Dr. Shuttleworth records the case of an inmate of the Royal Albert Asylum, who became, under instruction, an expert joiner, and from being a very imp of mischief, grew up into a well-conducted, self-reliant youth, and ultimately emigrated to one of our colonies, and when he was last heard of, he was practising his trade in a leading city.[41]
Equally satisfactory results have been obtained in our own Asylum. A few years ago, a boy of eight was admitted into our Asylum, who was quite unmanageable at home, a terrible incubus in the household of which he formed part, and the constant subject of jeers and derisions on the part of the other juveniles of the village. After about six months' systematic training, one of the officials of the Asylum wrote to inform me that the boy had so much improved that he was afraid the Commissioners of Lunacy, at their next visit, would consider the boy no longer a fit subject for detention in the Asylum. Being on a short visit to his relatives, who reside near Norwich, he was brought to me for inspection, when I was struck with the miraculous transformation that had been effected; from a restless, destructive boy, he had been changed into a well-conducted lad, and he had actually been taught to write. At my request, he wrote very legibly his name and address, with the date, "James Smith, Colchester;" but he made a little mistake in the date, writing backwards, in the Chinese fashion—it being September 29th, he wrote "September 92nd!" This same boy was regularly employed as one of the gardeners to the institution, and has recently been discharged, and is now earning his own living as gardener in a private family. This case illustrates a peculiarity not infrequently remarked in the inmates of an idiot asylum, that is the remarkable propensity they have for imitation and shamming. This boy came to stay with his relatives in Norfolk for a few weeks, when every few days he would have an epileptic fit. When his holiday was over and he had returned to the Asylum, these fits recurred, and were, of course, reported to the medical attendant, who had a shrewd suspicion the boy was shamming. He thereupon said to the attendant: "The next time a fit comes on, I must apply a redhot iron to the soles of the feet, it will hurt him, but it will cure him." From that time the boy had no epileptic fits!
Thyroid Treatment of Idiocy.—My sketch of the treatment of Idiocy would be incomplete without an allusion to the injection or internal administration of a preparation of the thyroid gland of the sheep, a method of treatment brought into notoriety by Professors Kocher and Schiff, on the continent, and by Professor Victor Horsley, Dr. Murray, and others in this country. Numerous cases have been published claiming successful results, and the thyroid treatment has been spoken of as a cure for at least one of the forms of idiocy.
Without quite endorsing this sweeping and enthusiastic statement, there cannot be a doubt that this method opens up a hopeful vista in the treatment of idiocy; in fact, Dr. Ireland has furnished me with the particulars of a girl, aged five years, treated by thyroid juice, in whom "the improvement was so decided that it seemed an escape from idiocy into normal intelligence."[42]
A striking instance of the good results of thyroid treatment has lately occurred in the Eastern Counties' Asylum, the particulars of which have been kindly furnished to me by Mr. Kirkby, the Resident Medical Officer. Esther C., aged 19, was admitted Nov. 8th, 1894, with marked symptoms of Sporadic Cretinism. She was at once put on thyroid treatment, beginning with half a five-grain tabloid gradually increased to a tabloid once, twice, and sometimes three times a day, intermitting them for short periods. Latterly, she has been taking one tabloid a day. Under this treatment, she has gained 10 lbs. in weight, and has grown 5 inches; the features are not so coarse, the previous myxœdematous condition of the subcutaneous tissues has subsided, the outline of the features having become more defined, and the skin which was formerly dry and rough, has become soft and naturally moist, having lost a great deal of its puffiness; but the most obvious change in the patient is the disappearance of the two prominent elastic swellings (pseudo-lipomata) which formerly occupied the posterior triangle of the neck on each side. The mental condition has also improved, she takes more interest in amusements, and her voluntary movements are much more rapid. This patient is still under observation, and the results hitherto attained afford a favourable illustration of the beneficial effects of this mode of treatment.
At a meeting of the New York Academy of Medicine of March 12th, 1896, Dr. Emily Lewi reported the history of a very marked case of Cretinism in a girl, aged 13 months, who was put on thyroid treatment; improvement was noted in a week, and the child grew gradually intelligent. At this same meeting, Dr. G.M. Hammond expressed the opinion, that for thyroid treatment to be effectual, it must be begun in early life.[43]
My colleague, Dr. Burton-Fanning, has recently shown me a case of Cretinism under his care, at the Lind Infirmary for Children, in which thyroid treatment produced the most favourable results, not only of a physical, but of a psychical character. Although the child was four years old, he had not previously spoken a word, and understood nothing; but during the treatment, his expression became much less vacant, and the faculty of speech was roused into action.
Several valuable contributions have lately been made to our knowledge of the effects of thyroid feeding, more especially in the treatment of insanity, not however the less valuable as a guide to its probable benefit in idiocy. I wish more especially to allude to the researches of Dr. Lewis C. Bruce, at the Royal Asylum, Edinburgh, as reported in the "Journal of Mental Science" for January and October, 1895. There is much in the above essay that I could profitably comment upon, but I will content myself with saying that the outcome of these researches, which intimately concern the treatment of idiocy, is that Dr. Bruce has established the fact that thyroid feeding acts as a direct cerebral stimulant, which he thinks "may prove advantageous in cases where the higher cortical cells remain in an anergic condition." Dr. Bruce mentions the case of a patient who had not spoken for several months; one day, during the administration of the thyroid extract, he suddenly began to talk, and soon became quite communicative.
Whilst these pages are passing through the press, M. Auguste Voisin, Physician to La Salpêtrière, has had the courtesy to send me detailed particulars of a case of insanity in which the success of the thyroid treatment was phenomenal. The patient was a female, aged 25, and her mental derangement assumed the form of religious monomania, insomnia, and aural hallucinations; there was great emaciation, dryness of the skin, and cold extremities.[44]
No benefit having resulted from six months' treatment, including hypnotism, M. Voisin determined to try the subcutaneous injection of sterilised thyroid juice. After a few weeks of this treatment, a notable amelioration was observed; shortly afterwards all her unfavourable symptoms disappeared, and she was discharged cured.