In the earlier stages of these investigations, there was another belief which was shared by most workers in this field: that mental defect was mainly a hereditary burden, and that it was distinctly evidenced that mental inferiority was transmitted from one generation to the next, in one or another form. Family charts were drawn up to prove this contention. Some of these charts tabulated hundreds of individuals in succeeding generations, marking each one as either "normal,' "normal," or "mentally defective" or "pauper," or "inebriate," or "epileptic," and what not. It did not occur to the enthusiastic and painstaking elaborators of these charts that the sources of their information were largely unscientific, and consequently unreliable; and that it would seem difficult to diagnose the case of the dead when we find it a still unsolved problem to properly diagnose the cases of the living.

The writer of this article has for a number of years maintained that the problem of mental defect has been approached from the wrong angle; that it has been overstated in a large measure, that the many ills of society cannot be solved by attributing social failure to mental defect, that the problem of relief is not a single, or simple problem, but one which involves a complete re-organization of our views of social efficiency. Recent utterances on the part of some of the most ardent advocates of the older theories of "mental defect" show that the truth of his contentions is beginning to be realized, and it may be well to refer briefly to some of the

have presented in their later researches and which form the basis of this change of mind and attitude.

In an address made at a meeting of the American Association for the Study of the Feeble-minded, Miss ELIZABETH E. FARRELL, Inspector of Ungraded Classes of the New York Public Schools, admitted frankly that we know very little about heredity; her own studies did not justify the sweeping conclusions that had been made by so many. This reminds me of the admission made by one of the foremost students of heredity and eugenics, eugenics, Dr. DAVENPORT, of Cold Spring Harbor, several years ago, that feeble-minded parents do not always have feeble-minded offspring. It had been found that normal children had been born from the union of two feebleminded persons. DR. DAVENPORT explained this on the basis of the theory that the two persons represented two different kinds of feeblemindedness, or social inefficiency, and that there were certain positive elements which united in the offspring, skipping the defects. However this may be, these facts show that feeblemindedness is not yet fully understood, and that we must be careful about making apodictory statements about the laws of human heredity.

DR. WALTER E. FERNALD, superintendent of the Massachusetts Institution for the Feeble-minded, one of the most reliable students of mental defect, still holds to the theory of the hereditary origin of most cases of feeble-mindedness, but, as will be shown later, had to confess in the same meeting, that he has had many

puzzling experiences with inmates of his institution, and that much of what he now had found to be a fact would have been, if propounded publicly three or four years ago, considered rank heresy.

That heredity, at any rate, does not explain all cases of mental defect was shown by DR. ARTHUR STEIN, of New York, in a paper read at the recent New York meeting of the American Medical Association. Speaking of congenital, not hereditary, causes of idiocy, he showed that certain cases may be only apparently congenital, but are really acquired thru obstetric traumatism in form of prolonged and unassisted labor. These cases are, therefore, preventable. Cerebral hemorrhages and contusions which are apt to follow on compression of the infantile skull in the internal passages prepare the soil for feeblemindedness. My own observations of mental defect have led me to believe that DR. STEIN is right. Instrumental cases furnish their quota. Even when the effect is not feeblemindedness, in the full sense of the word, distinct disturbances of the mental equilibrium of the child will often follow in the wake of difficult and ill-regulated labor.

A few other causes of mental defect or disturbance may here be suggested such as are not hereditary in the way this term is usually understood. One is the mother's functional weakness, either on account of local inefficiency, or thru cardiac exhaustion. There are women who cannot carry a child longer than eight months. The other conditions which ought to be carefully studied in their relations to the production of children who are

physically and mentally defective, are stillbirths and miscarriages. When stillbirths occur in a family, there is always suspicion of functional weakness which may have an effect upon the children who are born alive. These may have escaped the fate of their stillborn brothers and sisters in their intra-uterine existence, but will show the stigmata of weakness and inefficiency after they are born.

Miscarriages are likewise symptoms of functional inefficiency and indicate congenital conditions which must leave their mark upon those children who manage to get born. But there are cases of intentional abortion. Interference with the natural function of woman and with the process of gestation must have a most disastrous effect upon the female reproductive organs so that even when the mother is ready to assume her maternal responsibility, the child, or children, then allowed to mature and be born, may be weaklings and imbeciles. But the attempt at abortion is not always successful. The unwelcome child, born against the intention of its mother, will almost invariably be affected, and be the victim of its parents' sins.

Malnutrition, before birth and after birth, is a frequent cause of mental impairment in a child. The condition of the mother during pregnancy needs careful attention so that her own metabolism remain undisturbed and she may give her budding baby sufficient and proper nourishment. Dr. Julius LEVY, head of the Child Hygiene Department of the Newark Board of Health, in a paper read before the New Jersey State Association of Medical Inspection and School Hygiene,

May 26, laid great stress on proper nutrition of the infant in the early years to prevent mental defect. He showed the great influence of environmental causes upon the development of the nervous system and of the mental life of the young child. Thru proper control of obstetrical conditions, midwives, and nurses, as far as the regulations of his department reach, DR. LEVY has been able to demonstrate practically that much misery and failure can be prevented.

MISS FARRELL, in the convention referred to before, reported on results of after-care work with special class children. Some astounding facts were revealed. Very few of the former special class children were found to be criminal. A few petty thefts were recorded, it is true, but there was no general drift into the penal way. Besides MISS FARRELL explained, the foreign-born children may have been free with other people's property for the simple reason that they came here considering this country a "land of freedom" where everything belonged to everybody. These individuals merely needed a new socialization. Many of her former pupils were occupied in useful trades, and their wages compared favorably with those received by "normal" children of the same age. In fact, she claimed, that institutionally trained feeble-minded are better workers than the ordinary workmen. I will leave it to the readers to draw their own conclusions. One of her feeble-minded girls who was married had a precocious child; that the mother was really feeble-minded was testified to by the trained psychologists and psychiatrists who had done the examining for the New York Board of Education.

DR. FERNALD also presented a study of inmates discharged from the Massachusetts institution for the feeble-minded, and corroborated MISS FARRELL'S observations. Only four out of one hundred and sixty-seven discharged women, or about two and one-third percent, were in penal institutions. Only eleven of these girls had become illegitimate mothers. Of twenty-seven married girls, eleven did very well. All the rest of the girls were supporting themselves in proper and successful ways. Similar, or even better figures were obtained for the four hundred seventy discharged boys. Only eleven, or about the same percent as among the girls, were criminalistic. Twenty-two out of forty-three true imbeciles lived at home and did well. A very small number of the discharged boys had a bad reputation. One boy was the efficient foreman in the packing room of a munition factory. One has his own business as a sign painter: one is travelling salesman in the millinery trade. Some are in the United States and the English army and are good soldiers. Many are useful, perfect citizens and workers. Of twenty-eight who are married their wives say that while they are "simple-minded men," they are model husbands.

The most interesting fact revealed by Dr. FERNALD is this that he had protested against the discharge of some of the very ones who did best after their discharge. He confessed that the authorities had been unable to pick out those who would do well away from the institution. This proves, he said, that feeble-mindedness is not a simple x, all depends upon the other elements that make up the

equation. One cannot generalize as there is a variety of individual compositions. He demanded a refinement of our tests so that more than mere "intelligence" be examined.

Here we have the conditio sine qua non. All these children had been pronounced, by "expert psychologists and psychiatrists," as feebleminded. The trouble is we have allowed the psychological laboratory method to overshadow all other considerations. Even the psychiatrist has often enough been satisfied to test the intelligence, so-called, of a child

by the psychological laboratory

method, and to hinge his psychopathic diagnosis to these findings. A child was first of all "Bineted" as the term goes. searching into a child's conduct, the Binet mental age colored the diagnosis and biased the diagnostician.

With all the further

I may be permitted to refer the readers to my new book, "The Exceptional Child," published by CHAS. SCRIBNER'S SONS, in which I have discussed the problem of tests, together with all the problems entering into this field of research, quite fully. They will find that in this book, written in 1915, and revised up to date, the very "heresies" of which DR. FERNALD speaks, are propounded. But I must give DR. FERNALD credit for having shown the inadequacy of the Binet tests several years ago. I will quote some illuminating statements from his article on THE DIAGNOSIS OF THE HIGHER GRADES OF MENTAL DEFECT, published in the AMERICAN JOURNAL OF INSANITY, of January, 1914. He

says:

"The Binet tests corroborate where

we do not need corroboration, and are not decisive where the differential diagnosis of the high grade defective from the normal is in question......

"There is still some question as to the invariable fairness of these tests, in subjects with which the patient has had no practical experience, as a measure of native mental ability. . . . The Binet test does not register as defective certain persons who present plain evidence of mental defect in their personal history, school history, and performance, social and domestic reactions, etc., while on the other hand, certain individuals who fail to come up to the requirements of the Binet test do not present the usual personal, social and economic reactions of mental defect....

"The application of psychological tests should not constitute the exclusive method of examination......Absolute standards should be used with great caution......There are many grades of intelligence among normal people...... Feeble-mindedness is not merely a question of intelligence.

"The psychologists have been so interested in the diagnostic application of the Binet and other tests that while we are now familiar with certain rather empirical negative age standards and landmarks applicable to children and to cases of pronounced defect, we still possess no really scientific understanding of the exact psycological status of the ordinary cases of feeble-mindedness......The psychology of mental defect is yet to be written. . . . . . After all, the ability of a man to earn a living, to maintain himself independently in the station of life in which he is born is the one supreme test of mental normality......