Clinical lecture on idiocy and imbecility : delivered to students of Owens College, Manchester, (Dr. Ashby's class for diseases of children) / by G.E. Shuttleworth.

  • Shuttleworth, G. E. (George Edward), 1842-1928.
Date:
[1886]
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Licence: Public Domain Mark

Credit: Clinical lecture on idiocy and imbecility : delivered to students of Owens College, Manchester, (Dr. Ashby's class for diseases of children) / by G.E. Shuttleworth. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    cent, tliey are assigned as the cause of the imbecility. The prognosis, in these cases, is, as a rule, not very favourable ; of course, varying with the degree of brain-lesion left by the fits. Epilepsy is very freq^uently associated with idiocy ; and even here, though our rules exclude confirmed epileptics, 10 per cent, of our patients suffer from more or less frequent fits. You will recognise, in some cases, the peculiar suflused look about the eyes characteristic of epilepsy; and with regard to these I may say that the result of training is not encouraging, for with the recurrence of fits they are apt to lose the knowledge they had acquired. I show you one case in which Dr. Alexander, of Liverpool, has tied the vertebral artery with at least temporary benefit; and others who, by the long con- tinued administration of bromides, appear really to have lost the tendency to epilepsy ; but my experience is that these improving cases form but a small minority. Syphilitic cases are not so common, or, at any rate, not so com- monly recognised, in idiot asylums, as might be expected. I can show you but one case in which the history points to syphilis ; in this there are fissures about the mouth, but the teeth are not charac- teristic, though suggestive. Juvenile dementia, supervening at puberty, is probably more frequently the mental manifestation of syphilis than is original defect of intelligence; but possibly, as has been suggested—(see paper in Brain, April, 1883, by Dr. Judson Bury)—some of the cases of hydrocephalic imbecility may really be due to inherited syphilis. “Hutchinson’s teeth” are, however, very rare in idiot asylums. Postfebrile, or inflammatory cases, are those in which the mental defect has followed brain-affection, complicating the exanthe- mata, or resulting from the extension inwards of otitis. Speaking generally, the prognosis is not favourable in this class of cases, though, of course, depending upon the amount of damage which the brain has sustained. In some cases, irremediable lesion may have been left; in others, there has been merely an arrest of development from failing nutrition. With a neurotic family history, such cases may be classed as developmental; some, however, may properly be con- sidered accidental. Toxic idiocy is, in this country, chiefly associated with the ad- ministration to infants of opiates, which, under the name of “sooth- ing syrups,” are, unhappily, much in request with ignorant mothers. I show you the photograph of a lad, said to have been brought up from babyhood on porter instead of mUk. Though physically well favoured, he had evident atrophy of his nervous centres. Traumatic cases are those due to accident in early life affecting the head ; and the earliest form of such injury is pressure in parturition. This, when unduly prolonged, may give rise to the asphyxia neo- natorum, which is, no doubt, perilous to the integrity of the nervous system, giving rise to spastic rigidity and choreiform symptoms, even if it do not destroy the intelligence. Dr. Down states that, of 2,000 cases of idiocy examined by him, 20 were born with well marked symptoms of suspended animation. In 2.9 per cent, of our cases, prolonged labour, without instrumental interference, is the assigned cause ; and in 2.6 per cent, forceps-delivery is also recorded. The judicious use of instruments will, in many cases, avert the terrible consequences of too prolonged pressure. We have three or four cases in which falls on the head at the moment of birth, the labour being unexpectedly rapid, have been assigned as the cause; and many in which falls from the arms of careless nurses are blamed. Falls down steps, kicks from horses, etc., are other common causes of traumatic imbecility, the character and prognosis of which vary very consider- ably according to the severity of the accident.