4. Microscope reveals changes proportionate to the deficiency during
life.
=Blood-vessels in Amentia= show no marked changes from those of the
normal brain. Hyaline degeneration may be present; also pigmentation.
These conditions are not constant in amentia hence cannot be considered
causal.
=Neuroglia in Amentia.=—Sclerosis and hypertrophy occur in a large
proportion of cases. This is diffuse throughout the brain, with here
and there certain circumscribed areas forming nodules.
=Nerve Fibres of Cortex in Amentia.=—Association system fibres are
always diminished in number and not so complicated.
=Clinical Varieties of Amentia.=—There are two varieties of amentia and
conventionally for sake of study we must arrange them into those from
(1) Congenital causes and (2) acquired causes.
Among those which arise from congenital causes we have the
microcephalous and Mongolian types. In both cases there exist
constitutional taints through successive or immediately forgoing
generations of such diseases as syphilis, tuberculosis, epilepsy, and
acute alcoholism affecting proper collaboration of germ cells previous
to fertilization and hence impaired germinal endowment through a
weakened nervous system.
Those arising from acquired causes are from injury to mother or fetus.
=Macrocephalus.=—A person whose skull measures less than seventeen
inches in its greatest circumference. This class comprises less than
10% of all aments.
=Cause.=—The type is neither a freak reversion of the species to a
lower grade of development nor accidental, but due to an inherited
blight on the nervous system arising from constitutional disease,
alcoholic and sexual excesses, consanguinous unions and too numerous
latter-life pregnancies in undermined health states. They come entirely
from neuropathic stock and their brothers and sisters are degenerates.
Many dwarfs exhibit this type.
=Characteristics of Microcephaly.=—(1) Circumference of skull
diminished; (2) Brain smaller; (3) Stature small (5 feet); (4) Rarely
live to advanced age; (5) Die of tuberculosis; (6) Mostly imbeciles and
idiots (few morons).
They have their sensory impressions intact and are generally vivacious
and muscularly active, even restless. They have good sight and hearing
and are highly initiative but have not the ability to any sustained
effort. They are actively observant and the majority are affectionate
and well behaved. Some are unsteady in walking, others are helpless,
and about one-half are subject to epileptic fits.
=Mongolian Amentia= (Mongolism).—This type (Kalunk or Tartar variety)
received its name from Dr. J. Langdon Down from their facial
resemblance to members of the Mongolian race. They number about 5%
of all aments including the semi-mongols who have only a few of the
characteristics of this type.
=Cause.=—Eleven out of twenty-five are from syphilitic origin.
Glandular or nutritional defects are suggested as a cause. They will
show negative Wassermann test and positive tuberculin tests. Uterine
exhaustion and ill health of mother during gestation are factors
suspected of entering into this condition. The latter-born of large
families are frequently affected.
=Pathology of Mongolian Idiocy.=—The brain of the Mongolian ament is
considerably under-sized and has less convolutions and is more shallow.
The pons, medulla, and cerebellum are about half the size of ordinary
feeble minded types. The cells by microscopic examination show an
immature condition. This lack of brain development results in deficient
expansion of base of skull, hence the characteristic physiognomy. There
is no glandular abnormality.
=Description of the Mongol Type.=—This type is distinguished by
characteristics of skull, eyes and tongue and is usually observed at
birth.
1. The skull (Brachycephalous) is rounded and diminished in size
particularly through the antero-posterior diameter. The face is
flattened, there being no recession of frontal and supra-occipital
regions.
=Eyes.=—The palpebral fissures are narrow and slope obliquely downward
and inward. Lids inflamed.
=Tongue= protrudes, is large and marked by large papillæ and scored by
transverse fissures due probably to tongue sucking, predisposing to
inflammation of the mucous membranes.
=Ears= are small and round and have poorly developed and irregular
lobules.
=Nose= is short and flat and has triangular nostrils.
=Teeth= are soft and ill formed and tend to decay.
=Hair= is usually scanty and wiry and very dry.
=Cheeks= are flushed. Palate is high and narrow and mouth is open, and
lips are cracked. Adenoids exist in all cases.
=Hands and Feet= are broad and clumsy. Flat foot and knock-knees are
common. Skin is rough, coarse and dry.
=Abdomen= is large and mushy. Umbilical hernia often present.
=Circulation= is rarely good, causing blueness and coldness of
extremities, with sores and chilblains. Heart lesions are frequent.
Lesions of a chronic inflammatory nature in respiratory and digestive
tracts exist. Nasal and bronchial catarrh and diarrhea are common.
Mongols die early (about 14 years) usually of phthisis.
Available statistics show the various types and variations of these
conditions in great detail; however, the above will enable the reader
to classify and properly diagnose in given cases. It is not the
writer’s intention to portray here what is easily a treatise by itself.
=Osteopathic Consideration of Amentia.=—During a period of five years,
observation of the various types has led me to believe that much can
be done to correct circulation to cerebral structure with consequent
development of brain tissue and function, where discoverable trauma
exists. From all available sources there is traumatic interference
in from 15 to 45% of these cases, according to different authors.
Where history involves constitutional findings (syphilis, tubercular,
glandular and chronic alcoholism) I have treated them with the intent
of relieving only until the next phase of the condition would appear.
Where trauma alone exists and the family history is good, I know the
case is in the field of osteopathy alone, and can be developed to a
degree limited only by the intelligent care of those having the case
in charge. Especial attention should be given to discipline, housing,
sanitation, personal hygiene and general environment.
=Lesions.=—Atlas, generally rotated. Rarely posterior but frequently
resting beneath a posterior occiput. Lateral mass on the posteriorly
resting portion of misplaced atlas will become interlocked with
transverse process of axis in a few instances, combining the amentia
with a progressive inflammatory tendency to the middle ear which by
successive abscesses ultimately destroys structure and function;
possibly traumatic epilepsy, and surely catarrhal inflammations in all
mucous membranes of the head.
Many bony and ligamentous irregularities exist in the various types of
mental defective where the cause is inherited weakness, nutritional
diseases or kindred sources. Spinal luxations exist singly and in
series, causing various palsies, spastic muscles, and deformity.
Postural defects, particularly of ribs and costal cartilages cause
functional disturbance throughout the thorax and abdomen.
=Treatment.=—Invariably the care of aments entails wisdom of procedure.
Reconstruction is the prime object in every instance, hence time
and number of treatments must not be considered. Treat to =correct
structure; teach= as far as possible; =train= always.
Deft and intelligently applied technique are certainly required in the
correction of these cervical lesions. Treatment should be given thrice
weekly (never less than twice for progress) with definitely established
mental tests before, to discern the mental level, and at succeeding
periods of three months each, noting progress, if any. The Binet-Simon
scale or some other available mental test should always be made and
record carefully kept of each case for your own benefit as well as
the patient’s. After six months, if no appreciable gain is shown
treatment is discontinued and the case must be cared for in another
manner as beyond your special field of effort. Usually it is apparent
by the end of the third month if anything can be done to improve the
mentality. The physical advantages, in some cases warrant continued
treatment where there is no appreciable mental gain. Institutional care
of these types is the only practical means of handling them properly
from an osteopathic standpoint, as it requires some one properly
equipped to make your tests and keep your record;—it is sufficient
for the doctor to do the work demanded. They can thus be classified
and progress systematically shown. The higher grades must be taught
and though self dependence may never be attained they can in many
cases by training be capable of useful pursuits and quite frequently
remunerative work. It makes for happiness at least to keep them busy
and forestalls the mischief that would otherwise result. Even imbeciles
can help in routine work of an institution or home, and idiots may,
by training, gain some power of self help and cleanliness. Training
depends on the individual capacity for such in each case—his habits,
and general character of his propensities. Prevention of their marriage
should be positive and for prevention of their propagation this and
their sterilization by operation are the only two measures at hand.
Sterilization, however, is repugnant to some elements of society and
could be abused, hence the segregation of aments would appear to be
our only solution at present. The ultimate intention of treating any
case is to use any measure tending to stabilize the nervous system.
Corrective effort alone is not sufficient but these osteopathic
endeavors in conjunction with proper discipline, good food, regular
rest and personal hygiene both mental and physical and a scrutinizing
restriction tending to any kind of excess is rendering the osteopathic
procedure in such cases rapidly indispensable for the treatment of
amentia.