PSYCHO-PHYSIOLOGICAL TRAINING OF IDIOTS' 
By Chas H. S. Davis, M.D., Meriden, ConnA 
[From tlie New England Medical Monthly, April, 1882.] 
IT is only within the last thirty-five years that any steps were taken - 
in this country to educate idiots and imbecile children. Before 
that period they were left to grow up a source of great anxiety and 
care, and it was thought impossible that their condition could be im- 
proved ; and nothing indicates more fully the onward progress of civ- 
ilization than the care which is given in many States to the education 
and improvement of these unfortunates, who were once condemned to 
a solitary and miserable life. 
Experience has proved conclusively that idiotic children can be edu- 
cated, treated, improved, and cured, by a course of physiological train- 
ing. It is perfectly useless to attempt to teach these cases by taxing 
their memory, or by stimulating their feeble reasoning powers. They 
must be taught through their perceptive faculties, and all success de- 
pends upon strengthening their imitative gifts, their attention and 
affection. 
La Place in his Essay on. Probabilities* says : “ If one frequently 
performs the actions which result from a particular modification of the 
internal organ, their reaction on that organ may not only increase that 
modification, but sometimes give birth to it.” This is the object of 
the physiological training. By means of passive exercises, the pupil 
is lead in time to exert himself, perhaps unconsciously to continue 
them. The wdiole sum of human culture consists in observing sensa- 
tions and drawing inferences from them. In the normal child there 
is a spontaneous evolution of the faculties, but in the idiot, the senses 
have to be trained before any intelligence is manifested. There may 
be a deficiency of nerVous. or muscular power, or stupidity and inca- 
pacity to direct the complicated machinery of the human body. The 
nerves of the human body enable the mind to translate the impressions 
of the world into facts of consciousness and thought. 
In the treatment of idiotic children, it is absolutely necessary that 
the peripheral organs, the special senses, and the cutaneous and mus- 
cular senses must be carefully treated or educated, in order to reach 
the mind. The instruction must be given through the perceptions, 
the repetition of every task must be constant, and one thing must be 
well understood before another is attempted to be taught. This is the 
foundation of the physiological method. Persistent efforts must be 
made to diminish the torpidity and irritability, the attention must be 
developed, and some degree of ready obedience must be obtained. 
This requires great forbearance, kindness, gentleness, and persever- 
ance on the part of the teachers. 
Emily S. was nine years of age when she came under our observa- 
tion. She seemed more fully developed than the majority of idiots. 
The cranium was symmetrical. The contour of the face was regular 
and pleasing, with the exception of a large mouth. The eyes were 
dull and constantly roving about and it was impossible to fix her 
attention. She had but little control over her muscles, no matter in 
what position she was placed. If placed in a standing position she 
would remain for a long time, and if gently pushed she would move 
along by sliding her feet upon che floor. 
*Essai Philosophique sur les Probabilities, Paris, 1816, p. 227 She had no mind to use her senses any more than an infant. If food 
was placed in her mouth she would swallow it, but seemed to have no 
sense of taste. 
The digestive organs were in a very poor condition. She suffered 
alternately with diarrhoea and constipation. If any object was placed 
in her hand she would drop it. Through some defect in the nerves 
communicating between the ear and the brain, ordinary sounds failed 
to disturb her, although a loud noise made unexpectedly close to her 
ear would cause her to move her head. But she had never learned to 
interpret the sounds of the human voice into a living language. If 
she was pricked with a pin on her hands or feet, she would scream but 
wTould not move them. She very rarely shed tears. She was unable 
to speak, but when angry she would utter piercing screams. Her in- 
stincts and intelligence were far below those of an animal. She 
seemed to lead a purely vegetable life. This surely was not a very 
inviting case, but it was one of those cases in which it was necessary 
to reach and develop the mind through the medium of the senses. In 
all imbeciles there is a striking want of coordination in the muscular 
system, and our first effort was to overcome this mutiny of the muscles, 
and by a process of development we hoped to improve the nutrition 
of the central nervous ganglia themselves. 
Emily was first placed with her back to the wall, and her knees so 
that she could not bend them, then her feet were gradually drawn for- 
ward until her position became uncomfortable, when she was restored 
to a more comfortable position by pushing them back. 
This was tried again and again, until she finally to relieve herself 
began to draw back first one foot and then both feet. The next exer- 
cise was to have her walk on a spring-board until she learned to a 
certain extent to raise her feet, and then on some blocks elevated a 
few inches from the floor. It took her many days to learn to step 
from one block to another, at first with assistance and then alone. On 
the floor she would have slid her feet, but here she was obliged to step 
or else fall. She was then required to walk several feet on a narrow 
plank with head erect. These exercises occupied several weeks, but a 
great deal was accomplished. 
Emily had acquired confidence in herself but still it was necessary 
to compel her to walk, as she would not do it of her own impulse. 
The next exercise was to put her hand under control of the will. 
Emily’s hands were small, and, what is not often the case with idiots, 
soft and plump. The fingers were unable to grasp anything, and she 
could not employ her hands in any useful manner. All movements 
seemed to be from the wrist. A systematic course of exercises was 
commenced to educate the hand, and through the sense of feeling the 
brain. Says Dr. Seguin:* “We are so used to locate idiocy in the 
brain that the idea of an idiotic hand seems, at first enunciation, like 
a grammatical blunder. But we become reconciled to the idea the mo- 
ment we see the mutual dependence of the centers and the periphery, 
with a greater possibility of acting on the centers from the periphery, 
than on the periphery from the centers, at least in the period of 
growth.” 
As Emily could not grasp anything, a ball was placed in her hand, 
and they were both enclosed in the teacher’s hand. It was a long 
time before she would hold the ball until commanded to drop it. She 
was also exercised in catching a small bag of beans which were thrown 
* Psycho-Physiological Training of an Idiotic Hand. Archives of Medicine, Octobei 
1879, p. 155. a short distance. She was then put in front of an inclined ladder, her 
feet on a round, her hands on another, but it took weeks of practice 
before she would hold on without assistance. In the meantime she 
was made to observe what was round, smooth, angular, sharp, and so 
on, and that a ball would roll and that a smooth object would slide. 
The function of motion demands a distinct volition, while the sense of 
touch is automatic; this is the reason why a defective grasp is more 
common with idiots than a defective sense of touch. Emily could 
grasp the hand long before she could hold a pencil. It was necessary 
that there should be a cooperation of the sense of touch and that of 
vision, in order that the pupil might see what she wished to handle, 
and that the hand might become the conscious assistant of the eye. 
Emily was taught to watch the hands of her teacher, and her own 
hands, and a number of brightly colored sticks were placed before her 
and she was required by a great deal of patient teaching to take up 
one stick at a time of the same color as the one used by the teacher, 
and putting it into a similar position to his. But the most difficult 
matter was to teach her to speak. Some idiots who are very deficient 
in mind can often speak and sing, while others with considerable 
powers of attention and mental perception are unable to use their voice. 
The greater number of those who remain mute do not speak simply 
because they have no ideas to express. As their mental faculties im- 
prove words come; therefore it is necessary to cultivate their percep- 
tive faculties. 
Thus far all of Emily’s instruction had been by imitation ; no words 
had been used. These oft repeated experiments had slowly improved 
the sense of sight, quickened the movements, extended the range of 
perceptions, given accuracy to the understanding, and put parts of the 
body under control of the will. It was a long time before she could 
be prevailed upon to say ma and pa. After she had acquired the 
capacity of imitating a few words it did not take long for her to pro- 
nounce the vowels, but the most persistent training failed to get her 
to use words unless by imitation. In four months practice she could 
speak some twenty words distinctly. She has considerable control of 
her face, and when ordered can bring her lips together. The walk is 
easy without any swinging or shambling. When commanded she 
would raise her hands and pick up objects from the table when told to, 
but the most marked improvement was her ability to string buttons 
on a brass wire, first a large button and then a small one, and so on, 
and also to place blocks one on the top of another until four or five 
rows had been made. 
In various ways she showed that her reflective faculties had been 
considerably developed, and she has more the appearance of a back- 
ward child than of an idiot. During Emily’s treatment great atten- 
tion was given to her diet, as it was made to consist of a fair propor- 
tion of nitrogenous elements, and also rich in phosphatic and oleagi- 
nous constituents. 
The training of idiots has to be carried out in minute detail, so that 
every voluntary muscle and every congeries of muscles shall be called 
into action and trained to fulfill with rapidity the end for which they 
are designed. Teachers are apt to follow the old plan of crowding as 
much into a child’s brain as is possible in a given time, without con- 
sidering, or taking into account hereditary defects, abnormal tempera- 
ments, constitutional dullness or precocity, and such other abnormal 
conditions as prevent many children from keeping up with the more 
favored and precocious children.