The Idiot; his Place in Creation, and his Claims on Society
136 REVIEWS AND BIBLIOGRAPHICAL NOTICES.
- Author:
Frederic Bateman, M.D., F.R.C.P., &c. London:
Jarrold & Sons, 3 Paternoster Buildings.
Dr Bateman has, in this admirable address, eloquently and earnestly pleaded the cause of that most unfortunate of our fellow-creatures?the helpless and pitiable idiot. The address was delivered in St. Andrew’s Hall, Norwich, at a public meeting held in support of the Eastern Counties’ Asylum for Idiots (of which Dr Bateman is the consulting physician), under the presidency of the Duke of Norfolk, Earl Marshal of England; and was published at the special request of the Board of Directors of the Asylum The author’s prefatory remarks on the definition of idiocy are clear and convincing. He says :
” I would define idiocy as an infirmity consisting, anatomically, of a defective organisation and want of development of the brain, resulting in an inability, more or less complete, for the exercise and manifestation of the intellectual, moral, and sensitive faculties. There are various shades and degrees of this want of development, from those whose mental and bodily deficiencies differ but slightly from the lowest of the so-called sound-minded, to those individuals who simply vegetate, and whose deficiencies are so decided as to isolate them, as it were, from the rest of nature. “The first idiot that attracted the attention of scientific men was looked upon as a savage man, and every treatise on the subject contains some allusion to the so-called savage of the Aveyron, who excited so much curiosity, speculation, and interest among the psychologists of Paris in the early part of the present century.
” In old books on medical nomenclature, idiocy was classed amongst the varieties of insanity, and the visitor to a lunatic asylum, half a century ago, would find the idiot skulking in the corner of a courtyard, chained to a staple, and lying on a litter of straw; in fact, he was considered and treated more like a wild beast than a human being. He had but little talent given, and by neglect or abuse that little was lost, until, growing more and more brutal, he sank unregretting and unregretted into an early grave, without ever being counted as a man. Now, idiocy is not a form of insanity, and it is most important that no confusion should exist in the public mind upon this point, as the association of idiots and insane patients in the same asylum is a disadvantage to both classes. I desire especially to press this point upon the legislators of the country, and, as, in this county, our union-houses are far too large for the requirements of the age, I would suggest that one or more of them might, with advantage, be devoted to the care and treatment of pauper idiots.
” Insanity is a loss, more or less complete, of faculties formerly possessed ; it consists of a perturbation of the mental faculties after their complete development, or, as a noted French psychologist has beautifully put it, 4 L’homme en demence est prive des biens dont il jouissait autrefois, c’est un riche devenu jpauvre. Vidiot a toujours ete dans V in for tune et la misere.’’ (The man that is mad is deprived of possessions which he formerly enjoyed, it is a rich man become poor; whereas the idiot has always been in misfortune and misery.) The distinction between the idiot and the insane is clear and marked. The madman suffers from abnormal development of brain, the idiot from an ill-developed brain?the mind of the madman is not in proper balance, in the idiot it is not in proper power. The poor idiot (the word being derived from the Greek l8i(orr]s) is alone in the world; isolated as it were from the rest of nature, he sees, but does not perceive, he hears but does understand or appreciate, he cares for nothing, and is alike indifferent to the grandeur as to the beauties of nature; he stands unmoved at the thunder-clap, the foam of the rushing cataract, or the roar of the mighty ocean; he heeds not the hum of the insect world or the song of the early lark, that winged chorister of the air; the star-bejewelled canopy of heaven, the mountain landscape lighted up with all the purple splendour of the setting sun, all these are nothing to him?he is a soul shut up in imperfect organs.”
Dr Bateman agrees with those who consider the abuse of alcohol to be the most fruitful source of idiocy. He states that Dr Howe, of Massachusetts, observed that out of 359 idiots in that State, 99 were the children of inveterate drunkards. Dr. Kerlin, of America, gives a proportion of 38 out of 100 ; and Dr Fletcher Beach stated at the British Medical Association, held last year at Cambridge, that in 430 patients he traced a history of parental intemperance in 138 cases, or 31*6 per cent. With regard to the Histology and Pathological Anatomy of the brain of an idiot, Dr Bateman makes the following pertinent remarks. He asks:?
” What is there in the brain that makes one man a senior wrangler and another an idiot ? What is it that unfits one person for the discharge of the ordinary duties of domestic and social life, and endows another with capacities adapted for a statesman, a mathematician, or a philosopher ? Is it a defect in the quantity or the quality of the nervous matter of the brain ? Does it depend on a malformation of the cranium, on the size or shape of the head, or on the amount of development of the convolutions of the brain ? Upon this point, I am bound to tell you that science speaks with a somewhat uncertain sound, volumes having been written upon it without any definite solution or tangible result.
” It was formerly supposed that idiots always presented some obvious malformation of the cranium or skull. This is by no means necessarily the case ; one of the most remarkable cases of idiocy that has come under my notice was that of a child with a well-formed head, remarkably handsome face, and wellproportioned body. It has been said by some that the power of mental expression depends on the fineness and degree of complexity of the cerebral convolutions, or on their symmetry in each hemisphere. One of the most noted writers on the subject, after stating that a number of scientific men had spent thirty years measuring and weighing the heads of idiots, sums up their conclusions as follows :
44 1st. There is no constant relation between the development of the cranium and the degree of intelligence. ” 2nd. The dimensions of the anterior part of the cranium, and especially of the forehead, are, at least, as great among idiots as others. ” 3rd. Three-fifths of idiots have larger heads than men of ordinary intelligence. ” 4th. There is no constant relation between the degree of intelligence and the weight of the brain. ” 5th. Sometimes the brain of idiots presents no deviation in form, colour, and density from the normal standard; it is, in fact, perfectly normal.” The Author’s observations on ” Matter and Mind ” are so much in accordance with the antimaterialistic views which have been so strenuously advocated in the pages of the Journal of Psychological Medicine for many years, that we have much pleasure in giving them in extenso :
” I can imagine no more powerful weapon for combating the materialistic tendencies of the day than is furnished by a consideration of the natural history of the idiot. This is neither the time nor the place for me to enter into the question of the mysterious connection between matter and mind, a subject which I have developed at some length in my published works. In mj various public appeals on behalf of the Asylum of Idiots I have also usually taken the opportunity of pointing out how the experience afforded by the study of idiocy is utterly opposed to the extravagant dogmas of the materialistic school, and to the crude notions which pseudo-science has engendered, and I have also shown how the results of idiot training furnish a forcible demonstration of the dualistic theory of mind and matter, upon which science reposed till the times of Spinosa, Laplace, Haeckel, Huxley, and others.
” The pseudo philosophers of our time have bewildered the public mind by the wild flights of their imagination; thought, the so-called spiritual attributes of man, are merely a function of brain protoplasm ; the brain, say they, secretes thought, just as the liver secretes bile, or as oxygen and sulphur produce sulplmric acid, and all the varied phenomena of nature are nothing more than the molecular changes of matter; the operations of the mind are but the products of the caudate cells of the brain, and volition and consciousness are mere physical manifestations. They see only the physio-chemical side of nature, they utterly ignore any spiritual attribute in man, they regard metaphysics as a relic of mediaeval superstition, and they assert that all mental operations are bodily functions, and simply the result of some molecular or atomic change in the brain ; indeed, the German philosophers go so far as to say that life itself is only a 6 special and complicated act of mechanics;’ that there is no real distinction between living and dead matter, and that vitality is a metaphysical ghost (ein metaphysisches Gespenst).
” When I had the privilege, some few months since, of pleading the cause of this Asylum at Lynn, I stated that at an international congress of psychologists held at Paris in 1878, at which I was present, a celebrated Russian professor laid before the congress the result of his elaborate experiments on the brains of idiots, and I pointed out how the professor’s conclusions strongly militated against the notions of the school of philosophers of whom I have been speaking.1’ The professor referred to is Dr Mierzejewski. An interesting account of his experiments appeared in an article on ” Idiocy,” by Dr Bateman, published in Part I., Vol. V., of the Journal of Psychological Medicine. Dr Bateman alludes to them again in his address. They are so extremely valuable that no apology is needed for requoting them, with the comments upon them by the Author in his address: ” In order to understand the great value of Dr Mierzejewski’s investigations, I must remind you that the human brain is composed of two kinds of nerve structure of an essentially different nature, grey matter and white matter. Examined microscopically, the grey matter is found to be composed of cells, while the white matter consists of fibres; their function also is different, the former being regarded as the generator of nerve force, while the latter simply serves as the medium by which this force is transmitted. As the manifestation of the intellectual powers is supposed to be in some way connected with the development of the grey matter of the cerebral convolutions, one would expect to find in idiots a deficiency of this element of brain tissue. Dr Mierzejewski, who illustrated his communication by casts of the brains of idiots, showed that this is by no means the case, and he mentioned an instance of an idiot in whose brain the surface of grey matter was enormous. So it would seem that there is no fixed relation between the amount of grey matter of the brain and intellectual power, for richness of grey substance and abundance of nerve cells may be accompanied by idiocy.
“Now, as these startling statements of the Eussian professor were not made in a hole and corner, but were enunciated in the presence of leading psychologists from all parts of the world, I felt myself justified in telling the materialists that they must be faced, and either answered or admitted as correct, and as my address at Lynn was subsequently published in a leading London periodical and widely circulated, I am now justified in assuming that the inferences I then drew from these remarkable experiments cannot be controverted, and that the time has not yet arrived when the broad distinctions between mind and matter are to be obliterated, and man reduced to a mere automaton, a creature of a blind necessity.
“Without unduly exaggerating the importance of Dr. Mierzejewski’s experiments, it must be admitted that very great interest attaches to them at this juncture, when attention is so widely directed to the mysterious connection between matter and mind. Unhappily, instead of solving the question, the Eussian professor’s researches tend to shroud it in a still deeper mystery, and show that what has been termed the ‘ slippery force of thought?the vis vivida animce’?cannot be weighed in the balance; and they fully justify the eloquent language of a recent writer when he says, ‘ Far more transcendent than all the glories of the universe is the mind of man. Mind is indeed an enigma, the solution of which is apparently beyond the reach of this very mind, itself the problem, the demonstrator, the demonstration, and the demonstrand.’ … To those who may wish to pursue this subject further, I recommend a perusal of an essay on 4 Materialistic Physiology,’ in the Journal of Psychological Medicine for April 1877. In this article, the writer, Dr Winn, seems to share my views as to the paramount importance of boldly facing this matter, thus he says:? “’ The unphilosophical and extravagant dogma, that matter can think, is now so loudly and confidently asserted, and so widely spread by a numerous class of medical men and physiologists, both in this country and abroad, that the time has arrived when a doctrine so fallacious, and so fraught with danger to the best interests of society, should be fairly and carefully scrutinised. It is not by mere assertion, or the use of obscure and pedantic language, that such a theory can be established; and if it can be shown that the arguments on which it is based are shallow and speculative, words can scarcely be found too strong to censure the recklessness and folly of those who promulgate views so subversive of all morality and religion.
“’ The physicists have utterly failed to establish their position. They were asked to prove by inductive reasoning the truth of their theory, that the universe is the mere outcome of molecular force, and their defence has been clearly proved to be of the most evasive and inconclusive character.
“4 The doctrines of the modern school of materialistic physiology are permeating all classes of society, and it is these doctrines, based on the assumption that mind is a mere function of the brain?an assumption that, if true, would reduce man to the level of the beasts that perish?that we are offered as a substitute for the belief in the immateriality of the mind.’ ” The essay from which the above quotations are taken is full of sound and logical reasoning, and the writer’s position is not supported by mere theoretical statements, but by arguments drawn from well-accredited facts in anatomy and physiology.” Dr Bateman considers that idiot asylums are destined to be the ” battle-fields ” upon which the difficult problems of mental philosophy?the connection between Mind and Matter?is to be definitely solved.
In alluding to the brutal treatment to which idiots were formerly subjected, on the supposition they did not belong to the human family, he observes:
“All admitted that they had the cr<y/za, or material part of our nature; they also conceded to them the or principle of animal life, but they considered that the “rrvev/xa, or spirit of immortal life?that which essentially differentiates man from the brute?was absent in the idiot. This idea seemed to have been entertained by a great theologian of the 16th century, who, on being asked by a father what he was to do with his idiot boy, replied that the child might be drowned, as he possessed no soul! Times are happily changed. We don’t admit the lawfulness of drowning idiots now. It is proved beyond a doubt that the unhappy idiot of the lowest kind possesses what has been called the Tripartite Nature of Man. ‘ Non enim este sctxo sculptus e robore dolatus, liabet corpus, habct animum, movetur mente, movetur sensibus.
” 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 two :?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 little boy in the Massachusetts 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.’
Dr Bateman is diametrically opposed to the opinion of Esquirol, who stated that the mental condition of an idiot was irremediable. In answer to this he says :
“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 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 ultiREVIEWS AND BIBLIOGRAPHICAL NOTICES. 143 mately 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.
” It will thus be seen that science has done much for the idiot. Science will do more, for her motto is 6 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 point of bodily perfection.” We strongly recommend the whole of this address for careful perusal, and feel assured that it will be found as deeply interesting to the philanthropic as to the psychologist. Pennsylvania Hospital for the Insane.?Report for 1881. The excellent condition of the Pennsylvania Asylum under Dr Kirkbride’s control, has more than once been referred to in these pages, and we are glad again to welcome a favourable report of the institution. At the end of 1880, this held 356 patients, and during the succeeding 12 months there were 200 new admissions, with 158 discharges or deaths, leaving 398 under treatment at the close of the year. The total number in the hospital during 1881 was 556 ; the highest number at any one time was 405, the lowest, 339 ; and the average for the whole period, 370, viz., 168 males, and 202 females. The discharges are thus classified:?
Males. Females. Total. Cured …… 26 31 57 Much improved Improved Stationary Died 7 4 11 27 17 44 16 4 30 16 10 26
Of the patients discharged “cured,” 27 were residents of the hospital not exceeding three months; 15, between three and six months; eight, between six and one year; and seven, for more than one year.
Of those discharged “much improved,” five were under treatment less than three months ; two between three and six months ; two between six months and one year ; and two for more than one year.
Of the “improved,” 18 were under care less than three months ; 11 between three and six months; 11 between six months and one year; and four for more than one year. Of those discharged and reported ” stationary,” six were under care less than three months; two between three and six months; four between six months and one year; and eight for more than one year.
Sixteen males and ten females have died during the year. Of these deaths, three resulted from acute mania; three, from general paralysis ; seven, from acute melancholia ; three, from the exhaustion of chronic mania; three, from old age ; three, from pulmonary consumption: one, from pneumonia; one, from suicide; one, from peritonitis; and one, from erysipelas. The work of improving the institution, in the way of increased accommodation and the addition of hygienic and other apparatus, has been consistently carried out; and every effort has been made to aid in the recovery of patients who exhibited any tendency towards an amelioration of their symptoms. Added to this Report is a valuable series of tables dealing with the 8,480 cases treated in the Asylum since it was opened in 1841, to the end of 1881. From one of them we gather that of the total number, 8,082 have either been discharged, or have died. They are classified as :?
Total. Ha2es. Females. Cured 3 825 1,939 1,88G Much improved Improved Stationary Died 640 383 257 1 404 789 615 1,098 749 349 1,115 645 470
On the subject of entertainments for patients, Dr Kirkbride remarks that he has long been satisfied that ” with the proper kind of entertainments and means for passing the evening ?which it must be remembered during much of the winter embraces a period of at least four hours?such as can readily be provided for in any institution, where there is even a moderate degree of enthusiasm and the proper interest in the subject the patients feel, not a little, the omission of an entertainment a single night, and anyone who will take the trouble to walk through the hospital during such an omitted evening, will readily detect the changed appearance of the wards and their occupants.”
Nova Scotia Hospital for the Insane. 24th Annual Report. The twenty-fourth Annual Report of the Medical Superintendent of Nova Scotia Hospital for the Insane gives the number of patients under treatment during 1881 as 441. Of these 29 were discharged as recovered, two as improved, and 28 died. Eighty-one patients were admitted, 21 having been previously inmates of the asylum, and of these readmissions one had been in six times before, one five times, three twice, and 16 once. Moreover, of the 21 readmissions, 15 had been discharged as ” recovered ” and five as improved ; the remaining one had left ” unimproved.” The somewhat considerable rate of mortality is explained as being caused by the death of five patients who, at the time of their admission, were hopelessly ill, and who died soon after being received.
The causes of death in the 28 cases are thus arranged : Men. Women. Total. Phthisis 4 3 7 Paresis 2 02 Apoplexy and Paralysis 4 15 Epilepsy 2 13 General Debility and Marasmus …. 2 2 4 Locomotor Ataxy … . … .1 0 Pneumonia. 10 Diarrhoea …….. 1 0 Peritonitis …….. 1 0 Mania ……… 0 1 Gastric Ulcer ……. 1 0 Suicide. …….. 0 1 11 9 28 No reference is made in the Report to post-mortem examinations of the dead bodies?a fact which is much to be regretted.
Several attempts at suicide were made during the year by inmates of the hospital, and in one case, that of a woman, unhappily ended fatally. The circumstances attending the act are somewhat curious, and may prove interesting. They are recorded as follows in the Report :
” No. 1544, a female, was admitted in March and died July 15th, after about four months’ residence. She had several times attempted to hang herself before admission, and persisted in similar efforts during the time she was here. She received most careful watching all the time up to her death. She was quiet in bed an hour before the night watcli (at 1.20 A.M.) reported her as lying strangled on the floor. She had risen out of bed and managed to loosen her hands from the apparatus which confined them (a precaution used in addition to regular watching). She fastened one end of a strap about thirty inches long around her neck, and the other end to the bed ; then, by lying on the floor and pressing her feet against the wall, induced suffocation. She was found lying perfectly prone with body and head resting on the floor alongside the bed, and the arms straight at each side of the body. Although for some nights preceding this attempt she had been more tranquil than usual, yet there had been no relaxation in the attention paid. A coroner’s inquest was held, and a verdict was given in accordance with the facts.”
The recovery rate is given at 36*2 per cent, on admissions, and an apology for the comparatively low figure thus obtained is offered in the explanation that a considerable number of admissions took place at the end of the year ; and then also 14 patients were away at home on trial. Half of these latter are described as well, and others as in various stages of improvement ; but it was deemed advisable not to actually discharge any of them until a longer term had elapsed in which to determine the reality of the amendment already exhibited. In former years the average rate of recoveries, as compared with admissions, has been 44.
Mention is made of several improvements in the arrangements for securing the comfort of the inmates ; and the report is, generally speaking, a favourable one.
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