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Idiocy: And Its Treatment By The Physiological Method
The other disproportion affects the relative development of the three segments forming the vault of the cranium ; we will consider them in their relative expansion and in their mode of uniting to form a cavity. The posterior segment contains the cerebellum, and so much of the hemispheres as expands over it in proportion to natural or acquired development; the second contains the primitive cerebrum, the tubercula quadrigemina, and other ganglia; the third contains the largest accretions made to the human brain, according to race and education, in such a bulk as to atrophy the olfactory lobes, to depress the orbital cavities, and to raise the vault of the frontal bone very sensibly since the short period of two thousand years, as appears by all the monuments of our race. The harmonious development of these three parts, according to the standard for each race, represents the harmony of manly functions; and when it exists in large encephalic masses, insures great mental power.
Considering the modes of formation of the sutures by which the bones are united; the sutures may be formed too hastily, when there is atrophy of the brain, and are smooth and cannot be felt; or under the influence of a serous inflammation, and then their serrated structure is felt rough and elevated by the finger through the thin integuments. But when circumstances have prevented or retarded the formation of the sutures, palpation detects the opened or imperfectly closed fontanelles, the presence of wormian bones in anormal numbers, or the loose condition of the coronal, sagittal, and lamdoid sutures.
In the relative development of the segments; and in their modes of suture to form the cranium, resides the harmony or disharmony which strikes more than size or shape in human heads. Reserving the exceptions, any deviation from the Caucasian type among our children, in respect to harmony of proportions, must be looked upon, a priori, as representing some anomaly in their faculties; and any imperfection in the mode of union of the segments of the skull cannot fail to enlighten the etiology and pathology of our subject.
Nothing hinders us now from entering into the study of the physiological symptoms after having taken a rapid survey of the infant born idiotic, or predisposed to idiocy.
The only thing which could tempt us to form a diagnosis when the child is just born, is the often monstrous shape exhibited by the head. But it is so difficult to appreciate what part of it is due to deficiency of nutrition or to transitory compressions from manoeuvres or instruments; and the head is endowed with such a power of reaction and self-modulation against these transient deformities, that we had better let it receive its own finishing touch before venturing on the expression of a judgment upon its unfinished state. But after the first cries, the child shuts himself up into a chrysalid life. He is rosy and rather puffy, or greyish and shrivelled in his loose integuments, according to his general health. For a time nothing more of him may be foreseen than is seen. Even a few months later, if the mother, feeling her baby without reaction in her embrace, seized with a secret presentiment, seeks for advice, the physician rarely happens to see him otherwise than nursing and sleeping. He has scarcely the chance to notice the head hanging back, or rolling on the pillow automatically; the eyes unlighted and playing the pendulum in their sockets, fixed, or upward or sideways; the difficulty of swallowing the milk once drawn in the mouth; the absence of voice or its animal sounds; the inability of the spine to support the body; the flaccidity of the legs; the hands closed, thumbs inward, by the side, instead of coming out from the cradle to take with a firm grasp their share of this world.
In the midst of this uncertainty, profuse salivation, involuntary excretions, imperfect sensations or disordered movements appear daily more settled, instead of the opposite abilities vainly expected. Or after a fall, or blow, exposure to cold, insolation, prolonged successions, fright, or in the period of teething, coma sets in or convulsions appear. After which some function of the reflex or voluntary order, motor or sensitive, is impaired. But the commotion of the cerebro-spinal axis may be temporary or prolonged, producing more convulsions, deeper coma, other incapacitations; throwing the little sufferer far behind his fellows, or leaving him a confirmed idiot. Between these two extremes the majority of young idiots do not differ very sensibly from common babies; because the power of both may be expressed by the same verb, they cannot. But to-morrow the well infant will use his hands, the idiot will allow his to hang in half flexion; the first will move his head at will, the second will toss it about; the look of the former penetrates every day farther than the domain of the touch, that of the latter has no straight dart and wanders from the inner to the outer canthus; the one will sit erect on his spine, the other shall remain recumbent where left; the first will laugh in your face with a contagious will, the second shall not be moved into an intellectual or social expression by any provocation whatever. And each day carves more deeply the differential characters of both; not by making the idiot worse, unless from bad habits gotten by neglect, but by the hourly progress of the other. Idiocy so viewed from its origin is a continuance of the isolation and helplessness of babyhood under ampler forms and obsolete proportions. Compared unavoidably with children of his age, the idiot seems to grow worse every day; his tardy improvement looking like backward steps. With his incapacity of action, of expression, of feeling, he makes a sickening sight indeed by the side of a bright child entering into the intricacies of life as on an open play-ground.