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Read at the Frankfort Meeting.

IT is now nearly half a century since measures have been proposed for ameliorating the condition of idiots. Within that period not a few Institutions have been established to that end. But it is not strange, for a variety of reasons, that there is even now, in the professional as well as public mind, a very limited understanding of what are the peculiar features of idiocy, the theory upon which the efforts to remedy such condition is based, or the methods pursued.

Even for us who are assembled here, who have been directly engaged in the work for longer or shorter periods, it may not be unprofitable to devote a little time to an attempt to make some definite statements on these topics. Therefore I venture to lead your thoughts in that direction.

With the brief time allotted me, I shall need to confine myself principally to outlining the conditions which determine the starting-point in the training exercises, which narrow the scope of education in the case of idiots, and which may interfere with results anticipated. Even when we are able to set in motion the springs of thought and action, it should be remembered, to prevent undue discouragement, that the imperfection to organization may prevent the natural outcome of self-originating impulses or limit the extent of their manifestations.

What is called idiocy is a mental state. This is true, no matter what our idea may be of the nature of mind. It is true, whatever may be the physiological or pathological conditions associated with it. Thus, when we speak of idiocy or imbecility, of fatuity or feeble-mindedness, we refer to grades and shades of mental states below the normal standard of human intelligence.

It is hardly necessary to say that the test of normal intelligence is not a uniform one. Allowance must be made for the surroundings of those submitted to it; in other words, for the occasions and modes of exercise of their faculties and powers. Allowance must be made for hereditary, racial, and family influences. The same is true in the case of those deprived of the use of one or more of their senses.

Nevertheless, with this definition of idiocy, we are not to ignore or undervalue underlying or associated physical conditions. These last are important factors. First, because so far as the prevention of idiocy is a subject of consideration the physical conditions are the only ones to be regarded.

Again we know that human intelligence is dependent for its development and expression upon physical organization; in other words, upon the nervous system. We assume, also, that where idiocy exists there is an underlying physical defect or default as a prime cause of the mental state so defined.

The office and mode of action of some portions of the nervous structure are well defined. Physiological and pathological observations are constantly adding to our knowledge upon these points. The correlations between the functions of the nervous system and those of the other bodily organs are also better understood.

In attempting, then, to remedy mental defects we may gain some light as to the special direction our efforts should take by the knowledge thus attained. We may have a clearer idea of how much of the special work is medical, how much is educational.

Let it be noted, then, first, that so far as the physiological and pathological conditions that induce idiocy are organic or structural defects in the nervous system and nerve tissues, they are irremediable by our arts. Abnormal form or size, relation of parts or structural elements, cannot be altered by any direct means at our command.

Exceptions may be taken to this general statement in two respects. There are a limited number of cases -- thus, idiocy associated with cretinism -- where medical and hygienic means will produce positively favorable changes both in organ and structure as well as nerve action; changes followed by development under the ordinary conditions of mental growth.

Again, some of these physical conditions may be modified to a limited degree by the indirect and reflex influence of mental training and exercise. The relation of body and mind, whatever our definition of either, is a reciprocal one. Nerve force as well as muscular power can only be gained by exercise. And exercise in the case of the former means mental training.

But there is another aspect of the subject. When we recall the constant molecular changes that are taking place in the brain and nervous tissue generally, -- the "continual flux" of nerve elements, -- we shall understand the dependence of the nervous system upon the healthful action of the nutritive organs. We shall then realize the contributory agency of remedial and hygienic means adapted to induce normal activities in these correlated organs.

To the extent, then, indicated by the preceding remarks the work of ameliorating the condition of idiots is a medical one. It is not necessary to specify the means to be adopted. There are some that are of general application; others to be adjusted to the special needs of individual cases.