IDIOTIC AND FEEBLE-MINDED CHILDREN REPORT OF STANDING COMMITTEE TO THE ELEVENTH NATIONAL CONFERENCE OF CHARITIES AND REFORMS, ST. LOUIS, 1884 BY ISAAC N. KERLIN, M.D., of Pennsylvania AND Hon. H. M. GREENE, of Kansas BOSTON: Press of Geo. H. Ellis, 141 Franklin Street 1884 PROVISION FOR IDIOTIC AND FEEBLE-MINDED CHILDREN. By request of the honorable President of this Conference and in response to letters received from several of its members, your Standing Committee on Provision for Idiotic and Feeble-minded Children beccfmes active ; and, on its behalf, vve present two papers, — this, and one to follow by Hon. H. M. Greene, of Kansas,— con- stituting the first formal report made to this body by your Committee. It is not strange that the claims of idiotic and feeble-minded children should have waited a hearing until your twelfth conference ; for this clientage is almost a voiceless one, hidden away often from its nearest neighborhood, shunned of companionship, and until the last census but half reported. Society moves with most alacrity — whether to repress, to save, or to aid — toward those forms of misery or those conditions of accident to which its active members are most liable. Hence, hospitals for the physically maimed, hospitals for the sick, pest-houses for the plague-ridden? and asylums for the poor and aged are the first of a series of human activities, reaching a higher evolution of unself- ishness when the idiotic-born share their measure from the store- house of human sympathy. Do not understand me to say that this Conference has been entirely oblivious to the large class of unfortunates whom we would faithfully present to you to-day. On the contrary, the lamented Hervey B. Wilbur, the American pioneer in State provision for the idiotic and feeble-minded, stood here for years, their life-long friend; while there are found in your published records short but earnest and practical calls to broader thought and better labor for them. NUMBERS AND DISTRIBUTION OF THE IDIOTIC POPULATION. The total idiotic population of the United States, reported in the census of 1880, amounts to 76,895, which is only 5,102 less than the total insane, and nearly equals the total of the blind and deaf mutes. “ During the last decade, the increase of population has been 4 30 per cent.; but the apparent increase in the defective or afflicted classes has been a little more than 155 |>er cent.”— Page 1659, Com- pendium of the Tenth Census of the United States, 1880. The ratio in returns of idiocy for 1880 shows an increase of 209 per cent, over the returns of 1870. It is not claimed by any one that these returns do more than establish an approximation to the truth. With increased care in the taking of the census, and clearer apprehension on the part of the public of what are diseased and defective conditions, the tables will more and more approach accuracy. Those of 1880 are an im- measurable gain on the tables of 1870, but are still, in the records of idiocy, insufficient by 20 or30 per centum. The term “idiot” is so repugnant that it is only the most avowed subjects fhat will be so returned by its family. Of 295 applications for admission to our institution received during 1880, 178 do not appear in the census; an omission of 60 per cent. Hence, it is idle to attempt any conclusion as to the actual increase in the ratio of new cases of this class. No one can read the sources of error as presented by Mr. Wines without being fully convinced of the great labor performed by his bureau, its conscientiousness and thoroughness. Of this great army of 76,895 idiots, there were in institutions for the feeble-minded only 2,429, or a little over 3 per cent. Supplementing the valuable returns of the census on idiocy in Pennsylvania with what we gather from our correspondence, it is safe to say that there are about 3,500 idiotic and feeble-minded children, between five and eighteen years of age, who are recognized to be such in their families and communities. 1 think this gauge of one to every twelve hundred will apply, if laid to the population of the several older States of our Union. A careful examination into the social status of idiotic and feeble- minded children, made in 1871, indicates the following as about the distribution of these 3,500 feeble-minded children in our own Com- monwealth : 717 are in families of ample ability to furnish support, either luxuriously in their own homes or in private institutions; 604 are in families of moderate circumstances,— they could not pay more than half rates as are now charged in institutions; 1,619 are in poor families, who are quite unable to pay for support away from home, yet absolutely unwilling to relieve themselves of a painful burden by casting their Children on the county; 560 are in homes of the most degraded character or at public expense in almshouses. Or, putting these estimates in percentages, 20$ per cent, need 5 never become a burden to the State; 17 per cent, more might be classed in the same favorable category; while per cent, are being maintained at the most expensive rates in the homes of their suffering families,— families deserving of a prudent, State philan- thropy, which, meeting the mechanic and the laborer half way, and without absolutely pauperizing as the almshouse does, which he pain, fully refuses, would take the heavy end of the burden, lifting to a higher and better grade the imbecile himself, emancipating groups of brighter children from the tyranny of rule prescribed in almost any home where a blighted one dwells, and releasing exhausted mothers for the untrammelled care of their households. Who can estimate the waste of energy, money, and heart in this extravagant home care of feeble-minded and idiotic children ? When told, no history of the “ annals of the poor ” is more searching and pathetic, and no defence of the doctrine of State aid to relieve the calamities of her citizens more impassioned and irresistible. DEGREES AND GRADES OF IDIOCY. Any comprehensive survey of the defective class under considera- tion must take in the infinite variety of conditions embraced under the generic term, “ idiocy.” The popular and prejudiced sentiment, springing from an inadequate knowledge of the subject or originating in an accidental and imperfect acquaintance with one of its lower and more unpromising forms, is absolutely wrong, and doing unpardon- able injustice to very many innocent and helpful creatures, whose blight should not be made more sickly by mean aversion and selfish avoidance. You must permit me a few minutes of description of these chief varieties or grades of idiocy, before proceeding to their practical consideration. It has been found convenient to group them under the following syllabus : — i Idiocv APathetic- ‘ (b) Excitable. 2. Idio-imbeciles. (a) Lower grade. 3. Imbeciles: \b) Middle grade. (c) High grade. 4. Juvenile Insanity. Groups. To aid description, imagine that you walk through a considerable range of separated buildings, allowing me to select the types of the seven or eight grades we shall encounter in as many localities. 6 Here, in a large, airy, sunny room, lying on couches or advanced to rocking-chairs, is the saddest and lowest group. You are likely to stop before its type, a helpless gelatinoid creature, ten years of age, so limp and structureless that, in the language of the nurse, “ he doubles in three like a clothes-horse, when lifted from his l>ed.” The only noise that interests him is that of a bell. The only object he ever seems to look at is his hand. He cries when he is hungry. He enjoys being held and rocked, and shows actual delight when bathed. With his great, luminous, soft, jet eyes, he reminds one of a seal. Perhaps his intelligence is rather below that of a trained seal. It is certainly not that of a babe four weeks old. He is a profound idiot, with epileptic complication. Near by is another of the same age,— mute, dwarfed, and helpless. She actuates nothing. Her only expression of common wants is a low moan or cry ; but she rewards the faithful nurse by a smile, recognizing the epithet “baby,” which has been applied to her. She sleeps well, and enjoys her bath. Kxcitable idiots are not so common as t]ie apathetic. They usually die early from exhaustion or, less happily, sink into apathetic forms; but there is a group in every large asylum of this class, taxing the ingenuity of their present care-takers, after wasting the best life of their families. The temptation for their extinction rises to the lips of the careless, forgetful how far such practice would be from all moral or judicial right, how revolting to every religious sentiment and contradictory to every logical principle. So we have them with us, although so little oF us. Annie F., the saddest type, aged eight years, mute, wild, and vicious, biting any one whom she can reach, with a nervousness in the act that suggests its irresponsibility; darting to an open window to throw herself head- long below, her glittering eyes, tensely drawn lips, and sudden pal- lors indicating the pain and commotion of her poor and worried brain. How fittingly and terribly does this disturbed life project itself from its ante-natal unrest,— an unwilling and unhappy concep- tion, for the destruction of which the mother’s stormiest passions had unceasingly but unavailingly contended! And there are a few others as sad, exciting wonder why they continue to live, and greater wonder how the home and the neighborhood tolerated for years their cries, discordant noises, and uncouthness. Advanced beyond these apathetic and excitable idiots, we find an intermediate group, the idio-imbeciies. Many have the facial ap- 7 pearance, the deformed heads, the dwarfishness of body, the narrow buccal arches, the imperfect teeth of very imperfect creatures; but there is dawning intelligence. Taken from their isolation, they feebly grasp, through their shyness and sensitiveness, for the better things about them. Expecting them to do little or nothing, the trainer is daily sustained by successes, and goes on hopefully introducing most of them to a higher grade,— that of the lowest forms of imbe- cility; and here we discover the strongest individuality, so that it is quite impossible to select a type. T. T., age twelve, will illustrate as well as any. He is a microcephalic paralytic imbecile of low grade: articulation quite imperfect; sense of sight and hearing good ; hand well formed; imitation above the grade in which he is placed ; cruel in his disposition ; showing discrimination, analysis, and candor, when he says he “ likes to wear heavy boots,—good to kick boys with.” He is the better of two similarly mal-formed and im- becile brothers now living. In this lowest plane of imbecility will be found many mutes who are yet possessed of perfect hearing, ready appreciation of language, and often dexterous finger and hand ca- pacity. Under special training in articulation and the inspiring effect of concert recitation and song, they come to the partial posses- sion of speech. They rarely become perfect in speech. As their capacity is gradually developed, they are carried forward into the higher ranks, to become our most interesting children. The idiocy or imbecility displayed by them is, as often as not, the effect of their isolation. The brighter children of the family outgrow them. They betake themselves to solitary lives and belittling occupations, until the range of their intelligence becomes very limited. They are the Kaspar Hausers of our community. Advancing into another apartment, the fifth or sixth of the series through which you must imagine yourselves to have been led, we find the middle-grade imbeciles of a congregate family. They are orderly and neat at their school tables, because, from habit training, they have become so. They are patient under the discipline of light work, many of them becoming useful drudges and domestic servants. They crowd forward into our great laundry, where, com- mencing with the folding of our table napkins, they come to dispute with one another for the use of the ironing-table or power-mangle. The tone of the place being industry, they creep out of their sloth and indolence to keep lagging steps with the crowd that carries them forward. The unfairness of applying to the highest grade, or indeed to any 8 grade of imbecile children, the word “ idiot,” in any other than its generic sense, will occur to any sympathetic and thinking person, as he steps across the threshold of the class room, or calisthenium, devoted to the higher grades of our defective children. The mental deficiency or deviation is often so slight, or the im- perfection is found in such a limited range, perhaps involving only the power to form a judgment of values, or a judgment of social proprieties, or a judgment of moral risk, or a judgment of the preva- lent wickedness outside of asylums, that it may seem strange that several of these boys and girls should be under the care of an insti- tution of this character. In this first rank are often found children who have been typical cases of idiocy from deprivation, who, under the advantages of educational influences especially adapted to the infirmity, rise to the first rank, many to become self-supporting under kindly guidance, but who, left to themselves, sink lower in their enforced isolation. SUSCEPTIBILITY TO IMPROVEMENT. This has already been favorably suggested in the description given of degrees and grades of idiocy. The wisdom and economy of their training and education are no longer a question in those communities where institutions have been established. It is now a universal admission that one of the pointings of nature is that any organized creature, from monad upward, may be modified for advancement or retrogression, for good or ill, by the environments of its early life. None so subject to this law as human beings, and no humanity more obedient to it than the idiotic or feeble-minded child. Faith, patience, and the peculiar attributes of feminine skill have been exercised on more than five thousand congenital imbeciles in the institutions of these United States, and the results are quite up to the reasonable expectations of those who, in the beginning, pro- jected this work. The Ohio institution reports that 24 to 30 per centum of its inmates become capable of self-support. The Ken- tucky institution reports about the same percentage. If we, of the Pennsylvania institution, should count the available labor of those whom we retain on our free lists because of their service, perhaps almost the same favorable showing might be made. Of those dis- charged by us, 10 per centum are reported as getting along quite well and earning their living under moderate and judicious guardian- ship. Our institutions have received almost unanimous approval 9 from parents and guardians whose children or wards have been placed with us; and, even when necessity has compelled the re- admission to almshouses of discharged cases, the testimony of county authorities is nearly always commendatory of the improved condi- tion of their waifs. They note the diminished toil in administering to them, and often acknowledge that these children trained in our institutions become valuable in the county hospitals and infirmaries. It is not in harmony with the urgent and diffusive work of this Conference for me to recite cases confirmatory of these statements; and, moreover, the report of individual successes without as lengthy rehearsal of failures excites fancies about a very practical work, which end in disappointment and hindrance to the real progress of our institutions. Suffice it here to say that, in our own family of four hundred and fifty inmates, we count the productive value of work performed by the industrial classes as equal to $400 per month (that is a saving of wage labor of $400 per month), the performers being all imbecile persons, and some quite idiotic, who, unemployed, would not only be unproductive consumers, but worse ; and as con- fidently I can state that ninety per centum of those received are sig- nally and appreciably benefited in their own personal happiness, in their habits of nicety and cleanliness, in their notions of right and wrong, in their perceptions of the relations of things, in their sensi- bilities to external influences, and in their development of normal selfhood. Our work has been blindly done for years, based on the successes of accidental and experimental activity; but modern discovery floods our labor with a new light, and our experiences come to confirm the physiologist, who finds that it is not only true that, under sensory and mental exercise, cell growth and atomic residua are induced in ah undeveloped, possibly in a defective, part of the brain, but that the lost function of the impaired centre of one side or of one part of the brain may be restored in the development of another or of the cor- responding and, until now, inoperative centre of the opposite side. This the physiologist calls the vicarious substitution of one centre by another. A recent writer in the Popular Science Monthly presents the same physiological theory in another form, and with the merit that it has been proven by direct experimentation on lower animals and by the results of disease in the human subject. In brief, it is this : The various perceptions and the various mem- ories they fix have certain defined areas, or centres, which are con- 10 nected with the external organs by insulated white nerve fibres over which the sensory impressions are carried. The perceptive and memory centres, or areas, have each an inner boundary, where re- sides a present power to discriminate and memorize. This is called the actual area, outside of which is another boundary, enclosing what is called the potential area of the same capacity. Disease may attack the actual area, or, as possibly happens with many of our feeble-minded children, this actual area may not exist; but there resides in the lobule, or potential area, a power of development under necessity and stimulating impressions. Like the unimproved outlying acres of a farm, which, upon the exhaustion of the home tract, are by tillage made to rival the original, so this outlying potential area may come to possess all the powers of perception and of fixing memory pictures of which our patient had been temporarily deprived or had the misfortune to be born without.* Seguin, the first to apply himself studiously to the training of idiotic children, pointed out more than thirty years ago a physiologi- cal education of defective brains, based on cultivating the hand, eye, and ear. It was sneered at by many as visionary; but the experi- ence of his little school in Paris and the confirmation of the great institutions of which he was the seed-planter are to-day verified by the testimony of pathology and experimental physiology. THE OBLIGATION OF SOCIETY TO ITS DEFECTIVE MEMBERS. VVe might consider helpless idiocy in its relation to organized so- ciety from two points: — 1. That of the preservation of society itself from a baneful, hindering, or disturbing element generated within itself and too often from avoidable causes. 2. The right inherently existing in a defective and irresponsible member of society to protection from the body in exact ratio to his necessities. Two modes of treatment suggest themselves when considering the supposed increase of the defective classes : — The one is a cold, uncharitable disregard of misery itself, accept- ing the evil as a necessity and as a penalty for the offence against the laws of religion or of society or of health by which it comes, its advocates looking for the self-extirpation of defective classes and families, and the “ survival of the fittest.” •“ Where and How We Remember” By M. Allen Surr, M.D., in Popular Sc tone e Monthly, September, 18S4, p. 609. 11 Another view of this serious subject confesses that the need of this age and of ages to come is paternal government rather than an ideal impersonal government,— a government wisely dealing with the wants of individual man. It recognizes that a very large portion of humanity is still in its swaddling clothes, or scarcely yet beginning to walk, requiring much help and much patience before arriving at that self-knowledge which guarantees self-care. It holds that, in our pres- ent development, government, where best for the common weal, should assume the relation, not of almoner, but of parent to its subjects: licensing here and refusing license there ; correcting an evil at one point or absolutely abating that evil at another; giving personal liberty where self-reliance proves its rightful claim, abridg- ing personal liberty where its exercise is attended with a crusade against the rights of the peaceable, whether in the spoliation of the house-breaker or house-burner, in the tyranny and brutality of the inebriate’s home, or in the corruption of the very springs of life in the prostitution of the brothel. The only satisfactory way for a physician to treat a diseased con- dition is on a clear diagnosis of his case. Until that is made, his course is likely to be doubtful and hesitating; and errors are not only possible, but probable. So, in social and governmental dealing with the defective classes, it is all-important that a right interpretation be put upon observed phenomena; for, if a mistake be made in the premises, the sequences of the relief or correction administered may be most detrimental. To illustrate what I mean, I cannot do better than to note the so-called Juke family from a point of observation which does not seem to have been hitherto taken. Max and Ada Juke rarely fail of an introduction in these Conferences, and always, it seems to me, under a cloud of- prejudice, that may bias judgment as to true conditions. Any close study of this unfortunate people reveals clearly the existence of a neurotic taint as the rational expla- nation of their crime, pauperism, and bestiality, and suggests all through their needed protection against themselves. The undoubtedly weak-minded Juke sisters married the two sons of Max, who is known as “ a drunken, eccentric, and lazy ne’er-do- weel ” who leaves a large illegitimate offspring. It is not strange that these unions entailed blindness, pauperism, prostitution and crime upon children and grandchildren. The record of Ada Juke through the marriage of her first legitimate child, who married her first cousin, is only less fearful than that of the illegitimate line. Both, in the sixth generation, after passing through the darkest 12 and most loathsome channels of impurity, are represented in living stocks of half-witted bastards, criminals, and paupers, who will con- tinue to roll up the bill of expense for petty crime and misdemeanors and the untold expense of ruined character, wherever such plague spots are permitted. Had it not been too early in the history of society, it is fairly presumptive that the twenty-one grandchildren of Max and Ada might have been recognized as unfit members, and, very consistently with the public welfare and their own best interests, have been detained for the better part of their lives in jails or sequestered in asylums. The percentage of idiocy and insanity as presented by Mr. Dug- dale’s Table VII. on diseases, malformations, and injuries, bad as it is, is manifestly short of the truth ; for an analysis of the specific tables furnishes larger proportions. Blindness, an evident physical infirmity, is reported, because so evident; feebleness of mind and insane conditions, less readily distinguished, are passed over in silence; while the bias of study, being the detection of pauperism, crime, and prostitution, gives comprehensive figures. We cannot believe that less idiocy and less insanity existed in the Juke family than pertains to general population; but, rather, as the negro population exhibits in the census a lower ratio of idiocy than do the whites, so the general mental enfeeblement of the whole Juke race was such that only profound cases of idiocy could protrude themselves into recognition above the low and sensuous level of this stock of half-wits. But leaving this, with the hope expressed that another “mother of criminals” shall be studied hereafter in the charitable and illuminating light of her presumed weakness of mind, I submit that there is free in the community a great host of crime- doers who are not so much criminals as mental and moral imbeciles. Of these habitual criminals, it is estimated that their average crime life is eleven and a half years, of which three and a half years only are spent in jail. Of six thousand prisoners examined in Scotland by competent authority, twelve per centum exhibited decided mental weakness independent of those who became actually insane. A movement has been inaugurated in that country toward life confine- ment of the incorrigible, morally insane and the imbecile classes, that their propagation shall cease, and thus crime be measurably diminished by the partial extinction of criminals. To those who look upon moral insensibility as an imbecility, Mr. Brockway’s analysis of his prisoners (or patients, as he facetiously — wisely?—terms them) at the Klmira Reformatory is very sug- 13 gestive. Defining the moral sense as shown in “ filial affections, sense of shame or sense of personal loss,” he reports of 1,463 examinations : absolutely no moral sense, 1,082, or 73.9 per cent.; possibly some moral sense, 229, or 15.7 per cent.; ordinarily sensi- tive, 88, or 6 per cent.; specially sensitive, 64, or 4.4 per cent. And yet, further to establish the doubt as to our present interpreta- tion of the nature and origin of crime, the researches of a patholo- gist, Moriz Benedikt, are significant. He publishes an anatomical study of the brains of criminals, describing the convolutions of twenty-two brains. He found in these a marked peculiarity, — a tendency of the principal fissures to run into each other, producing what he terms a “confluent fissure type,” — not a formation of new fissures by the development of new convolutions, but the cutting up of a comparatively simple series of convolutions by the formation of secondary fissures or the prolongation of those usually existing beyond the normal limits, thus distinctively altering the normal formation of the surface (the active) part of the brain. Unfortu- nately, brief mention is made of the mental abilities of these twenty- two cases. In seven, the men are described as excessively ignorant or of weak mental power. Our assistant, Dr. A. W. Wilmarth, a reliable pathologist, in examining the convolutions of the brains of twelve feeble-minded children, has observed, among other anomalies, the same peculiari- ties as are mentioned in Benedikt’s cases. Hardly an idiotic brain has been examined which does not show this departure from what is regarded as the normal type, and in many of them to a marked degree. Corresponding observations with the same results have been made by Dr. Mills, of Philadelphia, and by foreign observers, showing very decided analogies between the brains of criminals and the brains of idiotic and imbecile persons not under criminal accusation. Akin to the criminal, less responsible and more pitiable, is a great host moving up and down our country roads, the much-abused tramp. The stamp of his intellectual weakness is clear in his features, in his loose articulations, in his aimless, dogged contentment. He is rarely a thief, as he lacks a thief’s capacity. Of over two score of these fellows examined recently, more than one-half were vagabond imbe- ciles, irresponsible for the condition in which they are living, and, failing the offices of mercy in their childhood, deserve the kindness of a lifelong detention within enclosures devoted to bringing out their own self-support. 14 There is another sorry phalanx of misery,— the abandoned pros- titutes of our city, recoiling on community for its laxity of law and surveillance, and contaminating how many births of even lawful wed- lock ! Who are these prostitutes? A class so feeble in will power, so ignorant, and of such uncontrollable emotions that it is no forced conclusion that very many are unsound and irresponsible, the sinned against rather than the sinners. And yet another host darkening the whole land,— the alcoholic in- ebriate,— more numerous than all the insane, idiotic, blind, and deaf mutes together, reinforcing the ranks of pauperism by other legions, and sowing a birthright of misery unto children of the third and fourth generations. Expert physicians are telling us — and daily their testimony is better received — that alcoholism is a neurosis, amenable to medical measures under the regime of complete isolation from provoking causes. This is wiser than to call it a crime, without de- priving the criminal of his misused liberty. To the practical, it would seem that the functions of government are not discharged toward its peace-loving, frugal, and law-abiding citizens so long as these disorderly, contaminating, and misery- breeding elements have share and share alike of that “ personal lib- erty under the Constitution ” which should only attach to personal reliability. Under the ethics of law and religion, they are almost unreached. The so-called education of the schools is admitted in the oldest communities to furnish a great many of its pupils only a better armament for mischief. So that, education, law, and religion failing, shall we not reform our conclusions as to the nature of the ills from which we suffer? May not the study of the humble idiot and imbecile in our institutions aid us in discovering some analogies heretofore undreamed of, and perhaps a healing to the so-called cor- rupt, and the only safety to the healthy, be found in an arbitrary but legal isolation of the unfit. There is no field in political economy which can be worked to better advantage for the diminution of crime, pauperism, and insanity than that of idiocy. The early recognition of some of its special, upper, and more dangerous forms should be followed by their with- drawal from their unwholesome environments and their permanent sequestration before they are pronounced criminals, and. have, by the tuition of the slums, acquired a precocity that deceives even experts. Only a small percentage should ever be returned to the community, and then only under conditions that would preclude the probability of their assuming social relations under marriage, or becoming sowers of 15 moral and physical disease under the garb of professional tramps and degraded prostitutes. How many of your criminals, inebriates, and prostitutes are con- genital imbeciles ? How many of your insane are really feeble- minded or imbecile persons, wayward and neglected in their early training, and at last conveniently housed in hospitals, after having wrought mischief, entered social relations, reproduced their kind, defied law, antagonized experts and lawyers, puzzled philanthropists, and in every possible manner retaliated on their progenitors for their origin and on the community for their misapprehension ? How many of your incorrigible boys, lodged in the houses of refuge to be half educated in letters and wholly unreached in morals, are sent out into the community the moral idiots they were at the beginning, only more powerfully armed for mischief? And pauperism breeding other paupers, what is it but imbecility let free to do its mischief ? We should not deplore, and we may certainly anticipate, a steady statistical increase of insanity and idiocy for the next four or five decades: even should it be at the rate of hundreds per centum in- crease for each census, it will indicate not so much an absolute increase of the diseases named as a broadening of definitions and better analysis of conditions ;—common sense, and a higher Chris- tianity dealing with defective and irresponsible people. THE INSTITUTION. When the facts relating to the distribution of idiotic and feeble- minded persons in any settled community are intelligently canvassed, it becomes conclusive that this distribution is not only detrimental to the individuals themselves, but subversive of the best interests of the family and neighborhood. Their aggregation into institutions be- comes, therefore, not only a charitable, but a conservative thing to do. American institutions, having been already in existence thirty years, it may be asserted that the experimental period is passed, and that, when States shall proceed to legislate for these defectives, it will be done on a permanent basis. The probability is that, because of the peculiar adaptation of fee- ble-minded persons to a community organization, State institu- tions may be created to embrace the care of all whose dependence needs it, and inclusive, too, of all the multiform grades; for it seems despotic to omit those who are epileptic, paralytic, or choreic, per- mitting a physical impediment to bar the individual from beneficial influences to which he is as responsive as any. This all-compre- 16 hending care has been contemplated in Pennsylvania under the suggestion of an asylum village to be developed from the nidus al- ready existing at Elwyn. The grades of specific idiocy and imbecility, as already described, presuppose a wide range of classification; and, at the commencement, this should be planned for somewhat as follows : — 1. Central buildings for the school and industrial departments, in the rear of which, or near at hand, should be located the shops. 2. A separate building, not too remote, for a nursery department, with such special arrangement of domitories, day-rooms, and con- veniences as the infirm character of the children committed to it may require. 3. Other more remote buildings for the asylum department, with arrangements to correspond for the necessities of both care and training. 4. Provision should eventually be made for colonizing lads as they grow into manhood in properly arranged and located houses as farmers, gardeners, dairy help, etc. 5. Other smaller structures, erected as the demand requires, might be devoted to the grouping of pay-patients, if the sentiment of the State would justify this. Or, at all events, such separated cottages would be useful for the lodgement of cases requiring unusual atten- tion and isolation. All of the above would constitute a general asylum or institution for the idiotic and feeble-minded of the State, and should be located at a point accessible to a city or town of considerable size and on a well-watered and productive farm. However limited in capacity, it should have at least fifty acres of good land devoted to garden and pleasure grounds, and more in pro- portion to the proposed growth and the special location. The State institution on the scale proposed should have a very large area of ground — hundreds of acres. In the great commonwealths of the West, sections of land should even now be set apart for the rapidly approaching future. An abundance of pure water is a desideratum, and means should be provided for raising it to reservoirs that will supply the highest part of the building with an amount equal at least to fifty gallons per inmate per diem. The appointments of the institution should be as homelike as possible, attractive and roomy without extravagance. The general dormitories of the schools and educational department should be arranged to accommodate from fourteen to sixteen or twenty, and there should be a few separate 17 and small rooms for single cases requiring special care. Adjoining the larger dormitories should be small communicating chambers for attendants, teachers, etc. Those buildings devoted to the asylum department should be planned to secure an abundance of sunlight and air without obstruc- tive partitions, with great liberality of floor space, and be located at some distance from the other departments,— say from one-half to three-quarters of a mile. Large space must be allowed in the principal buildings for day- rooms, in each of which not over twenty or thirty should collect. The school-rooms should be of similar size and limitation. At least, five hundred cubic feet of air per inmate should be apportioned to these rooms. Ample clothes rooms are likewise necessary on all the floors and accessible to the dormitories. Very liberal accommoda- tions of lavatory and water-closets are imperative, for the reason that habit-training in personal cleanliness is one of the most obvious requirements. A large calisthenium or drill floor, and an audience room that shall fully accommodate at one sitting all the children and employes, are indispensable to the perfect institution. The first story should be completely above ground, and of such height of ceiling and abundance of glass and doors that cheerful- ness and purity of air would be actually secured. The building should not be over three stories in height, those of the asylum department not over two stories. Basement stories of low ceilings and partly underground or closely embanked are highly objectionable places for day-rooms for feeble-minded children. The floors should be laid in the very best manner of the best materials, the joints filled and the whole oiled or painted or otherwise rendered impervious to dirt and soil. Those of bath rooms, water-closets, etc., should be made of granolith or other material that will not absorb moisture. The stairways should always be of iron, stone, or other indestructible material, ample in size and number, of easy tread and rise, and convenient of access, to afford ready egress in case of acci- dent or fire. The most modern and best approved methods of ventilation, heating, drainage, sewerage, etc., should be adopted. The general grounds of the institution should be hedged or fenced to keep off improper intrusion, but be freely used by the inmates for walking-exercise and work. Large and convenient play-areas should be provided for the various classes, and asphalt or other pavements be laid in those provided for the lower grades. 18 An institution for twelve hundred inmates may be thus described.* It is located, if possible, on broken ground, that ravines, woods, etc., may grant sequestration to the lower grades, but with arable grounds and levels for the promotion of agricultural work. The population embraces at least seven grades; and each of these should be again reclassified, in at least three separate buildings or groups of buildings. A community thus organized will have its industrial members, capable of doing the washing and ironing and domestic service of the whole, so that hired labor from the outside shall be reduced to a minimum. It will have its fields and gardens, which can be worked by the industrial classes in the production of a very’ large portion of the food. The same community will have its schools, where young, improvable feeble-minded children can be educated in habits of propriety and to read and write. Various forms of amusement will be developed. Many imbecile persons possess imitative faculties, by which they come to create and enjoy simple games, amusements, etc. Many have musical inheritance, and can lie trained to use fairly well, cornets and stringed instruments. So that such an ideal institution develops within itself means not only of subsistence, but means of improvement and amusement. The low* grade classes are made to participate in the trained capacities of the higher classes. The cornet band, the stereopticon, the dance, may lighten the dulness of even the infirmary, and all at little or no cost outside of the stock in apparatus and appliances. An institution so organized and developed furnishes an abun- dance of life and variety to the best class of attendants and teachers, who will come to live in and labor for it. To expect to get proper care-takers for an institution devoted exclusively to the lowest idiots and epileptics is to expect what is impossible. But the graded institution on a large scale and in scattered pavilions and cottages presents a multitude of phases and interests, that make official resi- dence in one not only tolerable, but singularly attractive. One of the agencies to this end is the constant movement between the proximate families. Details of trained cases may be tempo- rarily installed in the infirmary department, there to aid in nursing, cooking, etc. The monotony of living is broken into, and the inmates get the change which their temporary irritabilities and inharmonies require. The population of two whole pavilions may be annually * With this paper, Dr. Keriin presented a diagram of the (arm, adjacent land*, pretest plant, and prospective additions of the Pennsylvania Institution, all of which when accomplished will furnish residence for twelve hundred feeble-minded persons 19 turned over; and the stereotyped sameness of the views out of doors, and of the furniture, places, and sights indoors, be completely broken. Work is, by an experienced psychologist, pronounced a sedative to disordered minds. So, too, sharp and unexpected change of place will establish a new order of thought, and break up a perversely in- tractable habit. It is the small institution against which may be pronounced the objection of moral “hospitalism.” The large, diffuse, and thoroughly classified institution is another affair, and can be to its wards and employes as cosmopolitan as a city. No work that is worth doing can be well done without a liberal expenditure : the appropriations of to-day are but the beginning for this class of State dependents, if it be even less than well done on the line which has now been marked, and, coming from the general tax, must grow to an oppressive burden, if this humanitarian policy be pursued to its end under conditions as now existing. But the State, adopting as its policy the protection in institutions of the defective classes, acquires a right of inquest into the causes generating this tremendous burden to the thrifty tax-payer, who must be protected from the rapacious social ills which deplete his own strength. If the State assumes this duty, it may exercise the right to lessen the drain on its resources, when it can be proven that more than half the bulk of all this misery and its cost are avertible. Statistics are everywhere pointing that way; and it needs only the education of the people and perhaps some prohibitory legislation, springing out of popular sentiment and aversion, to diminish the number of the wards of any Commonwealth by choking the sources whence they spring. To this end, it would be wise State economy to attach to all appro- priations for charitable purposes an enabling clause that institutions disbursing this charity should contribute to the Commonwealth, in as precise form as possible, statistics of the origin of the evils they affect to relieve. Or, as it is made the duty of boards of public charities to act as bureaus, of statistics, these bodies should be so well supported that they could direct investigation in more minute forms than can now be done, and to distribute tracts very freely among the public through their county organizations, presenting in sharp lines such illustrations of deterioration of race as these in- quiries must furnish. Supported by an influence of this sort, our institutions might pre- sent such an array of facts as to be convincing of the truth, and 20 converting to better forms of living,— to natural marriage, normal birthhood, and noble child-culture. In this way only can a State receive adequate returns for its charitable expenditures. She will not receive them so much in the betterment of the imperfect, pauper, and criminal she protects, as in a scientific analysis of causes for these conditions through a knowl- edge of which must come prevention. The State, assuming her highest function of protection, obtains at last her authority for prevention. Not until she assumes one will she be able to carry out the other. THE OBLIGATION OF CIVILIZED SOCIETY TO IDIOTIC AND FEEBLE-MINDED CHILDREN. If civilization is the material expression of the beautiful tenets of Christianity, if the acme of its perfection is reached when society shall believe and practise the code of the Great Teacher, and hold the rights and claims of each other as sacred and dear as our own, it will not be difficult to accept this question as already disposed of. No mere matter of the helplessness, the repulsiveness, or the un- profitableness of these subjects, will affect its decision, other than the natural impression such characteristics should make upon our sympathy. If civilization accepts the task, without demur, of caring for the other dependent classes, upon what principle of logic or reason can prudent provision for the idiot and imbecile be denied ? Let us first briefly glance at the obligations civilized society is under on its own account. Organized society, which is but another name for the State, is an accretion of individuals guaranteeing the inherent rights common to each, and requiring in return for the protection it affords the best possible service of the citizen. One of the duties of selfhood is the maintenance and care, in their proper proportions, of each and every member of the body. If self-preservation is the first law of nature, a policy which allows any one of these members to become useless or deformed is suicide to the entire system. This being true, — and no physiologist will doubt or deny it,— it is equally the duty of the family to exercise equal care for each member thereof, not one of whom has been abridged in a single right by his entrance into that relation. When this self-care is impossible, it is the duty of other members of the family to exercise this supervision, at least until the individual becomes qualified to assume the task himself. No one regards this action as charity. It is accepted as a duty, inseparable from the relation which the parties sustain to each other. The same law which holds the relations in either of these organiza- tions rules in the State. 22 The same watchful intelligent care which the individual extends over even the minor parts of the system, that thereby injury to all parts may be prevented, is but the index of the oversight which must in a government comprehend all details, and every particle, even the most minute, and of the skilful application of remedies to the diseased or of preventions to the threatened portions. It follows that, if in the system of society there are found elements of in- harmony, a proper regard for the welfare of the whole dictates such care for the diseased portions as shall restore the harmonious condi- tions. It is admitted that some scientists have met this question in another way, and have advocated the excision of such affected members for the benefit of the whole body. But every dictate of humanity and enlightened self-interest prompts a use of restorative appliances, at least, before the act of amputation is performed. Not only has no person or community a right to invade the rights of another innocent of crime, but such invasion is in direct conflict with the fundamental principle of all governments, that which renders such organizations necessary; namely, protection for the weak. So that the duty of a government is but partly performed when it refuses to cast away or cut off its incomplete members, and magnani- mously allows them to remain under its nominal protection, without its real care. They must be cared for, and, if possible, restored to a condition which will cease injuriously to affect the other members. For, in all this statement, I regard not the interest of the affected members, but solely the effect of their condition upon the whole system. The duty, therefore, referred to is the duty due the inter- ests of good government. The fact that every individual is not self-supplied with ability to live comfortably and happily is the primal argument for human organizations. The family exists as an organism, because the chil- dren are unable to live without the fostering care of the family. The State exists because families are too weak to endure without its protection. So the State is really, and perhaps almost mainly, an outgrowth of this just sentiment of care for each of its component parts. In his essay on the “ Progress of Nations,” Seaman says : “Nearly all the elements and instruments of progress being artificial, in- vented by the intellect and genius of man, they require intellect and intelligence to use them advantageously. Hence a defect or weak- ness of natural element, and a want of intelligence and knowledge of the principles and instruments of mechanism, are both great 23 impediments to the progress of a people." If this be true in the aggrega.te, it will be true in detail. If ignorance is a defect or a weakness in a government, and constitutes an impediment to the progress of its people, the difference between the injury wrought by general or partial destitution of knowledge becomes only a question of quantity. In his celebrated essay in the Massachusetts Quarterly Review, in 1848, on the causes and prevention of idiocy, Dr. Howe says: — An ignorant, vicious, or suffering class is a disturbing class. It is a disturbing force in society. It has no business there. It must be removed, or there never can be order. Now, as it cannot be removed bodily, because the men and women composing it cannot be put out of the world, the only way of removing the disturbing forces is to change them into intelligent, virtuous, and enjoying persons ; and then there will be harmony. It has been indicated that a proper and, indeed, one of the most important subjects of governmental supervision is the scrutiny of all incongruous and inharmonious elements, and the adoption of measures for their conversion into harmonious action. And the insignificance of the obstacle cannot be logically pleaded. A grain of dust may blind a king. A beggar has slain a ruler, and changed the whole course of statecraft. A single woman mentally malformed has cost a great city many lives and thousands of treasure. The errant boy, who knows no guide or governor save his own lawless will, may lead a mob to the sack of a burning city. The statesman must recognize these perils, and provide against them. “Ill can he rule the great that cannot reach the small.” If Almighty Power stoops to support the falling bird, it may surely be considered a task no less divine to sustain the struggling child, and guide its feet in ways of purity and peace, especially when by this intervention many lives may be saved to the service of the State, who, but for it, would have been ruined by the tempter thus himself rescued. It may be held that the principle which governs in the family is affection for each member, and that this sentiment should still be permitted to provide suitable care for its defective members. But it can be shown that public welfare often demands measures which are strongly opposed by family affection. Vaccination is deemed a nec- essary operation, in order to protect the community; but it is often violently rejected by family affection. The patient dreads the nau- seous medicine, and refuses to receive it, even while convinced that it will remove the disease from which he suffers. So the ignorance 24 or false kindness of the family often negatives the acts most needed to promote its welfare, and in a degree that of the community. Of all the agencies for promoting and maintaining health, the ordinary family is least reliable and successful. That the ignorant, the super- stitious, the abjectly poor, even the openly vicious, should be in- trusted with the care and improvement of the most desperately deplorable case requiring aid, is a proposition, abhorrent as it seems, which is often urged by pretended statesmen. Scarcely better is the attitude of those States which permit their insane and idiotic popula- tion to die in county jails, wanting not means, but disposition, to build asylums for their care. In the paper previously mentioned, Dr. Howe says, alluding to the idiots in the State of Massachusetts, said to have been a thousand in number at that time: — “ Yet these thousand senseless human beings, who are utterly dependent upon others, who are regarded as irresponsible by the law, who may commit even murder without legal or moral guilt, are only occupants of the lowest rank in the social scale. Rising above them, little by little, are other ranks, up to the high platform upon which stand our most gifted and best educated men and women. In the rank next above the idiot stand those helpless creatures who are supposed to know right from wrong, and from whom are drafted almost all the tenants of our jails and prisons." And it might be added that above these rise, rank upon rank, successive gradations of enfeebled intellects, each capable of successful development, yet each banned by the contemptuous voice of the public as idiots. This quotation opens appropriately to a broader aspect of this work. There is certainly a field which, all will admit, may be profit- ably filled in the training of the multitudes in every State who are incapable of instruction in the common schools, and yet may be taught by the peculiar methods of the institutions for feeble-minded, and may thus become, under suitable supervision, factors in the pro- ductive forces of the State. If he is a public benefactor who causes two blades of grass to grow where but one grew before, of how much higher honor shall he be thought worthy, who has rescued from the garbage heap of society, into which have been shot as rubbish, the waste remnants, materials converted from incendiary menaces to in- telligent and honest, if humble, citizens of society? No one can refuse to acknowledge the importance of this work. Without in the least joining in the contemptuous condemnation of the endeavors for the education of the idiot,— while, in fact, claiming for it that it is 25 one of the loftiest in design and purpose among the grand beneficent operations of the age,— the training of feeble-minded children, that class of youth who possess faculties, few and dormant as they may be, will be readily seen by all to be labor well bestowed in the interest of society. It is in the interest of the repression of vicious instincts and dispositions, and the culture of powers which are capa- ble of rendering the possessor and the State some service. If there is a responsibility of different degree resting on the State to provide for its idiotic and insane, what shall constitute the differ- ence ? If insanity is a disease, why shall the Commonwealth en- deavor to effect a cure in this rather than in other classes of disease ? If the feeble-minded children of the State are susceptible of im- provement by culture, why shall the educational benefits bestowed upon more favored minds be denied them, in a scale adapted to their comprehension ? It is surely only justice that we plead for in the right of the one class to education as of the other to cure. The question of the cost cannot be logically nor justly pleaded in one case and denied in the other. In the last report of the Illinois State Board of Public Charities occurs this passage : — Suppose one-half of the idiots in the State to be under twenty- one years of age, how many of this two thousand is the State under obligation to educate, or at least to give such training as they are capable of receiving with profit to themselves ? If no amount of training will make them capable of self-direction and of earning a livelihood when removed from the care and oversight of the agents appointed by the State, then of what advantage to the State — we do not say to the idiots — is this training ? These are questions which have not yet been answered to our satisfaction; but upon the answer to be given to them depends the action to be taken in the matter of enlarged facilities for the care and custody of idiots upon the part of the State. The only comment upon this which occurs to me is to substitute the word “ insane ” for “ idiot,” throughout the paragraph. But I quote a sentiment of another character from the report. After considering at length the great cost of maintaining the several insane asylums and proposing various plans for meeting it, the report continues: — In the decision of the question, the first and most weighty con- sideration should be the welfare of the insane themselves. Other considerations, certainly, are not to be ignored, and may modify materially the action to be taken. But the interest of the insane 26 is the only one which cannot speak for itself and make itself heard and felt. It is the highest consideration, because it is the most un- selfish. It appeals, more than any other, to what is noblest in the human heart. This burden has not been imposed upon us without our receiving at the same time the necessary strength with which to bear it, and with comparative ease. If we have not understood the magnitude of the load to be carried, still less have we comprehended and been grateful for the resources which enable us to carry it almost without feeling it; that is to say, in a pecuniary sense. Permit me to ask, Why not extend the same grand charity, or rather justice, to the work in behalf of the feeble-minded ? Perhaps this will be a proper place to object to the common term “charity"in this connection. If by charity is meant that quality which the apostle apotheosizes,— loftiest and lowliest of the sacred trio,— the State, while leaving its proper function, might be pardoned in invoking such heavenly assistance. But, if it be like the charity which doles out the crust to the back-door tramp, or like the worthy that Pollock sings, who “ With one hand . . . put A penny in the urn of poverty, And with the other took a shilling out,” it will be better for the State and its beneficiaries to reject its aid. If the noble institutions of the times — those temples sacred to the restoration of fallen humanity, nearer Christ in his work than half the shrines dedicated in his name — must be fed or starved at the caprice of a thoughtless public or of a mercenary legislative lobby, it were better, perhaps, to leave their wards with their burdened fami- lies, where at least no flattering promises of amelioration are subject to such possibilities of cruel disappointment. What the officials and patrons of these institutions demand is not the vacillating support of an ethereal sentiment or the doles of an omnibus appropriation bill, subject to expansion or contraction as certain policies prevail or whims dictate, but the strong, constant sustenance of the right hand of the State, as secure in the knowledge that the asylums of the Commonwealth will be built and maintained as that the penitentia- ries will be supported or the courts upheld. All we ask for is justice, which Burke terms “ the great standing policy of government." I may be met here with the statement that the States of our Union do support, generously and willingly, institutions for the dependent classes. It is not the measure, but the manner of this support, to which I object. What man among you has not known the task of waiting upon a legislature in session, and devoting days 27 and nights to labor the most exhausting and most humiliating inci- dent to your position, in order to secure the passage of the neces- sary bill ? Who that is responsible for the asylums has not felt his heart burn at the repeated insults he receives, at the equivocal cold- ness he meets; or has not endured the pangs of suspense, fearing that, after all his labor, some freak may strike out an appropriation for indispensable items, and force him to go back to a work weak- ened and impaired thereby ? What would be thought of the judges of the respective circuits of a State who should attend the session of the legislature, and make personal appeals to the members to grant them living salaries? Yet the domain of one is accepted as that of justice, while the other is credited among the children of charity. Surely, in this instance at least, charity is not the greatest. We might be well content with justice.. But, before this body, I may urge a still stronger reason why the aid granted the institutions for which I speak should be bestowed as a measure of justice. Our wards are innocent of crime or fault. In the large majority of instances, they are the feeble and deformed expressions of parental sins or sorrows. And these sad traits, in very many instances, are the reflection of woes which the State has directly or indirectly caused. In my own State there have been successive eras of hostile invasion, with all the horrors of Indian and civil war, to say nothing of the occasional experiences of drouth and insect plague, which have left other traces than lonely graves and ruined homes and memories of eternal sadness. Picture a delicate woman, cultured and refined, leaving a beautiful Eastern home and loving life-long-known kindred and friends, and, in com- pany with the man she has chosen, selecting a dwelling-place far out on the green sea of the plains, where neighbors were a day’s journey away, and letters from home were weeks old before arrival. Lonely enough when he was with her; but, when he was gone and she was alone, who can picture her anxieties ? And when, one awful morning, the troops brought him home lifeless and mutilated, and she realized that life for her was done, you need not to be told the effects upon her new-born child. Affrighted at every sound, in a perpetual panic, he reproduces, happily for him without her mental sensibility, the terrible ordeal through which his mother passed. This is not a fancy sketch. The horrors of the formative era of our State can never be told, especially as they fell upon our brave pioneer women. The duty of the State to her heroic dead, slain in her settlement and service, is but half fulfilled when the dead 28 are cared for. The unfortunate children, upon whom are impressed all the terrors of the time, are rightful claimants of her fostering care. There is another and a broader view which I venture to present. The State which licenses the sale of intoxicating liquors becomes a partner in the transaction. The cost of the license represents only a part of this share in the partnership. For a paltry sum, the Commonwealth allows municipalities to protect the procurer of unnumbered crimes and sorrows. In some States, a provision of law makes him nominally responsible for injuries indicted by the business of the firm; but the State bears the costs of the prosecu- tions and executions, leaving the widows and orphans, and the wrecks denuded and damned by the partnership, to struggle unaided through the remainder of life as best they may. Even these melan- choly ruins do not represent the entire devastation wrought by this arrangement. These woes, sad as they are, are perpetuated and intensified in another generation. Innocent children are doomed to an eternal passion for debauch or to an existence of helpless imbecility. If the women of America, who endure from intemper- ance, evils more debasing and destructive than even African slavery inflicted upon its victims, cannot induce a prohibition of a traffic which desolates their homes and quenches their hopes, they have a right to demand that a State which has profited by the act which ruined their sinless children shall provide unquestioningly for their support. The time will come, comrades,— and it approaches with no tardy tread,— when a State which neglects to provide for her unfortunate classes upon a full measure of justice will receive the reprobation of her sisters, when it will be deemed impertinent to doubt that legislatures will appropriate all the means which intelligent officials suggest as necessary to the successful operation of benevolent estab- lishments, and when those whose hearts and minds arc thoroughly enlisted in this — among the noblest of human employments — shall be cheered by receiving the full appreciation of the work from every right-minded citizen of the State.