W. A. Potts, M.A., M.D
Medical Officer to the Birmingham Mental Deficiency Acts Committee, Physician in charge of the Mental Observation Wards, Hal lam Hospital.
The Royal Commission on the Feeble-minded in 1908, after special in- vestigations had been made by experts in different parts of the country, estimated that there were five Mental Defectives in every thousand of the population. The ” Wood Report ” in 1930, based on an examination arranged by the Board of Control, showed that there were eight Mental Defectives in every thousand of the population. Some critics challenged the finding of such an increase in less than a quarter of a century, and suggested that if the later report was correct the earlier investigators must have overlooked the high grade cases, which can only be diagnosed by an expert with considerable ex- perience. Comparison of the records, however, showed there was evidence that both reports had taken the same standards and were equally reliable.
In both reports the proportion of high grade defectives (feeble-minded) to the two lower grades (idiots and imbeciles) was the same. As a matter of fact Dr Doll, the Research Worker at the Vineland Institution, Jersey, U.S.A., at the recent Annual Conference of the Medico-Psychological Association at the Royal Eastern Counties Institution for Mental Defectives at Colchester, stated that investigations in the United States showed that there were ten mental defectives in every thousand of the population. It was generally agreed that the number in this country could not be much less, while the Chairman of the Board of Control stated that the ” Wood Report ” had been confirmed. Re- flection on the course of events between the two dates of investigation confirms the idea that the proportion of mental degenerates is likely to have increased. Although arrangements for the care and control of Mental Defectives are still extremely inadequate, a good deal has been done for the protection of many, with the result of prolonging their lives. At the same time the War, which like all wars caused a great increase of Venereal Disease and its spread in *Written by request of the British Social Hygiene Council, country districts where little existed before, must have been responsible for more cases of Mental Defect due to Syphilis, which is well known as an import- ant cause. While a proportionate increase of such degenerates has been taking place, it is necessary to remember that the other Venereal Disease, Gonorrhoea, though not a cause of Mental Defect, is responsible for more cases of sterility in both men and women than any other factor. Gonorrhoea is a contagious disease of the greatest national importance, because of its wide and constant prevalence in the human race in every part of the world. Specialists estimate that at least fifty per cent, of the total gynaecological complaints of women are due to Gonorrhoea. The serious menace of Gonorrhoea is increased by the great difficulty of curing many cases, and also in consequence of the long infectivity of the complaint, especially in women. In women, too, the symp- toms are sometimes so trifling that they are overlooked, and therefore not treated. The high water mark of Gonorrhoea was reached in the war and immediately afterwards. During the war there were always ten thousand cases of Venereal Disease, chiefly Gonorrhoea, in the Army hospitals. It must be remembered too that Gonorrhoea differs from most infectious diseases in that when cured it confers no immunity against a fresh infection. While there has been this great increase of Venereal Disease, Birth Control has been practised more than ever by the intelligent and healthy. Prevent the birth of normal children by Gonorrhoea and Birth Control, and increase the incidence of Mental Defect by a spread of Syphilis, and a larger proportion of degenerates in the population is inevitable. It must be remembered too that while Syphilis does not cause sterility, it is responsible for a large number of miscarriages, stillbirths and children who do not survive long. In a syphilitic family, before the birth of a normal child there are usually one or more miscarriages, still- births, and also one or more living children who are either mentally defective or degenerate in some other way. In this way too the birth of many who might have been satisfactory members of the community is prevented.
It is difficult to estimate the percentage of cases of Mental Defect due to Syphilis. Some syphilitic cases have characteristic notched teeth, and other physical abnormalities, pathognomonic of their heredity, but many have no diagnostic sign. In recent years diagnosis has often been possible by a special examination of the blood, the Wassermann test. But the results obtained by different investigators in different areas differ so much that no definite statement can be made. Weiss and Izgur on examining 1,633 mentally defec- tive children found signs suggestive of Syphilis in 15 per cent., but the Wasser- mann test was only positive in 2.5 per cent. It is certain, however, that Syphilis is responsible for many cases of Mental Defect; it must also be realised that syphilitic Mental Defectives arc often handicapped in other ways as well, such as being paralysed, epileptic, or debilitated with poor vitality. In some of the States of America the notification of all cases of Syphilis and Gonorrhoea is now required by law. Investigation in such States has shown that there is much backwardness and mental retardation in hercdo-syphilitic children; besides such marked abnormality there has also been noticed a depression of the level of mental activity and energy. Two investigators found that in four hundred and forty three children of such families 15.7 per cent, showed mental retarda- tion; they also found heightened nervous irritability in many, and noticed, as other investigators have done, a type of unruly or ” wild ” child, who was otherwise healthy. Other investigators have found that Dementia Precox (adolescent Mental Disorder) is more frequent in the offspring of syphilitic parents. There is no doubt that both in inherited and acquired Syphilis the nervous system frequently bears the brunt of the attack. Even if there is no definite lesion the central nervous system of syphilitic children is usually un- stable, so that Convulsions, Paroxysmal Vomiting, Nocturnal Incontinence, and at a later stage Migraine and Epilepsy are not infrequent. It may be said that a comparatively small percentage of syphilitic infants reach maturity; and that those who do are handicapped most cruelly in the struggle for life. It is not certain that the serious consequences end with the second generation, as the transmission of Syphilis to the third generation is a fact accepted by a con- siderable number of medical authorities.
There is no longer any difference of opinion as to whether Mental Defect is due to Heredity or to the Environment, as it is generally admitted that either or both may be responsible. In any particular case it is often difficult to pick out a fundamental factor. It has been shown by recent investigations into the laws of Heredity that while heredity is responsible for many abnormal con- ditions the environment may be such that a particular hereditary taint does not show itself. As regards Syphilis and Mental Defect it is of paramount import- ance that the primary disease should be checked at its source. Opinion is divided as to the value of compulsory notification of Venereal Disease. There is no doubt, however, that as long as institutional accommodation is so inade- quate that many ascertained Mental Defectives cannot be certified because no vacancy can be obtained for them in a certified institution, compulsory notifica- tion and treatment of all cases of Venereal Disease would reduce the risk of the spread of these diseases by mental defectives. There is scarcely any accom- modation for Mental Defectives suffering from Venereal Disease. Like preg- nant mental defectives, they sometimes go into Public Assistance Institutions, and take their discharge when they like. In one of the Birmingham Public Assistance Institutions, seven beds have been set aside for certified mentally defective women suffering from Venereal Disease. It is doubtful whether this limited accommodation will be sufficient. Feeble-minded women arc respon- sible for the dissemination of much Venereal Disease as they arc abnormally facile and lacking in control, and also incapable of appreciating the necessity for early treatment for Venereal Disease and for continuing it for the long period usually necessary.
At the present time many who are imperfectly acquainted with all the ramifications of Mental Defect think that Sterilisation is a solution of the prob- lem. They do not sufficiently appreciate the fact that many Mental Defectives who might be sterilised will still require institutional care, because they are criminal or delinquent, or incapable of earning a living or even keeping a situation, or have no home or only a bad home, or are an impossible burden in an ordinary household. Besides, Sterilisation does not diminish sexual desire or capacity in either sex. The sterilised feeble-minded woman might spread much Venereal Disease. Sterilisation can never be more than a very limited means of dealing with the problem of Mental Defect. Experience in California shows that in a limited number of carefully selected cases it is satis- factory. It would be helpful in the case of those feeble-minded women who repeatedly escape from an institution and when recaptured are often found to be pregnant.
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