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Thomas v. Barker.
596 country, are quoted as evidence of the failure of the reformatory system. What they really show, as the authoress another as lunatics, or, again, as inebriates or vagrants or rightly insists, is the absolute necessity of a skillecl pro3titutes ; and the observer who sees them in one and psychiatric scrutiny of the children whom it is proposed to only one of these phases is naturally disposed to exaggerate treat by these reformatory methods. in this
many different bio-social problems. As varying circumstance determines, they will appear at one time as criminals, at
as
to the particular form of anti-social activity his sphere of observation. into which It is the good fortune of Fraulein STELZNER that she is
It would appear that the unwillingness to recognise the rôle of the psychologist in matters of reformatory education is not confined to Great Britain, though the reactionary
able to take
tendency may not perhaps be shown in quite aggravated form in other countries as it is with
their
tendency comes
comprehensive view, for in addition to her opportunities of studying this morbid temperament in Professor ZiEHEN’s psychiatric clinic at the Charit6 and in his polyclinic, she can draw on her experience as physician to a reformatory for girls, as school doctor, and as alienist expert to the court for juvenile offenders at Berlin. Her opinions, therefore, are the outcome of an exceptionally wide survey of the question which she discusses ; and as many details of th tt question are engaging attention in this country at present we may learn some useful lessons from her experience. The main conclusion emphasised in her work is that the prevalence of the psychopathic diathesis is very much wider and its importance from a sociological point of view very much greater than it has been customary to assume. As becomes a pupil of Professor ZIEHEN, Fraulein STELZNER lays much stress on the exact determination of intellectual capacity, relying for this purpose on the methods devised by Professor ZtEKEr and described by him in his IPrinzipien und Methoden der IntelligenzpriiFung " (Berlin, 1908). And she maintains that the failure to apply such tests systematically I a more
that
such us.
an
The
trained alienist like Fraulein
very fact, indeed, STELZNER is attached as expert to the juvenile court of Berlin suggests a very ’instructive comparison with the attitude of our legislators, who, when they recently
established
1908,
juvenile of
never,
a
courts
course,
the mental condition of the
by
the
entertained
Children the
Act
idea
of
that
offender
evil both for the borderland cases, which do not receive the appropriate guidance and control that they need, and for the intellectually feeble, who are
youthful ought to be taken into account in determining the best method of treating him. Meanwhile, it is interesting to note that the experience gained in countries where it is considered worth while to make this question a matter of skilled investigation has found out, as Fidulein STELZNER tells us, one important reason why reformatories so frequently fail to reform. Fräulein STELZNER’S conviction on this point is, indeed, so strong that she does not hesitate to express the opinion that the whole elaborate and expensive machinery of juvenile courts, probationary supervision, rescue homes, and reformatories will prove very largely futile so long as rao provision is made for the detection and segregation of these special types of mentally abnormal children. This is a view which ought to be carefully considered by the responsible authorities who will have to organise those larger schemes for the treatment of the feeble-minded and socially detrimental classes which are supposed to be contemplated in the legisla-
dominated and
tion of the
to children who appear backward at school leads to
inclusion of classes for are
fraught
the
morally deficient and abnormal children in the mentally defective, with results which with
the quick-witted but unstable children of the psychopathic frequently perverse group. Instances are, of course, not uncommon where psychopathic symptoms are met with in children who
corrupted by
near
future.
and
Thomas v. Barker.
THE action of THOMAS v. BARKER, which occupied Mr. intellectually defective, but it appears to be in that inDARLING and a special jury for three days of last such cases Justice the experience tellectual weakness, if at all pronoanced, is the practically week and resulted in a verdict for the plaintiff with important factor, so that children of this sort do not 20 guineas damages, has brought to the most satisfactory of need to be segregated from the rest of the weak-minded. all possible tests the claim which has been brought forward, Such segregation, on the other hand, is imperatively neces- 3y or on behalf of the defendant, to be the discoverer of sary in the case of the psychopathic children, whose abnor- nethods of manipulating diseased or injured joints which mality is shown mainly in the sphere of feeling and impulse. are unknown to members of the surgical profession, and to And it is equally important to separate such children from be able, by the employment of these methods, to effect cures the normal but undisciplined ohildren who, as juvenile n cases in which the best surgical skill has failed. Mr, offenders, truants, and so forth, form the ordinary population K. A. BARKER has for nearly 20 years, we understand of reformatory schools. The system enforced in these ’rom Mr. W. T. STEAD’S pronouncements, carried on is for individuals of normal business as what is called a "bone-setter,"and appears, as it institutions, designed disposition, is wholly unsuited for the morbid temper ike many other medically unqualified claimants to the of the psychopathic child ; not only does it fail to possession of exceptional skill, to have enjoyed the confidence provide the special influences for developing such apti- >f a large clientèle. The comfortable position thus attained, tudes for good as he may possess, but it provokes lOwever, was regarded as incommensurate with his merits by and stimulates his anti-social tendencies by the restraints Mr. STEAD, a journalist who has from time to time achieved of a rigid discipline. The reformatory constitutes, therefore, various kinds of notoriety by methods which many persons vould have been content to leave unpursued, and who has a peculiarly unfavourable mÛie1l for children of this class, and Fraulein STELZNER maintains that such degenerates form )een conspicuous, among other things, for a general and a very large proportion of the incorrigibles who, in Germany Iympathetic admiration of several varieties of quackery. Mr. are
also
Fraalein STELZNR’s
597 The case of THOMAS f. BARKER displayed Mr. BARKER of Reviews for October, 1910, devoted as a member of a craft which has nothing recondite in its Mr. BARKER, eight double-column pages to a eulogium upon in the course of which the public were informed that "in the methods, and does nothing useful for which instruction
STEAD,
in the Review
last 19 years Mr. BARKER has treated by a careful manipulative surgery, without shedding of blood or use of drug,
may not be found in the writings of duly qualified practitioners. Mr. BARKER indeed has thrown important light
that necessary for the production of temporary anæsthesia, more than 30,000 cases. These have been selected
upon his own limitations. THOMAS v. BARKER came
save
from
a
much
greater
number which have been
brought
to
the great bone-setter for treatment. Of these 30,000 cases about 90 per cent. have been cured, and in almost every case the patient had patiently submitted himself to the best
or
the worst that the
regular
doctors could do for
his benefit. To put it in round numbers, 27,000 incurable cases-that is to say, incurable according to the recognised methods of the recognised practitioner-have now been proved to be curable." Mr. STEAD’S declared object was to urge that Mr. BARKER’S methods should be reported upon by a committee of surgeons, how to be constituted he did not show.
There a
can
be
no
doubt that the formation of such
A few
days before
case
of
on for trial he wrote a letter to the Tinteq in which he said. that the vaguest knowledge of
etiology or pathology would enable tinguish between tuberculous arthritis
its possessor to disand simple traumatic
We doubt whether Mr. BARKER could find a single surgeon who would agree with his dictum in this matter, or who would deny that the diagnosis in question is
adhesions.
of extreme
We publish in another Mr. Justice DARLING’Sof report summing-up in the recent case. Few things can be less satisfactory, from a scientific point of view, than a. trial of this kind as it is usually conducted, because-it is frequently the aim of counsel rather to obscure
frequently
one
difficulty.
verbatim
column
a
than to
bring
out the
truth, and expert witnesses
committee, if it had been formed, would have been often prevented from putting the
very valuable method of bringing Mr. BARKER’S name before the public, while there was then, and still is,
the
matter before
a
are-
jury-
intelligible way. In spite of the difficulties hence arising, the case of Mr. THOMAS was tolerably grave doubt whether the public is losing anything by plain, particularly as put to the jury by the judge. Mr. the attitude of surgery towards bone-setting. We did THOMAS sustained an injury to his knee ten years ago, not take Mr. STEAD very seriously in our reply to his from which it had never recovered, and before he went to attack upon ourselves in the course of his article on Mr. Mr. BARKER it was the seat of tubercle. Notwithstanding BARKER. With elementary manners he had referred to the its condition, Mr. BARKER caused gas to be adminisBritish Medical Jornal and ourselves under the respective tered to the patient and then moved the joint to an names of GoG and MAGOG (although we can perceive no maniextent and in a manner which were matters of fest reason why those distinguished civic characters should dispute. The same thing was done upon a second, have been dragged into the controversy) and complimented us occasion. The patient appeared to suffer no immediate illa
both with
a
shower of abuse.
in the most
We contented ourselves with
effect, but
soon
afterwards became
so
ill that the surgeons-
recalling to mind the completeness with which the nature of who were then consulted decided upon an immediate amputathe manipulations of successful bone-setters, and the con- tion of the limb. The joint was totally disorganised, but ditions in which these manipulations were useful, had been the plaintiff eventually made a good recovery, and in due laid before the medical profession, in the first instance in time brought his action for the injury which he alleged that he had sustained. It is quite clear that Mr. BARKER was our columns, by Dr. WHARTON HOOD, more than 40 years ago; and, while admitting that some unqualified bone. wrong in meddling with a tuberculous joint, but the amount setters had been dexterous, and even frequently successful, of his interference remains in doubt. Presumably this is why we expressed a doubt whether Mr. BARKER’S supposed the plaintiff did not obtain larger damages. His 20 guineas of without dissecwill probably not go far towards his costs as between knowledge anatomy, apparently gained tion, but by the perusal of two excellent manuals, could solicitor and client ; and hence the case will afford little or be sufficient to furnish him with safe guidance in his no encouragement to the subjects of Mr. BARKERfailures operations. Mr. STEAD was furious. He has discovered to take similar proceedings against him. It will, however, in THE LANCET a statement to the effect that manipulative we may reasonably hope, render Mr. BARKER more cautious surgery was a neglected corner of the surgical art, and, with- in his future proceedings ; for it is not likely that, in out mentioning that this was written over 40 years ago in any second trial of the same kind, he would be treated relation to then existing conditions, he now attempts to use it by the jury with equal leniency if again convicted of as an admission which we are making to-day, and does so negligence. with our article of Oct. 22nd, 1910, staring him in the face and acknowledged by himself with splutterings of abuse in INTERNATIONAL CONGRESS OF PATHOLOGY (TURIN). the Review of Reviews for November, 1910. Yet in a letter -The Congresso Internazionale dei Patologi in Torino will communicated as a sort of circular to the provincial press, take place from Oct. 2nd to 5th, 1911, in the Institute of and dated Feb. 14th, 1911, we find the statement that we Pathological Anatomy of the University of Turin. The have admitted that " manipulative surgery is a neglected Congress will coincide with the jubilee festivities celebrating the Italian independence. An invitation, dated Feb. 10th, has corner of the domain of surgery." When we said this it been issued inviting pathologists to take part in the Congress, it is not the truth and to was the truth ;
THE LANCET hood.
as
now,
believing
it to be the truth
now
represent and is signed by Professor P. Foà and Professor B. Morpurgo. a false- The offices of the Congress are at the Institute of General Pathology, Coiso Raffaello, 30, Turin, Italy.
is
’
many different bio-social problems. As varying circumstance determines, they will appear at one time as criminals, at
as
to the particular form of anti-social activity his sphere of observation. into which It is the good fortune of Fraulein STELZNER that she is
It would appear that the unwillingness to recognise the rôle of the psychologist in matters of reformatory education is not confined to Great Britain, though the reactionary
able to take
tendency may not perhaps be shown in quite aggravated form in other countries as it is with
their
tendency comes
comprehensive view, for in addition to her opportunities of studying this morbid temperament in Professor ZiEHEN’s psychiatric clinic at the Charit6 and in his polyclinic, she can draw on her experience as physician to a reformatory for girls, as school doctor, and as alienist expert to the court for juvenile offenders at Berlin. Her opinions, therefore, are the outcome of an exceptionally wide survey of the question which she discusses ; and as many details of th tt question are engaging attention in this country at present we may learn some useful lessons from her experience. The main conclusion emphasised in her work is that the prevalence of the psychopathic diathesis is very much wider and its importance from a sociological point of view very much greater than it has been customary to assume. As becomes a pupil of Professor ZIEHEN, Fraulein STELZNER lays much stress on the exact determination of intellectual capacity, relying for this purpose on the methods devised by Professor ZtEKEr and described by him in his IPrinzipien und Methoden der IntelligenzpriiFung " (Berlin, 1908). And she maintains that the failure to apply such tests systematically I a more
that
such us.
an
The
trained alienist like Fraulein
very fact, indeed, STELZNER is attached as expert to the juvenile court of Berlin suggests a very ’instructive comparison with the attitude of our legislators, who, when they recently
established
1908,
juvenile of
never,
a
courts
course,
the mental condition of the
by
the
entertained
Children the
Act
idea
of
that
offender
evil both for the borderland cases, which do not receive the appropriate guidance and control that they need, and for the intellectually feeble, who are
youthful ought to be taken into account in determining the best method of treating him. Meanwhile, it is interesting to note that the experience gained in countries where it is considered worth while to make this question a matter of skilled investigation has found out, as Fidulein STELZNER tells us, one important reason why reformatories so frequently fail to reform. Fräulein STELZNER’S conviction on this point is, indeed, so strong that she does not hesitate to express the opinion that the whole elaborate and expensive machinery of juvenile courts, probationary supervision, rescue homes, and reformatories will prove very largely futile so long as rao provision is made for the detection and segregation of these special types of mentally abnormal children. This is a view which ought to be carefully considered by the responsible authorities who will have to organise those larger schemes for the treatment of the feeble-minded and socially detrimental classes which are supposed to be contemplated in the legisla-
dominated and
tion of the
to children who appear backward at school leads to
inclusion of classes for are
fraught
the
morally deficient and abnormal children in the mentally defective, with results which with
the quick-witted but unstable children of the psychopathic frequently perverse group. Instances are, of course, not uncommon where psychopathic symptoms are met with in children who
corrupted by
near
future.
and
Thomas v. Barker.
THE action of THOMAS v. BARKER, which occupied Mr. intellectually defective, but it appears to be in that inDARLING and a special jury for three days of last such cases Justice the experience tellectual weakness, if at all pronoanced, is the practically week and resulted in a verdict for the plaintiff with important factor, so that children of this sort do not 20 guineas damages, has brought to the most satisfactory of need to be segregated from the rest of the weak-minded. all possible tests the claim which has been brought forward, Such segregation, on the other hand, is imperatively neces- 3y or on behalf of the defendant, to be the discoverer of sary in the case of the psychopathic children, whose abnor- nethods of manipulating diseased or injured joints which mality is shown mainly in the sphere of feeling and impulse. are unknown to members of the surgical profession, and to And it is equally important to separate such children from be able, by the employment of these methods, to effect cures the normal but undisciplined ohildren who, as juvenile n cases in which the best surgical skill has failed. Mr, offenders, truants, and so forth, form the ordinary population K. A. BARKER has for nearly 20 years, we understand of reformatory schools. The system enforced in these ’rom Mr. W. T. STEAD’S pronouncements, carried on is for individuals of normal business as what is called a "bone-setter,"and appears, as it institutions, designed disposition, is wholly unsuited for the morbid temper ike many other medically unqualified claimants to the of the psychopathic child ; not only does it fail to possession of exceptional skill, to have enjoyed the confidence provide the special influences for developing such apti- >f a large clientèle. The comfortable position thus attained, tudes for good as he may possess, but it provokes lOwever, was regarded as incommensurate with his merits by and stimulates his anti-social tendencies by the restraints Mr. STEAD, a journalist who has from time to time achieved of a rigid discipline. The reformatory constitutes, therefore, various kinds of notoriety by methods which many persons vould have been content to leave unpursued, and who has a peculiarly unfavourable mÛie1l for children of this class, and Fraulein STELZNER maintains that such degenerates form )een conspicuous, among other things, for a general and a very large proportion of the incorrigibles who, in Germany Iympathetic admiration of several varieties of quackery. Mr. are
also
Fraalein STELZNR’s
597 The case of THOMAS f. BARKER displayed Mr. BARKER of Reviews for October, 1910, devoted as a member of a craft which has nothing recondite in its Mr. BARKER, eight double-column pages to a eulogium upon in the course of which the public were informed that "in the methods, and does nothing useful for which instruction
STEAD,
in the Review
last 19 years Mr. BARKER has treated by a careful manipulative surgery, without shedding of blood or use of drug,
may not be found in the writings of duly qualified practitioners. Mr. BARKER indeed has thrown important light
that necessary for the production of temporary anæsthesia, more than 30,000 cases. These have been selected
upon his own limitations. THOMAS v. BARKER came
save
from
a
much
greater
number which have been
brought
to
the great bone-setter for treatment. Of these 30,000 cases about 90 per cent. have been cured, and in almost every case the patient had patiently submitted himself to the best
or
the worst that the
regular
doctors could do for
his benefit. To put it in round numbers, 27,000 incurable cases-that is to say, incurable according to the recognised methods of the recognised practitioner-have now been proved to be curable." Mr. STEAD’S declared object was to urge that Mr. BARKER’S methods should be reported upon by a committee of surgeons, how to be constituted he did not show.
There a
can
be
no
doubt that the formation of such
A few
days before
case
of
on for trial he wrote a letter to the Tinteq in which he said. that the vaguest knowledge of
etiology or pathology would enable tinguish between tuberculous arthritis
its possessor to disand simple traumatic
We doubt whether Mr. BARKER could find a single surgeon who would agree with his dictum in this matter, or who would deny that the diagnosis in question is
adhesions.
of extreme
We publish in another Mr. Justice DARLING’Sof report summing-up in the recent case. Few things can be less satisfactory, from a scientific point of view, than a. trial of this kind as it is usually conducted, because-it is frequently the aim of counsel rather to obscure
frequently
one
difficulty.
verbatim
column
a
than to
bring
out the
truth, and expert witnesses
committee, if it had been formed, would have been often prevented from putting the
very valuable method of bringing Mr. BARKER’S name before the public, while there was then, and still is,
the
matter before
a
are-
jury-
intelligible way. In spite of the difficulties hence arising, the case of Mr. THOMAS was tolerably grave doubt whether the public is losing anything by plain, particularly as put to the jury by the judge. Mr. the attitude of surgery towards bone-setting. We did THOMAS sustained an injury to his knee ten years ago, not take Mr. STEAD very seriously in our reply to his from which it had never recovered, and before he went to attack upon ourselves in the course of his article on Mr. Mr. BARKER it was the seat of tubercle. Notwithstanding BARKER. With elementary manners he had referred to the its condition, Mr. BARKER caused gas to be adminisBritish Medical Jornal and ourselves under the respective tered to the patient and then moved the joint to an names of GoG and MAGOG (although we can perceive no maniextent and in a manner which were matters of fest reason why those distinguished civic characters should dispute. The same thing was done upon a second, have been dragged into the controversy) and complimented us occasion. The patient appeared to suffer no immediate illa
both with
a
shower of abuse.
in the most
We contented ourselves with
effect, but
soon
afterwards became
so
ill that the surgeons-
recalling to mind the completeness with which the nature of who were then consulted decided upon an immediate amputathe manipulations of successful bone-setters, and the con- tion of the limb. The joint was totally disorganised, but ditions in which these manipulations were useful, had been the plaintiff eventually made a good recovery, and in due laid before the medical profession, in the first instance in time brought his action for the injury which he alleged that he had sustained. It is quite clear that Mr. BARKER was our columns, by Dr. WHARTON HOOD, more than 40 years ago; and, while admitting that some unqualified bone. wrong in meddling with a tuberculous joint, but the amount setters had been dexterous, and even frequently successful, of his interference remains in doubt. Presumably this is why we expressed a doubt whether Mr. BARKER’S supposed the plaintiff did not obtain larger damages. His 20 guineas of without dissecwill probably not go far towards his costs as between knowledge anatomy, apparently gained tion, but by the perusal of two excellent manuals, could solicitor and client ; and hence the case will afford little or be sufficient to furnish him with safe guidance in his no encouragement to the subjects of Mr. BARKERfailures operations. Mr. STEAD was furious. He has discovered to take similar proceedings against him. It will, however, in THE LANCET a statement to the effect that manipulative we may reasonably hope, render Mr. BARKER more cautious surgery was a neglected corner of the surgical art, and, with- in his future proceedings ; for it is not likely that, in out mentioning that this was written over 40 years ago in any second trial of the same kind, he would be treated relation to then existing conditions, he now attempts to use it by the jury with equal leniency if again convicted of as an admission which we are making to-day, and does so negligence. with our article of Oct. 22nd, 1910, staring him in the face and acknowledged by himself with splutterings of abuse in INTERNATIONAL CONGRESS OF PATHOLOGY (TURIN). the Review of Reviews for November, 1910. Yet in a letter -The Congresso Internazionale dei Patologi in Torino will communicated as a sort of circular to the provincial press, take place from Oct. 2nd to 5th, 1911, in the Institute of and dated Feb. 14th, 1911, we find the statement that we Pathological Anatomy of the University of Turin. The have admitted that " manipulative surgery is a neglected Congress will coincide with the jubilee festivities celebrating the Italian independence. An invitation, dated Feb. 10th, has corner of the domain of surgery." When we said this it been issued inviting pathologists to take part in the Congress, it is not the truth and to was the truth ;
THE LANCET hood.
as
now,
believing
it to be the truth
now
represent and is signed by Professor P. Foà and Professor B. Morpurgo. a false- The offices of the Congress are at the Institute of General Pathology, Coiso Raffaello, 30, Turin, Italy.
is
’