Some Abnormal Characteristics Of Idiots And The Methods Adopted In Obviating Them (1883)
Some Abnormal Characteristics Of Idiots And The Methods Adopted In Obviating Them
by H.B. Wilbur, a Presentation at the Frankfort Meeting of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons, 1883Hervey B. Wilbur, M.D. (1820 - 1884)[View Image]
Hervey B. Wilbur, M.D. (1820 – 1884)
IT is now nearly half a century since measures have been proposed for ameliorating the condition of idiots. Within that period not a few Institutions have been established to that end. But it is not strange, for a variety of reasons, that there is even now, in the professional as well as public mind, a very limited understanding of what are the peculiar features of idiocy, the theory upon which the efforts to remedy such condition is based, or the methods pursued.
Even for us who are assembled here, who have been directly engaged in the work for longer or shorter periods, it may not be unprofitable to devote a little time to an attempt to make some definite statements on these topics. Therefore I venture to lead your thoughts in that direction.
With the brief time allotted me, I shall need to confine myself principally to outlining the conditions which determine the starting-point in the training exercises, which narrow the scope of education in the case of idiots, and which may interfere with results anticipated. Even when we are able to set in motion the springs of thought and action, it should be remembered, to prevent undue discouragement, that the imperfection to organization may prevent the natural outcome of self-originating impulses or limit the extent of their manifestations.
What is called idiocy is a mental state. This is true, no matter what our idea may be of the nature of mind. It is true, whatever may be the physiological or pathological conditions associated with it. Thus, when we speak of idiocy or imbecility, of fatuity or feeble-mindedness, we refer to grades and shades of mental states below the normal standard of human intelligence.
It is hardly necessary to say that the test of normal intelligence is not a uniform one. Allowance must be made for the surroundings of those submitted to it; in other words, for the occasions and modes of exercise of their faculties and powers. Allowance must be made for hereditary, racial, and family influences. The same is true in the case of those deprived of the use of one or more of their senses.
Nevertheless, with this definition of idiocy, we are not to ignore or undervalue underlying or associated physical conditions. These last are important factors. First, because so far as the prevention of idiocy is a subject of consideration the physical conditions are the only ones to be regarded.
Again we know that human intelligence is dependent for its development and expression upon physical organization; in other words, upon the nervous system. We assume, also, that where idiocy exists there is an underlying physical defect or default as a prime cause of the mental state so defined.
The office and mode of action of some portions of the nervous structure are well defined. Physiological and pathological observations are constantly adding to our knowledge upon these points. The correlations between the functions of the nervous system and those of the other bodily organs are also better understood.
In attempting, then, to remedy mental defects we may gain some light as to the special direction our efforts should take by the knowledge thus attained. We may have a clearer idea of how much of the special work is medical, how much is educational.
Let it be noted, then, first, that so far as the physiological and pathological conditions that induce idiocy are organic or structural defects in the nervous system and nerve tissues, they are irremediable by our arts. Abnormal form or size, relation of parts or structural elements, cannot be altered by any direct means at our command.
Exceptions may be taken to this general statement in two respects. There are a limited number of cases — thus, idiocy associated with cretinism — where medical and hygienic means will produce positively favorable changes both in organ and structure as well as nerve action; changes followed by development under the ordinary conditions of mental growth.
Again, some of these physical conditions may be modified to a limited degree by the indirect and reflex influence of mental training and exercise. The relation of body and mind, whatever our definition of either, is a reciprocal one. Nerve force as well as muscular power can only be gained by exercise. And exercise in the case of the former means mental training.
But there is another aspect of the subject. When we recall the constant molecular changes that are taking place in the brain and nervous tissue generally, — the “continual flux” of nerve elements, — we shall understand the dependence of the nervous system upon the healthful action of the nutritive organs. We shall then realize the contributory agency of remedial and hygienic means adapted to induce normal activities in these correlated organs.
To the extent, then, indicated by the preceding remarks the work of ameliorating the condition of idiots is a medical one. It is not necessary to specify the means to be adopted. There are some that are of general application; others to be adjusted to the special needs of individual cases.
It is hardly necessary to say that the idiot should be exposed to the healthful influences of light and out-door air; that his food should be nutritious and varied; that he should be forced to take regular, persistent, and fatiguing exercise, to give tone to the system, to remove local apathies, to quiet irregular or mechanical muscular movements, and to secure sleep at night. That he should receive such medical treatment as his case may at any time demand to bring his bodily organs into the best working condition possible.
We may now consider the work in its educational relations. Education for idiots, however, is based upon certain physiological considerations. We know the general anatomical arrangement of the nervous system, the brain, spinal cord, the nerves of special sensation and the nerves ramifying throughout the system, establishing relations with the outer world. These are composed of two distinct forms of nervous matter, white and gray, each having obvious and demonstrably distinctive functions. The one is simply a conducting medium, though in the direction and character of the influences transmitted, two-fold; in one direction the agent of sensation or impression, in the other of impulse or volition. We also know the double function of the gray matter; in one portion responding to stimulation from without in what is technically called reflex action, in the other the seat of sensation, intelligence, and will. These various functions of the nervous system are intimately correlated, either co-operating or counter-active. There is also a physiological order of development of these several functions of the nervous system. All this is to be borne in mind in determining the proper method of training, its special aims, and the probable results in each individual case.
As we ascend in the scale of animal life the nervous centres become more defined in their special action. The intra-cranial seat of sensation and spontaneousness becomes relatively more and more developed, till culminating in man it is much superior to all the other portions.
As a consequence we have in man certain higher attributes dominating the lower, or at least exercising an inhibitory influence over the lower. In the case of a normal child we notice two forms of manifestation of functional activity of the nervous system. The first, in order of time, seem to be inherent in the organization, acting automatically and invariably. They are the reflex and instinctive act of infancy. The second, an inborn spontaneity, gradually appearing and progressively increasing in power till it ultimately controls the organization to a certain extent and within prescribed limits.
In a paper read before the Association a year ago, I attempted to show that, in the case of idiots, instinct was not a predominating principle as had been supposed by some; that its apparent prominence in some cases as simply the result of the absence of the counteracting influence of intelligence in preventing its manifestation.
At this time I propose to call attention to the antagonism between spontaneousness and reflex, or automatic movements in a certain stage of human growth; and, at a later period, the use that spontaneousness makes of the secondarily automatic movements to attain its ends.
We may notice, first, the nature of the so-called reflex movements.
Some form of irritation or stimulus is applied to the distal end of a sensory or afferent nerve. The influence is felt, or reaches a ganglionic centre, where it is reflected back by a retraction of the limb, or some appropriate movement to escape the irritation. Though the term reflex is used because expressive of the prompt responsiveness of the resulting movement, yet the character of the movement is in no other sense a reflection of the original impulse. The effect is different in kind from the cause; it is not even invariable. It is a mere sequence. In the oft-cited experiment of PflÃ¼ger: “When a drop of acetic acid is placed on the thigh of a decapitated frog, the foot of the same side is raised, and attempts made with it to rub the part, to rid itself of the irritating substance. On the foot being amputated and the acid applied as before, the animal makes a similar attempt, but failing to reach the point of irritation with the stump, after a few moments of apparent indecision and agitation raises the other foot, and attempts with it to remove the irritant.”
Other forms of reflex movements are seen in the acts of deglutition, coughing, and sneezing. Here the purpose of the mechanism differs essentially from that in the first-named instance, though in all cases it is either for defence or protection.
The closure of an eye before an approaching body or at a sudden noise, the throwing out of the arms in the act of falling, are cited by Bastian as familiar illustrations of reflex acts. Let us examine these for a moment. There is a form of winking that is undoubtedly reflex, namely, the occasional downward passage of the upper lid over the eye to distribute the secretion and remove any irritating particles from the surface. But when the eye closes to avoid impending danger, the ingoing impression (or announcement) is not through the medium of an ordinary sensory nerve (the result of contact), but through the nerves of special sensation, of sight, or hearing. A ray of light, a wave of sound, excites the ganglionic centre to respond by closing the eye.
So, too, in throwing out the arms in the act of falling, a kind of intuitive judgment is exercised as to which direction the movements of the arms shall take. In my own opinion, both of these instances are more properly to be assigned to what Hartley called secondarily automatic movements. That is, “actions which come to be performed by habit, without will or even consciousness, though originally learned and practised with conscious interest.” For in the lowest forms of idiocy these precautionary or protective movements do not occur.
For the well-performance of these reflex movements, it is necessary that the ingoing nerve should be in a condition properly to convey the influence from without, that the ganglionic centres are ready to convert this into an appropriate impulse, and the efferent nerve fit to transmit this impulse to fulfil its purpose. In other words, the machine must be in order.
Dr. Fox has expressed the opinion, “that of congenital cases of idiocy (especially those of low type), while the physical cause is often spoken of as an arrest of development, the abnormal incompleteness is more commonly dependent either on injury to the foetus, or on some disease occurring during foetal life. The brain, then, being formed late in the order of development is more likely to suffer from any injury to or diseases of the foetus than other portions of the nervous system.” This may be true of extreme cases of incompleteness in the nervous masses, the monstrosities recorded from time to time; yet, judging by my own experience, I cannot but regard the majority of cases submitted to my care as less the result of disease or injury than of ill-nourishment of the foetus. Sometimes it is due to general weakness in the reproductive organs of either parent — sometimes due to the fact that the maternal energy is wasted in other directions; as, for example, exhaustive physical or mental labor, anxiety, or even conformity to the unnatural requirements of modern social life.
In idiots, then, of low degree we might predicate imperfection and infirmity of the general nervous system in conductive and ganglionic power. At all events, in some extreme cases of idiocy there is this defect. Let me give a few illustrations. Dr. Howe, in his report for 1850, described the case of an adult idiot, who sometimes in cramming food into his mouth caught his fingers between his teeth, and, not knowing what pained him, used to howl and bite harder and harder until he was severely hurt. It is not an infrequent circumstance to see idiots of low grade when angry, beat themselves. You have all doubtless seen cases where flies settling on the face would excite no movement of the facial muscles, no apparent sense of uneasiness. In one of my early reports I described a case where the function of deglutition was ill-performed. The eyeball could be touched without exciting the act of winking. The same girl had never walked or even sat up without support on all sides. She could not maintain her equilibrium under any circumstances, and when unsupported would always fall obedient to the law of gravitation, without moving a muscle to save herself from injury. I have in other cases tried explosions of various sorts, where neither the flash nor the noise would produce winking. The reflex movement in this case being dependent upon sight and hearing, and these special senses being inactive, the necessary stimulus to the reflex movement was wanting.
In some of the cases that have fallen under my observation the responsive movement is not distinctly purposive, but rather a vague convulsive motion of all the limbs when one is irritated. It has seemed to me that, as a rule, the lower extremities have responded more promptly to irritation than the upper.
In pulmonary affections, in our lowest class of cases, the cough is often wanting; in other words, the irritation of the mucous membrane which should produce a cough, as a reflex, fails to do so,
These are the simpler forms of reflex action requiring no very complicated nervous apparatus. I have mentioned that in extreme cases of idiocy this apparatus may be defective and the function ill-performed. Yet these movements are so essential to the sustenance of life, that idiots who have vitality enough to reach an institution-attending age will generally manifest these reflex movements, though perhaps with less than normal promptness.
On the other hand, with a certain class of cases the reflex movements are excessive, — that is, in the absence of the inhibitory influence of the intelligence and will the manifestations are more marked.
But there is a broader range of reflex action. Besides the simple illustrations already given, the human organism is made up of a multitude of mechanisms acting automatically to perform certain work. Some of these are very complicated, as is seen by late physiological experiments.
Some of these are strictly reflex, — set in motion by the application of stimuli, and then the successive processes of the mechanisms are executed. Even these are not without a degree of adaptation, as has been witnessed in the lower forms of animal life.
Others are prompted to action by instinct. Take the act of suckling the infant. The nipple is placed in the mouth of a new-born child, then a complicated series of movements takes place and continues, not till the desire for food is satisfied, for the child as yet has no desire, but till the stomach is full.
Others are set in motion by the will, guided by intelligence. The process here is equally automatic, as in the former case. For, when we rise to the plane of voluntary action, we find the will not operating directly upon the immediate agencies by which the results are accomplished. The will only sets the appropriate train of mechanism agoing.
Thus the intelligence knows nothing of the machinery of articulate sounds. The intelligence knows nothing of the individual muscles to be brought in play to preserve equilibrium in standing alone or in walking. in fact, knows nothing of the immediate agencies by which any of its desires and results are attained.
Experience in infancy and childhood teaches what direction volition should take, what mechanism is to be started to accomplish any purpose. Habit operates to increase the facility by which this is done. Habit establishes new combinations and co-ordinations where associated exercise of simpler mechanism is required.
In normal childhood inborn spontaneousness is ceaselessly active in finding out the keys, in learning to play upon this “harp of a thousand strings.”
It is to be noticed, further, that movements once instinctively performed become voluntary. In which case it is through the fact that the parts are supplied with the nerves of voluntary movement, and the change takes place when the intelligence is developed.
Take the illustration already cited, — the act of nursing. When once begun the process continues till repletion is the result. No sounds or other means of attracting the child’s attention have any effect to interrupt it. At a later period when some power of observation has been attained, and a definite appetite has been developed, the child ceases to nurse when the appetite is satiated, or when its attention is attracted otherwise.
On the other hand, movements that are at first voluntary, in time, through habitual exercise, take on the characteristics of automatic or instinctive acts.
When we rise a step higher, to the nerves of special sensation, the nervous apparatus is still more complicated, their ganglionic centres still more intimately related to the gray matter of the brain. Though the distinction of automatic and voluntary is here also quite manifest, — the former being sometimes termed sensori-motor, — yet the correlation between these two modes of action is quite intimate. The passive sense of feeling (automatic) in time becomes the active sense of touch, and tiny hands go groping about to satisfy an inborn curiosity as to form and size and parts.
From the confusion of noise that perpetually rings in the child’s ears there is evolved the manifold distinctions of sound, articulate and inarticulate. The glare of light-emitting and reflecting objects is resolved the same innate faculty into the varied and definite features of the world of sight. Through the sensory organs the function of these ingoing impressions is to excite the spontaneous activity of the senses, to awaken consciousness, and to establish relations with it and the outer world. In time, as in the case of the reflex mechanisms, the voluntary and acquired use of the senses becomes secondarily automatic. For example in the one case the eye, taught by experience, closes automatically at approaching danger; or again, in one trained in the art of fencing, under similar threatenings, is automatically only the more open and alert.
The tendency all the while is towards a subserviency of the lower functions to the higher in human life. By this acquired and secondary automatism the individual is enabled to do several things at the same time. Thus I can be reading this paper aloud, with all the necessary articulations and emphasis, each one of which required conscious direction from the will at first. I can follow the train of thought that I had when writing it, and at the same time be watching my audience to see how my thoughts impress them.
These physiological details will help us to understand some of the difficulties in the way of developing the intelligence and the capabilities of idiots, and even the reformation of their habits. They will serve to suggest the means to adopt and obviate these difficulties, as also the order to be followed in applying these means.
It is the nervous system, in part or in whole, that is primarily at fault. It may be from want of development, organic change, or even hypertrophy of the brain. It may be from undue pressure upon these organs, from defect in the relation or connection of parts; it may be from impaired condition of the nervous tissue, either in the white or gray matter. The complicated nervous mechanism that makes up the human system is not in a proper working state. The failure of functions associated with these organisms is equally varied.
Herbert Spencer remarks substantially in one of his works that the difference between the manifestation of the lowest form of reflex action and the intelligence required to calculate an eclipse is a difference of degree and not one of kind. While few psychologists would be willing to accept this statement, yet it must be admitted that human spontaneousness, or self-determination, is first set in motion, first brought into exercise in connection with influences derived from sensation. Sensation is one of the conditions necessary, so far as our observation goes, to the first manifestations of instinct as well as of intelligence. Both in their exercise are at the outset, reactive. Later comes self-originating thought, feeling and action.
In the case of our pupils, then, we meet, first, with an undeveloped or torpid nervous centre that does not respond promptly to impressions from without. And human spontaneity, as has just been stated, is reactive if not strictly reflex in its first manifestations.
In the second place, the nerves of relation are impaired in function, or defective in structure, so that the natural stimuli to the exercise of spontaneousness are not transmitted promptly and clearly.
Thirdly, there is a defect or a default in the nervous organization by which the mandates of the will are executed; in other words, in the machinery of human action and expression the normal organic co-ordination, essential to the well-doing of the commonest act of childhood, may be defective.
The first step, then, in this physiological education will be in opening communication with the torpid nervous centre. This is done by efforts to render sensation more distinct. Contrasts of heat and cold appeal to the lowest range of human sensation. They affect the whole exterior nervous apparatus. Pungent odors come next in the series of active stimuli. The marked contrasts reported by the sense of taste will serve to awaken dormant consciousness. These may be followed by the presentation of sharp distinctions of sound and sight.
When communication with the pupil is established by the means suggested, there will be usually an accompanying consciousness of the presence and the agency of the master, and later, more or less subordination to his will. In fact, he soon comes to depend measurably upon this superior will. And then, after a period of apprenticeship to a series of exercises compelling responsive action, the controlling will is withdrawn, and he is brought to the point of self-originating movements, and in time to a greater or less degree of spontaneous use of his faculties and powers.
The peculiar methods by which the machinery of self-determination is set in motion, by appeals to awakened appetites, to the instinct of self-preservation in its various forms, and to the faculty of imitation, can only be described briefly.
Every one knows that imitation performs an important part in the development of every human being. So far as any germ of this faculty is manifested in any idiot, or, as in some instances, a precocity in this respect, we are to avail ourselves of either in the work before us. Below this faculty of imitation there is an analogous attribute which seems to be organic, because it is in early life quite irresistible. It is the unconscious mimicry of the movements or expression of surrounding persons. It precedes conscious imitation and prepares the way for it. It is common certainly in some other forms of animal life, and we may therefore assume that it is the necessary outcome of certain physiological conditions. A group of children watching the feats of an acrobat or the movements of a contortionist are seen to follow the motions with sympathetic muscular action. Even an audience of self-controlled adults yields a subdued tribute to the sway of expression and action in the presence of an accomplished actor. And the effect is still greater when the impulse falls upon a class or crowd touched by the same chord of sympathy.
It is this principle that is available in a very marked degree in the whole course of training of idiots or feeble-minded children. It meets them at the very door of institution life. There are constant class movements inspired and guided by the energetic voice and action of the attendant in charge; soon habit reinforces the impulse thus given in the direction of orderly and spontaneous action.
It follows them to the school-rooms. There the will of the teacher acts vicariously, supplementing the feeble will of the single pupil through the animating power of voice and gesture, but has an increased motive power when sustained by the conjoint influence imparted by surrounding wills similarly affected. In other words, in the bracing atmosphere of associated will-force the feebler members are moved onward to a degree beyond our preconceived notions.
Hence the advantages of institution life where class training and individual instruction can be combined. When we reach a more advanced stage of this special form of education, there are other advantages of association in classes that will suggest themselves to every one familiar with teaching. In fact, some things quite desirable in the case of our pupils can only be acquired under such circumstances.
I have dwelt more at length upon this point because of my conviction of its practical importance.
In the course of my experience I have known of many cases where individual instruction in the case of idiots has been fairly tried. I have in former years suggested such a course in certain cases about whose management I had been consulted. But I am constrained to say that in almost every case the effort has proved a failure, even in the hands of intelligent and zealous teachers. The pupil seems to tire of instruction persistently aimed at him alone. The power of attention flags under its inevitable monotony. There is nothing to awaken the spirit of emulation or sympathy.
I have spoken briefly of the method of opening communication with the nervous centres, and of the use that may be made of the lower order of human attributes in our attempts to develop the higher. It remains to say a few words as to the mode of development of general will-power in our pupils.
We begin by eliciting volition with reference to a simple muscular movement, by means that vary with the peculiarities of each individual case, then in a succession of similar acts. Ultimately we can bring the pupil’s will to bear upon combined movements, requiring the coordinated exercise of a more complicated muscular apparatus. In these early lessons the pupils’ consciousness becomes more active, and some discriminative power is engendered as to the direction which their efforts should take. These efforts may be continued till a habit is formed of executing them with promptness and facility. In time discrimination and judgment will be brought in as factors in the performance of the prescribed actions.
As an illustration, take a pupil who at the outset cannot or does not hold anything in his hand, not from want of muscular power, but from an inertia of will that makes him incapable of grasping it. We have brought him by successive steps up to a point where he will catch a bean-bag, or similar object, when thrown at him, and will toss it back. By changing the weight of the bag, by varying the distance at which we stand to receive it, or the direction, he learns to modify the force and direction to have it reach us. This, that an ordinary child seems to do intuitively, can only be acquired in the case of some idiots by quite a process of training in which the successive steps have been made very gradual.
In connection with this brief notice of methods of training with the lowest grade of idiots, I might, did time permit, describe the modes by which even the lower motives of human action may be developed. But I will content myself with saying that in every case likely to be brought to an institution there are, at least, faint germs of all the human faculties that can be discovered by proper study.
Fortunately, with the average bodily and mental condition of those submitted to our care we can start on a higher plane of endeavor. And yet the physiological truths that have been presented have a practical bearing upon our entire course of instruction.
In all our institutions much stress is laid upon physical exercises. These, of course, conduce to health and strength, but that is not the main purpose. They are more strictly educational. By them are developed the power of attention and the faculty of imitation. Simple muscular movements prepare the way for more complicated ones and bring them into the sphere of secondary automatism. The steps are thence to the management and control of the vocal organs, to general dexterity and its application to various forms of useful employment. These exercises develop a power of will that may be brought to bear in mental acquisitions and the growth of intelligence, and, lastly, in proper self-control.
With this approach to the domain of ordinary elementary instruction, I may leave the topic for your further discussion.
How to Cite this Article (APA Format): Wilbur, H.B. (1883). Some abnormal characteristics of idiots and the methods adopted in obviating them. Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons. Retrieved [date accessed] from /?p=10878.
Source: Disability History Museum, http://www.disabilitymuseum.org/dhm/lib/detail.html?id=1907&page=all.