The Classifications Of Idiocy

by H.B. Wilbur, An Article in the “Proceedings of the Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons.” 1877

I use the plural term classifications for two reasons. First, because idiocy, like any other general term, is susceptible of a variety of classifications; and, secondly, for the reason that I shall have occasion to speak of several modes of classification that have been suggested by others, before suggesting some inquiries as to the possibility of establishing a new one to meet certain needs that we all must feel.

Idiocy, or amentia of the older writers, may first be distinguished from dementia. The former applies to a default of mental faculties that is congenital, or manifests itself at an early age. The latter is an impairment or total loss of mental powers that have been once possessed. This occurs at a later period of life, and is always the result of diseased action of the nervous system.

The essential feature of both conditions is the absence or imperfection of normal mental faculties, without reference to the physical defect or default, or the pathological condition underlying or associated with them.

The difference or distinction between the two conditions is not one of age alone, but in other respects is a manifest one to those of us who have been accustomed to see and compare the two classes. The difference in manifestation is the result of the fact that, in the one case, the want of intelligence occurs in individuals who are undeveloped in every way, having only the germs of human faculties. There is, at the same time, an insusceptibility to development through agencies operating from without. There is an absence of normal instincts and intuitions going out for natural aliment and exercise, and the natural avenues of growth-stimulating influences from without are closed. In the other case, to one in possession of all the human faculties there comes a change, gradually or suddenly, that weakens or destroys them, — loosens the hold upon mental acquisitions, and undermines that mental constitution which has been built up upon the combined elements of observation, reason, mental discipline, and habit.

A single illustration from the range of physical education will explain my meaning. A certain degree of intelligence, of desire and volition, is necessary for an idiot child to learn to walk, where the organs of locomotion are perfect. But a much less amount of intelligence in the downward progress of dementia may leave the demented person capable of walking properly; for in the latter case a habit of the system and a facility of co-ordination of the locomotive organs make a moderate expenditure of mental impulse suffice for that particular work. The same may be said of other simple attainments, physical or mental.

Having made this prime distinction between dementia and idiocy, and remanded the former term to its proper place, namely, as a stage of insanity, and usually succeeding to certain other forms of that disease, as mania and melancholia, we may now turn our attention to distinctions or classes in the case of idiocy.

And, first, of the popular idea and classification of idiots. This we, as medical officers of institutions for the care and training of idiots, have various means of learning that I need not stop to specify. The people generally understand the fact that the range of idiocy is a wide one. Thus, at one end of the scale is seen almost the entire absence of manifestations of sensibility, of intelligence and will. At the other end of the series are to be found cases where, to a casual observation, the question may arise whether any default in these particulars exists at all.

A similar observation might be made of the cases of dementia.

The term idiot, then, however originally used, has acquired a popular meaning. From my experience, I may say that it is thus used in a generic sense, covering the whole range referred to. On the other hand, it is also used in a specific sense, and is then applied to the lower grades of idiocy, for the reason that in the formation of our ideas the type of any genus is usually made up of its most marked characteristics. There is a mental image formed of an individual thoroughly stamped with the peculiar features of the class. Applying this to the class before us, it is often said of an individual that he is, or is not, a complete idiot.

To those at the upper end of the scale, the term is commonly applied of imbecile, or weak-minded. In this country and Great Britain these two classes are recognized in this way. To the latter, also, are frequently applied the terms simple, foolish, innocent, etc.

Of course, in the popular mind, the line between these two classes is not well defined; but that is unavoidable, from the insensible gradation in the mental features of the individuals composing the whole category. This does not vitiate the merit of the classification. It meets the purpose of the popular need. The fact is recognized that there are degrees of idiocy; and contenting themselves with making two classes depending upon that distinction, people generally use the above-named terms to express their recognition of the fact.

In Dr. Ray’s work upon the medical jurisprudence of insanity, this popular classification is accepted, but the attempt is made to give it a scientific statement and bring it in accord with the current notions of mental philosophy. (I refer to the first edition of his work.)

He also quotes Hoffbauer, a German writer, who refines this classification not only by his mode of discriminating between idiocy and imbecility, but by establishing several sub-classes in each.

Esquirol, however, contents himself with the two classes of imbeciles and idiots, and describes, with characteristic felicity, the peculiar features of each. He also refers to the fact that the whole class may be divided into congenital and post-natal. This may or may not influence the mental condition of the idiot or imbecile; may or may not be a factor in the prognosis as to future development. From an impression rather than from any absolute statistics, I should say usually not.

Other well-known writers recognize the same general distinctions, and it is therefore, fair to assume that there is a natural basis for such classification in the phenomena of idiocy. It will be seen that this classification is strictly a psychological one, and so far imperfect, because it takes cognizance of only — what may be called — the external features of idiocy.

I may now refer to an attempt at classification in another direction. It is found in the work of Dr. Edward Seguin, published in Paris in 1846, on “The Moral Treatment, Hygiene, and Education of Idiots.” He turned over a new leaf in the discussion of the subject. He approached it from a new point of departure. Prior observations had been made, chiefly upon adult idiots, mingled with the mass of insane and demented in the public asylums. They were henceforth to be regarded as undeveloped or imperfectly developed human beings. Their condition was to be studied, not only independently, but in relation to others of their own age endowed with normal faculties. The new question was, Can such beings be developed by any means of training and education?

Incidental to this was a desire for another classification that should have a relation to the degree of susceptibility of training and education.

Seguin, then, laid the foundation of his classification in the assumption that the mental and moral features of idiocy were dependent upon conditions of the nervous system. He therefore proposed a classification based upon the seat or location of these underlying physical conditions or states. The remote cause or source might be physiological or pathological; the immediate cause was in abnormal conditions, either of the central nervous masses or in the nervous apparatus radiating from these centres, and which connect them with the individual’s environments.

Hoffbauer had discriminated between intensity and extensity, meaning thereby, as the first term, “the power of the mind to examine the data presented to it by the senses and therefrom to deduce correct judgments;” and for the second, “the mind perceives and embraces these data and suffers none to escape.” One of these, it may be added, is the reflective the other the perceptive power.

Dr. Seguin proposed to inquire and classify upon the underlying facts, namely, whether that portion of the nervous system that constitutes the mode of communication between the world of relation and the individual was affected; or that deeper or more central portion, whose function it is to receive, to feel, to consider, and to act upon the stimuli, the perceptions communicated from without.

Hence he speaks of the essential forms of idiocy:

1st. The chronic affection of the whole or a part of the central nervous masses, which is characterized as profound idiocy.

2d. A partial or total affection of the nervous apparatus, which ramifies through the tissues and presides over the life of relation, the result of which is superficial idiocy.

He also wisely discriminates upon another point. He describes, under the title of “backward children,” a class of cases where there is a retarded mental development in childhood, which may be said, briefly, to result from a mere functional torpidity of the nervous system.

Having thus laid down these essential divisions of idiocy, he then refers to the fact that all the forms of idiocy may be accompanied by various maladies, which may in their occurrence be precursory, coincident, or consecutive. He speaks of all such as accessory, but expresses the hope that others, with an accumulation of experience, may in time work out the problem of the relation or relations, if any exist, between these accessory maladies and the infirmity itself. He further adds, that it would not only be desirable to know such relations, but also quite important to class these correlated affections in the order of their importance relatively to the idiocy itself. “Idiocy and imbecility can be, let us always bear in mind, simultaneous with various particular states, like hemiplegia, paraplegia, epilepsy, etc., all special affections which the medical man should be able to diagnosticate by their symptoms, evidently distinct from the conditions of the nervous system proper to idiocy. These complications aggravate the primitive infirmity, without doubt, but it is not necessary to confound them with it.”

Boys in a Group Home 1880, Courtesy of Robert Bogdan Collection

Boys in a Group Home 1880, Courtesy of Robert Bogdan Collection

With as large an experience in the observation of idiots as perhaps any of my professional brethren, I am even now disposed to leave the subject of classification on this physiological basis where Dr. Seguin left it more than thirty years ago. I recognize, as he has recognized, two forms of physical degeneracy, one symptom of each of which is a greater or less degree of impairment of the mental faculties. I refer to cretinism as it occurs endemically as a rule, in some parts of Europe and in a few districts in this country; and also to that modified form of cretinism quite common in this country and in Great Britain, which has been called the Mongolian, or Kalmuc, type of idiocy. Under this latter class five per cent of the pupils admitted into American asylums would fall, I should judge. I am also convinced that the proportion would be still larger but for the fact that many of them die before the customary age of admission in our institutions; and the attention of physicians has not yet been called to their peculiarities.

Except in the oblique direction of their eye, I find little constant resemblance to the Mongolian race in these degenerate beings, any more than in the case of Albinos to any other race. The form of their skulls is rather incidental than racial. The hair and complexion, the skin and mucous membrane, the clumsy bodies and the shortness of the extremities, their respiration and temperature, the feeble vitality and the diseases they are subject to, all give evidence of their degeneracy. I have known but few who survived to adult life.

A recent writer, for whom I have great respect, has lately offered a classification based upon pathology, which should receive our attention. I refer to the classification of Dr. Ireland, first presented in a medical journal, and since elaborated and illustrated in his work on idiocy.

He introduces the subject by saying that, “coming to the study of idiocy after having gained some experience in medicine, I have from the beginning viewed it from the stand-point of pathology, and my idea of idiocy is compounded of the following classes, which are generalized from individual existing idiots, who resemble one another by having the same or similar diseases, as they resemble the type of idiocy by having mental deficiency along with a corporeal disease.

“1. Genetous Idiocy.
“2. Microcephalic Idiocy.
“3. Eclampsic Idiocy.
“4. Epileptic Idiocy.
“5. Hydrocephalic Idiocy.
“6. Paralytic Idiocy.
“7. Cretinism.
“8. Traumatic Idiocy.
“9. Inflammatory Idiocy.
“10. Idiocy by Deprivation.”

It should be borne in mind that the essential fact of idiocy is the mental deficiency. That the point of interest for us is the degree to which this condition can be obviated. Furthermore, it is dependent upon physical conditions, whether physiological or pathological, that are chronic or organic, — slowly produced structural changes, when pathological, — and so, as a rule, beyond the reach of remedial means. The sphere of these, when used in the treatment, is almost exclusively confined to ameliorating the accessory maladies.

The actual work of obviating the condition of idiocy is an educational one, using the term in a broad sense; and if any favorable effect is produced upon abnormal organic states, it will ordinarily be through the reflex action of properly adjusted mental exercises.

I have thus gone over hastily some of the forms of classification that have been suggested in the case of idiocy. Without venturing to propose another I open the inquiry for your consideration, whether there is not room for a supplementary one.

Taking my experience as a guide, I should say that we all have some practical tests that we use consciously or unconsciously in determining the relative degree of idiocy of any case brought to our notice, or when confronted with a new pupil. We have some basis for the decision we make as to the location of the new-comer in our scale of exercises in training and education; some reasons for the opinions we express to the friends of such pupil of the probable result of our system of management and training in each individual case. Incidentally, we notice the associated pathological conditions or complications, less from their supposed relation as causes of the idiocy, but as interfering, to a greater or less degree, with our efforts at instruction or training. The manifestations upon which we base our prognosis are more subtile -sic- than the accompanying conditions of microcephalus or paralysis, or others that form the basis of any pathological classification.

Can we not, then, by thought and consultation, give some practical order and distinctness to these data and indications, as a foundation for a tolerably clear and correct prognosis?

Finally, do we not need some effective form of description of our cases; some generally recognized tests of physical and mental condition that will show, in the first place, the starting-point in the pupil’s career, to which reference can be made from time to time to test their absolute or relative progress? Do we not need some mile-posts along in the educational path to the same end? This would be, in one sense, a form of classification, namely, in relation to the growth and development of the pupils.

Such a classification will not necessarily be an arbitrary one. There can be established, with the experience already accumulated upon the subject, a scheme of the general order of development of the mental faculties even in the case of idiots. Comprehension of language must precede the use of language. Certain sounds will precede others in articulation. Simple sentences will be used before compound sentences. Certain perceptions will lead to others. The will first acquires control over the muscular system, etc.

With such a scheme before us we should be able not only to define the position of our pupils, mentally, at the very start, but also to keep track of their progress in the intellectual way. Thus could we not only satisfy ourselves, but also record, for the benefit of others, the result of our labors.

I commend, then, to your attention the hitherto undefined and unrecorded signs and features of mental and moral condition, the peculiar habits of the different shades and grades of idiocy. I commend to your attention the question of methods of description and registration, that at our next or some future meeting we may be able to agree upon some form of classification that shall meet the need I have spoken of.

How to Cite this Article (APA Format): Wilbur, H.B. (1877). The classifications of idiocy. Proceedings from the Association of American Institutions for Idiotic and Feeble-Minded Persons. Retrieved [date accessed] from /?p=10835.

Source: Disability History Museum, http://www.disabilitymuseum.org/dhm/lib/detail.html?id=1794&page=all

 

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