NA TURE 



301 



THURSDAY, JUNE 14, 1917. 



PSYCHOLOGICAL MEDICINE. 

 Manual of Psychiatry. By Dr. J. Rogues de 

 Fursac and Dr, A, J. Rosanoff. Fourth edi- 

 tion. Pp. xi + 522. (New York: John Wiley 

 and Sons, Inc. ; London : Chapman and Hall, 

 Ltd., 1916.) Price 105. 6d. net. 



WAR has always been the most potent cause 

 of mental and physical suffering among a 

 people ; apart from the many direct injuries such 

 as wounds, sickness, and fever which are inflicted 

 upon the fighting forces. In war, military neces- 

 sities must precede any consideration for the civil 

 population, which experiences "stress and strain," 

 two factors that contribute more than any other 

 to the causation of insanity. For this reason we 

 should expect a greater incidence of insanity dur- 

 ing war than in peace-time ; yet, although this war 

 has lasted nearly three years, and much pain, 

 great sorrow, and almost unendurable grief have 

 been borne, there has been less registered in- 

 sanity than occurred before the war, and on 

 January i, 1916, there were 3278 fewer cases than 

 the year before. The causes for this diminished 

 incidence are many. In the first place, it is a 

 fact of experience that one great emotion is less 

 frequently the cause of insanity than are the many 

 small, but continuing, marginal, sub-conscious 

 worries, which are always just within the limits of 

 consciousness. It is also common knowledge 

 that the working classes as a whole have been 

 better off financially than in peace-time : the 

 enormous demands of the world-war have created 

 work on a colossal scale ; the great industries of 

 the country have been transformed into factories 

 for the output of munitions and into workshops 

 for the production of material for military require- 

 ments, and every responsible civilian capable of 

 useful work has had his or her attention fixed, his 

 or her interests maintained, and his or her domes- 

 tic anxieties relieved. In spite of the greatly en- 

 hanced cost of living, difficulties connected with 

 ways and means have even been less felt than in 

 normal times, so that this diminution may be only 

 temporary and due to social and economic condi- 

 tions. 



Other reasons for the diminished incidence of 

 insanity are, first, the fact that the Liquor 

 Traffic Control Board, exercising its powders 

 under the Defence of the Realm Act, has cur- 

 tailed the opportunities for drink — as alcohol 

 accounts for 20 p>er cent, of all insanity among 

 men, and 10 per cent, among women — and 

 secondly, and probably the main reason, 

 insanity occurring among the five millions 

 of our troops is now unrecorded. This latter 

 fact is of the utmost importance, because in all 

 previous wars the soldier disabled through a 

 mental illness was certified under the Lunacy Act, 

 registered, and removed for treatment into the 

 asylum in which he had a territorial settlement, 

 whilst in the present war no insane soldier has 

 been certified to be insane until he was deemed 

 NO. 2485, VOL. 99] 



to be incurable. When insane, he is now de- 

 tained under Military Law and maintained in a 

 "military hospital," the latter in many instances 

 a county asylum taken over by the War Office 

 exclusively for the treatment of the soldier. This 

 procedure has been adopted in order to avoid the 

 possible stigma of having suffered from an attack 

 of insanity should the soldier recover and desire 

 to re-enter civil life. In giving sanction to this 

 policy the Director-General of the Army Medical 

 Department has acted wisely and considerately 

 towards the insane soldier, and up to the present 

 the experiment has worked satisfactorily, and it 

 is because of this separate management of the 

 mentally disabled soldier that a review of a text- 

 book upon insanity is both appropriate and oppor- 

 tune. 



This text-book by Dr. de Fursac is well known 

 in this country, and its popularity is confirmed by 

 the fact that this is its fourth edition ; but it is in 

 the main an American revision, and out of more 

 than 350 references to authors in the text-book 

 not above a dozen refer to English contributors. 

 As in most American works upon mental diseases, 

 the classification of insanity comes from Germany : 

 the scheme is confused ; it classifies insanity partly 

 ufx>n the basis of factors of causation, e.g. 

 alcoholic insanity, syphilitic insanity, thyrogenic 

 insanity, and partly upon the • form of the 

 mental disorder^ so that a case may be in more 

 than one group at the same time, and the groups 

 are, therefore, not mutually exclusive. More- 

 over, the terms "manic-depressive insanity" and 

 " dementia precox " find a prominent place. They 

 refer, of course, to the varieties "alternating in- 

 sanity" and "primary dementia" of our English 

 classification. In regard to the technicalities of 

 certification — a matter of vital importance to the 

 family physician and to the general practitioner— 

 the text-book is useless. It refers to "commit- 

 ment " as the equivalent of certification, and upon 

 this point of procedure it affords no guide accord- 

 ing to English, Scottish, or Irish law. Neverthe- 

 less, the work is a helpful and instructive manual 

 to the student of psychiatry. 



Under aetiology, a section is introduced 

 up>on the Mendelian theory, which is not 

 yet perfect enough to deal with the com- 

 plex mental characters of human beings. In 

 the mental constitution of human beings it is 

 certain that " the segregation of unit-characters " 

 does not occur, because the mind of each person 

 is a hybrid blend, and the blended conditions ap- 

 pear in succeeding generations. The so-called 

 law of dominance is quite an irregular phenome- 

 non in Mendelism, as we know from the crossing 

 of the "Chinese" with the "star" variety <5 

 primula, the cross between these two types being 

 intermediate in form and easily distinguishable 

 from either of the pure types, the characteristics 

 having become blended. In human beings 

 mental characteristics are complex states and not 

 segregated units. There is no " purity " in the 

 reproductive cells with regard to these characters, 

 i.e. the hybrid condition that results as a blend 



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