some difficulty in appreciating the medical evidence in a case of high grade feeble-mindedness, and for this and other reasons, justice to the defective offender and public safety is better ensured, at least in my view, as the law stands at present, than if a verdict of "guilty but mentally defective" were permissible. In other words, the experienced judicial authorities of the criminal courts are in a better position to appreciate and assess defectiveness, than a petty jury who would probably have more difficulty in arriving at an accurate decision in cases of mental deficiency, than in insanity. Even with reference to insanity, the standard required on this ground to establish irresponsibility and excuse the offender from the full penalty of a crime varies. In a court of summary jurisdiction the generally accepted standard is that of certifiable insanity. At Sessions or Assizes this is insufficient, there the test is one of two. Either the accused must at the time of his trial-independent of his mental condition at the time of the offence-be so insane as to be unfit to plead, that is, the insanity from which he is at that time suffering must be such that he is incapable of knowing the nature of the charge against him, or of understanding the procedure in court, or of examining witnesses, or of giving instructions for his defence, or generally of appreciating what is going on at the time. Or, if fit to plead, the mental condition of the accused at the time of the offence-independent of his mental condition at the time of trial-must be such that as a result of disease of the mind he was incapable of knowing the nature and quality of his act, or that it was wrong. And with reference to the phrase "nature and quality of the act," it has been argued by medical men in the witnessbox and counsel for the defence in the Court of Criminal Appeal, that by 'nature' of the act is meant the physical aspect of the act, and that 'quality' refers to the moral aspect of the act, that is to its criminal or non-criminal nature. But the text-books, individual judges, and the Court of Criminal Appeal (Rex v. Codere-murder. Lord Chief Justice Reading, Mr Justice Atkins and Mr Justice A. T. Lawrence, Feb. 28th, 1916) have held that the "nature and quality of an act" refers only to its physical character.

Further, with reference to the phrase "know that it was wrong" medical men are tempted in some cases to construe this as meaning morally wrong, but it has been held to mean only wrong in law, that is, an act which a person ought not to do, and an act against the law. It is probably clear from the above that criminal irresponsibility due to insanity even within the narrow limits of the existing law is somewhat technical, it can hardly be denied that criminal irresponsibility if

acknowledged in the cases of feeble-mindedness or moral imbecility would cause much confusion to juries. It is well to remember that it is not only the welfare of the prisoner that has to be considered at a criminal trial, but also the safety of the public; a fact the medical witness appears sometimes to lose sight of when one considers that a person has been stated by a medical man to be a moral imbecile, when the only evidence of defect, as far as I could ascertain, was one charge of indecent exposure. The existing procedure for the trial of defectives whilst making for the safety, as far as possible, of the public does no injustice to the defective. It is, of course, self evident that all feeble-minded prisoners are not as responsible as the normal individual. Some such thought was apparently in the mind of a judge at Assize before whom a youthful somewhat high grade defective was on trial for carnal knowledge of a young woman of his own age and physique, and against whom the chief evidence was the statement he had made to the police. After evidence as to the mental defect of the prisoner had been given, the judge instructed the jury that they should not attach as much weight to his statements as they would to those of normal persons, with the result that the prisoner was acquitted. This limited responsibility is reflected in the sentence of detention in a defective institution provided by the law, but a precise and definite opinion as to the degree of responsibility which, as I have stated, would cause, in my view, much difficulty to the jury as well as to, at times, the medical witness however expert, is not required.

It would, however, seem desirable that the question of criminal responsibility in defectives should not be lost sight of by medical men dealing with such, for cases occur in which insanity and mental deficiency are combined in a person accused of a serious crime, and whilst certain features of the offence may suggest irresponsibility they may be due to the defect and not to the psychosis, and unless the medical witness has clearly made up his mind as far as is possible which are the points indicating irresponsibility from insanity, he may find himself in the witness-box suddenly faced with an awkward problem.

As with disease so with crime, adequate treatment depends upon accurate diagnosis; but the diagnosis of mental defect may be rendered extremely difficult in prison work on account of the inherent nature of the case, or its surrounding circumstances, or from insufficient history, or malingering, or from the defect being combined with malingering, psychosis, psychoneurosis, or a combination of these.

Inexperienced workers in this field may be led astray by the nature of the offence. Other offences due to adolescent instability, to conflict,

to undeveloped insanity, may to the unwary appear due to defect. I need not refer to other possible causes of error under this head, suffice it to say that whereas the nature of the offence, that is the actual charge, has no diagnostic value, the method and circumstance with which it is associated may have a considerable bearing. Of 200 consecutive male cases the offences were:

Stealing, embezzlement, false pretences, etc..........
Sex offences

...

57

49

36

10

14

12

7

3

2

5

1

1

These offences varied from the gravest to trivial ones and in general it may be said the defective may commit any variety of crime. I have no accurate statistics on the matter but it is probable that in dealing with defective delinquents, acts of dishonesty are liable to appear at an earlier age than other criminal actions. Only too frequently the criminal offence is not an isolated event in the defective's career; in many casehistories one finds a career of petty delinquency before actual police arrest.

The difficulties not only of diagnosis but of procedure dependent upon the inherent nature of the case is well shown in the trial Rex v. Emery. The prisoner came before Mr Justice Channell at Stafford Assizes on a serious charge, the method and circumstances of which suggested mental disorder or defect. He was a deaf mute who was unable to read or write, lip read or finger talk. No means were available whereby precise insight into his mental condition could be obtained, and none whereby he could be communicated with for the purpose of his trial. The medical officer of the prison who had had accused under observation was, when the case came on for trial, first sworn to testify whether the prisoner was mute of malice, or mute by the visitation of God, and when the jury had returned a verdict that the accused was mute by the visitation of God, the doctor

was again sworn to express his opinion as to whether the accused was fit or unfit to plead. On his evidence the jury found the accused incapable of pleading to, or taking his trial upon the indictment, or of understanding and following the proceedings by reason of his inability to communicate with, or be communicated with by others, and thereon the judge passed sentence that accused should be detained until His Majesty's Pleasure be known. The doctor had given his opinion that the prisoner was probably not insane, and counsel for the defence took the case to the Divisional Court hoping to have the sentence upset, but the Court consisting of the Lord Chief Justice, Mr Justice Darling, and Mr Justice Jelf upheld the sentence of the Assize Judge; the Lord Chief Justice stating that inability to understand the proceedings of a trial was, in point of law, insanity. The case occurred in 1909 but even now, assuming the prisoner was an imbecile, in a similar case the same procedure would almost certainly be adopted. And it may be remembered that in criminal law two classes of mental alienation are usually recognised:

1. Dementia accidentalis, or adventitia-insanity as we know it. 2. Dementia naturalis, or nativitate-in other words "absence of understanding from birth without lucid intervals." And "a person deaf and dumb from birth is by presumption of law an idiot, but may be shown to have some use of his understanding."

Insufficient or entire absence of history is well recognised as a bar to accurate diagnosis and has no more particular applicability to criminal than to other cases, except that a history of the criminal offence itself may be of such importance that certification, or not, may depend upon it. Thus there should be usually no hesitation in certifying a defective charged with a sexual offence because of the danger to the community, and the almost certainty that the offence will be repeated if the offender retains his liberty. But a defective of equal grade charged with a common assault may have received such provocation as would have caused a normal individual to retaliate, and such a defective if in a suitable environment and able to maintain himself should not, in my opinion, be certified.

Difficulties in diagnosis due to malingering mental defect may be very real and require all the examiner's skill to elucidate; they fall into three main groups:

1. The ordinary criminal assuming mental defect. 2. The mental defective assuming mental defect.

3. The mental defective assuming normality.

In the case of the defective assuming mental defect one does not expect to find any insight into his mental condition, but he does appreciate his liability for punishment, and the defect is assumed to evade the consequences of his offence. When the defective assumes normality and tries to hide his defect he has, generally speaking, some insight into his condition and sometimes some experience of defective institutions, and may hope to receive by his deceit a short sentence of imprisonment rather than an indeterminate detention in a defective institution. In neither of these cases is the medical problem as a rule formidable, but when a clever criminal assumes defect one's diagnostic capacities may be considerably exerted; the following case is fairly typical of its kind:

Case 350/22. Single, aged 26, remanded for report as to his mental condition, and charged with an indecent assault upon a girl aged 5. His own statement was as follows. He went to a special school, as an ordinary school would not have him, and between 10 and 16 was in several hospitals and had an operation on his brain. He could not remember the operating surgeon's name, but mentioned the hospital. Soon after this he was sent to an asylum for 12 months and then joined the Army in 1914, and after 12 months was discharged without a pension through a mental hospital where he remained 12 months and was in a padded cell. He then on discharge went to Canada and in 3 months was sent to an asylum and deported to England and then remained at home till turned out because he would not work. He added that recently he had had pleurisy and pneumonia and was subject to fits, but could give no description of them except that he woke up at night with his mouth full of blood. When questioned as to the offence he first denied all knowledge of the case, then said he took a little girl to Liverpool Street station, and bought her a ticket and gave her in charge of the guard, and that was all he knew. At a later interview he said he had been living with a woman for three nights in lodging houses, and she sent him into the country to fetch a little girl, which he did, and when he got back to the lodgings he could not find the woman and after 5 days looking for her in vain, sent the child back. On examination he was in poor physical condition but showed no bodily organic disease. He was slovenly in appearance, sullen in expression and hostile in demeanour; in the ward he appeared unable to carry out quite simple instructions and at first alleged deafness. He appeared to lack initiative and capacity for concentrated effort, to be apathetic and he was indolent; he did not occupy himself at all and seemed quite unconcerned as to his future. He appeared to be ignorant on matters of ordinary interest and common knowledge, not to know the value of