Chapter II: Part 2

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 sulphuric 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 mediæval 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 "special and most complicated act of mechanics;"[30] that there is no real distinction between living and dead matter, and that vitality is a metaphysical ghost (_ein metaphysisches Gespenst_).[31]

At the International Psychological Congress held in Paris, in 1878, at which it was my privilege to be present, Professor Mierzejewski, of St. Petersburg, laid before the congress the result of his elaborate experiments on the brains of idiots, his communication being illustrated by casts of the brains of idiots, and also of certain animals, and the learned Russian professor's conclusions strongly militated against the theories of the philosophers of whom I have been speaking.

In order to understand the great value and import 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.[32] Dr. Mierzejewski maintained 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 Russian 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 comments upon these experiments were 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 Russian 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 animæ_"--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 demonstrants."

Those who maintain that the brain is the organ of the mind, do not tell us what we are to understand by organ, brain, or mind; they seem to me to confound two things, the one with the other. In fact, they make no distinction between thought, mind, consciousness, and the _instrument_ by which these attributes become externally manifested. It is true, we have no evidence to show that the mind can operate independently of the nervous system; on the contrary, all physiological data bearing upon the question of this mutual relation, go to prove that where there is no nervous system there are no mental manifestations. Moreover, as G.H. Lewes says, "It is the man, and not the brain, that thinks: it is the organism as a whole, and not one organ, that feels and acts."[33]

Every faculty manifests itself by means of matter, but it is important not to confound the faculty with the corporeal organ upon which the external manifestation of such faculty depends. The word organ is the name given to a part of the human frame by which we have sensation, and by means of which we do a certain act or work; such are the organs of sight, sound, smell, taste, and touch. All these organs are passive, and require to be operated on _ab extra_, precisely in the same way as the musical organ, which is an instrument constructed by man, requires man's interference for the production of musical sounds.

When a musician sits down to a piano, the music cannot be said to be in the instrument, but in the soul of the performer. If the instrument be in good order, the inspiration of a Thalberg or of a Liszt will become apparent; break the cords or otherwise damage the instrument, and nothing but discordant strains are produced, the musical faculty of the performer, however, remaining unaffected. We are all familiar with Plato's celebrated dialogue on the Immortality of the Soul, where a disputant with Socrates inquires if the soul is not like the harmony of a lyre, more beautiful, more divine than the lyre itself, but yet is nothing without the lyre, vanishing when this instrument is broken.

Let me further illustrate this point by an allusion to the electric telegraph, by means of which ideas and words are transmitted from mind to mind with a rapidity to which ordinary language cannot attain. Now, the electrical battery may be not inaptly compared to the brain, and the telegraph wires to the nerves which emanate from it. If the battery be out of order, or the telegraph wires be broken, this lightning language, by which mind speaks to mind, becomes impossible. In the same way, idiocy may be considered as a disease of the instrument rather than of the performer; the idiot's brain is damaged and has become an unfit instrument for the outward manifestation of the powers of the mind, but the lowest idiot possesses the germs of intellectual activity and moral responsibility; and within his malconstructed organism, there lies concealed in its fragile, fleshly casket, a precious jewel of immortality--an imperishable essence that is destined to live on for ever and for aye, through countless æons of time, when the dicta of these dreamers of whom I have been speaking, to use the language of one of them, "shall have melted away like streaks of morning cloud into the infinite azure of the past."

I repeat it, we must take care not to confound the organ with the person who possesses this organ: the eye is not that which sees, it is only the organ by which we see; the ear is not that which hears, it is only the organ by which we hear. Precisely in the same way and in the same sense, the brain is the organ of mind, the organ by which our mental faculties become _externally_ manifested. That it cannot be otherwise is shewn by the results of memory. The brain is of a perishable nature, its atoms are constantly changing; the body is continually throwing off old particles and appropriating new ones, every breath that is drawn, and every exertion that is made, cause some minute change in the bodily frame-work, so that it is never entirely the same;[34] there is no person, therefore, who has the same brain that he had 20 years ago; and the vivid impressions of the past are utterly inexplicable on the supposition that mental activity is a mere function of any perishable organ like the brain, but they necessitate the conclusion that mind and body, spirit and matter, are two entirely heterogeneous substances, and that mind--the concrete _Ego_--is independent of the material organ by which its external manifestation is alone possible.[35]

However tempting it might be, I feel I must not trespass any further by dwelling on the mysterious connection between matter and mind, a subject the complete comprehension of which is beyond the limits of our finite capacities. As Goethe philosophically remarks, "We are eternally in contact with problems. Man is an obscure being, he knows little of the world, and of himself least of all."

It would seem that the great Roman orator, nearly 2,000 years ago, with prescient eye, foresaw the attempts that would hereafter be made to pry into the hidden mysteries of Nature, when he said:--

"Latent ista omnia, Luculle, crassis occultata et circumfusa tenebris, ut nulla acies humani ingenii tanta sit, quæ penetrare in cœlum, terra intrare possit."

These lines of Cicero would seem to be peculiarly applicable to certain modern philosophers, who, in their attempts to bridge over the gulf--the impassable gulf--which separates matter from mind, persistently ignore the fact that there are certain things which, from their very nature, are beyond the pale of precise knowledge, and which cannot be determined by physical investigation--which, in fact, lie outside the sphere of man's intellect. I believe the question I am discussing is one of these, and that, although we may grope with the taper of science into the dark caverns whence seem to issue the springs of humanity, we shall probably fail to understand the mysterious connection between matter and mind, a theme essentially beyond the grasp of human intelligence, and which cannot be fathomed by the puny plummet of human thought or touch.

The study of the idiot is calculated to elucidate this overwhelmingly important subject, and I believe the Idiot Asylum is destined to become the arena and battlefield on which this great question will have to be fought out.

FOOTNOTES:

[29] "Darwinism Tested by Language," Rivington, 1877; "Aphasia or Loss of Speech, and the Localisation of the Faculty of Language," 2nd edition, Churchills, 1890. The reader is referred to these treatises, and especially to his work on Darwinism, for a fuller exposition of the author's views, here only incidentally sketched; and also for a more complete knowledge of the scientific facts and different authorities quoted in support of the position here taken in reference to the connection between Matter and Mind.

[30] "Das Leben ist nur ein besonderer, und zwar der complicirteste Act der Mechanik; ein Theil der Gesammtmaterie tritt von Zeit zu Zeit aus dem gewöhnlichen Gange ihrer Bewegungen heraus in besondre organisch-chemische Verbindungen, und nachdem er eine Zeit lang darin verharrt hat, kehrt er weider zu den allgemeinen Bewegungsverhältnissen zurück."--

_Gesammte Abhandlungen zu wissenschaftlicher Medicin_ s. 25.

[31] One of the leaders of scientific thought in this country tells us that "Life is composed of ordinary matter, differing from it only in the manner in which its atoms are aggregated," and it has been gravely stated that the production of man in the chemist's retort may be recorded as one of the future discoveries of the age!

A clever French writer, commenting on these purely hypothetical statements of the "mechanistic school," makes the following appropriate remarks--

_"Quand on nous dit que l'organisme des êtres vivants n'est qu'un laboratoire où tout se passe en combinaisons et en compositions des éléments matériels primitifs, on oublie que ce laboratoire est habité par un hôte intime, le principe vital qui ne fait qu'un avec les éléments en fusion. Ici la combinaison chimique ne se fait pas toute seule; elle s'opère sous l'action d'une cause qui en transforme les éléments de façon à en faire un produit d ordre nouveau qui s'appelle la vie."--"La Vie et la Matière," par E. Vacherot, Revue des Deux Mondes,"_ 1878.

[32] In an original and very remarkable essay, entitled "The Brain not the Sole Organ of the Mind," Dr. Hammond, of New York, says, "There is no exception to the law that mental development is in direct proportion to the amount of grey matter entering into the composition of the nervous system of any animal of any kind whatever; and that in estimating mental power, we should be influenced by the absolute and relative quantity of _grey nerve tissue_, in which respect we shall find man stands pre-eminent, although, as we have already seen, his brain, _as a whole_, is relatively much smaller than that of many other animals; and it is to this preponderance of grey matter that Man owes the great mental development which places him so far above all other living beings. As this grey tissue is not confined to the brain, but a large proportion of it is found in the ganglia of the sympathetic and some other nerves, and as an amount second only to that of the brain in quantity--and, indeed, in some animals larger--is present as an integral constituent of the spinal cord, Dr. Hammond infers, and he cites numerous experiments in support of this inference, that mental power must be conceded to the spinal cord, and that the brain can no longer be considered as the sole organ of the mind."

[33] "The Physical Basis of Mind." Page 441.

[34] The late Bishop of Carlisle illustrates the independence of the Ego, by an allusion to moral feelings. "A murderer," he says, "is convicted twenty years after the offence had been committed, or he gives himself up after so many years, because his memory and his conscience make his life miserable. He has no doubt as to the fact that the person who did the deed of darkness years ago, is the same person as he who feels the pangs of remorse to-day. Every material particle in his body may have changed since then, but there is a continuity in his spiritual being out of which he cannot be argued, even if any ingenious sophist should attempt the task."--_Nineteenth Century_, March, 1880, p. 510.

[35] To those who may wish to pursue this subject further, I recommend a perusal of an essay on "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, when 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.

"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.

THE PNEUMA, OR SPIRITUAL ATTRIBUTE OF THE IDIOT.

Ὁ δε νους εοικεν εγγινεσθαι ουσια
τις ουσα, και ου φθειρεσθαι.

Aristot. _De Anima_, I. 4.

Inasmuch as the instrument by which the manifestation of mind is alone possible is undoubtedly damaged in idiots, they were formerly supposed not to belong to the human family, and their place in the order of creation was disputed. All admitted that they had the σωμα, or material part of our nature; they also conceded to them the ψυχη, or principle of animal life, but they considered that the πνευμα, 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 in these days, but we teach them to swim against the adverse currents to which they are exposed; we buoy them up on the tempestuous waves of life; we pilot them through the rocks and shoals of their ill-starred career till their chequered race is run, and they are safely landed in the haven of everlasting rest.

Not only in the 16th century, but certain philosophers of a later date have questioned the idiot's place in creation, and have disputed his right to be classed among the human family; and some scientists--believers in the so-called doctrine of Evolution, as applied to the Descent of Man--have gone so far as to pretend that the brain of the microcephalic idiot is so far removed from the human type, as to constitute him a connecting link between man and the anthropoid apes! Now, the interesting results of our training institutions, showing _the capacity for progressive improvement_ which exists in the idiot, gives the lie to this absurd and purely sensational hypothesis.

Here let me add that I strongly deprecate introducing the _odium 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.

Although the physiological effects of thyroid feeding may not be 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.

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]