The grades of imbecility can not be clearly marked off from one another, but, roughly speaking, there are three. The lowest grade of imbeciles understands simple commands, and has a slight manual dexterity. They express themselves by signs and in monosyllables. They can not concentrate attention upon anything, nor can they be taught to read or write. Careful training can advance them so far that they may do rough, menial work, and they are industrious when directed by a present superior. They are inclined to masturbation. If they are not teased, they are quiet; if annoyed, they may become dangerous.
Imbeciles of the middle grade can converse in a narrow vocabulary, and they commonly stammer. They may be taught to read monosyllables; they can not do even the simplest sum in addition, yet they show a certain shrewdness. They are irritable and quarrelsome, inclined to lying and stealing, and they have no sense of shame. They will not do any regular work, but change from one occupation to another. They may have sexual instincts and cause trouble on that account. They are slow to understand, their memories are defective, and they are always very vain. Their belly and what they shall wear are the chief things in their lives. They are less criminal than the highest grade of imbeciles.
The third class, the high-grade imbecile, is the most important, because he is commonly a criminal. His intellect is below the average, and his will is very flabby. He learns little at school, and what he does learn is acquired slowly. He reads and writes badly and he may be able to add simple [{115}] columns of numbers, but he can not multiply or divide. Sometimes such an imbecile has a remarkable facility in getting a speaking knowledge of two or three languages, and he may learn a trade. There is a high-grade imbecile that is cunning and shrewd, but he has no will, and he is a criminal. As imbeciles approach the normal in intellect they recede from it in abnormality of will.
Autopsies on imbeciles show an infantile development of the forebrain. Imprisonment does no good in these cases. They are not taught anything in prison, not even a trade, because the labour organisations and the protected industries will not permit prison labour. They should be confined so that they will not pervert youth and propagate their kind. It is impossible to say how far a given imbecile is morally accountable for what he does, but the accountability is not full in the best cases. A neurasthenic, however, is not to be mistaken for an imbecile. A neurasthenic person may have a tender conscience, an imbecile has no conscience. In imbecility the fault is in the will, rather than in the intellect, in the middle and highest grades. Many women, especially, that are hopeless fools intellectually have strong wills, but an imbecile never has a strong will except in the sense that stubbornness is strength. Stubbornness is perverted strength.
Morphine and Cocaine Intoxication,—Morphine, an alkaloid of opium, is used very extensively as an intoxicant. Since 1890 the importation of opium into the United States has increased fourfold, although physicians are now using less opium than they formerly did.
The insomnia, worry, moral distress, which bring on the alcoholic habit in some persons, lead to morphinism in others. Some physicians, by carelessly prescribing morphine for neuralgia, migraine, dysmenorrhoea, or any pain, make their patients slaves of this drug.
The degenerative effects of morphine are not so great nor so rapid as those of alcohol. It does not shorten life so much as alcohol does, nor are the children of a person addicted to the use of the drug so liable to idiocy and imbecility. The mind is enfeebled—slowly in some cases, rapidly in others. The patient will resort to almost any means to obtain the [{116}] drug, if he is deprived of it. Authorities hold that he will lie without reason, merely for the perverse pleasure in deceiving, that he is uncertain and treacherous, with a dull conscience and morbid impulses. There are exceptions to this in cases where the drug is easily obtained by the patients. Opium and morphine diminish the sexual appetite in males, even to impotence. The bodily changes are slow but profound.
When a user of morphine has been deprived of the drug for from ten to fifteen hours, he becomes so weak he can not stand; he gets diarrhoea with cramps; he sweats, trembles, and collapses. Later, mental disturbance comes on. He grows delirious, sees insects and small animals, as the delirium tremens patient does, and his suffering is very great. It is extremely difficult, and commonly impossible, to cure the morphine disease after it has been firmly established, and a deliberate acceptance of the habit is evidently a grave vice. Where a patient has become addicted to the use of the drug, through the fault of a physician, or through ignorance, the treatment from the social point of view of such a patient is commonly cruel.
Cocaine intoxication is much worse than morphinism. It is a new excess, which was unknown before 1886. Many users of morphine can carry on business, but the cocaine habitué can not do so. He is always extremely busy doing nothing. He writes long letters which are never finished. He changes from work to work, and even his conversation wanders. His bodily weight decreases rapidly, even one-third of his whole weight may be lost within a few weeks. The skin hangs in folds and is of a dirty yellow colour, the facial appearance is that of extreme distress, and the muscles are feeble. Fainting, irregular cardiac action, sweating, and insomnia are other symptoms.
Insanity is an occasional sequence, with hallucinations, especially of hearing. Such a patient hears roaring noises and voices; his secret thoughts are shouted out, he thinks, to crowds; loud screams, shrieks of murder, and similar noises appall him. Again, he sees swarms of flies, ants, roaches, which cover him and crawl into his mouth, nostrils, [{117}] and ears. He feels bugs crawling under his skin, and he has a multitude of similar interesting experiences.