November 17. 192 1I 



NATURE 



l^l 



mentally painful emotional tone, is also discussed 

 briefly. His theory of repression of painful ex- 

 periences and mental conflict are referred to, but 

 no mention is made of infantile repression, the 

 theory of erogenous, zones, and the analysis of 

 dreams and their significance, to which so much 

 importance is attached by psycho-analysts. We 

 are of opinion that a fuller account and criticism 

 of Freud's theories, whether the author is in 

 agreement therewith or not, would have been of 

 service to the student and practitioner. Whatever 

 view Prof. Buckley takes of the Freudian theories 

 he certainly is not in agreement with treatment 

 by psycho-analysis, for he says : — 



"The matter of psycho-analysis has as yet not 

 reached its proper level. Until that condition has 

 been reached it would be well to accept those 

 portions of it that can be demonstrated beyond 

 hypothetical bounds to be of real value and avoid 

 as far as possible going out of the way to inject 

 into the fatigued patient's mind a score of ideas 

 which though ' submerged ' in the unconscious, 

 possibly may do less harm than if brought to the 

 patient's realisation." 



Another matter which we have indicated previ- 

 ously as arousing public interest and exciting an 

 uneasy feeling in a large section of the public at 

 the present time is the failure to adopt hospital 

 methods of treatment of recoverable cases in our 

 large asylums in accordance with medical science. 

 At present these institutions are, generally speak- 

 ing, mental hospitals only in name. They appear 

 in a large number of instances to be really institu- 

 tions of detention in which recoverable cases are 

 herded together with, and treated in the same old 

 institutional manner as, the chronic and senile 

 cases. The superintendent of an institution in 

 which the majority of cases demand merely ad- 

 ministrative duties tends to grow out of 

 touch with medical science and progress. 

 Mental hospitals for the recoverable cases are 

 urgently needed in which medical officers are able 

 to apply hospital methods of psychological, 

 clinical, and laboratory investigation of the 

 patients committed to their care. 



Methods are described and their utility in 

 diagnosis, prognosis, and treatment are admirably 

 discussed by Prof. Buckley, who, from the follow- 

 ing paragraph in the preface, clearly emphasises 

 the importance of treating the bodily condition : — 



"As physicians and practitioners we have come 

 to consider the group of mental disorders which 

 belong to the class of recoverable psychoses, not 

 primarily as mental diseases, but as reflections of 

 some bodily disorder, which through its effect 

 upon the organ of adjustment, the nervous me- 

 chanism and its lower and higher (psychic) re- 

 NO. 2716, VOL. 108] 



flexes prevents the patient from making the neces- 

 sary appropriate adaptations to environmental 

 conditions, and therefore constitutes a thoroughly 

 biological problem." 



The author gives three fundamental groups of 

 factors in the production of mental disorders. 



" (i) The biogenetic factor dependent upon defects 

 of development, either structural or functional; 



(2) disturbances of function brought about by 

 toxic agents either exogenous or endogenous; 



(3) organic neuronic changes, occurring either as 

 primary disintegrative processes or structural 

 changes secondary to pathologic conditions in 

 non-neuronic structures." 



The most important question in reference to 

 the etiology, prognosis, and treatment resolves 

 itself into the matter of determining first of all 

 to which of these three groups the case belongs. 

 After eliminating the psychoses which may be the 

 result of bodily disturbances there remains a 

 group of biogenetic psychoses comprising de- 

 mentia prsecox and the manic-depressive psy- 

 chosis, "which develop upon an inherently defec- 

 tive foundation." "The dementia praecox patients 

 present an original defect, which is intensified by 

 some as yet unknown operative cause." The 

 author does not refer to the researches of Mott 

 upon the reproductive organs, who has shown a 

 primary, germinal, regressive atrophy of the testis 

 and ovary, which he correlates with the primary 

 nuclear degeneration of the neuron affecting first 

 the highest evolutional level. Nor does he refer 

 to the same observer's researches upon the ages 

 of admission to asylums of more than 3000 rela- 

 tives, showing that the offspring of insane parents 

 exhibit a marked tendency to have their first 

 attack at a much earlier age. ' This antedating or 

 anticipation tends to elimination of the unfit by 

 bringing the disease on in adolescence, rendering 

 the subject unable to compete with his fellows, 

 and antisocial, thereby necessitating segregation. 

 These psychoses are not peculiar to civilised races, 

 and are doubtless due to germinal variation. 



Nevertheless, Prof. Buckley's work is excellent 

 and calls for little criticism, though we are of 

 opinion that the pathology of mental diseases is 

 not on the same high level and as up-to-date as 

 the clinical and therapeutic portions of it. To 

 take an example, in discussing the symptoms of 

 myxoedema the author does not refer to the fact 

 of the diminution and, in extreme cases, of the 

 disappearance of the Xissl substance in the 

 neurones, while the important functions of the 

 cortex adrenalis are not mentioned. 



There are seventy-nine excellent illustrations, 

 mainly anatomical, psychological, clinical, and 



