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1. Sœurs Hospitalières.-The writer of the "Flemish Interiors" states that the Sisters at the Hospice St. Julien are Hospitalières of the order of St. Augustine, by whom, indeed, most of the hospitals in Belgium are tended. There is, perhaps, no order so varied and numerous as that of the Hospitallers; and even those who retain the name of sœurs grises are not all clothed in uniform, some wearing a habit of light grey, others of black, and others again of dark blue. Those who attend the sick in hospitals are simply called Hospitalières.

In the year 1483 statutes were drawn up for their regulation by the provincial vicar and visitor of the order. Their rule obliges them to rise at midnight, to recite matins and the "Little Office of the Blessed Virgin," and to remain in meditation and prayer until two o'clock, when they return to bed until five o'clock in summer, and six in winter. After their second rising they say prime, tierce and text, followed by mass, after which they go to their daily occupations, observing silence until dinner-time. After dinner they return to their work till three o'clock, and then say vespers, occupying themselves with their duties again till supper. When they are sent to visit the sick they always go two together, and may not separate.

2. The Asylum of Ghent is under the care of the Sœurs de la Charité de Jésus et Marie.-This order consists of 400 sisters, all in Belgium, where the entire number of their houses is twenty-four. They were founded by M. le Chamoine, Priest, about thirty-five years ago. They wear the habit of St. Bernard, and follow his rule, but to it they add the œuvres of St. Vincent de Paul, i.e., the care of the sick and needy. The dress is of white cloth, and being made long behind, is looped up when they are engaged in their active. duties; they have a white linen cap and scapular. In the hospital they wear a blue checked apron and sleeves of the same material, from the wrist to the elbow. Silence is one of their rules, and the word is painted in visible characters over the entrances to the cloisters and corridors, the refectory and work-room. Their noviciate lasts a year, after which they remain postulants for six months; when, if they take their vow, it is for life. Notwithstanding their active works and the bodily labour they go through, their rule includes contemplative exercises, and the recital of the Divine office. They rise at half-past three, and go to rest at nine, sleeping on straw. They are allowed meat except on certain

days, over and above the ordinary abstinences of the Church.

Would that we in Protestant England could point, not to four hundred, but even to forty sisters thus engaged for the love of the Lord Jesus, and without any thought of self or gain in the tending on our insane poor.

C. Lockhart Robertson.


On the Present Condition and Future Prospects of Idiot Education. By Dr. Ferdinand Kern, Superintendent of the Idiot School at Gohlis, near Leipsig. (From the Allgemeine Zeitschrift für Psychiatrie.)

The author is unable to determine to whom belongs the credit of having first attempted the education of idiot children. Saegert, of Berlin, believed that he had demonstrated scientifically the curability of idiocy in 1846. Seguin, of Paris had made known his efforts in the cause about the same period. Guggenbühl opened his institution upon the Abendberg in 1836; but Voisin in Paris had preceded him, and even Voisin was not the first labourer in the field. The Government of Saxony has been the first to found an idiot institution, at the cost of the State. The Government of Wurtemburg has given its support to the institutions of Mariaburg and Winterbach. The Government of the kingdom of Sardinia has proved its lively interest in this question by issuing in 1848 a Royal Commission to inquire into the nature and the causes of cretinism; and it has thus set an example to other Governments.

The author knows of no other Governments which have taken any steps in this matter. He distinguishes between cretinism, idiocy, and imbecility; and he defines imbecility as the psychical condition of weakness which prevents a human being, on account of its influence on his moral life, (innerhalb seiner Lebensphare,) from thinking and acting like healthy men. The question remains open, whether this condition is a normal psychical development or not. He distinguishes imbecility into acquired and congenital forms. He doubts, however, the actual correctness of the last term, since the condition may take its origin in early infancy, before the mental functions have become active. He thinks that there can be as little question of the congenitality of idiocy, (we shall use the term idiocy, as it undoubtedly corresponds to the word blödsinn.) as of congenital quickness of the intellectual functions, since there can be little doubt that the nature of the intellect is not at birth what we see it after its development; that the cultivated intellect of man is indeed a product of education, and not an original endowment. The possibility of perfect development in his psychical functions is the undoubted right of every child capable of living. But the original, free, and complete, or the arrested psychical development, above all things, depends on the normal or abnormal constitution of the brain and of the nervous system, the cause of which is to be sought for in the finer or coarser organization of the bodily organ Mistakes in the intellectual and moral education can easily introduce faise elements into the psychical formation; but the mind of the new-born

infant cannot commence its existence diseased and arrested-that would contradict its very essence. But if the actual congenitality of idiocy in the sense of a psychical arrest cannot be entertained, the question remains, when and in what manner does the mind become impeded in its development? The answer to this question is in concrete cases extremely difficult, and often impossible; for although the viable child has, from the first moment of its life to its death, been sufficiently active in shewing and developing its double nature, yet with the first breath and cry the commencing psychical development is by no means so clear as the corporeal. In early infancy one child is so like another that it is not easy to perceive a difference, unless there are actual defects or deformities in the bodily organs. We often hear the parents of idiot children declare that at first there was nothing by which they could be distinguished from other children in whom the psychical development has been normal.

No certain scale can be laid down for such children. A child surrounded by monotony, poverty, and misery, in the period of its early growth, cannot receive the due bodily care, nor will those mental impressions necessary to arouse the mental activity be experienced; and it will remain, at least to appearance, for a longer time in such an apathetic condition as can be taken neither for one of mental activity, nor yet for idiocy. On the other hand, the infant placed in advantageous circumstances, in which it has enjoyed reasonable care of its physical condition, in which the thoughtful mother has known how to make those mental impressions so useful to the child, the awaking and formation of the mental functions display themselves at a very early period; in such circumstances, an abnormal development, either in the physical or psychical condition, will be much sooner recognized.

The time of the first dentition is that at which any physical weakness is most frequently recognized. This period of life exercises, indeed, the greatest influence upon the development of the child; affording, in its purely physiological course, the conditions of so many diseased actions. Whenever plastic new formations are taking place in the organism, an hyperæmic condition is present. In the organism of children, the tendency to plastic formation is so rife, that hyperæmia proceeding from it must, to a certain point, be considered as natural. But hyperæmia is readily disturbed by injurious external influences, so that it no longer stands in relation to the physiological and anatomical constitution of the organ implicated, so much as to the economy of the organs in general. During the period of dentition, the whole organism of the child is urged to increased activity, and often into a state of excitement; but of all the organs in the child, the brain is so large, so tender, and so full of blood, that the greatest injury is inflicted upon it. Its anatomical and physiological connexion with the whole organism is so intimate, that either directly or through the influence of the reflex function, it is drawn into sympathy with every abnormal action of the body; and this the more readily in proportion to the intimacy of relation existing between it and the diseased organ. In the period of dentition, besides many other disturbances of health, hyperæmia exists near the brain, and this easily affects and draws into sympathy the brain, so little protected, and exposed through its commencing functions, to violent impressions. We see this in the change of nervous tone which takes place during the period of dentition in nearly all healthy children. If the unfavorable situation of the brain and of its extremely vascular membranes, in a natural course of dentition, is increased by any other adverse circumstances, then hyperæmia proceeds to inflammation, and exudations are the result, of which the greater or less resorption depends upon the energy of the system; this scarcely takes place, in the most fortunate cases, so completely as to leave no tendency to relapse. These events concur with congenital conditions of disease, in accordance with the degrees in which they are present, to occasion not only the disposition to disease of the brain, but scrophulous and rachitic disease, which often shew themselves, even in foetal life. The stamp of feebleness is often more or less impressed upon a child, even at birth. One child is indeed weakly, but psychical indications do not commonly develope at this early period, in consequence of any excitement of the brain dependent upon

the general health, or upon an uncertain exudation. Another child is of full habit, (vollsaftig) bearing all the marks of excellent health, but soon disturbances of nutrition (hyperæmic disturbances) in the plastic formations become apparent, in the cerebral system, in the bones, and in the glands.

In the second or third year, the whole appearance demonstrates externally the complete impress of a bodily and mental injury. The skin is flabby and pale, the muscles weak, the subcutaneous tissue devoid of fat, deformities and disproportions declare themselves, not only in the region of the head, but also in the limbs, the head is too large or pushed over to one side or another, angular, sparingly covered with weak hair, or, on account of chronic hyperemia of the galia aponeurotica, with hair bursting forth as if it were incapable of being smoothed; the sutures of the skull, from swelling of the brain or exudations, are prevented from closing; or the bone forming and firmness-giving mass is removed, at the cost of the remaining part of the osseous system, to the bones of the skull; the sutures are united at an early period, and prevent the contracting brain from developing itself normally.

We moreover observe the long and unnaturally broad expressionless countenance, the forehead full of wrinkles, the dull, often inflamed, squinting eyes, the thick projecting cartilaginous ears, often affected with offensive discharges, the thick open lips, which cannot cover the long irregularly formed teeth, the hollow bones, which are absolutely long although they are bent, and the extremities of which, are swollen at the joints, the enlarged glands, the stomach enlarged by infiltration of the mesenteric glands, or by intestinal gases.

The child gets no refreshing sleep; it either lies continually in a doze, or cries aloud; active diarrhoea alternates with long-continued constipation; incipient convulsions of the whole body increase to actual spasm; unable to bear the smallest weight, the child makes no effort to exercise itself like its more fortunate companions. External appearances leave no traces upon the excitability of its cerebral organs. No joyous rays glance from its sad eyes; no laughter animates its suffering countenance it makes no attempts at articulation, or only very incomplete ones, which correspond with its rudimentary psychical state. If we connect all these things, we have the picture of complete scrophulosis and rachitis, which, in all conditions of life, tends to increase. The development of scrophulosis and rachitis, depends in its highest form and intensity, upon the original disposition to the disease, and upon circumstances favouring its development. Scrophulous and rachitic children, who are fortunate enough to enjoy a rational and devoted treatment and care, get the better of their diseased conditions, although they may have inherited the tendency to them for several generations; but where the child has been born in poverty and surrounded by wretchedness and ignorance, the malady luxuriates; and bodily and mental abnormalities are called into existence in cases in which, under more favorable circumstances, they would have lain dormant, or shewn only their milder symptoms. We cannot wonder that when children are exposed to the uninterrupted impression of injurious climatic telluric and social influences, from one generation to another, that their tendency to disease should develop itself in the highest degree, and in particular families, gnaw like a worm, at the marrow of life, and even induce the physical and psychical ruin of whole districts.

1 have been particular to state the appearances of scrophulosis and rachitis; the causes of their development and their results in bodily and mental deficiency, inasmuch as they afford the picture of cretinism, which is no other than an epidemic form of scrophulosis and rachitis occasioned by influences particularly favourable to it; the epidemic character alone distinguishing it from the malady as it commonly appears, so that cretinism has been classified as "Cretinismus sporadicus seu campestris and Cretinismus endemicus seu alpinus." The fundamental connexion of these forms of disease is recognised from their nature and from their common origin. Moreover, it is found that where cretinism is endemic scrophulosis and rachitis are observed in all degrees, from their mildest forms even to that which is recognised as cretinism, and the causes

which are influential in the production of one malady are those by which the other is specially produced; indeed, Dr. Rösch asserts that where cretins are numerous, scrophulosis and rachitis in their mildest forms have first displayed themselves, and in particular individuals have intensified into complete cretinism. The identity of cretinism and scrophulosis has not been generally recognised, although, in addition to the above reasons for its recognition, the same methods of cure and prophylaxsis are valuable in both forms of malady, viz., crossing the breed, healthy localities for residence, light, fresh air, good nourishment, intelligently directed medical care, &c. At the present time, Dr. Guggenbühl particularly insists upon distinguishing cretinism as distinct from scrophulous and rachitic degeneration, as well as from other forms of idiocy.

The grounds upon which Guggenbühl supports this distinction are that, in spite of his many journeys, he has not recognised in forms of idiocy as they are elsewhere known, the peculiar character of alpine cretinism which finds its representation in Germany, where scrophulosis and rachitis have become endemic. Moreover, the higher forms of the malady have a peculiar stamp impressed upon them by local circumstances, as in parts of the Ertz and the Hartz Mountains, in the valleys of the Rhone, the Saone, and the Werra; but the cretin of Switzerland makes altogether a different impression to that found in Saltzburg and Steyermark.

In contra-distinction to so-called congenital idiocy, cretinism is very rarely congenital. The child has often been fine and healthy at birth: yet this matters not; for if defects and deformities are not observable little is to be said of newborn infants. But if a child is not allowed to see the light for many days or weeks, or is not taken out of its filth for twenty-four hours, as is the case in most of the districts affected with cretinism, even the altogether healthy child scarcely obtains the free use of its faculties in its third and fourth year. Dr. Guggenbühl, moreover, makes this distinction between idiocy and cretinism, that the cretin awakened out of his brain slumber, immediately apprehends all the designs of God, even before he is able to conceive a mental object, for instance, that of his dinner. This kind of assertion may be properly expressed to sensitive ladies, but such puerilities are not convertible to the uses of science.

[In support of the censure implied in this sentence, the author quotes the following passage from Dr. Guggenbuhl's "Abendburg Letters," page 61: "One day, as the setting sun splendidly gilded the evening sky, this magnificent pageant attracted with its powerful might the marked attention of all the infants in the institution. Joy, astonishment, wonder, and ecstasy, seized upon all the children; and even a boy who up to this time had been shy, unsociable, inaccessible to feelings of joy or sorrow, desire and pain, and who had been dumb, suddenly cried out, The sun, the sun! The mental ice-rind was now broken; the boy from this time held intercourse by means of speech with those around him, although his power of conception was yet so contracted that he was unable to distinguish parts of the most familiar things, for instance, the fingers of the hand."]

From what has been said above, it might be assumed that endemic cretinism is not to be distinguished from idiocy caused from scrophulous and rachitic processes, except by its endemic course. But scrophulosis and rachitis are by no means the only causes of idiocy occurring at an early period. Any other injury, as pressure upon the head in natural but very prolonged parturition, malpraxis in the so-called professional help, diseases and irritations of the peripheral nerves, decided diseases, as thymic asthma, asthmatic cough, &c., can, up to the sixth or seventh year, alter the integrity of the physical development of the brain, and call forth, to a greater or less extent, disorders in its psychical development; so that, as the causes of brain disease and the degrees of mental arrest are endless, an unbroken chain is formed between the perfect state of the mind of man, even down to the beings who scarcely bear, in their psychical powers or their bodily form, the appearance of belonging to the human race; so that it is clearly impossible to bring into a general category all the individual forms and modifications. On this account, all attempts to

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