Cases such as this are instances of the slightest degree of a condition which if not remedied may pass into confirmed insanity. I believe the gradations to be almost imperceptible by which the one state passes into the other; and I have known instances in which the ungovernable temper and occasional fury of the child have passed in youth into abiding insanity which rendered the patient the inmate, and I fear the permanent inmate, of a lunatic asylum.
In whatever circumstances insanity comes on in childhood, and it does sometimes, though very seldom, come on independently of any obvious exciting cause, it always assumes the character of what has been termed moral insanity, or of that condition in which the moral system rather than the mental power is chiefly disordered.
Idiocy is unquestionably of much more frequent occurrence in childhood, than any of those forms of mental or moral disorder of which I have been speaking hitherto. The term idiocy, however, is a very wide one, including conditions differing remarkably from each other both in kind and degree, while not seldom it is misapplied to cases in which there is mere backwardness of intellectual power.
Backward Children.—Enfants arriérés—as the French call them—constitute a class by no means seldom met with. They generally attain their bodily development slowly, and the development of their mind is equally tardy. They cut their teeth late, walk late, talk late, are slow in learning to wash and dress themselves, are generally dull in their perceptions, and do not lay aside the habits of infancy till far advanced in childhood. When the time comes for positive instruction, their slowness almost wears out everyone's patience; and among the poor indeed the attempt at teaching such children is at length given up in despair, and growing up in absolute ignorance, it is no wonder that they should be regarded as idiots. Still, dull as such children are, there is between them and the idiot an essential difference. The backward child, unlike the idiot, does not remain stationary; his development goes on, but more slowly than that of other children, he is behind them in the whole course of their progress, and his delay increasing every day, places at length an enormous distance between him and them—a distance which in fact becomes insurmountable.
In some of its minor degrees even, this backwardness not infrequently excites the solicitude of parents. It is sometimes observed in children who had been ill-nourished in infancy or who had been weakened by some serious or protracted illness, even though unattended by any special affection of the brain; but it is also met with independent of any special cause. The distinction, however, between such a case and one of idiocy is this, that though at four years old the child may not seem to be intellectually superior to most children at two, yet in manners, habits, and intelligence it does agree with what might be expected from the child at two; less bright perhaps, less joyous, but still presenting nothing which if it were but younger would awaken apprehension.
It is well in all cases of unusual backwardness to ascertain the condition of the sense of hearing, and of the power of speech, for I have known the existence of deafness long overlooked, and the child's dulness and inability to speak referred to intellectual deficiency; and have also observed mere difficulty of articulation, dependent partly on malformation of the mouth, lead to a similar misapprehension. In both instances I have seen this inability to keep up ready intercourse with other children cast a shadow over the mind, and the little ones in consequence be dull, suspicious, unchild-like. I have already referred to a similar result as sometimes following serious illnesses. The child will for months cease to walk, or forget to talk, if these had been but comparatively recent acquirements; or will continue dull and unequal to any mental effort for weeks or months together, and then the mind will begin to develop itself once more, though slowly, possibly so slowly as never altogether to make up for lost ground.
Idiocy.—In idiocy, however, there is much more than the mere arrest of the intellect at any period. The idiot of eight years old does not correspond in his mental development to the child at six, or four, or two; his mind is not only dwarfed but deformed; while feebleness of will is often as remarkable as mere deficiency of power of apprehension. Even in earliest infancy there is usually a something in the child idiotic from birth which marks him as different from babies of his own age. He is unable to support his head, which rolls about from side to side, almost without an effort on his part to prevent it. Next it is perceived that the child, though he can see, does not notice; that his eye does not meet his mother's with the fond look of recognition, accompanied with the dimpling smile, with which the infant, even of three months old, greets his mother. Then it is found to have no notion of grasping anything, though that is usually almost the first accomplishment of babyhood; if tossed in its nurse's arms there seems to be no spring in its limbs; and though a strange vacant smile sometimes passes over its face, yet the merry ringing laugh of infancy or joyous chuckle of irrepressible glee is not heard. As time passes on, the child shows no pleasure at being put down 'to feel its feet,' as nurses term it; if laid on the floor it probably cries, but does not attempt to turn round, nor try to crawl about as other babies do. It does not learn to stand or walk till late, and then stands awkwardly, walks with difficulty, crossing its legs immediately on assuming the erect posture, an infirmity which it often takes years to overcome. Just, too, as the idiot is slow to notice, slow in learning to grasp anything, or to stand or walk, so he is late in learning to talk, he often acquires but few words, for his ideas are few. He learns even these few with difficulty, and employs the same to express many different things; he generally articulates them indistinctly, often indeed so imperfectly as to be almost unintelligible.
In other instances the evidences of idiocy are not present at birth, or at any rate are not then noticed, but succeed to some attack of convulsions or to some illness attended with serious affection of the brain. Sometimes too there is no point in the child's history which can be laid hold on as marking the commencement of the weakening of his intellect, but as the body grows the mind remains stationary, or its powers retrocede, until by degrees the painful conviction that the child has become idiotic forces itself upon the unwilling parents. Here we have sometimes the sad spectacle of the body perfectly developed, hale and strong, but the mind obscured; the child in constant unrest, perpetually chattering, laughing without cause, destroying its clothes, or the furniture of its room, for no purpose; or sitting silent, with a weird smile upon its face, looking at its spread-out fingers, or stroking a piece of cloth for a quarter of an hour together as though the sensation yielded it a kind of pleasure. It would be almost endless to describe the various degrees of mental weakness; from the slight silliness down to the condition in which the child is, and remains all life long, below the level of the brute.
Parents as a rule are anxious to persuade themselves, and to persuade the doctor that their idiot child was once as bright and intelligent as others; and that the mind was darkened by some grave illness. We have, however, the highest authority, that of Dr. Down, for saying that as a rule which has but few exceptions idiocy from birth is more amenable to training than that which comes on afterwards, that in fact it is more hopeful to have to do with an ill-developed than with a damaged brain.
The one great question which still remains is what can the parents do for best and wisest whom the affliction has befallen of having an idiot child.