Part 5

One of the most interesting features in this case is the result of the analysis of the blood, as to its corpuscular richness. Before thyroid treatment was commenced, the number of corpuscles was only 2,225,000 per cubic millimetre; after the cure by the thyroid juice, the number was more than doubled, being 4,774,000 per cubic millimetre. In Dr. Lewis Bruce's cases, to which I have already referred, the result was the reverse of that observed by M. Voisin; for in the eight uncomplicated cases recorded by Dr. Bruce, with one exception, there was in all of them a diminution in the number of red corpuscles.

At the discussion on Myxœdema, at the Edinburgh Medico-Chirurgical Society, to which I have already alluded, Dr. Alexander Bruce showed a case of myxœdema under the care of Professor Fraser, in the Royal Infirmary, in which, as the result of thyroid feeding, a condition of relative anæmia had been developed. The patient had no murmurs when admitted, but since the administration of thyroid preparations, basal and mitral systolic bruits had developed themselves. It is further stated that the blood corpuscles had fallen from 4,600,000 to 3,700,000, and hæmoglobin from 78 per cent. to 59 per cent.[45]

Further researches would therefore seem to be necessary, before we can arrive at a satisfactory conclusion as to what effect the thyroid treatment has upon the blood.

Possibly the dose of the thyroid preparation may be an important factor in the result, for Dr. Byrom Bramwell, in an important and exhaustive monograph upon this subject, says, that anæmia is apt to be produced by large doses of the remedy; and he mentions a case where the red blood corpuscles and the hæmoglobin underwent a marked diminution during the period of acute thyroidism, but rapidly increased under the subsequent administration of small doses of the remedy.[46]

The subject of blood analysis is most important, as tending to throw some light upon a matter at present but little understood, namely the physiological effect of thyroid preparations upon the blood.

Dr. Telford-Smith has reported four cases of Sporadic Cretinism treated by thyroid extract at the Royal Albert Asylum, Lancaster, when a well-marked improvement was noticed in each case. The clinical history of these cases is given with minute detail by Dr. Telford-Smith, and is well worthy of close study by those interested in this subject.[47]

Quite recently, at the Annual Meeting of the British Medical Association, held at Carlisle in August of the present year, communications were read on the Thyroid Treatment of Cretinism and Imbecility, by Dr. Rushton Parker, Dr. Telford-Smith, Dr. John Thomson, and others. An animated discussion ensued, the tendency of which pointed to the undoubted advantages both physically and mentally of the use of this remedy.

Although the physiological effects of thyroid feeding may not be definitely recognised and understood, there is overwhelming evidence to show that it produces marked psychical results, that it acts as a direct cerebral stimulant, and we have every reason to rely upon it as a valuable adjuvant to our treatment of idiocy; and it is not too much to say that the treatment of this infirmity, as well as of other mental defects, by thyroid extract or some other preparation of the thyroid gland, is one of the greatest triumphs of modern medicine; but much still remains to be learnt, as Professor Victor Horsley remarks, "So definite and pronounced is the cachexia thyroidectomica, that few subjects in the range of pathology offer a more fruitful and inviting field of research."[48]

_Craniectomy._--The operation of Craniectomy (that is the cutting of strips of bone from the cranium) has been recommended and practised in cases of microcephalic idiocy, an operation suggested upon the theory of premature synostosis, or closure of the cranial sutures, thus causing an arrest in the development of the subjacent cerebral tissue. Although I could not omit a reference to this operation, it has not met with general acceptance, and one of the most recent writers on this subject, M. Bourneville, physician at Bicêtre, discourages it altogether; and from his examination of the skulls of a number of idiots, he affirms that "in the immense majority of cases, there was no premature synostosis, and that neither normal anatomy, pathological anatomy, or physiology, justified the operation of Craniectomy."[49] The late Sir George Humphry was of the same opinion, as, after an examination of 19 microcephalic skulls, he said, "There is nothing to suggest that the deficiency in the development of the skull was the leading feature in the deformity, or anything to give encouragement to the practice lately adopted in some instances of a removal of a part of the bony case, with the idea of affording more space and freedom for the growth of the brain."[50]

At a recent meeting of the New York State Medical Society, Professor Dana read a paper on Craniectomy for Idiocy and Imbecility, and he gave the following result of 81 cases:--In 35, there was improvement; in 22, no improvement; and death ensued in 24 cases. The conclusion at which Professor Dana arrives is that "it is largely through its pedagogic influence that an improvement takes place, and that the operation is allied in its effect to a severe piece of castigation!" Dr. Dana freely admits that this view of craniectomy for idiocy and imbecility lends itself readily to humour, and it would seem that he intended to kill the operation by ridicule.[51]

Of course, Dr. Ireland has something to say upon this point, and after a brief review of the literature of the subject, he says: "So many cases have been collected of microcephales with open sutures, that it is not likely that anyone will continue to hold that the small size of the brain is owing to the sutures closing in, and thus hindering their growth. Even in those cases where the sutures have closed in before birth, the question still remains whether the brain ceased to grow because the sutures are closed, or whether the sutures closed in because the brain ceased to grow; or, lastly, whether both the brain and its coverings ceased to grow under a common cause."[52]

The benefits to be derived in apparently hopeless cases of idiocy, from the systematic and persevering use of all the modern adjuvants and appliances now available for treatment, are now so universally recognised, that it would be superfluous to dwell further on this point. Science has done much for the idiot, and she will do more, for her motto is "Excelsior," and her votaries are not content to linger with complacency on the heights already attained, but they look for the period when, by the powerful lever of an enlightened philanthropy, this benighted race shall be raised from the grovelling level of the brute, to the highest attainable pitch of bodily perfection.

* * * * *

I trust that I have said enough to justify an earnest appeal for sympathy with this unfortunate branch of the human family. I have endeavoured to show that a great social evil exists amongst us, and that duty and interest should alike concur to induce us to face this evil and to master it. I have endeavoured to point out how the care and training of the idiot has become one of the recognised obligations of a philanthropic public. At the Eastern Counties' Asylum, we are trying to mitigate as far as we can this great social calamity, and our efforts have hitherto been crowned with unlooked-for success. We are doing a grand and glorious work, and I ask you to come and help us; the Board of Directors, a noble band of philanthropists, who devote a considerable amount of time to the objects of this charity, ask you to come and help us; nay, more, from the cottage homes in East Anglia rendered miserable by the presence of these unhappy beings, a thousand voices cry to you with trumpet tongue, "Come and help us."

We have in the Eastern Counties' Asylum an institution admirably adapted for the care and treatment of the idiot; standing in its own grounds of seven acres, it is furnished with all the machinery necessary to grapple with this great social calamity, and by the judicious combination of medical, physical, moral, and intellectual agencies, we are enabled to develop and regulate the bodily functions of the idiot, to arouse his observation, to quicken his power of thought, and thus develop the sensitive and perceptive faculties; and we have not only succeeded in raising these poor creatures from a state of hopeless degradation to a state of comfort and usefulness, but we have, in many instances, succeeded in kindling up in their dark and twilight minds some dim anticipations of a brighter world; the veil which obscured their intellect has been rendered transparent, and to use the language of the bard of Avon, we have been privileged to observe that--

"As the morning steals upon the night, Melting the darkness, so their rising senses Begin to chase the ignorant fumes that mantle Their clearer reason."

In addition to the Asylum proper, the Board has lately purchased a farm-house with 32 acres of land, immediately adjoining the main building. By means of this welcome acquisition, increased accommodation is afforded, and facilities are given for drafting off some of the most tractable patients who require less supervision than the majority of the inmates; moreover, farm work has proved very useful in training some of the patients who come from agricultural districts.

_Crossley House._--Our area of usefulness has recently been extended by the munificent gift of Sir Savile Crossley, Bart., of a Convalescent Home, at Clacton-on-Sea. The building has accommodation for twenty patients; it stands facing the sea, in its own grounds of nearly an acre, and its privacy is secured by a walled-in garden, in which the inmates are able to take ample exercise. As a large number of our patients suffer from scrofula, or from some tubercular disease, the want has been long felt of a seaside adjunct, where such patients could be treated in the initial stage. Thanks to Sir Savile Crossley's princely gift, we now possess this valuable addition to our medical resources, the advantages of which cannot be too highly estimated.

_The Ladies' Association._--The valuable additions that have recently been made to the Asylum, thus largely increasing the accommodation for patients, have necessarily entailed a largely increased expenditure, which could not have been met by the current income, had not the ladies of East Anglia come forward with great earnestness to help the objects of this Asylum by individual and energetic efforts; and one of the most interesting events of the last few years has been the formation of a Ladies' Association, the establishment of which is entirely due to the earnest and devoted efforts of the Marchioness of Bristol. Its object is to disseminate information respecting the working of the Asylum, to secure admission for necessitous cases, and to organise and carry out annually house to house collections for its funds. H.R.H. the Princess of Wales has given her countenance to this movement by graciously accepting the office of Patroness, several influential ladies have consented to act as presidents over the various districts into which the four counties have been divided, and as many as 1,400 ladies are engaged in this philanthropic work.

The success attending this movement has been phenomenal. During the first year of its operation, the substantial sum of £1,868 6s. 10d. was handed over to the general fund, this amount having been obtained from upwards of 20,000 contributors, who had thus the opportunity of joining in this good work, and whose aid could not have been secured in any other way. The efforts of these charitable ladies have been crowned with such signal success, that the large sum of £9,473 5s. 9d. has been added to the funds of the Asylum.[53] This substantial help is very gratifying to the Directors of the Institution, who now rely upon the Ladies' Association for nearly a fourth part of their income; and it is not too much to say that the future success of the Asylum is intimately connected with the continuance of the efforts of these philanthropic ladies, who seem to me to be influenced by the noble sentiments lately expressed by one of their number, that "The simple obligation of all thoughtful women, is that of making the world within our reach the better for our being, and gladder for our human speech. It is a work such as this that I am sure stirs us up to feel that we must also give our help, our sympathy, our lives for other people, and in this work lies the elements of unselfishness."[54]

All honour to these ladies, who, having learnt the elementary truth that privileges involve responsibilities, instead of hiding their talents in the napkin of selfishness, prefer to go forth as messengers of mercy, to try and flash the electric fire of philanthropy into the slumbering hearts of others, and to induce them to join in their grand and good work. They thus become a force and a factor of influence with all around them, and their reward will be the satisfaction of feeling that they are contributing their part in the great work of elevating these stricken members of our race, from their present unhappy and degraded condition to a higher position in the scale of created intelligence.

* * * * *

I trust I have said enough to show that the idiot ought and must be cared for; and in asking for your support, I will also ask you whether anything can be more gratifying than, as the result of scientific treatment, to see the idiot standing erect, asserting his birthright, and claiming brotherhood with the rest of the human family.

True philanthropy never stops short of the remotest boundary of human want, and in urging upon you the claims of the Eastern Counties' Asylum for Idiots, I would have you remember that I am pleading for a class who cannot plead for themselves, and whose very silence is eloquent with an appeal for your merciful aid.

Remember that these poor stricken individuals are members of the human family. They are heirs with us of all that human beings may hope for from the hands of a common Father. They possess the rudiments of all human attributes, especially the distinctive attribute of educability and of progressive improvement; their bodies are the vehicles which carry souls never destined to perish, through the series of ages, and when the walls of the cottages of clay in which their better part has sojourned collapse, and they mingle with their kindred dust, the freed inhabitants shall wing their way to brighter regions and to a more enduring home, and will thus illustrate the beautiful sentiment of one of our modern poets, when he said:

"In death's unrobing room we strip from round us This garment of mortality and earth, And breaking from the embryo-state which bound us, Our day of dying is our day of birth."

Each person here belongs to one of two classes. Either you have one of these unhappy beings in your own immediate circle, or you have not. If you have, you can feel all the more for those who are similarly afflicted with yourselves, but have not your means for mitigating their dire distress, and you will think of the narrow home of the humble artisan or labourer, rendered intolerable by the constant presence of one of these afflicted members of our race. If, on the other hand, you have been spared this overwhelming calamity in your own family, and have had the joy of watching the dawn of infant intelligence, and have experienced the delight of seeing the capacities shown in the early life of your own children gradually ripen and develop into the intelligence of manhood, you will look with an eye of pity on the numerous households rendered miserable by the intolerable incubus of the presence in their midst of an idiot child, and will, I am sure, consider any assistance you can render to so good a cause in the light of a thank-offering.

The wear and tear of an excitable idiot child has wrecked many a family and reduced it to pauperism, for not only is such child a dead weight on the material prosperity of the family, but the hands of those who have to work for their livelihood, are sadly tied and hampered, when such an inmate has to be constantly looked after in the home; the labour by which the household is supported is often interrupted by one who can contribute nothing to the common stock, and the time which is so precious to hard-working people must, in part at all events, be occupied in caring for the one, who, if uncared for and neglected, must sink lower in the social scale and fall into a still more degraded condition. The care and treatment of the idiot, therefore, becomes a vital question of Political Economy; for by relieving a household of the burden and anxiety incident to the care of the afflicted child, the parents are enabled to devote all their energies to the support of their family. Moreover, there is often a moral aspect corresponding with the mental aspect of this question, and the presence of an idiot often becomes a source of real danger. Our able superintendent, Mr. Turner, in his interesting report for the year 1895, has illustrated the terrible anxiety caused by the presence of an idiot child in the homes of the poor, by the history of an inmate of our Asylum, who, when at home, being left to mind the baby, blacked its face all over with soot, so that when his mother returned, she might think she had a black baby. On another occasion, his little sister wanted some water, and he told her to drink out of the kettle on the fire, by which she nearly lost her life. This boy, who was evidently a type of the mischievous class of idiots, was once turned out of the Parish Church during service, for pricking another boy with a pin, so that he yelled out and disturbed the whole congregation. Two cases of murder by idiots have been recorded in a report of the Commissioners on Idiocy to the General Assembly of Connecticut; an idiot girl, being left alone with an infant, killed it by striking it on the head with a flat iron; and another vicious idiot killed a man who was working with him, by striking him on the head with a shovel. Esquirol also records the case of an idiot in the Salzburg Hospital, who killed a man by severing his head from his body with a hatchet, and then calmly seated himself by the side of the dead body.[55]

Philanthropists of the Eastern Counties of England, many of you have been long accustomed to sympathise with suffering and want; here is another outlet for your charitable efforts. The most illustrious landowner in East Anglia has recently extended his Royal patronage to this institution, especially established for the care of idiots from the four counties of Norfolk, Suffolk, Essex, and Cambridgeshire; and his Royal Consort the Princess of Wales has most graciously consented to accept the position of Patroness of the Ladies' Association, thus showing the deep interest that is felt by their Royal Highnesses in this important Eastern Counties' Charity. I ask you to follow their noble example; I ask you to come and help us in our attempts to rescue a large section of the human family from the worse than Cimmerian darkness in which they have been hitherto enshrouded; come and help us to awaken faculties hitherto dormant, to restore lost minds, to arouse these unhappy beings from a moral death to a new birth of perception and feeling; come and help us in arousing the slumbering power to utterance, and you shall hear the once silent tongue eloquent with the outgushings of a liberated spirit.

In conclusion, I wish to reiterate and to emphasise the statement, that these unfortunate members of the human family possess the tripartite nature of man--body, soul, and spirit--σωμα, ψυχη, πνευμα; they have the _germ_ of intellectual activity and of moral responsibility, and this germ, cherished and nourished by the genial warmth of human kindness, fenced round and protected from the blasts and buffetings of the world by the cords of true philanthropy, watered by the dew of human sympathy, although possibly only permitted to bud here, is destined hereafter to expand into a perfect flower, and flourish perennially in another and a better state of being.

"Eternal process moving on, From state to state the spirit walks. All these are but the shattered stalks Or ruined chrysalis of one."

FOOTNOTES:

[39] A society has lately been formed under the name of "The National Association for promoting the welfare of the Feeble-minded," the object of which is to establish homes for defective and feeble-minded children of a class more highly-endowed with intelligence than those who would be received into an ordinary idiot asylum; statistics having shown that ignorance and mental dulness tend to crime in various forms. Without expressing any very decided opinion upon the above project, it seems to me that the unnecessary multiplication of charitable institutions is itself an evil, and is not calculated to promote efficiency or economy; and if special provision is made for those just above the highest class of idiots, as is proposed, the present Idiot Asylums must necessarily suffer. Without, therefore, in any way disparaging the above scheme, I would suggest great caution in reference to it, as it is impolitic and unwise to make fresh demands upon a philanthropic public, unless the need for it is clearly established, as the result must inevitably be the diversion of funds from existing institutions already doing a good and charitable work.

[40] Maladies Mentales, Tome ii., p. 76, par E. Esquirol, médecin en chef de la maison royale des aliénés de Charenton. "Les idiots sont ce qu'ils doivent être pendant tout le cours de leur vie. On ne conçoit pas la possibilité de changer cet état. Rien ne saurait donner aux malheureux idiots, même pour quelques instants, plus de raison, plus d'intelligence."

[41] "Mentally deficient children," page 110.

[42] This painstaking observer has investigated this subject in an interesting communication on Sporadic Cretinism in the "Edinburgh Medical Journal" for May, 1893. Dr. Ireland considers Sporadic Cretinism to be a congenital or infantile form of myxœdema, and bearing in mind the increasing mental torpor which has followed the ablation of the thyroid gland performed by Kocher, and the cretinoid condition induced in monkeys by the removal of the thyroid by Horsley, he is drawn to the conclusion that this gland secretes and pours something into the blood which has a powerful effect upon the nutrition and function of the brain, and of the whole organism, and these views receive a certain amount of confirmation from the fact that in most cases of Sporadic Cretinism the thyroid gland is totally wanting. Dr. Ireland also expresses the opinion, in which I fully concur, that there is too much solidism in our pathology, and that the vital powers of the blood have been too much overlooked.

Although the effect of thyroid treatment in the idiot is still _sub judice,_ there is overwhelming testimony of its value in Myxœdema, an allied affection; and I would refer those who desire further information upon this matter to an important discussion at the Edinburgh Medico-Chirurgical Society, in February, 1893, arising out of papers read by Professor Greenfield, Dr. Byrom Bramwell, Dr. Lundie, Dr. Dunlop, and Dr. John Thomson, when important additions were made to the literature of this affection by Dr. Affleck, Dr. George Murray, and others, whose matured views will form a valuable contribution to our knowledge of this somewhat obscure subject.

[43] "Pediatrics," May, 1896, p. 460.