may exist, while the intellectual powers are but slightly affected; in other words, that a child may be in external appearance a cretin, and even one of low grade, yet with a higher degree of intellectual capacity than most cretins possess. On the other hand, the bodily weakness and deformity may be slight, while the mental condition is very low. In the former case, we might reasonably expect, on the successful treatment of the rachitic symptoms, a rapid intellectual development; the child would soon be able to pursue its studies in an ordinary school, and a "perfect cure" would be effected. In the latter case, though far more promising, apparently, at first, a longer course of training would be requisite, and the most strenuous efforts on the part of the teacher would not, in all probability, bring the pupil up to the level of a respectable mediocrity.
From a great number of cases, narrated in the different Reports of Dr. Guggenbühl before us, we select one as the type of a large class, in which the development of the intellect seems to have been retarded by the physical disorder, but proceeded regularly on the return of health.
"C. was four years old when she entered, with every symptom of confirmed rachitic cretinism. Her nervous system was completely out of order, so that the strongest electric shocks produced scarcely any effect on her for some months. Aromatic baths, frictions, moderate exercise, a regimen of meat and milk, were the means of restoring her. Her bones and muscles grew so strong, that, in the course of a year, she could run and jump. Her mind appeared to advance in proportion to her body, for she learned to talk in French as well as in German. The life and spirits of her age at length burst forth, and she was as gay and happy as she had before been cross and disagreeable. She was particularly open-hearted, active, kind, and cleanly. She learned to read, write, and cipher, to sew and knit, and above all she loved to sing. It is now two years since she left, and she continues quite well, and goes to school."
We think our readers will perceive that this was not a case of confirmed intellectual degradation, but only of retarded mental development, the result of diseased bodily condition. These diseases are distressing to parents and friends, and he who succeeds in restoring them to health, intelligence, and the enjoyment of life, accomplishes a great and good work; but it does not necessarily follow that the cases where the mental degeneration is as complete as the physical would as readily yield to treatment; and we are driven to the conviction that the enthusiasm and zeal of Dr. Guggenbühl have led him to exaggerate the measure of success attained in these cases of low grade, and thus to excite hopes which could never be fulfilled.6
There are four other institutions in Germany devoted wholly or in part to the treatment of cretins; they are located at Bendorf, Mariaberg, Winterbach, and Hubertsburg. There are also two in Sardinia. All together they may contain three hundred children. The success of these institutions has not been equal to that of the Abendberg, although the teachers seem to have been faithful and patient. The statistics of the latest census of the countries of Central and Southern Europe render it certain that those countries contain from seventy-five to eighty thousand cretins, and as the cretin seldom passes his thirtieth year, the number under ten years of age must exceed thirty thousand. The provision for their training is, of course, entirely inadequate to their needs.
The limited experience of the few institutions already established warrants, we think, the conclusion, that too high expectations have been raised in regard to the complete cure of cretinism; that only a small proportion (cases in which the bodily disease is the principal difficulty, and the mental deterioration slight) can be perfectly cured; but that these institutions, regarded as hospitals for the treatment and training of cretins, are in the highest degree important and beneficial; and that, under proper care and medication, the physical symptoms of the disease may be greatly diminished and in many cases entirely eradicated, and the mental condition so far improved, that the patient shall be able, under proper direction, to support himself wholly or in part by his own labor. The hideous and repulsive condition of the body can be cured; the mental deformity will yield less readily; yet in some instances this, too, may disappear, and the cretin take his place with his fellow-men.
Let us now turn our attention to another class, in whom, as a people, we have a deeper interest; for though cretinism does undoubtedly exist in the United States, yet the cases are but few; while idiocy is fearfully prevalent throughout the country.
The possibility of improving the condition of the idiot is one of those discoveries which will make the nineteenth century remarkable in the annals of the future for its philanthropic spirit. Idiots have existed in all ages, and have commonly vegetated through life in utter wretchedness and degrading filth, concealed from public view.
During the early part of the present century, a few attempts were made to instruct them; the earliest known being at the American Asylum for the Deaf and Dumb, in Hartford, in 1818. In 1824, Dr. Belhomme, of Paris, published an essay on the possibility of improving the condition of idiots; and in 1828, a few were instructed for a short time at the Bicêtre, one of the large insane hospitals of Paris. In 1831, M. Falret attempted the same work at the Salpêtrière, another of the hospitals for the insane in the same city. Neither of these efforts was continued long in existence. In 1833, Dr. Voisin, a distinguished French physiologist and phrenologist, attempted the organization of a school for idiots in Paris. In 1839, aided by Dr. Leuret, he revived the School for Idiots in the Bicêtre, subsequently under the charge of M. Vallée. The "Apostle to the Idiots," however, to use a French expression, was Dr. Edward Seguin. The friend and pupil of Itard, the celebrated surgeon and philanthropist, he had in early youth entered into the views of his master respecting the practicability of their instruction; and when, during his last illness, Itard, with a philanthropy which triumphed over the terrible pangs of disease, reminded him of the work which he had himself longed to undertake, and urged him to devote his abilities to it, the young physician accepted the sacred trust, and thenceforth consecrated his life to the work of endeavoring to elevate the helpless idiot in the scale of humanity.
Previous teachers of the imbecile had not attempted to master the philosophy of idiocy. They had gone to work at hap-hazard, striking at random, hoping somehow, they knew not exactly how, to get some ideas into the mind of the patient, and, by exciting the faculty of imitation, perhaps improve his condition. They succeeded in making him more cleanly, and in inducing him to perform certain acts and exercises, as a well-trained dog, monkey, or parrot might perform them.
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