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]
Of course, Dr. Ireland has something to say upon this point, and after
a brief review of the literature of the subject, he says: "So many
cases have been collected of microcephales with open sutures, that it
is not likely that anyone will continue to hold that the small size of
the brain is owing to the sutures closing in, and thus hindering their
growth. Even in those cases where the sutures have closed in before
birth, the question still remains whether the brain ceased to grow
because the sutures are closed, or whether the sutures closed in
because the brain ceased to grow; or, lastly, whether both the brain
and its coverings ceased to grow under a common cause."[52]
The benefits to be derived in apparently hopeless cases of idiocy,
from the systematic and persevering use of all the modern adjuvants
and appliances now available for treatment, are now so universally
recognised, that it would be superfluous to dwell further on this
point. Science has done much for the idiot, and she will do more, for
her motto is "Excelsior," and her votaries are not content to linger
with complacency on the heights already attained, but they look for
the period when, by the powerful lever of an enlightened philanthropy,
this benighted race shall be raised from the grovelling level of the
brute, to the highest attainable pitch of bodily perfection.
* * * * *
I trust that I have said enough to justify an earnest appeal for
sympathy with this unfortunate branch of the human family. I have
endeavoured to show that a great social evil exists amongst us, and
that duty and interest should alike concur to induce us to face this
evil and to master it. I have endeavoured to point out how the care
and training of the idiot has become one of the recognised obligations
of a philanthropic public. At the Eastern Counties' Asylum, we are
trying to mitigate as far as we can this great social calamity, and
our efforts have hitherto been crowned with unlooked-for success. We
are doing a grand and glorious work, and I ask you to come and help
us; the Board of Directors, a noble band of philanthropists, who
devote a considerable amount of time to the objects of this charity,
ask you to come and help us; nay, more, from the cottage homes in East
Anglia rendered miserable by the presence of these unhappy beings, a
thousand voices cry to you with trumpet tongue, "Come and help us."
We have in the Eastern Counties' Asylum an institution admirably
adapted for the care and treatment of the idiot; standing in its own
grounds of seven acres, it is furnished with all the machinery
necessary to grapple with this great social calamity, and by the
judicious combination of medical, physical, moral, and intellectual
agencies, we are enabled to develop and regulate the bodily functions
of the idiot, to arouse his observation, to quicken his power of
thought, and thus develop the sensitive and perceptive faculties; and
we have not only succeeded in raising these poor creatures from a
state of hopeless degradation to a state of comfort and usefulness,
but we have, in many instances, succeeded in kindling up in their
dark and twilight minds some dim anticipations of a brighter world;
the veil which obscured their intellect has been rendered transparent,
and to use the language of the bard of Avon, we have been privileged
to observe that--
"As the morning steals upon the night,
Melting the darkness, so their rising senses
Begin to chase the ignorant fumes that mantle
Their clearer reason."
In addition to the Asylum proper, the Board has lately purchased a
farm-house with 32 acres of land, immediately adjoining the main
building. By means of this welcome acquisition, increased
accommodation is afforded, and facilities are given for drafting off
some of the most tractable patients who require less supervision than
the majority of the inmates; moreover, farm work has proved very
useful in training some of the patients who come from agricultural
districts.
_Crossley House._--Our area of usefulness has recently been extended
by the munificent gift of Sir Savile Crossley, Bart., of a
Convalescent Home, at Clacton-on-Sea. The building has accommodation
for twenty patients; it stands facing the sea, in its own grounds of
nearly an acre, and its privacy is secured by a walled-in garden, in
which the inmates are able to take ample exercise. As a large number
of our patients suffer from scrofula, or from some tubercular disease,
the want has been long felt of a seaside adjunct, where such patients
could be treated in the initial stage. Thanks to Sir Savile Crossley's
princely gift, we now possess this valuable addition to our medical
resources, the advantages of which cannot be too highly estimated.
_The Ladies' Association._--The valuable additions that have recently
been made to the Asylum, thus largely increasing the accommodation for
patients, have necessarily entailed a largely increased expenditure,
which could not have been met by the current income, had not the
ladies of East Anglia come forward with great earnestness to help the
objects of this Asylum by individual and energetic efforts; and one of
the most interesting events of the last few years has been the
formation of a Ladies' Association, the establishment of which is
entirely due to the earnest and devoted efforts of the Marchioness of
Bristol. Its object is to disseminate information respecting the
working of the Asylum, to secure admission for necessitous cases, and
to organise and carry out annually house to house collections for its
funds. H.R.H. the Princess of Wales has given her countenance to this
movement by graciously accepting the office of Patroness, several
influential ladies have consented to act as presidents over the
various districts into which the four counties have been divided, and
as many as 1,400 ladies are engaged in this philanthropic work.
[Illustration: CROSSLEY HOUSE, CLACTON-ON-SEA.]
The success attending this movement has been phenomenal. During the
first year of its operation, the substantial sum of £1,868 6s. 10d.
was handed over to the general fund, this amount having been obtained
from upwards of 20,000 contributors, who had thus the opportunity of
joining in this good work, and whose aid could not have been secured
in any other way. The efforts of these charitable ladies have been
crowned with such signal success, that the large sum of £9,473 5s. 9d.
has been added to the funds of the Asylum.[53] This substantial help
is very gratifying to the Directors of the Institution, who now rely
upon the Ladies' Association for nearly a fourth part of their income;
and it is not too much to say that the future success of the Asylum is
intimately connected with the continuance of the efforts of these
philanthropic ladies, who seem to me to be influenced by the noble
sentiments lately expressed by one of their number, that "The simple
obligation of all thoughtful women, is that of making the world within
our reach the better for our being, and gladder for our human speech.
It is a work such as this that I am sure stirs us up to feel that we
must also give our help, our sympathy, our lives for other people, and
in this work lies the elements of unselfishness."[54]
All honour to these ladies, who, having learnt the elementary truth
that privileges involve responsibilities, instead of hiding their
talents in the napkin of selfishness, prefer to go forth as messengers
of mercy, to try and flash the electric fire of philanthropy into the
slumbering hearts of others, and to induce them to join in their
grand and good work. They thus become a force and a factor of
influence with all around them, and their reward will be the
satisfaction of feeling that they are contributing their part in the
great work of elevating these stricken members of our race, from their
present unhappy and degraded condition to a higher position in the
scale of created intelligence.
* * * * *
I trust I have said enough to show that the idiot ought and must be
cared for; and in asking for your support, I will also ask you whether
anything can be more gratifying than, as the result of scientific
treatment, to see the idiot standing erect, asserting his birthright,
and claiming brotherhood with the rest of the human family.
True philanthropy never stops short of the remotest boundary of human
want, and in urging upon you the claims of the Eastern Counties'
Asylum for Idiots, I would have you remember that I am pleading for a
class who cannot plead for themselves, and whose very silence is
eloquent with an appeal for your merciful aid.
Remember that these poor stricken individuals are members of the human
family. They are heirs with us of all that human beings may hope for
from the hands of a common Father. They possess the rudiments of all
human attributes, especially the distinctive attribute of educability
and of progressive improvement; their bodies are the vehicles which
carry souls never destined to perish, through the series of ages, and
when the walls of the cottages of clay in which their better part has
sojourned collapse, and they mingle with their kindred dust, the freed
inhabitants shall wing their way to brighter regions and to a more
enduring home, and will thus illustrate the beautiful sentiment of one
of our modern poets, when he said:
"In death's unrobing room we strip from round us
This garment of mortality and earth,
And breaking from the embryo-state which bound us,
Our day of dying is our day of birth."
Each person here belongs to one of two classes. Either you have one of
these unhappy beings in your own immediate circle, or you have not. If
you have, you can feel all the more for those who are similarly
afflicted with yourselves, but have not your means for mitigating
their dire distress, and you will think of the narrow home of the
humble artisan or labourer, rendered intolerable by the constant
presence of one of these afflicted members of our race. If, on the
other hand, you have been spared this overwhelming calamity in your
own family, and have had the joy of watching the dawn of infant
intelligence, and have experienced the delight of seeing the
capacities shown in the early life of your own children gradually
ripen and develop into the intelligence of manhood, you will look with
an eye of pity on the numerous households rendered miserable by the
intolerable incubus of the presence in their midst of an idiot child,
and will, I am sure, consider any assistance you can render to so good
a cause in the light of a thank-offering.
The wear and tear of an excitable idiot child has wrecked many a
family and reduced it to pauperism, for not only is such child a dead
weight on the material prosperity of the family, but the hands of
those who have to work for their livelihood, are sadly tied and
hampered, when such an inmate has to be constantly looked after in the
home; the labour by which the household is supported is often
interrupted by one who can contribute nothing to the common stock, and
the time which is so precious to hard-working people must, in part at
all events, be occupied in caring for the one, who, if uncared for
and neglected, must sink lower in the social scale and fall into a
still more degraded condition. The care and treatment of the idiot,
therefore, becomes a vital question of Political Economy; for by
relieving a household of the burden and anxiety incident to the care
of the afflicted child, the parents are enabled to devote all their
energies to the support of their family. Moreover, there is often a
moral aspect corresponding with the mental aspect of this question,
and the presence of an idiot often becomes a source of real danger.
Our able superintendent, Mr. Turner, in his interesting report for the
year 1895, has illustrated the terrible anxiety caused by the presence
of an idiot child in the homes of the poor, by the history of an
inmate of our Asylum, who, when at home, being left to mind the baby,
blacked its face all over with soot, so that when his mother returned,
she might think she had a black baby. On another occasion, his little
sister wanted some water, and he told her to drink out of the kettle
on the fire, by which she nearly lost her life. This boy, who was
evidently a type of the mischievous class of idiots, was once turned
out of the Parish Church during service, for pricking another boy with
a pin, so that he yelled out and disturbed the whole congregation. Two
cases of murder by idiots have been recorded in a report of the
Commissioners on Idiocy to the General Assembly of Connecticut; an
idiot girl, being left alone with an infant, killed it by striking it
on the head with a flat iron; and another vicious idiot killed a man
who was working with him, by striking him on the head with a shovel.
Esquirol also records the case of an idiot in the Salzburg Hospital,
who killed a man by severing his head from his body with a hatchet,
and then calmly seated himself by the side of the dead body.[55]
Philanthropists of the Eastern Counties of England, many of you have
been long accustomed to sympathise with suffering and want; here is
another outlet for your charitable efforts. The most illustrious
landowner in East Anglia has recently extended his Royal patronage to
this institution, especially established for the care of idiots from
the four counties of Norfolk, Suffolk, Essex, and Cambridgeshire; and
his Royal Consort the Princess of Wales has most graciously consented
to accept the position of Patroness of the Ladies' Association, thus
showing the deep interest that is felt by their Royal Highnesses in
this important Eastern Counties' Charity. I ask you to follow their
noble example; I ask you to come and help us in our attempts to rescue
a large section of the human family from the worse than Cimmerian
darkness in which they have been hitherto enshrouded; come and help us
to awaken faculties hitherto dormant, to restore lost minds, to arouse
these unhappy beings from a moral death to a new birth of perception
and feeling; come and help us in arousing the slumbering power to
utterance, and you shall hear the once silent tongue eloquent with the
outgushings of a liberated spirit.
In conclusion, I wish to reiterate and to emphasise the statement,
that these unfortunate members of the human family possess the
tripartite nature of man--body, soul, and spirit--σωμα, ψυχη, πνευμα;
they have the _germ_ of intellectual activity and of moral
responsibility, and this germ, cherished and nourished by the genial
warmth of human kindness, fenced round and protected from the blasts
and buffetings of the world by the cords of true philanthropy, watered
by the dew of human sympathy, although possibly only permitted to bud
here, is destined hereafter to expand into a perfect flower, and
flourish perennially in another and a better state of being.
"Eternal process moving on,
From state to state the spirit walks.
All these are but the shattered stalks
Or ruined chrysalis of one."
FOOTNOTES:
[39] A society has lately been formed under the name of "The National
Association for promoting the welfare of the Feeble-minded," the
object of which is to establish homes for defective and feeble-minded
children of a class more highly-endowed with intelligence than those
who would be received into an ordinary idiot asylum; statistics having
shown that ignorance and mental dulness tend to crime in various
forms. Without expressing any very decided opinion upon the above
project, it seems to me that the unnecessary multiplication of
charitable institutions is itself an evil, and is not calculated to
promote efficiency or economy; and if special provision is made for
those just above the highest class of idiots, as is proposed, the
present Idiot Asylums must necessarily suffer. Without, therefore, in
any way disparaging the above scheme, I would suggest great caution in
reference to it, as it is impolitic and unwise to make fresh demands
upon a philanthropic public, unless the need for it is clearly
established, as the result must inevitably be the diversion of funds
from existing institutions already doing a good and charitable work.
[40] Maladies Mentales, Tome ii., p. 76, par E. Esquirol, médecin en
chef de la maison royale des aliénés de Charenton. "Les idiots sont ce
qu'ils doivent être pendant tout le cours de leur vie. On ne conçoit
pas la possibilité de changer cet état. Rien ne saurait donner aux
malheureux idiots, même pour quelques instants, plus de raison, plus
d'intelligence."
[41] "Mentally deficient children," page 110.
[42] This painstaking observer has investigated this subject in an
interesting communication on Sporadic Cretinism in the "Edinburgh
Medical Journal" for May, 1893. Dr. Ireland considers Sporadic
Cretinism to be a congenital or infantile form of myxœdema, and
bearing in mind the increasing mental torpor which has followed the
ablation of the thyroid gland performed by Kocher, and the cretinoid
condition induced in monkeys by the removal of the thyroid by Horsley,
he is drawn to the conclusion that this gland secretes and pours
something into the blood which has a powerful effect upon the
nutrition and function of the brain, and of the whole organism, and
these views receive a certain amount of confirmation from the fact
that in most cases of Sporadic Cretinism the thyroid gland is totally
wanting. Dr. Ireland also expresses the opinion, in which I fully
concur, that there is too much solidism in our pathology, and that the
vital powers of the blood have been too much overlooked.
Although the effect of thyroid treatment in the idiot is still _sub
judice,_ there is overwhelming testimony of its value in Myxœdema, an
allied affection; and I would refer those who desire further
information upon this matter to an important discussion at the
Edinburgh Medico-Chirurgical Society, in February, 1893, arising out
of papers read by Professor Greenfield, Dr. Byrom Bramwell, Dr.
Lundie, Dr. Dunlop, and Dr. John Thomson, when important additions
were made to the literature of this affection by Dr. Affleck, Dr.
George Murray, and others, whose matured views will form a valuable
contribution to our knowledge of this somewhat obscure subject.
[43] "Pediatrics," May, 1896, p. 460.
[44] I give M. Voisin's description of the symptoms in his own words.
"Elle est arrivée dans mon service en état d'extase mystique,
exécutant continuellement des mouvements de ses deux mains, surtout de
la droite, semblables à ceux d'une personne en prière; elle porte
souvent les mains à son front comme pour faire le signe de la croix.
Elle murmure des mots, entre autres, _Ave Maria_. La physiognomie
exprime la douleur mêlée d'extase."
[45] "Edinburgh Medical Journal," May, 1893, p. 1053.
[46] "Edinburgh Hospital Reports," Vol. 3, 1895, p. 245. "This is the
most complete monograph on thyroid treatment that has come under my
notice. Dr. Bramwell has recorded, in minute detail, the clinical
history of twenty-three cases of myxœdema, and five cases of sporadic
cretinism."
[47] "Journal of Mental Science," April, 1895, p. 280.
[48] "British Medical Journal," Jan. 30th, and Feb. 6th, 1892,
"Remarks on the Function of the Thyroid Gland." I recommend a careful
perusal of this important and exhaustive essay of Professor Horsley to
all those who desire to acquaint themselves with what is known about
the structure and functions of the thyroid gland; for it will be
remembered that it is to the experiments on animals by this learned
and accomplished scientist, that we are principally indebted for our
knowledge of the connection between myxœdema and loss of function of
the thyroid gland.
[49] "Traitement et Education des Enfants Idiots et Dégénérés," p.
241, par M. Bourneville, Médecin de Bicêtre, Paris, 1895. The author
of the above treatise is one of the most prolific French writers on
Idiocy, and I desire to call especial attention to that part of the
work which embraces the Medico-Pedagogic Treatment of Idiocy. In this
section, M. Bourneville describes in minute detail the gymnastic and
physical training adopted at Bicêtre, the description being copiously
illustrated by plates, which cannot fail to interest those engaged in
the treatment of idiocy.
[50] "Journal of Anatomy and Physiology," January, 1895, p. 304.
[51] "Pediatrics," March, 1896, p. 243.
[52] "On Idiocy and Imbecility," page 91.
[53] As showing the result of individual effort, I may mention that in
the year 1894, as much as £155 0s. 7d. was collected in the N. Walsham
District, £89 12s. 9d. in the Norwich District, and £80 15s. 6d. in
the Diss District, under the presidentship respectively of Mrs. Petre,
Lady Lade, and Mrs. Sancroft Holmes.
[54] The Countess of Warwick, at the "Young Helpers' League."
[55] Des Maladies Mentales, Tome ii., p. 103.
INDEX.
Affleck, Dr., 93
Alcoholic stimulants as a factor in the genesis of idiocy, 26
abuse of, in Sweden, 29
effects of, in France, 31
Sir B.W. Richardson on, 30
Anæmia, as the result of thyroid feeding, 97
Anderson, Mrs. Garrett, on Sex in Education, 37
Andriessen, on the cerebral convolutions of idiots, 51
Animals, relation between
their intelligence and the
size of their brain, 49
Association of idiots with
the insane, a disadvantage
to both classes, 19
Aveyron, the savage of the, 18
Beach, Fletcher, 25, 27, 28
Besant, Sir Walter, 76
Birth, injuries of the head at, 48
Blood, analysis of, in
thyroid feeding, 96
supply of, varies in the two sexes, 37
Bourneville, on Craniectomy, 101