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.
FOOTNOTES:
[36] I strongly deprecate, as lamentably wrong and needless, the
violent language sometimes used by writers on both sides of this great
controversy of the origin of man. If the _odium theologicum_ may have
inspired some of the opponents of evolution, it is undeniable that
there is strong evidence of an _odium antitheologicum_ amongst not a
few of the supporters of this doctrine, who indulge in abusive
epithets, launching into personalities of a most objectionable kind;
for instance, we are informed that "orthodoxy is the Bourbon of the
world of thought; it learns not, neither can it forget." Now I protest
against the attempt to obscure argument by appeals to the passions and
to prejudice. Science and Theology should not be regarded as two
opposing citadels, frowning defiance upon each other, but their
votaries should look upon each other as co-labourers in the cause of
truth, and they should welcome light and knowledge from whatever
quarter it may come, being fully convinced that all systems and
theories irreconcilable with truth, are built upon the sand, and must
ultimately be swept away.
[37] One of our popular novelists, Sir Walter Besant, has
philosophically said, "there is between the condition of Man and the
Brute an interdependence which cannot but be recognised by every
physician. So greatly has this connection affected some of the modern
physicians, as to cause doubt in their minds whether there be any life
at all hereafter; or if when the pulse ceases to beat, the whole man
should become a dead and senseless lump of clay. In this they confuse
the immortal soul with the perishable instruments of brain and body,
through which in life it manifests its being and betrays its true
nature, whether of good or evil."--_Faith and Freedom._
[38] Cases like this would seem to illustrate the truth of the
statement of that great philosopher, Sir Thomas Browne, when he says,
"Thus it is observed that men sometimes, upon the hour of their
departure, do speak and reason about themselves. For then the soul,
being more freed from the ligaments of the body, begins to reason like
herself, and to discourse in a strain above mortality."--_Religio
Medici_, p. 208.
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.