The Backward Baby
REVIEWS AND CRITICISM. :Author: Herman B. Sheffield, M.D. New York: Rebman Co., 1915. Pp. vi+186 (illustrated).
This “treatise on idiocy and the allied mental deficiencies in infancy and early childhood,” was awarded the Alvarenga prize of the College of Physicians of Philadelphia, July 14, 1914. The author’s aim “is to present to the profession a practical survey of the etiology, pathology, diagnosis, and treatment of the diverse mental deficiencies as they occur in children under five years of age. The existing monographs and textbooks on the’subject are almost exclusively devoted to the study of feeblemindedness in children of school age and adults,” he remarks, and it has seemed to him, “that with a more thorough knowledge of idiocy and the cognate affections in infants, the physician would be very much better prepared to ameliorate, or possibly cure, these conditions before the underlying lesions have permenantly destroyed the cerebral functions.” Amentia he defines as “not an affection sui generis, a precise morbid entity, but merely a symptom of a large group of congenital and acquired pathologic conditions, principally of the brain and the ductless glands.” He notes a fact which is not sufficiently understood by physicians, and hardly at all by the public, who expect to see any and every kind of mental defect cured by an operation,?”Profound idiocy is frequently encountered with seemingly insignificant structural changes in the brain or elsewhere, and vice-versa, gross brain lesions may occasionally be accompanied by only slight feeblemindedness. As a rule, however,” he says, “the predominance of characteristic lesions in certain types of cases” permits “the classification of idiocy and the allied mental deficiencies into distinct groups.” The lesions are by no means confined to the brain. “The ductless glands, more particularly the thyroid, thymus, pituitary, and adrenals, are often in a state of rudimentary development or degeneration.” Among the causes of mental deficiency Dr Sheffield is inclined to give slight importance to heredity, and “to place much more responsibility upon acquired etiologic factors. This reasoning,” he believes, “is partly corroborated by the investigations of Scholomowitch, Keller, and Diem, who found that the difference in the degeneracy ratio among the offspring of sane and insane ancestry is only about ten per cent in favor of the former.” In the case of notorious families of degenerates he thinks that “continuity of intermarriage among defectives generates the phase of permanent heredity,” until it is “exterminated by nature in accordance with the law of natural selection.” He does not, however, maintain this judicial attitude with respect to the etiological role of syphilis and alcholism. Further on in his book he recommends prohibiting the marriage of those members of the community who are “encumbered by chronic brain affection, grave wasting diseases, alcoholism, drug habits, and extreme poverty.”
In an excellent chapter on the examination of patients, he remarks what every careful clinician will confirm, “that histories obtained from parents are not always very reliable; first, because the latter are rarely very certain of their own mental shortcomings and more especially of those of their ancestors; secondly, they are usually loath to admit degeneracy in their immediate family; and thirdly, either for want of good judgment or in the hope of favorably influencing the doctor’s opinion, they are very apt to conceal certain mental inferiorities of their infants or to exaggerate their mental powers and thus to mislead the examiner.” He suggests that “while the parents are busy relating their experience and responding to questions, and the patient is still in a passive mood, unmolested and unaroused by the ordeal of the physical and mental examination, the physician should avail himself of the opportunity to note the attitude and behavior of both the parents and the child and to size up the general aspect of the case.”
A table of weights and measurements of average children up to five years is one of the many valuable features in this chapter, and another is a summary of the child’s psychological reactions to ordinary stimuli at one month, two months, and so on up to three years. “A normal infant,” he says, “is supposed to acquire the power of seeing, hearing, taste, and touch” in the first four months; “attention, voluntary motion and perception during the second four months; imitation, speech, and understanding in the third four months, and gradually, from month to month, to unfold and to strengthen these qualities, so that at the age of about three years it has developed into a real human being intellectually.” He compares the behavior of idiots with that of normal babies, and presents a series of tests adapted to the mentality of six months, twelve months, eighteen months, two, three, and four years.
With regard to prognosis he holds, “It is hardly just or expedient to declare a case of feeblemindedness unimprovable without giving it a fair test by way of physicial and mental training, or, possibly, medical or surgical treatment, whenever there is reason to believe that these therapeutic measures might prove of some benefit to the child, or at least will do no harm.” His chapter on training and treatment contains many suggestions which will be valuable to every one who has the care of a mentally deficient child under school age. A good bibliography and index complete the volume. ‘ ‘ A. T.
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