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Idiocy: And Its Treatment By The Physiological Method

Creator: Edward Seguin (author)
Date: 1907
Publisher: Teachers' College, Columbia University
Source: Available at selected libraries

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When the central nervous apparatus is affected in idiocy, the following alterations may be noticed: The substance of the brain is softer generally, or partially harder, and as it were shrivelled. The color is paler, with less distinction between the white and grey matters. The circumvolutions are neither so numerous nor so well defined on the surface, nor so deeply penetrating. The hemispheres do not expand above the sensory ganglia and cerebellum with their normal amplitude. The lateral and posterior lobes being particularly short of their normal expansions; the cerebellum which is not fully covered by the hemispheres being larger in proportion.


If the cranium were always and everywhere of the same thickness, and if the brain were always filling the whole of its cavity, the external configuration of the skull might be taken as the counterpart of the form of the brain, and used as the relative measure of its bulk. But the reverse is true. Crania are very thick or very thin, partly thick and partly thin, particularly so at the frontal sinus, the tables of which are often besides vastly apart. Moreover, the brain is very far from always adapting itself with the same exactness in reality as in theory to the form of the cranium. In fact there are cases in which the brain presses so strongly against the cranium, that either the internal table is eroded by the convolutions and bears a deep imprint of them, or other cases in which the compression exercised by the unyielding cranium is such as to deface all convolutions and enfractuosities of the hypertrophied mass; cases in which the distension of the cranium is due to the presence of a tumor, of hydrocephalus, or of hypertrophy; anomalies as difficult to discriminate on the living subject as the thickened tables of the skull.


If we pass from the sizes of large skulls, which are attributed to hydrocephalic origin, to those which present microcephalic proportions we shall see that we cannot judge by them more accurately of the condition of the brain. Sometimes a very small skull encloses quite a bulky and healthy encephalon; sometimes the skull will not be so very small, only irregular, and disclose internal anomalies, such as the following found by Lebert: (6) "Cerebrum very small, right hemisphere larger and 'bombé,' left smaller and flattened; circumvolutions narrow, more so posteriorly, where they are of the size of ground worms; they are twisted, and in their course are puffed up and constricted alternately." In other cases, the hemispheres may be found almost without convolutions, and the medullary substance covered only with a thin layer of cineritious matter. Or, in the absence of the corpus callosum, the hemispheres were found to communicate only through the medium of the anterior and posterior commissures. Or the pineal and pituitary bodies were much atrophied. These anomalies and many more are recorded from the autopsies of microcephalic idiots, but as usual without a word as to their corresponding psycho-physiological disabilities.

(6) Traité d'Anatomie Pathologique. Vol. I., p. 84. Pl. IX, fig. 1 and 2.


To sum up what we have said about size by two extreme cases, we are acquainted with a lady fifty years of age, whose head measures twenty-seven inches in circumference, and above twenty-two from one external auditory foramen to the other across the vertex, who could, in younger days, perform the duties of a Sunday-school teacher, and even now behaves like a lady in every respect. And we have seen enough of the Aztec children, so well observed by Dr. John C. Dalton, whose heads are under thirteen inches in circumference, to be sure that, previous to their training as show-things, they could have been educated like human beings, and improved as much as extreme microcephalic children have been by Drs. S. Howe and H. B. Wilbur (see Observations in Appendix). To close what we have to say about the size of the heads of idiots; it is most of the time quite normal, though it looks too big in infancy, because it stands on a sickly frame, and too small later, because the body has grown and the head has not, owing to the deficiency of special nutrition and to deprivation of intellectual gymnastics. Lastly, the two tables of crania, large or small, not being exactly parallel, and being sometimes very far apart, the internal capacity of the skull cannot be founded upon its external measurements. Hence, observers have tried to obviate this difficulty, at least on the dead, by measuring the internal capacity with instruments, liquids, sand, or seeds; but these new means could no more be invoked as tests of idiocy than the measure of the external size; since that cavity was not on the living necessarily filled up with medullary and cortical substance; and since savages are endowed with the full capacity allotted to their race, who have heads whose size is inferior to that of the idiots of ours.


If we pass from the consideration of the external size and internal capacity to that of shape, we see, equally, all sorts of forms among the heads of idiots. The shape of the head may be altered from its primitive type in each race by disease or by art. Idiocy presents mostly the following deformities: Heads flattened anteriorly or posteriorly, or circularly compressed to a cone, which tends upward or backward; flattened at the sides, or at the top; very low or very high, as if crowned by a stony table, or bibbed by a depression running along the coronal suture; or with both parietal eminences greatly exaggerated; or the vertex expanded like a balloon, whose neck would be represented by the compressed forehead and lower lateral bones, reposing on a diminutive face. These deformities are the principal, but many idiots do not present any of them, whilst they are found among people who practice them, not to incapacitate their children, but to make their heads correspond to some desired type by a sort of plastic orthophreny. We notice, besides, two kinds of disproportion in the component parts of the cranium. One from side to side, which, very rarely extreme, is seen accidentally in idiots and insanes; but which, in its milder forms, may be detected on, we may say, any cranium; even the circumvolutions presenting commonly, from side to side, disproportions and differences: consequently the disproportion from side to side of the head is not a test of idiocy.

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