Читать книгу The Atlantic Monthly, Volume 01, No. 04, February, 1858 - Various - Страница 6

WHAT HAS BEEN AND WHAT CAN BE DONE FOR THEM

Among the numerous philanthropic movements which have characterized the nineteenth century, none, perhaps, are more deserving of praise than those which have had for their object the improvement of the cretin and the idiot, classes until recently considered as beyond the reach of curative treatment.

The traveller, whom inclination or science may have led into the Canton Valais, or Pays-de-Vaud, in Switzerland, or into the less frequented regions of Savoy, Aosta, or Styria, impressed as he may be with the beauty and grandeur of the scenery through which he passes, finds himself startled also at the frightful deformity and degradation of the inhabitants. By the roadside, basking in the sun, he beholds beings whose appearance seems such a caricature upon humanity, that he is at a loss to know whether to assign them a place among the human or the brute creation. Unable to walk,—usually deaf and dumb,—with bleared eyes, and head of disproportionate size,—brown, flabby, and leprous skin,—a huge goitre descending from the throat and resting upon the breast,—an abdomen enormously distended,—the lower limbs crooked, weak, and ill-shaped,—without the power of utterance, or thoughts to utter,—and generally incapable of seeing, not from defect of the visual organs, but from want of capacity to fix the eye upon any object,—the cretin seems beyond the reach of human sympathy or aid. In intelligence he is far below the horse, the dog, the monkey, or even the swine; the only instincts of his nature are hunger and lust, and even these are fitful and irregular.

The number of these unfortunate beings in the mountainous districts of Europe, and especially of Central and Southern Europe, is very great. In several of the Swiss cantons they form from four to five per cent of the population. In Rhenish Prussia, and in the Danubian provinces of Austria, the number is still greater; in Styria, many villages of four or five thousand inhabitants not having a single man capable of bearing arms. In Würtemberg and Bavaria, in Savoy, Sardinia, the Alpine regions of France, and the mountainous districts of Spain, the disease is very prevalent.

The causes of so fearful a degeneration of body and mind are not satisfactorily ascertained. Extreme poverty, impure air, filthiness of person and dwelling, unwholesome diet, the use of water impregnated with some of the magnesian salts, intemperance, (particularly in the use of the cheap and vile brandy of Switzerland,) and the intermarriage of near relatives and of those affected with goitre, have all been assigned, and with apparently good reason; yet there are cases which are attributable to none of these causes.

The disease is not, however, confined to Europe. It is prevalent also in China and Chinese Tartary, in Thibet, along the base of the Himalaya range in India, in Sumatra, in the vicinity of the Andes in South America, in Mexico; and sporadic cases are found along the line of the Alleghanies. It is said not to occur in Europe at a higher elevation than four thousand feet above the sea level.

The derivation of the name is involved in some mystery; most writers regarding it as a corruption of the French Chrétien, as indicative of the incapacity of these unfortunate beings to commit sin. A more probable theory, however, is that which deduces it from the Grison-Romance Cretira, "creature."

The existence of this disease has long been known; references are made to it by Pliny, as well as by some of the Roman writers in the second century of the Christian era; and in the seventeenth and eighteenth centuries its prevalence and causes were frequently discussed. Most of the writers on the subject, however, considered the case of the poor cretin as utterly hopeless; and the few who deemed a partial improvement of his health, though not of his intellect, possible, merely suggested some measures for that purpose, without making any effort to reduce them to practice. It was reserved for a young physician of Zurich, Doctor Louis Guggenbühl, whose practical benevolence was active enough to overcome any repugnance he might feel to labors in behalf of a class so degraded and apparently unpromising, to be the pioneer in an effort to improve their physical, mental, and moral condition.

It is now twenty-one years since this noble philanthropist, then just entering upon the duties of his profession, was first led by some incidents occurring during a tour in the Bernese Alps to investigate the condition of the cretin. For three years he devoted himself to the study of the disease and the method of treating it. Two years of this period were spent in the small village of Seruf, in the Canton Glarus, where he was successful in restoring several to the use of their limbs. It was at the end of this period, that, with a moral courage and devotion of which history affords but few examples, Doctor Guggenbühl resolved to dedicate his life to the elevation of the cretins from their degraded condition. Consecrating his own property to the work, he asked assistance from the Canton Bern in the purchase of land for a hospital, and received a grant of six hundred francs ($120) for the work. His investigations had satisfied him that an elevated and dry locality was desirable, and that it was only the young who could be benefited. He accordingly purchased, in 1840, a tract of about forty acres of land, comprising a portion of the hill called the Abendberg, in the Canton Bern, above Interlachen. The site of his Hospital buildings is about four thousand feet above the sea, and one or two hundred feet below the summit of the hill; it is well protected from the cold winds, and the soil is tolerably fertile.

There are few spots, even among the Alps, which can compare with the Abendberg in beauty and grandeur of scenery. Doctor Guggenbühl was led to select it as much for this reason as for its salubrity, in the belief, which his subsequent experience has fully justified, that the striking nobleness of the landscape would awaken, even in the torpid mind of the cretin, that sense of the beautiful in Nature which would materially aid in his intellectual culture.

On the southern slope of the Abendberg he erected his Hospital buildings, plain, wooden structures, without ornament, but comfortable, and well adapted to his purpose. Here he gathered about thirty cretin children, mostly under ten years of age, and began his work.

To understand fully what was to be accomplished, in order to transform the young cretin into an active, healthy child, it is necessary that we should glance at his physical and mental condition, when placed under treatment.

Cretinism seems to be a combination of two diseases, the one physical, the other mental. The physical disorder is akin to Rachitis, or rickets, while the mental is substantially idiocy. The osseous structure, deficient in the phosphate of lime, is unable to sustain the weight of the body, and the cretin is thus incapacitated for active motion; the muscles are soft and wasted; the skin dingy, cold, and unhealthy; the appetite voracious; spasmodic and convulsed action frequent; and the digestion imperfect and greatly disordered. The mind seems to exist only in a germinal state; observation, memory, thought, the power of combination, are all wanting. The external senses are so torpid, that, for months perhaps, it is in vain to address either eye or ear; nor is the sense of touch much more active. The cretin is insensible to pain or annoyance, and seems to have as little sensation as an oyster.

It was to the work of restoring these diseased and enfeebled bodies to health, and of developing these germs of intellect, that Doctor Guggenbühl addressed himself. For this purpose, pure air, enforced exercise, the use of cold, warm, and vapor baths, of spirituous lotions and frictions, a simple yet eminently nutritive diet, regular habits, and the administration of those medicinal alternatives which would give tone to the system, activity to the absorbents, and vigor to the muscles, were the remedial measures adopted. As their strength increased, they were led to practise the simpler gymnastic exercises,—running, jumping, climbing, marching, the use of the dumb-bells, etc.

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 Guggenbühl 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. Guggenbühl 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. Guggenbühl, 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. Guggenbühl 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. Guggenbühl 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. Guggenbühl. 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. Guggenbühl 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. Guggenbühl 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.6

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 Bicêtre, one of the large insane hospitals of Paris. In 1831, M. Falret attempted the same work at the Salpêtrière, 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 Bicêtre, subsequently under the charge of M. Vallée. 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.