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Idiocy: And Its Treatment By The Physiological Method
To constitute the broad and lower stratum of a normal institution for idiots, they and their congeners must accordingly be chosen in view of forming what we may be permitted to call an efficient body of incapacities. In this body the life, though defective, circulates and may improve, because the children have been apposed with regard to the representation in the school of the many infirmities characteristic of typical idiocy. In this wise the establishment is made to represent in the concrete, abstract idiocy, with its normal amount of incapacities and of quasiaptitudes equipoised, so that it may be compared to a merchantman whose cargo is distributed for swift sailing. In general terms, if we want the institution to progress, the inmates must be chosen so that no special condition in them predominates over the others; but we must particularly warn any new establishment against three of them: 1st. Epilepsy, which too often aggravates idiocy, ranks foremost. It is nearly impossible to forward the general treatment with the impediment offered by the sight and care of convulsions, impressing badly the other children, and consuming the available force of the personnel. 2d. Extensive paralysis and contractures, when largely represented, raise the same objection. 3d. The admission of many very young children acts in the same manner by the incessant care they claim, part of which hinders the movement of a public institution. The nursing required by so young pupils is not only the caring and watching day and night, so necessary to weak children, but it is the ceaseless fondling against a warm breast, from which the child seems to derive part of his vitality; and as idiots are, besides their infirmity, generally by several years behind other children, they need several years more of tender nursing and motherly care. It is better, therefore, as we said, to teach their mothers how to apply at home the physiological process of development, sooner than to admit them to pine away in the midst of apparently favorable circumstances.
In private and select practice, provisions may be made to avoid these inconveniences; but in public institutions, the general end to be attained must not be lost sight of for the sake of improving more especially a class of patients, nor even a set of functions in all of them. The school is to be filled by a choice of pupils whose collection shall form a unit easy to move, easy to command, easy to progress with the expense of a given force of intelligent persons. And by such judicious choice of pupils on the one hand, and of assistants on the other, the moral being called institution for idiots is expected to be able to train her children up to the highest point of their possible attainment, instead of being herself dragged, by their dead weight, to their level.
Besides, to form a school, the children must be numerous enough to be worked successively into the various modes of general, group, and individual trainings. This minimum number must be attained to form anything like a school -- even a private one. We would not say that, to succeed, there must be at least so many pupils in training at once; for it would be like mistrusting the miracles of individual ingenuity, or denying the power of devotion, money, scientific investigation, etc.; it would be like producing false evidence against ourselves, since we treated idiots by ones, by tens, before we gathered them for the first time by the hundred in Bicêtre. But we say that whatever may be gained by the close contact of one teacher with one or a few pupils in individual lessons, is far from compensating the loss experienced by the necessary absence of group or general training among isolated children. No doubt they may, in this wise, learn more through the teacher, but they will acquire less intuition by themselves; they will obey more integrally, but they will not act so soon, nor so well by the impulse of their free will; they may understand more, but will certainly do less. In fact, the two modes of teaching act so differently, and are so completive, not suppletive of each other, that the best school is the one which includes both; and consequently, a public institution must he numerous enough to permit a rational classification, without reducing the groups to mere individualities. For this vital reason, it would be advisable to unite the means and efforts of two states to create a healthy institution, sooner than to foster several in deplete conditions, unfavorable to the circulation of activity among children. But this rule must only be affirmed in its most general terms, and for public establishments.
If we are reluctant to fix a certain minimum of pupils for an institution, we must be more cautious yet in regard to fixing their maximum number. Evidently the more numerous they are, the more easy would be the formation of groups, if this operation needed not to be strictly founded upon a thorough study of the individual cases. Here lies the difficulty which may be stated in a very few words: how many idiots may be studied, taught, and treated with unity and comprehensibility, under a single head, by a staff of officers? We do not say fed, warmed, and kept at the lowest ebb of vitality; we mean educated and developed to the fullest extent of their capacity. Unfortunately, experience in this matter is too young to be invoked as a guide. Good common sense may help to form a judgment; but the question will evidently remain open till practice shall have verified or corrected our conclusions. If we consider, as we think we must, an institution as a unit in itself representing the pathological unit idiocy, we see that the children forming its body may be grouped for the sake of training as are the symptoms of idiocy, in various categories; though the same child will, of course, enter at successive hours of the day into several of these groups.