NATURE 



[September 6, 19 17 



tion of English asylums for this purpose, and the 

 compelling want that exists for relaxing the 

 Law of Lunacy, so that cases of insanity may be 

 treated in the unconfirmed stages without the legal 

 certificate — the latter certainly an example of 

 preaching to the converted, as there were two 

 Bills before Parliament for this purpose at the 

 commencement of the war, and the London 

 County Council has since obtained the sanction 

 of law for the treatment of mental illness during 

 its early stages in the Maudsley Hospital, now 

 employed for military mental cases. 



It may be stated here that the authors show a 

 lack of practical knowledge of the law as applied 

 to the insane poor — in whose interests the book 

 pleads — when they state that the granting of the 

 reception order is conditional upon the friends of 

 the insane poor visiting from the outside world. 

 This reception order really only applies to private 

 patients — the richer of the community — and the 

 long experience of the reviewer recalls regulations 

 to limit the number and frequency of visits to 

 asylums for the insane poor rather than the 

 reverse. Nearly one-half of the essay is 

 devoted to the third feature, and, as stated 

 in the introduction, the object of the volume 

 is to rouse a feeling against " the British attitude 

 towards the treatment of mental disorder." 

 Naturally, therefore, and also avowedly., the work 

 is written for the general reader, and not for the 

 medical practitioner,^ and so far as the experience 

 ol the authors is concerned it Is an exceedingly 

 interesting essay; but we cannot subscribe to its 

 views, especially in regard to heredity. We find 

 this statement: "The war . . . has warned us 

 that the pessimistic, helpless appeal to heredity so 

 common in the case of insanity must go the same 

 way as its lugubrious homologue which formerly 

 did duty in the case of tuberculosis. In the causa- 

 tion of the psycho-neuroses heredity undoubtedly 

 counts, but social and material environment count 

 infinitely more." 



In the reviewer's experience, which has been 

 considerable with this class, a family history of 

 insanity, epilepsy, paralysis, neurasthenia, or 

 parental alcoholism has been obtained In 33 

 per cent, of all cases of shell-shock, and 

 probably the correct proportion Is much higher. 

 As those who investigate in this field of Inquiry 

 know, the admission of Insanitv occurring in the 

 family Is not readily made, owing to the stigma 

 attachlns' to it, and pedigrees ascertained are of 

 the briefest kind. In order to be of value the 

 family history should not only enumerate all the 

 members, but also embrace at least three 

 generations. In the absence of this Information 

 it would be Incorrect to state that shell-shock cases 

 presented no neurotic family history. In regard 

 to heredity we know that the Interaction of any 

 two sets of characters may be conditional upon 

 the presence of some third one, such as sex, as 

 In haemophilia, and In certain other diseases which 

 appear In first-cousin marriages, and the charac- 



'■i See also " Psycho-n(5vroses ( 

 (Paris : Mas^on et Cie.) 



Guerre." P.y Drs. Rous.'y and Hennitte. 



NO. 2497, VOL. 100] 



ter upon which these depend being recessive, the 

 diseases would not appear, therefore, until two 

 similar hybrids, each possessing this character, 

 had intermarried. If the disease be rare, two 

 such hybrids are not likely to meet unless they are 

 of the same family, yet there exists a deeply seated 

 defect which is highly hereditary. We have no 

 definite knowledge of what is inherited ; it may be 

 the faulty nutrition of some ancestor, some "in- 

 born error of metabolism " ; at any rate, it is 

 some deeply ingrained defect only curable by 

 extinction of the stock or by its repeated crossing 

 with other more stable stocks. 



We think, therefore, that the authors assert too 

 dogmatically that " there is no anatomical, patho- 

 logical, or chemical evidence of inheritance In the 

 cases of psycho-neuroses " which they had 

 treated. Surely this evidence would not be neces- 

 sary in order to prove the inheritance of disease, 

 which is not ascertained by microscopic or chemi- 

 cal evidence. These conditions are known much 

 more by perverted nervous action than by coarse 

 structural lesions or chemical reaction, and we 

 know that melancholia, epilepsy, paranoia, 

 hysteria, and neurasthenia are not only inter- 

 changeable among themselves, but also definitely 

 inherited, which indicates some deep underlying 

 nervous defect. The reviewer Is of the school 

 which regards heredity as a great factor, and he 

 believes there are few cases of shell-shock which 

 do not Inherit in their nervous system some locus 

 resistentiae minoris, which has tended towards 

 a breakdown at some age or other under 

 the necessary stress. The comparison made by 

 the authors between the heredity of tuberculosis 

 and that of Insanity Is scarcely to the point, for in 

 one instance the disease Is of microbic origin, 

 whilst in the other it is not. However, the 

 authors are men of science who deny that there 

 can be a true Inheritance of any microbic disease, 

 but observation and experience can best supply the 

 test answer In regard to this, and there are few 

 practical physicians who are not prepared 'to 

 admit that the body in which the germinal plasm 

 Is lodged, if deeply affected by exhaustiner disease, 

 may produce far-reaching effects upon this plasm, 

 and consequently upon the offspring, so that a 

 lower resistance to disease, or a greater proclivity 

 or susceptibility, is probably transmitted, and the 

 reviewer thinks it Is not too much to affirm that 

 this lowered resistance may be perpetuated — a 

 thesis which cannot to-day he denied. 



The reviewer is scarcely in agreement with 

 the authors, who adopt so wholeheartedly the 

 exclusively emotional origin of shell-shock as 

 against the physical origin. That shell-shock is 

 entirely of psychic origin and can be overcome by 

 psycho-therapeutics Is too sweeping a statement. 

 In many. If not In most, of these cases there are 

 physical weariness, fatigue, exposure. Insomnia, 

 exhaustion, and Irregular meals — possibly also on 

 occasion malaria and venereal disease ; the re- 

 viewer has known these. Moreover, the state of 

 the vital organs — the heart with its peripheral 

 extensions, the lungs, and the alimentary system^ 



