Page:Encyclopædia Britannica, Ninth Edition, v. 13.djvu/108

98 INSANITY speak nor understand speech, the second those who can understand a few easy words, the third those who can speak and can be taught to work, the fourth those who can be taught to read and write, and the fifth those who can read books for themselves. The treatment of idiocy and imbecility consists almost entirely of attention to hygiene, and the building up of the enfeebled constitution, along with endeavours to develop what small amount of faculty exists by patiently applied educational influences. The success which has attended this line of treatment in many of our public and private institutions has been very con siderable. It may be safely stated that all idiotic or im becile children have a far better chance of amelioration in asylums devoted to them than by any amount of care and teaching lavished upon them at home. In the class of idiots just spoken of imperfect develop-- ment of the intellectual faculties is the prominent feature, so prominent that it masks the arrest of potentiality of development of the moral sense, the absence of which, even if noticed, is regarded as relatively unimportant ; but, in conducting the practical study of congenital idiots, a class presents itself in which the moral sense is wanting or deficient, whilst the intellectual powers are apparently up to the average. It is the custom of writers on the subject to speak of " intellectual" and " moral " idiots. The terms are convenient for clinical purposes, but the two con ditions cannot be disassociated, and the terms therefore seve rally only imply a specially marked deprivation of intellect or moral sense in a given case. The everyday observer has no difficulty in recognizing as a fact that deficiency in re ceptive capacity is evidence of imperfect cerebral develop ment ; but it is not so patent to him that the perception of right and wrong can be compromised through the same cause, or to comprehend that loss of moral sense may result from disease. The same difficulty does not present itself to the pathologist ; for, in the case of a child born under circumstances adverse to brain development, and in whom no process of education can develop an appreciation of what is right or wrong, although the intellectual faculties appear to be but slightly blunted or not blunted at all, he cannot avoid connecting the psychical peculiarity with the pathological evidence. The world is apt enough to refer any fault in intellectual development, manifested by imper fect receptivity, to a definite physical cause, and is willing to base opinion on comparatively slight data ; but it is not so ready to accept the theory of a pathological implication of the intellectual attributes concerned in the perception of the difference between right and wrong. Were, however, two cases pitted one against another the first, one of so- called intellectual, the second, one of so-called moral idiocy it would be found that, except as regards the psychical manifestations, the cases might be identical. In both there might be a family history of tendency to degeneration of the nervous system, a peculiar cranial conformation, a history of nervous symptoms during infancy, and of a series of indications of mental incapacities during adoles cence, differing only in this, that in the first the promi nent indication of mental weakness was inability to add two and two together, in the second the prominent feature was incapacity to distinguish right from wrong. What complicates tho question of moral idiocy is, that many of its subjects can, when an abstract proposition is placed be fore them, answer according to the dictates of morality, which they may have learnt by memory. If asked whether it is right or wrong to lie or steal they will say it is wrong; still, when they themselves are detected in either offence, there is an evident non-recognition of its concrete nature. The question of moral idiocy will always be a moot one between tho casuist and the pathologist ; but, when the whole natural history of such cases is compared, there are points of differentiation between them and mere moral depravity which must appeal to even biased observers. Family history, individual peculiarities, the manifest im becility of the acts committed, the general bizarre nature of the phenomena, remove such cases from the ordinary category of crime. Statistics. According to the census returns of 1871 the total number of persons described as Idiots and Imbeciles in England and Wales was 29,452, the equality of the sexes being remarkable namely, 14,728 males and 14,724 females. Compared with the entire population, the ratio is one idiot or imbecile to 771 persons, or 13 per 10,000 persons living. "Whether the returns are defec tive, owing to the natural sensitiveness of persons who would desire to conceal the occurrence of idiocy in their families, we have no means of knowing ; but such a feeling is no doubt likely to exist among those who look upon mental iniirmity as humiliating, rather than as one of the many physical evils which afflict humanity. According to Ireland, this number (29,452) is 25 per cent, below the mark. The following table shows the number of idiots accord ing to official returns of the various countries ; probably they are subject to the same criticism as the census returns for England. Males. Females. Total. Proportion to 100,000 of popula tion. England and Wales 14,728 14,724 29 452 130 Scotland 2,304 2,317 4,621 134 Ireland 8,151 150 France (including Cretins) Germany (1873) 20,456 16,133 14,677 14,395 35,133 33,739 97 82 Sweden (1870) 1,632 38 Norway 2,039 116 United States (1870) 13,219 9,209 22,428 58 The relative frequency of congenital and acquired insanity in various countries is shown in the following table, taken from Koch s statistics of insanity in Wiirtcmberg, which gives the num ber of idiots to 100 lunatics : Prussia 158 Bavaria 154 Saxony 162 Austria 53 Hungary 140 Canton of Bern .., . 117 America 79 France 66 Denmark 58 Sweden 22 Norway 65 England and Wales 74 Scotland 68 Ireland... 69 It is difficult to understand the wide divergence of these figures, except it be that in certain jstates, such as Prussia and Bavaria, dements have been taken along with aments, and in others cretins. This cannot, however, apply to the case of France, which is stated to have only 66 idiots to every 100 lunatics. In many districts of France cretinism is very common ; it is practically unknown in England, where the proportion of idiots is stated as higher than in France ; and it is rare in Prussia, which stands at 158 idiots to 100 lunatics. Manifestly imperfect as this table is, it shows how im portant an element idiocy is in social statistics ; few are aware that the number of idiots and that of lunatics approach so nearly. Cretinism. Cretin probably comes from Chretien, either from the idea that the person was innocent in the sense in which that word is employed occasionally to imply a person who cannot sin, or from the religious respect in which cretins were held. Cretinism is a form of congenital insanity in asmuch as the cretino-genetic miasma acts before birth ; it is endemic in many mountainous countries, and is said to occur most frequently on magnesian limestone formations, but never at an elevation above 3000 feet. Although all cretins have not goitre, and all goitrous persons are not cretins, there is a very intimate relationship between the two conditions. The districts in Europe in which it is most common are the departments of Hautes-Pyre nees, Haute-Savoie, and Hautes-Alpes ; Styria, Upper Austria, the province of Aosta, and Sardinia. It is found more sparsely in other parts of Europe, and also among the Himalayas and Andes. It occasionally presents itself in flat countries, a remarkable instance being the island of Nieclerwerth below Coblentz, where out of 750 inhabitants there are 131 cretins (Dr Ireland). Notwithstanding the circumscribed area in which this disease exists, affording, it might be supposed, data founded on the conditions of