Atlantic Monthly, Vol. 1, No. 4, February, 1858 by Various

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The body thus partially invigorated, the culture of the mind was next to
be attempted,--a far more difficult task. The first step was, to teach
the child to speak; and as this implied the ability to hear, the ear,
hitherto dead to all sounds, must be impressed. For this purpose, sound
was communicated by speaking trumpets or other instruments, which should
force and fix the attention. The lips and vocal organs were then moulded
to imitate these sounds. The process was long and wearisome, often
occupying months, and even years; but in the end it was successful.
The eye was trained by the attraction of bright and varied colors,
and little by little simple ideas were communicated to the feeble
intellect,--great care being necessary, however, to proceed very slowly,
as the cretin is easily discouraged, and when once overtasked, will make
no further attempts to learn.

It was only by gaining the love of these poor creatures that they could
be led to make any progress; and at an early stage of their training,
Doctor Guggenbuehl deemed it wise to infuse into their dawning minds the
knowledge and the love of a higher Being, to teach them something of the
power and goodness of God. The result, he assures us, has been highly
satisfactory; the mind, too feeble for earthly lore, too weak to grasp
the simplest facts of science, has yet comprehended something of the
love of the All-father, and lifted up to him its imperfect but plaintive
supplication. That the enthusiasm of this good man may have led him
to exaggerate somewhat the extent of the religious attainments of his
pupils is possible; but the experience of every teacher of the cretin or
the idiot has satisfactorily demonstrated that simple religious truths
are acquired by those who seem incapable of understanding the plainest
problems in arithmetic or the most elementary facts of science. God has
so willed it, that the mightiest intellect which strives unavailingly
to comprehend the wisdom and glory of his creation, and the feeblest
intelligence which knows only and instinctively his love, shall alike
find in that love their highest solace and delight.

The phenomena of Nature were next made the objects of instruction;
and to this the well-chosen position of the establishment largely
contributed. Sunshine and storm, the light clouds which mottled the sky
and the black heaps which foreboded the tempest, the lightning and the
rainbow, all in turn served to awaken the slumbering faculties, and to
rouse the torpid intellect to greater activity.

The next step was, to teach the cretin some knowledge of objects around
him, animate and inanimate, and of his relations to them. The exercise
of the senses followed, and gayly colored pictures were presented to the
eye, charming music to the ear, fragrant odors to the smell, and the
varieties of sweet, bitter, sour, and pungent substances to the taste.

When the perceptive faculties were thus trained, books were made to take
the place of object lessons; reading and writing were taught by long and
patient endeavor; the elements of arithmetic, of Scripture history, and
of geography were communicated; and mechanical instruction was imparted
at the same time.

Under this general routine of instruction, Dr. Guggenbuehl has conducted
his establishment for seventeen years, often with limited means, and at
times struggling with debt, from which, more than once, kind English
friends, who have visited the Hospital, or become interested in the man,
during his occasional hasty visits to Great Britain, have relieved him.
His personal appearance is thus described by a friend who was on
terms of intimacy with him; the place is at one of Lord Rosse's
_conversazioni_. "Imagine in the crowd which swept through his
Lordship's suite of rooms a small, foreign-looking man, with features of
a Grecian cast, and long, shoulder-covering, black hair; look at
that man's face; there is a gentleness, an amiability combined with
intelligence, which wins you to him. His dress is peculiar in that crowd
of white cravats and acres of cambric shirt-fronts; black,
well-worn black, is his suit; but his waistcoat is of black
satin,--double-breasted, and buttoned closely up to the throat. It is
Dr. Guggenbuehl, the mildest, the gentlest of men, but one of those calm,
reflecting minds that push on after a worthy object, undismayed by
difficulties, undeterred by ridicule or rebuff."

In his labors in behalf of the unfortunate class to whom he has devoted
himself, Dr. Guggenbuehl has been assisted very greatly by the Protestant
Sisters of Charity, who, like the Catholic sisterhood, dedicate their
lives to offices of charity and love to the sick, the unfortunate, and
the erring.

Dr. Guggenbuehl claims to have effected a perfect cure in about one third
of the cases which have been under his charge, by a treatment of from
three to six years' duration. The attainment of so large a measure of
success has been questioned by some who have visited the Hospital on the
Abendberg; and while a part of these critics were undoubtedly actuated
by a jealous and fault-finding disposition, it is not impossible that
the enthusiasm of the philanthropist may have led him to regard the
acquirements of his pupils as beyond what they really were.

A greater source of fallacy, however, is in the want of fixed standards
for estimating the comparative capacity of children affected with
cretinism, when placed under treatment, and the degree of intellectual
and physical development which constitutes a "perfect cure," in the
opinion of such men as Dr. Guggenbuehl. It is a fact, which all who have
long had charge of either cretins or idiots well understand, that a
great degree of physical deformity and disorder, a strongly marked
rachitic condition of the body, complicated even with loss of hearing
and speech, 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.
Guggenbuehl 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. Guggenbuehl 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.[A]

[Footnote A: Dr. F. Kern, Superintendent of the Idiot School at
Gohlis, near Leipzig, in an article in the _Allgemeine Zeitschrift fuer
Psychiatrie_, published the present year, (1857,) states that he
examined a boy in the Abendberg Hospital in 1853, of whom Dr. Guggenbuehl
had said, in his work _Upon the Cure of Cretinism_, published a few
months previously, that, "after the painstaking examination of Dr.
Naville, he was held to be capable of entering a training school for
teachers, in order to qualify himself for a teacher": Dr. Kern found
that he knew neither the day of the week or the mouth, nor his birthday,
nor his age.]

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
Bicetre, one of the large insane hospitals of Paris. In 1831, M. Falret
attempted the same work at the Salpetriere, 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 Bicetre, subsequently under the charge of M. Vallee. 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.

Seguin adopted an entirely different course. By a long and careful
investigation he satisfied himself as to what idiocy consisted in,
and then adopted such measures as he deemed most judicious, for the
development of the intellect, and the elevation of the social, mental,
moral, and physical character of the idiot.

In his view idiocy is only a prolonged infancy, in which the infantile
grace and intelligence having passed away, there remains only the feeble
muscular development and mental weakness of that earliest stage of
growth. He proposes to follow Nature in his processes of treatment; to
invigorate the muscles by bathing and exercise, using some compulsion,
if necessary, to effect this; to fix the attention by bright colors,
strong contrasts, military manoeuvres, etc.; to strengthen and develope
the will, the imagination, the senses, and the imitative powers, by a
great variety of exercises; and at each step, to impress the mind with
moral principles. The mere acquisition of a few facts, more or less, and
the capacity to repeat these, parrot-like, he regards as an attainment
of very little consequence; the great object should be to make the child
do his own thinking, and this once attained, he will acquire facts as he
needs them.

Dr. Seguin met with a high degree of success in the instruction of
idiotic and imbecile children, and in 1846 published a treatise on the
treatment of idiocy, which will, for years to come, be the manual of
every teacher of this unfortunate class.

While Seguin was demonstrating the truth of his theory of instruction
at Paris, Herr Saegert, a teacher of deaf mutes at Berlin, having
attempted, unsuccessfully, the instruction of a deaf and dumb idiot, was
led to inquire into the reasons of his failure. Without any knowledge of
Seguin's labors, he arrived substantially at the same conclusions,
and devoted his leisure to medical study, in order to grapple more
successfully with the problem of the instruction of idiots. In 1840 he
commenced receiving idiotic pupils, and has maintained a school for them
in Berlin up to the present time. Herr Saegert is inclined to regard
idiocy as dependent upon the condition of the brain and nervous system,
to a greater extent, perhaps, than Dr. Seguin, and to rely upon
medication to some extent; though in his writings he professes to
consider it a condition, and not a disease.

The success of the efforts of Seguin and Saegert was soon reported
in other countries, and as early as 1846 excited the attention of
philanthropists in England and the United States. Schools for the
training of idiots were established, on a small scale at first, by some
benevolent ladies, at Bath, Brighton, and Lancaster, England. In
1847, an effort was made to establish an institution in some degree
commensurate with the wants of the unfortunate class for whom it
was intended. In this movement, Dr. John Conolly, the father of the
non-restraint system in the treatment of the insane, Rev. Dr. Andrew
Reed, Rev. Edwin Sidney, and Sir S.M. Peto have distinguished themselves
by their zeal and liberality. Extensive buildings were rented at
Highgate, near London, and at Colchester, for the accommodation of
idiotic pupils, while a strenuous and successful effort was made to
obtain the necessary funds for the erection of an asylum of great size.
The Royal Institution for Idiots, completed in 1856, has between four
hundred and five hundred beds, and is already nearly or quite full.
Essex Hall, at Colchester, has also been fitted up as a permanent
establishment for their instruction, and furnishes accommodation for
some two hundred more. Two small institutions, supported by private
beneficence, have also been organized in Scotland.

The British institutions have admitted, to a very considerable extent,
a class of pupils who are not properly idiots, but only persons of
imbecile purpose, or simply awkward, and of partially developed
intellects. Some of these, who have arrived even at the age of
twenty-five or thirty years, have been greatly benefited, and, after
two or three years' instruction, have left the institution with as much
intelligence, apparently, as most of those in the same walk of life.
This result is, and should be, a matter of great gratification to the
managers; but it is hardly just to regard success in such cases as cures
of idiocy. The greater part of the admissions to the Royal Institution
are from the pauper and poor laboring classes; and the simple
substitution of wholesome and sufficient food for a meagre and
innutritious diet is alone sufficient to effect a marked change in them.
The greater part of the pupils in that institution are instructed in
some of the simpler mechanic arts, and the Reports assure us that they
have generally acquired them with facility.

There can be no question of the benevolence of attempting the
restoration to society, and to active and useful life, of these
awkward, undeveloped, and backward youth,--of educating their hitherto
undeveloped faculties, of eradicating those habits which rendered them
disagreeable, and often almost unendurable; but these youths are not
idiots, and no such analogy exists between them and idiots as would
enable us to infer with certainty the successful treatment of the latter
from the comparatively rapid development of the former.

In our own country more satisfactory data exist for determining this
point. The movement for the instruction of idiots commenced almost
simultaneously in New York and Massachusetts. The first school for
idiots in this country was commenced at Barre, Massachusetts, by Dr.
H.B. Wilbur, in July, 1848; and the Massachusetts Experimental School,
by Dr. S.G. Howe, in October of the same year. There are now in the
United States six institutions for the instruction and training of this
unfortunate class, namely: the Massachusetts School, at South Boston,
still under the general superintendence of Dr. Howe; a private
institution for idiots, imbeciles, backward and eccentric children at
Barre, under the care of Dr. George Brown, being the one originally
founded by Dr. Wilbur; the New York State Asylum for Idiots, at
Syracuse, of which Dr. Wilbur is the superintendent; a private school
for idiots and imbeciles at Haerlem, N.Y., under the care of Mr. J.B.
Richards; the Pennsylvania Training School for Idiots, at Germantown,
Penn., under the care of Dr. Parish; and an Experimental School,
recently organized, at Columbus, Ohio, under an appropriation from the
State legislature, presided over by Dr. Patterson. Of these, only the
first three have had an experience sufficiently long to offer any
reliable results from which the success of idiot instruction can be
deduced.

The solution of the question, whether the idiot can be elevated to the
standard of mediocrity, physically and intellectually, is not merely one
of interest to the psychologist, who seeks to ascertain the metes and
bounds of the mental capacity of the race; it is also of paramount
importance to the political economist, who wishes to determine the
productive force of the community, physical and intellectual; it is
of practical interest to the statesman, who seeks to know how large a
proportion of the population are necessarily dependent upon the state or
individuals for their support; it is a matter of pecuniary importance
to the tax-payer, who is naturally desirous of learning whether these
drones in the hive, who not only perform no labor themselves, but
require others to attend them, and who often, also, from their
imbecility, are made the tools and dupes of others in the commission of
crime, cannot be transformed into producers instead of consumers, and
become quiet and orderly citizens, instead of pests in the community.

The statistics of idiocy are necessarily imperfect. No United States
census or State enumeration is at all reliable; the idea of what
constitutes idiocy is so very vague, that one census-taker would report
_none_, in a district where another might find twenty. It is very seldom
the case that the friends or relatives of an idiot will admit that he
is more than a little eccentric; many of the worst cases in the
institutions for idiots were brought there by friends who protested that
they were not idiots, but only a little singular in their habits.

In Massachusetts, Connecticut, and Ohio, efforts have been made, by
correspondence with physicians and town officers, to obtain data from
which an approximate estimate might be attained. These efforts, though
not so satisfactory as could be desired, are yet sufficient to authorize
the conclusion that there are in those three States (and probably the
same figures would hold good for the rest of the Union) about one fifth
of one per cent. of the population who are idiots of low grade, and
about the same number who are of weak and imbecile intellect. This would
give us in the United States about fifty-two thousand idiots, and as
many more imbeciles. At the lowest estimate, the cost of supporting this
vast army of the unfortunate, beyond the trifling sum which a few of
them may be able to earn, is more than ten millions of dollars per
annum. Nor is this all, or even the worst feature of their case. The
greater part of them are without sense of shame, without any notions of
chastity or decency, and so weak in moral sense as to be the ready
tools and dupes of artful villains, and often themselves exhibit a
perverseness and malignity of character which render them dangerous
members of society. Their influence for evil, direct and indirect, no
man can estimate. The chaplains and other officers of our State prisons
and penitentiaries will testify that a large proportion of the inmates
of those establishments, though not idiots, are weak-minded and
imbecile; and it by no means a rare circumstance to find persons, who
should properly be under treatment as idiots, suffering the doom of the
felon.

Under these circumstances, the question, What can be done with this
unfortunate and helpless class? becomes one of great importance.

A careful examination of the institutions for their training in this
country and Europe, and an extended inquiry into their present condition
when not under instruction, have enabled us to arrive at the following
conclusions.

There is very little hope of any considerable permanent improvement of
the idiot, if not placed under training before his sixteenth year.
His habits may, indeed, be somewhat amended, and the mind temporarily
roused; but this improvement will seldom continue after he is removed
from the institution.

The existence of severe epilepsy, or other profound disease, is a
serious bar to success.

Of those not affected by epilepsy, who are brought under instruction in
childhood, from one third to one fourth may be so far improved as to
become capable of performing the ordinary duties of life with tolerable
fidelity and ability. They may acquire sufficient knowledge to be able
to read, to write, to understand the elementary facts of geography,
history, and arithmetic; they may be capable of writing a passable
letter; they may acquire a sufficient knowledge of farming, or of the
mechanic arts, to be able to work well and faithfully under appropriate
supervision; they may attain a sufficient knowledge of the government
and laws under which they live, to be qualified to exercise the
electoral franchise quite as well as many of those who do exercise it;
they may make such advances in morals, as to act with justice and honor
toward their fellow-men, and exhibit the influence of Christianity in
changing their degraded and wayward natures to purity, chastity, and
holiness.

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