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be trained to perform simple unskilled labor. If we can teach them,—the boys to become useful in the shops or in the garden and on the farm with the rake and the hoe, and the girls in the kitchen and laundry or with the needle, the brush, or the broom, — then has some degree of right development been reached. To secure such development in institutions, the school affords the best means for their moral, physical, industrial, and intellectual training. In the school, under methods properly varied, they are kept interested and occupied ; and, by making the physical and industrial parts of the training the most important, they become fitted and prepared for useful employment after the school age is past. Occupation is, then, the great remedial factor; health and usefulness, the objects sought,- the former essential to the latter. And so, in turn, “the working hand makes strong the working brain.”

5. “THE RELATIONSHIP BETWEEN THE PHYSI

CAL AND MENTAL BEING IN CONNECTION
WITH THE TRAINING OF IDIOTS.”

BY

CHARLES BERNSTEIN, M.D., OF THE ROME STATE CUSTODIAL

ASYLUM, ROME, N.Y.*

(Read Wednesday morning.)

Being confronted at the outset, as we are, by these unsettled questions : What condition in the individual of the human family constitutes feeble-mindedness, and what idiocy? And do these terms refer alone to the mental state of the individual, or do they convey the idea of an associated mental and physical state of the animal economy? And what are their characteristics ?

Now believing that these terms, or at least that idiocy, should convey the idea of an associated abnormal physical and mental state, interdependent the one on the other, and due, as says the elder Seguin, to inter-uterine nutritive disturbances; and that a definition of these conditions can on a scientific basis, at least from a medical standpoint, be more satisfactorily and definitely arrived at from a consideration of the physical and mental rather than the mental or intellectual manifestations alone, I propose the following classification of juvenile mental affections as applying to these classes, namely, idiocy, imbecility, and feeble-mindedness, and define each thus :

First. Idiocy is a conjoined and interdependent perversion, deficiency, or arrest of development of the physical and mental being dating from birth and due to congenital causes, its characteristic features being the absence of any extra-uterine period of normal development and the presentation of congenital abnormal physical manifestations.

Second. Imbecility is an arrested mental development dating

* Owing to pressing administrative duties, Dr. FitzGerald (superintendent of the Rome Asylum) who was originally selected to read a paper on “The Idiotic,” could not comply with the request of Dr. Smith, Chairman of the Department. Dr. Bernstein, his assistant, filled the gap acceptably.

from some period during childhood, with more or less physical imperfection, all due to some specific disease or traumatism, its characteristic features being the presence of a period of extrauterine normal development and the presentation of non-congenital abnormal physical manifestations. Under this class we will have three divisions, namely: arrested mental development, total or permanent; arrested mental development with primary or progressive dementia ; and arrested mental development, partial or temporary.

Third. Feeble-mindedness is a retardation of mental development, especially marked along certain lines, detected with the unfolding of the higher mental faculties or subsequently during childhood, associated with no necessarily concomitant physical imperfections, and due to no specific cause, its characteristic features being the presence of continuous normal physical development and the presentation of no abnormal physical manifestations directly resultant to and concomitant with the mental condition.

Now, as the mental manifestations of epilepsy and dementia vary in degree and even in character, so will those of idiocy, imbecility, and feeble-mindedness.

From a pedagogic standpoint this classification may be unsatisfactory, as the various classes, especially the two former, will always be associated in our institutions, and to the teacher it will convey no idea of their mental capacity or degree of intelligence ; but here let the teacher, as in our graded schools, classify for himself and establish grades for training and educational purposes, never forgetting to give even those with the least or what some might think with no mental capacity a grade in such training and educational classifications and a chance to creep to a higher.

As a working basis for what is to follow, I would further define idiocy as that condition in the individual of the human family, with all the physical characteristics of his race, in whom there is a perversion in or deficiency of development of the cerebro-spinal nervous system existing from birth, with its concomitant physical imperfections, all interdependent and resulting from inter-uterine nutritive disturbances, this being based on Seguin's definition of idiocy.

Now, having assumed that idiocy is always due to mal-nutrition, and that there are always associated mental and physical imperfections, and that they are interdependent, what is the relationship between sound physical health and their training, and how are they best treated in our institutions ?

Our answer to these questions will be based on the following physiological axioms :

First. That the mutually interdependent processes of nutrition, growth, and physiological activity of any one part of the animal economy are interdependent with the same processes in all other parts of the animal economy; and that these processes cannot be normal in any one part if they are not normal in all parts; and, if they are abnormal in any one part, they will be more or less abnormal in all parts; and

Second. That the more normal the nutrition, growth, and physiological activity of a part, the greater its capacity for training and development; and the more normal these processes are in all parts, the greater will be the capacity for training and development of the whole, and therefore the greater the capacity of any one part.

Parts, as here used, refers to parts of the body as organs and members, and to functions of the cerebro-spinal nervous system as the various physiological areas and centres; and physiological activity as expressing the special function or use of an organ or part.

And these axioms are based upon such broad physical or physiological ground as, for example, perversion of circulation, as follows: if there is abnormality of these processes of nutrition, growth, and physiological activity in a leg or arm, as a result of this diminished physiological activity there will be a resulting diminished physiological activity of certain portions of the cord and brain, and, as a result, perverted circulation, this resulting in an unequalized or perverted circulation of the whole cord and brain, and, therefore, abnormal nutrition, growth, and physiological activity of the whole cerebro-spinal axis, with its resulting constitutional disturbances, all of which results may, with nature's normal inherent recuperative powers, be tided over while the constitution is rearranging and accustoming itself to conform physiologically to this new type of normality. But, with our idiot, nature has dealt less bountifully ; in fact it would seem she had often entirely withheld this vis medicatrix natura.

Then, with our idiot, with his associated mental and physical imperfections, with their interdependence, and all due to mal-nutrition, as we improve nutrition, growth, and physiological activity in any one part and bring it to approach its perfection, both physiologically and anatomically, so will we more or less directly improve these processes in all parts; and, if we improve these

processes directly in all parts possible, these improvements, together with the indirect improvements in these processes in all other parts, will result in a marked improvement of the whole, or a decided constitutional improvement, — the direct object sought.

And, as we improve an organ by making it approach the normal in nutrition, growth, and physiological activity, we will likewise increase its capacity and inherent tendency to functionate normally.

To this the brain, the organ of the mind, will be no exception, the constitutional improvement increasing its nutrition and growth, and the mental training or work of the teacher increasing its physiological activity, all working in a co-operative manner.

In this way the capacity and inherent disposition of the brain to functionate normally will broaden under the external stimuli until the mental capacity will approach that condition in which it will be able to maintain the body in a state of healthful existence; and in return the body will maintain the brain in a state of healthy nutrition, that physiological state of automatism, or normal mutual interdependence of mind and body, necessary for the maintenance of sound physical health in the animal economy.

This course of treatment and training will result in a being more nearly that of the normal the earlier the child is placed under our care, so that his treatment and training may the longer go hand in hand, as it were, with his period of greatest physiological activity and growth, this being the period in which most physical imperfections appear or become exaggerated, whether they be the result of improper innervation, trophic disturbances, progressive nervous disease, lack of physical exercise and neglect, or, that great cause, the assumption of faulty positions, or rather the persistent assumption of one position; also the period when all perverted physiological functions become established as habits, and the child is rendered for life strong and robust or weak and emaciated, tidy or untidy, cleanly or filthy, destructive or not; and especially the period during which we should prevent the child from becoming the subject of vices, many of which are established as habits very early in life, and become the deeper rooted therefor; or, to sum it all up in one statement, the period during which we should establish in the idiot that great perfecter of physiological development, regularity of daily life.

Now this constitutional treatment, to bring about sound physical health or as nearly that condition as possible, should constitute a

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