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The circumstances which favor the production of idiocy are endemic, hereditary, parental, or accidental. Idiocy is endemic only as connected with some forms of cretinism. It is considered hereditary where there have been cases of idiocy or of insanity in the preceding or collateral generations. It is called parental when referred to certain conditions of the father or mother. The direct influence of the former ceases after conception; the intimacy of the latter with her fruit is incessant during the eventful periods of gestation and lactation; hence the share of the mother in the circumstances favoring the production of idiocy is the larger. She may have been under-fed in poverty herself, or through previous generations; or so miserably enervated by music, perfumes, savors, pictures, books, theatres, associations, that a precocious loveliness has outgrown her motherly capabilities, as forcing converts the pistils and stamens of flowers into beautiful fruitless petals.

She, being pregnant, has used for exclusive food unnutritious substances, such as pickles, dainties, lemons, tea, brandies, etc.; or vomited all real food soon after ingestion.

She has conceived at a time when spermatozoa have encountered noxious fluids of venereal or menstrual origin, or have been altered in their vitality previous to their emission by drunkenness, etc. She is often passive under the causes of impressions, depressions, shocks, privations, exertions, abuses, excesses, altering the nutrition of the unborn or newborn child.

But all these circumstances do not seem to act with the same energy or frequency in the production of idiocy, which is attributed most of the time, by women worthy of being trusted, to sudden or protracted impressions of an accidental or moral nature. The same testimony appears to extend the power of these circumstances through the period of lactation, in which mothers, morally affected, have seen symptoms precursor of idiocy, such as convulsions, follow immediately the ingestion of milk, and idiocy, paralysis, epilepsy, or death supervene.

Accidental idiocy, after birth, is caused by unnutritious diet, want of insolation and of other hygienic requisites; by hydrocephalus, measles, whooping-cough, intermittent fever, etc.

In the above circumstances, as far as we have learned, must we look for the origin of idiocy and its annexes. But everything pertaining to conception, gestation, parturition, lactation, remains enshrouded behind the veil of Isis. If women would only speak, we should be able to call upon them in the name of science, a social protection they do not seem to need, nor care for in their present mutism; and we should soon be enabled to generalize from their individual experience frankly told, the laws of anomalous creation in our race. Since idiocy is ascribed to so many circumstances, taking place at such different periods of the formation of the child, it is not to be expected that it should assume an identical appearance; in fact, on entering a school, the idea of similarity is soon dispelled by the heterogeneous features of the inmates; therefore the same drawing cannot represent them but as a type, after a practical study of the varieties. These varieties are simple and complicated idiocy.

To clear the field we begin with the last named.

Endemic idiocy is interwoven with alpine or lowland cretinism and bronchocele, producing at birth the cretin-idiot, in youth the cretin-imbecile, and after puberty the cretin (simplex), able to procreate his like. Thus cretinism, besides its apparent geological connexion or origin, is hereditary, like scrofula; a taint in the blood, preparing children for idiocy or imbecility, according to the age of its invasion. This alpine cretinism is due to locality and to intermarriage, and it is never isolated; it affects the skin with a bistre or maroon color. Its action does not cease after having produced idiocy, for if its victim be put in a locality where cretinism will aggravate, idiocy will do the same; and if placed in circumstances of climate, of hygiene, of exercise, where cretinism may improve, idiocy will also improve, and shall become more amenable to the physiological treatment, as the labors and devotion of Guggenbuhl have abundantly proved. The lowland cretinism of Belgium, of Virginia, etc., with its discrete goitre, its grey and dirty straw-colored skin, bears the same relation to idiocy and imbecility as the more extensive alpine variety.

So does the furfuraceous cretinism with its milk-white, rosy, and peeling skin; with its shortcomings of all the integuments, which give an unfinished aspect to the truncated fingers and nose; with its cracked lips and tongue; with its red, ectropic conjunctiva, coming out to supply the curtailed skin at the margin of the lids.

Let us here remark that bronchocele may exist with or without cretinism, or cretinism with or without bronchocele; but that cretinism cannot be found without being allied to one of the three alterations of the integuments above described.