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he is shown to be insane or mentally defective. These terms may be briefly defined
as follows:—
Insanity.—A "lunatic" is an idiot or person of unsound mind, and the
term is capable of wide application. In practice he is only dealt with by the
community if his conduct is persistently dangerous to himself and/or others.
Lunatics are transferred to mental hospitals, and those whose condition is
due to encephalitis lethargica, in London, are sent to West Park Mental
Hospital.
Mental deficiency.—In the case of the Mental Deficiency Act, it must be
shown that there is a state of failure of development of mind which has existed
from birth or an early age. In addition to this the affected persons must comply
with certain postulates, namely, that they are neglected, criminal or inebriate,
or, if of school age, that they are incapable of being educated in a special school.
Some difficulty has arisen owing to the fact that the term "early age" is not
legally defined, and although it has been the practice of the Board of Control
to accept cases if the onset of the disorder arose during school age, some judicial
authorities and some medical practitioners are not prepared to go so far.
With a view of dealing, inter alia, with the difficulty of the term "early age,"
a Bill was passed in the Autumn Session of 1926 through the House of Lords to amend
the Mental Deficiency Act. In this Bill it was proposed to define mental defectiveness
so as to include all cases where there is a "condition of arrested or incomplete
development of mind, whether innate or induced after birth by disease, injury or
other cause." The Bill, however, lapsed in the Commons, and it is understood that
a Private Bill will shortly be introduced substantially embodying the provisions
of the Government Bill.*
As regards patients exhibiting sleep disorders and the peculiar feature known
as inversion of the sleep rhythm, the treatment at Winchmore Hill has effected
considerable improvement. The neurological types have not on the whole responded
materially to treatment. This category includes the Parkinsonian cases already
referred to, those showing excito-motor phenomena (cases of muscular unrest) and
the intermediary types exhibiting various kinds of paralysis or paresis and disturbances
of the respiratory rhythm, speech changes, etc. The Board suggest that a
hospital school for the milder Parkinsonian cases, and treatment in an infirmary
ward or special hospital for the severer types, is indicated. It is further recommended
that the severe cases of muscular unrest should be treated in an institution on the
lines of the existing unit, their ultimate disposal depending on their physical and
mental condition, and that the bedridden cases should be transferred to a hospital
or infirmary if unable to be dealt with in their homes.
It is pointed out that the paralysis cases, including those in which the respiratory
rhythm and organs of speech are affected, have resisted treatment. The Board
suggests that some of these cases might be dealt with in an ordinary special school
if otherwise suitable, and that the severer types should be treated in the same way as
the Parkinsonian group.
It cannot be too strongly emphasised that the provision of this special unit at
Winchmore Hill has materially assisted in the solution of the problem of the disposal
and treatment of cases of chronic epidemic encephalitis. Admittedly the results
as regards positive cures have not been as encouraging as had been hoped, but it
must be remembered that the unit was experimental and the outlook when the
scheme was inaugurated was very uncertain. One of the principal objects of the
experiment was to provide residential treatment for cases which had not proved
amenable to ordinary hospital treatment.
*In the new Bill, which has passed the second reading in the Commons, "mental defectiveness"
is defined as "a condition of arrested or incomplete development of mind existing before the age of
eighteen years, whether arising from inherent causes or induced by disease or injury."