Part 2

Just now that the attention of the Legislature is being prominently called to the treatment of habitual drunkards, it cannot be too widely known that their innocent offspring are but too frequently the victims of the brutish excesses of their parents, who, a few years ago, were well described by the then Secretary of State for the Home Department, when receiving a deputation on the subject, as not quite criminals nor quite lunatics, although nearly approaching both classes in many cases. The above statistics fully corroborate the pertinency of Lord Cross's remarks.

I do not allude to these facts with the view of casting any reflection upon the poor, honest, and temperate East Anglian labourer, who may be afflicted with the calamity of having an idiot child; but I merely mention them in order that they may serve as an additional caution against habits of intemperance, and may strengthen the hands of that noble band of philanthropists who are endeavouring to check the torrent of this hideous vice so prevalent in the present day.

_Consanguine Marriages._ There is no point connected with the causation of idiocy that has given rise to so much controversy as the marriage of near relations; formerly one of the most popular notions was that consanguineous marriages were among the most common causes of idiocy, whereas the researches of later observers have tended to modify, to a considerable extent, this sweeping assertion.

Different observers have furnished different results, as to the proportion of idiots found to be the offspring of consanguine marriages; thus Dr. Grabham's statistics give the proportion as about 2 per cent., Dr. Langdon Down's rather more than 5 per cent., and Dr. Shuttleworth's less than 5 per cent. The statistics of the Eastern Counties' Asylum, kindly supplied to me by Mr. Turner, the Resident Superintendent, show that about 6·5 per cent. were the offspring of cousins.

Of 359 cases observed by Dr. Howe, 17 were known to be the children of parents nearly related in blood. The history of these 17 families, the heads of which being blood relatives intermarried, showed that there were other causes to increase the chances of an infirm offspring, besides that of intermarriages, as most of the parents were intemperate or scrofulous; some were both the one and the other. There were born unto them 95 children, of whom 44 were idiotic, 12 others were scrofulous and puny, one was deaf, and one was a dwarf! In one family of 8 children, 5 were idiotic.[9]

Dr. Ireland, who has investigated this point with great minuteness, pertinently remarks that it has been the custom to collect instances of cousins who have married, and have had unhealthy children, as if this never happened to anyone else; and he adds that "the proper way to examine the question clearly, is to find what is the proportion of marriages of blood relations in a given population, and then to inquire if there be in the issue of such marriages a larger percentage of insane, idiotic, or otherwise unhealthy children."[10]

There cannot be a doubt that consanguinity has hitherto been considered too great a factor in the production of idiocy, and that in weighing the evidence, we must not lose sight of the fact that in many cases recorded, other factors beside intermarriage of relatives have contributed concurrently to the development of the mental defect.[11]

_Educational Overpressure._ There is one cause of idiocy which has been pointed out by Dr. Séguin, and which he says is due to the unsatisfactory social conditions under which women of the present day exist. "As soon," he says, "as women assumed the anxieties pertaining to both sexes, they gave birth to children whose like had hardly been met with thirty years ago."[12]

Great prominence has lately been given to this subject by an oration on "Sex in Education," by Sir James Crichton Browne, at the Medical Society of London, in which he called attention to the "growing tendency to ignore intellectual distinctions between the sexes, to assimilate the education of girls to that of boys, and to throw men and women into industrial competition in every walk of life." Elsewhere, he adds, that "to throw women into competition with men is to insure to them a largely increased liability to organic nervous disease.... Woe betide the generation that springs from mothers amongst whom gross nervous degenerations abound." Sir J.C. Browne supports his views by showing that there are organic cerebral differences between men and women, and that therefore they must be educated in different ways, being destined to play different parts on the stage of human life.[13]

The above views of Sir J.C. Browne have not remained unchallenged, and the eminent psychologist has found uncompromising opponents in Mrs. Garrett Anderson and others, who stoutly refuse to recognise the position of the "_Tacens et placens uxor_" of old-time dreams. Mrs. Anderson, who, I need scarcely add, writes most temperately upon this matter, in alluding to Sir J.C. Browne's assumption of the intellectual difference between men and women, remarks, "All I would venture to say is that, if it could be proved that an average man differs from an average woman as much as Newton differed from a cretin, it would still be well to give the cretin all the training which he was capable of receiving.... When we hear it said that women will cease to be womanly if they enter professions or occasionally vote in parliamentary elections, we think that those who conjure up these terrors should try to understand women better, and should rid themselves of the habit of being frightened about nothing."[14]

The limits of this essay will not permit me to dwell at any great length on the important question under consideration. There cannot be a doubt that the tendency of the present age is to encourage women to choose careers and to accept burdens unfitted for them. In thus expressing myself, I distinctly deprecate any hostility to the woman's movement of the present day, which rests on the claim for women for an open career; and I should be glad to see our universities ignore the ancient and exploded prejudices, which led to the long subjection of women to hardship and inequality. They ask for the same facilities as are enjoyed by men, and they have amply shown that they can compete with men in intellectual pursuits, and all they ask is to be allowed to compete on equal terms. I therefore cordially welcome the gradual emancipation of women from comparative subjection to comparative freedom; but the multifarious fields of energy and usefulness open to modern women, have brought with them disadvantages as well as gains.

Whilst, therefore, unreservedly admitting the claims of the _fin de siècle_ woman to freedom of action and to intellectual equality, I must think there are certain branches of study, described by a modern writer as belonging to the "gynagogue" class, which are less suited to women than some others; and amongst these, I would name the abstruse study of mathematics, for although success in this branch of knowledge may lead to a brilliant career as a high wrangler, I think that a female mathematical athlete is not suited for the duties and responsibilities of maternity, and that the mental endowments of her children are likely to be below the average.

I am quite aware that I am treading on dangerous and delicate ground, but although I would not discourage the highest aspirations of women, whether of an intellectual, social, or æsthetic character, I must think that a word of caution is necessary against the overpressure of the present day in the direction above indicated.[15] With every desire to treat this question from a liberal point of view, I desire to emphasise the fact that men and women have different parts to play on the stage of life, and should be trained differently; but provided mental overpressure is guarded against, I have no fear of women engaging in certain occupations which custom has not hitherto recognised as feminine, and experience has shown us that they may be safely left to follow the promptings of their own powers and instincts.

* * * * *

Amongst the various other predispositions to idiocy, I would mention scrofula, which, according to Dr. Ireland, is the remote cause of two-thirds of all cases; phthisis and epilepsy in the parents are also potent factors in the development of idiocy in their offspring.

* * * * *

Before quitting the question of the cause of idiocy, I should like to say a word or two about what is technically called its histology and its pathological anatomy. What is there in the brain that makes one man a senior wrangler and another an idiot? What is it that unfits one person for the discharge of the ordinary duties of domestic and social life, and endows another with capacities adapted for a statesman, a mathematician, or a philosopher? Is it a defect in the quantity or in the quality of the nervous matter of the brain? Does it depend on a malformation of the cranium, on the size or shape of the head? does the form of a cranium illustrate the quality of the mind whose cerebral substratum it encloses, or can genius of a high order enshrine itself in a comparatively narrow and malconstructed tenement?[16] Does mental capacity depend on the size or weight of the brain, or on the degree of complexity of the cerebral convolutions, or on their symmetry in each hemisphere?[17] Upon this point, I am bound to tell you that science speaks with a somewhat uncertain sound, volumes having been written upon it without any definite solution or tangible result.

An eminent Italian psychologist, Dr. Mingazzini, in a recent work on the study of the cerebral convolutions, shows that in men of genius, the brain offers no certain indications of intellectual eminence, either by the greater richness of the frontal or the parietal lobes; and in support of this opinion he cites the researches of Wagner, which showed that, in the development and richness of the convolutions, the brains of many celebrated Gottingen professors were inferior to those belonging to individuals of low intellectual capacity.[18]

The average brain weight in man may be said to range from 40 to 52-1/2 ounces, and in women from 35 to 37-1/2 ounces; the question of the increase in size and weight of the brain, in proportion to intellectual power, is by no means determined; statistics exist of the weight of 23 eminent men, the list being headed by Cuvier, the naturalist, whose brain weighed 64-1/2 ounces, whilst that of the orator, Gambetta, weighed only 39 ounces, being much below the average weight in the adult male; an imbecile died at the Montrose Asylum, whose brain weighed 63 ounces, and the heaviest brain on record, which weighed 67 ounces, was that of a bricklayer, who could neither read nor write; it must therefore be conceded that no definite statement can be made as to the relation that brain weight has to intelligence.[19]

It was formerly supposed that idiots always presented some obvious malformation of the cranium or skull. This is by no means necessarily the case; one of the most remarkable cases of idiocy that has come under my notice was that of a child with a well-formed head, remarkably handsome face, and a well-proportioned body.

Dr. Ireland says, "the principal anomalies met with in the skull of genetic idiots are flatness of the head behind, a rapid slope of the clivus, an osseous rim round the foramen magnum, unsymmetrical size of the cavities on each side, irregularities in the wings of the sphenoid, and differences in the size and shape of the jugular and other foramina; but these appearances are not constant, and often the skull is quite regular, both in structure and capacity."[20]

One of the most noted writers on the subject, after stating that a number of scientific men had spent thirty years in measuring and weighing the heads of idiots, sums up their conclusions as follows:--

1st. There is no constant relation between the development of the cranium and the degree of intelligence.

2nd. The dimensions of the anterior part of the cranium, and especially of the forehead, are, at least, as great among idiots as others.[21]

3rd. Three-fifths of idiots have larger heads than men of ordinary intelligence.

4th. There is no constant relation between the degree of intelligence and the weight of the brain.[22]

5th. Sometimes the brain of idiots presents no deviation in form, colour, and density from the normal standard; it is, in fact, perfectly normal.

After such a statement as this, I can readily imagine that some of you may say, it seems to us that you doctors really know but little about the genesis of idiocy. I am afraid this is, to some extent, true. We are only on the threshold of inquiry, and science of to-day is unable to bridge over the gulf that separates matter from mind.

Modern investigation, however, does not quite bear out the above sweeping statements in their integrity, although the most conflicting theories have been enunciated. Doubtless, attention has been too much concentrated on the gross morphology of the brain, without taking into account microscopical appearances. Dr. Shuttleworth, in giving the result of his long experience at the Royal Albert Asylum says, "We have occasionally found, when least expected, extraordinary defects in brain conformation;... microscopic examination will discover in many instances some abnormality of structure, such as the preponderance of simply formed braincells devoid of processes, denoting persistence of fœtal structures; or, on the other hand, degenerative changes resulting from inflammatory atrophy."[23]

Professor Luys, of Paris,[24] gives the result of the examination of the brain of 14 idiots, the anomalies observed being want of symmetry in the frontal lobes, and partial atrophy of the cortical folds especially of the frontal convolutions.[25]

Quite recently, Dr. Andriessen, at a meeting of the Leeds and West Riding Medico-Chirurgical Society, exhibited specimens of the brains of epileptic idiots, which showed conditions of microgyria with atrophy and sclerosis of the convolutions.

In considering the pathology of idiocy, I think sufficient attention has not been given to the chemical constitution of the cerebral substance. The most extravagant notions were at one time prevalent as to the rôle played by phosphorus in the animal economy; the Dutch naturalist, Moleschott, maintaining that "without phosphorus there was no thought." A celebrated chemist, Couerbe, also considered phosphorus to be the exciting principle of the brain, and according to him, the brain of ordinary men contained 2-1/2 per cent. of phosphorus, that of the idiot 1-1/2, and that of the madman 4 to 4-1/2; from these data he concluded, "that the absence of phosphorus in the brain reduced man to the condition of the brute; that a great excess of this element irritated the nervous system and plunged the individual into the frightful delirium which we call madness; and that a medium proportion re-established the equilibrium and produced the admirable harmony which is none else than the soul of the spiritualists."[26] Professor Janet, in criticising the above theory, remarks that the brain of fishes, who do not pass for great thinkers, contains a large amount of phosphorus, also that the statistics of M. Lassaigne have shown that the brain of madmen does not contain more phosphorus than that of sane individuals.[27]

The late Bishop of Carlisle, in rebutting this phosphorus theory, remarks, "Why should we not go further and assert that there could be no thought without carbon or without any other element of which the human body is composed; for you can have no actual thought without a living creature, and no living creature without a body, and no body without carbon."[28]

I have treated the subject of the Chemistry of the Brain at considerable length in my treatise on "Aphasia and the Localisation of Articulate Language," to which book I would refer those who desire further information in reference to the connection between the amount of phosphorus and intellectual vigour.

FOOTNOTES:

[5] The question of the influence of alcoholic stimulants on the development of mental disease formed a prominent feature in the proceedings of this congress, and it is also a subject which is just now engaging the attention of pathologists in all parts of the world.

[6] "Mentally-deficient Children, their treatment and training." By G.E. Shuttleworth, M.D. Page 36.

[7] Toussenel, a French writer, says "La plupart des idiots sont des enfants procréés dans l'ivresse bacchique. On sait que les enfants se ressentent généralement de l'influence passionelle qui a présidé à leur conception." At a discussion at the Obstetrical Society, Dr. Langdon Down is reported to have entertained similar views.

[8] I would refer those who may wish to pursue the inquiry as to the baneful influence of alcohol on the human frame, to the celebrated Cantor Lectures on Alcohol, by my friend Sir B.W. Richardson, in which he introduces the physiological argument into the temperance cause, asserting that alcohol cannot be classified as a food; that degeneration of tissues is produced, that it neither supplies matter for construction nor production of heat, but, on the contrary, militates against both. Sir B.W. Richardson's latest views upon this subject are developed in the pages of the "Hospital" for February 1st and March 14th, of this present year.

In France, M. Lunier, Inspector of Asylums, has shown that the departments in which the consumption of alcohol had increased most, were those in which there had been a corresponding increase of insanity, and this was shown most strikingly in regard to women, at the period when the natural wines of the country gave way to the consumption of spirits.

In Sweden, Dr. Westfelt has lately made a communication to the Stockholm Medical Society, containing the statistics of alcoholic abuse and its results in Sweden. He calculates that at least from 7 to 12 or 13 per cent. among males, and from 1 to 2 per cent. among females, of all cases of acquired insanity, are due to the abuse of alcohol; and in reference to its influence on progeny and race, he shows that a steady diminution of the population was coincident with a period when drunkenness was at its greatest height.

[9] "On the Causes of Idiocy." By S.G. Howe, M.D. Page 35.

[10] "Op cit," page 19.

[11] That eminent clinical observer, the late Professor Trousseau, in treating of the influence of consanguine marriages, gives the history of a Neapolitan family, in which an uncle married his niece. There had previously been no hereditary disease in the family; of the four children, the issue of this marriage, the eldest daughter was very eccentric; the second child, a boy, was epileptic; the third child very intelligent; and the fourth was an idiot and epileptic. "Clinique Médicale de l'Hôtel-Dieu de Paris." Tome ii., page 87.

[12] "New Facts and Remarks concerning Idiocy," by E. Séguin, M.D., p. 28. Dr. Séguin has been a voluminous contributor to the literature of Idiocy, and for many years his writings were the only available source of information on the management and education of idiots.

[13] Sir J.C. Browne, in speaking of the brain of men and women, says there can be no question of inferiority or superiority between them any more than there can be between a telescope and a microscope; but they are differentiated from each other in structure and function, and fitted to do different kinds of work in the world. He maintains that the weight of the brain is less in women than in men, that the specific gravity of the grey matter is less, that the distribution of the blood varies in the two sexes to a considerable extent, and that the blood going to the female brain is somewhat poorer in quality than that going to the male brain, and contains four millions and a half corpuscles to the cubic millimetre, instead of five millions in the case of the male.

[14] It seems that one of their own sex is of a different opinion, as in a series of articles in the "Nineteenth Century" for 1891 and 1892, Mrs. Lynn Linton strongly deprecates any departure from the comparatively restricted area of usefulness hitherto open to women, and she even baldly states that it is for maternity that women primarily exist! She also adds, "be it pleasant or unpleasant, it is none the less an absolute truth--the _raison d'être_ of a woman is maternity ... the cradle lies across the door of the polling booth and bars the way to the senate."

In a powerful article in the same serial, entitled "Defence of the so-called Wild Women," Mrs. Mona Caird severely criticises Mrs. Lynn Linton's views as to the restrictions she would impose upon the freedom of women to choose their own career.

[15] Although the injurious effects of overpressure in education have been principally referred to in the education of girls, the same pernicious results may accrue in the case of boys. Dr. Wynn Westcott, in his work on "Suicide," states that during the last few years there have been several English cases of children killing themselves because unable to perform school tasks. He also says that child-suicide is increasing in England and in almost all Continental states, and that the cause in many cases is due to overpressure in education. Dr. Strahan, writing upon the same subject, in his treatise on "Suicide and Insanity," corroborates Dr. Westcott's views, and remarks that fifty years ago, child-suicide was comparatively rare; but that during the last quarter of a century it has steadily increased in all European states, and that the high-pressure system of education is generally considered as the cause of it.

If any apology be needed for dwelling at such length on the evils of the educational overpressure so prevalent in our days, I would observe that it has an indirect bearing upon the causation of idiocy; for although the sinister results recorded by Drs. Westcott and Strahan may be comparatively rare, still, consequences of a more remote character may ensue, for the injury done to the nervous system is cumulative and transmissible from generation to generation, and a neurotic tendency may be engendered in the offspring of those who have been exposed to this evil, which may manifest itself in the appearance of idiocy or some lesser form of mental defect.

[16] One of the most distinguished French psychologists, has thus expressed himself on this point--"Dans des réunions ou l'idiotisme étendait son triste niveau, il m'est arrivé plusieurs fois de rencontrer des crânes, qui dans leur partie frontale eussent fait honneur aux hommes les plus justement célèbres, et où l'on eût pu trouver avec avantage les organes de toutes les sortes d'esprit, de celui même qui apprend à rire des mystifications et des sots."--_Rejet de l'Organologie Phrénologique_, par F. Lelut, p. 196.

[17] Dr. Wilmath, of the Pennsylvania Institution for Feeble-minded, reports that in six brains the island of Reil was exposed through defective development of the 3rd frontal convolution; in four cases, on both sides; in two cases, on one side only.--_Notes on the Pathology of Idiocy._

[18] Il Cervello in Relazione con i Fenomeni Psichici. Studio sulla morfologia degli emisferi cerebrali dell'uomo, Torino, 1895. P. 89.