[2] "Idiocy and Imbecility," by W.W. Ireland, M.D. P. 36.

[3] I am glad to find that this question of the depletion of our workhouses is engaging the attention of Boards of Guardians, as shown by a meeting lately held in Norwich, to consider the propriety of reducing the number of workhouses in the district. At this conference, which was attended by delegates from various unions, Mr. Bartle H.T. Frere stated that the Aylsham workhouse, originally built for 619 persons, had never had more than 117 inmates during the past eleven years; and that in other unions, not more than a quarter of the actual workhouse accommodation was utilized, although a complete staff of officials was kept in each union. Mr. Frere pointed out the folly of keeping up such elaborate machinery, for such totally inadequate results, and that an enormous saving would be effected by the amalgamation of two or more unions for the purpose of housing their pauper population.

[4] This term is applied by the Greek writers to a person unpractised or unskilled in anything—one who has no professional knowledge, whether of politics or any other subject, and it seems to have corresponded with our word layman; thus, Thucydides, in describing the plague that broke out at Athens during the Peloponnesian War, in speaking of a physician and a layman, uses the phrase ?at??? ?a? ?s??t??; Plato also uses the word in the same sense (Legg. 933 D), and the same author, in contrasting a poet with a prose-writer, uses the phrase, "e? ?t?? ?? p???t??, ? ??e? ?t??? ?? ?s??t??" (Phaedr. 258 D). I doubt very much the appropriateness of the word idiot as applied to these unfortunate creatures, and I think the American term of Feeble-minded more correctly represents their condition.

[5] The question of the influence of alcoholic stimulants on the development of mental disease formed a prominent feature in the proceedings of this congress, and it is also a subject which is just now engaging the attention of pathologists in all parts of the world.

[6] "Mentally-deficient Children, their treatment and training." By G.E. Shuttleworth, M.D. Page 36.

[7] Toussenel, a French writer, says "La plupart des idiots sont des enfants procrÉÉs dans l'ivresse bacchique. On sait que les enfants se ressentent gÉnÉralement de l'influence passionelle qui a prÉsidÉ À leur conception." At a discussion at the Obstetrical Society, Dr. Langdon Down is reported to have entertained similar views.

[8] I would refer those who may wish to pursue the inquiry as to the baneful influence of alcohol on the human frame, to the celebrated Cantor Lectures on Alcohol, by my friend Sir B.W. Richardson, in which he introduces the physiological argument into the temperance cause, asserting that alcohol cannot be classified as a food; that degeneration of tissues is produced, that it neither supplies matter for construction nor production of heat, but, on the contrary, militates against both. Sir B.W. Richardson's latest views upon this subject are developed in the pages of the "Hospital" for February 1st and March 14th, of this present year.

In France, M. Lunier, Inspector of Asylums, has shown that the departments in which the consumption of alcohol had increased most, were those in which there had been a corresponding increase of insanity, and this was shown most strikingly in regard to women, at the period when the natural wines of the country gave way to the consumption of spirits.

In Sweden, Dr. Westfelt has lately made a communication to the Stockholm Medical Society, containing the statistics of alcoholic abuse and its results in Sweden. He calculates that at least from 7 to 12 or 13 per cent. among males, and from 1 to 2 per cent. among females, of all cases of acquired insanity, are due to the abuse of alcohol; and in reference to its influence on progeny and race, he shows that a steady diminution of the population was coincident with a period when drunkenness was at its greatest height.

[9] "On the Causes of Idiocy." By S.G. Howe, M.D. Page 35.

[10] "Op cit," page 19.

[11] That eminent clinical observer, the late Professor Trousseau, in treating of the influence of consanguine marriages, gives the history of a Neapolitan family, in which an uncle married his niece. There had previously been no hereditary disease in the family; of the four children, the issue of this marriage, the eldest daughter was very eccentric; the second child, a boy, was epileptic; the third child very intelligent; and the fourth was an idiot and epileptic. "Clinique MÉdicale de l'HÔtel-Dieu de Paris." Tome ii., page 87.

[12] "New Facts and Remarks concerning Idiocy," by E. SÉguin, M.D., p. 28. Dr. SÉguin has been a voluminous contributor to the literature of Idiocy, and for many years his writings were the only available source of information on the management and education of idiots.

[13] Sir J.C. Browne, in speaking of the brain of men and women, says there can be no question of inferiority or superiority between them any more than there can be between a telescope and a microscope; but they are differentiated from each other in structure and function, and fitted to do different kinds of work in the world. He maintains that the weight of the brain is less in women than in men, that the specific gravity of the grey matter is less, that the distribution of the blood varies in the two sexes to a considerable extent, and that the blood going to the female brain is somewhat poorer in quality than that going to the male brain, and contains four millions and a half corpuscles to the cubic millimetre, instead of five millions in the case of the male.

[14] It seems that one of their own sex is of a different opinion, as in a series of articles in the "Nineteenth Century" for 1891 and 1892, Mrs. Lynn Linton strongly deprecates any departure from the comparatively restricted area of usefulness hitherto open to women, and she even baldly states that it is for maternity that women primarily exist! She also adds, "be it pleasant or unpleasant, it is none the less an absolute truth—the raison d'Être of a woman is maternity ... the cradle lies across the door of the polling booth and bars the way to the senate."

In a powerful article in the same serial, entitled "Defence of the so-called Wild Women," Mrs. Mona Caird severely criticises Mrs. Lynn Linton's views as to the restrictions she would impose upon the freedom of women to choose their own career.

[15] Although the injurious effects of overpressure in education have been principally referred to in the education of girls, the same pernicious results may accrue in the case of boys. Dr. Wynn Westcott, in his work on "Suicide," states that during the last few years there have been several English cases of children killing themselves because unable to perform school tasks. He also says that child-suicide is increasing in England and in almost all Continental states, and that the cause in many cases is due to overpressure in education. Dr. Strahan, writing upon the same subject, in his treatise on "Suicide and Insanity," corroborates Dr. Westcott's views, and remarks that fifty years ago, child-suicide was comparatively rare; but that during the last quarter of a century it has steadily increased in all European states, and that the high-pressure system of education is generally considered as the cause of it.

If any apology be needed for dwelling at such length on the evils of the educational overpressure so prevalent in our days, I would observe that it has an indirect bearing upon the causation of idiocy; for although the sinister results recorded by Drs. Westcott and Strahan may be comparatively rare, still, consequences of a more remote character may ensue, for the injury done to the nervous system is cumulative and transmissible from generation to generation, and a neurotic tendency may be engendered in the offspring of those who have been exposed to this evil, which may manifest itself in the appearance of idiocy or some lesser form of mental defect.

[16] One of the most distinguished French psychologists, has thus expressed himself on this point:—"Dans des rÉunions ou l'idiotisme Étendait son triste niveau, il m'est arrivÉ plusieurs fois de rencontrer des crÂnes, qui dans leur partie frontale eussent fait honneur aux hommes les plus justement cÉlÈbres, et oÙ l'on eÛt pu trouver avec avantage les organes de toutes les sortes d'esprit, de celui mÊme qui apprend À rire des mystifications et des sots."—Rejet de l'Organologie PhrÉnologique, par F. Lelut, p. 196.

[17] Dr. Wilmath, of the Pennsylvania Institution for Feeble-minded, reports that in six brains the island of Reil was exposed through defective development of the 3rd frontal convolution; in four cases, on both sides; in two cases, on one side only.—Notes on the Pathology of Idiocy.

[18] Il Cervello in Relazione con i Fenomeni Psichici. Studio sulla morfologia degli emisferi cerebrali dell'uomo, Torino, 1895. P. 89.

This is a work of great merit, in which the author compares the structure of the brain of man with that of other primates; he then treats of the morphology of the brain in different races, in criminals, in the insane, in deaf mutes, and in microcephales. An extremely interesting chapter is that devoted to the assumed difference of the cerebral hemispheres in the two sexes, containing statistical tables constructed by Dr. Mingazzini himself and others. Although he mentions certain minor differences that have been noticed by different observers, he summarises his own opinion by the statement that, "from the numerous but incomplete observations upon this subject, it may be concluded with certainty that essential differences do not exist" (si puÒ inferire quasi con certezza che differenze essenziali non esistono).

[19] Further information as to brain weight and cranial capacity, will be found in the author's treatise on "Aphasia and the Localisation of Articulate Language," chapter xii. (Prize Essay of the Academy of Medicine of France.)

[20] Op. cit., page 64.

[21] The attention of the medical profession has lately been called to the obstetric aspect of idiocy, and I would refer those who take an interest in this subject to the valuable statistics of Dr. Langdon Down, which contain the result of his inquiries into the history of 2,000 cases of idiocy that have come under his observation; from which it would seem that primogeniture plays an important part, as no less than 24 per cent. of all the idiot children observed were primiparous. The increased difficulty of parturition seemed to be an important factor. In reference to the use of the forceps in delivery as an assigned cause of idiocy, Dr. Down says, "there is no evidence that instrumental interference has any injurious influence on the mental condition of the children, but he thinks that those who delay the use of the forceps incur a much greater risk from the prolongation of pressure, resulting in suspended animation, which condition should be especially avoided. Of Dr. Down's 2,000 cases, the ratio of males to females was 2·1 to 0·9. This was probably due to the larger size of the head giving rise to the prolonged and difficult parturition, continued pressure, and suspended animation."—Obstetrical Journal, vol. iv., p. 681.

[22] Dr. Hammond, Professor of Diseases of the Nervous System at Bellevue College, New York, has published some interesting statistics in reference to the relative weight of the brain, as compared with that of the body, in various classes of vertebrate animals, by which he shows that there is no definite relation between the intelligence of animals and the absolute or relative size of the brain. Thus, he says, "the canary bird and the Arctic sparrow have brains proportionately larger than those of any other known animals, including man, and yet no one will contend that these animals stand at the top of the scale of mental development. Man, who certainly stands at the head of the class of mammals, and of all other animals, so far as mind is concerned, rarely has a brain more than one-fiftieth the weight of the body, a proportion which is much greater in several other mammals, and is, as we have seen, exceeded by many of the smaller birds."

[23] Clinical Lecture on Idiocy, p. 14.

[24] L'EncÉphale, March 1881, p. 82.

[25] At a meeting of the Medico-Psychological Society of Paris, my friend M. Auguste Voisin exhibited plates of the brains of idiots who had only begun to speak at the age of from three to five years, in which the frontal and first parietal convolutions were rectilinear without secondary folds, resembling the foetal condition of the convolutions at the sixth month of intra-uterine life.

[26] The imagination of certain psychologists seems to have gone rampant upon this subject; one writer, M. Moreau, of Tours, maintained that genius was a nervous disease—"le gÉnie est une nÉvrose"; and in order that there may be no mistake about his meaning, he adds that "the constitution of many men of genius is in reality the same as that of idiots!" M. Moreau's doctrine may thus be summarised in his own words:—"Les dispositions d'esprit qui font qu'un homme se distingue des autres hommes par l'originalitÉ de ses pensÉes et de ses conceptions, par son excentricitÉ on l'Énergie de ses facultÉs affectives, par la transcendance de ses facultÉs intellectuelles, prennent leur source dans les mÊmes conditions organiques que les divers troubles moraux, dont la folie et l'idiotie sont l'expression la plus complÈte."

[27] Le Cerveau et la PensÉe, par Paul Janet Membre de l'Institut. Paris, 1867, p. 58. This learned treatise contains an immense deal of information in reference to the mysterious connection between matter and mind, and I have found it of great service to me in my psychological researches.

[28] "Nineteenth Century," March, 1880, p. 509.

[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.

[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.

[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 myxoedema, 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 Myxoedema, 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 myxoedema, 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 myxoedema 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.