Remarks on the Origin, Varieties, anil 1 erminations of Idiocy
- Author:
Gkabhaii, M.D., Superintendent of Earlswood Asylum.
A paper on the above-mentioned subject was read by Dr Grabham? at a meeting of the South-Eastern Branch of the British Medical Association, but subsequently the author was requested to publish it as- a pamphlet.
Dr Grabham commences his little book by drawing a distinction between Idiocy, Imbecility, Cretinism, and Dementia. With regard to cretinism, it may be regarded as ” an endemic form of idiocy or imbe- cility, in which there is, moreover, characteristic arrest of development,, malformation, and deformity of the whole organism.” To the other terms the accepted definitions are given, and they are all more or less allied to each other. The causes of these affections are divided into’ four heads?endemic, hereditary, parental, accidental; but the same- cause may produce, according to the age of the patient, different results. In infancy epilepsy will produce idiocy, in more advanced years imbecility will ensue, and in old age it will cause dementia.
A very large portion of the idiots at present under treatment at Earlswood are of the male sex, the proportion being two to one, and 65 per cent, of the cases are reported as being congenitally defective. Among the various causes discussed at length by Dr Grabham, Ave may mention hereditary predisposition as the chief one. Dr Grabham says r ” Many of my patients, not born with defective intellect, have, never- theless, inherited a predisposition which ultimately led to it. In about 18 per cent, hereditary taint is admitted, but I am convinced that it exists in a far greater proportion ; indeed, I have in numerous instances found this to be the fact from observations of the parents, or enquiries among their acquaintances. A mother, from whom I could learn no> history of mental disease, and who certainly showed no indication of it in my presence, was afterwards found frequently to be removing to new lodgings, because 1 poison Avas put doAvn the chimney into her food.’ In another case I learned, after strenuous denial of any mental affection in the family, that tAvo of the mother’s sisters had been insane,. .and that she herself was highly hysterical. Where actual mental disease cannot be ascertained to have existed, we frequently find a history of neuroses, or chorea, and often eccentricity in one or both parents. A lady tells me, in a letter, that ‘ her husband used to say that there was no such a place as Hell, but she hopes now that he has found out his mistake.’
These two cases are sufficient to illustrate the eccentricities of some persons, and amounts to positive insanity.
Intemperance of parents is cited as one of the principal causes. Dr Langdon Down, the late superintendent at Earlswood Asylum, considered ” drunkenness during conception” as one of the chief causes, but Dr Grabham takes exception to this. It has been univers- ally the opinion of psychologists that consanguinity of the parents is ?one of the chief causes of mental disorder, and especially idiocy, and we must confess that the majority of cases of idiocy which have fallen under our immediate notice could be traced to intermarriages, especi- ally of first-cousins. We are here, however, told that only G per cent, of the cases admitted into Earlswood Asylum during the past six years could be traced to consanguinity of the parents, and in 11 cases out of 543 the parents were first-cousins. Tubercular diathesis and history ?of phthisis were found in 22 per cent, of the cases, and in G6 per cent, injury to the mother during pregnancy acted as the cause. The reason here given for the prevalence of idiocy among males is that, in conse- quence of a larger cranium than is found in females, more risk follows in delivery.
Convulsions shortly after birth, or during the first dentition, account for .nearly 20 per cent, of Dr Grabham’s cases; and amongst the other causes may be mentioned injuries, illness or shocks during infancy or childhood, fevers, whooping-cough, or congenital syphilis; but in 27 per cent, of the cases no cause could be ascertained. In discussing the varieties of idiocy, Dr Grabham says: ” The varieties of idiocy, using the term in a general sense, are very numerous, and run so much one into another, that it is difficult to classify them; and, as a rule, it is impossible to connect the various types with their respective causes. It may, however, prove interesting to describe the salient features of some classes, with a few remarks on diagnosis and prognosis. Idiocy, unless very marked, is not always to be recognised in early infancy. The form and size of the head alone must not be relied upon, but may furnish valuable evidence when considered in conjunction with other physical and mental signs. Some idiots have well-proportioned heads, and a small head does not necessarily betoken idiocy. It is necessary to observe the way in which the infant takes and swallows nourishment; its general aspect, the flaccidity or other- wise of its muscles ; its ability to raise or steady its head, to grasp the finger with its hand ; its capability of noticing any passing objects, and following them with its eyes; its listening to or disregarding sounds, and the character of its voice. As life advances the diagnosis becomes daily more easy. We compare the progress the child makes with that of other children; notice the state of the fontanelles as to closure; the form, size, and symmetry of the head; the palate, whether highly arched; the existence of any deformity; the state of the hands, as to their power of grasping; whether the fingers are thin, tapering, moist with saliva, and flaccid; the power of co-ordinating the muscles and directing the movements of the eyeballs; the circulation, whether feeble in the extremities; the presence or absence of paralysis or epilepsy : all these points will aid our diagnosis.”
We are told that some idiots appear so intelligent that the propriety of their detention in an asylum is sometimes questioned, but Div Grabham clearly proves that they are only fit to be so treated. Epilepsy is prevalent in a very large portion of the cases; and one or more functional derangements, such as bad assimilation, physical weakness,, atrophy of the bones, &c. etc., are universally present. The diseases met with in idiots are of the ” asthenic tj’pe,” and consumption is one of the natural terminations of the affection. A very interesting case is given, in which Dr Grabham found hard masses the size of a filbert in the white matter of the hemispheres, and the corpus dentatum of the cerebellum was nearly entirely supplanted by a hard scirrhous mass, through which nerve-fibres were seen to pass: this, upon sub- mission to Dr Lockhart Clarke, Avas pronounced to be tubercle. The pamphlet is an attractive one, and we trust at a future period we may have some more of Dr Grabhatn’s practical experiences.
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