Paralytic Idiocy.— In the foetus and in the infant and very young child certain accidents or diseases may cause cerebral hemorrhages, which, just as in the adult, cause in turn various kinds df paralysis. The most common are hemiplegia or paralysis of the arm and leg on one side; diplegia, or paralysis of both arras and legs; and monoplegia, or paralysis of one limb. Such an accident in life is apt to cause more or less idiocy or imbecility in add tion to the paralysis. Some of these patients also have epileptic attacks.
Epileptic Idiocy.— A rather large propor tion of feeble-minded children also have epilep tic attacks. This symptom may be associated with paralysis of various kinds, as already said, or it may not be complicated in any way with marked physical defects. It is only too likely, however, to induce a progressive mental de terioration; or, to speak more accurately for some cases, to prevent a normal brain develop ment. The epileptic child is usually feeble minded - some more, some less.
Sensorial some cases the organs of sight or hearing, or both, may be defective or undeveloped, and the child's brain does not develop normally, merely because it is deprived of these important avenues of sensation. Such children may have more brain capacity than at first appears, and they can be educated. In some cases, however, as in some deaf-mutes, the mental faculties remain more or less unde veloped.
Genetous Idiocy.— Ireland, a well-known authority, proposes this term for a certain class of congenital idiots, but it is not very distinc tive. It includes feeble-minded children, usu ally of a rather low grade, who are born with undeveloping brains. The term really applies to many members of the other groups already ref erred to.
High and Low Grade Idiots.—These terms and intermediate ones are often applied merely to designate feeble-minded children according to the approximate degree of their lack of de velopment. While lacking in scientific pre cision, such terms denote conveniently various grades of idiocy. There are many idiots who are not microcephalic, nor hydrocephalic, nor Mongolian, nor paralytic, nor epileptic, nor in i fact to be included in any usually accepted class, and yet they are unmistakably idiots, and often of low grade. The truth is, that all classifica tions must remain unsatisfactory until we know more about the causation and pathology of the various forms. • A highly specialized form of idiocy is cretinism. This is always associated with defect in the thyroid gland; sometimes this gland is entirely absent, in others it is im mensely hypertrophied, and thus practically de stroyed. Cretinism is endemic in some coun
tries, as in and about • the Alps and Pyrenees. The cretin is both physically and mentally stunted. He is of low stature, of peculiar and characteristic physiognomy, of pale and un healthy skin,' usually beardless, sometimes sexually undeveloped, and with many defects in the skeleton and muscular system. Mentally he is usually an imbecile at least, and in some cases even quite idiotic. Cases vary very widely, however, in the degree of feeble-mind edness. In the United States cretinism is only sporadic.
Pathology.— As already indicated, idiocy is due to a wide variety of causes, and therefore its pathology also varies extensively. Among the processes found in the brains of idiots are sclerosis, atrophy, porencephalic defects, old in flammations, occluded 'and destroyed blood ves sels, distended ventricles and thickened mem branes.
In recent years the effort has been made to train and educate the feeble minded child, and to develop in it as far as possible the defective mental faculties. Train 'ing schools for these patients now exist in this country and in Europe, and the most humane and enlightened efforts are being put forth to ameliorate the condition of these unfortunates, and to render the more hopeful of them useful members of society. It is needless to say, how ever, that not much can be accomplished with feeble-minded children of low grade, and with the very lowest nothing whatever can be done. With the imbecile and demi-imbecile, however, the results obtained sometimes justify the pains and expense. For the vast majority of feeble minded children asylum treatment is desirable, even indispensable. These unfortunate patients cannot associate with healthy children, and they require a special environment. 'The prospect for cure in most cases is quite hopeless.
Cretins may be cured by the use of thyroid gland. See also INSANITY.
Bibliography.— Brush 'Idiocy and Im becility) (in Keating's 'Cyclopedia of the Dis eases of Children) Vol. IV, 1890) ; Ireland, 'Idiocy and Imbecility) (1:.:7); White and Jelliffe, 'Modern Treatment of Nervous and Mental Disease' (1913), and 'Diseases of the Nervous (3d ed., 1914) ; Seguin, 'Idiocy, and its Treatment by the Physiological Method' (1866); Tuke, 'A Dictionary of Psy chological Medicine) (1892).