The Health of the Nation
- Type:
Book Reviews & Abstracts.
- Author:
Lt.-Col. F.
C. Fremantle, M.P., M.B., F.R.C.P., F.R.C.S., D.P.H. Philip Allan & Co., Ltd.:1927.
In the ” Housing of the Nation,” published earlier in the year, Lt.-Col. F. C. Fremantle gave a valuable resume of the bewildering re- cent legislation on Housing and of various as- pects of this special public health problem. A companion book entitled, ” The Health of the Nation,” dealing with public health broadly, lias now followed from the pen of the same author, than whom there is no one in a better position to undertake such a review. With his medical training, his experience as an active Medical Officer of Health for an important County, as a member of the London County Council (including Chairmanship of the Pub- lic Health and Housing Committee) and lat- terly for eight years as a Member of the House of Commons, he has had occasion to consider Public Health Problems from a variety of standpoints. The advantages he has gained in these various capacities have been put to full use in the ” Health of the Nation,” and it may be said in one sentence that in no one of the many books on public health that have appeared of recent years is there given so com- plete a bird’s eye view of the intricate nature of the subject, legal and medical, and that in an octavo volume of about 200 pages of well displayed type.
Col. Fremantle in the preface says ” I hope (the volume) may be as useful to my Coll- eagues in both Houses of Parliament, and to all to whom may fall the opportunity to in- struct and encourage public opinion in such matters, as the writing of it has been to my- self.” From the range of the ground covered Col. Fremantle must have dipped deeply into the best sources of information and the assist- ance given to him by various persons named is gracefully acknowledged in the preface. The general plan of the book is indicated by the following selection from the titles of the chap- ters :?The Joy of Life, History of Public Health Legislation, Economics of Health, Mother and Child, Education, Poor Law and Hospitals, Insurance, The Four Scourges, Mental, Industrial, Overseas.
The ” Mental ” chapter deals as fully as can be expected in a book of this size with lunacy, criminal responsibility, mental defic- iency and mental health, giving information as to the numbers of affected persons, the agencies dealing with each class and also as to legislation. In his remarks on this special subject, as in other sections, Col. Fremantle gives evidence of the very high value he sets on the work of voluntary agencies. Thus he ob- serves “The Central Association for Mental Welfare has 35,940 cases registered at its Cen- tral Office, and through its 51 local associations in 23 Counties and 43 County Boroughs, pro- vides when required, guardianship, super- vision, training and aftcr-care. It arranges courses for Doctors, Teachers, attendants and supervision of occupation centres, and through its Occupational and Guardianship Officers and publications, assists the several councils, guilds, and societies to arouse interest and deal with the problems of mental welfare, espec- ially in the wise and friendly unofficial visit- ing of the homes of the defectives.” Another more general example is given on page three, when Col. Fremantle says, ” The system (of public health) must be supple and apply intim- ately to every individual, thus giving a special value in health matters to private agencies which so long as they are filled with enthusiasm for their several sections of the common task, may take more trouble than public authorities, give more encouragement to initiative and experiment, hit the mark more certainly, learn much themselves and pass their learning on.” As examples he quotes District Nurses, Voluntary Hospitals and the Associations that maintain them.
At the end of the volume are included a Bibliography of publications for current in- formation on special problems, on legal aspects, professional Text Books and general aspects of health work : a Directory of Lead- ing Organisations (from which Local Sanitary Authorities are, curiously, omitted) and an Index. These all greatly increase the worth of such a volume to all to whom it is available and the list of those persons should include not only those whom Col. Fremantle addresses, more particularly, his Colleagues at Westmin- ster, but also Members of Local Authorities, who are sometimes inclined to forget theiy duties as health administrators owing to ex- alted ideas as to their responsibilities as rep- resentatives of the rate payers.
Without being captious it may be permitted to regret that Col. Fremantle has introduced so marked a political atmosphere into a very useful volume. True as it may be that we owe valuable public health legislation to one polit- ical party more than another, it does not help forward a matter that calls for the active co- operation of all agencies and persons to do anything to give it the slightest political colour.
The Rt. Hon. Neville Chamberlain, M.P., Minister of Health, contributes a foreword and to quote from it “I welcome this book as a useful and comprehensive review of the organisation and purpose of our public health service.”
J. Middleton Martin.
Clinical and Abnormal Psychology. By J. E. Wallace Wallin, Ph.D., Professor of Clinical Psychology, Miami University, U.S.A. George G. Harrap & Co., Ltd. : 1927. Price 8s. Gd. net.
This book is one of the Riverside scries pub- lished by Houghton Griffin & Co, New York and Chicago, and is a companion volume to another by the same author?” Education of Handicapped Children “?which appeared three years ago.
The book forms a refreshing contrast to cer- tain recent publications by American authors on the subject of the mentally abnormal child. Some of these authors appear to have con- tracted the habit of ” thinking in print ” with the result that their publications are charact- erised more by the exuberance of their verb- osity than by statements of ascertained facts, while such views as are expressed have changed completely in the next edition.
The book under review, on the other hand, is clear and concise throughout and the views expressed therein are evidently the result of years of patient observation and reflection. The author has carried out, consistently, the inten- tion expressed in the preface, viz., to open up the field to the general reader and to supply a broad foundation of facts, procedures and principles on which the technical worker may build. It is claimed that this is the only book in existence which includes, under a single cover, all subjects associated with the men- tally abnormal child. This comprehensive nature of the book has rendered it impossible for the author to deal, in detail, with many of the individual topics. He has, however, en- larged upon those which are of more general application and curtailed his remarks upon those which relate to specific branches of the subject. While a whole chapter (Chapter V.) is devoted to general directions and principles to be observed in making psychological tests, and two chapters (Chapters XVII. & XVIII.) to the important subjects of associational pro- cesses, association defects and complexes, he refers the reader to the appropriate manuals for directions relating to the application of in- dividual tests; restricts, in other parts of the book, his remarks on the interpretation of dreams, on Freudian principles, to seven and a half pages; dismisses the whole subject of logic in four, and that of automatic writing in just over one. For additional information on Freudian methods and other specialities the reader is referred to an appended fully classi- fied bibliography.
The volume is divided into four parts. Part I is introductory and is devoted to clinical ex- aminations, deviation from norms and general aims and principles. Part II. is devoted to general intelligence?levels and specific intell- ectual abilities and disabilities. Part III. re- lates to general levels of motor competency and specific motor abilities and disabilities and Part IV. to states of emotional development and emotional, instinctive, temperamental and character peculiarities. There are no less than thirty-four illustrations. The addition of one more to illustrate the positions and rela- tions of the four cerebral centres concerned in the aphasias would greatly help the general reader to understand this part of the text. Having regard to the frequency with which correlations are quoted, it would add to the comprehensive character of the book, and would add very little indeed to its size, if a brief explanation were to be given of the sig- nificance of the co-efficient of correlation and of the probable error, referring the reader to the appropriate text books on statistical math- ematics for details relating to the methods of calculation,
The contents of the book are based upon a course of lectures delivered by the author in various universities and other educational establishments of the United States during the past fifteen years. The book will prove inval- uable, first of all to those who desire to gain a general knowledge of the whole subject pre- paratory to adopting a specific branch of it, such as social mental welfare work, teaching in the special school and kindred matters, as well as to school medical officers not yet well versed in psychological matters, school teach- ers in general, and to magistrates of the Children’s Court. In the second place it will prove invaluable as a book of ready reference. It is well indexed and contains, under a single cover, a masterly summary of knowledge already acquired in greater detail by the more expert at this kind of work from a large num- ber of varied sources.
Robert Hughes.
The Measurement of Mental Capacities. (A Review of the Psychology of Individ- ual Differences). By Professor Cyril Burt. Oliver & Boyd. 6d.
This paper formed the subject of the seventh Henderson Trust lectures delivered at Edin- burgh and the Trustees are to be congratulated not only on their choice of lecturers but also on their policy of subsidising the publication of the lectures at a price which facilitates their wide distribution. In the fifty-two pages of this lecture Professor Burt has packed in so tightly an account of the present and probable future developments in the field of the psy- chology of individual differences along with the conclusions which may be drawn from his own many-sided work in this field that a re- viewer is compelled to select those points which have a direct bearing on the field of this journal and refer everyone who reads this review to an immediate perusal of the lecture itself for further illumination. But to the un- initiated this warning is necessary : in this relatively short outline of conclusions, where practically all the necessary background of elaborate statistical analysis has been removed for the sake of intelligibility to the layman in statistics, the full force of the evidence behind the various statements may not be realised by the reader who has not followed Professor Burt through the more abstruse but fascinating- elaboration of his larger and more technical treatments of the subject as contained in his ” Mental and Scholastic Tests,” and ” The Young Delinquent,” and other discussions.
For those who are interested in the special problem of Mental Welfare the following points are probably of most interest. Pro- fessor Burt says, “For any given individual we have to investigate, first the intellectual, and, secondly, the temperamental aspect of his mind; under either heading we then have to measure, first, the inborn qualities, and, sec- ondly, those which are acquired ; and these inborn qualities in turn may be divided into, first, one or two all-important general factors, and, secondly, a larger number of more limited or specialised tendencies.” From this group he selects intelligence as ” inborn, general, intellectual ability.”
After dealing with such physical criteria as the outward aspects of the body, the shape and size of the skull, the expression of the face and the study of handwriting, he comes to what he calls the central maxim of individual psy- chology of to-day: “Judge mental functions by mental symptoms, not by physical.” After showing and describing very interesting causes of the growth of intelligence with age com- pared with the growth of height with age and also the distribution of intelligence; the author takes up the study of the group of special in- tellectual capacities which are shown by the statistical methods of correlation to vary some- what independently of general intelligence. Anyone who is interested in the two problems of avoiding the danger of certifying a child as weak in general intelligence, i.e., mentally de- fective, who may only be suffering from a specific defect, and, secondly, in the effort to discover some form of specific ability in an otherwise mentally defective child should make a close study of the eleven special capac- ities postulated by Professor Burt. An illus- tration of the first is the inability of some people to analyse what they undoubtedly hear with the result that they cannot possibly learn reading by the phonic method. Illustrations of the second are the occasional cases of high or even exceptionally high achievements of some mental defectives in some highly specialised line as for example the boy from a Glasgow older boys’ special school who showed such an exceptional capacity for paint- ing that he was given a scholarship to the Art School. Such are only a few of the very in- teresting points dealt with in Professor Burt s customary lucidity in this very succint but stimulating lecture.
D. Kennedy Fraser. Readings in Abnormal Psychology and Mental Hygiene. By Professor Taylor of Smith College. Appleton. New York. 1927.
This is a book of considerable weight both literally and figuratively speaking, for it runs into some seven hundred and fifty pages and under a very comprehensive variety of head- ings gives pithy extracts from the writings of all the most prominent men and women in the world of Psychology, Psychiatry, and Men- tal Hygiene in America together with excerpts from the works of Freud, Jung, Bernard Hart, Cyril Burt and many others.
It is a book to be kept for reference as well as to be read, the bibliography which is espec- ially valuable for reference purposes gives over three hundred works on various aspects of the subject.
Many of the extracts are extremely inter- esting and informative, as for instance one on page 5, which deals with the sub-normal mind, and discusses the difference between sub- normality and feeble-mindedness. It is point- ed out that mental tests in the American Army established a mental age of 12 years or under for some 45 per cent of the soldiers tested, yet it would be absurd to assume that anything like this percentage are feeble-minded. Stress is laid on the point that feeble-mindedness is only present in cases where there exists ” In- ability to manage their own affairs with ordin- ary prudence and compete with their normal fellows.”
Thus true feeble-mindedness contains an element of abnormality as well as of sub- normality; ” The sub-normality being due to incomplete structure and the abnormality to imperfect functioning.” For example, ” a certain man of 10 year mentality would be able to support himself if it were not for his violent temper whereby he continually loses his jobs.”
There is a valuable section setting out the Classification of Mental Diseases approved by the American Medico-Psychological Associa- tion, and now adopted for statistical purposes by the Mental Hospitals of America, and other good features of the book are the chapters on Functional Motor Abnormalities, dissociation of Personality and the accounts that are fre- quently introduced of specific cases with details of the treatment employed and its results. This last is an aspect which is often omitted in other works on this and allied sub- jects, and which is of the first importance. For the rest the book suffers from ” The faults of its qualities ” in its endeavour to present only the essentials the extracts are necessarily somewhat scrappy, and we are at times presented with controversial conclusions without being given the chain of reasoning that led up to them. This is neither fair to the reader nor the writer.
It cannot hope to appeal to a very wide pub- lic in England at least, in that it is primarily an expression of American experience and opinion and also that it is too technical for any but a specialist and too scrappy to be wholly satisfying to any who wish to read on the sub- ject in a scientific spirit.
Doris M. Odlun. Saorstat Eireann. Report of the Commis- sion on the Relief of the Sick and Desti- tute Poor, including the Insane Poor. The Stationery Office, Dublin, 1927. Price 2/6d.
This Commission of eleven members was appointed in March, 1925, and issued its report last October. The Commission whilst dealing chiefly with the administration of the Poor Law and proposed reforms of Local Govern- ment includes amongst its objects: ” To in- quire into the existing provision in public institutions for the care and treatment of mentally defective persons and to advise as to whether more efficient methods can be in- troduced, especially as regards the care and training of mentally defective children, due regard being had to the expense involved.” The sections of the report dealing with these questions are naturally of greater interest to us, but the fact that the report as stated in a footnote (362) interprets the term Mentally Defective ” to include mentally disordered as well as mentally deficient persons,” makes it rather difficult to abstract anything with a direct bearing on the problem of mental defic- iency as understood in this country.
One section of the report (438) deals ex- clusively with the ” accommodation for Men- tally Defective Children.” At the moment the mentally defective comes under the legislation of the Poor Afflicted Person Relief (Ireland) Act, 1878, which gave power to the Guardians of any Union ” to send, with the consent of the Local Government Board an idiot or im- becile pauper to the Workhouse or any other Union or to contract for the maintenance of such person in any public or licensed estab- lishment for the relief of idiots and imbeciles at a cost not exceeding five shillings a week. No Workhouse was ever yet set apart for these classes and until recently the only establish- ment for the care of these idiots and imbeciles was the Stewart Institution at Palmerston, County Dublin.
In 1926 the Sisters of Charity of St. Vincent de Paul, in consultation with the Commission- ers for the Dublin Union, rented old work- house school buildings at Cabra and opened St. Vincent’s Home as a school for mentally defective children. There were in December, 1926, 118 inmates principally from the Dublin Union. At the same date there were 51 child- ren idiots and imbeciles in country homes. The report in recommending that a govern- ment grant should be made towards the cost of maintenance states ” The Boards of Health should be encouraged to avail itself of the ac- commodation for mentally defective children that now exists. The only difficulty that arises is on the question of cost. At present, whilst there is a government capitation grant in res- pect of lunatics in district and auxiliary men- tal hospitals, there is no grant towards the maintenance of mentally defective children unless they are placed in mental hospitals? institutions which were not intended for them. If a government grant of half the net cost of maintenance were made, it would be reason- able and, we think, sufficient inducement to the local authority to send these children to those who were fitted to train them.” There is at present no data available from which to estimate the total number in need of provision. ” Where the parents of a mentally defective child are unable by reason of expense to make provision for the education or the care of such a child we recommend that the Board of Health be empowered with the consent of the parents to send the child to an approved institution and to pay the expenses of maintenance or join with the parents in paying the expenses, subject to the condition that the child can ben- efit by the training.
It appears that the Stewart Institution, originally intended for the training of defect- ives, has become more and more an Asylum for the most hopeless cases.
The Commission is perhaps unduly optimis- tic with regard to the results of training the mentally defective. They say ” The training side of the work ” (in a special institution) ” must be kept uppermost and we think that no child should be retained in a training estab- lishment at the public expense beyond the time when improvement in his or her condition cannot be effected.” The boy or girl should then either be returned home or transferred to the auxiliary mental hospital of the district from which he or she was sent. Where the numbers would justify it the auxiliary mental hospital should have a department dealing especially with cases of congenital mental deficiency. Judging by experience in Institutions in this country, the probability of any considerable number of mental defectives being discharged from Institutions, capable of earning a living, or even of living in safety at large in the community, is very small. Dr. Turner in his report as Medical Superinten- dent of the Royal Eastern Counties’ Institu- tion writes on this point ” I must confess to a considerable degree of pessimism about the possibility of getting the higher grade cases back into the world.”
At present too there are no voluntary After- care Associations in Ireland, although the report encourages the formation of these. A rather striking reform is the suggested abolition of the Board of Health (282-287). The Commission suggests “the assumption by the County Council itself of the control of poor relief working through a paid official whom they could place in charge of the entire Poor Law Services of the county in the same man- ner as the general manager of a company under the control of a board of directors.” The Health of the School Child. Annual Report of the Chief Medical Officer of the Board of Education for the year 1926. H.M. Stationery Office, 1927. Price l/6d. Before entering on the main part of his report the Chief Medical Officer emphasises the importance of the School Medical Service and the real purpose of school medical inspec- tion. Sir George Newman describes the duties of the service as falling into four categories : to fit the child to receive the education pro- vided by the State, to detect any departures from normal psychological health and growth and advise a remedy or amelioration of them, to seek the causes and conditions of such defect and disease and as far as may be to prevent them, to teach and to practise personal hy- giene in every school.
Schemes have been developed during the past year for the treatment and training of the cripple (p. 23). 132 Local Education Author- ities are now concerned in working these out. (Orthopaedic treatment is carried on in 59 hospitals, 122 school clinics and upwards of 100 voluntary clinics.
A section of the report is given to the prob- lem of special schools and the care of the mentally defective child. The chief advance in this respect has been the opening of Open Air Schools. The number of these has been increased during the year by 9 and the future programme includes proposals for the acquis- ition of sites for 32 such schools, which, when completed, will accommodate 3,600 children. A summary is given of what was said in the last report on the subject of mentally subnor- mal children, the division of these into three classes, the dull and backward, the educable, and ineducable mentally deficient children. Sir George Newman says ” It is true to say that the very much larger group is that of the Dull and Backward who constitute not less than 10 per cent, of all the children of school age … it is from this group that we get our neuropathies, delinquents, unemployables and criminals.” The difficulties are greater when dealing with the rural areas, ” which are not large^ enough to make possible either a useful classification of mentally subnormal children ?r the provision of special accommodation for their treatment and education. Thus, the establishment of special schools, valuable though it has been in urban districts, does not wholly meet the problem and indeed it cannot be said that in any area the provision made for these mentally subnormal children is entirely complete or comprehensive. A special resi- dential school on the one hand or a custodial institution on the other do not alone solve the problem. Special classes are an alternative method.” These classes have been tried in Cheshire in several of the larger schools, also in Kent. At Barnstaple a school for 40 back- ward children has been in existence for some years. At various such schools test and trial enquiries and experiments in practical teach- ing methods have been made. Apart from benefiting the children they have led to new methods of ascertainment of deficient children.
The characteristics of the Neuropathic Child are described (p. 48). With regard to their clinical examination, Sir George Newman says ” The clinical examination of debilitated children is dependent in large degree upon their individual and domestic history and upon a closer observation of the objective signs of disease or abnormality. The history should include particulars of the family and the indiv- idual Its present illness should be traced step by step from the last date on which the child was quite well the clinical examination of the child will usually include general inspection as to facial expression, nu- trition, character of the respiration, posture and nervous condition the usual meas- urements (height, weight, etc.) should be made, etc.” Both here and in other sections of the report Sir George Newman stresses the importance of realising that all the factors likely to be the cause of disease must be con- sidered; ” no system of medical inspection is really adequate that fails to take into account the child as a whole/’ He describes disease as ” disharmony arising from untoward phy- sical conditions, the reaction of the body to the influence of unfavourable agents or infections. Not only is this reaction disabling to the body (making the person invalid) but both in origin and in effect its province is very wide, almost illimitable. For the origin of this reaction, this disease, and its results, may, and gener- ally do, concern the whole nature of man?his body, mind and spirit, his comprehensive social being.”
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