"Mental Deficiency (Amentia)" Second Edi- tion. -By A. F. tuEDGOLD. Published by Messrs.

Bailliere, Tindall it Cox.

This edition fully maintains the high standard of its predecessor. It lias been brought up-to- date and gives in a lucid manner an excellent account oflts subject in all its aspects. No one who reads this work can fail to grasp the import- ance of this subject, as affecting the nation, and the necessity of prompt and carefully chosen legislation for the proper care and management of such cases, so that by proper training the burden which they at present impose upon the rest of the community may be lessened and by a well-devised system of engines that their inci- dence may be diminished in the future.

In Chap. I, the meaning of the term is dis- cussed, and it is finally defined as " a state of rest- ricted potentiality for, or arrest of, cerebral development, in consequence of which the person affected is incapable at maturity of so adapting himself to his environment or to the requirements of the community as to maintain existence in- dependently of external support."

482 THE INDIAN MEDICAL GAZETTE. [Dec., 1914.

Chap. II deals with the statistics of such cases in Great Britain and Ireland. The work of the Royal Commission of 1904 is here refer- red to, and valuable deductions made and tables drawn up which are of great interest from many points of view.

Chap. Ill is devoted to the aBtiological aspect of the subject which is discussed under the headings " Intrinsic or Primary

" in which all defects or

variations of the germ-plasm, leading to imper- fect development of the brain, are included, and " extrinsic or environmental causes." The enor- mous power of the first, or hereditary, group is strongly emphasized. The author in discussing the question is inclined to discard the Mende- lian theory and to explain many such cases as the results of heredity and those of environment

(very commonly some abnormal physical con-

dition of the mother during gestation), and he is convinced that in the great majority of cases the real underlying condition is an impair- ment of the germ-cell. The discussion of the causes of the impairment

of the germ-cell is original, lucid, and well

supported by outside evidence. The doctrines of De Tries, Mendel, and Weismann are all set

aside and the author ably upholds his dictum that the germ-plasm is not immutable but that it

may, and does, undergo modification by the environment. This he explains as an impairment of the intrinsic potentiality for development which may affect the nerve-cell as a whole or

only its neurotic determinant. Extrinsic causes acting alone are said to

account merely for some 10-15 per cent, of all

cases, the cause in most cases being malnutrition in infancy, generally due in most cases to that " combination of causes?dirt, drink, and

depravity?which goes to make up slum-life in its worst form."

The remainder of the chapter ably sums up the various causes, both intrinsic and extrinsic, and it is interesting to note that in the author's

experience illegitimacy, the mental state of the mother duriug pregnancy, and the mother's

impressions, frights, and shocks during the same period have but little result on the mental state of the offspring provided she be free from a

neurotic inheritance.

Chapter IV deals with the pathological aspect of the subject. A brief resume of the normal

cerebral development is first given, and then the changes found in the various elements of the brain tissue are gone into in detail and changes in the meninges, blood-vessels, and skull are also discussed. This chapter is well arranged and

capably handled, and will be found interesting and instructive by those who concern themselves in this matter.

The classification dealt with in Chapter V is one founded mainly on degree, and secondly on

etiological causes. It has the merits of being clear, simple, and easy to follow, while giving its

adherents also very clear indications as to the

proguosis in individual cases. Chapter VI gives the reader a precis of "Neuro-

physiology and Psychology." This part of the

subject is dealt with under three headings, sensa- tion, cerebration, and action ; each of which is

again divided into various sub-headings. The

chapter is well arranged and up to date, and

gives a clear, concise account of its subject in

simple easily comprehended language. In discussing the physical characteristics of

amentia (Chapter VII) the author is not in accord with the various classifications of the

"stigmata of degeneration" promulgated by other writers. He holds that the development of mankind is still progressing, that it is practically impossible to define the "normal," and that quite possibly many of the anomalies at present des- cribed as "stigmata," far from being retrogressive, may even be progressive in character. This

chapter is well worth perusal, for, besides giving a good idea of the physical anomalies met with in sucli cases, the subject is dealt with in a broad-

minded commonsense manner which should render

it valuable to the sociologist and medical jurist as well as to the ordinary medical practitioner. The

chapter closes with a discussion on the mortality among the mentally deficient, and some interest- ing

" tables " are given'which demonstrate clearly

the diminished "expectation of life" which pre- vails among such cases at every age-group. The seven succeeding chapters are devoted to a

description of the various types of mental-defi- cients. The types laid down by the Royal Com- mission of 1904 are first described in detail, each type being excellently elucidated by various cases as well as by illustrations. The subject is then discussed from a clinical point of view, and here again each type is illustrated by cases and plates. This section of the book closes with a most inter-

esting chapter on " idiots savant " where the lives

of several renowned aments are narrated. The chapter on moral deficiency and criminal

aments is ably carried out and should be one of

much interest in view of the present unsatis- factory state of legislation on this question as well as on criminal responsibility.

Mental tests and case-taking are matters of some little trouble to many medical practitioners, when dealing with cases of this kind, and the pages devoted by the author to a description of these should prove invaluable to his professional brethren.

Similarly* the diagnosis and prognosis, treat- ment and training of such cases form chapters replete with information valuable not only to the generfjl practitioner and those of the laity interest- ed in such matters but also to those who devote themselves to this special branch of medicine. The last chapter is given up to a discussion of

the law in England with regard to Aments. This is one of the most valuable chapters in the whole book and deals with the various questions raised in a trite, commonsense manner, looking

Dec., 1914,] PUNJAB SANITARY REPORT 483

at each and all from every side and remembering that besides legislating for the benefit of the

mentally deficient the welfare of the community as a whole deserves at least an equal amount of attention. The book is well worth perusal by all interest-

ed in a subject so important to the welfare and

prosperity of a nation, and it can be thoroughly recommended to all who have the well-being of their race at heart and wish to maintain its

present standard and raise it, if possible, to still

hisher levels.