142

Reviews and Notices of Books.The Soldier’s Heart and the Effort Syndrome. By TaoMAs

LEWIS. M.D. Lond. London: Shaw and Sons. 1918.

Pp. 144. 7s. 6d.

INTO this small book Dr. Lewis has packed much informa-tion. As is his wont, he writes only of those things he hashimself found to be true, and he sets these down in a well-knit form easy to apprehend. His experience of cardiacdisabilities in soldiers is probably unrivalled, and this bookis therefore one which no one handling these problems canafford to do without. It is written especially to helpmembers of invaliding and pensions boards, and this purposeis admirably fulfilled.

Dr. Lewis’s main thesis is that the "soldier’s heart" "

syndrome is made up of the same subjective and objectivecomponents as follow strenuous exercise in healthy men.In the exhausted soldier, however, the point of cardiacdistress is much more easily reached. For its causation thisexhaustion depends on several factors, some inherent, someacquired. It is to be detected mainly by testing the manwith physical exercises. These, if graduated, constitute ameans of prognosis as well as of treatment. They are alsoapplicable to the recruiting problem. These arguments, withtabulated results of the treatment based thereon, and muchsound advice as to the discernment of organic heart disease,constitute the bulk of the book. It appears at an opportunemoment, for one of the great tasks which the PensionsMedical Service (if and when we have one) must tackle isthat of assessing fairly the claims of the man with a cardiacdisorder or lesion. The book is clearly printed, and can beread in two or three evenings.

LIBRARY TABLE.

Kala-azar, its Diagnosis and Treatment. By ERNEST MUIR,M.D. Edin., F.R.C.S. Edin. London and Calcutta : Butter-worth and’Co. 1918. Pp. 38. Rs. 2.-This little book is intro-duced by Sir Leonard Rogers, and is written with the objectof supplying to the medical practitioners in small towns andvillages in India .a guide to the diagnosis and treatment ofthis very prevalent disease. Until lately kala-azar wasalmost always fatal, but Dr. Muir considers that if the con-dition be treated by the intravenous injection of soluble

antimony salts, as advocated by Sir Leonard Rogers,’’ recovery may be expected in almost all cases wherethe treatment is begun in time and carried out

efficiently." Having considered the question of diagnosis,the author describes his method of treatment, whichhe divides into four divisions : (1) the production of

leuoocytosis by the intramuscular injection of turpentine,camphor, creosote, and olive oil ; (2) the destruction of

parasites by antimony salts ; (3) the treatment of complica-tions ; and (4) general tonic treatment. The work shouldbe useful to those who are actively engaged in dealing withkala-azar, as the technique of various operations, such asspleen puncture and the intravenous injection of antimony,are described in detail.

At Home in the War. By G. S. STREET. London: ’,Heinemann. 3s. 6d.-The normal psychological attitude ’,displayed towards the war, as it went on, by middle-agedmen averagely endowed for comprehension and sympathy isprobably a fair definition of the thing which Mr. Street wastrying to express in this little book. He has been misled byhis modesty if he thinks that his description of such an attituderepresents the average man’s ability. Such remarks as this :"It is a universal foible of humanity to exaggerate thework of what you know and another man does not know ;the vanity of special knowledge is seen everywhere " ; or theanalysis of the anti-national spirit in the paper entitled’’ Our Intellectuals," are in their neat and terse mannerexpressions of what most of us would be proud to say halfas well. The "Revanche" for middle age, in the paper called’’ The War and Age," is a specimen of the author’s pleasanthumour. On page after page one finds set out with lightnessand charm some thoughts of which most middle-aged men athome have been conscious without being able to define them.Mr. Street holds up to many of us a mirror from which thehaze obscuring our real thoughts has been skilfully wipedaway. Many quite conscious of an imperfect realisation of

what is really being thought will value the little book and feelthankful and friendly towards its author. In a somewhatdifferent vein to most of the book is an " essay in little, called" The War and Kensington Gardens," which Mr. Street says

S should have been really a sonnet or sonnet sequence. It

,. would be pleasant if the author would try his hand in thatmode; he has not only the deftness and delicacy but alsothe power which make up the true sonneteer.

S A Health Reader for Girls. By AGNES L. STENHOUSE- and E. STENHOUSE, B Sc. Lond. London : Macmillan and

Co., Limited. 1918. Pp. 190. 3s.-This is an excellent little: book in which the subject of health is dealt with in the

simplest language. The body is first described, afterwhich an account is given of food, digestion, care

of the teeth and cleanliness, clothing, breathing, ventila-tion, the blood, the nervous system, and special senses.

’ The only chapter to which we take exception is that on theFood of Babies. Milk is not necessarily sterile after being

, stood in a pan of boiling water for a quarter of an hour.

; The information given on preparing the baby’s food, on the amounts which should be given, and on the times of feeding is long out of date. No special dilution and no definite amount

of food is now given to a baby of a certain age, and, thoughthese instructions may be useful in helping to prevent

) disasters, it is a mistake to put a hard-and-fast rule on recordin a book which may be referred to in the home, or to give a

l mother the idea that her baby can be fed by any rule-of-,

thumb method. Babies’ digestions, like babies themselves,i are not all made on one pattern.

New Inventions.A "DROPPED-FOOT" APPLIANCE.

WE have received from Mr. Frank Jenner, surgical boot-maker, Christchurch-road, Boscombe, an appliance intendedto enable the sufferer from "dropped foot" to walk withease and comfort. It consists of an iron framework formedof two sickle-shaped arms joined together at the straightends by a short transverse bar passing under the sole of theboot and close to the heel, to which it is affixed by a flitbroad hook. The straight parts of the sickle-shaped

! sides pass upwards towards the ankles, the bend inthe sickle allowingfor the protrusionof the malleoli.The frameworkis kept rigid

! and in place by’ a strap passing

round the back ofthe boot. The free

" ends of the frame-work are joined tothe front part of

// B the boot by spiralB B ,,, springs at points

at either side ofand at a level with

! the bottom of the

laced opening. These springs can be adjusted so as to .

correct any tendency to inversion of the foot or the opposite,and the whole apparatus can be adapted to any sized boot.The appliance, which costs 15s., is ingenious and mayprove useful in practice-we are informed that it has beenused with satisfaction at the Boscombe Military Hospital-but it seems to us that the upper portion of the lever is tooshort, consisting as it does only of the part corresponding tothe last inch of the tibia and that the pressure of the strapover the tendo Achillis can hardly fail to be excessive if thedevice is to keep the toe from dropping. The hooks, too, bywhich the springs are connected with the boot do not seemvery well adapted for hard wear. These criticisms, if inpractice they are found to be just, can be readily met.

143THE PSYOHOPATHIC ORIMINAL.

THE LANCET.

LONDON: SATURDAY, JANUARY 25, 1919.

The Psychopathic Criminal.AMONGST the problems to which the war has

given a new aspect and an added urgency the Jtreatment of the mentally defective and unstable I

criminal is one of considerable importance.Large numbers of men will be returning to thiscountry or will be coming out of the militaryhospitals while still suffering in some degree frommental and nervous disabilities brought about bythe unexampled stresses of modern warfare. It

may be anticipated with a fair measure of assurancethat in many cases the mental enfeeblement of theseinvalids will be manifested by disorders of conductof more or less gravity, bringing them intoconflict with the law; and several instances ofthis kind have, in fact, come before the criminalcourts within the last few weeks. Public opinionwill not tolerate the treatment of these war victims

by the indiscriminate methods which have beenapplied to the general mass of law-breakers. Thedemand will certainly be made that in everysuch case full consideration should be given tothe mental condition of the offender, and that heshall be dealt with on curative lines adapted to hisindividual needs, and not merely by the stereo-typed punitive and repressive measures which up tothe present have been the sole resource of thelaw. To satisfy this demand, which can obviouslybe urged with no less force in regard to other

categories of psychopathic delinquents, it will be

necessary to introduce an entirely new spirit intothe system of procedure in criminal cases and torecognise to a far greater extent than in the pastthe importance of the help which the expert inmorbid psychology can give in the administrationof justice.A proof of public opinion in this direction is

supplied by the proposals in a report which wassubmitted to a meeting of the justices of the Cityof Birmingham on Jan. 2nd of this year by theirGeneral Purposes Committee. This report, pre-sented by Mr. GERALD BEESLY, deputy chairman ofthe justices, voices the dissatisfaction which hasbeen felt by the Birmingham magistrates-a dis-satisfaction which has doubtless been shared by°magistrates in other parts of the country as well-at being compelled to deal with criminal cases

without having any regular facilities for obtainingexpert advice touching the mental condition ofthe offenders, and without adequate means ofgiving effect to such advice even if it were

obtainable. In the opinion of the com-

mittee, this deficiency in the legal machineryhas been an important factor in the relative failureof the existing penal system as a reforming agencyand as a preventive of recidivism. With a view toorganising a more satisfactory method of treatmentthe committee have put forward a number of

valuable suggestions, which they divide into twocategories-those which are immediately practic-able, and those which can only be carried out byspecial legislation. Of the proposals under theformer heading the most important is the recom-mendation that a physician with expert knowledgeof psychiatry should be attached to the court, withwhom the justices can confer and take counsel inany particular case. It is interesting to note, asbearing on this suggestion, that a similar systemwas introduced in 1914 at the instance of ChiefJustice HARRY OLSON, in connexion with theMunicipal Court of Chicago. Here a psycho-pathic laboratory was instituted under thedirection of Dr. W. J. HICKSON, for the examina-tion of accused persons presenting indications

suggestive of mental abnormality; and accordingto the recent reports of the Court (Tenth andEleventh Annual Reports of the Municipal Court ofChicago) the results obtained have been such as toI convince the judicial authorities of the practicalutility of psychiatric assistance, not only in

deciding as to the treatment of offenders butalso, in many cases, in assessing the reliability ofwitnesses. It is difficult to think of Chicago as afield for the propagation of academic theories anddoctrinaire views ; and the fact that the authoritiesof this typically business centre have been movedby scientific psychology to consider the propertreatment of the criminal justifies the attach-ment of considerable weight to such testimonyto the value of psychiatry in the administrationof the law. The example of Chicago shouldencourage the citizens of Birmingham to carryout the interesting experiment which they haveprojected. They will, of course, be impeded inthis enterprise by the fact that, in the presentstate of the law, only very limited means existfor applying differential treatment to the variouscategories of mentally defective and unstableoffenders; but the accumulation of definite dataregarding the relation of mental abnormality tocrime, which this scheme should provide within ashort time, will in itself be of considerable valuein educating public opinion, and will do muchto further the adoption of the legislative reformswhich they advocate.These reforms are set out in Mr. BEESLY’S report

as follows :-1. The provision of 11 placers of detention" for observation

of cases of mental instability, instead of prison on remand.2. The provision of farm colonies and the like for cases

which cannot be dealt with under the Lunacy or MentalDeficiency Acts, instead of prison.

3. The establishment of a consultative clinic, associatedwith the administration of justice, with expert medicalpractitioner and lady superintendent in charge, for voluntarytreatment of cases where some form of mental weaknessis exhibited, and to which the friends or relations of theperson anected might appeal for help and guidance.

4. The clinic might also: (a) Assist in determining howfar more or less recidivist criminals submitted for examina-tion by the police are fit to be at large; (b) examine personssuffering from "borderland insanity," whether submittedby public authorities or by their relatives, prescribing (orcertifying) appropriate treatment where mental instabilityis established; (c) deal with feeble-minded women and girlswho have borne illegitimate children, or have becomeinfected with venereal disease.

5. Amendment of the Mental Deficiency Act, 1913, especially by extending its operation to cases of mental debilityother than those existing " from birth or from an early age."These proposals should find general acceptance asindicating the principles to be kept in view inreforming our ,present methods of dealing withmental weakness which leads to anti-social conduct.Such modification as they may need in detail will