of Massachusetts to ascertain the causes of this calamity in that State, it is stated that "out of 359 idiots, the condition of whose progenitors was ascertained, 99 were the children of inveterate drunkards;" and the report goes on to say further, "that when the parents were not actually habitual drunkards, yet amongst the idiots of the lower class, not one quarter of the parents could be considered as temperate persons. From a table drawn up by the late Dr. Kerlin, an American physician, in which the causes of the infirmity are given in 100 cases of idiotic children, I observe that in 38 of the number, intemperance on the part of the parents is traced as an accessory, main, direct, or indirect cause.
At the annual meeting of the British Medical Association, held at Cambridge, Dr. Fletcher Beach read a paper on the Intemperance of Parents as a predisposing cause of idiocy in children. In 430 patients, he was enabled to trace a history of parental intemperance in 138 cases, or 31·6 per cent.; of this number, 72 were males and 66 females."5
Other observers lay less stress upon parental intemperance as a cause of idiocy. Dr. Wilbur found that out of 365 cases in the State of Illinois, only eight cases were assigned to the abuse of drink in the parents; and Dr. Shuttleworth could trace this cause in only 16·38 per cent. of the cases observed by himself and by Dr. Fletcher Beach;6 the same writer, under the head of toxic idiocy, mentions the case of an idiot boy, who was said to have been brought up on porter instead of milk. It will therefore be seen that there exists a great difference of opinion about the influence of intemperance of the parent in the causation of idiocy; but although statistics may vary upon this point, there cannot be a doubt that the children of drunken parents inherit an unhealthy nervous system, which in many cases culminates in idiocy.
Idiocy is especially prevalent in Norway, and Ludwig Dahl, a Norwegian writer, says that to the abuse of brandy, especially in the fathers, but also in the mothers during pregnancy, may be assigned an important, perhaps the most important, influence in the production of the large number of idiots in that country.
In considering this question, we must bear in mind that intemperance is only a relative term; for in the early part of the century we read of our ancestors indulging in a bottle of port wine to each individual, without, it seems, incurring the charge of drunkenness. There cannot be a doubt, however, that the habitual use of alcohol, without being carried to the extent of actual intoxication, is calculated to cause a low and feeble condition of the body, and thus conduce to the production of idiocy in the offspring; for we may fairly assume that what too severely tries the nervous system in one generation will appear in their descendants.7 Without, therefore, exaggerating the influence of alcohol on the genesis of idiocy, I think I shall not be deviating from the path of strict scientific accuracy, if I say that over indulgence in alcoholic beverages is calculated to produce a low state of vitality, and a degeneration of nerve tissue which may culminate in the development of idiocy in subsequent generations.8
Just now that the attention of the Legislature is being prominently called to the treatment of habitual drunkards, it cannot be too widely known that their innocent offspring are but too frequently the victims of the brutish excesses of their parents, who, a few years ago, were well described by the then Secretary of State for the Home Department, when receiving a deputation on the subject, as not quite criminals nor quite lunatics, although nearly approaching both classes in many cases. The above statistics fully corroborate the pertinency of Lord Cross's remarks.
I do not allude to these facts with the view of casting any reflection upon the poor, honest, and temperate East Anglian labourer, who may be afflicted with the calamity of having an idiot child; but I merely mention them in order that they may serve as an additional caution against habits of intemperance, and may strengthen the hands of that noble band of philanthropists who are endeavouring to check the torrent of this hideous vice so prevalent in the present day.
Consanguine Marriages. There is no point connected with the causation of idiocy that has given rise to so much controversy as the marriage of near relations; formerly one of the most popular notions was that consanguineous marriages were among the most common causes of idiocy, whereas the researches of later observers have tended to modify, to a considerable extent, this sweeping assertion.
Different observers have furnished different results, as to the proportion of idiots found to be the offspring of consanguine marriages; thus Dr. Grabham's statistics give the proportion as about 2 per cent., Dr. Langdon Down's rather more than 5 per cent., and Dr. Shuttleworth's less than 5 per cent. The statistics of the Eastern Counties' Asylum, kindly supplied to me by Mr. Turner, the Resident Superintendent, show that about 6·5 per cent. were the offspring of cousins.
Of 359 cases observed by Dr. Howe, 17 were known to be the children of parents nearly related in blood. The history of these 17 families, the heads of which being blood relatives intermarried, showed that there were other causes to increase the chances of an infirm offspring, besides that of intermarriages, as most of the parents were intemperate or scrofulous; some were both the one and the other. There were born unto them 95 children, of whom 44 were idiotic, 12 others were scrofulous and puny, one was deaf, and one was a dwarf! In one family of 8 children, 5 were idiotic.9
Dr. Ireland, who has investigated this point with great minuteness, pertinently remarks that it has been the custom to collect instances of cousins who have married, and have had unhealthy children, as if this never happened to anyone else; and he adds that "the proper way to examine the question clearly, is to find what is the proportion of marriages of blood relations in a given population, and then to inquire if there be in the issue of such marriages a larger percentage of insane, idiotic, or otherwise unhealthy children."10
There cannot be a doubt that consanguinity has hitherto been considered too great a factor in the production of idiocy, and that in weighing the evidence, we must not lose sight of the fact that in many cases recorded, other factors beside intermarriage of relatives have contributed concurrently to the development of the mental defect.11
Educational Overpressure. There is one cause of idiocy which has been pointed out by Dr. Séguin, and which he says is due to the unsatisfactory social conditions under which women of the present day exist. "As soon," he says, "as women assumed the anxieties pertaining to both sexes, they gave birth to children whose like had hardly been met with thirty years ago."12
Great prominence has lately been given to this subject by an oration on "Sex in Education," by Sir James Crichton Browne, at the Medical Society of London, in which he called attention to the "growing tendency to ignore intellectual distinctions between the sexes, to assimilate the education of girls to that of boys, and to throw men and women into industrial competition in every walk of life." Elsewhere, he adds, that "to throw women into competition with men is to insure to them a largely increased liability to organic nervous disease… Woe betide the generation that springs from mothers amongst whom gross nervous degenerations abound." Sir J.C. Browne supports his views by showing that there are organic cerebral differences between men and women, and that therefore they must be educated in different ways, being destined to play different parts on the stage of human life.13
The above views of Sir J.C. Browne have not remained unchallenged, and the eminent psychologist has found uncompromising opponents in Mrs. Garrett Anderson and others, who stoutly refuse to recognise the position of the "Tacens et placens uxor" of old-time dreams. Mrs. Anderson, who, I need scarcely add, writes most temperately upon this matter, in alluding to Sir J.C. Browne's assumption of the intellectual difference between men and women, remarks, "All I would venture to say is that, if it could be proved that an average man differs from an average woman as much as Newton differed from a cretin, it
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.
