482 



NA TURE 



[SErTEMBER I 7, 1 908 



initiated — and tlie testimony of many witnesses who 

 gave evidence before tliis commission gives tiie fact 

 publicity — that vagrancy, prostitution, petty delin- 

 quencv, pauperism, and inebriety are the pitfalls into 

 VN-hich numbers of the poorer and less protected feeble- 

 minded ultimately stumble. 



Mentally defective children do not, however, by any 

 means exhaust the category of persons requiring to 

 be dealt with in any scheme of reform aiming at 

 comprehensiveness. In illustration let us take the 

 question of delinquency. .Vniong feeble-minded delin- 

 quents two classes may be distinguished : — (i) Intellec- 

 tually feeble persons in whom the moral sense is either 

 practically wanting or so imperfectly developed as to 

 afford no guide for conduct. (2) Those in whom the 

 intellectuaf faculties are of average development, but 

 who are either morally perverted or who possess such 

 feeble moral resistance when the mind is crossed by 

 certain emotional currents as to be practically irrespon- 

 sible. Now it is evident that nersons of the second 

 class may up to adult age evade all ordinary tests 

 applied for the detection of feeble-mindedness and 

 afterwards manifest bv their conduct such persistent 

 moral obliquity as to raise the question of their mental 

 responsibility. Many such persons pass most of their 

 time in gaol as short-sentence prisoners, repeatedly 

 convicted week after week on account of drunkenness, 

 breaches of the peace, pilfering, &c. It may be that 

 most of them are inebriates, but they are, in addition, 

 weak-minded, irritable, profligate, and lacking in self- 

 control in other directions than indulgence in alcohol. 

 The entire uselessness of these repeated convictions is 

 apparent, and the expenditure of money upon police, 

 judicial procedure, and maintenance in prison must 

 necessarily be greater than if these individuals, in 

 accordance with the recommendations of the commis- 

 sioners, were committed to homes or colonies on 

 indeterminate sentences, where they might, to a certain 

 limited extent, at any rate, be partially self-supporting. 

 The recommendations in the report would make it 

 obligatory upon the police and prison authorities to 

 report such cases to the local authority, and upon the 

 medical officer of the latter to act upon such reports. 



In order that such notification may be of practical 

 utility, it is necessary to reform the procedure under 

 the various criminal lun.acy acts. To this end the 

 commissioners recommend that when a court of sum- 

 mary jurisdiction is of opinion that a person charged 

 is mentally defective the court may (i) remand the 

 person charged to a receiving house or institution for 

 observation, or (2) make out a summary order for 

 the reception of such a person into an institution on 

 the certificate of the medical officer, or (3) after con- 

 viction may hand him over to the care of an officer 

 of the local authority who becomes surety for his 

 conduct. Such a person would remain under the care 

 of the local authority until it sees fit to discharge 

 him. Similarly in assize and quarter sessions' cases 

 the justices may hand a feeble-minded prisoner over to 

 the local authority pending trial; or when brought to 

 trial the court may direct that the accused be sub- 

 mitted to examination, and, if necessary, certification, 

 notwithstanding that he has been acquitted of the 

 offence charged, if it is considered desirable that pro- 

 vision should be made for his care. 



The analysis of the various types of the mentally 

 defective, with their peculiarities and special dangers 

 and inconveniences to society, and the many sugges- 

 tions in the report for dealing with them, might be 

 indefinitely prolonged and criticised, but sufficient has 

 been said to indicate the wide scope of the field 

 traversed by the commissioners. It remains to 

 examine cursorily the machinery which the commission 

 proposes for carrying out its recommendations. With 

 NO. 2029, VOL. 78] 



logical consistence it urges that one central authority 

 in each of the three kingdoms should have the control 

 of all the mentally afflicted, and that that authority 

 should be the existing lunacy commissions, enlarged 

 and suitably equipped for the purpose. The advantage 

 of having one central authority to supervise the care 

 of all classes of the msane is apparent, and the with- 

 drawal of certain classes of the insane from the control 

 of such departments as Education and Local Govern- 

 ment, where official interests are necessarily directed 

 into totally different channels, needs no apology. 

 Moreover, experience amply shows that progress in 

 scientific and administrative knowledge is best attained 

 when those at the head of any such department have 

 at any rate such interest in its welfare as to encourage 

 scientific pursuit in connection with it. With equa) 

 wisdom it recommends the utilisation of existing local 

 authorities — in England and Ireland a statutory com- 

 mittee of county councils or borough councils, as the 

 case may be, and in .Scotland the district lunacy 

 board. These local authorities shall, subject to the ' 

 supervision of the central authority, have the entire 

 control of all insane, feeble-minded, or mentally 

 affected persons within their jurisdiction who are not 

 otherwise adequately cared for privately, and it shall 

 be their duty to provide such accommodation as is 

 suitable to the various classes, e.g. asylums for the 

 insane, training schools for imbeciles, colonies or 

 private homes for the mentally enfeebled, &c. 



.■\ question of great importance both in its bearing 

 on the liberty of the subject and the proper inclusion 

 of every class of the mentally afflicted within the scope 

 of the proposed measure is the form of the medical 

 certificate prescribed. 



The commissioners recommend that the word 

 " lunatic " in the ordinary medical certificate be 

 deleted and replaced by the words " mentally defective 

 person." So far as comprehensiveness goes this is 

 admirable. Whether it is a sufficiently accurate term 

 to merit universal acceptance is another matter. There 

 will, however, be general agreement with the resolu- 

 tion that the word " lunatic " shall be henceforth 

 discontinued as a descriptive term, that " asylums " 

 shall be called " hospitals," that the Board of Com- 

 missioners in Lunacy shall be called " The Board of 

 Control," and that the term " mentally defective " 

 shall be defined in the proposed .Act as comprising 

 " persons of unsound mind," mentally infirm persons, 

 idiots, imbeciles, feeble-minded persons, moral imbe- 

 ciles, epileptics, and inebriates who are mentally 

 affected, and deaf, dumb, or blind persons who are 

 also mentally affected. It is only by such a radical 

 change in nomenclature that the object of including 

 all these classes in one legal category could be attained, 

 though the definite term suggested may not, as has 

 been hinted, be the most appropriate. 



With regard to the financial aspect of the proposed 

 scheme, it will probably be much more formidable 

 than the estimate given by the commissioners on 

 p. 295 of the eighth volume of the report. Against 

 the danger of any excessive financial burden being 

 laid upon the country as the result of an Act, based 

 upon the report, becoming law, it must be borne 

 in mind that the great majority of the mentally un- 

 sound in the country are already under care — more or 

 less perfect, and more or less expensive. The trans- 

 ference of those already under care from one form 

 of administrative control to another ought not to entail 

 any great additional expenditure ; but the cost of 

 the more perfect provision for some 60,000 feeble- 

 minded persons in England alone is an item which 

 cannot be lightly entertained. If, however, the other 

 side of the account — the social dilapidation and 

 degradation, the useless penal measures, the illegiti- 



