THE FEEBLE-MINDED BY GEORGE H. KNIGHT, M.D. LAKEVILLE, CONN. Read before the National Conference of Charities and Correction at New Haven, Conn., May, 1895 THE FEEBLE-MINDED BY GEORGE H. KNIGHT, M.D. LAKEVILLE, CONN. T{ead before the National Conference of Charities and Correction at New Haven, Conn., Mar, 1895 BOSTON Geo. H. Ellis, Printer, I4t Franklin Street 1895 THE FEEBLE-MINDED. For the past ten years the status of the work accomplished, the methods used, the reforms advocated for the care and training of the feeble-minded, have been as familiar to the members of this Con- ference as have those of any other charity or reform which have been brought before us for help, encouragement, suggestion, or advancement. You are so familiar with our statistics that you are not startled by the fact that, while the Census of 1880 showed that there were 76,000 feeble-minded persons in the United States, the Census of 1890 shows nearly 96,000,— an average increase of 2,000 a year for ten years, of which in actual numbers only about 6,500 are cared for in private or public institutions. This makes an average which seems discouragingly small until we recall the fact that the belief has been general until within a few years that persons of feeble mind were both useless and harmless. We have no record whatever of any sustained effort in behalf of the idiot, or imbecile, until the year 1800, when a small beginning was made in France. And, now that the Conference is here upon Connecticut soil, it may not be amiss to state, with pride in the fact, that the first steps taken in America in behalf of the imbecile were taken right here in our sister city of Hartford, when as early as 1818 a few children of feeble mind were cared for, taught, and, it is needless to state, improved in the Asylum for the Deaf and Dumb. Massachusetts led in establishing the first institution devoted especially to the feeble-minded ; and, while it is not literally true, as we wish it were, that others have followed from Maine to California, yet it is true that, from Massachusetts to the ambitious young State of Washington, we have, here and there, successful schools and homes for this class of defectives. Wisconsin has been the last to wheel into line, but may yet lead 4 all the others if she cares for her dependants of feeble mind with the same zeal and judgment which she has already shown in her care of the insane. Recognizing the fact that the Conference audience is made up of practical, earnest, thinking men and women from every part of our country, we have each year urged upon you the need, the pressing need, of having provision made for the feeble-minded in every State in the Union. It is not enough that seventeen States have shown justice, as well as mercy, toward this class. Every State owes a like provision to her citizens. There is no more pitiable, helpless object on the face of the earth than a boy or girl of feeble mind who is uncared for. There is no one of this class who can ever plead his own cause or that of his fellows, no matter how fortunate he may have been in his environment. He must always remain defective and dependent, at the mercy of his more fortunate brother, uplifted or debased by him. Even our newly settled States are not free from this burden of imbecility. The sturdy emigrant, who comes to this land of promise full of hope, brings his misfortunes with him as surely as his cour- age and endurance. The hardships and privations incident to the development of a new country, the hard life of the women in the fields, perhaps the inheritance of generations of poverty and op- pression,— all these make themselves felt in the number of defective children found among our foreign population. We do not stand before you as theorists. Practical proof of all that we have hoped and claimed could be done for the feeble-minded is to be had by any one who will take the trouble to visit our insti- tutions. We have shown that humanity and economy, public safety and individual interest, are each most truly conserved when we have given this class our best care and have surrounded them with every safeguard. We have been the pioneers in that new education which aims at developing mind and body at the same time. Nothing has been too small, too insignificant, to be of value, if it could awaken even a passing interest in these children under our charge. All our training, school, and trade and service of every kind have had to have for their object the development of each individual. It does not alter the obligation that our results are meagre from an intellectual standpoint. They are meagre, looked at from any point except that of comparison with the same class untrained. But 5 is it not to the honor of our civilization to-day that, in spite of the fact that the most persevering efforts of intelligent men and women result only in this meagreness, there are yet those who are willing to spend a lifetime in making the best of this human wreckage? Those of us who come closest to this work, those of us who are its warmest advocates, have no illusions. We know' the hopeless- ness of trying to imitate intelligence or common sense, just as we know that, when a child of feeble mind needs hospital care, usually the most welcome message we can send to his parents or guardian is that his days are numbered. Yet that does not prevent our bringing to bear upon the case all the skill available to prolong the life of even one of the lowest types in our custodian grade. We do not strive to educate the feeble-minded with any hope of “turning them out Harvard graduates,” as we were once charged with thinking to do in the early days of the work in Minnesota. The sum total of what is called “book knowledge ” which can be gained by a person of feeble mind is comparatively insignificant. That is simply a means to an end. '1'he end is to secure the best results in caring for a class who are found in every condition in life,— a burden upon the home, a tax upon the community, a responsibility which must be met by the State, whether or not. That we have been able to create opportunities for usefulness for them inside institution walls is one of the happiest results of our methods of training. The details of institution care and training for the feeble-minded are, in a way, minor considerations. What we claim and stand ready to prove is that the establishment of an institution is a tre- mendous force as a preventive measure, in addition to the value of the institution as a place of refuge. No one needs to be convinced of the impracticability of trying to place out children of this grade. When the natural ties of blood cannot bear the strain of constant association with the peculiarities of a person of feeble mind, it is hopeless to try to find voluntary affection or forbearance for them among strangers, except under very exceptional circumstances. Experience has taught that we must have institutions for the paupers of feeble mind; and it is also true that outside of institutions wealth, influence, and position are useless in securing the highest bene- fits for an imbecile child of even the most fortunate parentage. What it needs and must have for any development is what it can 6 get in an institution, and in no other way; namely, companionship, instruction, and amusement. Otherwise isolation is inevitable. We have also proved that we must have large institutions if we would get the best results ; for, while the training of the imbecile must always depend mainly upon individual effort, yet the types are so diverse that it is only from considerable numbers that classes of a general degree of development are secured. We have proved, too, that in large institutions we can give employ- ment to those adult imbeciles who are beyond what we call the “ school age,” but are, unfortunately, not beyond the reproductive age, and who must therefore remain under guardianship, or else prove a menace to the public welfare. This is one of the reasons why we so strongly advocate the colony plan for all grades of the feeble-minded as the cheapest as well as the wisest method, utilizing, as it does, the labor of a class whose work would command absolutely noth- ing if brought into competition with even the most unskilled labor of persons of normal mind. No one will gainsay the fact that an imbecile who can pay for his board and his clothes by his own work justifies the expense of bringing within his reach what we will call a “home market.” He can no longer be considered a pauper, a State charge, consuming more than he produces. This is especially true of the work of a large per cent, of the epileptic, who are, by reason of their infirmity, debarred from many of the occupations for which their mental qualifications would fit them. As superintendents of institutions, we are constantly striving not only to convince an indifferent public of the necessity of providing a suitable home for this large class of dependants who must be pro- tected, but we are also working out new methods in management, in economy and education. As physicians, we are following up each clew, hint, or history of the cases under our charge, with the hope of some time being able to give to the world that ounce of prevention which shall lessen the appalling number of the feeble-minded. But, so far, our efforts have been mainly in behalf of those who have been safely housed between the walls of institution homes, the 6,500 fortunate ones who are cared for by private or State charity. But there is a duty which, as citizens and tax-payers and law-makers, we have neglected; and that is our failure to secure by suitable leg- islation such a series of laws as shall prevent the tremendous increase 7 in our imbecile population, which to a large extent is due to the laxness of supervision given to the imbecile women who drift from time to time into our almshouses. We cannot, at present, secure the legislation which shall prevent the marriage of epileptics, that most prolific source of imbecility. I doubt if it can ever be brought about, for the victims of this disease are so variously affected. There is such a wide gulf between such epileptics as Caesar and Napoleon, for instance, and the low grade custodial case, which is an embodiment of the disease at its worst, that the thousands who are between these extremes, who are its occasional victims, and who are not prevented from filling positions of importance, often for a lifetime, would rise like a mighty army to protest against any legislation which would aim at bettering the race at their expense. The world is not yet ready for this kind of radical reform. The same thing is true of alcoholism as a factor in the causation of imbecility. It will be a long day before any reforma- tion can be hoped for in either of these most productive sources of idiocy and imbecility. Neither have we been able to convince the general public nor even the charitable public of that which is an article of firm belief with us, growing out of our experience as superintendents; namely, that a large proportion of the criminal class is recruited from a type which, when found in our institutions, we designate as moral imbeciles. But we confidently believe that the time will come when the recognition of these as a distinct and dangerous type among the defective classes will result in such timely and thorough preventive measures as shall give them custodial care for life, make them wards of the State, and trained to usefulness, thus arresting the tendency to crime instead of attempting to reform the full- fledged criminal. These are the preventive measures of the future toward which we must work; but, when we do find a foul spot which we can rub out at once if we will bend all our energies to the task, in the name of humanity let us attack it without delay. The first annual report of the New York State Asylum for Feeble- minded Women stated that about twenty per cent, of the whole num- ber of inmates received had borne illegitimate children. A faithful record of the number of children borne by the imbecile women among the 90,000 who are without the constant supervision of an institution home would horrify the respectable community support- ing them. 8 Here is an opportunity for an immediate work of prevention upon which we should concentrate all our efforts. I should like to place this question before the Conference for discussion : How shall we educate public opinion to the point where overseers of the poor and town officials shall feel the same humiliation and sense of dis- grace at the birth of an illegitimate child among their charges which any superintendent of an institution would feel under like circumstances ?