CHAPTER II. EDUCATION AND CUSTODY OF THE FEEBLE-MINDED. "Idiocy 1. Definition. The term "feeble-minded" is used, especially in the United States, to denote both imbeciles and idiots. is mental deficiency, or extreme stupidity, depending upon malnutrition or disease of the nervous centres, occurring either before birth or before the evolution of the mental faculties in childhood." The word "imbecility" is generally used to denote a less decided degree of mental incapacity. This distinction is preserved in legal and medical writings (Ireland). 2. Classification. — Provision for the feeble-minded, both educational and custodial, must be based on the distinctions of infirmity and the grade of the patient. It is, perhaps, impossible to give a classification which is satisfactory from every point of view, since the variations are so many and complex. Dr. F. Petersen defines the idiot proper as 66 an individual able to give little or no care to his person, incapable of intelligent communication, barely able to express his material wants, most awkward and ungainly in his movements, if he move at all, and presenting marked evidence in his lack of expression, apathetic attitudes, and physical stigmata, of degeneration, of the profound stunting of his mental and physical development. On the other hand, the imbecile is able to care for his person and dress, attend to his physical wants, comprehend fairly what is said to him, carry out orders more or less intelligently, is often able to speak well; if not paralyzed, he has good use of his muscles; he is not destitute of expression, though the expression may vary from an evil, mischievous, cunning cast of countenance, to one of rollicking good nature; there are fewer stigmata of degeneration in this class than among idiots." Some marks of distinction of various classes will illustrate the variety of defects which pass under the name feeble-minded. In our public schools there are found many grades of ability, from the dull and slow pupils who vex the patient teacher, all the way up to those who give promise of talent and genius. Now and then a child misses altogether the advantage of school, and remains a hidden mystery, secluded in the home, or goes abroad to suffer from the persecutions, ridicule, and misunderstanding of ordinary children. One variety of the feeble-minded, thus isolated from society or kept in special institutions, is the small-headed or microcephalous, characterized not only by deficiency in the size of the skull, but also by its form, the narrow and receding forehead, pointed vertex and flat occiput, and by imperfect development of the brain. If the circumference of the head is less than seventeen inches, the intellectual power must be very restricted, but the health of the nervous centre is as important as its size. The stature is usually much below the average. Genetous idiocy is a term used to describe a congenital condition, complete before birth, and not due to any specific disease. The circulation is feeble, temperature low, sensibility deficient. There are defects and deformities in palate, jaws, teeth, tongue, glands, ears, and skull. The brain is not fully developed, and the heart is frequently too small and feeble in action to supply blood to the brain. This form of idiocy is often due to hereditary causes or to some accident or injury to the mother before the birth of the child. The hydrocephalic idiot suffers from a very serious nervous disease. Before or not long after birth the brain is pressed down and the skull urged outward by accumulation of fluid; and sometimes attains enormous size and deformed appearance. The patients are often victims of consumption or scrofula. In disposition they are generally gentle and docile. Those called eclampsic idiots have brains which were injured in connection with convulsions at birth or during the teething period. The child may remain a mute and be difficult to eduThe muscular power may be preserved and the person may learn to work. cate. Epilepsy is a common cause of idiocy, and this dreadful disease is frequently an inheritance from neurotic parents. The unfortunate children of this class have an eccentric disposition and often make droll and humorous speeches. If the convulsions are frequent and severe, cure is difficult. They are often helped by suitable vegetable diet, open air exercise, and industrial training. Paralysis of the brain may occur before or after birth, and lead to idiocy. It may affect one or both sides of the body. Fever and convulsions often usher in the attacks; the limbs become stiff, the muscles hard, locomotion and action difficult. Mental power may be cultivated even when walking and arm movements are impossible. Rubbing, electricity, and surgical aid may improve the condition of the limbs. The term "traumatic idiocy" is used to designate the feeblemindedness caused by a blow on the head and the consequent lesion of some part of the brain. Inflammation may result in serious defect of the mental powers. Scarlet fever, measles, and other diseases often leave behind them inflamed mucous surfaces, with deafness. Sclerotic idiocy is a rare form whose predisposing causes are tuberculous diathesis and neurotic tendencies in progenitors. The immediate occasion may be an accident to the mother, prolonged labor, asphyxia, or injury to the head of the child. The head is generally small and sometimes wanting in symmetry. The tissues of the brain differ from normal in being fibrous, hard, and shrunken, or tuberous and enlarged. Syphilis is seldom proved to be the direct cause of idiocy, perhaps partly because the rate of mortality of infants affected by this disease is very high, so that the effects are not registered in institutions. Cretins are seldom met outside of certain well defined areas of country, usually in the deep valleys of mountain regions; and cretinism is thought to be due to the action of specific microbes or miasma. The disease is endemic and may be inherited, although early removal to a good climate causes the tendency to disappear. Idiocy may result from the deprivation of two or more of the senses, as sight and hearing, on which the mind is dependent for its awakening and for materials of memory, imagination, and judgment. By providing a substitute for sight and sound in touch and pressure many of the blind deaf mutes have become bright and thoughtful who otherwise had sunk into the permanent darkness of utter idiocy. Among the idiots are found those who are called moral imbeciles, children who show a proneness to evil, a callous selfishness, a want of sympathy with other people. The mental deficiency is often not so noticeable as this hardness and absence of all consideration for the feelings and rights of others. It is probable that many examples of Lombroso's "born criminal" really belong to this not very large class. Even with these persons education in social coöperation sometimes awakens and cultivates the affections in a high degree. In general it may be said of all classes of the feeble-minded that they attain, on the average, less than the normal stature and weight, the entire body being seriously affected by arrest of growth. The average mortality between the ages of five and twenty years is at least nine times that of normal persons of that period of life. They are peculiarly exposed to nervous and other diseases, and require constant personal supervision of a resident physician. 3. Causes. - The general laws of inheritance and of acquired defects have been discussed. Only a few illustrations of a special character need to be added here. Among the specific hereditary antecedents of mental deficiency are counted consumption, insanity, imbecility, parental intemperance, consanguinity of feeble parents, maternal ill health, accident or shock during gestation. Extreme youth or extreme age of parents, or disproportionate age, and rarely consanguinity, are noted as causal factors. Causes connected with birth are prolonged parturition, excessive pressure, premature birth. Causes following birth are convulsions, epilepsy, paralysis, injuries to the head, fright, fever. Neurotic inheritance seems to be the cause of idiocy in about forty to fifty per cent of cases; tuberculosis and scrofula of parents, fifteen to thirty per cent; alcoholism, nine to sixteen per cent; hereditary syphilis, one to two per cent; gestational causes, eleven to thirty per cent; parturitional causes, about eighteen per cent; infantile convulsions, over twenty-five per cent; acute febrile diseases, six per cent (Petersen). 4. The Feeble-Minded propagate Defects. There is general agreement among authorities that there is no trait, physical or mental, which is so likely to be inherited as feeble-mindedness. While many cases arise from accident, by far the largest number can be traced to some distant inferiority of parents. This law of causality, which could be richly illustrated and demonstrated by the records of institutions, must be considered in relation to the measures of treatment. The defective 5. Social Disadvantages of the Feeble-Minded. child injures the family to which it belongs, if it is kept at home. It is a source of constant humiliation, annoyance, often of physical danger, loss of time and energy, weakness of the mother, and vicious example to other children. This aspect is so important, and the domestic and social consequences are so weighty, that some illustrations will be taken from a report of Dr. Rogers, which might be enriched from many other sources. One girl when crossed in any way becomes excitable and is inclined to do bodily harm to those about her, unless she is restrained. . . A certain boy is not fit to be left alone, is a great care to his widowed mother, and a menace to a younger brother. . . . A sensitive boy of seventeen threatens to commit suicide, and this worries his mother and makes her excessively nervous. Another boy is so dangerous that his mother's life is in hourly peril. farmer takes a feeble-minded boy to bring up with his own children, but the ... A |