Part 4

Professor Luys, of Paris, 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.

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." 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.

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."

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:

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.

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

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.

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.

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

"Op cit," page 19.

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.

"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.

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.

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.

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.

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.

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.

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

This is a work of great merit, in which the author compares the structure of the brain of man with that of other primates; he then treats of the morphology of the brain in different races, in criminals, in the insane, in deaf mutes, and in microcephales. An extremely interesting chapter is that devoted to the assumed difference of the cerebral hemispheres in the two sexes, containing statistical tables constructed by Dr. Mingazzini himself and others. Although he mentions certain minor differences that have been noticed by different observers, he summarises his own opinion by the statement that, "from the numerous but incomplete observations upon this subject, it may be concluded with certainty that essential differences do not exist" (si può inferire quasi con certezza che differenze essenziali non esistono).

Further information as to brain weight and cranial capacity, will be found in the author's treatise on "Aphasia and the Localisation of Articulate Language," chapter xii. (Prize Essay of the Academy of Medicine of France.)

Op. cit., page 64.

The attention of the medical profession has lately been called to the obstetric aspect of idiocy, and I would refer those who take an interest in this subject to the valuable statistics of Dr. Langdon Down, which contain the result of his inquiries into the history of 2,000 cases of idiocy that have come under his observation; from which it would seem that primogeniture plays an important part, as no less than 24 per cent. of all the idiot children observed were primiparous. The increased difficulty of parturition seemed to be an important factor. In reference to the use of the forceps in delivery as an assigned cause of idiocy, Dr. Down says, "there is no evidence that instrumental interference has any injurious influence on the mental condition of the children, but he thinks that those who delay the use of the forceps incur a much greater risk from the prolongation of pressure, resulting in suspended animation, which condition should be especially avoided. Of Dr. Down's 2,000 cases, the ratio of males to females was 2·1 to 0·9. This was probably due to the larger size of the head giving rise to the prolonged and difficult parturition, continued pressure, and suspended animation."--Obstetrical Journal, vol. iv., p. 681.