The Idiot: His Place in Creation, and His Claims on Society

Here let me add that I strongly deprecate introducing the odium theologicum into the discussion of this subject, being fully conscious of the futility of attempting to check an unwelcome or distasteful theory by means of ecclesiastical censures; and I further admit that in anything like a scientific demonstration of truth, an appeal to the affections would be absurdly out of place.36 Moreover, I should not reject the Darwinian theory from any sensational notion that its adoption was derogatory to Man's dignity, and I fully echo the sentiment of the naturalist who said that he would prefer being descended from a good honest monkey, than to be obliged to avow himself the offspring of certain fanatical enemies of scientific knowledge and progress; but I do complain of the tendency of the present day to accept new ideas without knowing or caring how to sift them. Everything is hypothetical, and allowed to enter the mind through the ivory gate of fancy; and on purely hypothetical premises, an attempt is made to found conclusive arguments. Strip the assertions of all their vagueness and superficial varnish, and reduce them to a skeleton of logical statement, and we shall see how much is assumed and how little is proved; and we shall find that we are asked to accept a chain of hypotheses, as if it were an induction founded on ascertained and indisputable facts. In thus expressing myself, I wish to add that the ultimate goal of the scientist is the establishment of truth, and I should as soon attempt to stop the progress of the avalanche that has become dislodged from the mountain top, as to try to bar the path of scientific progress, or to extinguish the torch of discovery. The tide of scientific truth will continue to flow on in spite of the modern Canutes, who may utter from time to time their imperial commands to stay its course. Magna est veritas et prevalebit.

The supporters of evolution base their arguments upon the remarkable resemblance between the brain of man and that of certain other animals. Now, I admit this striking analogy; I admit that every chief fissure and fold in the brain of man has its counterpart in that of the gorilla and the ourang-outang; and I am not prepared to deny the statement, that as far as the organ of intelligence is concerned, there is no very striking physical difference between him who weighs the stars and makes the light tell its secrets as to the constitution of distant worlds, and the howling senseless brute, who lives merely to satisfy his animal appetites. All animals of the vertebrate type are constructed on a plan which is essentially similar, not only as regards their skeleton, but as regards their brain. I don't deny that man is an animal, and that he has the essential properties of a highly organised one; but what I do maintain is, that the brain, after all, is merely an instrument by which the high psychological attributes peculiar to man become externally manifested.37 Thought is not phosphorus, as some would have us believe; the human mind is not the result of a mere molecular arrangement of cerebral matter. There is something over and above all this, and the very resemblance of man's physical nature to that of some members of the brute creation, proves beyond all doubt that his superiority to them is hyperphysical, and I fully endorse Mr. Froude's philosophical remarks, when he says, "It is nothing to me how the Maker of me has been pleased to construct the organised substance which I call my body. It is mine, but it is not I. The νους, the intellectual spirit, being an ουσια – an essence – I believe to be an imperishable something which has been engendered in me from another source." The unhappy idiot, that stricken member of our race, possesses the tripartite nature of man – for he has not only the σωμα or material part, and the ψυχη or principle of animal life, but he also undoubtedly possesses the πνευμα or principle of immortal life.

The above statement could be amply borne out by a reference to cases which have been observed in idiot asylums. I will, however, mention but three: – An idiot boy has been known to retire alone, when there was a thunderstorm, to ask God to take care of his father, who was a sailor. A former superintendent of our Asylum, the late Mr. Millard, noticed one of the inmates praying in private, and on saying to the boy, "God hears prayer," he quietly observed, "Yes, and answers it, too." A little boy in the Massachussetts Asylum for Idiots was in declining health, and became, during his dying illness, an object of great interest to the matron and attendants. Unbidden, he said his prayers frequently, and putting up his little hand, he muttered, "Me want to go up! me want to go up!" Surely he was thinking of some sort of hereafter, because he added distinctly, "They'll say, here comes one of the boys from the Boston School for Idiots." The approach of death seemed to awaken his spiritual life; out of the decaying body appeared to rise the growing soul, for, after repeating the verse of a hymn, the spirit of this simple child became liberated from its earthly tenement – its material habitat – the connection between matter and mind was severed, and, to use the touching language of his biographer, "this poor little idiot boy bade a long adieu to his sorrowing friends, and doubtless there was then joy in heaven, as the recording angel wrote in the Book of Life the name of George Tobey."38

In an interesting essay published many years ago, entitled, "A Morning at Essex Hall, Colchester," its author, the Rev. Edwin Sidney, in describing his visit to the Asylum, remarked that, "The conduct of those who go to Church on Sunday is very decorous. One of the most cheering things in connection with these objects of benevolent solicitude, is the capability some of them manifest in receiving and being comforted by religion. There are amongst them instances of high conscientiousness and piety, which might be examples to such as are gifted with unimpaired faculties."

If any apology be due for pointing out how the mysterious connection between mind and matter may be illustrated by a study of idiocy, I will observe that the subject is of such absorbing interest that it is well that it should occasionally be removed from the heated arena of biological bias, into the calmer and more judicial atmosphere of the class of readers who may be interested in the important subject I am endeavouring to elucidate.

TREATMENT AND RESULTS

"Distinguish'd link in being's endless chain,Midway from nothing to the Deity.Though sully'd and dishonour'd, still divine,An heir of glory, a frail child of dust.Helpless immortal!" —Young.

According to the census of 1881, there were about 32,717 idiots and imbeciles in England and Wales; the Census Commissioners, however, ascertained that owing to the reticence of parents, the returns were far from trustworthy, and, after careful inquiry, they estimated the total number of idiots and imbeciles at 41,940; of these, it is calculated that about 3,000 cases belong to the four Eastern Counties. Of this number, it is estimated that, after deducting pauper and other cases not considered suitable for this charity, there remain at least 1,000 idiots who need the benefits of the Eastern Counties' Asylum, whereas, our present accommodation is limited to 250 cases.39

The Board of Directors being forcibly impressed with their inability adequately to supply the wants of the district, have recently instituted a Permanent Endowment Fund. As the institution is mainly supported by voluntary contributions, the fluctuating nature of which has often caused considerable anxiety, the Board has felt the desirability of placing a considerable portion of their resources on a more solid basis; and it is with the view of giving stability and permanence to the work of the Asylum, that the Endowment Fund has been started, which it is proposed shall be inalienable, the interest only being used for the purposes of the Institution. In the year 1891, H.R.H. the Prince of Wales, with the view of furthering this object, graciously consented to preside at a Festival Dinner, at the Hotel Metropole, London, which resulted in an immediate contribution of £6,000. This fund, started under such happy auspices, has already reached the sum of £25,334 12s. 8d., which it is hoped may eventually reach £50,000, the amount which the Directors think indispensable to insure the efficient maintenance of the Asylum.

Now let us bring this matter home to ourselves. Where are the 3,000 unhappy blighted individuals that claim the Eastern Counties for their home? It is true that some of them are in the homes of the affluent, but the greater number are in the cottages of the poor, where the trouble of providing for one such member often reduces a working family to pauperism; the poor child beloved by its parents, is, perhaps, loathed by their neighbours, is avoided by other children, hidden from visitors, a constant care and sorrow to the mother, a source of anxious foresight to the father; in fact, the poor idiot child is like a Upas tree, that poisons the whole atmosphere around it, and the burden of his presence in a poor man's family is a new weight added to the load that was already sinking them down. Perhaps you may say, we agree with you, we lament as you do, that the narrow home of the humble artisan should be rendered intolerable by the presence of these stricken members of our race; but, we have been given to understand, that if not absolutely incurable, but very little can be done for them, that they baffle the efforts of the most zealous educators, and are almost beyond the reach of human sympathy.

Now this was the language generally used half a century ago, and a celebrated French authority on the subject, Esquirol, considered that idiots were what they must remain for the rest of their lives; that there was no possibility of ameliorating their condition, and that no means were known by which a larger amount of intelligence could be developed in them.40 In fact, an effort to ameliorate the condition of the congenital imbecile was regarded by psychologists and physicians as absolutely hopeless, and the standard "Dictionnaire de Médecine," published in 1837, broadly stated that it was useless to attempt to combat idiotism; in order that the intellectual exercise might be established, it would be necessary to change the conformation of organs which are beyond the reach of all modification. So great was the pessimism prevalent on this subject, that it was insinuated that the idea of teaching an idiot could only enter the brain of one somewhat closely allied to that class!

Now, I am happy to tell you, that in the broad daylight of the nineteenth century, science gives an emphatic denial to this statement. Yes, the results obtained at our own Asylum and elsewhere, show that much, very much, may be done for the unhappy idiot, who in a private house is an intolerable incubus, but who, under proper training in a suitable asylum, becomes sociable, affectionate, and happy. It has been shown that in the majority of cases, the idiot may not only cease to be a source of annoyance and danger to those around him, but by care and training he may be made able to contribute to his own sustenance; the knowledge of simple trades of a mechanical kind, such as that of a carpenter, shoemaker, or tailor, has been reached by some, and household industrial pursuits have fitted others for domestic usefulness.

A celebrated German authority, Herr Saeger, of Berlin, has stated that in his establishment he had indubitable cases of idiocy, in which the head was small and malformed, yet in which the results of education were so triumphant, that they were ultimately able to mix with the world without being recognised as idiots. Further, he tells us that in one instance a young man underwent confirmation without the priest suspecting that he had been delivered from idiocy.

Dr. Shuttleworth records the case of an inmate of the Royal Albert Asylum, who became, under instruction, an expert joiner, and from being a very imp of mischief, grew up into a well-conducted, self-reliant youth, and ultimately emigrated to one of our colonies, and when he was last heard of, he was practising his trade in a leading city.41

Equally satisfactory results have been obtained in our own Asylum. A few years ago, a boy of eight was admitted into our Asylum, who was quite unmanageable at home, a terrible incubus in the household of which he formed part, and the constant subject of jeers and derisions on the part of the other juveniles of the village. After about six months' systematic training, one of the officials of the Asylum wrote to inform me that the boy had so much improved that he was afraid the Commissioners of Lunacy, at their next visit, would consider the boy no longer a fit subject for detention in the Asylum. Being on a short visit to his relatives, who reside near Norwich, he was brought to me for inspection, when I was struck with the miraculous transformation that had been effected; from a restless, destructive boy, he had been changed into a well-conducted lad, and he had actually been taught to write. At my request, he wrote very legibly his name and address, with the date, "James Smith, Colchester;" but he made a little mistake in the date, writing backwards, in the Chinese fashion – it being September 29th, he wrote "September 92nd!" This same boy was regularly employed as one of the gardeners to the institution, and has recently been discharged, and is now earning his own living as gardener in a private family. This case illustrates a peculiarity not infrequently remarked in the inmates of an idiot asylum, that is the remarkable propensity they have for imitation and shamming. This boy came to stay with his relatives in Norfolk for a few weeks, when every few days he would have an epileptic fit. When his holiday was over and he had returned to the Asylum, these fits recurred, and were, of course, reported to the medical attendant, who had a shrewd suspicion the boy was shamming. He thereupon said to the attendant: "The next time a fit comes on, I must apply a redhot iron to the soles of the feet, it will hurt him, but it will cure him." From that time the boy had no epileptic fits!

Thyroid Treatment of Idiocy.– My sketch of the treatment of Idiocy would be incomplete without an allusion to the injection or internal administration of a preparation of the thyroid gland of the sheep, a method of treatment brought into notoriety by Professors Kocher and Schiff, on the continent, and by Professor Victor Horsley, Dr. Murray, and others in this country. Numerous cases have been published claiming successful results, and the thyroid treatment has been spoken of as a cure for at least one of the forms of idiocy.

Without quite endorsing this sweeping and enthusiastic statement, there cannot be a doubt that this method opens up a hopeful vista in the treatment of idiocy; in fact, Dr. Ireland has furnished me with the particulars of a girl, aged five years, treated by thyroid juice, in whom "the improvement was so decided that it seemed an escape from idiocy into normal intelligence."42

A striking instance of the good results of thyroid treatment has lately occurred in the Eastern Counties' Asylum, the particulars of which have been kindly furnished to me by Mr. Kirkby, the Resident Medical Officer. Esther C., aged 19, was admitted Nov. 8th, 1894, with marked symptoms of Sporadic Cretinism. She was at once put on thyroid treatment, beginning with half a five-grain tabloid gradually increased to a tabloid once, twice, and sometimes three times a day, intermitting them for short periods. Latterly, she has been taking one tabloid a day. Under this treatment, she has gained 10 lbs. in weight, and has grown 5 inches; the features are not so coarse, the previous myxœdematous condition of the subcutaneous tissues has subsided, the outline of the features having become more defined, and the skin which was formerly dry and rough, has become soft and naturally moist, having lost a great deal of its puffiness; but the most obvious change in the patient is the disappearance of the two prominent elastic swellings (pseudo-lipomata) which formerly occupied the posterior triangle of the neck on each side. The mental condition has also improved, she takes more interest in amusements, and her voluntary movements are much more rapid. This patient is still under observation, and the results hitherto attained afford a favourable illustration of the beneficial effects of this mode of treatment.

At a meeting of the New York Academy of Medicine of March 12th, 1896, Dr. Emily Lewi reported the history of a very marked case of Cretinism in a girl, aged 13 months, who was put on thyroid treatment; improvement was noted in a week, and the child grew gradually intelligent. At this same meeting, Dr. G.M. Hammond expressed the opinion, that for thyroid treatment to be effectual, it must be begun in early life.43

My colleague, Dr. Burton-Fanning, has recently shown me a case of Cretinism under his care, at the Lind Infirmary for Children, in which thyroid treatment produced the most favourable results, not only of a physical, but of a psychical character. Although the child was four years old, he had not previously spoken a word, and understood nothing; but during the treatment, his expression became much less vacant, and the faculty of speech was roused into action.

Several valuable contributions have lately been made to our knowledge of the effects of thyroid feeding, more especially in the treatment of insanity, not however the less valuable as a guide to its probable benefit in idiocy. I wish more especially to allude to the researches of Dr. Lewis C. Bruce, at the Royal Asylum, Edinburgh, as reported in the "Journal of Mental Science" for January and October, 1895. There is much in the above essay that I could profitably comment upon, but I will content myself with saying that the outcome of these researches, which intimately concern the treatment of idiocy, is that Dr. Bruce has established the fact that thyroid feeding acts as a direct cerebral stimulant, which he thinks "may prove advantageous in cases where the higher cortical cells remain in an anergic condition." Dr. Bruce mentions the case of a patient who had not spoken for several months; one day, during the administration of the thyroid extract, he suddenly began to talk, and soon became quite communicative.

Whilst these pages are passing through the press, M. Auguste Voisin, Physician to La Salpêtrière, has had the courtesy to send me detailed particulars of a case of insanity in which the success of the thyroid treatment was phenomenal. The patient was a female, aged 25, and her mental derangement assumed the form of religious monomania, insomnia, and aural hallucinations; there was great emaciation, dryness of the skin, and cold extremities.44

No benefit having resulted from six months' treatment, including hypnotism, M. Voisin determined to try the subcutaneous injection of sterilised thyroid juice. After a few weeks of this treatment, a notable amelioration was observed; shortly afterwards all her unfavourable symptoms disappeared, and she was discharged cured.

One of the most interesting features in this case is the result of the analysis of the blood, as to its corpuscular richness. Before thyroid treatment was commenced, the number of corpuscles was only 2,225,000 per cubic millimetre; after the cure by the thyroid juice, the number was more than doubled, being 4,774,000 per cubic millimetre. In Dr. Lewis Bruce's cases, to which I have already referred, the result was the reverse of that observed by M. Voisin; for in the eight uncomplicated cases recorded by Dr. Bruce, with one exception, there was in all of them a diminution in the number of red corpuscles.

At the discussion on Myxœdema, at the Edinburgh Medico-Chirurgical Society, to which I have already alluded, Dr. Alexander Bruce showed a case of myxœdema under the care of Professor Fraser, in the Royal Infirmary, in which, as the result of thyroid feeding, a condition of relative anæmia had been developed. The patient had no murmurs when admitted, but since the administration of thyroid preparations, basal and mitral systolic bruits had developed themselves. It is further stated that the blood corpuscles had fallen from 4,600,000 to 3,700,000, and hæmoglobin from 78 per cent. to 59 per cent.45

Further researches would therefore seem to be necessary, before we can arrive at a satisfactory conclusion as to what effect the thyroid treatment has upon the blood.

Possibly the dose of the thyroid preparation may be an important factor in the result, for Dr. Byrom Bramwell, in an important and exhaustive monograph upon this subject, says, that anæmia is apt to be produced by large doses of the remedy; and he mentions a case where the red blood corpuscles and the hæmoglobin underwent a marked diminution during the period of acute thyroidism, but rapidly increased under the subsequent administration of small doses of the remedy.46

The subject of blood analysis is most important, as tending to throw some light upon a matter at present but little understood, namely the physiological effect of thyroid preparations upon the blood.

Dr. Telford-Smith has reported four cases of Sporadic Cretinism treated by thyroid extract at the Royal Albert Asylum, Lancaster, when a well-marked improvement was noticed in each case. The clinical history of these cases is given with minute detail by Dr. Telford-Smith, and is well worthy of close study by those interested in this subject.47

Quite recently, at the Annual Meeting of the British Medical Association, held at Carlisle in August of the present year, communications were read on the Thyroid Treatment of Cretinism and Imbecility, by Dr. Rushton Parker, Dr. Telford-Smith, Dr. John Thomson, and others. An animated discussion ensued, the tendency of which pointed to the undoubted advantages both physically and mentally of the use of this remedy.

Although the physiological effects of thyroid feeding may not be definitely recognised and understood, there is overwhelming evidence to show that it produces marked psychical results, that it acts as a direct cerebral stimulant, and we have every reason to rely upon it as a valuable adjuvant to our treatment of idiocy; and it is not too much to say that the treatment of this infirmity, as well as of other mental defects, by thyroid extract or some other preparation of the thyroid gland, is one of the greatest triumphs of modern medicine; but much still remains to be learnt, as Professor Victor Horsley remarks, "So definite and pronounced is the cachexia thyroidectomica, that few subjects in the range of pathology offer a more fruitful and inviting field of research."48

Craniectomy.– The operation of Craniectomy (that is the cutting of strips of bone from the cranium) has been recommended and practised in cases of microcephalic idiocy, an operation suggested upon the theory of premature synostosis, or closure of the cranial sutures, thus causing an arrest in the development of the subjacent cerebral tissue. Although I could not omit a reference to this operation, it has not met with general acceptance, and one of the most recent writers on this subject, M. Bourneville, physician at Bicêtre, discourages it altogether; and from his examination of the skulls of a number of idiots, he affirms that "in the immense majority of cases, there was no premature synostosis, and that neither normal anatomy, pathological anatomy, or physiology, justified the operation of Craniectomy."49 The late Sir George Humphry was of the same opinion, as, after an examination of 19 microcephalic skulls, he said, "There is nothing to suggest that the deficiency in the development of the skull was the leading feature in the deformity, or anything to give encouragement to the practice lately adopted in some instances of a removal of a part of the bony case, with the idea of affording more space and freedom for the growth of the brain."50

At a recent meeting of the New York State Medical Society, Professor Dana read a paper on Craniectomy for Idiocy and Imbecility, and he gave the following result of 81 cases: – In 35, there was improvement; in 22, no improvement; and death ensued in 24 cases. The conclusion at which Professor Dana arrives is that "it is largely through its pedagogic influence that an improvement takes place, and that the operation is allied in its effect to a severe piece of castigation!" Dr. Dana freely admits that this view of craniectomy for idiocy and imbecility lends itself readily to humour, and it would seem that he intended to kill the operation by ridicule.51