after  having  been  for  several 
days  "  nervous  "  with  disturbed  sleep.  A  third  and 
subsequent  severe  convulsions  led  to  the  discon- 
tinuance of  the  mother  s  milk  and  the  child  then 
speedily  recovered. 

[d)  Other  Toxic  Agents. — Heller  ^  refers  to 
three  cases  in  which  the  mothers  of  feeble-minded 
children  suffered  from  malaria  during  pregnancy. 
Seguin  ^  states,  as  a  matter  of  personal  observation, 
that  idiocy  is  common  in  the  class  of  artisans  who 
work  in  copper,  while,  according  to  Roque  and 
others,  idiocy,  imbecility,  and  epilepsy  occur  with 
abnormal  frequency  in  the  children  of  workers  in 
lead.  It  is  suggested  also  that  the  widely  spread 
practice  of  giving  soothing  syrups  and  similar  opiates 
to  children  has  perhaps  contributed  in  some  measure 
to  the  imperfect  cerebral  evolution  of  those  children. 

There  are  to  be  found  in  the  various  English  and 
foreign  works  treating  of  idiocy  and  its  congeners 
numerous  statistical  tables  setting  forth  the  per- 
centage of  cases  in  which  the  different  agencies 
above  enumerated,  and  possibly  others,  have  been 
credited  with  ''causing"  feeble-mindedness. 

Unless  we  are  in  a  position  to  judge  of  the 
competence  of  an  observer  and  of  his  disinter- 
estedness we  cannot  estimate  correctly  the  worth  of 
any  evidence  he  may  submit  and  there  can  be  no 
question   that  the  raw  material  of  the  statistics  of 

1  T.  Heller,  op.  cit.,  p.  163. 

2  E.  Seguin,  Traitement  Morale  Hygiene  et  Education  des  Idiots., 
etc.,  1846,  p.  182. 


V       CAUSATION  OF  FEEBLE  MIND      173 

etiology  is  to  a  great  extent  furnished  by  persons 
who  are  neither  capable  nor  free  from  bias. 
Information  supplied  by  the  relatives  and  friends 
of  the  feeble-minded  may  require  to  be  discounted 
very  considerably  before  its  true  value  can  be 
arrived  at,  and  it  is  not  always  clear  that  this 
process  has  been  properly  carried  out.  Sufficient 
proof  of  the  need  for  the  adoption  of  an  attitude  of 
scepticism  in  regard  to  the  explanation  of  their 
relatives'  condition  proffered  by  the  common  people 
is  to  be  found  in  the  following  table,  taken  from  the 
Report  of  the  Commission  on  the  Care  and  Control 
of  the  Feeble- Minded.  Here  the  causes  are  stated 
just  as  they  were  given,  in  apparent  good  faith, 
by  various  relatives. 

(a)  Conditions  affecting  the  mothers  : — 

Mental  shock  during  gestation       14  cases. 

Physical  injury  ...       4      ,, 

Accidents  of  parturition       ...         5      „ 

(d)  Conditions  affecting  the  patient  only  : — 

Physical  injury,  usually  a  fall         ...         ...         ...     12  cases. 

"Fits" 6      „ 

Frights  4      5, 

Rupture,  vaccination,  rickets,  and  scarlet  fever  ;  of 

each  2      „  ' 

"  Brain  fever,"  "  brain  affection,"  "  closing  of  the 
skull,"  hydrocephalus,  operation  for  adenoids, 
removal  of  the  tonsils,  heart  disease,  teething, 
measles,  typhoid  fever,  eczema,  pain  in  the 
back,  and  dog-bite  ;  of  each i      „ 

In  only  one  case  was  there  any  suggestion  that 
inheritance  had  played  a  part.  The  reply  ran — 
''  Have  no  idea  unless  it  is  taken  through  the 
family." 

It   is    interesting   to   note   that   the    cause    most 


174 


THE   FEEBLE-MINDED 


CHAP. 


frequently   given   was  ''maternal  impressions"  and 
that  alcoholism  is  not  once  mentioned. 

The  necessity  for  maintaining  a  critical  attitude 
being  realised  we  may  venture  to  study  the  statistical 
data  to  which  allusion  has  been  made.  Of  these 
the  English  ones  are  readily  accessible,  and  our 
illustrations  may  therefore  be  drawn  more  profitably 
from  foreign  sources.  At  Lucerne  in  1903  there 
was  laid  before  the  4th  Swiss  Conference  on  Idiocy 
by  Direktor  Friedrich  Kolle,  of  Zurich,  a  compilation 
from  the  sources   indicated  in  the  following  table. 


Name  of  Recorder. 

Volker. 

Schwenk. 

Piper. 

Zeitschrift. 

^Hereditary  defect.. 

53% 

31% 

27% 

18% 

Family  history    of 

tubercle 

22-9% 

— 

23% 

— 

fcJD^ 

Family    history    of 

•!i^ 

alcoholism 

21% 

io-3% 

10% 

9-5% 

Maternal      impres- 

sions       

io-3% 

7% 

10% 

3-6% 

Consanguinity     ... 

47% 

3-5% 

3% 

5% 

0^ 

Acute    disease    of, 
or  injury  to,  the 

the  mother 

3-1% 

— 

2.5% 

— 

^Parental  syphiHs... 

1% 

— 

5% 

— 

S  ^^'  r Primogeniture... 

23-2% 

29% 

32% 

35% 

pq  !&  ^."S  J  Prolonged  labour 

97% 

2% 

6% 

Q-^"^  [Premature  birth 

o-6% 

3% 

2% 

13% 

'Convulsions      soon 

after  birth 

33-1% 

34-3% 

— 

31-3% 

Acute        infectious 

^■s 

diseases 

11% 

12% 

27% 

6% 

■-tj  J-i 

Meningitis         and 

apoplexy 

8% 

6% 

9% 

22% 

.^  B 

Rickets      

3-9% 

13% 

9% 

4% 

0       ^ 

Ill-treatment      and 

neglect 

5-4% 

— 

7% 

Head  injuries 

37% 

4% 

20% 

11% 

^Scrofula    

o-i% 

2% 

V       CAUSATION  OF  FEEBLE  MIND      175 

The  total  number  of  cases,    upon   which  the  per- 
centages given  are  based,  was  thus  made  up  : — 

Volker  2037  (except  in  section  "  B,"  where  it  was 
332).     Schwenk  175.     Piper  416. 

Zeitschrift  fUr  die  Behandlung  Schwachsinniger 
und  Epileptiker  1287. 

It  is  obvious  that  there  exists  among  those  con- 
cerned with  the  care  of  the  feeble-minded  some 
considerable  diversity  of  opinion  in  regard  to  the 
relative  importance  in  etiology  of  the  cardinal  factors, 
innate  and  environmental,  which  v/e  have  been 
studying.  As  already  mentioned  this  is  no  doubt 
primarily  due  to  the  lack  of  precise  information  on 
the  point,  but  it  seems  to  indicate  also  a  regrettable 
want  of  the  scientific  spirit  on  the  part  of  those  who 
make  confident  pronouncements  on  the  matter. 
As  a  set-off  to  the  views  already  ventilated,  and 
without  any  pretence  of  assuming  other  than  a 
strictly  neutral  position,  we  may  quote  an  opinion 
expressed  by  G.  Archdall  Reid.-^  *'  We  have," 
he  says,  ''no  option  but  to  believe  that  medical  men 
are  mistaken  in  supposing  that  morbid  conditions 
affecting  parents  tend  to  render  offspring  degen- 
erate." 

We  must  note  also  the  results  obtained  by 
workers  in  the  Galton  Laboratory  of  the  University  /> 
of  London.  Statistical  inquiry  was  made  into 
(among  other  things)  :  (a)  The  influence  of  drink 
in  the  parents  on  the  height,  weight,  general  health, 
and  intelligence  of  the  children ;  and  (/S)  The 
influence  of  overcrowding,  bad  economic  condition 

^  G.  Archdall  Reid,  Rep.  of  Roy,   Comm.  on  the  Feeble-Minded^ 
vol.  5,  p.  248. 


176  THE   FEEBLE-MINDED  chap. 

of  the  home,  and  the  moral  and  physical  condition  of 
the  parents  on  the  intelligence,  eyesight,  glands,  and 
hearing  of  the  children. 

The  investigations,  so  far  as  they  have  gone, 
**  show  clearly  the  small  influence  of  environment." 
The  various  conditions  enumerated  appear  to  have 
exercised  practically  no  effect  on  the  intelligence  of 
the  children  or,  for  that  matter,  on  any  of  the 
qualities  mentioned.^ 

It  v^ould  seem  then,  on  reviewing  the  whole 
position,  that  we  may  accept  as  most  in  accordance 
with  modern  ideas  the  conclusion  of  the  Commission 
on  the  Feeble-Minded  : — 

''  That  both  on  the  grounds  of  fact  and  theory 
there  is  the  highest  probability  that  feeble- 
mindedness is  usually  spontaneous  in  origin— that 
is,  not  due  to  influences  acting  on  the  parent — and 
tends  strongly  to  be  inherited."  ^ 

Before  the  subject  of  etiology  is  dismissed  the 
vexed  question  of  what  is  called  "the  transmission 
of  acquired  characters  "  maybe  briefly  noticed.  In 
the  light  of  the  theory  of  heredity  here  adopted  it 
does  not  present  any  special  difficulty.  We  have 
seen  that  the  portions  of  bioplasm  which  are  separ- 
ated off  for  the  purpose  of  reproduction  may  exhibit 
variations  or  mutations,  arising  "spontaneously"  or 
as  the  result  of  some  unknown  environmental 
influence,  which  may  persist  and  be  handed  down 
from  generation  to  generation.  To  this  extent,  then, 
acquired  characters  are  transmitted.     In  the  second 

1  E.  M.  Elderton,  The  Relative  Strength  of  Nurture  and  Nature, 
1909. 

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


V       CAUSATION  OF  FEEBLE  MIND      177 

group  of  cases  with  which  we  have  just  been  deaUng 
we  had,  again,  Hving  matter  altering  under  the  action 
of  various  forces.  But  of  this  Hving  matter  the 
bioplasm  which  is  the  basis  of  continuity  forms  only 
a  small  part.  The  process  of  alteration  may  there- 
fore not  reach  it  at  all.  The  lopping  off  of  a  limb,  or 
similar  mutilation,  could  hardly  affect  the  germinal 
substance  and  it  is  inconceivable  that  such  a  "  modi- 
fication," as  a  biologist  would  term  it,  should  be 
transmitted.  If,  however,  the  germinal  substance  is 
reached  by  an  injurious  agent,  e.g.,  a  poison  circu- 
lating in  the  blood,  it  may  respond  by  undergoing 
either  a  ''variation,"  which,  like  other  variations,  will 
be  permanent  or  not  according  as  it  is  fixed  by 
natural  or  artificial  selection;  or  a  "mutation"  which 
will  remain  as  a  permanent  character.  Again,  a  modi- 
fication may  act  indirectly  by  making  an  opening  for 
the  appearance  of  a  variation  or  mutation,  and  in 
the  former  case  its  continued  operation  during  many 
generations  may  become  evident  in  heredity  through 
the  appearance  of  what  is  seemingly  a  mutation. 

As  this  matter  of  the  handing  on  of  acquirements 
is  one  to  which  Dr.  Archdall  Reid  ^  has  devoted 
special  attention,  it  will  be  fitting  to  give  a  summary 
of  his  views  on  the  point.  ''  Living  beings,"  he  says, 
*'  develop  mainly  under  the  influence  of  three  distinct 
kinds  of  stimuli — nutriment,  use,  and  injury."  What 
are  ordinarily  called  "  acquirements  "  are  characters 
arising  under  the  stimulus  of  use  or  injury.  The 
capacity  to  develop  "  acquirements  "  is  present  "only 
in  structures  where  it  is  useful,  to  the  extent  to  which 
it  is  useful,  and  during  the    time  it  is  useful."     Al- 

1  G.  Archdall  Reid,  The  Laws  of  Heredity,  1910. 

N 


178  THE   FEEBLE-MINDED         chap. 

though  the  "  power  of  responding  to  the  stimulus  of 
injury  is  clearly  allied  to,  and  is  derived  from,  the 
power  of  responding  to  the  stimulus  of  nutriment," 
there  is  so  great  a  difference  between  them  that  In 
order  to  explain  the  appearance  of  ''acquirements" 
in  offspring  we  should  have  to  assume  not  so  much  a 
**  transmission  "  as  a  "  transmutation  "  of  characters 
in  the  sense  that  features  which  were  evoked  in  the 
case  of  the  parent  by  means  of  the  stimulus  of  injury 
would  be  called  forth  In  the  offspring  by  nutritional 
stimuli.  This  consideration  applies  equally  to  the 
effects  of  use,  which,  however,  come  less  frequently 
into  the  question,  since  the  capacity  for  responding 
to  the  stimulus  of  use  is  more  limited  than  that  of 
responding  to  the  stimulus  of  Injury. 

The  need  for  the  doctrine  of  the  transmission  of 
acquirements  depends  on  the  view  taken  as  to  the 
adequacy  of  Natural  Selection  in  accounting  for 
evolution,  and  since  Dr.  Reid  finds  in  Natural  Selec- 
tion a  sufficient  explanation  of  the  phenomena,  the 
Lamarckian  hypothesis  is  for  him  superfluous,  to  say 
the  least  of  it. 

But  all  biologists  are  not  satisfied  that  Natural 
Selection  is  the  only  method  of  evolution,  and  there 
are  cases  in  which  the  supposition  that  characters 
acquired  by  a  parent  can  be  transmitted  to  offspring 
involves  fewer  difficulties  than  the  view  that  only 
the  weeding-out  process  of  the  struggle  for  existence 
has  been  in  operation.  A  recent  statement  of  the 
case  for  the  transmission  of  acquired  characters  is 
that  of  Professor  R.  Meyer.^ 

1  R.     Meyer,    "  Gibt  es  Vererbung  erworbener  Eigenschaften  ? 
Deutsche  Medizinische  Wochenschrift,  June  9,  19 10,  p.  1086. 


V       CAUSATION  OF  FEEBLE  MIND     179 

It  is  the  conception  of  the  isolation  of  the  germ- 
plasm  as  the  sole  vehicle  for  inheritance  which  puts 
out  of  court  even  the  most  plausible  story  of  the 
handing  on  of  an  acquirement.  But  if  that  isolation 
is  not  complete;  if,  that  is,  some  portion  of  "so- 
matic," as  distinct  from  ''germ,"  plasm  goes  to  the 
formation  of  a  new  individual,  the  case  for  "  acquire- 
ments "  is  greatly  strengthened.  Dr.  Paul  Buchner  ^ 
has  described  such  a  condition  of  affairs  as  actually 
existing  in  the  organism  known  as  Sagitta,  where, 
according  to  his  observations,  chromatin  from  an 
epithelial  cell  wanders  into  the  "ovocyte  "  and  plays 
a  part  in  the  subsequent  development  of  the  egg. 

^  P.  Buchner,  "  Kelmbahn  und   Ovogenese   von  Sagitta,"  Anafo- 
mischer  Anzeiger^  Bd.  35,  Jan.  1910,  p.  433. 


N    2 


CHAPTER   VI 

THE  VARIETIES    OF    FEEBLE-MINDED  PERSONS 

Since  no  two  cases  of  feeble-mlndedness  are  alike, 
the  making  of  a  classification  involves  the  acceptance 
of  certain  conventions.  There  must  be  agreement 
as  to  the  respects  in  which  likeness  exists,  and  as  to 
the  degree  of  likeness,  in  any  particular  respect, 
which  is  to  be  regarded  as  constituting  similarity. 
Classification  is  akin  to  the  formation  of  concepts. 
Its  aim  is  to  render  a  mass  of  facts  more  easily 
handled  by  substituting  one  for  many,  and  its  utility 
will  depend  on  the  amount  of  information  which  the 
type  form  supplies  as  to  the  characteristics  of  the 
group  for  which  it  stands. 

In  drawing  up  a  scheme  of  classification  many 
interests,  some  of  them  conflicting,  have  to  be 
consulted.  We  shall  get  a  notion  of  the  difficulties 
which  arise  by  considering  what  are  the  features 
which  a  good  classification  should  exhibit. 

1.  It  should  be  based  on  matters  of  fact  rather 
than  of  opinion. 

2.  It  should  be  complete  and  exclusive.  A 
division  of  human  beings  into  those  with  red  hair, 
those  who  subscribe  to  The  Times,  and  those  who 

take  sugar  in  their  tea  will  at  once  be  seen  to  leave 

1 80 


CH.  VI  VARIETIES  OF  FEEBLE-MINDED  181 

much  to  be  desired  ;  yet  on  such  lines  as  these  are 
some  of  the  existing  systems  drawn  up.  Take,  for 
instance,  Dr.  Ireland's  familiar  classification  of  idiots 
into  genetous,  microcephalic,  hydrocephalic,  eclamp- 
sic,  epileptic,  paralytic,  traumatic,  inflammatory, 
sclerotic,  and  syphilitic  varieties,  to  which  are  added 
cretins  and  idiots  by  deprivation.  Here  the  cases 
are  arranged  in  sections,  of  which  the  distinguishing 
features  are  now  anatomical,  now  physiological,  now 
etiological.  This  objection  is  to  be  met  by 
introducing  a  further  consideration  in  regard  to 
classification. 

3.  It  should  have,  at  any  rate  for  groups  at  the 
same  level,  a  constant  determining  factor.  In  Dr. 
Ireland's  arrangement  the  principle  of  uniformity  is 
not  carried  out  even  to  the  extent  of  providing  a 
common  grammatical  form  for  the  terminology. 
This  criticism  is  not  offered  with  any  desire  to 
belittle  Dr.  Ireland's  work.  The  defects  of  his 
system  are,  to  a  great  extent,  inherent  in  the  subject, 
as  will  be  appreciated  if  one  attempts  to  devise  a 
better  scheme.  No  single  aspect  of  feeble-minded- 
ness  has  been  studied  with  sufficient  thoroughness 
to  provide  an  adequate  foundation  for  the  satisfactory 
erection  of  species,  genera,  and  orders.  In  the 
present  state  of  our  knowledge  a  classification  on 
strictly  anatomical,  etiological,  or  even  psychological, 
lines  would  be  as  artificial  and  as  little  indicative  of 
the  number  of  points  of  contact  between  different 
forms  as  is  the  Linnean  system  in  its  application  to 
plants.  Thus  schemes  based  on  head  measure- 
ments ;  or  on  assumed  modes  of  causation  ;  or,  as  in 
Esquirol's    case,   on    the   power  of  speech ;    would 


182  THE   FEEBLE-MINDED  chap. 

bring  together  cases  having  nothing  In  common 
except  the  arbitrarily  selected  factor.  It  would  be 
pedantic,  then,  to  insist  too  strongly  upon  uniformity 
of  plan  in  a  taxonomic  arrangement  of  which  the 
chief  raison  d'etre  Is  convenience. 

4.  It  should  be  based  on  definitions  of  universal 
acceptance.  The  value  of  any  convention,  con- 
sidered qua  convention,  Is  proportional  to  the 
number  of  persons  who  subscribe  to  it.  However 
much  ingenuity  may  have  been  expended  on  a 
scheme  Its  utility  will  be  small  if  nobody  employs  it 
but  Its  author. 

5.  It  should  be  authoritative.  There  is,  on  their 
merits,  so  little  to  choose  between  the  different 
systems  which  have  been  proposed  by  various 
writers  that  the  selection  of  a  particular  one  by  some 
acknowledged  authority  supplies  a  strong  argument 
for  employing  It  to  the  exclusion  of  others. 

Keeping  these  considerations  before  us  we  may 
briefly  review  some  of  the  almost  innumerable 
suggestions  for  classifying  the  feeble-minded  which 
have  been  propounded.  Fanciful  analogies,  such  as 
that  which  gave  us  Brephoid,  Therold,  and  Ethnoid 
types,  or  that  underlying  the  distinction  of  Kalmuck, 
Aztec,  Papuan,  etc.,  types,  have  no  more  than  some 
slight  historical  interest.  On  the  basis  of  his  studies 
In  pathological  anatomy  Bourneville  distinguished 
forms  of  Idiocy  marked  by  the  following  conditions : 

1.  Meningitis. 

2.  Meningo-encephalitis. 

3.  Simple  arrest  of  development. 

4.  Atrophic  sclerosis. 

5.  Hypertrophic  sclerosis. 


VI    VARIETIES  OF  FEEBLE-MINDED  183 

6.  Primary  porencephaly. 

7.  Secondary  porencephaly. 

8.  Hydrocephaly, 

9.  Cretinism. 
10.  Microcephaly. 

Although  this  arrangement  has  merit,  in  that  it 
serves  as  a  reminder  of  the  chief  forms  of  cerebral 
defect  found  at  post-mortem  examinations  of  Idiots, 
it  is  open  to  objection  as  being  of  little  use  during 
life,  as  assigning  to  the  different  conditions  enumer- 
ated a  fictitious  independence,  and  as  leaving 
undifferentiated  all  except  the  most  marked  cases  of 
feeble-mlndedness. 

In  the  section  dealing  with  causation  reasons 
were  adduced  for  recognising  innate  and  environ- 
mental etiological  factors.  This  distinction  supplies 
the  foundation  for  various  systems,  e.g.,  those  of 
Heller  and  Tredgold,  in  which  the  first  step  in 
classification  is  the  separation  of  a  group  of 
primary  or  inherent  mental  defects  from  a  group 
of  secondary  or  acquired  defects.  Such  systems  are 
practically  valueless.  The  uncertainty  attending 
the  mode  of  origin  of  cerebral  abnormalities  leaves 
us  with  no  test  which  is  applicable  to  the  great 
majority  of  cases.  Tredgold  admits  that  the  so- 
called  congenital  cases  may  be  either  ''  primary  "  or 
"  secondary,"  and  his  tabular  statement  of  the 
"  primary  "  and  ''  secondary  "  types  shows  a  marked 
absence  of  those  differentia  which  he  charges  other 
authors  with  neglecting. 

Since  we  are  admittedly  concerned  with  a  disorder 
of  the  mind,  a  classification  on  the  lines  of  psychology 
would   appear  to  be  most  rational.     This   thought 


184  THE   FEEBLE-MINDED         chap. 

has  occurred  to  many,  and  has  resulted  in  the  pro- 
duction of  a  number  of  schemes,  some  of  which  are 
purely  academic,  while  others  aim  at  being  practical. 
Sollier  measured  the  degree  of  mental  defect  by 
noting  the  extent  to  which  the  faculty  of  attention 
was  impaired.      He  made  three  classes  : — 

1.  Absolute  idiocy  :  complete  absence  and  im- 
possibility of  attention. 

2.  Simple  idiocy :  weakness  and  difficulty  of 
attention. 

3.  Imbecility  :  instability  of  attention. 
Wildermuth    attempted  to  define  various  grades 

of  idiocy  by  comparing  them  with  stages  of  the 
development  of  normal  persons  on  the  assumption 
that  idiocy  was  simply  the  result  of  an  arrest  of  the 
processes  of  growth.  This  attempt  is  chiefly  of 
interest  in  that  its  failure  serves  as  a  reminder  of 
the  complexity  of  the  etiological  problem. 

Voisin  and  Weygandt  have  regarded  the  idiot's 
capacity  for  being  educated  as  affording  the  most 
useful  criterion,  though,  as  Heller  shrewdly  remarks, 
this  depends  not  only  on  the  mental  state  of  the 
taught  but  also  on  the  skill  and  experience  of  the 
teacher.     Weygandt's  arrangement  is  as  follows.^ 

1.  Idiots  incapable  of  being  taught. 

2.  Idiots  capable  of  being  taught 

a.  Apathetic  type. 

b.  Excitable  type. 

3.  Imbeciles. 

a.  Apathetic  type. 

b.  Excitable  type. 

^  W.  Weygandt,  Die  Behandlimg  idioHscher  und  imbeciller  Kinder^ 
1900. 


VI    VARIETIES  OF  FEEBLE-MINDED  185 

In  Germany  this  distinction  of  apathetic  (apath- 
ische)  and  excitable  (erethische)  forms  is  very 
generally  accepted.  It  is  adopted,  for  example,  by 
Kraepelin  in  his  classical  treatise  on  insanity. 
Heller,  however,  holds  that  most  weak-minded 
children  cannot  be  relegated  to  one  or  the  other 
group  with  certainty,  and  this  accords  with  the 
present  writer's  experience.  A  rough  distinction 
can  be  drawn  between  the  superficial,  shallow  minds 
which,  within  the  narrow  limits  of  their  powers, 
learn  easily,  to  forget  as  easily,  and  minds  which, 
being  impressed  only  with  difficulty  yet  retain  the 
impression  made  for  a  relatively  long  period.  This 
latter  distinction,  which  has  practically  no  taxonomic 
value,  seems  to  depend  on  the  affective  reaction  to 
stimuli. 

The  best  classification  on  practical  lines  is  that 
suggested  by  the  Royal  College  of  Physicians  of 
London  and  adopted  from  considerations  of  utility 
by  the  Royal  Commission  on  the  Feeble- Minded. 
It  is  no  worse  than  those  quoted  above  as  regards 
the  first  four  criteria  mentioned  and  it  has,  since  it 
represents  the  considered  judgment  of  a  body  of 
able  persons,  the  merit  of  being  authoritative.  The 
following  groups  are  recognised  : — 

Idiots,  i.e.,  persons  so  deeply  defective  in  mind 
from  birth  or  from  an  early  age  that  they  are  unable 
to  guard  themselves  from  common  physical  dangers, 
such  as  in  the  case  of  young  children  would  prevent 
their  parents  from  leaving  them  alone. 

LnbecileSy  i.e.,  persons  who  are  capable  of  guard- 
ing themselves  against  common  physical  dangers 
but  who  are  incapable  of  earning  their  own  living 


186  THE  FEEBLE-MINDED  chap. 

by  reason  of  mental  defect  existing  from  birth  or 
from  an  early  age. 

Feeble- Minded,  i.e.,  persons  who  may  be  capable 
of  earning  a  living  in  favourable  circumstances,  but 
are  incapable  from  mental  defect  existing  from 
birth  or  from  an  early  age  :  (a)  of  competing  on 
equal  terms  with  their  normal  fellows  ;  or  {b)  of 
managing  themselves  and  their  affairs  with  ordinary 
prudence. 

Moral  Imbeciles,  i.e.,  persons  who  from  an  early 
age  display  some  mental  defect  coupled  with  strong 
vicious  or  criminal  propensities  on  which  punishment 
has  little  or  no  deterrent  effect. 

Criticism  has  been  directed  at  the  above  scheme 
on  the  ground  that  no  definition  is  given  of  what 
constitutes  ''  an  early  age,"  and,  further,  that  the 
test  of  capacity  for  w^ork  is  not  applicable  to  the 
children  who  form  a  large  proportion  of  the  feeble- 
minded. As  regards  the  latter  of  these  contentions 
it  may  be  said  that  for  practical  purposes  the 
difficulty  is  not  a  serious  one,  and  that  it  could  be 
met  by  reading  "  learning  to  earn  "  for  '*  earning,'* 
wherever  necessary.  There  is,  unquestionably, 
about  the  phrase  '*  an  early  age  "  a  want  of  explicit- 
ness  which  detracts  from  the  value  of  the  definition 
of  which  it  forms  part.  The  Commissioners  in 
Lunacy  have  tried  to  avoid  this  pitfall  in  the  defini- 
tions of  the  kinds  of  unsoundness  of  mind  recognised 
by  them,  by  speaking  of  a  "  congenita)  or  infantile 
mental  deficiency  (Idiocy  or  Imbecility)  occurring  as 
early  in  life  as  it  can  be  observed."  By  common 
agreement  "  congenital  "  means,  in  the  language  of 
the  Standard  Dictionary,   ''  born  with  us  :   existing 


VI   VARIETIES  OF  FEEBLE-MINDED  187 

from  birth."  But  the  term  ''infantile"  cannot  be  so 
easily  disposed  of.  ''  Infancy  "  from  a  chronological 
standpoint  may  be  taken  to  signify  the  first  few 
months  of  life,  which  is  the  way  in  which  medical 
men  employ  the  description,  or  the  word  may 
be  used  in  one  of  its  legal  bearings  to  denote 
periods  expiring  at  the  age  of  seven,  or  fourteen,  or 
twenty-one  years.  If  the  first  mentioned  interpreta- 
tion is  to  be  accepted,  it  must  not  be  lost  sight  of 
that  certain  mental  qualities  do  not  appear  till  long 
after  the  first  year  of  life  and,  consequently,  any 
aberration  involving  them,  occurring  "as  early  in 
life  as  it  can  be  observed "  cannot  be  either 
''  congenital  "or  "  infantile." 

Another  objection  to  the  scheme  of  the  Royal 
Commission  on  the  Feeble-MInded  Is  that  it  does 
not  go  far  enough,  since  it  takes  no  heed  of  obvious 
differences  between  the  members  of  each  primary 
grouping,  and  therefore  fails  to  convey  so  much  in- 
formation about  the  individuals  concerned  as  an 
ideal  classification  should.  We  cannot,  then,  dis- 
pense, as  yet,  with  the  old  empirical  principles,  and 
in  order  to  cover  the  ground  more  completely  we 
must  combine  the  scheme  of  the  Commissioners 
with  a  preliminary  subdivision  of  the  cases  on  clinical 
lines  by  picking  out  from  the  aggregate  such  as 
have  distinctive  points  of  resemblance,  even  though 
these  points  are  not  all  of  the  same  order. 

A  combination  of  the  different  systems  mentioned 
would  appear  to  give  the  most  generally  useful 
arrangement.  Taking  the  whole  range  of  persons 
of  unsound  mind  we  may  distinguish  two  '*  sub- 
kingdoms "  thus  :—  ' 


188  THE  FEEBLE-MINDED  chap. 

1.  The  Feeble-Minded  : — In  whom  the  defect 
dates  from  *'as  early  in  life  as  it  can  be  observed." 

2.  The  Insane  : — In  whom  the  defect  occurs 
"  later  in  life."  We  are  concerned  only  with  the 
former  group,  which  includes — 

la.  The  morally  feeble-7ninded\  those  who  display 
incorrigible  criminal  propensities. 

\b.  The  intellectually  feeble-minded  \  those  in 
whom  the  defect  is,  primarily,  one  of  intelligence. 

In  this  latter  class  there  can  be  distinguished, 
clinically,  families,  the  members  of  which,  in  view  of 
their  salient  characteristics,  may  be  described, 
respectively,  as — 

A.  Ateleiotic. 

B.  Mongolian. 

C.  Microcephalic. 

D.  Macrocephalic. 

E.  Cretinous. 

F.  Epiloiac. 

G.  Plegic. 

H.   Progressive. 
I.   Residual. 

Each  of  these  groupings  will  supply  instances  of 
three  grades  of  mental  defect  which  may  be  called, 
respectively,  **  Idiocy,"  "Imbecility,"  and  ''Weak- 
Mindedness." 

Details  of  the  above  scheme  of  classification  will 
be  more  conveniently  considered  under  the  different 
headings,  but  before  proceeding  further  some 
remarks  are  called  for  on  the  position  which  is  to  be 
assigned  to  epilepsy.  From  the  point  of  view  of 
treatment   the    existence   of   epilepsy    is    of    great 


VI   VARIETIES  OF  FEEBLE-MINDED  189 

moment,  but  its  manifestations  are  so  widely  spread 
among  the  feeble-minded  that  they  do  not  afford 
much  assistance  in  classification.  We  may  note 
however  that,  in  spite  of  this  fact,  according  to  the 
scheme  approved  by  the  Commissioners  in  Lunacy, 
cases  of  congenital  intellectual  deficiency  are  divided 
into  those  complicated  by  epilepsy  and  those  not  so 
complicated. 

Moral  Feeble-Mindedness 

The  distinction  which  has  been  drawn,  for  the 
purposes  of  classification,  between  moral  and  intel- 
lectual defect  is,  perhaps,  an  artificial  one,  and  the 
propriety  of  making  it  calls  for  some  discussion 
before  its  adoption  is  approved.  It  is  easy  to 
understand  why,  as  common  experience  teaches, 
obvious  intellectual  defects  are  accompanied  by 
moral  ones,  for  no  individual  can  be  expected  to 
follow  rules  of  life  which  are  incomprehensible  to 
him,  but  whether  moral  defect  can  exist  apart  from 
intellectual  is  more  difficult  to  decide. 

In  his  treatise  on  psychiatry  Kraepelin^  expresses 
the  view  that  in  cases  of  moral  feeble-mindedness 
one  never  fails  to  find  some  diminution  of  the 
reasoning  faculty,  and,  as  already  noted,  the  Com- 
mission on  the  Feeble-Minded  include  in  their 
definition  of  moral  imbecility  the  phrase  "some 
mental  defect."  On  the  other  hand,  Maier,^  after 
reviewing   the   whole  position,   comes  to  the  con- 

1  E.  Kraepelin,  Psychiatrie^  1904,  Bd.  2,  p.  817. 
^  ^  H.  W.   Maier,  "  Uber  moralische  Idiotic.  Festschrift  zu  Forels 
Sechzigstem  Geburtstag,"  Journal  fiir  Psychologic  und  Neurologic^ 
Bd.  XIII,  1908,  p.  57. 


190  THE   FEEBLE-MINDED         chap. 

elusion  that  "  there  is  a  congenital  moral  defect,  that 
is  to  say,  a  want  of  appreciation  of  the  moral 
conditions  of  the  environment,  associated  with 
normal  intellectual  tendencies."  Cramer,^  again, 
gives  it  as  his  opinion  that  ''there  is  only  one 
certain  clinical  sign  of  moral  idiocy  and  that  is  a 
more  or  less  well-marked  ethical  defect." 

If  the  intellectual  sentiments  were  of  earlier 
evolution  than  the  ethical,  the  existence  of  a  purely 
moral  defect  would  be  intelligible,  and  the  possibility 
that  such  may  be  the  case  is  not  excluded  by  the 
fact  that  some  dull  people  are  virtuous,  while  some 
clever  ones  are  not,  for  a  certain  grade  of  miorality 
is  appropriate  to  every  intellectual  level,  and  its 
failure  to  appear  at  that  level  might  be  due  to 
arrested  development.  We  get  some  indication  of  a 
process  of  this  kind  in  the  cases  to  which  Sir  James 
Crichton  Browne  ^  referred  in  his  evidence  before  the 
Royal  Commission  on  the  Feeble-Minded.  "  Many 
nervous  children  in  good  circumstances,"  he  re- 
marked, **at  certain  epochs  of  development,  sud- 
denly take  to  motiveless  and  systematic  lying  or 
stealing.  Wisely  treated  they  soon  get  over  it  and 
return  to  the  paths  of  rectitude." 

From  the  psychical  standpoint  moral  defect  seems 
to  be  due  to  a  failure  of  development  in  the  affective 
sphere.  We  have  seen  already  that  to  the  primitive 
organism  the  maintenance  of  its  nutrition  is  the  first 
consideration  and  that  closely  bound  up  with  the 
question  of  nutrition  is  that  of  reproduction.     Such 

^  A.  Cramer,  Gerichtliche  Psychiatrie^  IQOS)  P-  352. 
2  J.    Crichton    Browne,   Rep.   of  the  Roy.  Comin.    on    the  Feeble- 
Minded.,  vol.  I,  p.  333. 


Yi   VARIETIES  OF  FEEBLE-MINDED  191 

acts  as  further   these    interests   are   fundamentally 
pleasant  and  therefore  tend  to  determine  the  will  in 
the  direction  of  continuing  them.     The  acts  which 
are  opposed  to  nutrition  and  reproduction  are  funda- 
mentally unpleasant  and  tend  to  be  discontinued. 
The    various    functions    involved    in  obtaining  and 
assimilating  food,  excreting  waste  products  and  pro- 
pagating the  species  have  thus  an  inherent  pleasur- 
able quality,  which  constitutes  them  the  dominating 
motives    of  the  organism,   but    to  render  them  of 
maximum  advantage  they  require  to  be  exercised  with 
due  regard  to  the  environmental  conditions,   some 
present  sacrifice  being  counterbalanced  by  a  greater 
future     gain.       The   primitive    idea   thus    becomes 
associated  with  other  ideas  in  a  complex  of  which 
the  affective  tone  may  be  different  from  that  of  the 
original   motive  and   the  resulting  activity  will   be 
modified  accordingly.      It  is  an  inability  to  associate 
affected    ideas,    expressing   itself  as   defect   in    the 
evolution  of  the  sentiments,  which  chiefly  character- 
ises the  immoral  mind.     The  defect  may  show  itself 
on  the  aesthetic  side,  which  is  not  a  matter  of  great 
practical  moment ;  or  on  the  logical  side,  as  seems 
to  be  the  case  in  what  is  called  pathological  lying. 
Particularly,  however,  it  becomes  manifest  in  regard 
to  the  sentiment  of  expediency.     But,  as  we  have 
seen,  the  sentiments  involve  judgments,  and,  that 
being  so,  it  is  difficult  to  see  how  the  exclusion  of 
an  ''  intellectual  "  element  from  moral  feeble-minded- 
ness  is  to  be  justified.     The  discussion  as  to  the 
possible  existence   of  a   purely   moral    defect   has, 
indeed,  turned  to  a  very  great  extent  on  the  meaning 
attached  to  the  term   ''intellectual."     It  is  merely 


192  THE  FEEBLE-MINDED         chap. 

because  we  do,  in  practice,  meet  with  cases  In  which, 
though  there  is  obvious  immorality,  the  ordinary 
methods  of  examination  fail  to  detect  any  intellectual 
shortcomings  ;  or  in  which  the  moral  deficiency  is  so 
much  more  in  evidence  than  the  intellectual ;  that  it 
is  convenient  to  establish  a  special  class  for  the 
reception  of  such  cases. 

Clinically  the  signs  of  moral  feeble-mlndedness  are, 
in  a  typical  case,  those  of  unqualified  viciousness,  by 
which  is  meant  that  the  activities  of  the  individual 
are  designed  to  satisfy  his  present  desires  without 
any  reference  to  the  bearing  of  such  a  course  on 
himself  or  others.  Judged  by  the  accepted  standard 
of  morals,  he  is  purely  selfish.  He  has  no  affection 
for  his  relatives,  no  sense  of  personal  or  family 
honour,  and  no  reverence  for  family  ties ;  and  he 
will  commit  an  offence  against  a  member  of  his 
family  as  readily  as  against  a  stranger  :  there  is  thus 
not  even  a  rudiment  of  the  social  instinct.  In  his 
relations  with  the  world  at  large,  he  shows  an  entire 
lack  of  sympathy  with  man  and  beast,  and  may  even 
be  actively  cruel.  Altruism  Is  entirely  foreign  to  his 
nature  ;  he  is  untruthful,  obscene,  lustful,  unstable, 
restless,  devoid  of  discretion,  and  unregulated  as  to 
his  imagination.  He  makes  no  friends,  and  is 
averse  from  doing  any  work ;  he  knows  neither 
gratitude,  shame,  nor  repentance,  and  Is,  as  Maier 
found  in  a  well-marked  case,  so  completely  im- 
pervious to  reproaches  and  appeals  that  they  produce 
in  him  no  obvious  emotional  reaction,  whether  as 
regards  facial  expression,  bodily  movement,  the 
pulse  and  respiration  rates,  or  speech.  To  the  law 
he  is  known  as  thief,  train-wrecker,  incendiary,  or 


VI   VARIETIES  OF  FEEBLE-MINDED  193 

murderer ;    or    as    addicted  to  assaults,   and   sexual 
offences  of  all  kinds. 

Grades  of  moral  feeble-mindedness  designated  as 
moral  idiocy,  moral  imbecility,  and  moral  debility, 
have  been  distinguished,  but,  since  the  criteria 
employed  in  the  differentiation  are  not  the  capacity 
for  avoiding  ''common  physical  dangers"  and  the 
ability  to  earn  a  livelihood,  this  mode  of  classification 
is  unsuitable.  As  met  with  in  practice,  members  of 
the  class  under  consideration  may  show  a  special 
prominence  of  some  only  of  the  moral  failings 
above  enumerated,  so  that  it  is  possible  to  dis- 
tinguish at  least  the  following  types,  individual 
examples  of  which  may  exhibit  any  stage  between 
mere  brutishness  and  a  shallow  but  audacious 
cunning. 

(i)  The  Unstable. — In  this  group  are  included 
many  of  the  anti-social  individuals  whom  we  call 
"  the  unemployable."  These  are  the  people  who 
when  they  can  be  made  to  work  are  laggards  in 
beginning  but  prompt  in  discontinuance  :  such 
imagination  as  they  possess  is  employed  in  finding 
excuses  for  resting ;  the  hours  are  too  long,  the  pay 
is  too  small,  they  have  no  tools,  the  work  demanded 
of  them  is  such  as  should  be  assigned  to  some  other 
craftsman,  and  so  on  :  they  suffer  frequently  from 
minor  ailments  of  an  elusive  but  seriously  disabling 
character  and  require  lengthy  periods  for  recupera- 
tion :  they  are  well  content  to  live  at  the  expense  of 
their  relatives  or  of  the  community,  and  if  the  path 
of  intemperance  is  open  to  them  they  will  follow  it 
to  the  end.  Other  members  of  the  group  are  beggars, 
vagrants,  and  prostitutes. 

O 


194  THE   FEEBLE-MINDED         chap. 

(2)  The  Mendacioits. — Most  people  who  move 
about  in  the  world  have  made  acquaintance  with 
persons  "whose  word  no  man  relies  on  "  :  they  give 
promises  which  they  make  no  attempt  to  keep  ;  they 
borrow  money  which  they  have  no  intention  of 
returning ;  they  treat  with  disdain  the  accepted 
canons  of  honour  and  probity  ;  "  good  form  "  has  no 
meaning  for  them,  and  they  have  no  reverence  for 
the,  it  must  be  admitted,  rather  quaint  fetich  which 
men  call  ''  sportsmanship."  In  more  extreme  cases 
they  are  thieves  or  swindlers  or  romancers,  whose 
inaccuracy  of  statement  is  so  phenomenal  that  it  has 
been  dignified  by  Delbriick  and  others  with  the 
imposing  name  of  ' '  pseudologia  phantastica. "  From 
time  to  time,  through  the  intermediation  of  the 
sensational  reporter,  public  sympathies  are  harrowed 
by  a  tale  of  woe  unfolded  in  the  police  court  by 
some  youthful  offender.  With  an  appearance  of 
truthfulness  which  carries  conviction  to  all  except 
the  most  experienced  minds,  the  small  boy  (or  girl) 
tells  how  he  has  been  driven  into  his  present  pre- 
dicament through  oppression  on  the  part  of  cruel 
parents  or  relatives,  and  the  hearers  are  raised  to 
heights  of  righteous  indignation  from  which  they 
fail  to  detect  little  inconsistencies  or  contradictions. 
Inquiries  are  set  on  foot  and  it  soon  appears  that 
the  statements  made  are  untrue  in  every  material 
particular.  Harassed  parents  or  guardians,  whose 
good  faith  is  clearly  beyond  question,  appear  to 
remove  the  delinquent  and  he  enlivens  the  journey 
home  with  an  account  of  the  abuses  of  which  he  has 
been  the  victim  while  in  the  hands  of  the  police,  and, 
being  restored  to    his    original   circle,   brags  about 


VI  VAUIETIES  OF  FEEBLE-MINDED  195 

the  exploits   which    he   has  performed   during   his 
absence. 

(3)  The  Sexual. — In  these  cases  there  is  more 
evidence  of  physiological  abnormality  than  in  the 
others,  for  not  only  is  the  sexual  instinct  irregular 
in  its  mode  of  manifestation  but  it  exhibits  a 
precocity  of  development  which  points  to  a  definitely 
pathological  state  of  the  organs  involved.  No 
lengthy  account  of  sexual  aberrations  is  needed,  for 
the  topic  is  one  which  runs  no  risk  of  being  over- 
looked so  long  as  an  enterprising  press  continues  to 
regale  us  with  columns  of  information  respecting  its 
various  forms.  The  exposition  of  the  subject  is 
not,  of  course,  confined  to  our  newspapers,  and  there 
is  a  vast  fund  of  literature  on  more  scientific  lines 
now  available.  Whether  the  fact  that  such  literature 
is  mainly  Continental  is  to  be  regarded  as  evidence 
that  in  our  own  country  the  moral  level  is  higher 
may  perhaps  be  doubted.  One  caution  is  necessary 
in  regard  to  this  matter.  It  is  peculiarly  in  the 
province  of  ethics  which  deals  with  questions  re- 
lating to  the  instinct  of  sex  that  the  difficulty  of 
forming  a  correct  judgment  as  to  the  expediency  of 
actions  is  met  with.  The  canon  of  sexual  propriety 
varies  with  the  latitude,  and  in  all  latitudes  is  more 
or  less  obsolete,  since  nowhere  is  it  established  on 
biological  principles.  One  redeeming  feature  of  the 
ventilation  which  sexual  matters  have  received  of 
late  years  is  a  partial  blowing  away  of  the  mists  of 
ignorance,  prejudice,  and  superstition  which  made 
anything  like  a  rational  philosophy  of  the  re- 
productive process  impossible.  So  long  as  the 
scientific   spirit   actuates   those   who   carry  on   the 

o  2 


196  THE   FEEBLE-MINDED         chap. 

work  of  investigation,  nothing  but  benefit  to  society 
at  large  can  result  from  a  critical  study  of  our 
conceptions  of  sexual  morality. 

(4)  The  Contentious. — Kraepelin^  has  described 
a  group  of  morally  defective  persons  to  whom  he 
applies  the  name  ''  pseudo-querulanten."  They  are 
unduly  sensitive  in  regard  to  their  own  interests  and 
violently  resent  any  real  or  fancied  interference 
with  what  they  esteem  to  be  their  rights.  They 
accept,  without  proof,  any  statement  which  is  in 
accordance  with  their  prejudices  and  refuse  to  listen 
to  anything  of  contrary  tenor.  They  hug  their 
grievances  and  devote  themselves  to  revenge,  pursu- 
ing those  whom  they  believe  to  be  opposed  to  them 
with  malicious  stories,  molestation,  abusive  language, 
slander,  and  legal  process,  in  which  they  do  not 
hesitate  to  commit  perjury.  Their  persistence  brings 
them  into  conflict  with  all  sorts  of  people  on  whom 
they  try  to  vent  their  ill-will  until  at  last  every  man's 
hand  is  against  them  and  the  exhaustion  of  their 
resources  reduces  them  to  impotent  anger.  Accord- 
ing to  Kraepelin,  this  type  of  moral  defect  is  quite 
distinct  from  the  cases  of  insanity  with  delusions  of 
persecution  :  it  represents  a  temperamental  peculiarity 
dating  back  to  early  life  and  therefore  to  be  classified 
as  a  manifestation  of  feeble-mindedness. 

There  Is  but  little  to  be  said  as  regards  the 
pathology  and  the  etiology  of  moral  feeble-minded- 
ness. Kraepelin  refers  to  two  cases  in  which  Nissl 
found  evidence  of  chronic  changes  in  the  cortical 
cells.  Cramer  remarks  that  there  may  be  no 
discoverable   anatomical  lesion  to  account  for   the 

^  E.  Kraepelin,  op.  cit.,  p.  836. 


VI    VARIETIES  OF  FEEBLE-MINDED  197 

condition  in  cases  of  this  kind.  Bodily  abnormalities 
of  all  kinds  may  occur  just  as  in  the  other  groups  of 
the  feeble-minded,  but  there  is  about  these  nothing 
definitive.  As  regards  etiology  it  is  to  be  noted 
that  the  persons  under  consideration  generally  come 
of  demonstrably  bad  stocks. 

The  family  histories  ascertained  by  Maier  in  three 
of  the  cases  which  he  describes  at  length  are  shown 
in  the  following  diagrams  : 


(I) 


\  immoral  7^ 


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


(Patient) 


I 

$  (Procuress) 


I  / Sexually \ 
(jUnimoral/ 


S 
(Thief) 


? 
(Immoral) 


(2) 


/Weak-minded 
\  Drunkard 


■y 


(3) 


I 
(Patient) 
(Drunkard)  (^- 


I 
(Patient) 


?  (Prostitute) 


(Weak-minded) 
—  ?  (Immoral) 


I 

? 
(Normal) 


In  the  fourth  case  the  paternity  of  the  child  was 
doubtful  though  there  was  good  ground  for  be- 
lieving him  to  be  the  son  of  a  moral  idiot  with  a  bad 
family  history. 

The  differential  diagnosis  of  moral  feeble-minded- 
ness  has  to  be  considered  under  two  aspects,  the 
medical  and  the  legal.  We  have  to  distinguish,  on 
the   one   hand,   moral    insanity,    and  on   the  other, 


198  THE   FEEBLE-MINDED         chap. 

criminality.  The  former  task  is  relatively  un- 
important :  all  that  need  be  said  is  that  cases  of 
*'  acquired  "  immorality  do  not  differ  in  their  general 
character  from  those  of  ''developmental"  origin, 
and  that  the  history  of  any  given  case  will  afford 
the  most  satisfactory  means  of  defining  it.  The 
second  topic  supplies  one  of  the  most  prolific  sources 
of  disagreement  between  the  medical  and  the  legal 
professions — the  question  of  criminal  responsibility. 

So  much  confusion  has  resulted  from  the  dis- 
cussion as  to  what  is  the  true  test  of  responsibility 
for  wrongful  actions  that  in  practice  every  judge  is,  to 
a  great  extent,  a  law  unto  himself.  There  are,  how- 
ever, well  recognised  underlying  principles  derived 
from  the  famous  ''  Answers  of  the  Judges  "  in  the 
MacNaghten  case.  The  following  summary  of  these 
is  taken  from  Dr.  Oppenheimer's  recent  work.^ 

''  To  establish  a  defence  on  the  ground  of  insanity 
it  must  be  proved  that  at  the  time  of  committing 
the  act,  the  accused  was  prevented  by  disease 
affecting  his  mind  from  knowing  the  nature  and 
quality  of  his  act,  or  from  knowing  that  the  act  was 
wrong." 

'*  A  person  labouring  under  specific  delusions  but 
in  other  respects  sane  shall  not  be  allowed  to  benefit 
by  the  plea  of  insanity  unless  the  delusions  caused 
him  to  believe  in  the  existence  of  some  state  of 
things  which,  if  it  existed,  would  justify  or  excuse 
his  act." 

Whether  ''  wrong  "  means  either  ''  morally  wrong  " 
or  '*  illegal,"  or  both,  is  still  in  dispute.     One  may 

^  H.  Oppenheimer,  Tke  Criminal  Responsibity  of  Lunatics^  I909) 
P-  19. 


VI   VARIETIES  OF  FEEBLE-MINDED  199 

comparatively  easily  define,  in  terms  of  the  common 
law  or  of  the  statute  law,  what  constitutes  illegality, 
but  to  decide  whether  a  thing  is  immoral  or  not  is  a 
much    more   difficult    matter.     It    is    felt  by  many 
persons  that  to  adopt  a  purely  legal  interpretation 
of  the  word   ''wrong"    is    inexpedient.     A  person 
suffering  from   chorea   who    destroys    the   sight  of 
another  by  an  involuntary  movement  set  up  by  some 
unexpected  stimulus  can  hardly  be  absolved  from 
the  legal  consequences  of  his  act  on  the  ground  that 
he  was  prevented    "by  disease  affecting  his  mind 
from  knowing  the  nature  and  quality  of  his  act  or 
from   knowing  that  the    act  was    wrong,"  and   Sir 
James  Stephen  is  doubtful  whether  there  should  not 
be  added  to  the  above  statement  of  the  law  a  clause 
excusing  him  who  is  prevented   ''  from  controlling 
his  own  conduct  unless  the  absence  of  the  power  of 
control  has  been  produced  by  his  own  default."     In 
his  book  on  *'  Criminal  Responsibility  "  Mercier  ex- 
haustively considerswhat  constitutes  wrong-doing  and 
he  concludes  that  ''  to  incur  responsibility  by  a  harm- 
ful act  the  actor  must  will  the  act :  intend  the  harm  : 
desire  primarily  his  own  gratification.     Furthermore, 
the   act    must    be  unprovoked  and  the  actor  must 
know  and  appreciate  the  circumstances  in  which  the 
act  is  done."     This  teaching  certainly  shows  a  truer 
appreciation  of  the  problem  than  did  the  answers  of 
the  judges,  but  it  is  admittedly  not  an  exposition  of 
the  law  as  it  is.    One  deduction  may,  for  our  present 
purpose,  be   profitably  drawn    from    these    various 
dicta :    it    is    that    in    each    case   the   test    is    an 
''  intellectual  "  and  not  a  ''  moral  "  one,  and  that  to 
regard  '' moral  feeble-mindedness  "  as  involving  no 


200  THE   FEEBLE-MINDED         chap. 

intellectual  defect  is  to  drag  those  displaying  it  from 
the  sanctuary  of  irresponsibility. 

A  similar  attitude  is  taken  up  by  the  criminal  law 
of  Germany,  under  which,  as  Cramer^  remarks, 
''  accountability  for  moral  defect  is  only  excluded 
when  that  defect  is  due  to  pathological  disturbance." 
It  may  be  noted  in  this  connection  that  the  English 
law,  unlike  that  of  Scotland,  Denmark,  Greece, 
Italy,  Sweden,  and  some  of  the  Swiss  Cantons,  does 
not  provide  for  mitigation  of  punishment  by  formally 
recognising  grades  of  responsibility,  although  its 
indefiniteness  leaves  to  the  judges  a  fairly  free 
hand. 

Mercier's  analysis  of  "  responsibility,"  though  not 
perhaps  intended  to  do  so,  raises  doubts  as  to 
whether  the  law  relating  to  crime  is  not  funda- 
mentally unsound.  A  responsible  person  is,  accord- 
ing to  him,  one  who  is  "  liable  to  punishment  on 
grounds  that  appear  fair  and  just  to  the  ordinary 
man  when  they  are  explained  to  him — grounds  that 
commend  themselves  as  equitable  and  right,  not  to 
the  faddist,  the  pedant,  or  enthusiast,  but  to  the 
common  sense  of  the  common  man  of  this  time  and 
this  country."  The  arbiter  of  the  destinies  of 
society  is  thus  to  be  ''  the  man  in  the  street."  To  a 
great  extent  this  is  the  case  already.  The  criminal 
law  is  an  idol  which  men  have  fashioned  with  their 
own  hands  and  have  set  up  in  a  high  place.  To  it 
they  have  dedicated  temples  and  for  the  adornment 
of  its  priests  they  have  fabricated  robes  of  silk  and 
ermine.  Deceived  by  the  pretences  with  which  they 
have  themselves  surrounded  the  god,  they  forget  that 

^  A.  Cramer,  op.  cit.^  p.  353. 


VI   VARIETIES  OF  FEEBLE-MINDED  201 

his  voice  is  but  that  of  the  people  and  that  the 
utterances  which  appear  to  proceed  from  his  Hps 
are  but  echoes  of  the  cries  for  vengeance  in  which 
their  crude  passions  express  themselves.  Is  this 
the  best  which  philosophy  can  do  for  us  ?  Can  it 
not  provide  us  with  some  more  practical  ideal  than 
the  satisfaction  of  that  primitive  instinct  of 
retaliation  which  was  appropriate  to  a  long  past 
stage  of  evolution  ?  Let  us  desist  from  the  pursuit 
of  that  ignis  fatuus,  a  criterion  of  ''responsibility," 
and  realise  that  the  interest  of  society  in  any 
member  of  its  community,  good  or  bad,  sane  or 
insane,  consists,  primarily,  not  in  speculating  as  to 
his  moral  worth,  but  in  devising  schemes  for  turning 
to  the  best  account  such  powers  as  he  possesses. 

Intellectual  Feeble-Mindedness 

Feeble-mindedness  of  what  has  been  distinguished 
as  the  "intellectual,"  as  opposed  to  the  "moral," 
form  exhibits  no  less  diversity  than  marks  the 
latter.  The  infirmity  of  mind  ranges  from  mere 
defect  of  educability  to  degradation  of  such  an 
extreme  type  as  almost  to  remove  the  subject  of  it 
from  the  pale  of  human  sympathy.  Examples  of 
the  slighter  degrees  of  feeble-mindedness  are 
provided  by  the  children  who,  in  spite  of  the  most 
skilful  teaching,  cannot  keep  pace  with  their  fellows 
at  school.  Later  in  life  the  deficient  capacity  will 
be  expressed  in  different  ways  according  to  the  sex 
and  the  social  status  of  the  individual.  If  a  worse 
fate  does  not  befall  her,  the  girl  of  the  lower  classes 
will  become  a  slatternly  drudge,  while  the  one  born 


202  THE   FEEBLE-MINDED         chap. 

in  the  purple  will,  perhaps,  after  suffering  many 
things  at  the  hands  of  parents  and  tutors  engaged 
upon  the  task  of  moulding  her  to  the  conventional 
pattern  of  her  class,  cut  the  Gordian  knot  by  leaving 
home  with  the  footman  or  the  chauffeur.  The  boy, 
if  compelled  to  earn  his  own  living,  will  be  the  butt 
of  his  workshop,  and  will  never  be  able  to  carry  out 
other  than  the  roughest  forms  of  unskilled  labour. 
With  a  suitable  environment,  he  may  become  a 
hooligan,  or  a  thief,  or  a  deserter.  Aided  by  the 
numerous  advantages  which  the  possession  of 
adequate  pecuniary  resources  confers,  he  may  be 
able  to  enter  upon  a  business  or  professional  career, 
which  in  due  course  may  lead  him  to  the  almshouse, 
or  the  penitentiary ;  or,  if  no  attempt  has  been 
made  to  turn  his  energies  into  profitable  channels, 
he  becomes  a  wastrel  and  a  prodigal,  distributing 
his  means  among  the  hoard  of  rascals  who  will  have 
attached  themselves  to  him. 

At  the  other  end  of  the  scale  occur  cases, 
fortunately  few  in  comparison,  which  are  such  pain- 
ful caricatures  of  humanity  that  members  of  the 
general  public,  seeing  them  for  the  first  time,  usually 
suggest  the  establishment  of  a  lethal  chamber,  as 
affording  the  only  feasible  method  of  dealing  with 
them.  Entering  a  ward  in  one  of  our  asylums  for 
idiots,  one  may  observe  huddled  up  on  a  bed,  since 
it  can  neither  stand  nor  sit,  a  piece  of  life's  flotsam 
with  mis-shapen  head,  deformed  chest,,  twisted  spine, 
and  distorted  limbs.  Its  hands  are  claws,  and  if  it 
exhibits  only  two  complicated  forms  of  club-foot, 
that  is,  apparently,  because  the  circumstances  do 
not  permit  of  more.     At  intervals  it  shrieks  in  an 


VI   VARIETIES  OF  FEEBLE-MINDED  203 

uncanny  way  for  the  food  with  which  it  is  unable  to 
feed  itself  and  over  which  it  would  choke  but  for  the 
care  of  the  attendant.  Saliva  dribbles  from  its 
mouth  as  it  gnaws  at  the  bed-clothes,  and  its 
excretory  organs  perform  their  functions  without 
control.  The  expressionless  features  twitch  gro- 
tesquely and  from  time  to  time  the  ungainly  frame 
is  racked  by  convulsions.^ 

As  illustrating  an  intermediate  type  we  may  take 
those  cases,  usually  classed,  without  special  reference 
to  the  definition  of  the  Commission  on  the  Feeble- 
Minded,  as  ''  imbeciles,"  which  one  meets  with  in 
such  institutions  as  asylums.  For  these  the  world 
is  a  very  small  stage.  The  trivial  round,  the 
common  task,  furnish  them  with  sufficient  interests 
and  about  those  few  interests  their  feelings  are  as 
keen,  if  not  as  enduring,  as  those  of  the  normal 
person.  There  is,  in  fact,  little  of  that  limitation  in 
the  affective  sphere  which  is  peculiarly  characteristic 
of  moral  feeble-mindedness.  Their  want  of  experi- 
ence makes  them  easily  misled,  but  they  have  no 

^  The  following  description  of  idiots  as  Dr.  Pariset  saw  them  long 
ago  is  worth  rescuing  from  the  comparative  obscurity  of  Seguin's 
Traitement  Morale  Hygiene  et  Educatio?i  des  Idiots^  published  in 
1846 ;  "  Quel  spectacle !  I'un  s'agite  en  forcene,  vocif^re  et  crie ; 
I'autre  se  tient  accroupi  dans  le  silence  et  I'immobilitd  d'un  automate  ; 
le  premier  a  qui  vous  adressez  la  parole  se  sauve  en  ricanant ;  le 
second  vous  envoie  k  profusion  des  salutations  et  des  baise-mains  ;  un 
troisieme  se  couvre  de  signes  de  croix  ;  un  quatriem.e  se  couche  k  terre  ; 
un  cinqui^me  se  mord  .les  doigts  en  riant  d'un  rire  insense.  Aux 
questions  que  vous  leur  faites,  pas  un  ne  fait  une  rdponse  intelligible, 
tant  leur  langue  est  embarrassde,  tant  leur  voix  est  sourde,  confuse  et 
inarticulde.  ...  lis  ont  des  yeux  qui  voient  et  qui  ne  regardent  pas  ; 
des  oreilles  qui  entendent  et  qui  n'ecoutent  pas.  S'ils  ont  des  jambes 
inhabiles  a  la  station,  a  I'equilibre,  a  la  marche,  au  saut,  ^  la  course, 
leurs  mains  incertaines  sont  egalement  inhabiles  a  toucher,  a  saisir,  a 
mouvoir,  a  deplacer  les  corps." 


204  THE  FEEBLE-MINDED  chap. 

inherent  prejudice  against  virtue,  and  are  quite 
willing  to  be  as  good  as  they  know  how  to  be. 
When  their  simple  wants  in  the  way  of  food  and 
clothing  are  satisfied  they  are  cheerful  and  contented 
and  quite  ready  to  devote  themselves  to  the  tasks 
assigned  to  them,  until  their  small  fund  of  energy 
is  exhausted.  They  are  apt  to  be  impolite  and 
uncouth,  disdaining  distinctions  of  rank,  and 
recognising  no  order  of  precedence  except  that 
which  gives  them  the  first  place  ;  but  their  failings, 
unlike  those  of  the  morally  feeble-minded,  are 
almost  entirely  due  to  Ignorance  and  are  easily 
eradicated  by  suitable  training.  Indeed,  they  tend 
under  tuition  to  go  to  extremes  in  the  other  direc- 
tions :  they  will  say  *'  Good  Morning  "  at  whatever 
hour  or  however  frequently  one  meets  them,  and 
the  males  will  indulge  in  amusingly  extravagant 
parodies  of  the  salutes  with  which  the  attendants 
acknowledge  the  presence  of  superior  officers,  while 
the  females  may  become  great  sticklers  for  the 
proprieties  and  may  show  themselves  eager  to  dis- 
play their  familiarity  with  what  they  esteem  to  be 
the  rules  of  etiquette.  ''Why  do  you  stick  your 
little  finger  out  like  that  ?  "  was  asked  of  an  imbecile 
girl  who  was  lifting  her  teacup  with  much  empresse- 
ment,  "  That's  manners !  "  was  the  reply,  in  a  tone 
expressing  surprise  at  the  questioner's  ignorance  of 
correct  social  usage.  Among  the  females,  too,  the 
love  of  finery  Is  strongly  pronounced,  though  the 
decorative  effect  achieved  Is  sometimes  a  little 
bizarre.  The  incapacity  for  adapting  means  to  ends, 
which  is  a  prominent  feature  of  imbecility,  comes 
out,  perhaps,  in  no  more  striking  fashion  than  in  the 


Yi   VARIETIES  OF  FEEBLE-MINDED  205 

playing  of  games.  At  football,  for  instance,  the  sole 
principle  recognised  is  to  kick  the  ball  hard. 
Nothing  in  the  way  of  combination  occurs,  and  the 
ball  will  pass  to  and  fro  in  the  middle  of  the  field 
throughout  the  whole  of  the  game  unless  some 
enthusiast  kicks  it  through  his  own  goal  ;  a  pro- 
ceeding, by  the  way,  which  earns  for  him  loud 
applause  from  the  rest  of  his  side.  Cricket  is 
conducted  on  similar  lines.  Unless  prevented  by 
those  in  charge  the  spectators  squat  around  the 
wicket,  undeterred  by  the  imminent  probability  of 
"  wides  "  or  of  a  batsman's  vigorous  swipes,  resulting 
in  the  despatch  among  them  of  both  ball  and  bat. 
The  ball  is  chased  by  half  the  field  ;  easy  catches 
are  muffed  ;  wild  shies  are  made  in  all  directions  ; 
and,  finally,  unless  the  contingency  has  been  guarded 
against,  the  result  of  the  match  may  remain  in  doubt 
owing  to  the  scorer's  having  placed  all  the  runs  for 
both  teams  to  the  credit  of  the  first  man  whose  name 
happens  to  have  caught  his  eye. 

A  sense  of  humour,  which  is,  after  all,  mainly  a 
sense  of  proportion,  is  hardly  to  be  expected  among 
imbeciles,  but  obvious  jokes  and  the  antics  of  the 
knock-about  comedian  are  rewarded  with  hearty 
laughter.  Displays  of  primitive  passion  appeal  to 
their  sympathies,  and  the  instinctive  tendency  to 
find  gratification  in  the  misfortunes  of  others  is  not 
kept  in  check.  Naive  allusions  to  sexual  matters 
may  be  made,  and  in  view  of  the  difficulties  attend- 
ing the  subject,  it  is  not  surprising  to  find  that 
quaint  interpretations  are  put  upon  the  teachings  of 
religion. 

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


206  THE   FEEBLE-MINDED         chap. 

so  since  the  earlier  years  of  an  imbecile's  life  are 
often  passed  in  circumstances  which  provide  him 
with  abundant  experience  of  vice.  Many  imbeciles 
are  mischievous  and  prone  to  outbreaks  of  temper 
which  may  lead  to  violence  :  they  may  fight  with 
one  another,  or  smash  windows  and  table-ware : 
they  may  use  obscene  and  abusive  language,  or 
indulge  in  sexually  immoral  conduct :  they  may 
steal  food  or  anything  else  which  excites  their 
cupidity  :  they  may  set  fire  to  the  ward  in  which 
they  live,  or  generally,  they  may  give  trouble  in  any 
of  the  score  of  ways  which  those  in  charge  of  them 
usually  include  under  the  generic  term  "  playing- 
up." 

ATELEIOTIC  FORMS 

It  Is  a  moot  point  whether  feeble-mindedness  Is 
ever  a  purely  quantitative  and  not  a  qualitative 
defect  of  mental  capacity.  Theoretically,  there  is  no 
difficulty  in  supposing  that  the  process  of  normal 
development  may  simply  stop  when  a  certain  stage 
has  been  reached,  leaving  the  individual  concerned 
in  a  state  of  permanent  infantilism  or  juvenility,  but 
in  practice  it  Is  rare  to  find  a  case  which  can  be 
confidently  accounted  for  in  this  way.  Infantile 
characteristics  are  common  enough  among  the 
feeble-minded,  but  they  are  almost  always  closely 
Interwoven  with  signs  which  suggest  that  the 
current  of  growth  has  been  deflected  at  some  point 
from  its  proper  course.  We  do,  however,  occasion- 
ally meet  with  what  may  be  described  as  ''minds  in 
miniature,"  which  may  perhaps  be  associated  with 
bodies  of  the  same  order.     The  sensory  apparatus 


VI    VARIETIES  OF  FEEBLE-MINDED  207 

is  efficient  but  limited  in  the  range  of  its  utility. 
Memory  is  of  the  ordinary  type,  so  far  as  it  goes, 
there  being  neither  the  gross  incapacity  nor  the 
one-sidedness  which  the  ''qualitatively"  feeble- 
minded may  exhibit.  Ideas  are  associated  in  a 
normal  way.  Judgments,  if  few,  are  sound,  and 
conclusions,  if  they  are  drawn  at  all,  are  logically 
deducible  from  their  premises.  Most  important 
of  all,  presentations  and  representations  have 
the  affective  colouring  which  is  in  harmony  with 
the  experience  of  the  majority,  and  which  must, 
therefore,  be  regarded  as  the  natural  one.  The 
emotions  are  not,  however,  strongly  pronounced,  and 
they  do  not  supply  any  very  powerful  incentives  ; 
thus  the  sexual  instinct  may  remain  in  abeyance  to 
a  great  extent.  Speech  may  show  the  defects  due 
to  a  lack  of  grasp  of  grammatical  principles.  Such 
unprofitable  forms  of  industry  as  playing  with  dolls 
collecting  the  numbers  of  passing  motor-cars,  string- 
ing used  postage  stamps  into  the  semblance  of  a 
serpent,  or  other  of  the  futile  employments  which 
children  ordinarily  grow  out  of,  may  occupy  the 
years  which  should  be  devoted  to  more  serious 
labours.  There  may  be  a  disinclination  to  leave 
the  mother's  apron-strings.  Irresolution,  depend- 
ence, suggestibility,  and  want  of  tenacity  of  purpose, 
may  make  persons  of  this  class  a  prey  to  the 
pernicious  influence  of  some  stronger  mind,  but  the 
activities  in  which  their  thought  expresses  itself  are 
never  wilfully  anti-social.  On  the  physical  side  also 
there  may  be  persistence  of  juvenile  characteristics, 
e.g.,  a  childish  voice ;  ill-developed  sexual  organs 
and  want  of  union  of  epiphyses. 


208  THE   FEEBLE-MINDED         chap. 

In  another  group  of  cases  a  condition  of  infantilism 
seems  to  be  dependent  on  disease  of  some  particular 
organ,  e.g.,  the  pancreas,  the  liver,  the  adrenal,  or 
the  pituitary  ;  or  to  be  a  sequel  to  some  general 
disease,  e.g.,  congenital  syphilis. 

When  the  retardation  of  development  is  so  marked 
as  to  be  accepted  as  pathological,  there  may  con- 
veniently be  used  for  it  the  term  '*  Ateleiosis " 
{aTe\r)s,  not  arriving  at  perfection),  which  seems  to 
have  been  originally  employed,  with  a  somewhat 
narrower  signification  than  is  here  given  to  it,  by 
H.  Gilford.^ 

A  good  example  of  "Ateleiosis"  was  recently 
brought  before  the  Royal  Society  of  Medicine  by 
Dr.  F.  Parkes  Weber.^  This  was  the  case  of  a  man 
aged  42  years,  whose  development  seemed  to  have 
ceased  at  about  the  age  of  9  or  10  years,  though  in 
some  respects  the  proper  attributes  of  his  age  were 
recognisable. 


THE  MONGOLIAN,  KALMUCK  OR  TARTAR  TYPE 

Custom  has  for  so  long  sanctioned  the  application 
of  the  name  ''Mongolian"  to  the  group  of  feeble- 
minded persons  about  to  be  described,  that  it  is 
convenient  to  retain  the  designation,  even  though 
its  meaning  is  vague  and  its  suggestion  of  a 
resemblance  to  any  of  the  Chinese  types  of  physi- 
ognomy  is    largely   fanciful.       The   physical    pecu- 

^  H.  Gilford,  "Ateleiosis,  a  Disease  characterised  by  Conspicuous 
Delay  of  Growth  and  Development,"  Med.-Chir.  Trans. ^  1902,  p.  305. 
■J-  F.  Parkes  Weber,  "Ateleiosis  in  a  Man  aged  42,"  Proc.  of  the 
Royal  Society  of  Medicine,  June,  1910. 


VI   VARIETIES  OF  FEEBLE-MINDED  209 

liarities  of  Mongolism  are  nevertheless  sufficiently 
distinctive,  in  most  cases,  and  make  up  a  clinical 
ense^nble  which  renders  diagnosis  easy,  although  no 
one  feature  can  be  regarded  as  pathognomonic. 
A  consideration  of  the  various  abnormalities  which 
have  been  noted  by  different  writers,  shows  how 
numerous  are  the  morbid  appearances  which  may 
be  exhibited.  Stated  briefly,  the  signs  of  Mongolism 
may  include  any  or  all  of  the  following  conditions, 
which  are  arranged  according  to  the  requirements  of 
clinical  convenience  and  without  reference  to  their 
relative  significance,  since  that  is  decidedly  obscure. 

(Fig-   ^3-) 

Head  small,  with  high  cephalic  index  owing  to  the 

depression  of  the  glabella  and  the  want  of  promin- 
ence of  the  occipital  region.  The  cephalic  index 
has  been  recorded  as  having  reached  loo,  i.e.,  the 
antero-posterior  and  transverse  diameters  of  the 
head  were  equal. 

Eyes  wide  apart,  with  the  palpebral  fissures 
sloping  upwards  and  outwards,  the  lids  displaying 
the  condition  of  epicanthus,  and  bearing  few  lashes  ; 
unilateral  ptosis,  and  strabismus,  nystagmus,  and  a 
speckled  condition  of  the  iris  ;  chronic  blepharitis 
going  on  to  corneal  opacity,  ectropion,  and  epiphora. 

Nose  short,  nostrils  looking  forward.     Adenoids. 

Ears  small  and  rounded. 

Tongue  large  and  fissured,  protruding  from  mouth 
if  very  large. 

Skin  of  face  red,  of  hands  thick  and  wrinkled  ; 
chilblains. 

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

p 


210  THE   FEEBLE-MINDED         chap. 

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

Laxity  of  ligaments  and  hyperextensibility  of 
joints. 

Congenital,  and  other,  forms  of  heart  disease. 

Abdomen  large  and  tumid ;  umbilical  hernia ; 
constipation. 

Of  these  signs  the  most  characteristic  are,  perhaps, 
the  redness  and  flatness  of  the  face,  the  state  of  the 
tongue  and  the  obliquity  of  the  eyes  ;  which  last, 
though  responsible  for  the  name  given  to  the  type,  is 
by  no  means  invariably  present.  Epicanthus  is  an 
hereditary  character  not  peculiar  to  Mongolism, 
since,  as  Ashby  showed,  it  occurs  among  the 
relatives  of  Mongols  as  frequently  as  among  the 
Mongols  themselves,  and  it  is  also  met  with  in 
families  which  show  no  trace  of  Mongolism.  All 
the  remaining  morbid  conditions  may  be  encountered 
in  cases  of  feeble-mindedness  which  do  not  in  other 
respects  conform  to  the  Mongolian  type. 

It  is  not  surprising  that  the  considerable  degree  of 
abnormality  which  the  head  displays  in  Mongolism 
should  obliterate  the  numerous,  but  individually 
unimportant,  differences  which  serve  to  distinguish 
human  beings  of  the  same  race,  and  that,  con- 
sequently, well-marked  cases  of  Mongolism  should 
resemble  each  other  so  closely  that  they  look  like 
members  of  the  same  family.  Taken  together,  the 
signs  of  Mongolism  suggest  that  the  condition  is  due 
to  some  definite,  if  unknown,  disorder  of  nutrition, 
and  the  morbid  process  may  be  far-reaching  in  Its 
effects  or  of  but  limited  extent.  The  mental 
symptoms  show,  as  might  be  anticipated,  a  certain 


VI    VARIETIES  OF  FEEBLE-MINDED  211 

parallelism  with  the  physical,  and  all  grades  of  defect 
are  found  from  simple  weakness  of  mind  to  complete 
idiocy.  There  are,  however,  certain  features  of  the 
mental  state  which  may  be  noted.  When  sufficiently 
intelligent  to  be  capable  of  such  manifestations 
Mongols  often  show  an  imitativeness  and  an  appre- 
ciation of  rhythm  which  are  rather  striking.  They 
are  good  tempered  as  a  rule,  though  infants  showing 
the  condition  may  be  subject  to  storms  of  passion, 
willing  and  submissive  to  authority.  They  show 
an  interest  in  what  is  going  on  about  them,  and 
sometimes  they  are  lively,  talkative  and  restless. 
There  is  a  marked  immunity  from  epilepsy,  but  they 
may  simulate  epileptic  fits  if  they  are  in  wards 
which  provide  them  with  models  to  copy.  It  may 
be  that  the  early  death  which  overtakes  most 
Mongols  is  in  some  measure  accountable  for  the 
absence  of  epilepsy  among  them.  Of  the  six  cases 
referred  to  below,  one,  a  woman  of  twenty-five,  has 
had  several  apparently  genuine  epileptic  fits  in 
addition  to  the  imitation  ones  with  which  she 
sometimes  favours  observers,  while  another  had,  at 
the  age  of  twenty-three,  a  series  of  slight  and 
transient  convulsions  affecting  only  the  left  side  of 
the  body.  As  with  other  diseases  there  is  an  inverse 
ratio  between  the  severity  of  the  symptoms  and  the 
duration  of  life.  Dividing  the  cases  according  to 
their  powers  of  taking  care  of  themselves  and  of 
doing  useful  work,  we  find  that  the  idiots  die  young, 
the  imbeciles  probably  break  down  before  reaching 
middle  life,  while  the  weak-minded,  if  suitably  cared 
for,  may  attain  a  fairly  advanced  age.  In  the  milder 
cases  the  state  of  puberty  is  duly  arrived  at  though, 

P    2 


212  THE  FEEBLE-MINDED  chap. 

perhaps,  a  little  late  ;  thus  in  six  female  Mongols,  of 
ages  ranging  from  twenty  to  thirty-nine  years,  under 
the  writer's  care,  menstruation  is  normal  except  in 
the  case  of  the  eldest  one  who  suffers  from 
menorrhagia. 

The  proportion  of  Mongols  to  the  whole  body  of 
the  feeble-minded  at  any  age  is  difficult  to  ascertain 
accurately.  Shuttleworth  states  that  they  consti- 
tuted about  5%  of  2900  admissions  to  the  Royal 
Albert  Asylum  and  that  the  condition  is  commoner 
in  the  north  of  England  than  in  the  south.  Among 
250  male  feeble-minded  children,  between  the  ages 
of  5  and  16  years,  the  writer  found  6  Mongols,  and 
among  a  similar  group  of  female  children,  8,  i.e., 
taking  the  sexes  together,  nearly  3%  ;  while  among 
600  females  over  the  age  of  16  there  were  5  cases. 
Both  the  institutions  from  which  the  figures  were 
obtained  are  in  the  south  of  England.  According  to 
H.  Vogt,  Mongolism  is  much  less  common  in  Ger- 
many than  in  England,  supplying  only  1%  of  the 
cases  of  feeble-mindedness. 

As  regards  the  causation  of  Mongolism  there  is 
little  to  be  added  to  what  has  been  said  on  the 
general  subject  of  etiology  in  Chapter  V.  Several 
observers  have  tried,  with  some  success,  to  connect 
the  development  of  this  form  of  feeble-mindedness, 
in  the  child,  with  a  state  of  impaired  nutrition,  in 
the  mother,  during  pregnancy.  The  children  have 
certainly,  in  many  cases,  been  the  last  members  of 
large  families  so  that  the  mothers  at  the  time  of 
conception  were  approaching  the  age  of  decline  of 
the  reproductive  powers.  That  some  other  factor 
besides  the  age  and  exhaustion  of  the  mother  has 


Fig.  14.^ — Lateral  aspect  of  the  left  hemisphere  of  the  brain  of  a  Mongolian 

idiot. 


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


[Face  page  213. 


VI    VARIETIES  OF  FEEBLE-MINDED  213 

to  be  taken  into  account  is  shown  by  the  following 
table  of  the  family  history  of  twelve  of  the  most 
recently  reported  cases.  The  first  eleven  are  from 
the  Proceedings  of  the  Royal  Society  of  Medicine 
for  May  1909,  the  last  from  the  Lancet  for  January 
ist,  1 9 10. 


Position  of  child 

Age 

of  mother  at        Recorded 

in  family 

birth  of  child                    by 

I. 

Only  child  ... 

... 

43] 

2. 

2nd  of  2 

... 

40  - 

Dr.  G.  A.  Sutherland 

3- 

3rd  of  3 

... 

4- 

Last  but  one  of  large  family 

40] 

2nd  of  3 

~\ 

Dr.  F.  J.  Poynton 

6. 

3rd  of  3       ... 

-J 

7. 
8. 

Only  child  ... 
loth  of  II   ... 

261 

39) 

Dr.  F.  Langmead 

9. 

1st  of  2 

40] 

10. 

loth  of  10   ... 

44 

Dr.  H.  M.  Fletcher 

II. 

4th  of  5 

32/ 

12. 

7th  of  7 

43 

Dr.  J.  P.  Cullen 

Mongolism  being  a  comparatively  rare  condition 
the  number  of  cases  in  which  an  examination  of 
the  brain  after  death  has  been  made  is  small.  Fig. 
14,  which  is  a  photograph  of  the  brain  of  a  Mon- 
golian idiot,  aged  about  6  years,  shows  no  very 
striking  peculiarities  except  the  smallness  of  the 
superior  temporal  convolution.  The  roundness  and 
shortness  of  the  hemisphere  and  the  concavity  of 
the  orbital  surface  are  to  be  correlated  with  the 
shape  of  the  skull,  though  which  is  to  be  regarded 
as  cause  and  which  as  effect  is  open  to  discussion. 
The  right  hemisphere  weighed  1 5f  ozs.  and  the  left 
15  ozs.,  while  the  cerebellum,  pons,  and  medulla 
together  weighed  2>2  ^^^-^  ^^^  cerebrum  thus  con- 
stituting 8978%  of  the  whole  encephalon.  The 
ratio  of  the  several  parts  of  the  brain  undergoes 
change  during  growth,  and  in  the  absence  of  statistics 


214  THE   FEEBLE-MINDED         chap. 

relating  to  normal  brains  of  males  at  the  age  of  this 
case,  it  is  impossible  to  say  to  what  extent  this 
particular  brain  is  exceptional,  but  if  Huschke's 
figures  giving  the  weight  of  the  cerebrum  as  93% 
of  the  total  brain  weight  at  birth  and  '^'jj^  at 
maturity  be  correct  there  is  little  indication  here  of 
the  abnormal  smallness  of  the  cerebellum  which  has 
been  described  as  a  feature  of  the  Mongolian  brain. ^ 
On  the  whole  it  seems  most  satisfactory  to  regard 
Mongolism  as  a  distinct  pathological  entity  referable, 
as,  for  example,  cretinism  is,  to  a  disturbance  of 
the  function  of  some  glandular  structure  of  which 
the  physiology  is  as  yet  but  imperfectly  known. 
Bufe  ^  found  that  Mongols  excrete  lime  salts  to 
only  a  slight  extent  in  the  urine,  but  that  a  much 
larger  amount  than  in  normal  children  of  the  same 
age  is  excreted  in  the  faeces.  The  disease  has  thus 
some  points  of  contact  with  osteomalacia  and  he 
suggests  that  its  occurrence  depends  on  an  abnormal 
trophic  action  of  the  sexual  glands. 

MICROCEPHALIC    TYPE 

The  cases  of  feeble-mindedness  which  fall  into 
this  category  form  a  less  natural  grouping  than 
those  just  described  since  the  establishment  of 
the  class  is  conditioned  by  the  arbitrary  selection  of 
one  particular  anatomical  feature  instead  of  having 
reference,  as  in  Mongolism,  to  a  number  of  such 
characters.     Opinions    differ    so    much    as   to  what 

Ix  ^  Paul    Biach,    "  Zur    Kenntnis    des    Zentralnervensystems    beim 
Mongolismus,"   Deutsche   Zeitschr.    ^.  Nervenheilk,   Bd.  ^7^   H.   1-2, 
p.  7. 
V      ^  E.    Bufe,  Die   mo7igoloide  Fonjt  der  Idiotie.    Zeitschr.  f.   drztl. 
Praxis^  No.  3. 


VI    VARIETIES  OF  FEEBLE-MINDED  215 

constitutes  a  small  head  that  it  becomes  necessary 
to  agree  upon  a  standard  of  measurement.  Ireland 
includes  all  cases  having  crania  with  a  maximum 
circumference  of  17  inches  or  less,  and  his  ruling 
is  generally  followed  in  this  country.  In  Germany, 
Schwalbe's  plan  of  fixing  the  maximum  circum- 
ference at  45  cm.  or  the  maximum  brain  weight  at 
900  grms.  is  more  usually  adopted.  Something,  of 
course,  depends  on  the  age  of  the  patient.  Accord- 
ing to  Ashby  and  Wright  ^  the  average  circum- 
ference of  the  normal  head  is  18  in.  at  i  year,  20  in. 
at  2  years,  21  in.  at  4  years,  and  21^  at  10  years. 
They  state  the  position  thus  : 

"  If  a  child's  head  is  3  in.  under  the  average  cir- 
cumference for  its  age  the  child  will  be  an  imbecile. 
If  2  in.  under  the  average  the  child  will  probably  be 
feeble-minded  in  more  or  less  degree.  Thus  a  child 
from  seven  to  ten  years  with  a  head  measurement  of 
19  in.  or  under,  and  at  the  same  time  fairly  well-grown 
for  his  age,  is  almost  certain  to  be  of  weak  intellect." 
Berkhan  ^  gives  the  following  as  the  average 
measurements,  for  males,  of  the  circumference  of  the 
skull  at  the  ages  mentioned  : 


Age 

Measurement 

6  months 

40  cm. 

I  year 

45-5  cm. 

2  years 

47'5  cm. 

5  years 

50  cm. 

10  years 

52  cm. 

15  years 

54  cm. 

20  years 

55 

to  55-5  cm. 

in  the  case  of  females  the  measurements  are,    for 

1  H.  Ashby  and  G.  A.  Wright,  The  Diseases  of  Childre7i^  1905,  p. 
584. 

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


216  THE  FEEBLE-MINDED  chap. 

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

Apart  from  the  small  size  of  the  head  there  is 
clinically  so  little  which  is  distinctive  about  micro- 
cephaly that  the  interest  of  the  condition  is  mainly 
pathological.  The  well-marked  abnormality  which, 
as  a  rule,  the  microcephalic  brain  exhibits  has  opened 
up  a  fertile  field  for  theorists,  although  the  total 
number  of  brains  studied  is  as  yet  so  small  that 
definite  conclusions  as  to  the  fundamental  causes  of 
the  defect  can  hardly  be  arrived  at.  Biassed  in  their 
judgment  by  the  study  of  particular  instances  which 
have  fallen  into  their  hands,  different  writers  have 
propounded  hypotheses  which,  as  a  wider  survey 
shows,  are  individually  inadequate.  Speculation 
upon  the  genesis  of  pathological  states  of  the  nervous 
system  takes  three  principal  directions.  The  abnor- 
mality may  be  due  to  causes,  such  as  mechanical 
interference  or  infection,  which  produce  gross  lesions 
of  the  growing  organ  ;  it  may  represent  a  return  to 
an  earlier  stage  in  the  development  of  the  organism, 
i.e.y  it  may  be  reversionary  ;  or  thirdly,  it  may  be 
explicable  as  a  more  or  less  irregular  curtailment 
of  those  vital  activities  which  result  in  growth. 
Explanations  of  microcephaly  on  all  three  of  these 
lines  have  been  advanced  from  time  to  time.  With 
the  first  hypothesis  the  name  of  VIrchow  is  particu- 
larly associated  ;  with  the  second  that  of  K.  Vogt ; 
with  the  third  that  of  Aeby. 

The  notion,  ascribed  to  VIrchow  and  to  Baillarger, 
that  a  small  brain  was  to  be  accounted  for  by  pre- 
mature synostosis  of  the  bones  of  the  skull,  received 
some  support  from  the  occasional  occurrence  among 


VI   VARIETIES  OF  FEEBLEMINDED  217 

microcephalic  idiots  of  hypertrophied  scalps  which 
seemed  to  be  intended  to  cover  larger  skulls  than 
actually  bore  them.  It  led  to  operative  procedures 
which,  however  useless  they  may  have  been  in  other 
respects,  served  to  dispel  confidence  in  a  seductive, 
but  entirely  unwarranted  assumption.  Traumatism, 
obstruction  of  blood-vessels,  and  inflammatory  pro- 
cesses may,  however,  be  responsible  for  a  maiming 
of  the  brain  which  may  prevent  its  reaching  the 
normal  size  and  weight. 

In  1867,  when  Vogt  published  his  paper,  biologists 
were  engaged  in  a  lively  discussion  of  the  evolu- 
tionary theory  which  Darwin  had  promulgated  a 
few  years  before,  and  an  intemperate  zeal  led  the 
adherents  of  the  new  school  of  thought  to  conclude, 
somewhat  rashly,  that  microcephalic  idiots  repre- 
sented a  return  to  the  simian  stage  in  the  genealogy 
of  human  beings — a  view  which  Darwin  himself 
seems  to  have  accepted.  Although  it  soon  became 
apparent  that  this  explanation  was  not  particularly 
well  founded,  there  can  be  little  doubt  that  develop- 
mental errors  play  their  part  in  the  production  of 
the  small  brains  of  microcephalic  idiots,  though  to 
what  extent  those  errors  are  due  to  a  process  of 
reversion  remains  open  to  question.  In  a  case 
which  he  investigated  with  great  thoroughness, 
G.  Mingazzini^  found  what  he  regarded  as  evidence 
of  two  distinct  series  of  anomalies,  one  due  to 
arrested  growth,  the  other  to  ''true  atavistic  retro- 
gression."    Cunningham    and    Telford-Smith  ^    ex- 

Cr^i  G.  Mingazzini,  Beitrag  zum  klinisch-anatomzscken  Studimn  der 
Mikrocephalie.  Monatssch.  f.  Psychiat,  u.  Neurol.  Bd.  7,  1900,  p.  429. 
,J-  D.   J.    Cunningham  and  T.   Telford-Smith,   "The  Brain  of  the 
Microcephalic  Idiot,"  Trans,  of  the  Roy,  Dublin  Soc,  vol.  5,  1895. 


218  THE   FEEBLE-MINDED         chap. 

amined  in  much  detail  the  brains  of  two  micro- 
cephaHcs,  *'Fred"  and  ''Joe,"  and  their  report  shows 
a  distinct  leaning  towards  the  **  atavistic  "  hypothesis. 
In  regard  to  the  brain  of  ''  Fred  "  they  say  : — ''  We 
do  not  think  that  it  is  possible  to  avoid  the  con- 
clusion that  we  are  dealing  with  a  case  of  partial 
atavism  or  a  case  in  which  the  brain,  so  far  as  its 
convolutionary  condition  is  concerned,  has  reverted 
wholly  or  partially  to  a  condition  in  which  it  existed 
in  an  early  stem-form."  They  consider  that  the 
brain  of  "Joe"  also  displayed  ''simian  features." 

That  no  simple  solution  of  the  problems  of 
microcephaly  is  likely  to  be  found  becomes  in  the 
highest  degree  probable  when  the  wide  differences 
in  type  which  small  brains  may  display  is  clearly 
recognised.  A  comparison  of  several  brains  which 
have  passed  through  the  writer's  hands  will 
demonstrate  this,  and  since  there  are  still  but  few 
records  of  such  brains,  a  brief  description  of  each 
will  not  be  superfluous. 

H.  H  : — male,  aged  at  death  28  years.  (See  Figs, 
15  to  18.) 


Weight  of  right  cerebral  hemisphere 5|  ozs.' 

»       „  left  „  „  6    ozs./^^*[-i5  ozs. 

„       „  cerebellum,  pons,  and  medulla 


,..  5|ozs.|  ^^ 
,..  6  ozs./^^4l 
...     3f  ozs.  J 


These  weights  were  taken  after  stripping  and 
after  the  brain  had  been  preserved  in  ten  per  cent, 
formalin  for  several  months.  In  such  circumstances 
brains  are  said  to  gain  ten  per  cent,  in  weight,  so 
that  the  weight  in  the  fresh  state  would  be  less  than 
14  ozs.  The  convolutions  are  reduced  in  number 
rather  than  in  size,  and  there  are  considerable 
differences  between  the  two  sides.     At  the  right  side 


Fig.  1 6. — Lateral  aspect  of  the  right  hemisphere  of  a  microcephalic  brain. 


Fig.  17. — Lateral  aspect  of  the  left  hemisphere  of  a  microcephalic  br 


[Face  page  21 


Fig.  1 8. — Mesial  aspect  of  the  hemispheres  shown  in  Figs.  i6  and  ij. 


■1 

\     '" 

f  -. 

^^B 

/- 

^^^K  ■ 

J 

V 

\ 

*«^J^^^H 

^^^^^B 

r   ^ 

^^ 

J 

^^^^H 

HHJC 

j:^ 

^p 

^^^^^^^H 

^^H 

1 

Fig.  19.  —  Lateral  aspect  of  the  left  cerebral  hemisphere  of  a  microcephalic 
idiot.  The  parieto-occipital  region  is  represented  by  a  sac  of  which 
the  cavity  is  continuous  with  that  of  the  lateral  ventricle. 


[Face  page  219. 


VI   VAKIETIES  OF  FEEBLE-MINDED  219 

the  fissures  of  Sylvius  and  Rolando  are  directly 
continuous  with  each  other,  forming  a  single  furrow- 
running  from  the  dorsal  to  the  ventral  aspect,  while 
the  parallel  sulcus  is  separated  by  a  narrow  gyrus 
from  the  intra-parietal  which,  in  its  hinder  part, 
forms  the  boundary  of  an  operculum  overlapping  the 
occipital  convolutions.  At  the  left  side  the  Sylvian 
fissure  is  slightly  more  normal  in  its  arrangement, 
and,  while  the  parallel  sulcus  is  carried  far  back, 
there  is  no  definite  operculum.  In  both  hemi- 
spheres the  parieto-occipital  fissure  runs  well  out 
over  the  outer  face  of  the  hemisphere  and  joins  the 
intra-parietal. 

E.   G.  : — male  :  died  at  age  of    26  years.     (See 
Fig.  19.) 


Weight  of  right  cerebral  hemisphere  ...         ...       9|  ozs. 

„       J,  left  „  „  I2f  ozs./^'^s  [-29I0ZS. 

„       5,  cerebellum,  pons,  and  medulla     ...       7    ozs. 


}22il 


In  the  right  hemisphere  the  mid-frontal  con- 
volution only  extends  half-way  to  the  apex  of  the 
lobe  ;  the  ascending  parietal  convolution  is  divided 
about  the  middle  by  a  gap  which  contained  an 
arachnoid  cyst  one  inch  in  diameter  ;  behind  the 
post-central  sulcus  a  single  convolution  represents 
the  only  normal  portion  of  the  parietal  lobe  :  the 
parallel  sulcus  runs  up  into  the  Sylvian  fissure  ;  the 
calloso-marginal  sulcus  is  continuous  with  the  post- 
central and  from  the  junction  a  groove  runs  across 
the  ventral  aspect  of  the  hemisphere  to  the  middle 
temporal  sulcus.  At  the  left  side  the  fissure  of 
Rolando  joins  the  end  of  the  Sylvian  ;  there  are  no 
normal  convolutions  behind  the  ascending  frontal  ; 
the   calloso-marginal    ends    blindly    and    a    sulcus 


220  THE   FEEBLE-MINDED  chap. 

parallel   to   its  hinder  part  runs  across  the  ventral 
aspect  as  on  the  right  side. 

In  each  hemisphere  the  parietal  and  occipital 
regions  are  represented  by  a  sac  with  walls  about 
-|  in.  in  thickness  which  show  an  indefinite  arrange- 
ment of  grey  and  white  matter. 

This  case  exhibited  in  a  marked  degree  the 
hypertrophy  of  the  scalp  above  alluded  to,  a  series 
of  antero-posterior  ridges  and  furrows  suggesting 
the  arrangement  of  the  ranks  of  bristles  in  a 
brush. 

F.W.  : — female  :  died  at  age  of  32  years.  (See 
Fig.  20.) 

Weight  of  right  cerebral  hemisphere 6|  ozs.l      A 

»      »    left  „  „  7    ozsJ^3?li8Jozs 

„      „    cerebellum,  pons  and  medulla       ...     4^  ozs.         J 

As  will  be  seen  from  the  photograph  this  case  is 
marked  by  a  deficiency  in  the  size  rather  than  in  the 
number  of  the  convolutions,  considerable  areas  of 
the  cortex  showing  only  the  slightest  differentiation 
into  folds.  In  the  left  hemisphere  the  frontal  and 
occipital  regions  are  comparatively  normal  in 
appearance  except  for  the  small  size  of  the  convolu- 
tions, but  the  parietal  and  the  hinder  portion  of  the 
temporal  region  present  the  aspect  of  an  irregularly 
tuberculated  surface  with  some  trace  of  mis-shapen 
radiating  convolutions  in  the  upper  part.  The 
whole  motor  area,  with  the  fissure  of  Rolando,  Is 
reduced  to  a  shrivelled  sclerosed  plate,  the  central 
lobe  being  exposed.  On  the  mesial  aspect  the 
marginal  convolution  is  very  narrow,  and  the  calloso- 
marginal  fissure  terminates  opposite  the  middle  of 
the  corpus  callosum.     The  parieto-occipital  fissure, 


Fig.  20. — Left  lateral  aspect  of  the  brain  of  a  female  microcephalic  idiot. 


Fig.  21. — An  epileptic  idiot   with  well-marked  adenoma 
sebaceum. 


\_Face  page  220. 


VI    VARIETIES  OF  FEEBLE-MINDED  221 

which  extends  for  a  long  distance  over  the  outer 
surface  of  the  hemisphere,  is  separated  from  a  double 
calcarine  fissure  by  a  small  gyrus.  At  the  right 
side  normally  convoluted  regions  occur  In  the 
anterior  part  of  the  frontal  lobe,  the  posterior  part 
of  the  occipital,  and  the  middle  part  of  the  parietal, 
the  Intervening  areas,  together  with  the  middle 
temporal  convolution,  being  poorly  developed  and 
showing  the  tuberculated  appearance  already  men- 
tioned. The  central  lobe  Is  even  more  completely 
exposed  on  this  side  than  on  the  other,  owing  to 
the  small  size  of  the  various  opercula  which  ordinarily 
overlie  it.  Mesially  the  condition  is  much  like  that 
at  the  left  side,  except  that  the  doubling  of  the 
calcarine  fissure  is  less  obvious.  Comparison  of 
the  type  of  deformity  which  the  brain  exhibits  with 
that  shown  by  the  case  of  porencephaly  figured  in 
the  photographs  9  and  10  suggests  a  mode  of 
origin  common  to  both,  and  the  brain  under  notice 
did  in  fact  show  traces  of  hollowing  In  connection 
with  a  cyst  of  the  pla-arachnoid  In  the  posterior  part 
of  the  frontal  region  at  the  right  side. 

Accepting  Schwalbe's  standard  of  900  grms. 
(roughly  2  lbs.)  as  denoting  the  weight  which 
constitutes  the  upper  limit  of  microcephaly,  the 
porencephalic  brain  just  mentioned,  which  weighed 
31  ozs.,  must  be  regarded  as  an  example  of  the 
condition.  There  were  also,  In  addition  to  that  of 
H.  H.,  two  brains  below  32  ozs.  in  weight  among 
the  100  cases  referred  to  in  an  earlier  chapter  as 
series  A.  Of  these  one,  which  weighed  31^  ozs., 
presented  no  very  striking  features  beyond  opacity 
of  the  pia-arachnoid  and    excess  of  cerebro-spinal 


222  THE   FEEBLE-MINDED         chap. 

fluid,  while  the  other,  which  weighed  only  28|-  ozs., 
is  shown  in  Fig.  5.  Its  abnormality  is  expressed 
mainly  in  the  want  of  development  of  the  right 
hemisphere,  which  weighed  only  6f  ozs.,  the  weight 
of  the  left  being  1 7f  ozs. 

In  view  of  the  anatomical  differences  which  the 
brains  of  microcephalics  exhibit,  it  is  not  surprising 
that  the  mental  symptoms  show  little  indication  of 
belonging  to  a  distinctive  type.  As  with  most  of 
the  other  groups  of  the  feeble-minded,  a  high  degree 
of  abnormality  in  the  brain  connotes  a  low  degree  of 
intelligence.  All  the  cases  with  heads  measuring 
less  than  17  inches  in  circumference  have  been,  in 
the  writer's  experience,  such  as  would  be  classed  as 
idiots,  but  many  small-headed  persons  are  to  be  found 
in  the  ranks  of  the  imbeciles  and  the  weak-minded. 

The  patient  H.H.,  whose  skull  was  found  at  the 
post-mortem  examination  to  have  a  maximum  cir- 
cumference of  I5|-  inches,  was  of  faulty  habits 
and  of  destructive  disposition.  He  made  attempts 
at  speech  but  never  said  anything  intelligible.  He 
learnt  to  feed  and  dress  himself  after  a  fashion  and 
on  occasion  would  do  a  little  work,  e.g.^  dusting 
or  polishing  in  his  ward. 

E.  G.  was  also  faulty  In  habits  and  even  more 
incapable  of  looking  after  himself  than  H.  H.  Thus 
he  had  to  be  fed  since,  even  when  supplied  with  a 
spoon  and  a  basin  of  food,  he  did  not  seem  to  know 
what  to  do  with  them.  Yet  he  would  ask  for  food, 
saying,  e,g.,  ''Teddy  like  milk"  and  would  call 
attention  to  the  fact  that  he  had  wet  himself.  He 
obviously  had  some  notion  of  his  own  personality 
since   he    would  come    when  called.      It    Is    worth 


VI   VAUIETIES  OF  FEEBLE-MINDED  223 

noting  that,  notwithstanding  the  condition  of  his 
occipital  lobes,  he  was  apparently  not  blind  though 
his  sight  was  doubtless  very  defective.  He  could 
find  his  way  about  the  ward  and  airing-court, 
avoiding  obstacles,  and  seemed  to  recognise  those 
who  had  charge  of  him.  It  Is  recorded  of  him  that 
he  liked  to  stand  facing  the  sun,  which  suggests  that 
he  could  perceive  light  but  that  his  retinae  were  not 
very  sensitive. 

The  female  patient  F.  W.  could  make  Inarticulate 
noises  but  was  unable  to  talk.  Owing,  In  part  at 
any  rate,  to  deformity  of  the  feet,  she  was  unable  to 
walk  and  she  had  to  be  dressed  and  undressed  and 
fed,  while  she  never  acquired  even  the  rudiments  of 
the  art  of  attending  to  her  personal  cleanliness. 

In  two  cases  of  microcephaly  brought  before 
the  Royal  Society  of  Medicine,  Carpenter^  found 
changes  in  the  fundus  oculi  which,  though  not 
specially  characteristic  of  the  condition,  are  worthy 
of  notice.  A  female  child  aged  2^  years,  with  a  head 
1 5  inches  in  circumference,  showed  In  the  central 
region  of  the  left  retina  a  large  patch  of  choroidal 
atrophy  believed  to  be  due  either  to  a  coloboma 
or  to  syphilitic  choroiditis ;  while  another  female 
child  of  five  months,  whose  head  measured  14 
Inches,  showed  a  dense  ring  of  black  pigment  round 
the  right  optic  disc. 

MACROCEPHALIC   TYPE 

Just  as  there  are  to  be  found  among  the  feeble- 
minded a  certain  number   whose   heads  are  unduly 

^^  G.  Carpenter,  "Two  Cases  of  Microcephaly:  Changes  in  the  Fundus 
OcuH,"  Froc.  Roy.  Soc.  of  Medicine.,  Nov.  1908. 


224  THE   FEEBLE-MINDED         chap. 

small,  so  it  is  possible  to  pick  out  others  with  heads 
exceeding,  sometimes  by  a  relatively  large  amount, 
the  normal  dimensions.  The  group  of  large-headed 
or,  as  they  are  often  called,  Macrocephalic  cases  is  a 
distinctly  artificial  one,  since  no  standard  of  maxi- 
mum size  for  normal  heads  has  been  agreed  upon. 
Moreover,  whereas  a  small  skull  is  clearly  incom- 
patible with  a  large  brain,  the  converse  of  this  state- 
ment is  not  necessarily  true,  for  a  large  skull  affords 
no  evidence  whatever  of  an  accumulation  of  nervous 
tissue.  As  to  the  size  which  heads  may  attain,  it  is 
very  rare  for  a  circumference  of  30  inches  to  be 
exceeded,  though  Seguin  speaks  of  a  girl,  aged 
seventeen  years,  whose  head  measured  thirty-seven 
inches  and  Millard^  has  recorded  a  case  in  which  the 
circumference  was  ninety  cm.,  and  the  distance  from 
ear  to  ear  over  the  vertex,  75  cm. 

The  feeble-minded,  probably  even  more  than  the 
mentally  sound,  are  liable  to  the  diseases  of  skeletal 
structures  known  as  rickets,  acromegaly,  leontiasis 
ossia,  achondroplasia,  osteitis  deformans,  and  syphi- 
litic osteitis  ;  and  still  more  frequently  do  they 
show  enlargement  of  the  skull  due  to  its  expansion 
under  the  pressure  of  contained  fluid,  as  occurs  in 
hydrocephalus.  When  all  these  conditions  can  be 
excluded,  the  presumption  is  that  the  large  head 
contains  a  large  brain,  but  even  so  the  probabilities 
are  all  in  favour  of  the  view  that  only  a  small  propor- 
tion of  the  encephalic  mass  is  of  functional  value 
from  the  psychological  standpoint. 

A  subdivision  of  the  class  of  macrocephalics  on 

U'l  K.  Millard,  "  An  Extraordinary  Case  of  Hydrocephalus,"  Jour7i.  of 
America7i  Med,  Associatio?t^Yo\.  51,  No.  2,  p.  128. 


VI    VARIETIES  OF  FEEBLE-MINDED  225 

the  anatomical  lines  just  laid  down  will  supply  the 
most  convenient  arrangement  of  the  cases.  As  in 
the  case  of  microcephalics,  it  Is  not  feasible  to  estab- 
lish a  classification  on  a  purely  psychological  basis, 
but  such  distinctions  as  can  be  drawn  in  regard  to 
the  mental  state  will  be  duly  noted.  To  each  group 
the  test  of  social  capacity  can  be  applied  as  with  the 
other  types,  and  groups  of  idiots,  imbeciles,  and  the 
weak-minded  established. 

(i)  Cases  in  which  the  large  size  of  the  head  is 
referable  to  disease  of  the  bone.  The  attendant  mental 
defect  is  in  these  cases  apparently  a  mere  accident. 
Large  and  badly  shaped  heads  are  quite  consistent 
with  soundness  of  mind,  but  they  occur  among  the 
feeble-minded  with  a  relatively  greater  frequency 
than  among  ordinary  individuals.  Rickets  seems  to 
be  the  most  prolific  source  of  the  abnormality.  It 
results  in  the  production  of  a  skull  irregularly  thickened 
and  perhaps  asymmetrical,  with  bosses  on  the 
frontal  and  parietal  bones.  The  cranial  vault  is 
flattened  and  the  forehead  bulgy,  while  the  fontanelles 
may  not  be  completely  closed. 

(2)  Cases  In  which  there  is  an  excess  of  fluid 
within  the  cranial  cavity.  These  are  examples  of 
the  condition  known  as  hydrocephalus.  Not  all 
hydrocephalics  are  large-headed,  and  therefore  a 
certain  number  of  cases  in  which  hydrocephalus  is 
associated  with  feeble-mindedness  must,  owing  to 
the  lack  of  distinctive  clinical  features,  be  relegated 
to  the  residuary  group  ;  but  when  the,  as  yet,  not 
fully  known  conditions  which  give  rise  to  accumula- 
tion of  cerebro-splnal  fluid  act  in  early  life,  there 
takes  place  an  expansion  of  the  skull,  affecting  more 

Q 


226  THE   FEEBLE-MINDED         chap. 

particularly  the  thinner  and  less  firmly  united  bones 
of  the  vault,  which  in  a  well-marked  case  results  in 
the  production  of  a  sub-globular  cranium  of  char- 
acteristic shape.  How  rapidly  the  enlargement  may 
take  place  is  illustrated  by  a  case  recorded  by  E. 
Schneider,^  in  which  the  measurement  of  a  child's 
head  increased  from  44  cm.  to  71  cm.  in  less  than 
4  months. 

Although  there  is  no  simple  ratio  between  the 
dimensions  of  the  skull  and  the  degree  of  mental 
defect,  the  higher  measurements  are  associated  with 
considerable  impairment  on  both  the  sensory  and 
the  motor  sides.  Apparently  as  the  result  of  the 
stretching  of  the  optic  and  auditory  nerves,  sight 
and  hearing  may  be  greatly  interfered  with.  There 
is  general  muscular  weakness,  and  this,  taken  in 
conjunction  with  the  weight  of  the  contained  fluid, 
causes  the  patient  to  seek  support  for  the  head  either 
on  a  pillow  or  on  the  back  or  arm  of  his  chair.  In 
the  bed-ridden  cases,  partly  from  a  disturbance  of 
the  cerebral  functions  and  partly  from  want  of 
exercise,  atrophy  of  the  muscles  and  contracture 
occur,  though  movement  may  be  induced  from  time 
to  time  through  the  onset  of  epileptic  seizures.  It 
is  perhaps  the  being,  so  to  speak,  tied  down  by  the 
head  which  makes  hydrocephalics  lethargic  and 
docile,  at  any  rate  they  rarely  indulge  in  the  rest- 
lessness and  ill-temper  which  some  of  the  feeble- 
minded display. 

About  the  pathology   of  hydrocephalus  there   is 

^  E.  Schneider,  Ein  Fall  von  aussergewohnlicher  Grosse  eines 
kindlichen  Wasserkopfes ;  v.  Jahresbericht  liber  die  Lelstungen  und 
Fortschrltte  auf  dem  Geblete  der  Neurologle  und  Psychlatrle^  1909, 
p.  505. 


VI   VARIETIES  OF  FEEBLE-MINDED  227 

little  to  be  said,  except  by  way  of  surmise.  The 
accumulation  of  fluid  usually  takes  place  in  the  lateral 
ventricles  of  the  cerebrum,  causing  a  dilatation  which 
flattens  out  the  convolutions  against  the  inner  aspect 
of  the  skull  and  reduces  the  wall  of  the  hemisphere 
to  the  thickness  of  a  few  millimetres.  There  is 
evidence  of  increased  intra-cranial  pressure  so  that 
some  more  potent  force  than  that  of  simple  transud- 
ation from  blood-vessels  is  called  into  play,  but  it  is 
not  clear  whether  the  choroid  plexuses  actively 
secrete  the  cerebro-spinal  fluid  against  an  increasing 
resistance,  or  whether  the  conditions  are  such,  owing 
for  instance  to  the  presence  in  the  ventricles  of  some 
soluble  substance,  that  an  abnormal  osmotic  flow 
from  the  blood-vessels  is  determined.  When,  as  in 
cases  of  cerebellar  tumour,  there  is  obstruction  of 
the  veins  of  Galen,  the  state  of  affairs  sufficiently 
resembles  that  found  in  some  forms  of  ascites  to 
render  the  pouring  out  of  fluid  from  the  congested 
choroid  plexus  intelligible,  but  this  explanation  is 
only  rarely  available.  An  inflammatory  process  set 
up,  for  instance,  by  the  meningo-coccus  or  the  tubercle 
bacillus  can,  it  would  seem,  be  held  responsible  in 
other  cases.  There  remains,  however,  a  large  pro- 
portion of  cases  to  account  for  which  no  adequate 
hypothesis  has  so  far  been  advanced,  for  the  proposal 
to  lay  the  onus  on  congenital  syphilis  can  hardly  be 
accepted  in  view  of  the  fact  that  in  three  (and  those 
the  best  marked)  of  four  cases  of  chronic  hydro- 
cephalus Knoepfelmacher  and  Lehndorff^  obtained 

ij  1  W.  Knoepfelmacher  und  H.  Lehndorff,  Hydrocephalus  chronicus 
internus  coftgenitus  und  Lues;  v.  Jahresbericht  Uber  die  Leistimgen^ 
&-C.,  1909,  p.  504. 

Q  2 


228  THE   FEEBLE-MINDED         chap. 

a  negative  reaction  when  employing  the  method  of 
Wassermann,  while  Dean^  obtained  a  positive 
reaction  in  only  four  out  of  fourteen  cases. 

(3)  Cases  in  which  there  is  enlargement  of  the 
brain  (megalencephaly).  Several  workers  among 
the  feeble-minded  have  attempted  to  differentiate 
from  the  rest  of  the  large-headed  cases  a  section 
presenting  certain  characteristic  symptoms,  to  wit, 
general  muscular  weakness,  headache  and  epileptic 
seizures.  Whatever  justification  there  may  be  for 
erecting  a  special  clinical  category,  there  is  no  doubt 
that  at  autopsies  brains  are  sometimes  found  which 
considerably  exceed  the  average  in  weight  and 
which,  since  they  have  belonged  to  mentally  defective 
persons,  are  presumably  defective  in  some  way.  A 
definite  overgrowth  of  neuroglia,  in  some  instances 
accompanied  by  sclerosis,  has  been  observed  in  con- 
nection with  brains  of  this  class,  while  in  other  cases, 
as,  for  example,  in  one  recorded  by  v.  Hansemann^ 
where  the  brain  weighed  i860  grams,  no  histological 
abnormality  was  discovered.  Ashby  and  Wright  ^ 
speak  of  having  found  a  cerebral  hypertrophy  of  the 
kind  mentioned  in  association  with  rickets,  and  so 
lend  some  colour  to  the  popular  conception  of 
rickets  as  a  cause  of  feeble-mindedness  ;  but  the 
matter  must,  at  present,  be  regarded  as  undecided. 

V-^  1  H.  R.  Dean,  "  An  Examination  of  the  Blood  Serum  of  Idiots  by 
the  Wassermann  Reaction,"  Lancet^  July  23,  1910,  p.  227. 

*'  2  D.  V.  Hansemann,    Uber  echte  Megalencephalie :   Berline)'  klin 
Wochenschr.  1908,  No.  i,  p.  7. 

^  H.  Ashby  and  G.  A.  Wright,  The  Diseases  of  Children,  1905,  p. 
21Q. 


VI    VARIETIES  OF  FEEBLE-MINDED  229 

CRETINISM. 

One  of  the  most  striking  features  of  feeble- 
mindedness, when  considered  from  the  historical 
standpoint,  is  the  way  in  which  Cretinism  has  gradu- 
ally ceased  to  occupy  its  originally  prominent 
position.  On  the  Continent  of  Europe,  to  which  the 
available  literature  chiefly  relates,  the  distinctive 
peculiarities  of  cretins,  and  in  some  regions  the  large 
proportion  of  them  among  the  inhabitants,  caused 
cretinism  to  be  regarded  as  constituting,  to  the 
exclusion  of  less  conspicuous  abnormalities,  an 
essential  characteristic  of  the  more  severe  grades  of 
mental  defect. 

Practically  all  the  earliest  institutions,  e.g.,  that 
founded  by  Guggenmoos  at  Salzburg  in  1828  ;  that 
of  Haldenwang  at  Wildberg  in  1835  ;  and  the  still 
more  famous  one  established  by  Guggenbtihl  on  the 
Abendberg  in  1841,  were  designed  for  cretins,  with 
whom,  no  doubt,  were  included  the  ''  Mongolians " 
of  that  day.  Griesinger's  dictum  that  while  every 
cretin  is  an  idiot,  every  idiot  is  not  a  cretin,  has  now 
quite  lost  its  application,  for  in  this  country,  at  any 
rate,  the  cretin  is  becoming  a  clinical  curiosity, 
though  there  is  no  lack  of  idiots.  Among  the  500 
feeble-minded  children  under  16  years  of  age,  to 
whom  reference  has  frequently  been  made,  only 
three  presented  signs  of  cretinism,  while  of  600 
females  over  16,  only  one  was  an  example  of  the 
condition.  The  introduction  of  the  treatment  by 
means  of  thyroid  gland  preparations  has  revolu- 
tionised the  position,  and,  since  every  private 
practitioner   is    only   too   glad    to   gain    the    kudos 


230  THE   FEEBLE-MINDED         chap. 

associated  with  the  transformation  of  a  youthful 
monstrosity  into  the  fairer  semblance  of  a  normal 
child,  the  admission  of  a  cretin  into  an  institution  for 
idiots  is  comparatively  rare/ 

Just  as  in  the  case  of  Mongolian  idiocy,  well- 
marked  cretinism  involves  so  many  departures  from 
the  normal,  that  minor  racial  characteristics  are 
obliterated  and  a  certain  uniformity  of  type,  which 
has  caused  it  to  be  said  that  "to  see  one  is  to  see 
all,"  is  created.  This  compendious  statement  must 
not,  however,  be  accepted  too  confidently.  In  a 
typical  case  there  are  bodily  and  mental  symptoms 
of  a  pronounced  character.  The  stature  is  short  and 
there  may  be  deformity  of  the  limb  bones,  which, 
taken  in  conjunction  with  the  clumsy  hands  and 
feet,  interferes  with  walking,  or  the  pursuit  of  any 
manual  employment.  The  skin  is  rough  and 
thickened,  with  few  and  coarse  hairs,  and  is  cold  and 
clammy  to  the  touch  ;  over  the  face  its  redundancy 
causes  the  obliteration  of  the  ordinary  folds  and 
wrinkles,  and  lends  a  stolid  aspect  to  the  expression  ; 
the  upper  eyelids  are  thickened,  the  lower  baggy ; 
an  enormous  tongue  protrudes  between  the  swollen 
lips,  which  cover  carious  and  irregular  teeth  ;  large 
collections  of  fat  fill  in  the  supra-clavicular  fossae,  and 

1  In  some  parts  of  Europe,  however,  cretinism  is,  even  at  the  present 
day,  a  social  factor  of  the  first  importance.  Thus,  speaking  of  the 
cretins  in  the  Valley  of  Aosta,  F.  Ferrero  says  "many  roam  freely 
in  the  villages  and  importune  strangers,  begging  with  the  most  obdurate 
insistence  and  forcing  into  evidence  their  horrid  bodies  "  :  and  again 
"  the  cretin  still  wanders  aimlessly  about  emitting  uncanny  sounds  from 
his  distorted  mouth,  a  clouded  intelligence  in  a  useless  body — a 
horrible  example  of  the  miseries  that  flourish  by  the  side  of  the  divine 
glory  of  the  great  mountains." 

The  Valley  of  Aosia^  1910,  pp.  49  and  51. 


VI   VARIETIES  OF  FEEBLE-MINDED  231 

the  pendent  abdomen  frequently  shows  a  hernial 
bulging  in  the  umbilical  region  :  there  may  or  may 
not  be  enlargement  of  the  thyroid  gland.  In  some 
cases  the  incidence  of  the  disease  seems  to  be  chiefly 
upon  the  nervous  system,  a  condition  resembling 
that  in  cerebral  diplegia  resulting.  Many  of  the 
cases  are  deaf  and  dumb,  the  deafness  being 
apparently  due,  in  some  measure,  to  myxomatous 
thickening  of  the  mucous  membrane  of  the  middle 
ear ;  and  cutaneous  sensibility  is  so  much  diminished 
that  there  is  indifference  to  what  would,  ordinarily, 
be  painful  impressions. 

Mentally  there  is  marked  apathy  with  sluggish 
reaction  to  stimuli.  Cretins  are  generally  timorous, 
shy,  and  retiring,  but  they  resent  interference  and 
are  liable  to  outbreaks  of  anger  if  not  let  alone.  Their 
appetites,  so  far  as  these  exist  at  all,  are  depraved, 
leading  them  to  filth-eating  and  other  offences  against 
good  manners,  and  the  more  active  of  them  are 
prone  to  vagabondage  and  deeds  of  wanton  mischief. 

Considering  the  extent  of  the  literature  relating  to 
cretinism,  it  is  remarkable  how  little  information  of 
scientific  value  is  available  in  regard  to  the  condition. 
The  following  brief  exposition,  however,  appears  to 
summarise  the  present  state  of  our  knowledge  of  the 
subject. 

For  the  maintenance  of  life  there  is  necessary  the 
harmonious  co-operation  of  various  systems  of  organs 
which  are  concerned  with  the  acquisition,  the  absorp- 
tion, and  the  assimilation  of  food  materials,  and  the 
elimination  of  waste  matter.  The  necessary  control 
is  exercised  by  the  nervous  system  and  might,  con- 
ceivably,  have  its  origin    in   some  psychic  agency 


232  THE  FEEBLE-MINDED  chap. 

capable  of  effecting  the  desired  co-ordination.  But 
it  is,  in  fact,  so  largely  unconscious  that  a  physical 
source  for  the  provision  of  adequate  determinants 
must  be  sought.  Of  such  sources  there  appear  to  be 
several,  though  only  one,  the  thyroid  gland,  is  of 
immediate  interest.  An  interference  with  the 
functions  of  the  thyroid — expressing  itself  in 
deficiency  of  the  thyroid  secretion — gives  rise  to  a 
series  of  pathological  changes  in  the  body  generally, 
which  vary  with  the  age  and  with  other  less  easily 
ascertained  circumstances,  but  which  mainly  follow 
two  directions,  one  being  the  accumulation  of  a 
mucoid  substance  and  the  other  the  disablement  of 
nervous  tissue.  If  the  deficiency  occurs  in  early  life 
the  processes  of  growth  are  seriously  disorganised 
and  cretinism  results.  It  appears  from  the  observa- 
tions of  Captain  McCarrison^  that  in  the  Chitral 
and  Gilgit  Valleys  of  the  Himalayas  two  types  of 
cretinism,  the  ''  myxcedematous  "  and  ''  the  nervous," 
characterised  by  a  predominance  of  one  or  the  other 
group  of  symptoms,  are  clearly  recognisable. 

This  comparatively  simple  proposition  is,  however, 
complicated  by  sundry  factors  which  call  for  notice. 
In  the  first  place,  a  deficiency  of  thyroid  secretion 
may  be  associated  with  an  apparent  hypertrophy  of 
the  thyroid  gland,  and  it  is  a  familiar  fact  that 
cretinous  individuals  frequently  exhibit  a  goitrous 
swelling  of  the  neck.  Thus  among  McCarrison's 
203  cases  of  cretinism  there  were  88  in  which  a 
goitre  was  present. 

Ireland,   expressing  the  view  which   is  generally 

V  1  R.  McCarrison,  "Observations  on  Endemic  Cretinism  in  the 
Chitral  and  Gilgit  Valleys,"  Proc.  Rov.  Soc.  of  Med.,  Nov.  1908, 


VI   VARIETIES  OF  FEEBLE-MINDED  283 

held  and  which  on  the  face  of  it  seems  most 
plausible,  speaks  of  the  goitre  as  ''  being  the  begin- 
ning of  the  disease,"  but  it  appears  from  McCar- 
rison's  studies  that  the  thyroid  enlargement  is  not 
the  cause  of  cretinism,  since  its  occurrence  is  sub- 
sequent, and  not  prior,  to  the  development  of  cretinic 
symptoms.  Cretinism  and  goitre  seem  to  have  a 
common  origin,  which  is,  according  to  McCarrison, 
''defective  thyroid  function  in  the  mother."  He 
found  that  in  86  per  cent,  of  his  cases  the  mother 
was  certainly  goitrous  and  that  in  only  4  per  cent, 
could  goitre  be  definitely  excluded,  and  he  suggests 
that  it  is  the  consequent  toxicity  of  the  mother's 
blood  which,  by  its  action  on  the  developing  thyroid 
of  the  unborn  child,  determines  cretinism.  The 
hereditary  element  in  the  disease,  which  may  perhaps 
follow  Mendelian  lines  in  transmission,  is  thus 
accounted  for,  but  there  is  such  overwhelming 
evidence  that  cretinism  is  to  some  extent  dependent 
on  topical  conditions  that  its  etiology  cannot  be  said 
to  be  fully  elucidated  until  an  explanation  of  the 
influence  of  those  conditions  is  forthcoming.  So  far 
we  have  failed  to  discover  the  mysterious  agency 
which  converts  some  regions  of  the  earth's  surface 
into  hot-beds  of  the  disease,  and  we  can  only  picture 
it  as  a  **  miasm"  which,  as  E.  and  H.  Bircher  claim 
to  have  shown,  follows  in  its  distribution  certain 
sedimentary  rocks  (being  apparently  a  decompos- 
ition product  of  organic  matter),  and  is  introduced 
into  the  body  by  means  of  drinking  water.  Professor 
Wilms  ^  of  Basle  has  brought  forward  evidence  in 

'"^  M.  Wilms,  Expermientelle  Erzeugung  und  Ursache  des  Kropfesj 
Deutsche  Medizinische  Wochenschrift^  Mar.  31,  19 10. 


234  THE   FEEBLE-MINDED         chap. 

support  of  the  view  that  the  "  miasm  "  is  in  reality 
a  soluble  toxin  or  ferment  which  cannot  be  filtered 
out,  but  which  can  be  rendered  innocuous  by  heating 
the  water. 

The  fact  that  cases  of  cretinism  occasionally 
appear  in  places  far  removed  from  the  districts 
where  the  disease  is  rife  has  led  to  a  distinction 
between  "endemic"  and  "sporadic"  forms  which, 
while  generally  insisted  upon  by  authors,  appears  to 
have  little  practical  value,  since  clinically  the  two 
conditions  are  similar.  The  suggestion  that  the 
former  type  is  distinguished  by  the  presence,  the 
latter  by  the  absence,  of  a  goitre,  seems  to  be  quite 
unsubstantiated.  Tanzi  ^  says  of  sporadic  cretinism, 
*'  It  is  not  even  a  family  disease  :  the  subject  of 
sporadic  cretinism  always  represents  a  solitary  case 
of  the  disease  in  his  family,  and  commonly  has 
brothers  and  sisters  who  are  perfectly  normal." 
But  this  diagnostic  character  appears  to  be  as 
untrustworthy  as  the  one  already  mentioned,  for 
Stevens  ^  has  recorded  four  cases  of  sporadic 
cretinism,  all  with  enlarged  thyroids,  occurring  in  a 
family  which  did  not  live  and  had  not  lived  in  a 
district  where  cretinism  is  endemic. 

It  has  been  customary  in  the  past  to  distinguish 
three  grades  of  mental  defect  associated  with 
cretinism  and  to  describe  these  as  the  "cretin,"  the 
"semi-cretin,"  and  the  "cretinoid,"  according  to  the 
severity  of  the  symptoms.     Weygandt,^  in  a  recent 

1  E.  Tanzi,  A   Text-book  of  Mental  Diseases^   trans,  by  W.  Ford 
Robertson  and  T.  C.  Mackenzie,  1909,  p.  377. 

^  ^  V>.C  Stevens,  "  Four  Cases  of  Sporadic  Cretinism  in  One  Family," 
Lancet^  June  18,  19 10,  p.  1684. 

3  W.  Weygandt  :  v.  Art.  "Kretinismus,"  in  Enzyklopddisches  Hand- 
buck  der  Heilpddagogik.^  I909« 


VI   VARIETIES  OF  FEEBLE-MINDED  235 

contribution  to  the  literature  of  the  subject,  adversely 
criticises  this  arrangement.  In  harmony  with  the 
classification  adopted  in  this  work,  it  will  be  more 
convenient  to  subdivide  the  cases  into  three  groups, 
to  which  the  terms  "  idiotic,"  "  imbecilic,"  and 
''weak-minded"  may,  respectively,  be  applied. 

In  practice  it  is  often  difficult  to  distinguish  with 
certainty  between  the  Mongolian  and  the  cretinous 
type  of  the  feeble-minded,  and  no  test  other  than 
the  administration  of  preparations  of  the  thyroid 
gland  is  of  much  value  for  the  purpose  of  differential 
diagnosis.  Sometimes  a  partial  recovery,  which 
serves  to  bring  into  relief  the  previously  obscured 
Mongolian  elements  of  the  picture,  renders  it 
probable  that  we  have  to  do  with  a  combination  of 
the  two  disease  processes.  At  other  times,  especially 
when  the  exhibition  of  the  remedy  has  not  been 
undertaken  sufficiently  early,  obvious  signs  of 
cretinism  remain  in  spite  of  treatment,  being 
apparently  too  firmly  fixed  to  be  eradicated. 
Whether,  as  has  been  suggested,  there  is  a 
distinct  disease  having  some  features  common  to  both 
Mongolism  and  cretinism,  is  a  question  calling  for 
further  elucidation. 


EPILOIAC    TYPE. 

In  the  scheme  of  classification,  based  on 
considerations  of  morbid  anatomy,  adopted  by 
Bourneville,  a  place  is  assigned  to  cases  ex- 
hibiting after  death  the  condition  which  he  has 
called  '*  sclerose  hypertrophique,"  and  which  is 
widely  known  to  English  speaking  pathologists  as 


236  THE  FEEBLE-MINDED         chap. 

'*  tuberose  "  or  "  hypertrophic  "  sclerosis.  Bourne- 
ville's  first  case,  which  was  pubHshed  in  the 
Archives  de  Neurologie  for  1880,  showed,  at  the 
autopsy,  striking  changes  in  the  brain  and  kidneys. 
In  the  former  organ,  there  were,  to  quote  his 
own  words,  ''  lesions  consistant  en  Hots  arrondis 
formant  saillie,  de  volume  variable,  dune  coloration 
blanchatre,  opaque,  d'une  densite  bien  superieure 
aux  parties  avoisinantes  et  faisant  partie  des  circon- 
volutions.  II  s'agit,  en  un  mot,  d'une  sorte  de 
sclerose  hypertrophique  de  portions  plus  ou  moins 
grandes  des  circonvolutions."  The  kidneys,  he  says, 
presented  "  masses  blanchatres,  mamelonnees,  dures, 
formant  une  saillie  de  3  a  5  millimetres.  "  Shortly 
afterwards  Bourneville  described,  in  conjunction  with 
E.  Brissard,  a  further  case  in  which  similar  appear- 
ances had  been  observed.  Both  cases  were  subject 
during  life  to  epileptiform  convulsions. 

This  combination  of  pathological  characters  was 
met  with  at  intervals  in  the  practice  of  the  Bicetre 
Hospital  and  accounts  of  the  cases  were  given  by 
Bourneville  in  his  annual  reports.  A  summary  of 
them  appears  in  the  ''  Compte-rendu  du  Service  de 
Bicetre"  for  1898,  where  allusion  is  made  to  ten 
cases  observed  up  to  that  time.  In  the  same  year, 
Sailer  directed  attention  to  an  instance  of  what  he 
called  "  hypertrophic  nodular  gliosis  "  occurring  in  a 
boy  who  died  of  exhaustion  from  epilepsy  at  the 
age  of  fifteen  years.  There  were  indurated  areas  in 
the  cerebral  cortex  and  nodules  projecting  into  the 
lateral  ventricles  from  the  basal  ganglia  ;  the  right 
kidney  ''contained  a  huge  tumour-like  mass"  and 
there  were   smaller  growths    in    the   left.     Sailer's 


VI   VARIETIES  OF  FEEBLE-MINDED  237 

article  makes  allusion  to  thirty  other  cases,  including 
five  from  Bourneville's  clinic,  but  the  descriptions 
given  are  not  always  complete  enough  to  make 
the  exact  nature  of  the  cases  clear.  The  more 
recent  literature,  in  English,  contains  reports  by 
A.  W.  Campbell,^  M.  B.  Dobson,^and  Messrs.  Fowler 
and  Dickson,^  while  Ch.  de  Montet  ^  has  described  a 
French  case,  and  R.  Bonfigli,^  has  added  particulars 
of  two  Italian  ones.  In  a  lengthy  paper  published 
in  1908,  H.  Vogt^  reviews  thirty  cases,  including 
three  of  his  own. 

Campbell's  paper  contains  a  detailed  account  of  the 
minute  anatomy  of  the  condition.  He  found  in  the 
affected  regions  of  the  brain  a  neuroglial  proliferation 
ranging  from  a  diminution  of  nerve  cells  and  fibres 
with  substitution  of  glia  cells  of  peculiar  character 
to  the  formation,  at  the  centres  of  the  indurated  areas, 
of  "a.  matrix  composed  of  a  dense  network  of  indefinite 
structure,  a  tissue  showing  neither  nuclei  nor  distinct 
fibres."  Sub-ependymal  growths  of  the  lateral  ven- 
tricles were  composed  of  a  "  coarse  fibrous  tissue  " 
and  contained  "an  abundance  of  corpora  arenacea." 
In  connection  with  the  cortical  sclerosis  he  observed 
"giant"    or    "ganglion"   nerve    cells    and    curious 

A'^  A.  W.  Campbell,  "Cerebral  Sclerosis,"  Brain^  Feb.  1906. 
*^2  M.    B.    Dobson,    "  A   Case  of  Epileptic   Idiocy  associated  with 
Tuberose  Sclerosis  of  the  Brain,"  Lancet^  Dec.  8,  1906. 
^3  J.  s.  Fowler  and  W.  E.  C.  Dickson,  "Tuberose  Sclerosis,"  Proc* 
Edi7i.  Med.-Chir.  Soc.  v.  La?tcet,  May  14,  19 10,  p.  1351. 
Q,'^  Ch.  de  Montet,  Reciter ches  sur  la  sclerose  tubereuse.  DEjicephale  3 
Anne'e,  No.  2,  p.  97. 

i^  ^  R.  Bonfigli,  Uber  tuberose  Sklerosej  Monatssch.  f.  Psychiat.  und 
Neurol.  Bd.  27,  19 10,  p.  395. 

.  6  H.  Vogt,  "Zur  Pathologic  und  pathologischen  Anatomic  der 
¥erschicdenen  Idiotieformen,"  Monatssch.  f.  Psych,  u.  Neur.  Bd.  24, 
1908,  p.  106. 


238  THE  FEEBLE-MINDED         chap. 

structures  resembling  tubular  glands.  Somewhat 
similar  appearances  are  described  by  de  Montet  and 
the  observations  are  supported  by  a  study  of  the 
writer  s  own  preparations,  though  as  these  were  made 
from  material  which  reached  him  in  a  badly  pre- 
served state,  they  do  not  afford  very  conclusive 
evidence.  In  a  case  described  by  Geitlin  and  quoted 
by  Vogt,  two  of  the  tuberose  masses  in  the  occipital 
region  contained  small  cysts,  there  was  a  condition 
of  heterotopia,  and  the  ventricular  tumours  contained 
embedded  in  them  bodies  described  as  ''  corpora 
amylacea "  which  apparently  correspond  to  the 
"  corpora  arenacea "  of  Campbell.  Geitlin  noted 
also  the  presence  of  rounded  concentrically  arranged 
structures  which  he  regarded  as  derived  from  blood- 
vessels and  which  perhaps  have  affinities  with  the 
"  tubular  glands  "  mentioned  by  Campbell.  Vogt 
finds  reason  for  thinking  that  the  giant  cells  are  of 
two  kinds,  some  being  related  to  ganglion  cells  and 
others  to  neuroglia  elements. 

The  tumours  in  the  kidneys  are  said  by  Geitlin 
to  be  allied  to  those  which  appear  in  the  lateral 
ventricles  ;  other  writers  detect  in  them  a  resem- 
blance to  adrenal  gland  tissue.  They  show, 
sometimes,  a  tendency  to  malignancy  and  may  be 
the  immediate  cause  of  death.  Occasionally  there 
have  been  observed  tumours  in  the  heart  muscle, 
usually  at  the  right  side  and  of  the  nature  of  a 
rhabdomyoma.-^  That  such  neoplasms  are  not 
described  more  frequently  is  attributed  by  Vogt  to 

Kj  1  A.  J.  Abricossoff,  "  Ein  Fall  von  multiplem  Rhabdomyom  des 
Herzens  und  gleichzeitiger  herdformiger  kongenitaler  Sklerose  des 
Gehirns,"  Bez'tr.  zur pathol.  A7iat.^  Bd.  45,  H.  3,  p.  376, 


VI   VARIETIES  OF  FEEBLE-MINDED  239 

the  fact  that  they  would  be  Hkely  to  cause  early 
death  so  that  the  subjects  of  them  would  never  come 
under  the  notice  of  alienists.  Still  more  rarely  new 
growths  have  been  noted  in  the  liver,  the  spleen, 
the  thyroid,  the  thymus,  the  duodenum,  or  the 
skin. 

As  to  the  general  pathology  of  the  condition, 
Campbell's  hypothesis  is  that  the  morbid  processes 
giving  rise  to  it  originate  in  the  vascular  system  of 
the  affected  parts.  Vogt,  however,  makes  out  a 
case  for  regarding  the  widespread  incidence  of  the 
disease  as  resulting  from  errors  of  development,  a 
view  taken  also  by  Geitlin  and  de  Montet. 

It  will  be  seen  that  there  is  nothing  in  the  above 
descriptions  to  justify  the  separation  of  tuberose 
sclerosis  as  a  clinical  entity.  Bourneville  seems  to 
have  observed  during  the  lifetime  of  his  cases  noth- 
ing which  he  regarded  as  pathognomonic.  Writing 
in  the  Twentieth  Century  Practice,  P.  Sollier  says 
that  "  while  atrophic  sclerosis  may  be  diagnosed  in 
a  certain  number  of  cases,  the  recognition  of  the 
hypertrophic  form  is  absolutely  impossible,  in  my 
opinion  at  least,  not  only  because  it  has  no  charac- 
teristic symptom,  but  also  because  being  such  a  rare 
condition  we  are  seldom  led  to  think  of  it  at  all." 

Of  late  years,  however,  there  has  accumulated  a 
considerable  amount  of  evidence  in  favour  of  the 
view  that  some  at  any  rate  of  the  cases  of  tuberose 
sclerosis  may  be  diagnosed  during  life,  owing  to  the 
co-existence  with  the  cerebral  and  renal  conditions 
of  the  peculiar  skin  affection  known  as  adenoma 
sebaceum.  For  a  complete  description  of  the  state 
of  the  skin  in  adenoma  sebaceum  one  of  the  larger 


240  THE   FEEBLE-MINDED         chap. 

text-books  of  dermatology  may  be  consulted  ;  it  will 
suffice  here  to  give  briefly  the  principal  features. 
Over  all  parts  of  the  body  the  skin  may  be  found 
to  exhibit  small  nodules  or  thickenings  apparently  of 
a  fibrous  character.  On  the  face  the  nodules  are 
generally,  as  shown  in  the  accompanying  figure, 
arranged  fairly  symmetrically  across  the  nose  and 
cheeks  giving  rise  to  one  of  the  forms  of  "  butter- 
fly rash "  and,  owing  to  an  association  with  the 
nodules  of  dilated  blood-vessels,  there  is  usually 
well-marked  redness.  Elsewhere  the  fibrotic  change 
is  much  more  irregular  both  in  distribution  and 
character,  so  that  structures  resembling  raised 
scars  and  warty  growths  may  be  found  anywhere  on 
the  trunk  and  limbs  (Fig.  21). 

In  recording  the  results  of  the  routine  examina- 
tion of  his  cases  Bourneville  makes  mention  of 
dermatological  conditions  to  which  he  obviously 
attached  no  importance,  though  in  the  light  of  our 
present  knowledge  there  can  be  little  doubt  that 
what  he  observed  was  the  symptom  referred  to 
above.  His  first  case  showed  what  he  calls  ''acne 
rosacee  et  pustuleuse  de  la  face  ; — de  plus,  eruption 
vesiculo-papuleuse  confluente  du  nez,  des  joues,  du 
front ;  nombreux  petits  molluscums  a  la  nuque  et  sur 
les  parties  du  cou."  Of  another  case  he  says  "  La 
peau  du  visage  presente  de  nombreuses  rides,  avec 
une  teint  pale ;  il  existe  quelques  productions  de 
nature  verruqeuse  sur  les  joues " ;  while  a  third 
displayed  an  ''  eruption  erythemateuse  a  la  base  du 
nez ;  pointille  plus  rouge  sur  la  face,  a  la  joue 
gauche  en  particulier ;  petites  saillies  oflrant 
Tapparence  de   naevi."       A  similar  association    has 


VI    VARIETIES  OF  FEEBLE-MINDED  241 

been  noted  on  several  occasions  at  the  Darenth 
Asylum  for  feeble-minded  persons  :  it  is  recorded  in 
the  papers  by  Campbell,  Dobson,  and  H.  Vogt  to 
which  allusion  has  already  been  made,  and  by 
Volland,^  while  Hornowski  and  Rudzki  ^  seem  to 
have  met  with  it  also. 

It  is  difficult  to  believe  that  if  a  skin  condition  so 
distinctive  as  that  in  adenoma  sebaceum  had  been 
present  in  all  ten  of  the  cases  observed  by  Bourneville 
that  keen  pathologist  would  have  failed  to  note  the 
fact,  and  the  remark  is  equally  true  of  other  skilled 
workers  who  make  no  mention  of  such  a  striking 
dermatologlcal  peculiarity.  Bonfigli,  indeed,  states 
explicitly  that  it  was  absent  from  his  cases. 

Assuming  the  existence  of  an  association  between 
tuberose  sclerosis  and  adenoma  sebaceum  to  have 
been  definitely  established  in  certain  instances  no 
special  importance  attaches  to  the  occurrence  of  the 
former  condition  without  the  latter.  That  some 
particular  element  of  a  clinical  syndrome  should  be 
wanting  in  cases  conforming  otherwise  to  the  type 
is  no  uncommon  experience,  and  the  cases  in  point 
are  susceptible  of  various  explanations.  There  may 
be,  for  example,  more  than  one  form  of  tuberose 
sclerosis,  or  the  skin  changes  may  appear  only  at  a 
particular  stage  in  the  development  of  the  disease. 

Serious  interference  with  the  excretory  functions 
of  the   kidneys  may  occur  :  thus  in  two  of  Vogt's 

1  Volland,  "  Weitere  Beitrage  zum  Krankheitsbild  der  tuberosen 
Sklerose,"  Zeitsch.f.  die  Erforsch.  u.  Behandl.  d.  jugendl.  Schwachs.^ 
Bd.  3,  H.  3,  p.  245. 

2  Hornowski  und  Rudzki,  Sclerose  tubdreuse  {Bourneville)  :  cf. 
Jahresbericht  iiber  die  Leistungen  und  Fortschritte  auf  dein  Gebiete  der 
Neurologie  und  Psychiatrie,  1910,  p.  249. 

R 


242  THE  FEEBLE-MINDED         chap. 

cases  death  resulted  from  dropsy,  while  In  one  of 
those  recorded  by  Bonfigli  it  was  preceded  by 
uraemic  symptoms.  Sometimes,  also,  the  renal 
tumours  have  been  large  enough  to  be  detected 
during  life.  Morbid  states  of  the  urine  are  not,  in 
the  writer's  experience,  especially  connected  with 
the  presence  of  adenoma  sebaceum.  Except  for  a 
tendency  to  the  formation  of  a  deposit  of  triple 
phosphate  crystals,  which  the  urine  from  one  case 
exhibited,  the  writer  has  not  observed  anyabnormality 
discoverable  by  the  ordinary  tests  in  the  samples 
which  he  has  had  an  opportunity  of  examining.  A 
colleague  has,  however,  met  with  a  trace  of  albumin. 

In  the  great  majority,  if  not  in  all,  of  the  cases 
which,  after  death,  have  been  found  to  exhibit  a 
condition  of  tuberose  sclerosis,  there,  has  been  a 
history  of  epileptiform  seizures.  These  may  have 
been  of  the  types  met  with  In  ''  major,"  '*  minor,"  or 
"Jacksonlan"  epilepsy,  or  they  may  have  had 
affinities  with  syncopal  attacks  or  uraemic  con- 
vulsions. 

It  would  appear,  then,  that  in  favourable  circum- 
stances it  may  be  possible  to  differentiate  clinically 
a  group  of  cases  of  feeble-mlndedness  having  the 
characters  above  dealt  with,  and,  this  being  so, 
there  arises  a  need  for  a  name  based  on  clinical 
rather  than  pathological  considerations.  Some 
years  ago,  the  writer  proposed  as  a  convenient 
designation  the  term  ''Anoia."  This  word  has, 
however,  been  applied  by  Jolly  to  cases  of  acute 
dementia,  and  by  Herfort  to  an  imperfectly  defined 
form  of  congenital  mental  defect.  The  term 
"  Epiloia,"  coined  for  the  purpose,  and  having,  the 


VI   VARIETIES  OF  FEEBLE-MINDED  243 

writer  believes,  no  existing  connotation,  is  therefore 
suggested  as  being  more  suitable.  It  has,  at  any 
rate,  some  of  the  features  which,  according  to  Dr. 
Pye-Smith,  characterise  a  good  name  :  it  is  short, 
unmeaning,  distinctive,  and  capable  of  forming  an 
adjective. 

The  writer's  earlier  experience  of  "  Epiloia,"  led 
him  to  regard  the  condition  as  one  involving  grave 
risk  to  life,  mainly  on  account  of  the  severity  of  the 
fits  which  occur.  In  twelve  cases  of  the  disease 
which  have  died  in  Darenth  Asylum  the  apparent 
cause  of  death  was  as  stated  in  the  following 
table  :— 

No.    Sex.    Age  at  death.  Circumstances  attending  death. 

1  M  27  years  Supervention    of    "  pneumonia "    while 

having  20  to  40  fits  a  day. 

2  F  23  years  Status  epilepticus  for  2  days  with  temper- 

ature reaching  105  F. 

3  F  13  years  Status    epilepticus.      The    temperature 

reached  107.4  shortly  before  death. 
Status  epilepticus. 
Vomiting     and     convulsive     twitchings 

lasting  for  3  days. 
Status  epilepticus  lasting  3  days. 
Status  epilepticus  ;  death  occurred  after 

46  fits. 
Pneumonia. 

Malignant  disease  of  skin. 
Died    suddenly    20    minutes    after    an 

epileptic  fit. 
Status  epilepticus. 
Died  in  one  of  the  "  syncopal  attacks  " 

to  which  he  was  subject. 

A  more  extended  acquaintance  with  the  disease, 
however,  has  taught  him  that  while  no  known 
treatment  produces  any  definite  amelioration  of  the 
symptoms,  the  cases  are  not  necessarily  progressive. 
Nine  cases  are  at  present  known  to  him,  and 
although  they  have  not  been  continuously  under  his 
care,  he  has  been  in  touch  with  eight  of  them  for 

R  2 


4 

5 

F 

M 

15  years 
6  years 

6 

7 

F 
F 

9  years 
19  years 

8 

9 
10 

F 
M 

M 

14  years 
9  years 
8  years 

II 
12 

F 

M 

17  years 
6  years 

244  THE   FEEBLE-MINDED         chap. 

the  past  five  years,  and  with  the  ninth  for  three 
years.  A  short  account  of  these  cases  may  not  be 
devoid  of  interest. 

1.  H.  C.  This  is  the  patient  of  whom  a  photo- 
graph is  appended.  She  came  under  notice  at  the 
age  of  eight  years,  and  is  now  eighteen.  Adenoma 
sebaceum  was  observed  on  admission  and  has  been 
getting  worse  pretty  steadily  since.  There  are 
many  fibroid  nodules  in  the  skin  of  the  trunk.  In 
October  1904,  she  had  a  series  of  fits  spreading 
over  three  days,  which  left  her  in  an  exhausted 
state,  and  fits  have  been  of  frequent  occurrence 
since.  Thus  during  the  first  six  months  of  1907 
there  were  recorded  : 

1907    Jan.     Feb.     Mar.     Apr.     May     June 
70      62       40       6       21       19 

During  the  corresponding  period  in  1910  the 
numbers  were  : 

1910        Jan.  Feb.  Mar.  Apr.  May  June 

13  2  4  6  I  2 

a  diminution  which  has  not,  however,  been 
accompanied  by  any  improvement  in  the  mental 
state.  The  girl  is  unable  to  walk  without  a  good 
deal  of  assistance,  is  faulty  in  her  habits,  and  has  to 
be  dressed  and  fed.  Usually  she  sits  quietly  with 
her  head  hanging,  but  at  times  she  rotates  the  head 
slowly.  She  appears  to  understand  nothing  of  what 
is  said  to  her,  though  occasionally  when  she  is 
spoken  to  a  faint  smile  seems  to  denote  that  she  is 
not  wholly  impervious  to  auditory  impressions. 

2.  P.  F.  A  rash  was  noted  on  the  face  at  the 
age  of  five  years,  but  there  is  no  evidence  to  show 


VI   VARIETIES  OF  FEEBLE-MINDED  245 

how  long  it  had  been  present  at  that  time.  It  is 
now  most  marked  over  the  malar  bones  and  is  slight 
over  the  bridge  of  the  nose,  and  there  is  a  small 
confluent  area  in  the  right  frontal  region.  There 
are  small  fibrous  nodules  scattered  over  the  arms 
and  the  upper  part  of  the  trunk,  in  addition  to  larger 
collections  over  the  lower  part  of  the  abdomen  and 
the  inner  surface  of  the  right  thigh.  The  first  fit 
occurred  in  February  1900,  when  the  boy  was  seven 
years  old,  and  since  then  the  fits  have  not  averaged 
more  than  one  a  year,  but  the  mental  state  has 
slowly  deteriorated  and  the  patient  is  now  an  idiot 
of  faulty  habits. 

3.  M.  L.  S.  This  girl  has  been  subject  to 
epileptic  fits  since  the  age  of  three  years,  but  since 
1890,  when  she  was  described  as  having  them 
"  nearly  every  week,"  they  have  been  becoming  less 
frequent  and  none  has  occurred  for  a  long  but  rather 
uncertain  period.  The  condition  of  adenoma  seba- 
ceum is  not  pronounced  and  the  patient  might  be 
described  as  an  imbecile,  for  her  mental  capacity  has 
proved  sufficient  to  enable  her  to  become,  under 
supervision,  a  useful  laundry  worker. 

4.  A.  S.  The  facial  eruption  was  first  noticed  in 
1903,  when  the  patient  was  ten  years  old,  and  has 
never  been  strongly  marked.  There  are  some 
fibrous  nodules  scattered  over  the  trunk,  back  and 
front.  In  April  1899,  this  patient  was  recorded  as 
having  frequent  attacks  of  petit  mal  with  major  fits, 
of  no  great  severity,  about  once  a  week.  The  fits 
then  became  much  rarer ;  thus  there  has  been  only 
one  noted  during  the  past  two  years,  but  the  boy 
suffers  from  periodic  attacks  of  vomiting. 


246  THE   FEEBLE-MINDED         chap. 

5.  E.  B.  There  have  been  occasional  severe  fits 
but  none  of  recent  occurrence.  The  patient,  who  is 
now  twenty-six  years  of  age,  exhibits  fair  intelHgence. 
He  can  talk  and  give  a  sensible'  account  of  himself, 
and  he  is  a  good  ward  worker. 

6.  H.  W.  A  boy  of  sixteen.  The  skin  affection 
is  not  pronounced  and  does  not  appear  to  get  worse. 
No  definite  epileptiform  seizure,  unless  ''fits  when 
teething  "  are  to  be  regarded  as  of  this  nature,  has 
so  far  been  recorded.  Mentally,  the  condition  is 
one  of  imbecility. 

7.  S.  W.  This  boy  came  under  observation,  at 
the  age  of  twelve  years,  in  April  1905.  In  November 
of  that  year  it  was  noted  that  he  was  having  severe 
fits  and  occasionally  series  of  fits.  A  further  batch 
of  fits  was  recorded  in  March  1906.  During  the 
early  months  of  1907,  it  was  noted  that  the  fits 
became  entirely  nocturnal  in  character  and  averaged 
three  per  month.  The  boy  is  fairly  intelligent  and 
does  not  appear  to  be  getting  more  demented. 

8.  F.  V.  S.  A  girl  eight  years  old.  There  is 
at  present  no  history  of  epilepsy,  and  she  appears  to 
be  fairly  bright,  but  she  is  uncleanly  in  her  habits. 

9.  A.  D.  Female,  aged  24  years.  There  is  on 
the  face  a  symmetrical  eruption  which  is  confluent 
over  the  cheeks  and  the  bridge  of  the  nose,  but 
discrete  elsewhere.  Fibro-vascular  nodules  are 
present  over  the  upper  part  of  the  chest,  and  there 
are  fibrous  patches  in  the  skin  over  the  abdomen. 

Cases  like  these  supply  a  means  of  transition  to 
the  ones  which  remain  within  the  province  of  the 
dermatologist,  although  these  latter,  as  is  now 
generally  admitted,   usually  present  some  signs  of 


VI   VARIETIES  OF  FEEBLE-MINDED  247 

mental  defect.  So  long  ago  as  1890,  J.  J.  Pringle  ^ 
noted  that  ''  the  subjects  of  the  disease  (adenoma 
sebaceum)  appear  to  be  generally  intellectually 
below  par."  H.  Radcliffe  Crocker  ^  speaks  of  the 
majority  of  the  cases  as  passing  ''  unrecognised  into 
the  hands  of  the  neurologists,"  and  agrees  that  ''all 
the  marked  cases  show  intellectual  infirmity,  a  large 
proportion  being  chronic  epileptics  or  imbeciles." 


PLEGIC  FORMS. 

Some  degree  of  paralysis  is  one  of  the  commonest 
symptoms  of  the  more  severe  grades  of  feeble- 
mindedness. A  reference  to  the  sections  on 
pathology  will  provide  illustrative  figures.  The 
type  of  paralysis,  taken  in  conjunction  with  the 
history  of  its  development,  will  serve  as  a  basis  for 
the  isolation  of  a  set  of  cases  which  may  be 
collected  into  a  clinical  group  marked  off  from  the 
others,  in  the  scheme  of  classification  adopted  in 
this  work,  by  the  fact  that  the  special  differentia  of 
the  other  subdivisions  are  wanting.  By  assigning 
to  the  group  conveniently  elastic  limits  it  may  be 
made  to  comprise  all  those  cases  of  feeble- 
mindedness in  which  a  more  or  less  extensive 
cerebral  lesion  gives  rise  to  a  deficient  muscular 
activity ;  whether  this  involves  many  muscles  or 
few,  or  whether  the  lesion  is  in  the  sensory  or  the 
motor  part  of  the  cerebral  pathway  which  impulses 
traverse  during  their  transition  from  the  afferent  to 

1  J.  J.  Pringle,  "  A  Case  of  Congenital  Adenoma  Sebaceum,"  BrU, 
Joiirn.  of  Dermatology^  Jan.  1890. 

2  H.  Radcliffe  Crocker,  Diseases  of  the  Skin^  1903,  p.  922. 


248  THE   FEEBLE-MINDED         chap. 

the  efferent  phase.  We  may,  consequently,  meet 
with  monoplegia  or  diplegia  ;  hemiplegia  or  para- 
plegia ;  ophthalmoplegia  or  laryngoplegia  and  so 
on  ;  with  visual,  auditory,  tactile,  or  other  sensory 
anomalies  which  indirectly  express  themselves  in 
muscular  activities  of  various  kinds  ;  or  with  word- 
deafness,  word-blindness,  or  other  species  of  the 
genus  *' aphasia." 

The  lesions  display  as  much  variety  in  their  mode 
of  origin  as  in  their  mode  of  manifestation.  They 
may  be  of  that  indeterminate  character  which  we 
call  "inherent"  or  they  may  be  explicable  on 
ordinary  physical  principles  as  the  result  of  the 
action  of  disruptive  or  toxic  agents. 

A  description  of  these  pathological  states  has 
been  given  in  Chap.  IV.  Affections  of  the  cerebral 
or  meningeal  vessels  are  the  chief  source  of  trouble. 
There  may  be  rupture,  embolism,  or  thrombosis 
occurring  at  birth  or  later.  There  may  be  the 
inflammatory  process  in  the  cerebral  grey  matter, 
due  to  the  conveyance  thither  by  the  blood  vessels 
of  toxic  bodies,  which  is  said  to  give  rise  to  infantile 
hemiplegia.  There  may  be  sclerotic  changes  of  the 
atrophic  type  which,  from  their  distribution,  appear 
to  have  a  vascular  origin  even  though  the  exact 
modus  operandi  is  not  clear.  The  somewhat  in- 
definite clinical  grouping  of  cases  of  paraplegia  and 
diplegia  dating  back  to  birth  or  early  infancy  and 
known  as  Little's  disease  will  be  included  here  though 
it  Is  worthy  of  note  that  many  French  writers  accept 
a  definition  of  Little's  disease  which  would  exclude  it 
from    this    category.     Thus   Ballet  ^  distinguishes  a 

1  G.  Ballet,  Trait e  de  Pathologie  Meftiale,  1903,  p.  1217. 


VI    VARIETIES  OF  FEEBLE-MINDED  249 

form  of  diplegia,  to  which  he  applies  the  name 
**  maladle  de  Little,"  which  is  especially  characterised 
by  the  absence  of  ''  troubles  intellectuels  graves," 
though  there  may  be  an  "  air  d'imbecillite." 

Hemiplegic  forms  of  paralysis  usually  occur  some 
little  time  after  birth.  They  affect  the  whole  of  one 
side  of  the  body,  including  the  face,  and  pass  through 
a  phase  of  flaccidity  followed,  on  the  one  hand,  by 
some  measure  of  functional  restoration,  on  the  other, 
by  spasm  and  contracture  and  by  atrophic  processes 
which  may  involve  not  only  the  muscles  but  also  the 
bony  and  other  structures  of  the  paralysed  limb. 

Among  the  diplegic  forms  there  may  be  recognised, 
according  to  Freud  (as  quoted  by  Tanzi  ^),  the 
varieties  enumerated  below  : — 

(i)  General  Rigidity. 

(2)  Paraplegic  Rigidity. 

(3)  True  Paraplegic  Paralysis. 

(4)  Bilateral  Hemiplegia. 

(5)  General  Chorea. 

(6)  Double  Athetosis. 

Morbid  states  of  the  central  nervous  system  more 
subtle  in  their  nature — perhaps  impossible  of  detec- 
tion by  ordinary  histological  methods  and  dependent 
on  physical  and  chemical  conditions,  as  yet  beyond 
the  range  of  analysis— may  be  at  the  bottom  of  the 
cases  in  which  there  is  no  definite  paralysis,  but  in 
which  the  abnormalities  of  the  muscular  apparatus 
take  the  shape  of  localised  wasting,  hypo-  or 
hyper-tonus,    exaggerated    or    diminished    reflexes, 

^  E.  Tanzi,  oj^.  df.,  p.  463. 


250  THE   FEEBLE-MINDED         chap. 

epileptiform    or    choreiform    movements,     tremors, 
inco-ordination,  or  the  tics. 

Of  some  interest  is  the  reputed  occurrence  of  cases 
of  what  has  been  called  ''psychical  cerebroplegia  "  in 
which  a  gross  cerebral  anomaly  is  overlooked  during 
the  sufferer's  lifetime  owing  to  the  absence  or  in- 
conspicuousness  of  other  than  psychical  defects.  With 
our  present  views  on  the  structure  of  the  encephalon 
it  is  not  difficult  to  imagine  such  a  state  of  things  as 
this,   for  we  may  suppose  that  only  the   "higher" 
cortical  regions    are   affected,   and  how  widely  the 
brain  may  depart  from  the  normal  without  serious 
interference  with  motor  functions  may  be  gathered 
from    the    case   of  an   imbecile  who  suffered   from 
frequent  epileptic  fits  but  whose  physical   condition 
was  good,  there  being  no  paralysis  or  deformity  such 
as  might  be  expected  from  the  cerebral  condition. 
He  died  at  the  age  of  twenty-six   years.     At  the 
post-mortem   examination   the  right  cerebral  hemi- 
sphere, which  showed  much  wasting  and   sclerotic 
change  in  the  occipital  lobe  and  the  hinder  portion 
of  the  parietal  and  temporal   lobes,  was   found   to 
weigh  only  13  ozs.,  while  the  left  weighed  24  ozs. 
and  appeared  to  be  of  normal  structure.     The  left 
side  of  the  cerebellum  was,  as  is  customary  in  such 
cases,  rather  smaller  than  the  right. 

PROGRESSIVE    FORMS. 

In  the  clinical  types  so  far  dealt  with,  while  the 
expectation  of  life  has  been  low,  there  has  not, 
except,  perhaps,  in  some  of  the  cases  of  tuberose 
sclerosis,   been  any  evidence  that   the  patient  was 


VI   VARIETIES  OF  FEEBLE-MINDED  251 

steadily  tending  to  an  early  death.  It  is,  however, 
possible  to  distinguish  a  group  of  cases  in  which  a 
rapidly  progressive  deterioration  as  regards  both 
mental  and  physical  characters  is  the  outstanding 
feature.  The  relationship  of  the  members  of  the 
group  is  by  no  means  clear  and  any  scheme  of  sub- 
division which  may  be  adopted  is  liable  to  adverse 
criticism,  but  one  may  differentiate  with  some  degree 
of  confidence  the  following  forms  : 

(i)  General  Paralysis. 

Of  late  years  it  has  been  recognised  that  children 
are  subject  to  a  form  of  progressive  paralytic 
dementia  resembling  in  its  symptoms  and  course 
the  disease  which  in  adults  is  usually  known  as 
general  paralysis  of  the  insane.  The  "juvenile" 
type,  like  that  of  adults,  seems  to  have  its  origin  in 
syphilis  but  differs  in  that  this  disorder  has  not  been 
acquired  by  direct  infection  but  has  been  transmitted 
by  one  or  both  parents.  The  stage  of  growth  at 
which  the  influence  of  the  syphilitic  taint  becomes 
manifest,  so  far  as  the  mental  state  is  concerned,  is 
variable  ;  thus  the  child  may  appear  healthy  up  to 
the  time  of  puberty  or  may  exhibit  mental  defect 
from  infancy.  The  propriety  of  including  cases  of 
the  former  kind  under  the  description  of  feeble- 
mindedness may,  in  view  of  the  definition  given  at 
the  beginning  of  this  chapter,  be  questioned,  but  it 
may  be  argued  that  the  defect,  though  not  at  first 
apparent,  is  really  congenital,  and  in  any  case  it  is 
convenient  to  consider  together  all  the  varieties  of 
juvenile  general  paralysis  which  are  met  with. 
Definite  symptoms  of  paralytic  dementia  have  been 
noted  as  early  as  the  eighth  year,  but  such  symptoms 


252  THE   FEEBLE-MINDED         chap. 

are  sometimes  preceded  by  conditions  of  idiocy 
which  in  the  light  of  the  subsequent  history  may  be 
regarded  as  prodromal. 

A  close  parallelism  between  the  symptoms  of 
''juvenile"  and  " adult "  general  paralysis  is  hardly 
to  be  looked  for,  since  in  the  child  the  field  for  the 
development  of  possible  abnormalities  is  smaller  ; 
but  the  classical  features  of  a  progressive  paralysis 
leading  to  atrophy  and  contracture  of  the  muscles, 
convulsive  seizures,  and  a  steady  diminution  in 
mental  capacity  with  loss  of  emotional  control  and 
an  exaggerated  bien  etre  are  present.  Any  or  all 
of  such  signs  as  abnormal  pupillary  reactions ; 
irregular  knee-jerks  ;  grinding  of  the  teeth  ;  lingual, 
labial,  and  facial  tremors ;  inco-ordination;  disordered 
speech  ;  irregular  pyrexia  ;  a  ravenous  appetite  ;  and 
trophic  disturbances  may  occur.  Of  the  different 
types  of  the  disease  that  known  as  the  **  dementing  " 
is  the  one  with  which  the  juvenile  form  has  most  in 
common,  but  expansive  delusions  may  be  met  with, 
as  in  a  case  recorded  by  H.  Vogt.  The  usual  history 
is  of  a  gradual  physical  and  mental  deterioration 
occurring  at  school  age,  whereby  a  perhaps  bright 
and  intelligent  child  becomes  increasingly  dull, 
stupid,  and  helpless,  eventually  losing  control  of  the 
bladder  and  rectum  and  being  confined  to  bed  with 
contracted  limbs,  inability  to  converse  or  swallow 
food,  and  rapidly  progressive  emaciation,  until  some 
intercurrent  disorder  or  simple  inanition  ends  the 
scene. 

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


VI   VARIETIES  OF  FEEBLE-MINDED  253 

both  classes  though  in  both  different  cases  exhibit 
considerable  diversity  in  detail.  The  best  account 
of  the  pathological  anatomy  of  juvenile  general 
paralysis  is  that  of  Watson,^  who  examined  the 
brains  of  twelve  cases  finding  in  all  evidence  of  a 
chronic  degeneration  of  the  nerve  cells  in  the  shape 
of  chromatolysis,  shrinking  of  the  cells,  displacement 
of  nuclei,  and  breaking  down  of  cytoplasm.  In  some 
of  the  cases  there  was  also  acute  degeneration  of  at 
least  two  types  : — 

(a)  Swelling  of  the  cell  and   chromatolysis  with 
sometimes  vacuolation. 

(d)  Coagulative  necrosis. 

A  further  important  contribution  to  the  pathology 
of  juvenile  general  paralysis  is  that  of  Rondoni.^ 
In  a  patient  formerly  under  the  writer's  care,  who 
presented  during  life  typical  signs  of  the  disease  and 
died  at  the  age  of  twenty  years,  the  dura  mater  was 
found  to  be  very  thick  and  adherent  in  places  to  the 
pia-arachnoid,  which  was  opaque  and  thickened 
irregularly.  There  was  an  excessive  amount  of 
cerebro-spinal  fluid.  The  right  cerebral  hemisphere 
weighed  i8  ozs.  the  left  i6|-  ozs.  a  decidedly  low 
weight  for  the  brain  of  a  male  originally  of  good 
physique  and  intelligence.  The  father  of  this 
patient,  in  regard  to  whom  there  was  a  definite 
history  of  syphilitic  infection,  had  himself  died  of 
general  paralysis.  In  another  patient,  a  female  who 
died  at  the  age  of  nineteen  years  and  in  whom  also 


1  G.  A.  Watson,  "  The  Pathology  and  Morbid  Histology  of  Juvenile 
General  Paralysis,"  Archives  of  Neurology^  vol.  2,  1903,  p.  621. 
c..^2  pietro  Rondoni,  "  Beitrage  zum  Studium  der  Entwickelungskrank- 
heiten  des  Gehirns,"  Archiv.f.  Psychiatrie^  Bd.  45,  H  3,  p.  1004. 


254  THE   FEEBLE-MINDED         chap. 

the  condition  during  life  had  been  such  as  to  justify 
a  confident  diagnosis  of  general  paralysis,  the  brain, 
as  observed  at  the  post-mortem  examination,  could 
not  be  regarded  as  displaying  typical  signs  of  that 
disease  ;  indeed  its  most  distinctive  character  was  a 
patchy  induration  having  some  analogy  with  that  of 
tuberose  sclerosis.  In  this  instance  the  family 
history  afforded  no  evidence  of  the  existence  of 
syphilitic  infection. 

(2)  Familial  Forms. 

We  turn  now  to  an  ill-defined  group  of  cases  of 
progressive  bodily  and  mental  enfeeblement,  of 
which  the  salient  features  are  some  or  all  of  the 
following  characters. 

(a)  An  incidence,  suggesting  transmission  of  some 
parental  defect,  upon  several  members  of  the  same 
generation  of  a  family. 

(d)  Affections  of  vision. 

(c)  Peculiar  anatomical  changes  in  the  central 
nervous  system.  Some  few  of  the  members  of  this 
group  are  so  closely  allied,  as  regards  (i)  etiology, 
(2)  course,  and  (3)  pathology,  that  they  may  be  placed 
in  a  special  class.  The  remainder  are  not  sufficiently 
clearly  outlined  to  admit  of  classification  with  the 
same  precision  and  at  present  their  relationships 
remain  in  doubt.  There  is  some  confusion  as  to 
terminology,  but  the  most  convenient  arrangement 
seems  to  be  to  include  all  the  cases  under  the 
designation  "amaurotic  family  idiocy,"  which  is 
now  too  widely  employed  to  be  ignored,  and  to 
differentiate  two  types  of  this  disease. 

A.   Infantile  type. 

The  chief  characteristics  of  this  disease,  which  is 


Yi   VARIETIES  OF  FEEBLE-MINDED  255 

known  also  by  the  names  of  the  earHest  students  of 
it,  Mr.  Waren  Tay  and  Dr.  B.  Sachs,  may  be  briefly 
considered  under  the  three  heads  just  mentioned. 

(i)  Etiology. — As  a  rule  the  patients  are  of  Jewish 
extraction.  Whether  the  rule  is  absolute  is  a  little 
uncertain.  From  time  to  time,  one  finds  in  the 
literature  references  to  cases  which  are  said  to  have 
occurred  in  Gentiles,  but  it  is  possible  that  these 
belong  rather  to  the  second  of  the  classes  here 
accepted.  Syphilis,  apparently,  has  nothing  to  do 
with  the  matter  ;  the  blood  and  the  cerebro-spinal 
fluid  have  been  found  not  to  give  Wassermann's 
reaction.^ 

(2)  Course. — The  disease  begins  at  about  the  end 
of  the  third  month.  There  is  a  rapidly  increasing 
general  muscular  weakness,  which  may  be  associated 
at  first  with  a  well-nourished  condition,  and  a 
rapidly  diminishing  acuity  of  vision.  Wasting  and 
rigidity,  with  blindness  due  to  optic  atrophy,  result, 
and  death  takes  place  after  an  illness  of  about  two 
years'  duration. 

(3)  Pathology. — Until  the  later  stages  supervene 
there  is  recognisable,  in  addition  to  the  signs  above 
mentioned,  a  distinctive  condition  of  the  retina.  In 
the  region  of  each  macula  lutea,  a  whitish  patch 
with  the  position  of  the  fovea  centralis  marked  as  a 
cherry-red  spot  is  observable.  In  some  cases,  at 
any  rate,  this  appearance  is  "  due  to  the  chorio- 
capillaris  showing  through  a  thin,  if  not  perforated 
retina."  There  is  a  consensus  of  opinion  that  the 
disease   is   primarily    an    affection    of   the    nervous 

^^  F.  J.  Poynton,  "  Amaurotic  Family  Idiocy,"  Bri^.  Med.  Journ.^ 
May  8,  1909,  p.  1106. 


256  THE   FEEBLE-MINDED         chap. 

elements.  Poynton,  Parsons,  and  Holmes^  found 
in  their  detailed  study  of  three  cases  that  the  cells 
in  all  parts  of  the  central  nervous  system  were 
swollen  and  showed  eccentric  nuclei,  loss  of  *'  tigroid 
masses,"  vacuolated  protoplasm,  and  breaking  up  of 
neuro-fibrils,  together  with  loss  of  nerve  fibres  and 
a  secondary  increase  of  neuroglia.  Mott  ^  records 
similar  changes  in  two  cases  and  notes  that  the  cells 
of  the  sympathetic  ganglia  are  also  affected.  As 
the  result  of  a  chemical  investigation,  he  found  a 
diminution  of  nucleo-proteid  and  an  increase  ot 
simple  proteid  which  he  correlates  with  the  dis- 
appearance of  Nissl  substance  and  the  increase 
of  glia  fibrils.  Schaffer  ^  also  agrees  with  the 
conclusions  of  Foynton  and  his  fellow-workers,  and 
Sachs*  expresses  the  view  that  *'the  morbid  process 
in  the  disease  affects  primarily,  or  at  least  to  a  great 
extent,  the  entire  grey  matter  of  the  brain  and  of 
the  spinal  cord."  In  cases  examined  by  Sachs  the 
cortical  changes  had  given  rise  to  such  a  degree 
of  hardness,  that  ''the  knife  grated  as  it  passed 
through." 

B.  Juvenile  type. 

Sachs  recognises  a  form  of  amaurotic  family  idiocy 
which  is  not  restricted  to  Hebrews,  and  the  duration 

^1  F.  J.  Poynton,  J.  H.  Parsons,  and  G.  Holmes,  "A  Contribution  to 
the  Study  of  Amaurotic  Family  Idiocy,"  Brain^  June,  1906. 
U  ^  F.  W.  Mott,  "Two  Cases  of  Amaurotic  Dementia  (Idiocy)  and  a 
Correlation  of  the  Microscopic  Changes  in  the  Central  Nervous  System, 
with  the  Results  of  a  Chemical  Analysis  of  the  Brain,"  Archives  of 
Neurology^  vol,  3,  1907. 

t  ^  ^  K.  Schaffer,  "  Uber  die  Pathohistologie  eines  neueren  Falles  (viii) 
von  Sachsscherfamiliar-amaurotischer  l^xoixt^^  Journ.fur  PsychoL  und 
Neurol.^  Bd.  10,  1907,  p.  121. 

*  B.  Sachs,  "  On  Amaurotic  Family  Idiocy,"  Jour?t.  of  Nerv.  and 
'\Me7ital  Dis.,  Jan.,  1903. 


VI   VARIETIES  OF  FEEBLE-MINDED  257 

of  which  extends  over  a  number  of  years.  H. 
Vogt^  has  described  a  "family"  disease  marked  by 
mental  defect,  blindness,  and  paralysis  with  bulbar 
symptoms,  which  he  regards  as  belonging  to  the 
same  category.  Several  cases  have  now  been 
recorded:  thus  Jansky^  has  given  an  account  of  a 
boy,  healthy  up  to  the  fourth  year  of  his  age,  who 
became  the  subject  of  a  progressive  dementia  with 
blindness,  general  hypersesthesia,  spastic  diplegia, 
increased  knee-jerk,  and  hyperakusis,  dying  at  the 
age  of  six.  This  boy  was  one  of  a  family  of  eight, 
of  whom  three  died  with  similar  symptoms  between 
the  ages  of  four  and  six  years.  Brooks  ^  has  also 
described  three  cases  of  somewhat  allied  character 
occurring  in  a  family  of  seven  children,  and  Mayou  * 
has  given  an  account  of  a  family  containing  seven 
members,  of  whom  four  have  been  affected  in  a 
similar  way. 

As  yet  cases  of  the  familial  form  of  idiocy  are  too 
few  for  a  satisfactory  determination  of  their  taxo- 
nomlc  position  to  be  made,  and  It  Is  possible  that 
with  increasing  knowledge  the  boundaries  of  the 
group  may  become  less,  rather  than  more,  sharply 
delimited.  Several  years  ago  Sachs  expressed  the 
opinion  that  "  there  Is  a  close  anatomical  relationship 
between  amaurotic  family  Idiocy  and  other  cerebral 

V  1  H.  Vogt,  "  Uber  familiare  amaurotische  Idiotie  und  verwandte 
Krankheitsbilder,"  Mo?tatssch.  f.  Psychiat.  it.  Neur.^  Bd.  i8. 

2  j^  Jansky,  "  Uber  einen  bisher  nicht  publizierten  Fall  von  familiarer 
amaurotischer  Idiotie  &c."  v.  Jahresbericht  uber  die  Leistungen  &^c., 
1909,  p.  1025. 
W  3  H.  Brooks,  "Amaurotic  Family  Idiocy,"  Journ.  of  Nefv.  and 
Me?tt.  Dis.^  April  19 lo,  p.  251, 

*  M.  S.  Mayou,  v.  papers  in  Proc.  Ophthalmological  Society .^  1904, 
p.  142  ;  and  Proc.  Roy.  Soc.  of  Medicine^  July  1908. 

S 


258  THE   FEEBLE-MINDED  chap. 

diseases  of  childhood,  which  are  dependent  on  an 
arrest  of,  or  at  least  a  disturbance  in,  the  normal 
development  of  the  central  nervous  system,"  and 
recently  Huismans^  has  published  the  following 
conclusions  to  which  he  has  been  led  by  his  study  of 
the  subject. 

(a)  Amaurotic  family  idiocy  of  the  kind  described 
by  Waren  Tay  and  Sachs  cannot  be  isolated  as  a 
definite  morbid  entity  because  all  the  clinical 
features,  even  the  macular  spot,  may  occur  singly 
or  together  in  other  familial  and  hereditary  as  well 
as  heterogeneous  diseases  of  the  central  nervous 
system. 

(d)  Amaurotic  family  idiocy  belongs  to  the  great 
province  of  familial  and  hereditary  diseases  of  the 
central  nervous  system,  and  is  a  variety  of  Little's 
disease  or  cerebral  diplegia. 


Residual  Forms 

While  the  types  of  mentally  defective  persons 
described  in  the  preceding  pages  are,  from  the 
clinical  and  pathological  standpoints,  the  most 
interesting  cases  which  we  have  to  consider,  they 
constitute,  taken  together,  quite  a  small  proportion 
of  the  total  number  of  the  feeble-minded.  Thus  of 
the  500  cases  alluded  to  as  series  D  {v.  p.  95) 
a  large  number  could  not  be  included  under  any 
of  the  above  headings,  and  among  the  class  of 
persons    exhibiting    the    slighter    forms    of    defect, 

\j  1  L.  Huismans,  "  Kurze  Bemerkungen  zur  Tay-Sachsschen  familiaren 
amaurotischen  IdioUe" /ourn.  f.  Psychol,  u.  Neurol.^  Bd.  lo,  1908,  p. 
282. 


VI   VARIETIES  OF  FEEBLE-MINDED  259 

such  for  instance  as  are  not  certified  under  the 
Idiots  Act  of  1886,  or  the  Lunacy  Act  of  1890, 
but  attend  special  schools,  the  percentage  is  still 
higher.  We  are  left  then  with  a  large  residual  group 
requiring,  for  its  complete  subdivision,  a  more 
minute  analysis  than  has  so  far  been  employed. 
Clinically  the  members  of  the  group  show  all  kinds 
of  physical  abnormalities,  but  these  are  of  too 
moderate  extent  and  too  irregular  distribution  to 
help  in  the  differentiation  of  distinct  types  of  disease. 
For  sociological  purposes,  however,  it  does  not 
seem  to  be  necessary  to  attempt  any  more  elaborate 
classification  than  the  one  into  cases  of  idiocy, 
imbecility,  and  weak-mindedness  already  utilised. 

Epilepsy 

It  has  been  usual  for  writers  on  mental  defect 
to  distinguish  as  a  group  co-ordinate  with  other 
clinical  groups  those  cases,  or  some  of  them,  in 
which  epileptic  seizures  occur.  Such  a  distinction 
is  essentially  unsound,  for  convulsions  which  cannot 
be  described  otherwise  than  as  epileptiform  occur  in 
diverse  types  of  feeble-mindedness.  It  will  be 
better,  therefore,  to  consider  this  symptom  in  relation 
to  the  different  forms  of  defect  recognised  in  this 
chapter,  without  accepting  it  as  in  itself  a  criterion 
for  purposes  of  clinical  classification.  We  note  then 
that  in  Mongolism  there  is  a  conspicuous  freedom 
from  epileptiform  seizures,  while,  on  the  other  hand, 
such  seizures  are  one  of  the  most  striking  and 
constant  features  of  tuberose  sclerosis.  In  the  cases 
which   have    been    included    under    the    headings 

s  2 


260  THE  FEEBLE-MINDED  chap. 

microcephalic,  macrocephalic,  and  plegic,  the  ratio 
of  epileptics  to  non-epileptics  Is  high.  It  is  not, 
however,  true  that  all  paralysed  idiots  are  epileptic. 
Thus  in  a  series  of  150  cases,  half  being  epileptic, 
the  following  condition  as  regards  paralysis  was 
observed. 

All  limbs     Rt.  hemiplegia     Lt.  hemiplegia     Paraplegia 
Epileptics  6  4  10  9 

Non-epileptics         11  19 

These  figures  may  be  compared  with  those  given 
by  Bourneville.  At  the  end  of  December  1904,  he 
had  under  his  care  fifty-nine  mentally  defective 
patients  suffering  from  hemiplegia.  In  thirty-two 
of  these  the  affection  was  at  the  left  side,  in  twenty- 
seven  at  the  right.  Of  the  former  nineteen  suffered 
from  epilepsy,  and  of  the  latter  twelve.  As  to  the 
relationship  of  epilepsy  and  cretinism  there  is  some 
doubt.  McCarrlson  obtained  a  history  of  convulsive 
seizures  in  a  few  of  his  cases  of  the  "  nervous  "  type 
of  cretinism,  which  has  points  of  contact  with 
cerebral  diplegia,  but  such  seizures  appear  to  be 
rare  in  the  myxoedematous  type.  On  the  other 
hand.  Stern  ^  has  noted  the  rarity  of  epilepsy  as  a 
complication  of  Graves'  disease  and  believes  that 
there  exists  a  certain  antagonism  between  thyroldism 
and  epilepsy.  Thus  he  found  that  a  slight  enlarge- 
ment of  the  thyroid  was  associated  with  improvement 
in  the  condition  of  two-thirds  of  the  patients  in  a 
series  kept  under  observation.  The  cases  here 
grouped  under  the  heading  ''  progressive  "  differ  as 
regards  the  occurrence  of  convulsive  attacks,  these 

^  R.     Stern,    "  Zur    Prognose    der    Epilepsie,"    Jahrbiicher  fiir 
Psychiatrie  und  Neurologie^  Bd.  3,  1909,  p.  i. 


VI   VARIETIES  OF  FEEBLE-MINDED  261 

being  a  common  symptom  of  juvenile  general 
paralysis,  but  not  of  the  familial  forms.  A  consider- 
able percentage  of  cases  of  epilepsy  is  found  in  the 
**  residual  "  group. 

Among  500  feeble-minded  children  under  sixteen 
years  of  age  (250  of  each  sex),  examined  in  an 
asylum,  there  were  142  suffering  from  epilepsy, 
while,  in  another  set  of  asylum  cases,  of  500  males 
and  600  females  over  sixteen  there  were,  respec- 
tively, 128  and  196  epileptics,  a  total  of  324. 
These  figures  give  a  grand  total  of  466  cases  among 
1,600  certified  idiots  and  imbeciles,  i.e,,  approxi- 
mately, 29%.  Since  epileptics  call  for  closer 
supervision  than  non-epileptics  the  distinction 
between  the  two,  though  it  may  be  clinically  little, 
is,  for  asylum  administration,  of  great  importance. 
It  is,  doubtless,  for  this  reason  that  the  Com- 
missioners in  Lunacy  have  given  prominence  to 
epilepsy  in  the  scheme  of  classification  approved  by 
them. 


CHAPTER  VII 

THE    HANDLING    OF    THE    FEEBLE-MINDED 

According  to  the  estimate  of  the  Royal  Com- 
mission on  the  Care  and  Control  of  the  Feeble- 
Minded  there  are,  approximately,  150,000  "  mentally 
defective  "  persons,  apart  from  certified  lunatics,  in 
England  and  Wales.  Of  these  some  66,000  are  not 
suitably  provided  for  either  as  regards  their  own 
well-being  or  that  of  the  public  generally.  Clinically, 
some  of  these  defectives  would  not  be  embraced 
even  by  the  wide  definition  of  feeble-mindedness 
accepted  in  this  work,  but  this  is  of  no  importance 
from  the  sociological  standpoint.  The  figures,  too, 
may  be,  to  some  extent,  inaccurate.  An  incomplete 
census,  taken  by  investigators  equipped  with 
different  standards  of  what  constitutes  **  mental 
defect,"  will  not,  in  the  nature  of  things,  give 
entirely  trustworthy  results.  This  also  is  not,  for 
our  present  purpose,  a  matter  of  great  consequence. 
The  essential  thing  is  that  there  are  in  the  com- 
munity, to  use  the  Commissioners'  own  words, 
**  numbers  of  mentally  defective  persons  whose 
training  is  neglected,  over  whom  no  sufficient 
control  is  exercised,  and  whose  wayward  and 
irresponsible  lives  are  productive  of  crime  and 
misery  ;  of  much  injury  and  mischief  to    themselves 

and  to  others  ;  and  of  much  continuous  expenditure 

262 


VII  HANDLING  OF  FEEBLE-MINDED  263 

wasteful  to  the  community  and  to  individual 
families  "  ;  and  that  there  is  urgent  need  of  a  satis- 
factory scheme  for  dealing  with  them. 

Difficulties  of  two  kinds  are  met  with  in  attempting 
to  satisfy  this  demand.  Not  only  have  we  to  select 
the  scheme  which  is  theoretically  the  best,  but  we 
have  also  to  consider  how  it  can  be  carried  out. 
The  interests  of  ihe  feeble-minded  and  of  society  in 
general  may  be,  and  apparently  are,  in  some  measure 
conflicting,  and  the  decision  as  to  what  is  expedient 
will  only  inspire  confidence  in  so  far  as  it  is  founded 
on  the  widest  possible  survey  of  the  position. 

Our  study  of  the  subject  will,  then,  begin  appro- 
priately with  a  consideration  of  the  point  of  view 
from  which  we  are  to  regard  it. 

A.  The  Point  of  View. 

So  long  as  there  have  been  human  beings  on  the 
face  of  the  earth  these  beings  have,  we  may  assume, 
exhibited  inequality  as  regards  their  mental  status, 
some  falling  so  far  short  of  the  work-a-day  require- 
ments of  communal  life  as  to  be  necessarily  pre- 
cluded from  entering  into  the  social  organisation  of 
their  day  on  the  ordinary  footing.  There  are  in- 
dications that  the  average  man  has,  at  all  stages  in 
history,  looked  at  his  abnormal  contemporaries  with 
mixed  feelings.  They  have  appealed  now  to  his 
selfishness,  now  to  his  altruism  ;  gusts  of  pity  and 
repugnance ;  reverence  and  contempt ;  fear  and 
amusement  ;  have  in  turn  passed  over  the  surface  of 
his  abysmal  ignorance  :  guiding  the  weaker  vessels 
towards  a  haven  of  sympathy  and  forbearance,  or 


264  THE  FEEBLE-MINDED  chap. 

overwhelming  them  in  storms  of  cruelty  and  oppres- 
sion. Sometimes,  doubtless,  the  cruelty  has  been 
well-intentioned  and  has  been  designed  to  exorcise 
the  evil  spirits  which  were  thought  to  have  taken 
possession  of  the  sufferer,  and  the  responsibility  for 
the  resulting  inhumanity  must  rest  on  the  shoulders 
of  the  priests  and  teachers  of  the  community  rather 
than  upon  the  ordinary  citizen.  Even  in  these 
later  days  we  are  not  far  advanced  in  the  matter 
of  dealing  with  the  feeble-minded  in  a  philosophic 
spirit :  we  have  learnt  a  little  and  are  more  tolerant, 
but  we  still  fall  short  of  Bacon's  ideal  of  "employing 
the  Divine  gift  of  reason  to  the  use  and  benefit  of 
mankind." 

It  is  idle  to  blink  the  fact  that  popular  prejudice 
is  one  of  the  most  potent  of  the  forces  which  have 
to  be  reckoned  with  in  any  scheme  of  reform.  The 
spirit  of  opposition  to  changes  in  accepted  usage  as 
regards  the  treatment  of  mental  diseases,  which  one 
finds  in  civilised  communities,  does  not  differ  in 
essence  from  that  which  the  Indian  native  displays 
in  the  matter  of  plague. 

Probably  only  those  who  are  brought  into  direct 
contact  with  the  feeble-minded  appreciate  the  social 
force  behind  them.  They  are  not  isolated  person- 
alities to  be  considered  on  their  merits.  Nearly 
every  one  of  them  has  such  far-reaching  ramifications 
of  relationship  penetrating  the  body  politic  that  any 
shock  applied  to  the  individual  may  be  transmitted 
in  an  ever  widening  wave  which  causes  a  vast  social 
upheaval.  Every  British  asylum  medical  officer  has 
had  experience  of  the  stupidity,  the  unfairness,  the 
suspicion,  the  untruthfulness,  of  the  relatives  of  his 


VII  HANDLING  OF  FEEBLE-MINDED  265 

patients.  In  Germany  things  are  no  better  ;  indeed, 
according  to  Dr.  M.  Fischer,^  they  are  even  worse 
than  with  us.  Nor  is  it  merely  the  illiterate  who 
are  guilty  of  such  questionable  conduct.  An 
American  work  entitled  "  The  Lunacy  Law  of  the 
World,"  by  J.  A.  Chaloner,  Counsellor-at-Law,  which 
is  in  the  writer's  possession,  indulges  in  the  wildest 
charges  of  corruption  against  asylum  authorities, 
impugning  even  the  good  faith  of  our  own  Lunacy 
Commission  and  employing  language  of  a  character 
so  extravagant  as  to  be  ludicrous  to  anyone  having 
practical  knowledge  of  lunacy  law.  Thus  in  regard 
to  the  Idiots  Act  of  1886  we  are  told: — 

"  All  that  is  required  to  incarcerate  a  person  upon 
the  possibly  false  charge  of  idiocy  or  imbecility  is 
the  action  of  his  parents  or  guardians  or  '  any  person 
undertaking  and  performing  towards  him  the  duty 
of  a  parent  or  guardian '  supported  by  a  medical  man 
upon  whose  bare  allegation,  unsupported  by  affidavit, 
the  alleged  idiot  or  imbecile  may  be  imprisoned  for 
life." 

And  it  is  not  only  the  antagonism  born  of  ignor- 
ance and  superstition  which  the  reformer  has  to 
meet.  Behind  this  is  a  more  subtle  sentiment,  which 
doubtless  has  its  roots  in  the  primitive  struggle  for 
existence,  that  of  shirking  responsibility  ;  of  leaving 
others  to  bear  the  brunt.  No  scheme  yet  devised 
by  man  for  the  amelioration  of  the  conditions  which 
result  from  the  existence  of  feeble-minded  persons 
fails  to  demand  some  immediate  self-sacrifice  on  the 
part  of  individual  members  of  society  even  though 
it  offers  them,  in  compensation,  an  ultimate  advantage 

^  M.  Fischer,  Laienwelt  unci  Geisteskranke^  1903- 


266  THE  FEEBLE-MINDED         chap. 

much  greater  than  that  which  they  have  foregone. 
It  is  not  disputed  by  the  vast  majority  of  persons 
that  the  segregation  of  the  feeble-minded,  so  far  as 
it  has  been  effected,  has  been  of  benefit  to  the  com- 
munity, but  that  segregation  has  involved  some 
interference  with  social  amenities  in  the  places  where 
the  feeble-minded  have  been  collected  and  has  been 
bitterly  complained  of  in  consequence.  Further,  it 
is  not  disputed  that  by  following  such  industries  as 
are  within  the  limited  compass  of  their  abilities  the 
feeble-minded  have  lightened  the  burden  of  the 
community  ;  yet  workers  not  handicapped  by  mental 
infirmity,  instead  of  turning  their  attention  to  the 
higher  branches  for  which,  presumably,  their  greater 
capacity  fits  them,  resent  the  intrusion  of  the  feeble- 
minded and  place  such  obstacles  as  they  can  in  the 
way  of  their  employment.  Equally  indifferent  to 
the  duties  of  citizenship  are  those  parents  who, 
under  the  pretence  of  family  affection,  try  to  exploit, 
for  their  own  private  ends,  the  labours  of  the  feeble- 
minded ;  and  who  utilise  the  privileges  which 
society  has  conferred  upon  them  in  respect  of  their 
relationship  in  order  to  defeat  the  fundamental 
purpose  of  those  concessions. 

A  conscientious  desire  to  do  one's  best  for  the 
feeble-minded  does  not,  however,  remove  one  beyond 
the  risk  of  falling  into  errors  of  judgment,  as  is 
shown  by  the  existence  of  conflicting  suggestions, 
all  of  which  have  been  advanced  in  entire  good 
faith. 

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


VII  HANDLING  OF  FEEBLE-MINDED  267 

doing  they  are  conforming  to  the  natural  law  of  the 
survival  of  the  fittest.  Glib  suggestions  of  the 
erection  of  lethal  chambers  are  common  enough, 
being,  indeed,  the  ordinary  sequel  to  the  first 
introduction  of  the  unthinking  to  cases  of  profound 
idiocy.  Apart  from  the  difficulty  that  the  provision 
of  lethal  chambers  is  impracticable  in  the  existing 
state  of  the  law,  the  scope  of  the  procedure  is  so 
restricted  that  it  promises  no  more,  as  a  set-off  to 
outraged  feelings  of  humanity  than  the  saving  of 
the  relatively  small  sum  which  the  housing  and 
feeding  of  a  few  short-lived  idiots  costs  society. 
Such  cases  as  could  alone  be  dealt  with  in  this  way  are 
not  the  ones  which  breed  feeble-mindedness,  simply 
because  they  do  not  breed  at  all,  and  the  removal  of 
them  would  do  practically  nothing  towards  solving 
the  chief  problem  which  the  mentally  defective  set : 
that  of  the  persistence  of  the  obnoxious  stock. 

For  asexualisation  by  surgical  means  a  more 
plausible  case  may,  perhaps,  be  made  out,  but  the 
conditions  under  which  this  method  would  be 
feasible  are  rare.  It  might  be  practised  under 
suitable  control  in  those  cases  where  an  ungoverned 
sexual  instinct  leads  to  crimes  against  the  person. 
Here  it  would  probably  prove  advantageous,  not 
only  to  society  at  large  but  also  to  the  offender  as 
removing  him  from  the  sway  of  impulses  and 
obsessions  which,  besides  being  dangerous  to  those 
about  him,  are  sources  of  misery  to  himself. 

At  the  other  extreme  of  opinion  are  the  persons 
who  see  in  the  feeble-minded  only  channels  for  the 
outpourings  of  a  lively  emotionalism.  Their  as- 
piration is  the  moulding  of  defective  minds  to  the 


268  THE  FEEBLE-MINDED         chap. 

conventional  pattern  of  thought  and  conduct  to 
which  they  themselves  endeavour  to  conform.  It 
involves,  as  a  necessary  corollary,  that  the  greater 
the  mental  abnormality,  the  greater  the  effort  which 
should  be  made  to  correct  it.  But  our  social 
resources  are  limited,  and  from  the  standpoint  of  the 
national  interest  it  is  desirable  that  they  should 
be  invested  where  they  are  most  likely  to  produce 
some  return. 

That  the  matter  of  dealing  with  the  feeble-minded 
has  not,  so  far,  been  managed  in  a  business-like 
way,  seems  to  be  due  in  great  part  to  its  having 
been  so  generally  left  in  the  hands  of  women.  It  was, 
of  course,  a  perfectly  natural  development  that  the 
care  of  those  who,  in  many  respects,  remain  children, 
should  rest  with  the  customary  guardians  of  child- 
hood. There  were  also  such  considerations  as  the 
catholicity  of  feminine  sympathies,  feminine  patience 
with  unpleasant  and  discouraging  conditions,  and, 
perhaps,  though  to  mention  it  savours  of  anti- 
climax, the  cheapness  of  feminine  labour.  So  long 
as  the  scholastic  interest  is  predominant  this  state  of 
things  is  likely  to  continue.  Thus  in  his  evidence 
before  the  Royal  Commission  Dr.  J.  J.  Flndlay,^ 
Professor  of  Education  in  the  University  of 
Manchester,  said  :  "  It  maybe  taken  for  granted  that 
although  men  (physicians  and  teachers  both)  may 
do  in  the  future  as  in  the  past  much  of  the  work 
of  research  and  of  organisation,  the  daily  task  of  train- 
ing defectives  will  fall  to  women  teachers."  The 
trouble  Is  that  men  have  hitherto  done  so  little  '*of 

^  J.  J.  Findlay,  Rep.  of  Roy.  Comm,  on  the  Feeble- Minded.,  vol.  "5, 
p.  249. 


VII  HANDLING  OF  FEEBLE-MINDED  269 

the  work  of  research  and  organisation,"  and  have 
accepted  women's  services  as  trainers  without  con- 
sidering what  purpose  the  training  should  be 
adapted  to  forward. 

Some  enhghtenment  on  this  point  may  be  derived 
from  a  consideration  of  the  way  in  which  education 
seems  to  have  evolved.  We  may  suppose  that  the 
newly-appeared  human  animal  would  instruct  his 
offspring  in  the  means  of  satisfying  the  primitive 
needs  of  his  day.  Information  as  to  the  ways  of 
escaping  danger  and  of  obtaining  food,  with  perhaps 
some  guidance  in  sexual  matters,  would  be  first 
imparted.  It  would  then  be  realised  by  the  teacher 
that  the  energies  of  the  taught  need  not  be  wholly 
absorbed  in  satisfying  the  wants  of  the  latter  and  he 
would  endeavour  to  direct  some  portion  of  those 
energies  into  channels  profitable  to  himself.  A 
reverence  for  authority  would  have  to  be  inculcated 
to  replace  the  feeling  of  dependence  on  parents 
which  the  developing  mind  of  the  child  would  tend 
to  outgrow,  and  an  appeal  to  supernatural  sanctions 
would  be  an  obvious  expedient  for  compelling  that 
deference  for  which,  on  purely  mundane  grounds, 
there  would  be  little  apparent  justification.  With 
the  establishment  of  extraneous  social  relations  new 
obligations  for  both  teacher  and  taught  would  arise 
and  the  scheme  of  education  would  require  modifica- 
tion accordingly.  As  political  interests  predominated 
over  personal  ones  there  would  be  initiated  two 
tendencies,  one  in  the  direction  of  society's  depriving 
the  parent  of  the  option  of  educating  and  the  other 
towards  dictating  the  form  which  education  should 
take. 


270  THE  FEEBLE-MINDED         chap. 

The  State  is,  indeed,  gradually  assuming  towards 
individual  members  of  society  a  position  similar  to 
that  which  we  have  attributed  to  the  parents  of  an 
earlier  age.  It  endeavours  to  control  education  in 
the  interests  of  the  individual  and  in  its  own  interests, 
and  it  does  not  scruple  to  claim,  in  order  to  justify 
Its  action,  familiarity  with  the  laws  which  govern 
the  universe.  As  yet  It  Is  not  strong  enough  to 
ignore  completely  Individual  predilections.  In  this 
country,  at  any  rate,  the  sentiment  of  nationality  is 
not  so  robust  as  to  lead  to  the  willing  sacrifice  of 
Immediate  personal  interests,  and  the  iniquity  of 
taxation,  the  Immorality  of  learning  to  bear  arms, 
and  the  Indecency  of  applying  physiological  know- 
ledge, still  afford  themes  for  eloquent  protest ;  while 
religious  teachers  of  all  denominations  are  aggrieved 
because  their  particular  conceptions  of  the  eternal 
verities  are  not  at  once  recognised  as  the  only 
legitimate  ones. 

If  the  body  politic  is  not  to  be  subjected  to  per- 
petual disruptive  strains  and  stresses,  It  must  be 
founded  on  an  equivalence  of  demands  and  obliga- 
tions. Society  should  know  nothing  of  rights  and 
duties  in  the  abstract :  It  should  admit  the  claims  of 
any  Individual  only  In  so  far  as  these  are  counter- 
balanced by  services  rendered.  This  principle 
applies  to  feeble-minded  persons  as  to  others,  but 
the  matter  Is  complicated  In  this  special  case  by  the 
difficulty  In  the  way  of  placing  the  issue  clearly 
before  both  parties  to  the  bargain.  As  a  set-off  to 
the  charges  which  the  community  must  bear  on  his 
account  the  mentally  defective  offers  his  capacity 
for    labour    and    for     engendering    those    pleasing 


VII  HANDLING  OF  FEEBLE-MINDED  271 

emotions  of  righteousness,  which,  whether  they 
originate  in  the  maternal  instinct  or  in  that  of  self- 
assertion  are  sources  of  gratification  to  our  souls. 
If  in  both  these  respects  the  capacity  of  the  feeble- 
minded person  is  small,  so  are  his  needs  few,  and  if 
the  return  which  he  makes  by  affording  opportunities 
for  the  practice  of  altruism  is  inadequate,  the  balance 
must  be  adjusted  by  getting  more  profitable  work 
out  of  him.  There  is  no  inhumanity  in  this,  for  the 
things  in  his  repertory  which  he  can  do  best  are  the 
things  which,  from  the  social  standpoint,  he  ought 
to  do.  That  this  fact  is  only  now  being  recognised 
is  due  to  the  darkening  of  counsel  which  has  resulted 
from  leaving  a  biological  problem  to  be  solved  by 
pedagogues  and  particularly  by  female  pedagogues. 

The  case  of  the  feeble-minded  who  do  not,  on 
account  of  their  defect,  become  directly  or  indirectly 
a  charge  upon  the  public  purse  presents  special 
features  which  alter  the  position. 

**  It  is  not  intended,"  say  the  Commissioners,  in 
the  Preamble  to  their  Recommendations,  "  that  the 
maintenance  at  public  expense  of  the  mentally 
defective  or  epileptics  not  mentally  defective  should 
be  extended  to  those  who,  either  at  their  own  cost 
or  at  that  of  their  relatives  or  friends,  can  be  other- 
wise suitably  and  sufificiently  provided  for."  Society's 
interest  in  this  group  of  persons  is  simply  to  make 
it  relatively  as  large  as  possible  by  increasing  the 
facilities  for  obtaining  suitable  and  sufficient  provision 
at  such  cost  as  falls  within  the  means  of  the  par- 
ticular person  or  his  relatives  or  friends.  If  the 
relatives  or  friends  accept  nothing  from  Society 
they  need  not  consult   its  wishes,  and   they  are  at 


272  THE  FEEBLE-MINDED         chap. 

liberty  to  arrange  the  lives  of  their  feeble-minded 
dependents  on  any  lines  which  are  not  actually  anti- 
social. Training  in  accordance  with  the  ordinary 
scholastic  ideals  may  in  such  cases  be  legitimate 
enough,  though,  if  the  ordinary  scholastic  methods 
are  employed,  it  may  be  productive  of  but  little 
result. 

B.  The  Method. 

When  a  dozen  eminent  Commissioners  have 
devoted  nearly  four  years  of  earnest  study  and 
discussion  to  a  subject  it  may  reasonably  be 
regarded  as  having  been  thrashed  out  as  thoroughly 
as  is  practicable,  and  no  personal  predilections  would 
justify  a  rejection  of  the  conclusions  reached  even 
if  they  did  not,  as  the  Recommendations  of  the 
Royal  Commission  do,  carry  conviction  to  the  minds 
of  the  most  prejudiced.  What  follows  will  be 
largely  an  exposition  of  the  views  of  the  Com- 
missioners with  such  comments,  amplifications,  and 
minor  criticisms,  as  the  writer's  experience  seems  to 
warrant. 

Stated  concisely,  the  principles  which  in  the  view 
of  the  Commissioners  should  guide  attempts  to 
adjust  the  relations  of  the  feeble-minded  to  the  rest 
of  the  community  are  that :  — 

1.  Suitable  special  protection  of  the  feeble- 
minded should  be  provided  by  the  State. 

2.  Not  the  poverty  or  the  crime  but  the  mental 
incapacity  of  the  feeble-minded  should  supply  the 
motive  for  the  interference  of  the  State. 

Corollaries  of  these  are  the  considerations  that 
since   feeble-mindedness  is  a  lifelong  condition  the 


VII  HANDLING  OF  FEEBLE-MINDED  273 

protection  afforded  should  be  of  lifelong  duration  ; 
that  the  persons  to  be  protected  must  first  be 
identified ;  and  that  the  machinery  of  protection 
would  be  most  satisfactorily  controlled  by  a  central 
authority. 

Special  protection  can  only  be  provided  by  the 
establishment  of  appropriate  institutions  and  the 
Commissioners  discuss  in  their  report  the  various 
expedients  available.  They  speak  with  approval  of 
the  system  of  "  boarding  out "  or  family  guardian- 
ship, when  practised  under  suitable  conditions, 
and  they  advocate  the  introduction  of  large  farm 
colonies  on  the  lines  of  those  which  are  to  be  found 
in  the  United  States  and  Canada. 

"  Boarding  out "  has  the  great  merit  of  cheapness, 
but  there  is  always  the  risk  that  in  aiming  at  cheap- 
ness economy  may  be  sacrificed.  Thus  against 
the  fact  that  cases  are  being  maintained  at  a  low 
rate  must  be  set  the  probability  that  the  earning 
capacity  of  those  cases  is  not  being  utilised  to  the 
full.  It  is  not  easy  also  to  find  the  necessary 
combination  of  a  good  house  and  a  good  house- 
holder. A  working  man  of  the  better  class,  for 
example,  does  not  want  an  idiot  always  about  the 
house,  especially  if  he  has  children  of  his  own,  and 
anything  like  adequate  inspection  is  likely  to  be 
resented.  The  risks  that  the  feeble-minded  person 
may  injure  himself  or  another,  or  may  give  way  to 
drunkenness  or  sexual  malpractices,  naturally  vary 
inversely  as  the  supervision  exercised  over  him  and 
a  check  is  given  to  scientific  investigation  if  only 
unskilled  observers  are  ordinarily  at  hand.  More- 
over, under  the  existing  lunacy  law  the  need  for 


274  THE   FEEBLE-MINDED         chap. 

periodical  re-certlficatlon  has  proved  an  obstacle  In 
practice. 

In  England  the  scope  of  ''boarding  out"  Is  likely 
to  be  restricted  except  It  be  combined  In  some 
such  way  as  mentioned  below  with  the  opening  of 
Industrial  colonies.  All  the  Indications  point  to 
these  latter  as  the  most  hopeful  agencies  In 
remedying  the  social  Ills  for  which  the  feeble- 
minded are  responsible,  although  our  experience  of 
such  establishments  Is,  as  yet,  so  slight  that  any 
action  taken  In  providing  them  would  be  to  a  large 
extent  experimental.  The  Commissioners  were  of 
opinion  that  a  "  farm  colony  in  England  would  be 
of  the  greatest  service  both  directly  and  Indirectly," 
and  as  some  enterprising  local  authority  may  be 
desirous  of  putting  the  matter  to  the  test  a  little 
space  may  be  devoted  to  a  consideration  of  what  is 
feasible  In  this  regard. 

Although  the  term  '*  farm  colony  "  Is  used  by  the 
Commissioners,  what  they  had  in  mind  would  be 
better  designated  an  "industrial  colony,"  since  other 
Industries  besides  farming  would  be  followed.  The 
cases  for  which  accommodation  is  needed,  being 
those  not  at  present  under  supervision,  are  generally 
those  showing  the  slighter  degrees  of  mental  defect, 
and  since  such  cases,  whatever  else  they  may  lack, 
are  likely  to  have  a  fair  capacity  for  work  the  Ideal 
of  a  self-supporting  institution  may  be  approached. 
The  mutual  disabilities  which  sane  and  insane 
persons  impose  and  experience  are  largely  a  matter 
of  elbow  room  and  therefore  the  colony  should  be 
as  far  from  the  hives  of  human  activity  as  is 
consistent    with    economical    working.     A    ''model 


VII  HANDLING  OF  FEEBLE-MINDED  275 

village"  of  special  type  seems  to  be  what  should  be 
aimed  at.  In  Fig.  22  is  shown  a  plan  for  such  a 
village,  though  of  course  many  alterations  in  detail 
might  be  rendered  necessary  by  the  conformation 
of  the  ground  selected,  and  with  the  help  of  the 
ensuing  description  the  reader  may  be  able  to 
envisage  the  place  as  it  would  be  in  working 
order. 

A  site  of  200  acres  is  required.  Anywhere  within 
easy  reach  of  London  the  land  would  probably  cost 
;^ioo  per  acre,  but  elsewhere  this  amount  would 
cover  also  the  cost  of  draining.  There  should  be  a 
good  supply  of  water;  preferably  of  such  a  character 
that  it  could  be  used  for  power  generation,  in  which 
case  the  problem  of  lighting  would  incidentally  be 
solved.  By  road,  rail,  river,  or  canal  there  should  be 
convenient  access  to  some  commercial  centre.  The 
soil  should  be  fertile  and  of  a  kind  suitable  for 
cultivation  by  manual  labour.  Experience  at  Alt- 
Scherbitz  and  elsewhere  has  shown  how  superfluous 
is  the  costly  wall  which  usually  surrounds  institu- 
tions for  those  of  unsound  mind,  and  with  inmates  of 
the  class  now  under  consideration  there  would  be 
even  less  need  than  in  the  case  of  an  ordinary 
asylum  for  mural  enclosure.  The  precautions 
necessary  to  prevent  the  escape  of  patients  and  to 
protect  the  property  of  the  institution  from  theft 
can  be  carried  out  by  less  cumbrous  means  than  the 
erection  of  barricades. 

Accommodation  is  designed  for  2000  of  the 
feeble-minded  and  for  the  staff,  say  200,  who  would 
be  required  to  control  them.  The  number  2000  is 
selected   as   representing   the   total   beyond    which 

T    2 


276  THE   FEEBLE-MINDED         chap. 

economy  In  capital  expenditure  is  counteracted  by- 
increased  cost  of  administration, 

Such  a  collection  of  buildings  as  that  shown  could, 
probably,  be  provided  at  the  cost  of  ;^ioo  per  bed 
if  due  care  were  devoted  to  the  selection  of  the  site 
and  to  the  elimination  of  superfluous  architectural 
features.  The  East  Harling  and  Ackworth  re- 
formatories, described  in  the  Report  of  the  Royal 
Commission,  are  examples  of  how  much  can  be  done 
with  ;^ioo  if  it  be  judiciously  expended.  Economy 
can  be  effected  by  proceeding  gradually  with  the 
work  of  providing  accommodation,  admitting  first 
such  persons  as  can  learn  to  render  assistance  in 
further  preparation.  Thus,  if,  to  begin  with,  pro- 
vision were  made  for  sane  epileptics,  a  number  of 
comparatively  skilled  workers  could  be  got  together 
and  their  labours  could  be  turned  to  account  with 
much  profit  to  the  Institution. 

Failing  any  special  indications  as  to  the  class  to 
be  provided  for  we  may  assume  that  the  total  will 
include  looo  males  and  looo  females,  each  group 
being  subdivided  Into,  say  :— 

500  Children. 

400  Adults  ;  Including  40  of  the  immoral  or 
Intemperate  type  requiring  special  supervision. 

50  Infirmary  Cases. 

50  Sane  Epileptics. 

These  would  be  housed  In  separate  buildings, 
arranged,  as  shown  in  the  plan.  In  convenient 
proximity  to  the  workshops  and  the  administrative 
departments.  The  buildings  would  differ  In  detail 
according  to  the  requirements  of  the  different 
groups    into    which    it    might    be    found    necessary 


VII  HANDLING  OF  FEEBLE-MINDED  277 

to  divide  the  inmates.  Since  the  plan  given  is  only- 
intended  to  embody  a  general  idea  no  attempt  is 
made  to  indicate  these  minor  features. 

For  the  staff  there  would  be  required  a  certain 
number  of  houses  for  married  men,  and  suitable 
staff  blocks  for  women.  Cottages  for  the  employees 
of  subordinate  rank  should  be  of  sufficient  size  to 
enable  the  occupier  to  take  in  as  a  lodger  some 
unmarried  officer  or,  in  special  circumstances,  a 
patient.  It  would  be  necessary  also  to  assign 
rooms  in  the  patients'  blocks  to  some  of  the 
attendants. 

The  controlling  authority  which,  if  the  recom- 
mendations of  the  Royal  Commission  are  adopted, 
would  be  a  Statutory  Committee  of  the  County 
Council  with  co-opted  members,  of  whom  at  least 
one  would  be  a  woman,  might  also  with  advantage 
be  entrusted  with  powers  which  would  enable  it 
to  sell  or  let  on  lease  to  persons  not  in  its  employ, 
but  attracted  to  the  site  by  business  or  other 
considerations,  such  land  as  might  be  suitable  for 
the  purpose  ;  and  to  enter  into  contracts  with  such 
persons  for  the  boarding  out  of  patients.  Further, 
it  might  appropriately  supply  and  control  those 
products  of  civilisation,  the  post-office,  the  police 
station,  and  the  public-house,  without  which  no 
community  can  be  expected  to  be  happy. 

As  head  of  the  establishment  would  be  installed 
a  resident  Director,  preferably  a  medical  man ;  for 
medical  men,  as  they  have  frequently  shown,  are 
capable  administrators,  inspiring  respect  in  their 
subordinates  by  their  professional  status  and  supple- 
menting their  technical  knowledge  of  mental  disease 


278  THE   FEEBLE-MINDED         chap. 

by  broad  views  of  human  nature.  Such  a  Director, 
having  been  appointed  with  due  deliberation  by 
the  Statutory  Committee,  should  be  allowed  to 
direct.  Committees  are  apt  to  lose  sight  of  the 
fact  that  they  are  concerned  rather  with  results  than 
with  methods  and  that  the  man  on  the  spot, 
especially  when  he  brings  to  bear  upon  his  duties 
the  experience  born  of  years  of  service,  will  probably 
be  able  to  deal  single-handed  with  administrative 
details.  Farming  operations,  in  particular,  cannot 
be  carried  on  satisfactorily  if  at  every  stage  of  the 
cultivation  of  the  soil,  the  purchase  of  stock,  and  the 
disposal  of  produce,  a  specific  authorisation  has  to 
be  obtained  from  a  committee  meeting  only  once  a 
fortnight  and  perhaps  failing  to  constitute  a  quorum 
at  critical  moments.  The  Director  would  maintain 
discipline  by  means  of  suitable  rewards  and  punish- 
ments and  it  would  probably  be  advisable  to  confer 
upon  him  the  powers  of  a  Justice  of  the  Peace. 

In  many  respects  the  staffing  of  a  colony  of  the 
kind  here  described  would  differ  from  that  of  an 
ordinary  asylum.  The  bulk  of  the  colonists  would 
be  actual  or  potential  workers  and  the  chief  purpose 
of  the  colony  would  be  the  utilisation  of  their 
labour.  Immediately  subordinate  to  the  Director 
there  would  be  the  following  officers  each  in  charge 
of  a  special  department. 

A  Senior  Assistant  Medical  Officer. 

A  Steward. 

A  Craftsmaster. 

A  Craftsmistress. 

And  in  addition  to  these  there  would  be  an  officer, 


VII  HANDLING  OF  FEEBLE-MINDED  279 

not  necessarily  resident,  who  would  make  arrange- 
ments for  the  provision  of  religious  instruction.  To 
the  officers  just  mentioned  would  be  assigned  duties 
appropriate  to  their  several  positions,  as  thus  : 

The  Senior  Assistant  Medical  Officer,  He  would 
in  the  absence  of  the  Director  assume  the  func- 
tions of  that  officer.  Ordinarily  he  would  have 
control  of  the  medical  treatment,  including  the 
nursing  of  the  colonists,  and  he  would  be  looked  to 
for  the  development  of  that  scientific  aspect  of 
feeble-mindedness  which  has  hitherto  been  so  greatly 
neglected.      He  would  be  assisted  by 

A  Junior  AssistantMedical  Officer. 

A  Superintendent  Nurse,  supervising  Charge  and 
Ordinary  Nurses. 

Mortuary  Attendants. 

The  Steward.  Stated  briefly  the  duties  of  the 
Steward  would  be  to  keep  all  books  and  accounts 
and  produce  them  for  inspection  or  audit  when 
required  ;  to  submit  estimates  for,  purchase,  receive, 
examine,  and  issue,  all  goods ;  to  conduct  corre- 
spondence and  supply  information  to  duly  authorised 
persons ;  to  receive  and  pay  out  all  moneys ;  to 
arrange  for  the  admission,  transfer,  discharge,  and 
interment  of  the  colonists ;  and  to  protect  from 
theft,  wanton  destruction,  or  improper  use  the 
property  of  the  colony.  The  officers  in  his  depart- 
ment would  include 

An  Assistant  Steward. 

Clerks. 

Male  and  Female  Store-keepers. 

Store,  Hall,  and  General  Porters, 


280  THE   FEEBLE-MINDED  chap. 

A  Fire  Brigade. 

The  Craftsmaster,  This  officer  would  be 
responsible  for  the  control  of  all  the  male  colonists 
who  could  be  usefully  employed.  He  would  have 
charge  of  them  both  while  they  w^ere  at  work  and 
while  they  were  at  leisure  and  would  endeavour, 
generally,  so  to  order  their  lives  as  to  make  them 
happy  and  useful  members  of  the  community.  His 
lieutenants  would  be 

A  Chief  Industrial  Attendant  (Male),  at  the  head 
of  a  staff  of  industrial  trainers  and  ordinary  attend- 
ants. 

An  Engineer  with  his  subordinates. 

A  Farm  Bailiff  with  the  necessary  farm  and  garden 
labourers. 

The  Craftsmistress.  Many  of  the  duties  usually 
attached  to  the  post  of  a  matron  would  fall  to  this 
officer,  but  as  nursing  would  not  be  one  of  them  she 
would  not  require  to  have  had  special  training  in 
that  art.  She  would  hold  in  relation  to  the  female 
colonists  a  position  similar  to  that  of  the  craftsmaster 
and  would  have  under  her 

A  Chief  Industrial  Attendant  (Female),  with 
industrial  and  ordinary  attendants. 

A  Cook,  with  her  helpers  in  the  kitchen. 

A  Laundress,  with  her  staff. 

To  enter  in  any  detail  into  the  question  of  the 
salaries  which  should  be  paid  to  the  officers  above 
mentioned  is  beyond  the  scope  of  this  book,  the 
more  so  since  the  matter  is  one  which  would  be 
controlled  to  a  large  extent  by  local  conditions. 
Taking  the  current  rates  of  remuneration  in  poor 
law  and  asylum  service  as  a  guide  the   cash  pay- 


[Fig.  33.] 

PLAN    OF    INDUSTRIAL    COLONY 
FOR    2,000    PERSONS. 

REFERENCE. 


A.  Rouses  fm  Members  of  Subordinate  Staff. 

B.  Farm  Buildings. 

C.  Church. 

D.  Isolation  Hospital. 

E.  House  for  Craftsmistress. 

F.  Female  Staff  Block. 

0.  Blocks  for  ChAld/ren  :  each  to  accommodate  SO. 
H.    Combined  Training  School  and  Recreation  Hall. 

1.  House  for  Craftamasier. 

J.  Blocks  for  Adult  Patients.  These  might  be 
planned  on  the  lines  of  the  blocks  figured  in  the 
account  of  the  Rev.  H.  W.  Burden's  Colony  Scheme 
which  appears  in  tlte  Report  of  tlie  Royal  Comm. 
on  the  Feehle-Minded,  vol.  5.  Each  block  would 
hold  40 patients  and  cost .approMmately,  £2,000. 

K.    Mortuary. 

L.    Fire  Station. 

M.  Pumping  Machinery. 

N.    Wood  Shed. 

0.  Workshops  for  Women. 

P.    Lamidry  with  Drying  Ground. 

Q.    Engines ;  Boilers ;  Chimney  Shaft ;  Water  Tower. 

B.    Coal  Store. 

S.     Workshops  for  Men. 

T.    Kitchen. 

V.    Steward's  Stores. 

V.    Steward's  House. 

W.  Nurses'  House. 

X.    Receiving  Wards. 

Y.    Blocks  for  Scne  Epileptics. 

Z.    Admimistrati/oe  and  Infirmary  Block. 

1.  House  for  Senior  Assistant  Medical  Officer. 

2.  House  for  Director. 


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VII  HAl^DLING  OF  FEEBLE-MINDED  281 

ments  to  the  principal  officers  might  be  somewhat 
as  follows  : 


^Director       .... 

£600  per  annum 

■^Senior  Assistant  Medical  Officer  . 

ZSo   » 

Junior  Assistant  Medical  Officer  . 

175    » 

•^Steward       .... 

250   » 

*Craftsmaster 

250   » 

Craftsmistress 

150   » 

To  which  would  be  added  various  emoluments,  e.g. 
unfurnished  houses,  with  coals,  light,  and  washing, 
in  the  case  of  those  marked  with  an  asterisk,  who 
would  probably  be  married,  and  furnished  quarters 
with  rations,  etc.,  for  the  other  two. 

It  will  be  noted  that  no  provision  in  the  way  of 
school  teachers  of  the  ordinary  type  is  made.  Such 
elementary  instruction  in  reading,  writing,  and 
arithmetic  as  would  be  required  would  be  given  by 
the  attendants  in  charge  of  the  colonists.  To  have 
the  school  life  and  the  home  life  under  separate 
control  not  only  adds  to  the  difficulties  of  administra- 
tion, but  introduces  into  the  training  a  discontinuity 
which  embarrasses  the  feeble-minded  person. 

The  Obtaining  of  Control. 

Adequate  control  and  supervision  are  the  urgent 
needs  of  the  feeble-minded  and  in  order  that  these 
may  be  supplied  there  must  be  some  interference 
with  the  ''liberty  of  the  subject."  When  this  is 
effected  by  private  individuals  in  regard  to  those 
having  a  familiar  relation  to  them,  the  public  con- 
science is  not  touched  and  no  difficulty  arises,  but  it 
is  otherwise  when  society  at  large  takes  action. 
This  is  in  no  way  surprising  because  there  is  involved 
in  it  an  antagonism  between  the  stronger  and  more 


282  THE   FEEBLE-MINDED         chap. 

primitive  instincts  of  family  life  and  the  weaker 
secondary  tendencies  which  bind  separate  families 
into  a  community.  Private  enterprise  has  provided 
sundry  schools,  homes,  asylums,  and  kindred  insti- 
tutions for  the  feeble-minded  and,  under  the  existing 
law,  these  can  be  utilised  by  anybody  who  is  pre- 
pared to  pay  for  the  privilege  ;  such  legal  sanction 
for  detention  as  is  found  necessary  being  afforded  by 
the  Idiots  Act  of  1886. 

When,  however,  there  comes  into  the  question  the 
exercise  of  compulsion  by  the  State,  the  matter 
assumes  quite  another  aspect.  Two  categories  of 
cases  may  be  recognised,  according  as  the  interven- 
tion of  the  State  does  or  does  not  involve  pauperism 
on  the  part  of  the  recipients  of  State  aid. 

(A)  Taking  the  latter  category  first,  we  find  that 
under  the  Elementary  Education  (Defective  and 
Epileptic  Children)  Act,  1899,  modified  by  the 
amending  Act  of  1903,  education  authorities  may 
make  a  certain  limited  provision  for  the  feeble- 
minded. The  limitations  are  in  part  directly  imposed 
by  the  Act  and  in  part  are  due  to  practical  difficulties 
in  working  it.  Their  effect  may  be  thus  sum- 
marised :■-- 

1.  The  supervision  is  restricted  to  school  hours, 
except  in  the  few  instances  in  which  boarding  houses 
have  been  established. 

2.  The  Act  applies  only  to  such  children  as  are 
between  the  ages  of  seven  and  sixteen  years.  Of 
the  two  classes  named,  the  "defective"  includes  only 
those  who  **  not  being  imbecile  and  not  merely  dull 
and  backward  are  by  reason  of  mental  or  physical 
defect  incapable  of  receiving  proper  benefit  from  the 
instruction  in  the  ordinary  public  elementary  schools 


VII  HANDLING  OF  FEEBLE-MINDED  283 

but  are  not  incapable  by  reason  of  such  defect  of 
receiving  benefit  from  instruction  in  such  special 
classes  or  schools  as  are  in  this  Act  mentioned  "  ; 
while  the  ''epileptic"  comprises  those  who  "not 
being  idiots  or  imbeciles  are  unfit  by  reason  of 
severe  epilepsy  to  attend  the  ordinary  public 
elementary  schools." 

3.  The  necessity  of  distinguishing  the  forms  of 
mental  disorder  referred  to  in  paragraph  two  opens 
up  the  way  for  disputes  as  to  certification  in  which 
the  medical  officer  of  the  education  authority, 
unattached  medical  practitioners,  the  parents  of  the 
child,  and  the  magistrate  to  whom  appeal  is  eventu- 
ally made,  join.  Messrs  Garbutt  and  Crowley,^  in 
their  evidence  before  the  Royal  Commission,  noted 
the  objections  raised  by  parents  who  think  their  child 
mentally  sound,  or  who  do  not  want  it  to  attend  the 
**  Silly  School,"  or  who  want  it  to  go  to  work,  or 
who  are  alarmed  by  the  formalities  of  admission  to 
the  special  school  and  by  the  number  of  persons 
present  to  carry  them  out. 

4.  Minor  difficulties  are  the  religious  question, 
the  distance  of  the  special  school  from  the  homes  of 
the  children,  and  the  supply  of  teachers. 

(B)  The  machinery  for  dealing  with  feeble-minded 
persons  of  the  pauper  class  is  as  intricate  as  it  is 
ineffective.  Guardians  of  the  poor  may,  under 
certain  conditions,  utilise  the  provisions  of  the  Idiots 
Act,  1886,  in  obtaining  for  such  idiots  and  imbeciles 
as  are  ''  capable  of  deriving  benefit  from  the  treat- 
ment to  be  received  "the  necessary  care  and  control, 
but  it  is  questionable  whether  the  detention  author- 
ised could  be  maintained  in  opposition  to  the  wishes 

^  Garbutt  and  Crowley,  Rep.  of  Roy,  Comm.,  vol.  2,  p.  121. 


284  THE  FEEBLE-MINDED         chap. 

of  the  parent,  guardian,  or  other  approved  person 
who  took  the  Initiative  In  procuring  It.  The  accom- 
modation available  Is  also  too  scanty  and  too  expen- 
sive to  meet  the  public  needs. 

When  the  degree  of  Idiocy  or  Imbecility  Is 
sufficiently  marked  to  justify  the  Institution  of  pro- 
ceedings under  Section  24  of  the  Lunacy  Act,  1890, 
which  relates  to  "lunatics  In  workhouses,"  there  Is, 
on  theoretical  grounds,  no  particular  difficulty,  but,  in 
practice,  the  procedure  is  very  cumbrous.  The  case 
may  reach  the  workhouse  either  by  transfer  from  an 
asylum  under  Sections  25  and  26  of  the  Act,  or 
directly.  A  perusal  of  Section  24  will  show  that 
for  permanent  detention  In  the  workhouse  there  Is 
necessary, 

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

which  order 

''may  be  made  upon  the  application  of  a 
relieving  officer  of  the  union  to  which  the 
workhouse  belongs  supported  by  a  medical 
certificate  under  the  hand  of  a  medical  prac- 
titioner not  being  an  officer  of  the  workhouse 
and  by  the  certificate  under  the  hand  of  the 
medical  officer  of  the  workhouse  hereinbefore 
mentioned." 

Two  medical  certificates,  respectively,  in  Forms  8 
and  10  in  the  Schedule  to  the  Act,  are  thus 
apparently  required,  but  the  number  is  really  three, 
for  Form  11,  according  to  which  the  justice  makes 
his  order,  winds  up  with  the  words 


VII  HANDLING  OF  FEEBLE-MINDED  285 

*'  and,  if  the  workhouse  medical  officer  shall 
certify  it  to  be  necessary  to  detain  the  said  A.B. 
as  a  patient  in  your  workhouse," 

and  the  law  officers  of  the  Crown  have   given    it 
as  their  opinion  that 

"  the  certificate  must  be  obtained  before  any 
detention  against  the  will  of  the  patient  takes 
place." 

The  Commissioners  in  Lunacy  do  not  regard  the 
order  in  which  the  two  medical  certificates  mentioned 
in  Section  24  (4)  are  given  as  of  any  importance,  but 
it  may  be  noted  that  whereas  the  certificate  given  by 
the  workhouse  medical  officer  is  alone  sufficient 
authority  for  detaining  the  patient  for  not  more  than 
14  days,  that  given  by  the  outside  practitioner  has 
not  the  same  effect.  A  correct  chronological  relation 
between  the  justice's  order  and  the  certificates  and 
statement  of  particulars  upon  which  it  is  based  is 
however  essential  to  the  validity  of  the  first-named 
document.  The  words  ''  not  being  an  officer  of  the 
workhouse "  have  given  rise  to  a  good  many 
difficulties  :  thus  the  Commissioners  in  Lunacy  have 
had  occasion  to  decide  that  "a  member  of  a  board 
of  guardians  is  not  an  officer  of  the  workhouse  within 
the  meaning  of  Section  24  (4)  of  the  Lunacy  Act, 
1890."  It  is  curious  that  no  fee  is  payable  to  the 
medical  officer  of  the  workhouse  under  this  section 
though  he  is  entitled  to  one  if  he  certifies  the  patient 
as  suitable  for  detention  in  an  asylum. 

In  London  the  position  is  complicated  by  the  fact 
that  the  institutions  referred  to  in  the  Lunacy  Act  of 
1890  as  "workhouses"  are  of  two  distinct  kinds. 
There  are,  on  the  one  hand,  the  ordinary  "work- 


286  THE  FEEBLE-MINDED  chap. 

houses  "  maintained  by  the  separate  boards  of 
guardians  and,  on  the  other,  the  ''asylums"  main- 
tained by  the  MetropoHtan  Asylums  Board.  The 
latter  establishments  do  not  receive  patients  directly 
from  the  outer  world,  but  only  through  the  ordinary 
workhouses  or  occasionally  through  other  asylums. 
A  special  set  of  formalities  to  control  this  transfer 
has  been  devised  by  the  Local  Government  Board, 
but  since  these  formalities  do  not  replace  the 
procedure  for  detention  under  the  Lunacy  Act,  1890, 
this  has  to  be  utilised  just  as  in  the  case  of  the 
provincial  workhouses.  The  imposing  dossier  which 
accompanies  a  feeble-minded  person  to  one  of  the 
"  asylums "  which,  under  the  Metropolitan  Poor 
Act,  1867,  the  Metropolitan  Asylums  Board  has 
provided,  includes,  then,  the  following  documents. 

1.  Application  by  relieving  officer  to  a  justice 
having  jurisdiction  in  the  place  where  the  workhouse 
is  situate  for  an  order  for  the  detention  of  the  case 
in  the  workhouse  of  the  parish  or  union  to  which  he 
is  chargeable. 

2.  Statement  of  particulars  by  the  relieving  officer 
to  accompany  the  application. 

3.  Certificate  by  the  medical  officer  of  the  work- 
house under  Section  24  of  the  Lunacy  Act,  1890. 

4.  Certificate  by  an  outside  medical  practitioner 
under  the  same  section. 

5.  The  medical  certificate  referred  to  in  Form  1 1 
of  the  Schedule  to  the  Lunacy  Act,  1890. 

6.  Order  for  detention  made  by  the  justice  under 
Section  24. 

7.  Order  for  the  admission  of  the  patient  to  one 
of  the  asylums  of  the  Metropolitan  Asylums  Board, 


VII  HANDLING  OF  FEEBLE-MINDED  287 

signed  by  the  clerk  to  the  guardians  of  the  parish  or 
union  from  which  the  patient  proceeds. 

8.  Certificate  by  a  medical  officer  of  the  parish 
or  union  to  which  the  patient  is  chargeable,  to  the 
effect  that  the  patient  is  *'  a  chronic  and  harmless 
lunatic,  idiot,  or  imbecile "  suitable,  and  physically 
fit  for  removal.  This  certificate  differs  in  several 
respects  from  the  certificate  referred  to  in  paragraph 
3  supra,  though  its  general  purport  is  the  same,  and 
it  is  usually  given  by  the  same  medical  officer.  The 
chief  difference  seems  to  be  that  it  may  include 
'*  facts  communicated  by  others." 

9.  A  report  "  signed  by  the  chairman  or  vice- 
chairman  of  the  board  of  guardians  of  the  parish  or 
union  to  which  the  pauper  is  chargeable  or  by  some 
member  of  the  visiting  committee  of  such  board  of 
guardians." 

10.  A  second  medical  certificate  as  to  the  patient's 
bodily  condition  is  frequently  necessary  for  the 
following  reasons.  The  admission  order  mentioned 
in  paragraph  7  supra,  is,  according  to  the  Order  of 
the  Local  Government  Board  of  Feb.  loth,  1875, 
which  regulates  admissions  to  the  asylums  here 
considered,  to  be  signed  by  the  clerk  by  direction 
of  the  board  of  guardians  and  it  is  further  laid 
down  that  ''  such  direction  shall  not  be  given  until 
the  certificate  and  report  above  mentioned  (cf.  8 
and  9  supra)  have  been  laid  before  the  board  of 
guardians."  The  medical  certificate  must,  there- 
fore, be  anterior  in  date  to  the  admission  order, 
and,  as  this  is  available  for  seven  days,  it  sometimes 
happens  that  the  statement  of  the  medical  ofificer  as 
to  the  patient's  physical  fitness  for  removal  has  been 


288  THE  FEEBLE-MINDED         chap. 

made  so  long  before  the  removal  to  the  asylum 
actually  takes  place  as  to  afford  no  satisfactory 
evidence  about  the  patient's  condition  at  that  time. 
In  the  case  of  children  admitted  to  **  the  Asylum  for 
Children  at  Darenth"  the  admission  order  is  available 
for  fourteen  days  and  the  force  of  the  objection  just 
noted,  to  having  the  medical  certificate  as  to  fitness 
for  removal  given  several  days  before  such  removal, 
is  recognised  by  the  Local  Government  Board, 
which,  by  an  Order  dated  May  5th,  1890,  requires 
that  the  certificate  should  be  given  on  the  day  of 
the  removal  or  on  the  day  immediately  preceding. 

Since  December,  1907,  the  Metropolitan  Asylums 
Board  has  been  able  to  admit  into  its  asylums 
patients  at  any  age  above  3  years.  Such  cases 
as  do  not  appear  to  require  certification  under 
Section  24  of  the  Lunacy  Act,  1890,  are  received 
into  certain  homes  and  schools  which  are  under  the 
control  of  the  Board,  but  in  which  detention  is  not 
authorised.  These  last  mentioned  cases,  if  received 
before  reaching  the  age  of  16  years,  remain  until 
they  are  21.  Detention  is,  however,  of  the  essence 
of  control  and  it  may  be  of  interest  to  note  briefly 
what  authority  outside  the  purview  of  the  Lunacy 
Act,  1890,  is  available  for  the  purpose.  The 
detention  of  a  lunatic  is  said  to  be  justifiable  at 
common  law  if  necessary  for  his  safety  and  the 
safety  of  others.  For  the  rest,  feeble-minded 
persons  are  on  the  same  footing  as  ordinary  persons. 
Guardians  of  the  poor  have  limited  powers  under  : — 

(1)  The  Children  Act,  1908.  (8  Edw.  7,  c.  67.) 
Parts  2,  4,  and  5.  This  Act  repeals  much  of  the 
Prevention  of  Cruelty  to  Children  Act,  1904. 


VII  HANDLING  OF  FEEBLE-MINDED  289 

(2)  The  Pauper  Inmates  Discharge  and  Regu- 
lation Act,  1871.     (34  and  35  Vict.  c.  108.) 

(3)  The  Poor  Law  Act,  1899.     (62  and  6^  Vict. 

c.  37.) 

(4)  Art.  115  of  the  General  Consolidated  Order, 
July  24th,  1847.^ 

The  sum  total  of  these  falls  far  short  of  the 
needs  of  the  position. 

In  order  to  simplify  the  procedure,  the  Royal 
Commission  on  the  Feeble- Minded  have  made  a 
series  of  Recommendations  which  they,  and  others, 
hope  to  see  embodied  in  an  Act  of  Parliament. 
These  Recommendations  are  set  out  at  length  in 
vol.  8  of  their  Report,  but  it  will  be  convenient  to 
give  here  the  gist  of  such  of  them  as  apply  to  the 
question  of  detention.  By  eliminating  the  word 
''pauper"  and  replacing  the  word  ''lunatic"  by 
the  words  "mentally  defective  person"  in  sundry 
sections  of  the  Lunacy  Act,  1890,  the  scope  of  that 
measure  would  be  largely  increased  with  a  minimum 
of  disturbance  of  the  existing  machinery  :  important 
results  would  be  that  Sections  24  to  27,  which 
apply  to  "workhouses,"  would  become  unnecessary: 
Section  206,  which  refers  to  lunatics  cared  for 
without  charge  by  their  friends  or  in  some  charitable 
establishment,  would  become  applicable  to  the  feeble- 
minded :  Sections  4  to  8,  dealing  with  Reception 
Orders  on  Petition,  might  be  utilised  :  and  Sections 
II  to  23,  which  lay  down  the  procedure  for  obtaining 
Urgency  and  Summary  Reception  Orders,  would 
become  available.  Similarly,  it  Is  proposed  to 
extend  the  provisions  of  the  Idiots  Act,  1886,  so  as  to 

1  V.  Notes  in  Glen's  Poor  Lmv  Orders^  1898,  p.  312. 

U 


290  THE   FEEBLE-MINDED  chap. 

cover,  without  limit  of  age,  seven  of  the  nine  classes 
into  which  the  Commissioners  divide  "  mentally 
defective"  persons.  These  7  classes  are  ''  Idiots"  ; 
''  Imbeciles  "  ;  ''  the  Feeble-Minded  "  :  *'  Moral 
Imbeciles "  ;  and  mentally  defective  persons  who 
are  "  Epileptics,"  "  Inebriates,"  or  *'  Deaf  and  Dumb, 
or  Blind,"  the  remaining  two  classes,  to  be  dealt  with 
under  the  revised  Lunacy  Act  of  1890,  being 
*' persons  of  unsound  mind  "  and  ''  persons  mentally 
infirm."  Mentally  Defective  and  Epileptic  children, 
as  defined  by  the  Elementary  Education  (Defective 
and  Epileptic  Children)  Act,  1899,  would  no  longer 
be  affected  by  that  statute,  but  ample  powers  for 
dealing  with  them  would  be  assigned  to  the  local 
authority.  Finally,  Recommendations  are  made  as 
to  the  control  of  mentally  defective  criminals  and 
inebriates  and  of  epileptics  not  mentally  defective. 


The  Procedure  on  Admission. 

Having  obtained  control  of  the  feeble-minded 
individual,  we  are  confronted  with  the  problem  of 
deciding  the  use  to  which  he  shall  be  put,  the  ideal 
being,  as  already  indicated,  such  employment  as 
shall  be  congenial  to  him  and  profitable  to  society. 
To  this  end  it  is  desirable  that  the  individual  con- 
cerned should  be  examined  with  some  thoroughness, 
not  with  a  view  to  bolstering  up  some  obsolete 
theory  of  etiology,  but  in  order  to  learn  the  nature 
and  extent  of  his  capabilities.  This  examination 
will  appropriately  embrace  the  customary  two  sets 
of    conditions :     those     bearing     on     the    person's 


VII  HANDLING  OF  FEEBLE-MINDED  291 

previous  history  and  those  relating  to  his  present 
state. 

The  information  respecting  the  former  would  be 
best  contributed  by  the  medical  man  who  certified 
the  case  as  suitable  for  admission.  Being  brought 
into  immediate  contact  with  the  patient's  environ- 
ment, he  is  in  a  much  better  position  to  record 
such  features  of  it  as  are  noteworthy  than  is  the 
medical  officer  at  an  asylum,  perhaps  miles  away, 
whose  sole  means  of  eliciting  facts  is  the  questioning 
of  untrustworthy  relatives.  This  principle  is  acted 
upon  in  various  parts  of  Germany,  where  the 
*'  Kreisarzt "  furnishes,  by  means  of  a  series  of 
**Arztliches  Gutachten,"  ample  particulars  of  the 
cases  he  certifies.  It  is  proposed  by  the  Royal 
Commission  that  there  should  be  appointed  by  each 
local  authority  a  special  advisory  medical  officer 
and  a  sufficient  number  of  "  certifying  medical 
practitioners  "  so  that  the  method  suggested  would 
be  feasible.  The  record  should  be  arranged  in  such 
a  form  that  it  can  be  filed  without  transcription  into 
"  case  books,"  such  transcription  Involving  much 
clerical  labour  of  an  unprofitable  sort  which  usually 
devolves  upon  the  medical  officers  of  the  institution 
into  which  the  case  is  received.  It  does  not  appear 
that  anything  Is  gained  by  having  the  enquiries 
made  and  the  results  of  them  recorded  according  to 
a  set  form  :  a  wide  discretion  as  to  what  is  worth 
reporting  may^be  given  to  the  certifying  practitioner. 
One  of  the  points  on  which  stress  may,  however,  be 
laid,  in  view  of  the  uncertainty  surrounding  It^  is  the 
family  history  in  so  far  as  this  bears  upon  the 
presumed  Inheritance  of  the  mental  defect.     As  a 

u   2 


292 


THE   FEEBLE-MINDED 


CHAP. 


convenient  means  of  registering  facts   in  this  con- 
nection  the    form    shown    in    Figs.    23    and    24    is 


Male  Cousins  of  A)  „ 
Female  Cousins  of  A  i^'-oif'^'^ 
Male  Cousins  of  A)  si^fg^g 
Female  Cousins  ofAi 


Half -brothers  of  A-i 
Half-sisters  of  A i 


A  =  the  person  under  examination. 


j Father 
\\  Mother 


Uncles 
Aunts 


Uncles 
Aunts 


Nephews,  g^^^,,^^^ 
Nieces  ) 


Sisters  i  A'epAeu/s 
I  Nieces 


(Male  Cousins  of  A 
^'-°*''^''^\Feniale  Cousins  of  A 

Sistersi  '^"'^  Cousins  of  A 
'"^^^'^^X  Female  Cousins  of  A 


fHalf-brothersofA 
I  Half -sisters  of  A 


Females 


O 

9 


o 


Insanity  Feeble- 

mindedness 


Epilepsy 


Fig.  23. 


€        3 

Neruous         Alcoholism 
Disease 


A  numeral  before  the  symbol,  e.g.  3  $  ,  indicates  the  number  conforming 
to  a  particular  type  ;  in  the  example  given,  3  epileptic  females  of  the  same 
degree  of  relationship  to  A. 

Only  those  persons  in  regard  to  whom  reliable  information  is  obtainable  are 
inserted. 

The  sign  ©  indicates  that  reference  should  be  made  to  a  marginal  note. 

recommended.     Fig.  23  is  a  key  diagram  showing 
the   relationships  which  can  be    indicated  and   the 


Fig.  24. 


symbols  which  are  employed,  while  Fig.  24  shows 
an  actual  family  history  recorded  with  the  help  of 


VII  HANDLING  OF  FEEBLE-MINDED  293 

the  diagram.  It  is  also  desirable  to  ascertain,  as 
the  writer  believes  is  done  at  Earlswood  Asylum, 
whether  the  census  return  relating  to  the  patient 
was  properly  filled  up. 

Ignoring  for  the  moment  the  consideration  that 
all  the  characters  capable  of  investigation  have, 
presumably,  a  physical  basis,  we  may  follow  the 
usual  convention  which  distinguishes  between 
physical  and  mental  attributes  and  divide  the 
examination  on  admission  into  two  parts,  one  dealing 
with  the  former  group  and  the  other  with  the 
latter. 

I .  Examination  of  the  physical  condition. 

This  serves  several  purposes,  e.g.  : 

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

{b)  It  gives  opportunity  for  the  detection  of  any 
conditions,  e.g.,  infectious  disease,  which  would  make 
rejection  necessary. 

{c)  It  supplies  data  for  subsequent  identification 
in  case  of  escape. 

(d)  It  affords  information  as  to  the  nature  and 
amount  of  the  work  which  may  properly  be 
demanded. 

The  examination  may  be  conducted  on  the 
ordinary  lines  familiar  to  medical  men.  In  order 
to  save  time  and  labour  line  diagrams  of  the  various 
parts  of  the  body  may  be  employed  freely,  in 
conjunction  with  the  customary  abbreviations  and 
signs.  The  notes  may  be  conveniently  made  on 
the  back  of  a  card  bearing  a  stereoscopic  portrait 
of  the  case,  the  portraits  being  filed  in  accordance 
with  one  of  the  systems  now  in  vogue. 


294  THE   FEEBLE-MINDED  chap. 

(2)  Examination  of  the  mental  condition. 

Motives  of  economy  are  likely  to  prevent  the 
provision  in  working  colonies  of  an  elaborate 
equipment  for  pursuing  psycho-physiological  methods 
in  the  examination  of  the  residents.  Moreover,  in 
the  present  state  of  our  knowledge,  the  results  yielded 
by  reaction  time  experiments ;  the  exact  deter- 
mination of  differences  in  visual,  auditory,  or  tactile 
sensibility  ;  or  the  measurement  of  emotional 
reactions  ;  have  no  immediate  applicability  to  social 
problems  and  the  collection  of  them  must  be  left  in 
the  hands  of  persons  not  primarily  concerned  with 
administrative  details. 

It  is  necessary,  however,  to  obtain  such  a 
familiarity  with  the  mental  state  of  the  defective 
person  as  will  enable  us  to  place  him  under  the 
most  favourable  conditions  for  profitable  develop- 
ment, and  this  is  done  by  asking  him  questions  and 
inviting  him  to  perform  sundry  exercises.  A  certain 
discretion  must  be  displayed  in  these  procedures  in 
order  to  obtain  information  of  value.  In  the  first 
place  allowance  must  be  made  for  the  examinee's 
opportunities  of  acquiring  knowledge.  Thus  a  set 
of  questions  suitable  for  testing  the  intelligence  of  a 
country-bred  child  might  give  very  misleading 
results  if  employed  for  one  who  had  never  previously 
left  a  London  slum.  Then  it  must  be  remembered 
that  people  whose  mental  gifts  are  up  to,  or  above, 
the  average  may  be  unobservant  or  ''  absent- 
minded  "  and  may  consequently  fail  to  answer 
correctly  simple  questions.  It  is  a  common  practice 
to  test  the  intelligence  of  a  child  by  asking  it  to 
name  the  day  of  the  month  or  describe  what  it  had 


VII  HANDLING  OF  FEEBLE-MINDED  295 

for  dinner  on  the  previous  day,  questions  which,  on 
occasion,  the  examiner  himself  would  probably  fail 
to  answer  off-hand.  It  is  advisable  also  to  avoid 
questions  which  admit  of  only  a  limited  choice  of 
answers,  since  the  less  scope  there  is  in  this  respect 
the  greater  is  the  chance  that  the  right  answer  may 
be  given  by  accident.  If  one  tells  a  child  to  pick 
up  one  of  two  coloured  beads  lying  before  him  he 
may  easily  select  the  right  one  even  though  colour- 
blind. In  the  performance  of  exercises,  too,  the 
opposing  effects  of  practice  and  fatigue  must  be  duly 
set  off  against  each  other. 

The  following  scheme  is  designed  to  elicit  such 
general  information  as  to  the  capabilities  of  a  feeble- 
minded person  as  will  enable  the  examiner  to  classify 
him  with  sufficient  accuracy  for  the  purposes  of 
an  industrial  colony.  Many  of  the  questions  and 
exercises  could  doubtless  be  replaced  by  others 
equally  serviceable,  but  it  is  desirable  to  stick  as 
far  as  possible  to  one  system  in  order  to  facilitate 
comparison  and  the  compiling  of  the  necessary 
statistics.  Further,  since  mind  must  be  regarded 
not  as  a  fixed  conglomerate  of  the  elements  which, 
in  the  first  chapter,  we  believed  ourselves  to  have 
discovered  In  it,  but  rather  as  a  flowing  stream  of 
ever-varying  constitution,  we  cannot,  in  fact,  cut  it 
up  into  the  various  sections  enumerated  below, 
although  it  is  convenient  to  gather  together  the 
data  obtained  under  the  different  headings  there 
mentioned. 

(A)  Sensitiveness  to  stimulation. 

The  various  senses  may  be  tested  thus. — 

(i)  Sight 


296  THE   FEEBLE-MINDED  chap. 

(a)  Light  perception : —  Bring  up  gradually  behind 
a  screen  of  ground  glass,  or  of  ordinary  glass 
covered  with  translucent  paper,  lighted  from  behind, 
some  object  of  simple  outline,  e.  g.  a  pencil,  and  note 
the  distance  between  object  and  screen  at  which  the 
shadow  is  detected.  An  apparatus  consisting  of  a 
graduated  rod  along  which  the  object  can  slide 
between  the  fixed  screen  and  the  source  of  light,  as 
in  Fig.  25,  can  be  constructed  at  trifling  cost. 


-7 ,-/  ///////  rrjri 


'/'"''> 


A  B  C 

A.  Source  of  Light.         B.  Rod  on  sliding  base.         C.  Screen. 

Fig.  25. — Apparatus  for  Testing  Acuity  of  Perception  of  Light. 

(d)  Distance  of  distinct  vision.  The  ordinary 
test-types  can  be  employed  for  children  who  know 
their  letters  ;  for  others  some  familiar  and  attractive 
object,  e.  g,  a  piece  of  toffee  or  an  orange,  will  be 
preferable. 

{c)  From  a  number  of  brightly  coloured  wooden 
beads  let  those  of  similar  colour  be  sorted  out. 

(2)  Hearing.  Two  tuning  forks  of  different  pitch 
are  required.  The  person  is  asked  if  there  is  any 
difference  between  the  sounds  of  them,  and,  one  of 
them  being  sounded,  he  is  to  say  when  he  ceases  to 
hear  it. 

(3)  Taste.  Two  powders  one  of  starch  mixed 
with  a  little  saccharin  and  the  other  of  starch  with 
a  little  quinine  sulphate  are  to  be  discriminated 
between. 


VII  HANDLING  OF  FEEBLE-MINDED  297 

(4)  Smell.  Fluids  consisting  the  one  of  olive  oil 
containing  oil  of  cloves  and  the  other  of  olive  oil 
and  oil  of  peppermint  will  serve. 

(5)  Cutaneous  sensibility.  Test  reaction  to 
temperature  by  tubes  containing  hot  and  cold  water 
respectively ;  susceptibility  to  pain  by  pricking  with 
a  needle  ;  touch  by  wooden  blocks  of  different 
shapes,  sizes,  and  degrees  of  superficial  roughness  ; 
pressure  by  means  of  similar  rubber  balls,  some 
empty,  others  solid  or  filled  with  a  hard  substance, 
e.g.,  plaster. 

(B)  Attention. 

The  testing  of  the  sense  organs  will  have  sup- 
plied much  information  in  regard  to  this.  Further 
evidence  will  be  afforded  by  the  subjoined 
exercises. 

(i)  Mix  two  packs  of  ordinary  playing  cards  and 
note  the  time  taken  in  sorting  them  out,  {a)  into  two 
groups  by  the  pattern  on  the  back  ;  (b)  into  suits  ; 
[c)  into  cards  of  the  same  denomination. 

(2)  Bourdon's  Method.  Hand  to  the  person  a 
piece  of  printed  matter  and  tell  him  to  underline  or 
otherwise  mark  all  the  examples  of  a  particular 
letter  present.  The  letter  "n"  which  is  likely  to  be 
mistaken  for  ''  u  "  is  perhaps  the  most  suitable  for 
the  purpose.  Note  the  number  of  mistakes  and  the 
time  taken. 

(3)  Kraepelln's  Method.  Numerals  printed  in 
columns  are  added  up  In  pairs,  the  time  taken  to 
complete  a  certain  number  being  noted.  Suitable 
sheets  of  figures  are  published  by  the  Unlversitats- 
Buchdruckerel  von  J.  Horning,  of  Heidelberg,  and 
can  be  obtained  at  the  cost  of  a  few  pence. 


298  THE   FEEBLE-MINDED  chap. 

(C)  Memory. 

(i)  Method  of  Ebblnghaus.  A  number,  6  to  12, 
of  disconnected  monosyllabic  words  is  read  by  or  to 
the  person  until  it  can  be  repeated  without  mistake. 
The  number  of  readings  necessary  for  learning  will 
be  a  measure  of  the  memory,  as  will  also  be  the 
amount  forgotten  after  an  interval. 

(2)  Copying  from  memory  Ziehen's  5-angled 
figure  (v.  Fig.  26). 


Fig.  26. — Ziehen's  5-Angled  Figure. 

Note  that  the  base-line  is  not  horizontal,  and  that  the  sides  and  angles  are 
all  unequal.  (From  Ziehen's  Die  Prinzipien  und  Methoden  der  Intelligenz- 
prufungy  1908.) 


(3)  Description  from  memory  of  the  furniture  in 
the  room  where  the  examination  is  taking  place. 

(4)  Familiar  articles  are  shown  and  questions 
are  asked  about  their  names  and  uses.  For  the 
lowest  grades  a  spoon  is  suitable,  while  for  patients 
of  somewhat  greater  intelligence  an  article  of 
clothing,  a  coin,  a  clock,  a  key,  and  a  compass 
constitute  a  convenient  ascending  series. 

(5)  Questions  are  asked  about  matters  of  common 
knowledge,  e.g, : 

What  is  the  day  of  the  week,  the  month,  the 
season,  the  year,  the  century  .-^ 


VII  HANDLING  OF  FEEBLE-MINDED  299 

What  is  the  name  of  the  King,  your  own  country, 
some  other  country  ? 

What  things  are  used  in  washing,  cooking, 
mending  ? 

What  is  to  be  seen  on  a  farm,  in  a  street,  at  a 
railway  station  ? 

(D)  Reasoning. 

Such  tests  as  the  following  may  be  employed. 

(i)   Untie  a  knot  of  simple  design. 

(2)  Put  on  a  coat  of  which  the  sleeves  have  been 
turned  inside  out. 

(3)  Explain  purport  of  a  picture  post-card  and 
fit  together  the  portions  of  it  when  it  has  been 
cut  up. 

(4)  Identify  objects  from  drawings  showing 
different  degrees  of  detail.  The  simple  figures 
designed  by  Heilbronner,  one  set  of  which  is  shown 
in    the    accompanying   illustration    (Fig.    27),    will 


Fig.  27. — Examples  of  Heilbronner's  Figures. 

These  particular  ones  are  taken  from  Cimbal's  Tasckenbtcck,  but  a  variety  of 
others  on  the  same  lines  are  given  in  Heilbronner's  original  paper,  "  Zur 
klinisch-psychologischen  Untersuchungstechnik,"  in  Monatssch.  f.  Psych,  u. 
Neur.^  Bd.  17,  1905. 

serve  for  cases  of  low  capacity ;  for  more  intelligent 
persons  a  series  of  photographs  of  some  scene 
showing  some  feature  with  gradually  increasing 
clearness  is  a  convenient  device. 

(5)  Supply  a  missing  word.     The  cards  designed 


300  THE    FEEBLE-MINDED  chap. 

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

(6)  Explain  the  purpose  of  some  unfamiliar 
object. 

(7)  Describe  common  dangers  and  the  way  of 
avoiding  them. 

(E)  Morals. 

(i)  Instances  of  virtuous  and  vicious  practices 
are  to  be  recognised  and  named. 

(2)  Inquiry  is  to  be  made  as  to  the  person's 
ideals. 

Instinctive  and  emotional  activities,  habits,  and 
powers  of  work  cannot  be  thoroughly  investigated 
at  the  first  sitting.  A  note  in  regard  to  them  may 
be  made  at  the  expiration  of,  say,  one  month  from 
admission. 

The  Training  to  be  Given. 

'' Education"  says  Professor  J.  Sully ^  ''is  an  art 
and  as  such  needs  to  have  a  clear  idea  of  its  end. 
We  cannot  begin  to  educate  intelligently  until  we 
know  what  we  are  aiming  at.  "  The  end  is,  however, 
''plainly  something  large  and  complex"  and  to 
define  it  we  must  have  recourse  to  Ethics,  Sociology, 
Logic,  Esthetics,  and  Psychology.  Even  when  it 
is  defined  our  approach  to  it  can  only  be  asympto- 
tical, for  it  is  undergoing  an  evolution  which  must 
render  our  pursuit  of  it  interminable.  So  far  as  it 
is  capable  of  exact  statement  our  ideal  is  the  "intel- 
ligent,   refined    and   good    person. "     Now    for   the 

1  Published  at  56  Romola  Road,  Heme  Hill,  S.E. 

^  J.  Sully,  The  Teacher's  Handbook  of  Psychology^  1909,  p.  11. 


VII  HANDLING  OF  FEEBLE-MINDED  301 

realisation  of  this  ideal  there  is  necessary  at  least  a 
normal   capacity  for  development,  which,  ex  hypo- 
thesis   the   feeble-minded    individual    has    not.     To 
some   extent   feeble-mindedness   appears   to    be    a 
reversion,  though  opinions  differ  as  to  the  degree  to 
which   this    is    the    case.     The    evolution    of    the 
individual  follows  that  of  the  race  sufficiently  closely 
to  lead  us    to   expect   that   if  a    simple    failure   of 
development  were  the  cause  of  idiocy  we  should  find 
more  marked  resemblances  than  in  fact  exist  between 
idiots  on  the  one  hand  and  savages  or  the  lower 
animals  on  the  other  in  respect  of  mental  capacity. 
But  the  parallelism  is  close  enough  to  suggest  that 
the  fields  of  activity — economic  or  moral — open  to 
the  feeble-minded  will  correspond  to  those  of  living 
beings  at  the  various  stages  to  which  retrogression 
has  occurred    and    that  It   Is    consequently  idle  to 
attempt   to    reach    the   standard  set    by    Professor 
Sully.     Obviously,  then,  as  we  must  cut  our   coat 
according  to  our  cloth,  a  more  modest  conception  of 
the  end  in  view  must  be  accepted.     Our  aim  must 
be  to  provide  the  feeble-minded  person,  in  so  far  as 
he  Is  capable  of  receiving  them,  with  a  fund  of  ideas 
of  such  a  character  that  the  exercise  of  his  limited 
capacity  for  associating  them  will  result  in  the  pro- 
duction  of  activities   as   little    detrimental   to    the 
interests  of  society  as  is  possible. 

Two  distinct  ideals,  which  may  be  designated, 
respectively,  the  ornamental  and  the  useful,  are  met 
with,  and  the  former  is  the  one  which  In  the  past 
teachers  have  usually  kept  before  them  and  have  set 
their  course  by.  The  preliminary  steps  in  training 
will,  however,  be  the  same  whichever  line  is  to  be 


302  THE   FEEBLE-MINDED  chap. 

ultimately    followed.       They    may    be    thus    sum- 
marised. 

(i)  Procedures  for  attracting  and  retaining  the 
attention  of  the  pupil.  Without  these  no  progress  is 
possible,  and  failure  at  this  stage  denotes  that  the 
case  Is  unimprovable.  It  seems  probable  that  the 
mentally  defective,  like  normal  persons,  belong  to 
different  Ideational  types — visual,  auditory,  kinaes- 
thetlc,  etc.,  and  the  best  results  are  therefore  likely  to 
be  obtained  by  stimulating  that  part  of  the  sensory 
apparatus  which  is  of  chief  Importance  for  the  initia- 
tion of  mental  processes. 

(2)  Exercise  of  the  sense-organs  and  of  the 
mechanism  of  memory.  It  is  a  moot  point  whether, 
strictly  speaking,  any  development  of  the  senses  or 
of  the  memory  can  take  place  as  a  result  of  such 
exercise.  Acuteness  of  sensibility  and  the  capacity 
for  reproducing  Ideas  are  probably  dependent  on 
Innate,  or  as  Dr.  Archdall  Reld  would  have  It, 
nutritional  conditions  of  the  germ-plasm  which  are 
only  modifiable  by  use  In  so  far  as  use  affords  a  field 
for  their  expression.  Thus  a  person  may  learn  to 
distinguish  between  sights  or  sounds  which  at  first 
were  alike  to  him  not  because  his  visual  or  auditory 
acuity  has  Increased  but  because  of  an  alteration  in 
the  circumstances  attending  the  perception  of  them  ; 
and  he  may  acquire  a  larger  store  of  facts  not 
because  his  memory  has  improved  but  because  the 
facts  have  been  presented  In  such  a  way  as  to  link 
up  with  the  Ideas  already  present  In  his  mind  and  so 
come  within  the  scope  of  the  laws  governing  the 
association  of  Ideas.  The  procedure  for  improving 
sensation    Is,    in    the   main,    an    application    of  the 


VII  HANDLING  OF  FEEBLE-MINDED  303 

principle  of    contrast,    while    In    the    case    of    the 
memory  rhythm  is  largely  utilised. 

(3)  Exercise  of  muscles.  Voluntary  control  with 
co-ordination  may  be  encouraged  in  three  ways — by 
passive  movement,  by  imitation,  and  by  play.  It 
should,  as  soon  as  practicable,  be  rendered  purposive, 
i.e.  the  pupil  should  be  taught  to  walk  and  to 
minister  to  his  own  wants.  Incidentally,  a  check 
should  be  placed  on  bad  habits  by  the  acquisition  of 
good  ones.  Various  devices  have  been  employed 
for  teaching  suitable  movements,  and  apparatus 
on  the  lines  of  that  used  by  Frankel  in  cases 
of  tabes  has  been  suggested,  but  such  measures 
call  for  a  degree  of  intelligent  co-operation  on 
the  part  of  the  pupil  which  usually  puts  them 
out  of  court.  Even  the  familiar  walking-frame  Is 
condemned  by  Heller  ^  who  mentions  a  case  in 
which  a  child  walked  with  the  aid  of  one  for  three 
years  without  learning  to  walk  alone.  For  tuition  in 
walking  he  advises  that  one  person  should  lead  the 
child  by  the  hands  while  another  places  the  feet  In 
the  proper  positions  from  behind.  The  movements 
of  conveying  food  to  the  mouth  and  of  dressing  and 
undressing  are  among  the  most  Important  which  a 
child  has  to  learn,  but  the  list  can  be  indefinitely 
extended  by  the  teacher  in  accordance  with  the 
necessities  and  the  possibilities  of  each  individual 
case. 

(4)  Object  lessons.  This  generic  term  will 
Include  all  the  methods  by  which  the  pupil  Is  taught 
to  associate  names  and  properties  with  things  as  a 
preliminary  to  using  those  things.     It  comprises  the 

^  T.  Heller,  Grundriss  der  Heilpddagogik,  1904,  p.  225, 


304  THE   FEEBLE-MINDED  chap. 

distinguishing  of  objects  as  observed  in  nature,  as 
figured  in  models,  and  as  represented  in  pictures ;  the 
distinction  of  the  properties  of  objects,  i.e.  their  form, 
colour,  size,  material,  and  so  on  ;  the  development 
of  the  concepts  of  time  and  space  ;  and  the  use  of 
signs  as  representing  things. 

(5)  The  development  of  speech  by  exercises  in 
articulation,  reading,  and  writing ;  and  of  the 
concept  of  number  by  exercises  in  arithmetic.  This 
brings  us  to  the  parting  of  the  ways  and  it  becomes 
necessary  to  decide  whether  education  is  to  proceed 
on  conventional  lines  or  whether  utilitarian  ideals  are 
to  prevail. 

The  arts  popularly  known  as  the  "three  Rs " 
require  from  their  practitioners  quite  a  high  degree 
of  intelligence  and  they  are  completely  beyond  the 
range  of  many  feeble  minds  though  teachers  are 
slow  to  admit  the  fact.  By  employing  devices  for 
memorising  it  is  possible  to  invest  the  mentally 
defective  person  with  a  pretence  of  erudition  which 
may  deceive  the  inexperienced  observer  but  which 
will  not  bear  a  moment's  critical  investigation. 
Thus  with  the  help  of  a  rhythmic  arrangement  of 
the  letters  it  is  possible  for  an  idiot  child,  after 
prolonged  tuition,  to  repeat  the  alphabet.  When 
prompted  to  display  this  accomplishment  the  child 
may  recite  in  a  sing-song  manner  : — 

a'    b    c'    d  e'    f    g' 

h'    i     j'    k  I'  m-n-o  p' 

r    m-n-o  p'  q    r'    s    t' 

u'    V     w'    X  y'     z' 

but  he  will  probably  be  unable  to  say  what  letter 
comes  before  or  after  another  taken  at  random,  or 


VII  HANDLING  OF  FEEBLE-MINDED  305 

what  is  the  last  letter,  without  running  through  the 
whole  series.  It  may,  perhaps,  be  questioned 
whether  committing  the  alphabet  to  memory  is  the 
best  preliminary  to  learning  to  read  even  in  the  case 
of  normal  children,  but  to  regard  the  process  as  an 
end  in  itself  is  obviously  futile.  Taught  in  this  way 
the  idiot  merely  accepts  the  alphabet  as  a  finished 
piece  of  mentation,  not  as  a  collection  of  tools  by 
means  of  which  new  products  of  the  mind  are 
to  be  fashioned,  and,  since  it  has  no  application  to 
the  circumstances  of  his  daily  routine,  he  speedily 
forgets  it.  In  a  similar  way  an  idiot  who  has 
learned  to  count  up  to  ten  with  the  aid  of  his  fingers 
may  be  unable  to  say  how  many  toes  he  has.  He 
may  be  able  to  quote  large  sections  of  the 
multiplication  table  and  yet  not  know  how  many 
beans  there  will  be  in  five  groups  of  five  each,  or  be 
able  to  do  the  simplest  problems  in  addition  or 
subtraction. 

It  is  not  either  a  wise  or  a  kind  thing  to  deprive 
the  developing  mind  of  such  mental  nutriment  as  it 
can  assimilate,  but  it  is  still  less  wise  and  kind  to 
persist  for  years  in  a  policy  of  stuf^ng  indigestible 
data  into  a  mind  incapable  of  dealing  with  them. 
Quite  a  short  time  will  suffice  to  make  clear  in  any 
particular  case  the  intellectual  limitations  which 
make  progress  on  the  ordinary  scholastic  lines 
impossible,  and  the  attempt  to  make  a  silk  purse  out 
of  a  sow's  ear  should  be  promptly  given  up  so  that 
no  time  may  be  lost  in  discovering  such  aptitudes 
as  may  happen  to  exist. 

The  immediate  purpose  in  teaching  a  child  to 
read  and  write  is  to  open  up  channels  for  conveying 


306  THE   FEEBLE-MINDED  chap. 

Instruction.  Attempts  on  these  lines  proving 
unsuccessful  one  must  employ  the  channels  provided 
by  the  child's  primitive  impulses  to  imitate  or  to 
play,  and  correct  ideas  of  conduct  may  be  imparted 
by  supplying  correct  models  of  behaviour  for 
imitation  and  by  suitably  directing  the  movements  of 
play.  The  case  of  the  feeble-minded  person  is 
sufficiently  similar  to  make  these  methods  applicable 
to  it  also.  Imitation,  in  particular,  affords  a  means 
of  supplying  ideas  of  a  useful  kind.  A  mentally 
defective  child  sent  out  with  a  party  engaged  in 
picking  up  stones,  or  chopping  wood,  or  dusting 
furniture,  will  readily  join  in  the  work  and,  being 
successively  tried  with  duties  involving  more  and 
more  skill,  will  soon  find  a  niche  to  suit  him. 
Placed  there  patient  and  repeated  demonstrations 
on  the  part  of  a  sympathetic  instructor  may 
gradually  convert  him  into  a  craftsman  of  quite 
surprising  dexterity  in  the  art  of  brush-making, 
basket-weaving,  or  cobbling. 

In  general  the  feeble-minded  are  willing  workers, 
and  if  their  work  is  so  arranged  as  not  to  impose  too 
prolonged  a  strain  on  their  attention  their  industry 
leaves  little  to  be  desired.  Many  of  them  are  open 
to  the  stimulus  of  emulation  and  many,  too,  take  so 
great  a  pride  in  what  they  turn  out  that  any 
evidence  of  its  being  appreciated  supplies  a  strong 
inducement  to  continued  efforts  at  improvement. 

Almost  all  forms  of  manual  labour  are  available 
for  the  feeble-minded,  who,  it  must  not  be  forgotten, 
embrace  a  great  variety  of  mental  types.  The 
occupations  usually  followed  are,  for  the  males, 
farm-work,   wood-chopping,  the  mending  of  boots, 


Yii  HANDLING  OF  FEEBLE-MINDED  307 

chair-caning,  basket-making,  brush-making,  mat- 
making,  tailoring,  painting,  carpentry,  book-binding, 
and  printing ;  for  the  females  needlework,  laundry- 
work,  and  the  making  of  the  lighter  kinds  of  mats, 
baskets,  and  brushes.  For  both  sexes  toy-making 
offers  a  field  as  yet  practically  unexploited  in  this 
country. 

If  for  any  reason,  as  in  the  case  of  children  who 
are  not  and  are  not  likely  to  become  a  charge  on  the 
community,  it  is  deemed  advisable  to  try  to  mould 
the  feeble  mind  to  the  orthodox  scholastic  pattern 
a  prolonged  course  of  tuition  in  the  rudiments  of 
grammar,  arithmetic,  and  social  observances  may  be 
undertaken  with  a  view  to  hiding,  as  completely  as 
may  be,  the  state  of  intellectual  emptiness.  Since 
society's  demands  in  this  respect  are  not  high  it  may 
be  possible  to  make  a  person  with  only  a  moderate 
degree  of  mental  defect  pass  muster  if  expense  is  no 
object.  In  such  cases  the  procedure  will  follow  the 
same  general  lines  as  are  adapted  for  normal 
children,  advantage  being  taken  of  modern  develop- 
ments in  the  way  of  kindergarten  methods.  Every 
case  must  be  treated  on  its  merits,  so  that  it  is  im- 
possible to  lay  down  a  course  of  study  of  universal 
application.  One  element  is,  however,  essential. 
It  is  the  possession  by  the  teacher  of  a  strong  but 
sympathetic  disposition,  so  that  the  interest  of  the 
pupil  may  be  aroused,  his  attention  held,  and  his 
tendency  to  take  up  an  attitude  of  opposition  over- 
borne. As  evidence  of  technical  skill  on  the  part  of 
the  teacher  such  certificates  as  those  of  the  National 
Froebel  Union  would  be  acceptable. 

So  far  we  have  considered  only  the  economic  side 

X    2 


308  THE   FEEBLE-MINDED  chap. 

of  the  activities  of  the  feeble-minded,  but  the  moral 
aspect  is  of  no  less  importance  though  one  approaches 
it  with   fear  and  trembling.     Religious  training  is 
universally  regarded  as  an  integral  portion  of  the 
education  of  the  feeble-minded,  but  little  attempt  is 
made   to   adapt    it    to   the    special    circumstances. 
Feeble-minded  persons  include  all  grades  up  to  the 
normal  in  intelligence,  and  it  would  seem  then  that  a 
corresponding  graduation  of  ethical  teaching  is  called 
for.       If  we   consider   the   diversity   exhibited   by 
persons  reputed  to  be  of  sound  mind  as  regards  their 
manifestations  of  the  religious  sentiment,  we  find  an 
inverse  ratio  between  the  development  of  the  reason- 
ing powers  and  the  demonstrativeness  of  the  form 
of  religion  which  appeals.     The  appetite  for  signs 
and   wonders    diminishes   as    the    mental    horizon 
broadens :  fervour  no  longer  demands  confirmatory 
miracles  nor  is  conviction  intensified  by  the  banging 
of  a  big  drum  or  the  singing  of  a  hymn  out  of  tune. 
It  seems  a  legitimate  deduction   from  this  line  of 
argument  that  a  progressive  crudity  should  mark  the 
ministrations  provided  for  the  mentally  defective  as 
one  proceeds  from  the  slighter  degrees  of  imbecility 
into  the  deeps  of  idiocy. 

Looking  at  the  matter  from  the  ethical  standpoint 
McDougalP  recognises  four  levels  of  conduct,  which 
may  be  thus  described  : — 

(i)  Instinctive  behaviour  modified  only  by  the 
influence  of  the  pains  and  pleasures  that  are  in- 
cidentally experienced. 

(2)  Operation  of  the  instinctive  impulses  modified 
by  the    influence  of  rewards  and  punishments  ad- 

^  W.  McDougall,  An  Introduction  to  Social  Psychology. 


VII  HANDLING  OF  FEEBLE-MINDED  309 

ministered  more  or  less  systematically  by  the  social 
environment. 

(3)  Control  in  the  main  by  the  anticipation  of 
social  praise  and  blame. 

(4)  Regulation  by  an  ideal  of  conduct  which 
prompts  to  act  as  seems  right,  regardless  of  the 
praise  or  blame  of  the  immediate  social  environ- 
ment. 

This  highest  plane  is  one  which  the  feeble-minded 
cannot  be  expected  to  reach,  and  the  religious  teach- 
ing provided  for  them  must  be  of  a  kind  not  appeal- 
ing to  non-existent  powers  of  reasoning,  but  offering  a 
scheme  in  which  the  relation  of  rewards  to  virtuous 
acts  and  of  punishments  to  misdeeds  is  as  direct  as 
possible.  At  an  early  stage  of  development  the 
promise  of  a  dainty  is  the  most  potent  influence  for 
good,  and  the  prospect  of  receiving  a  rap  across  the 
knuckles  will  have  a  greater  deterrent  effect  than 
will  the  fear  of  incurring  the  wrath  of  the  Almighty. 
Since  sectarianism  belongs  to  the  fourth  level  it  can 
have  no  place  in  the  instruction  of  the  feeble-minded, 
and  there  can  consequently  be  no  need  to  provide  a 
whole  set  of  teachers  armed  with  different  dogmas 
as  part  of  the  equipment  of  an  industrial  colony. 
The  formal  presentation  of  a  feeble-minded  person 
for  reception  into  any  church  is  a  proceeding  reflect- 
ing discredit  both  on  the  church  and  on  the  priest 
who  adopts  this  reprehensible  way  of  serving  it. 

The  practice  of  assembling  the  feeble-minded  for 
public  worship  has  its  merits.  As  Dr.  Needham  ^ 
has  expressed  it,  ''the  absolute  self-control  which  is 
requisite  to  be  maintained  by  these  people  during 

1  Rep.  of  Roy.  Comm.  on  the  Feeble- Minded^  vol.  2,  Q.  15463. 


310  THE   FEEBLE-MINDED  chap. 

an  entertainment  and  during  the  chapel  services 
Is  very  Important  discipline  In  their  treatment." 
Moreover,  the  people  like  to  attend  divine  service 
since  it  provides  a  break  In  the  monotony  of  their 
daily  lives.  There  Is  here  no  question  of  religious 
enthusiasm,  for  the  services  are  welcomed  as 
heartily  by  the  nominal  opponents  of  the  doctrines 
taught  as  by  the  professed  supporters  of  them. 
Indeed,  care  has  constantly  to  be  exercised  In  an 
institution  for  the  mentally  defective  to  see  that 
patients  do  not  attend  the  services  of  some  de- 
nomination other  than  that  to  which  they  are 
accredited,  their  tolerance  In  such  matters  not  being 
shared  by  relatives  and  pastors.  Much  of  the 
utility  of  the  services  is  lost  if  they  are  made  the 
occasion  for  disquisitions  on  abstruse  tenets  ;  they 
should  rather  be  enlivened  by  music  and  pictures 
and  confined  to  the  exposition  of  those  practical 
distinctions  between  right  and  wrong  which  are  at 
the  root  of  the  social  scheme  and  which  are  accepted 
by  all  denominations.  Even  in  the  use  of  pictures 
care  must  be  exercised,  for,  as  Heller^  points  out, 
the  apparently  innocent  picture  books  of  children 
may  suggest  undesirable  ideas.  Thus  he  thinks 
that  the  adventures  of  the  naughty  Frederick,  as 
recorded  in  the  familiar  Struwelpeter  chronicle,  are 
calculated  to  excite  sympathy  with,  rather  than 
aversion  from,  mis-doing,  since  it  Is  only  towards  the 
end  of  his  Immoral  career  that  retribution  overtakes 
the  hero. 

1  T.  Heller,  op.  cit.^  p.  250. 


VII  HANDLING  OF  FEEBLE-MINDED  311 


Medical  and  Surgical  Treatment. 

Except  in  those  comparatively  rare  cases,  e.g., 
cretinism  and  some  traumatic  conditions,  in  which  the 
causation  of  mental  defect  is  obvious  and  amenable 
to  simple  medical  or  surgical  procedures,  we  are  too 
much  in  the  dark  in  regard  to  the  etiology  of  feeble- 
mindedness to  be  able  to  attempt  with  any  hope  of 
success  the  repair  of  the  damaged  brain.  Such 
indications  for  treatment  as  seem  to  be  present  have 
so  far,  owing  to  our  limited  knowledge,  proved  more 
misleading  than  helpful.  Thus  the  operations  of 
craniectomy  in  cases  of  microcephaly  and  of  para- 
centesis in  cases  of  hydrocephaly  have  proved 
valueless  since  the  root  of  the  trouble  lies  deeper 
than  they  can  reach.  Similarly  in  the  case  of  drugs 
the  indications  for  treatment  are  almost  always  too 
obscure  to  be  intelligible.  We  have  hitherto  failed 
to  interpret  them  correcdy  and  the  shots  we  have 
made  have  been  wide  of  the  mark.  In  view  of  the 
diversity  which  abnormalities  of  the  brain  exhibit  it 
seems  unreasonable  to  expect  to  discover  any  single 
remedial  agent  which  shall  be  of  universal  application. 
On  the  other  hand  we  need  not  take  up  the 
pessimistic  attitude  of  some  writers  and  accept  it  as 
a  settled  fact  that  we  never  shall  be  able  to  influence 
cerebral  development  favourably,  even  though  the 
results  achieved  so  far  have  been  in  the  highest 
degree  discouraging. 

But  although  the  cure  of  feeble-mindedness  is,  in 
the  vast  majority  of  cases,  beyond  our  power,  we 
can  do  a  good  deal  in  the  way  of  patching  up  the 


312  THE   FEEBLE-MINDED  chap. 

defective  machinery  so  that  its  efficiency  may  be 
increased.  On  the  surgical  side  the  profitable  field 
is  chiefly  that  in  which  work  the  orthopaedic  surgeons. 
Paralysed  limbs  may  have  their  deformities  corrected 
and  some  degree  of  mobility  imparted  to  them 
by  means  of  tenotomy,  transplantation  of  tendons, 
excisions  of  joints,  nerve  transference,  and  the  like. 
In  special  cases  operations  of  considerable  magnitude, 
e.g.,  Foerster's  excision  of  portions  of  the  lumbar  and 
sacral  posterior  nerve  roots  in  cerebral  diplegia, 
may  be  undertaken  with  advantage  to  the  patient. 
The  correction  of  optical  and  auditory  defects,  the 
removal  of  adenoids,  attention  to  the  teeth,  and 
circumcision  are  other  procedures  which  may  be 
indicated.  It  must,  however,  be  borne  in  mind 
that  feeble-minded  persons  are  not  able  to  give 
the  surgeon  that  assistance  without  which  many 
otherwise  desirable  operations  become  inadmissible, 
and  regard  must  be  paid  not  only  to  the  need 
for  operation  but  also  to  the  possibility  of  providing 
adequate  after-care. 

The  scope  of  medical,  as  distinct  from  surgical, 
treatment  is  also  restricted.  Suitable  feeding,  the 
proper  working  of  the  excretory  organs,  the  checking 
of  outbursts  of  excitement,  the  combating  of  sleep- 
lessness, all  require  attention.  Many  idiots  have 
not  wit  enough  to  feed  themselves  and  for  this 
reason,  or  on  account  of  the  presence  of  palatal 
deformities  or  paralytic  conditions  of  the  muscles 
of  the  throat,  have  to  be  fed  by  an  attendant. 
Others  eat  too  fast  or  too  indiscriminately  if  left  to 
themselves,  or  involve  themselves  in  strife  by 
gnatching  food  from  their  fellows.      Want  of  con- 


VII  HANDLING  OF  FEEBLE-MINDED  313 

trol  over  the  bowel  and  the  bladder  is  a  common 
trouble  with  them,  and  is  met  to  a  limited  extent 
by  education  in  habits  of  cleanliness,  but  more 
particularly  by  frequent  changes  of  garments  and 
the  protection  of  the  beds  by  means  of  waterproof 
sheeting.  In  large  wards  noisiness  may  be  a 
source  of  great  annoyance  to  other  patients  and 
may  call  for  isolation  of  the  case  as  far  as  is 
practicable.  Some  idiots  scream  or  cry  almost  con- 
tinuously, no  doubt  on  account  of  suffering  some 
discomfort  which  they  are  not  able  to  explain. 
Before  medicinal  agents  are  resorted  to  in  such 
cases  it  is  well  to  try  the  effect  of  greater  warmth 
and  additional  food.  Undue  restlessness  and  want 
of  sleep  will  need  to  be  treated  by  hypnotics.  In 
the  way  of  sedative  drugs  the  best  is  paraldehyde  in 
doses  of  m.  xxx  to  3  j-  Rarely  is  a  larger  dose  called 
for,  and  it  is  always  worth  while  to  begin  with  the 
small  one  since  that  may  prove  quite  sufficient. 
Paraldehyde  is  nasty,  but  this  does  not  seem  to  trouble 
idiots  very  much;  indeed  some  of  them  appear  to 
like  the  drug. 

Of  special  importance  is  the  treatment  of  epilepsy. 
Perhaps  because  in  many  cases  the  seizures  which 
occur  among  the  feeble-minded  have  their  origin  in 
gross  cerebral  defect  they  are  peculiarly  insusceptible 
to  medical  treatment.  A  routine  employment  of 
bromide  of  potassium  is  not  always  advisable,  indeed 
sulphate  of  magnesium  will  often  prove  more  to  the 
purpose.  On  occasion  a  powerful  purgative  such  as 
croton  oil  is  needed.,  and,  though  its  effects  are  apt 
to  be  unpleasantly  drastic,  patients  will  sometimes 
ask  for  it  owing  to  the  relief  it  affords  them  from 


314  THE   FEEBLE-MINDED  chap. 

states  of  acute  irritability.  In  the  status  epilepticus, 
too,  better  results  are  likely  to  be  obtained  by 
keeping  the  bowels  open  and  administering,  by 
nasal  tube  if  necessary,  a  liberal  supply  of  nourishing 
liquid  food  than  by  poisoning  the  patient  with  large 
doses  of  chloral  hydrate  or  opium.  Constant  super- 
vision by  night  as  well  as  by  day  is  the  first  require- 
ment in  the  care  of  epileptics.  Fanciful  procedures, 
such  as  the  use  of  pillows  stuffed  with  hay  to  prevent 
suffocation  in  case  the  subject  turns  over  in  a  fit,  are 
a  poor  substitute  for  watchfulness  on  the  part  of 
nurses  and  attendants. 

On  account  of  the  success  which  has  followed  the 
employment,  in  cases  of  cretinism,  of  preparations  of 
the  thyroid  gland  they  have  been  tried  in  many 
other  forms  of  feeble-mindedness.  The  results 
obtained  have  not  been  particularly  satisfactory. 
One  meets  even  with  old-standing  cases  of  what  is 
apparently  cretinism  which  receive  no  obvious 
benefit  from  the  drug.  Some  observers  have 
described  an  amelioration  in  the  condition  of 
epileptics  as  due  to  the  use  of  thyroid  extract,  but 
its  efficacy  in  this  respect  is  not  universally 
admitted. 

In  the  absence  of  conclusive  data  it  is  hard  to  say 
to  what  extent,  if  at  all,  the  feeble-minded  are  more 
susceptible  to  infection  than  normal  personsv  Cer- 
tainly diseases  of  an  infectious  character  are  rife 
among  them  when  they  are  segregated,  but  this  may 
be  due  not  so  much  to  a  lack  of  natural  immunity  as 
to  the  difficulty  of  getting  the  cases  to  conform  to 
sanitary  laws.  Apart  from  the  state  of  the  brain 
there  is  nothing  particularly  characteristic  about  the 


vii  HANDLING  OF  FEEBLE-MINDED  315 

forms  of  disease  from  which  they  suffer,  but  asylum 
dysentery  and  the  chronic  blepharitis  which  is  so 
frequently  associated  with  Mongolism  are  to  some 
extent  special  to  them.  In  tubercular  disease  of  the 
lung  the  foci  are  apt  to  be  more  widely  distributed 
through  the  organ  than  in  the  sane,  thus  adding  to 
the  difficulty  of  diagnosis,  and  tubercular  ulceration 
of  the  small  intestine  is  relatively  common,  apparently 
because  the  patients  swallow  their  sputum  instead  of 
expectorating. 

As  on  the  surgical  side  the  mental  state  places 
obstacles  in  the  way  both  of  examination  and  of 
treatment.  The  prognosis  in  ophthalmia,  for 
example,  cannot  be  regarded  as  good  when  the 
patient  takes  every  opportunity  of  rubbing  dirt  into 
the  eye,  and  it  is  of  little  use  to  prescribe  a  scanty 
liquid  diet  for  an  idiot  suffering  from  enteric  fever 
unless  at  the  same  time  one  takes  measures  to  pre- 
vent his  eating  the  bed-clothes. 

There  remains  a  factor  of  which  the  importance 
is  apt  to  be  overlooked.  The  wonders  performed 
by  medical  and  surgical  art  are  rendered  possible  by 
the  capacity  for  repair  with  which  organisms  are 
endowed.  Like  other  manifestations  of  vitality,  the 
processes  of  regeneration  are  under  the  influence  of 
the  nervous  system,  and  while,  in  the  normal  person, 
the  mode  of  operation  of  the  vis  medicatrix  naturce 
is  obscure  enough,  the  potentialities  of  a  nervous 
apparatus  which  is  out  of  gear  are  such  as  to  baffle 
the  ingenuity  of  the  most  acute  mind. 


INDEX 


Abbreviations,  22 

Abortion,  164 

Ackworth  Reformatory,  276 

Acquired  characters,  transmission 

of,  176 
Adenoma  sebaceum,  239 
Affection,  6,  47,  51 
Affection  and  moral  defect,  190 
Affection  in  feeble-mindedness,  74, 

.75 
Affective  tone,  6 

Agrammatism,  84 

Agyria,  104 

Alcoholic  diathesis,  162 

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

174 
Alphabet,  304 

Alternation  of  generations,  153 
Alt-Scherbitz,  275 
Amaurotic  family  idiocy,  254 

infantile  type,  254 

juvenile  type,  256 
Ambidexterity,  87,  124 
Amblystoma,  154 
Amentia,  133 
Amoeba,  47,  51,  139 
Amphibia,  58 
Amyloid  bodies,  no 
Ankle-clonus  in  the  feeble-minded, 

124 
Anoia,  242 

Answers  of  the  Judges,  198 
Aphasia,  83,  248 
Aphonia,  82 
Aphthongia,  82 
Archi-cortex,  58 
Archi-pallium  59 


Artificial  selection,  163 
Artistic    capacity    in    the    feeble- 
minded, 90,  91 
Asexualisation,  267 
Association  areas,  60 
Association  centres,  56 
Association  in  feeble-mindedness, 

Asymmetry  and  epilepsy,  100 

cerebral,  1 1 1 

of  brain,  99 

of  head,  119 
Atavism,  151 
Ateleiosis,  206 
Attention,  14,  15,  65,  302 

in  feeble-mindedness,  76,  'j'j 

involuntary,  14 

tests  for,  297 

voluntary,  14 
Auditory  centre,  66 
Automatism,  20 
Axolotl,  154 


B 


Babinski  reflex,  124 

Belmont  Asylum,  95 

Bioplasm,  43,  46,  52,  139,  140,  141, 
164,  177 

Birth,  incidents  of,  165 

Blended  inheritance,  146 

Blindness,  81 

Blood-vessels,  intra-cranial,  114 

Boarding  out,  273 

Bourdon's  method  of  testing  atten- 
tion, 297 

Bradylalia,  82 

Brain,  as  organ  of  mind,  34 


317 


818 


INDEX 


Brain  of  "  Fred,"  218 
Brain  of  "  Joe,"  218 
Brain,  weight  of,  96 

in  the  feeble-minded,  no 
Brain,  weight  of  in  relation  to  body 
weight,  127,  128,  129 

height,  127,  129,  130 
Bridgman,  Laura,  case  of,  167 


CephaHc  index,  119,  130 
Cerebellum,  62 

abnormality  of,  104 
Cerebral   congestion    as   cause   of 

feeble-mindedness,  167 
Cerebral  cortex,  98 

functions  of,  63 

measurements  of,  106 

structure  of,  63 
Cerebral  degeneration,  109 
Cerebral  levels,  62 
Cerebroplegia,  166 
Cerebro-spinal  fluid,  114 

excess  of,  132 
Cerebrum,  relative  weight  of,  98 

convolutional  pattern  of,  loi 
Children  Act,  1908,  288 
Classification,  principles  of,  180 

systems  of,  181 
Colloid  bodies,  no 
Conation,  17 
Concept,  15 
Conduct,  levels  of,  308 
Consanguinity,  162 
Consciousness,  2,  16,  30 
Conservation  of  energy,  37,  44 
Control  of  the  feeble-minded,  281 
Copper-workers  andfeeble-minded- 

ness,  172 
Corpora  amylacea,  238 
Corpora  arenacea,  237,  238 
Corpus  callosum,  absence  of,  108 
Cortico-rubro-spinal  system,  61 
Craniectomy,  311 
Cretinism,  181,  183,  229,  260,  314 

and  goitre,  233 

and  Mongolism,  235 

endemic  forms,  234 

myxoedematous  form,  232 

nervous  form,  232 

sporadic  form,  234 

thyroid  preparations  in,  229 


Cretins,  asylums  for,  229 
Criminal  responsibility,  198 
Cutaneous  sensibility,  tests  for,  297 


D 


Darenth  Asylum,  95,  120,  241,  288 

Definitions  adopted  by  the  Royal 
Commission  on  the  Feeble- 
Minded,  185 

Degeneration,  cerebral,  109 

Delusion,  88 

Dementia,  132,  133 

Determinants,  140 

Developmental  errors,  forms  of,  131 

Development,  factors  in,  135 

Didinium,  48,  50 

Dimorphism,  seasonal,  154 
sexual,  146 

Diplegia,  248,  258,  312 

Diplegic  forms  of  feeble-minded- 
ness, 249 

Discrimination,  49 

Dominant  characters,  148 

Duahsm,  35 

Dura  mater,  115 

Dysarthria,  81 

Dyslogic  speech  defects,  83 


Ears,  peculiarities  of,  among  the 

feeble-minded,  117 
East  Harling  Reformatory,  276 
Ebbinghaus'     method    of    testing 

memory,  298 
Echolalia,  85 
Educability,  72 
Education,  269,  300,  305 
Ego,  13,  16,  17,  18,  30,  65,  71,  88 
Elementary  Education   (Defective 

and  Epileptic  Children)  Act, 

1899,  282,  290 
Emotion,  9,  21,  74 
expression  of,  10 
"  Energetische  Situation,"  44 
Engramm,  45,  52 
Environment,  144 

influence  of,  135,  136,  163,  164 
Ependyma,  113 
Epicanthus,  209,  210 
Epicritic  system,  4 


INDEX 


319 


Epilepsy,  i88,  259,  313 

and  sclerosis,  1 12 

in  Mongolism,  211 

relation  of  to  paralysis,  260 
Epileptiform  seizures  in  epiloia,  242 
Epiloia,  242 

epileptiform  seizures  in,  242 

prognosis  in,  243 

renal  conditions  in,  241 
Epiloiac  type  of  feeble-mindedness, 

235 
Exclusive  inheritance,  146 
Exercise  of  muscles,  303 
Eyes,  peculiarities  of,  among  the 

feeble-minded,  116 


Familial  forms    of  feeble-minded- 
ness, 254 
Family  history,  291 
Farm  colonies,  274 
Feeble-minded,      examination      of 
mental  condition  in  the,  294 
physical,  293 
medical  and  surgical  treatment 

of  the,  311 
number  of  the,  262 
procedure   on   admission   to   in- 
dustrial colony,  290 
workhouses,  284 
religious  training  of  the,  308 
Feeble-mindedness,  apathetic  forms 
of,  185 
causes  of  popularly  assigned,  174 
excitable  forms  of,  185 
forms  of  as   recognised  by  the 

Royal  Commission,  185 
nature  of,  70 
primary  and  secondary  types  of, 

183 
table  of  alleged  causes  of,  174 
Feeling,  9 

Fertility  of  insane  stocks,  160 
Free  will,  17 

Fright  as  cause  of  feeble-minded- 
ness, 167 


Gemmules,  140 

General  paralysis,  168,  251 


Germ-plasm,  156,  179 

Gesture,  81 

Gliosis,  no 

Goitre  and  cretinism,  233 

Granulation,  in 

Graves'  disease,  260 

Gregarines,  46 


H 


Head  measurements,  119,  215 
Hearing,  tests  for,  296 
Heart,    weight   of    in    the  feeble- 
minded, 125 
Height  in  relation  to  brain  weight, 

127,  129,  130 
Heilbronner's    method    of   testing 

the  reasoning  powers,  299 
Hemiplegia,  248,  249 
Heredity,  137 

in  feeble-mindedness,  157 
Heterotopia,  104,  107,  238 
Hydrocephalus,  104,  224,  225,  311 

pathology  of,  227 
Hydromyelia,  104 
Hypertrophic  nodular  gliosis,  236 
Hypertrophy  of  scalp,  217,  220 


I 

Idea,  7 

Idea  considered  objectively,  34 

Idealism,  36,  37 

Ideas,  association  of,  12 

Ideas,  kinaesthetic,  9 

Ideation,  7 

Identity  theory,  40 

Idiocy  by  deprivation,  167,  181 

Idioglossia,  84 

Idiots  Act,  1886,  259,  265,  282,  283, 

289 
Idiots  savants,  89 
Imagination,  15,  76 
Inco-ordination,  123 
Index  of  size,  122 
Industrial  colonies,  274 
administration  of,  276 
duties  of  craftsmaster,  280 

craftsmistress,  280 

director,  277 

medical  officers,  279 

steward,  279 
Infantilism,  206 


320 


INDEX 


Inferior  protrusion,  119 
Inheritance,  137,  138,  154 

blended,  146 

exclusive,  146 

mosaic,  146 

particulate,  146 
Innate  tendency,  135,  136 
Insane  diathesis,  156,  160,  162 
Instinct,  21,  78,  79 
Instinctive  activities,  20,  61,  74 
Instinct,  varieties  of,  21 
Intellectual  feeble-mindedness,  201 
"  Intellectualisirung,"  27 


J 


Judgment,  13,  14,  29,  76 

rudimentary,  29 
Juvenile  form  of  general  paralysis, 
251 

pathology  of,  253 


K 


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

Keller,  Helen,  case  of,  167 

Kidney,  tumours  of,  238 

Kidney,  weight  of  in  feeble-minded, 
125 

Knee-jerk  in  feeble-minded,  124 

'  Korrekturbildung,"  131 

Kraepelin's  method  of  testing 
attention,  297 


Lalhng,  83 

Language,  22,  65 

Law  of  ancestral  inheritance,  145 
151,  160 

Law  of  filial  regression,  151 

Law  of  healthy  birth,  142,  152 

Lead-workers  and  feeble-minded- 
ness, 172 

Left-handedness,  124 

Lethal  chambers,  provision  of,  267 

Lisping,  82 

Little's  disease,  165,  248,  258 

Liver,  weight  of,  in  feeble-minded, 
125 


Local  Government  Board  Orders, 

286,  287,  288 
Lunacy  Act,   1890,   259,  284,   285, 

286,  288,  289,  290 
Lunacy  Commission,  157,  186,  189, 

261,  285 
Lunatics  in  workhouses,  284 


M 


MacNaghten  case,  198 

Macrocephalic     type     of     feeble- 
mindedness, 223,  260 

Macrocephaly  due  to  bone-disease, 
224,  225 

Macrogyria,  102 

Malaria,  172 

Mastigophora,  46 

Materialism,  35 

Maternal  impressions,  165,  174 

Mathematical  capacity   in    feeble- 
mindedness, 89,  90 

Megalencephaly,  224,  228 

Memory,  6,  15,  302 
in  the  feeble-minded,  72,  73 
tests  for,  298 
unconscious,  30,  31 

Mendehan    inheritance,    147,    149, 
160 

Meninges,  114 

Meningo-encephalitis,  252 

Mentally  defective  persons,  classes 
of,  290 

Mesoglia,  no 

Metagenesis,  153 

Metropolitan  Asylums  Board,  120, 
286,  288 

Metropolitan  Poor  Act,  1867,  286 

Microcephalic     type     of     feeble- 
mindedness, 214,  260 

Microcephaly,  311 
pathology  of,  216 

Microgyria,  102,  104,  112 

Mind  and  brain,  39 

Mind  as  a  secretion,  37 

Mirror  writing,  86,  87 

Mneme,  45,  71,  127 

Model  village,  scheme  of,  275 

Modification,  177 

Mongolian  imbeciles,  118 

Mongolian  type  of  feeble-minded 
ness,  208 

Mongolism,  259,  315 


INDEX 


321 


Mongolism  and  cretinism,  235 

and  epilepsy,  211 

pathology  of,  212 

signs  of,  208 
Monism,  35,  40 
Mood,  10 
Moral,  as  distinct  from  intellectual, 

defects,  189 
Moral  capacity,  examination  of,  300 
Moral  defect  and  affection,  190 
Moral  defect  in  children,  190 
Moral  feeble-mindedness,  1 89 

characters  of,  192 

contentious  type  of,  196 

diagnosis  of,  197 

etiology  of,  196 

forms  of,  193 

mendacious  type  of,  194 

pathology  of,  196 

sexual  type  of,  195 

unstable  type  of,  193 
Mosaic  inheritance,  146 
Motility,  origin  of,  52 
Motor  area,  56,  59 
Mouth,  condition  of,  in  the  feeble- 
minded, 117 
Multiple  personality,  30,  31 
Muscular     abnormalities     in     the 

feeble-minded,  123 
Mutation,  142,  156,  177 
Myehnation,  104,  126 


N 


National  Froebel  Union,  307 
Natural  Selection,  144,  163,  178 
Neo-pallium,  59,  60 
Nerve  cells,  embryonic  type,  97 

nature  and  relation  of,  96 
Nervous  system,  development  of,  57 
Nervous  tissue,  54 
Neuroglia,  97,  no 

contraction  of,  in 

hypertrophy  of,  no 
Neurone  theory,  55 
NissFs  substance,  126 
Noird's  theory,  28 


Object  lessons,  303 
Ontogeny,  150 


Opiates  as  cause  of  feeble-minded- 
ness, 172 

Organs,  nature  of,  139 

Origin  of  speech,  27 

Osteoid  plates  in  spinal  pia- 
arachnoid,  115 


Pachygyria,  102 

Paedogenesis,  154 

Pain,  48,  64 

Palaeo-cortex,  58 

PaliEO-pallium,  59 

Palate,  condition  of,  in  the  feeble- 
minded, 117 

Pangens,  140 

Paracentesis,  3n 

Paraldehyde,  use  of,  313 

Paralysis,  123,  312 
forms    of,    among     the     feeble- 
minded, 248 
relation  of,  to  epilepsy,  260 

Paramoecium,  48,  139,  142 

Particulate  inheritance,  146 

Passion,  10 

Pathological  lying,  191 

Pauper    Inmates     Discharge    and 
Regulation  Act,  1871,  289 

Percept,  8,  15 

Perseverance,  6,  ']2i 

Phylogeny,  150 

Physical  characters  of  the  feeble- 
minded, 92 

Pia-arachnoid,  114 

Pigmentation  of  nerve  cells,  97 

Plasson,  46 

Pleasure,  48,  64 

Plegic  forms  of  feeble-mindedness, 
247,  260 

Poor  Law  Act,  1899,  289 

Porencephaly,  103,  114,  221 

Pre-established  harmony,  40 

Presentation,  4 
in  feeble-mindedness,  72 

Prevention  of  Cruelty  to  Children 
Act,  1904,  288 

Progressive  forms  of  feeble-minded- 
ness, 250 

Proteomyxa,  46 

Protopathic  system,  4 

Protophyta,  4 

Protozoa,  46,  48,  51,  55 


322 


INDEX 


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

"  Psycho-physischen  Wechselwirk- 
ung,"  36 


R 


Reaction,  44 

Reality,  38,  39 

Reasoning,  14,  29,  76 

Reasoning,  tests  for,  299 

Recessive  characters,  148 

Recollection,  15 

Reflex  activity,  20,  65 

Reflexes  in  the  feeble-minded,  124 

Renal  conditions  in  epiloia,  241 

Re-presentation,  6 

in  feeble-mindedness,  73 

Reptiles,  59 

Residual  forms  of  feeble-minded- 
ness, 258,  261 

Responsibility,  criminal,  198 

Reversion,  150 

Rhabdomyoma,  238 

Rickets  in  the  feeble-minded,  228 

Royal  Commission  on  the  Care 
and  Control  of  the  Feeble- 
Minded,  90,  158,  159,  161, 
170,  173,  175,  176,  185,  187, 
189,  190,  262,  268,  271,  272, 
273,  274,  276,  277,  283,  289, 
290 


Sagitta,  179 

Scalp,  hypertrophy   of,     116,    217, 

220 
Scanning,  82 

Sclerose  hypertrophique,  235 
Sclerosis,  104,  iii,  228 

hypertrophic,  236 

of  cornu  Ammonis,  112 

tuberose,  112,  236,  239,  241,  242, 
259 
Seasonal  dimorphism,  154 
Selection,  artificial,  163 


Selection,  natural,  163,  178 
Self,  88 

Self-consciousness,  65 
Sensation,  4 

auditory,  5,  51 

cutaneous,  4,  61 

epicritic,  4 

gustatory,  5 

kinaesthetic,  5 

labyrinthine,  5 

motor,  5 

olfactory,  5 

organic,  4,  9 

protopathic,  4 

tactile,  51 

visceral,  5,  62 

visual,  5 
Sense  organs,  302 

in  the  feeble-minded,  116 
Sensitiveness  to  stimulation,  tests 

for,  297 
Sentiment,  15,  76,  191 
Sexual  dimorphism,  146,  149 
Sex  limitation,  147 
Sight  testing,  295 
Simian  characters  in  microcephaly, 

218 
Skull-cap,  115 
Slurring,  82 
Smell,  tests  for,  297 
Solipsism,  37 
Soul-substance,  35 
Speech,  23,  65,  79,  80,  304 

centres,  66,  67,  68 

emotional — volitional,  27 

motor  defects  of,  83 

origin  of,  27 

psychic  defects  of,  82 

sensory  defects  of,  8^ 
Spinal  cord,  abnormality  of,  104 
Spleen,  weight   of,   in   the  feeble- 
minded, 125 
Stammering,  82 
Status  epilepticus,  314 
Stigmata,  108 
Stimulation,  3,  44 

ekphoric,  45 
Strains  and  stresses  in  relation  to 
feeble-mindedness,  164,  166 
Stuttering,  82 
Sub-consciousness,  30,  31 
Symbols,  22 
Synapse,  55,  107 
Syphilis,  168 


INDEX 

Volition,  14,  17,  49,  65 


323 


Tartar  type  of  the  feeble-minded, 

208  W 

Taste,  tests  for,  296 
Technitella,  48,  50 
Teeth,  condition  of,  in  the  feeble-      Wassermann  reaction,  168,  228 

minded,  117  Weight  of  body  in  relation  to  brain 

Telegony,  153  _  weight,  127,  128,  129 

Thyroid    gland,    condition    of,    in      Wild  boys,  167 


cretmism,  231 
Tics,  79,  124 
Torus  palatinus,  118 
Toxic  agencies,  167 
Transmission  of  acquired  characters, 

176 
Truth,  definition  of,  33 
Tubercular  diathesis,  162 
Tuberculosis,  169 

in  the  feeble-minded,  315 
Tuberose   sclerosis,  112,  236,  239, 

241,  242,  259 


Wolf  children,  167 
Word  blindness,  85 
Word  deafness,  85 
Workhouses  in  London,  285 
Writing,  81 


X 


Xenia,  153 


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


Ziehen's  method  of  testing  memory, 
298 


Y    2 


INDEX    OF    AUTHORS 


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

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


B 


Baillarger,  216 

Balbiani,  E.  G.,  48 

Ballet,  G.,  248 

Bateson,  W.,  140,  143,  149,  150 

Baumgarten,  171 

van  Beneden,  E.,  46 

Berkhan,  O.,  215 

Biach,  P.,  214 

Binet,  A.,  6,  48 

Bircher,  E.,  233 

Bircher,  H.,  233 

Bolton,  J.  S.,  63,  97,  106,  132 

Bonfigli,  R.,  237,  241,  242 

Booth,  B.,  158 

Bosbauer,  H.,  89,  167 

Bose,  J.  C.,  49 

Bourdon,  297 

Bourneville,  171,  182,  235,  236,  239, 

240,  241,  260 
Brill,  A.  A.,  75 
Brissard,  E.,  236 
Brooks,  H.,  257 
Browne,  J.  Crichton,  190 
Buchner,  P.,  179 
Budin,  P.,  171 
Bufe,  E.,  214 


Campbell,   A.   W.,   237,  238,   239, 

241 
Carpenter,  G.,  223 
Chaloner,  J.  A.,  265 
Cimbal,  299 
Condillac,  73 
Coquelin,  10 
Craig,  M.,  171 
Cramer,  A.,  190,  200 
Crocker,  H.  Radcliffe,  247 
Crowley,  283 
Cullen,  J.  P.,  213 
Cunningham,  D.  J.,  217 


D 

Darwin,  C,  140,  154,  217 
Dean,  H.  R.,  168,  228 
Delbriick,  194 
Dendy,  M.,  170 
Descartes,  R.,  40 
Dickson,  W.  E.  C,  237 
Dobson,  M.  B.,  237,  241 
Dubois,  128,  129 


Earland,  A.,  48 
Ebbinghaus,  298 
Eichholz,  A.,  159 
Eisler,  R.,  36,  '},'] 
Elderton,  E.  M.,  170,  176 
Esquirol,  80,  181 


INDEX   OF   AUTHORS 


325 


Ferrero,  F.,  230 
Findlay,  J.  J.,  268 
Fischer,  M.,  265 
Fisher,  J.  H.,  86 
Flechsig,  P.,  56,  61,  104 
Fletcher,  H.  M.,  213 
Fcerster,  312 
Fowler,  J.  S.,  237 
Frankel,  303 
Frazer,  A.,  103 
Freud,  S.,  75,  76,  249 


Galton,  F.,  10,  145,  151 

Garbutt,  283 

Geitlin,  238,  239 

Gilford,  H.,  208 

Gladstone,  R.  J.,  95,  119,  120,  121, 

122,  123,  130 
Glen,  289 
Griesinger,  167,  229 


H 


Haldane,  R.  B.,  39 

V.  Hansemann,  D.,  228 

Harper,  96 

Head,  H.,  4 

Heilbronner,  299 

Heller,  T.,  83,  87,  89,  90,  166,  167, 

172,  183,  184,  185,  303,  310 
Herfort,  K.,  133,  134,  242 
Heron-Allen,  E.,  48 
Heron,  D.,  157,  159,  160,  162,  166 
Hicks,  J.  A.  Braxton,  96,  99 
Holmes,  G.,  256 
Hornowski,  241 
Huismans,  L.,  258 
Huschke,  99,  214 
Huxley,  T.  H.,  2 


Illingworth,  W.  H.,  90 

Ireland,  W.  W.,  93,  125,  181,  215, 

232 
Isserlin,  M.,  75 


J 


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


K 


Kant,  I.,  40 

Kellogg,  V.  L.,  141 

Klebs,  G.,  144 

Knoepfelmacher,  W.,  227 

Kolle,  F.  174 

Kraepelin,  E.,  185,  189,  196,  297 

Kussmaul,  62,  67 


Lange,  10 

Langmead,  F.,  213 

Lankester,  E.  Ray,  43,  46    161 

Legrand  du  SauUe,  164 

Lehndorff,  H.,  227 

Leibniz,  G.  W.,  40 

Lewis,  Bevan,  97 

Lichtheim,  67 

Liebmann,  84 

Little,  W.  J.,  165,  248,  249 

Locke,  J.,  38 

Loeb,  J.,  141,  144,  164 

Lotze,  R.  H.,  37 

Lugaro,  E.,  38,  126 


M 


MacDougal,  D.  T.,  144 

Mackenzie,  T.  C.,  234 

Maier,  H.  W.,  189,  192,  197 

Marshall,  H.  R.,  48 

Mason,  300 

Mayou,  M.  S.,  257 

McCarrison,  R.,  232,  233,  260 

McDougall,  W.,  16,  21,  308 

Mendel,  G.  J.,  147 

Mercier,  C.  A.,  17,  157,  199,  200 

Meumann,  E.,  25,  26,  27,  29 

Meyer,  R.,    178 

Miklas,  L.,  89,  167 

Mill,  J.  S.,  36 

Millard,  K.,  224 


326 


INDEX  OF  AUTHORS 


Mingazzini,  G.,  217 
Mitchell,  W.,  39 
V.  Monakow,  107 
de  Montet,  Ch.,  237,  238,  239 
Morgan,  C.  Lloyd,  16,  49,  163 
Mott,  F.  W.,  256 
Miinsterberg,  H.,  31,  38 
Myers,  C.  S.,  62 


N 

Needham,  F.,  309 

Nissl,  196 

Norman,  Conolly,  103 


Oekonomakis,  102 
Oppenheimer,  H.,  198 


Pariset,  203 

Parr,  R.  J.,  170 

Parsons,  J.  H.,  256 

Paulsen,  F.,  40 

Pearson,  K.,  170 

Piper,  174,  175 

Pocock,  R.  J.,  148 

Potts,  W.  A.,  158 

Poynton,  F.  J.,  213,  255,  256 

Preyer,  W.  T.,  27 

Pringle,  J.  J.,  247 


Raehlmann,  62 

Raid,  G.  Archdall,   137,   143,    144, 

149,  151,  163,  175,  177,  302 
Ribot,  Th.,  18,  20 
Rivers,  W.  H.  R.,  4 
Robertson,  W.  Ford,  98,  109,  no, 

120,  132,  234 
Romanes,  G.  J.,  30 
Rondoni,  P.,  253 
Roque,  172 
Rudzki,  241 
Rzesniezek,  24 


Sachs,  B.,  255,  256,  257,  258 

Sailer,  J.,  236 

S chaffer,  K.,  256 

SchelHng,  F.  W.  J.,  40 

Schenker,  G.,  169 

Schiner,  H.,  89,  167 

Schmiedel,  25 

Schneider,  E.,  226 

Schwalbe,  E.,  102,  108,  215,  221 

Schwenk,  174,  175 

Seguin,  E.,  172,  203,  224 

Semon,  R.,  12,  44,  45,  52,  71 

Sengelmann,  89 

Shand,  A.  F.,  16 

Sherren,  J.,  4 

Sherrington,  C.  S.,  51,  65 

Shuttleworth,  G.  E.,  212 

Smith,  G.  Elhot,  58,  59 

Sollier,  P.,    18,  118,  125,  133,  184, 

239 
Spencer,  H.,  40,  46,  50,  52,  53,  139, 

140 
Spinoza,  B.  de,  40 
Stephen,  J.  F.,  199 
Stern,  R.,  260 
Stevens,  B.  C.,  234 
Stewart,  H.  G.,  108 
Stoddart,  W.  H.  B.,  61 
Storring,  67 
Sullivan,  W.  C.,  171 
Sully,  J.,  29,  300,  301 
Sutherland,  G.  A.,  213 


Tanzi,  E,  133,  234,  249 

Tay,  Waren,  255,  258 

Telford-Smith,  T.,  217 

Thomas,  C.  J.,  86 

Thomson,  J.  A.,  137,  138,  140,  141, 

150,  151 
Titchener,  E.  B.,  6,  20,  51,  T] 
Tracy,  F.  27 
Tredgold,  A.  F.,  91,  97,  166,  183 


V 


Vierordt,  25 
Virchow,  216 


INDEX   OF   AUTHORS 


327 


Vogt,  H.,  io8,  212,  237,  238,  239, 

241, 252, 257 

Vogt,  K.,  37,  216,  217 
Voisin,  184 
Volker,  174,  175 
Volland,   241 
de  Vries,  H.,  140 


Weber,  F.  Parkes,  208 

Wegener,  H.,  87 

Weismann,  A.,  140,  143,  154,  156 

Weygandt,  W.,  169,  184,  234 

Wildermuth,  184 

Wilms,  M.,  233 

Wright,  G.  A.,  25,  215,  228 

Wundt,  W.,  7,  40,  51 


W 


Warncke,  P.,  128,  129 
Watson,  G.  A.,  63,  253 


Ziehen,  133,  298 
Zwaardemaker,  5 


Richard  Clay  and  Sons,  Limited, 

bread  street  hill,  e.g.,  ast) 

bungay,  suffolk. 


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