PSYCHICAL SYMPTOMS.—The defect ive intelligence is the most marked char acteristic of the idiot. There may be shrewdness, or rather cunning, a reten tive memory, acuteness of the special senses, and even the mathematical faculty may be highly developed in cer tain directions, but judgment and self control are lacking. There is nearly al ways defect of articulation; indeed, articulate voice may be absent altogether, the only vocal sound the idiot can make being an inarticulate cry. The expres sion is generally placid and good-natured. He seems often to feel the necessity of guidance, and fawns upon those with whom he comes in contact. At other times, however, especially when his train ing has been neglected and he has ac quired bad habits, his expression may be come brutified. At best, the idiot is not an agreeable companion.
Self-control is often lacking. The slightest irritation causes an outbreak of rage during which he may commit violence. Sexual instincts are often ac tive. Masturbation is frequent and its constant practice still further brutifies the defective subject. The uncontrolled sexual desire may also lead to offenses against morality in both sexes. Sexual perversion is not infrequent.
There is often a perversity of charac ter, a collection of bad habits, which make the idiot or imbecile an extremely offensive companion. He will strike without provocation, spit at those who endeavor to correct him, and he seems to have an especial tendency to soil his clothing with excretal matters. It is very probable that these habits are the result of bad training, some of them being adopted as means of defense against those who use the idiot as a butt for their miscalled pleasantries,—un pleasantries would seem the better word.
The so-called "moral idiot" belongs to the same class with the other idiots. While his apparently total lack of regard for the moral law is the most prominent of his characteristics, a careful examina tion and consideration of his history will show that the essential feature of his malady is weak-mindedness.
Cretinoid idiocy differs entirely in pathology and etiology and is treated under another heading. (See INFANTILE MYXCEDEMA, volume iii.) Diagnosis.—In the absence of a history of the subject the only difficulty of diag nosis possible is with consecutive de mentia. In advanced stages of this con dition the resemblance to imbecility is sometimes great, but a short period of observation will usually show point of divergence. The malady of the chronic
dement is progressive; the symptoms of the idiot remain unchanged.
The recognition of idiocy in early life is important, but the delay in the normal development of the intellectual powers generally postpones the recognition of feeble-mindedness in children until the third or fourth year.
Prognosis.—The prognosis of idiocy and imbecility, taking into account the pathogeny of the condition, is unfavor able. There is at present no means known to medical science or art by which a brain defective in structure or organiza tion can be made perfect. But training by tactful teachers in properly equipped institutions, and in some cases of con tracted skull, surgical intervention, to permit the brain to expand, have wrought great improvement. In cretinoid cases the administration of thyroid extract has produced marked changes for the better. (See ANIMAL EXTRACTS, volume i.) Treatment.—The treatment of feeble mindedness should be primarily prophy lactic. The irrational way in which many children are brought up leads naturally to imbecility. If anatomical defects are at the base of the feeble mindedness, no method of treatment known offers any chance of improvement. In cases where premature synostosis of the skull is certainly present, there should be no hesitation to do Lan nelongue's operation of craniectomy. While the results of the operation to the present time have not been generally en couraging, there is sufficient ground for the hope that some good will result from the operation in properly-selected cases. The main reliance must be placed upon good pedagogic methods. The idiot must be taken in hand as early as prac ticable by a qualified teacher. Correct habits must be taught and their practice enforced by constant supervision. The idiot must be looked upon as an unfortu nate, and not as a pervert with criminal instincts. Endeavors must be made to lead him to correct behavior. It will be found usually much easier to lead than to drive him.
More benefit is to be anticipated from training than from operation in micro cephalus, since the condition is generally dependent on faulty intrauterine brain development rather than premature syn ostosis. G. E. Shuttlesworth (Brit. Med. Jour., Sept. 28, '95).
The mistake must not be made of ex pecting too much from training an idiot. The best qualified teacher cannot make brains. He can only utilize those he finds ready to hand.