THE ROYAL COMMISSION ON POOR-LAW.

THE FEEBLE-MINDED CRIMINAL.-EPSOM COLLEGE.

THE FEEBLE-MINDED CRIMINAL. To t7te

Editors of

THE LANCET.

SiBS,—From your article with the above heading in THE LANCET of Nov. 25th, p. 1556, it appears that the medical inspector of prisons, Dr. H. Smalley, suggests that a particular category of weak-minded offenders, " those incapable of conforming to ordinary penal discipline" by reason of mental defect, should be dealt with on special lines, meaning thereby, it seems, permanent detention in a suitable institution, where, it is suggested, whatever manual aptitudes they possess might be developed. Compared with the work of the New York State Reformatory at Elmira, as detailed by Mr. Havelock Ellis in his book "The Criminal (my edition is the third), this appears a modest programme indeed, and one quite in keeping with the conservative method of progression which is so characteristic of this country. I should wish to point out that there are obviously-and as much may be inferred from your remarks-prisoners who manifest lesser, but still evident, degrees of mental defect who, unhappily for them, are able to rise to the peculiar standard (ability to conform to ordinary penal discipline) by which offenders appear to be tested (and which I must, for my part, continue to regard as a rude criterion, notwithstanding the justification set up in your article), and are consequently punished in the orthodox That there are not a few such mental defectives in manner. prisons I believe would be apparent upon a skilled investigation systematically carried out by anthropometric methods. My experience of cases transferred from prisons to asylums has been that such persons are obviously defective, apart from any superimposed and recent attack of insanity, and I believe they ought never to have been committed for trial, much less subjected to prison régime (" penal discipline "). I described such a case in the t/cM7’?M;Z of Mental Science for April, 1903 (" An Unrecognised Degenerate Punished by the Law "). This man was examined by an anthropometric scheme which I drew up1 and which Mr. Ellis gives in his bcok referred to and showed difference from the normal standard in one half the measurements and in 43’5 per cent. of the observations comprising the descriptive "

signalment. From your article it further appears that, apart from instances of real mental defect, there are, amongst these socalled "criminal defectives," cases of insanity in the shape of persons exhibiting "senile and alcoholic dementia and other forms of enfeeblement, rather inert and helpless than actively mischievous" ; and these form a not inconsiderable share" of the total of the criminal class under consideration. I shou’d say the only " suitable institution " which these unfortunates need is the nearest asylum. Many alienists and others have advocated special institutions for mentally defective criminals and pre-eminent amongst these is Dr. Jules Morel of Belgium, who, I believe I am right in saying, is still the medical inspector of Belgian prisons. Mr. Ellis states that Magnan advocates hospital-prisons for mixed cases whose sanity is doubtful and that separate institutions appear first to have been advocated by Dr. Koch, of the Wurtemberg State Lunatic Asylum, in 1888. But, as Mr. Ellis asks, why should not all mentally defective criminals I I be placed in a reformatory of the Elmira type ? do not know what the latest accounts of Elmira are but at the date of Mr. Ellis’s account (1901) it was evidently doing magnificent work. The aim of Elmira as there set out is not to devise a punishment to fit the crime, after the fashion of Mr. Gilbert’s lord high executioner, or a mediseval inquisitor, but rather to provide an education to suit the criminal. Its programme, which is fully set forth in the work I cite, consists briefly in education, physical, ethical, and industrial. The criminals at Elmira were there at the date of the account under the system of the indeterminate sentence, though with the condition of a time limit, which, however, it was sought absolutely to abolish in favour of an unconditional indeterminate sentence. Cases were discharged on parole or at the expiry of sentence to earn their living at the trade taught them. During the 13 years from the opening of the reformatory to the end of 1898 nearly 9000 prisoners were received at Elmira. Whether released on parole or at expiry of their sentence 15’2 per cent. only were estimated to have "probably returned to criminal practices." In 1901 Mr. 1

THE LANCET,

July 15th, 1899, p. 149.

1727

Ellis described Elmira as "the most promising direction in which we can turn for light on the treatment of the criminal." Just as in our treatment of the insane we are still hampered by the legal idea of the lunatic, the"alien " (no doubt some ponderous legal machinery will have to be set in motion before the mentally sick can be treated in a hospital block side by side with the physically sick as the acute cases ought to be), so no doubt, and probably to a much greater degree, is the prison physician hampered,by the legal conception of the criminal and his crime. The law looms too large in these matters, for reasons which need not be entered into here, but which are not complimentary to the medical profession. Unless the Elmira system has turned out a failure, which one cannot imagine can be the case-on the contrary, I should expect to hear that it has been more and more widely followed since the date of my information-it would be interesting to learn why it has not been adopted here. It may have been, unknown to me, but I should judge not from your article. Another point upon which I think it would be interesting to have information is as to what facilities, if any, are afforded in this country to medical men who deal with the criminal classes to learn and to practise the methods of criminal anthropology, a subject which receives the attention it merits in other countries, such as Italy, France, and the United States, and by the study of which, combined with some knowledge of mental disorders (such as, I believe, the medical officers of prisons are now desired to have), cases of defective development of body and mind are to be recognised and classified, rather than, if I may be allowed,to say so, by their ability to conform to

" ordinary penal discipline." T am fiirc

V01W!’:

faithfn11v

EDWIN GOODALL. Joint Counties

Asylum, Carmarthen,

Nov. 27th, H£

EPSOM COLLEGE. To the Editors of THE LANCET. SIRS,-Since my letter of Nov. 27th earnestly asking for pecuniary help I have received from a warm supporter of the College an offer of 200 if nine others will subscribe a similar amount to enable a payment which must be made of P,2000 to our drainage contractor in the first week of

January.

I

can

but

hope.

I am, Sirs, yours faithfully, C. HOLMAN. 37, Soho-square, London, W., Dec. lst, 1905.

THE ROYAL COMMISSION ON POOR-LAW. To the Editors of THE LANCET. SIRs,-I observe with astonishment, not unmixed with indignation, that the Royal Commission on Poor-Law, the personnel of which you published last week, includes no independent medical expert amongst its distinguished members. Is it possible that of all the medical men working in the Poor-law Service there is not one with sufficient knowledge, of eminence enough, to render him a fit person for this office ? On what other ground can we explain such an omission ? 99 per cent. of all the inmates

of workhouses and workhouse infirmaries are either sick or The medical officer has to undertake the care of all these, yet he is totally unrepresented on the body which is to indicate the rules which shall in future govern these institutions and their inmates. Or can it be that the forces which for so long have more or less successfully thwarted our efforts to bring the treatment of the Poor-law sick up to a modern standard have again been successful, have again secured the right to lay down the rules which shall in future govern the medical treatment of these persons ? It is unnecessary, Sirs, to point out to you the great defects of the system, especially in the provinces, but perhaps I may mention for the benefit of your readers that in the addenda to the report of the departmental committee on the Nursing of the Sick in Workhouses (1903) is a paper of my own which deals with the subject from the medical point of view. The departmental committee failed to solve the difficulties of the task allotted And not only this but in its recommendations it to it. evinced a lamentable ignorance of the rudiments of the subject of its inquiries. Yet, Sirs, the only medical member of the Royal Commission was a member of this departmental committee, and eminent as he is as a Poor-law official, yet

aged and infirm.

1728 1 1 GIV

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" MATERNAL IMPRESSIONS."-A NEW SURGICAL DRESSING-MICA. --""""""--"-’’’’’’’’.&JJ

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his presence on the Commission cannot make up for its lack of independent medical men, men free from the habitual trammels of red tape and tradition-tradition founded upon the prevention of idleness and not upon the treatment of disease-a defect which strikes at the root of the Poor-law and renders to a great extent nugatory the elaborate system under which we at present groan. I cannot but think, Sirs, that if your immense influence and that of your readers were to be exerted for the rectification of such an omission as that which I have indicated it would not be found too late to do so. As it stands it makes the Royal Commission a very weak one and inflicts a gross injustice amounting to an insult upon the medical I am, Sirs, yours faithfullv, profession. F. R. HUMPHREYS. Fellows-road, N.W., Dec. 2nd, 1905. PS.-I have already called attention to the matter in one of the daily papers.

"MATERNAL IMPRESSIONS." To the Editors

of THE LANCET. the existent SiRs,-Among many popular beliefs about which there are many fallacies that concerning "maternal impressions"" is one of the most common and abiding. That there may be some, if not much, truth in the popular explanation of certain phenomena in this connexion the following cases of interest may show. A married woman has five children, all boys. The fourth was born 18 months ago with a hare lip and cleft The first operation for its relief took place palate. during his first fortnight and since then seven operations have finally led to complete success, leaving only a linear, slightly raised, scar as evidence of former deformity. When this child was about nine months old and still under treatment his mother again became pregnant and when her fifth son was born two weeks ago her first question was, " Is its lip marked?" Sure enough it was, not with hare lip or cleft palate but with a linear raised scar extending from the left nostril to the lip, identical with that of his brother. The mother tells me that at the time she became pregnant with her fourth son there were a man and woman in the same village each with hare lip and although she did not fear any evil result to her offspring from seeing them she was "constantly dreaming about them." When the fifth i-on was conceived she was very anxious about the elder child who, at the time, had the scar resulting from the earlier

operation. One might say these were cases of reversion or arrested development but this does not explain why arrest of development occurred. The popular idea of the mother’s mental affecting the child’s physical state seems reasonable in the cases quoted, I think. The important point seems to be the fact of the " impression " occurring at or about the time of conception, for, of course, the possibility of any maternal impression affecting the physical or anatomical

condition of a feetus of, say, three or four months would be I am, Sirs, yours faithfully, unthinkable. G. FRANCIS SMITH. Watford, Dec. 3rd, 1905.

A NEW SURGICAL DRESSING—MICA. 2b t7te -Editors of THE LANCET. SiRS,—1am greatly interested in the article by Mr. J. L. A. Aymard in your issue of Nov. 18th. I have long advocated the use of glass in dressings but for a totally ditferent reason, not as in Mr. Aymard’s case, purely as a non-irritating and convenient dressing, but because I believe sunlight to have a direct and beneficial influence on the healing of wounds. I, however, propose to try a number of cases before further rushing into print on the matter. Being dissatisfied with glass I am experimenting with mica as a substitute, but as this material is opaque to violet rays, which are those which would be most beneficent in the healing of wounds, its use as a dressing for the treatment of wounds by sunlight is doubtful. For making a window for inspection over the damaged area, or for the purposes mentioned by Mr. Aymard, I am of opinion that it is in every way superior to glass ; it bends without breaking ; it can be used mucti thinner, consequently it is not so clumsy as glass ; it can be fastened over the wound with strapping, and 1 have myself worn a piece strapped on my arm for a considerable time without it

it enables one to dispense with a considerable amount of bandaging and is consequently cooler and more comfortable. By enabling the surgeon to inspect the site of injury without disturbing any dressings it is a source of great comfort to the patient and a great convenience to the surgeon, who in satisfactory cases can leave the first and only dressing on until the wound has healed instead of having frequently to change the dressings purely to ascertain how things are going on under it. I have subjected mica for a period of 24 hours to the following chemicals, &c., which might come in contact with it during use and I have,been unable to find any change in the mica so used : Dry heat; boiling in water; carbolic acid lotion, 1 in 20 ; hydrarg. perchlor., 1 in 100 ; formaldehyde, 40 per cent.; pot. permang.; chinosol, 1 in 250; izal ; glycothymolin;

breaking or cracking ;

listerine ; hydrogen peroxide ; chloroform; and adrenalin. Messrs. Down Bros. are obtaining me the mica plates in different sizes. My method is to take three or four layers of gauze or lint, place them over the skin, a hole being cut through the layer of lint to leave the wound exposed; over this a mica plate is placed and the whole is fastened on with some adhesive plaster. These windows cannot be used everywhere or in cases with much discharge but they are possible in a considerable proportion of cases. I am, Sirs, yours faithfully, ARTHUR TODD-WHITE. Leytonstone, N.E., Nov. 29th, 1905.

SPIROCHÆTE PALLIDA AND LEISHMANDONOVAN BODIES. To the Editors

of THE LANCET.

SIRS,-It is not difficult to demonstrate in syphilitic (at least in primary and secondary eruptions) a

lesions

identical in characters with those described by Schaudinn and Hoffmann, McWeeney, Dudgeon, and others. By fixing in alcohol and staining with Giemsa’s or Leishman’s mixtures I prepared slides from the fluids expressed from mucous tubercles of a case under Dr. F. J. Paley which showed numbers of these delicate spirillary bodies. If it is true that a spiroch-.L-te be a protozoon and a stage in the lifehistory of a trypanosome one might find in pseudo-diphtheritic angina, relap-.ing fever, &c., the Leishman-Donovan bodies of kala-azar, which is probably a trypanosome disease. In this re-pect and in its possible causal relation to syphilis the presence or absence of these bodies in syphilised man or apes would be of value as evidence. I cannot find any references in available literature of the subject so far. I am. Sirs, yours faithfully, F. G. BUSHNELL. Brighton, Nov. 29th, 1905.

spirochsete

ROYAL COLLEGE OF SURGEONS OF ENGLAND. 70 the Editors of THE LANCET.

SIRS,-In thanking you for your words of support and encouragement to the Members of this College contained in the leading article in your issue of Dec. 2nd, p. 1630, may I venture to suggest that these would be more valuable if

published before instead of the old days to which you

after the annual meeting ? In refer THE LANCET always drew the attention of its readers to the meeting about to be held. This year I do not think there was a single anticipatory notice in the medical press. As honorary secretary of the Society of Members I can fully endorse your statement regarding the principal reason for the poor attendance at these meetings. From letters which I constantly receive I know that many Members are sick of the College and all its works. If they are not wanted there they are more than willing to stay away; they cannot be expected to take any interest in the affairs of a College in which they are steadily denied any representation. The Council persists in regarding those of the Members who do attend as hostile to the interests of the College, than which nothing can be more absurd ; in fact, the Council seems to imagine that it is conferring a favour on the Members by taking any notice of them at all, although they are the legal owners of the College property. While this attitude is maintained is it surprising that the Members, who after all form the bulk of the profession, take no -notice of the

Council ?