VOLUNTEER PAPERS. THE CARE AND TRAINING OF FEEBLE-MINDED CHILDREN. BY SAMUEL J. FORT, M. D. The subject to which I call your attention is one of particular interest to this Society, individually and collectively. Individually, as it is the medical man who assists at the birth of the feeble one, who assumes the charge of its physical welfare, and toward whom the parents turn for advice as to its future. Collectively, as men of education, as a body of philanthropists, as a society whose aim is the promotion of science, you will see its importance, especially since the Legislature has refused for the sixth or seventh consecutive time to grant an appropriation for a state asylum. It is beyond the limits of this paper to do more than give a general resumé of the work of training feeble-minded children, from its inception up to the present, the etiology, pathology, and the purely medical side of idiocy and imbecility must be left to abler hands. At the beginning of this century two prominent French surgeons, Esquirol and Itard, made the first effort to educate something akin to an idiot in the person of the so-called "Wild Man of Aveyron," but more as an experiment in metaphysics than with any desire to investigate and lay down a method of educating a defective class. About 1836 Dr. Edouard Seguin, a student of surgery under Itard, at his teacher's suggestion, began training idiots after methods of his own; and making close studies of their psychological conditions, he produced some remarkable results. In 1839, with Esquirol, Seguin published a pamphlet upon the training of idiots, which attracted considerable attention toward his work. Continuing his work alone after this period, Seguin established a school in Paris, with a number of feeble-minded and. idiotic children as pupils, which he procured from the great Hospice des Incurables. In 1844 a committee from the Parisian Academy of Sciences, consisting of Serres, Flourens and Parriset, examined his methods of training and educating these unfortunates, and commended them in the highest manner, declaring that previous to Dr. Seguin, no one had been able to train or cure an idiot by any means, but that he (Seguin) had solved the problem. In 1839 Dr. Guggenbuhl, a young physician of Switzerland, had his attention called to the miserable cretins of that country, and established a retreat for idiots in the Abendberg. With Paris and Switzerland as centres the wave of charity spread to England and the Continent, and led to the establishment of an institution at Bath and one at Leipsic. In 1872 there were in operation about 20 schools in England, 2 in Scotland, 8 in Germany and Austria, 2 in Wurtemburg, 1 in Bavaria, 1 in Saxony, at Berlin, Vienna, Coblentz and the Hague.* There are also three institutions located near Copenhagen, Denmark; the history of the first one of these and its Superintendent, the Rev. Prof. Durloo, constitutes a chapter of self-denial and patient charity unparalleled in these utilitarian times. In Norway there exists a law providing for the compulsory education of all idiots capable of being taught, when the number of schools reach six; there are now three in active operation. In Sweden it dates back to the year 1866; in which year Miss Emannella Carlbeck founded a small school. The great success of the work stimulated the formation of a society for the education of idiots, which resulted in the founding of a new institution at Stockholm, with a normal school attached, where teachers are trained in the work. There are now 12 asylums or training-schools in Sweden, being one for every two prefectures or counties. Efforts to train individual cases of idiocy and imbecility in America date back to 1818, but Dr. Hervey B. Wilbur opened the first school at his own home, in Barre, Mass., in 1848. A few months later, in the same year, an experimental state school was begun at South Boston, with Dr. S. G. Howe at its head. In 1851 the New York * Proceedings of the Association of Medical Officers of the American Institutions for Idiotic and Feeble-minded Persons. State School was founded by Dr. Hervey B. Wilbur; in 1853, Pennsylvania; 1857, Ohio; 1860, Kentucky; 1865, Illinois; 1876, Iowa; 1879, Indiana and Minnesota; 1881, Kansas; 1883, California; 1884, Nebraska. Thirteen states have established state institutions on "as liberal footing as those for any other specially defective or diseased." By special legislation New Jersey provides for 75 children in the Pennsylvania and Connecticut institutions; Delaware provides for six children in the Pennsylvania institution; Maine, Rhode Island and Georgia send children to the Massachusetts school; making in all 20 states on whose statute books these saving acts appear." The United States Senate also provides for six children at the Pennsylvania school. Besides these state schools, Massachusetts, Connecticut, New York, New Jersey, and recently Maryland, have private institutions. In 1880 Maryland had a population of 934,943, of which 1,319 were idiotic or imbecile people; 46 of this number, or about 4 per cent. are named as inmates of institutions-presumably, receiving improvement; 86, or 7 per cent., are named as in almshouses; the remaining 89 per cent., 1,187, are at home. Of this latter number it is no exaggeration to say that 45 per cent. are being maintained in homes ill able to bear the burden of support of "families deserving of a prudent state philanthropy, which, meeting the mechanic and laborer halfway, and without pauperizing, as the almshouse does, 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 untrammeled care of their households. "Who can estimate," says the same writer,* "the waste of energy, money and heart in this extravagant home-care of idiotic and feeble-minded children? When told, no history of the Annals of the Poor' is more searching and pathetic, and no defense of the doctrine of state aid to relieve the calamities of her citizens more impassioned and irresistible." The term idiocy, as applied by the mass, includes the infinite varieties of conditions found in the defective class under consideration; and does wrong to many capable of considerable * Dr. I. N. Kerlin. improvement by including them with the lowest and most unpromising forms. The following syllabus* gives a convenient form of grouping: Notwithstanding the results of the efforts to train and improve feeble-minded children, which have been published in this country and Europe, there are still many who steadfastly believe that the idiot must a priori be mindless; of what use then, they say, is it to cultivate that which has no mind? This idea is wrong; the mental faculties are not absent, simply dormant, weak, and need strengthening, non-coördinating, and need control. The cost of caring for the weak-minded will always be heavy; but those who would hinder the course of legislation, because of the severity of taxation, let them read that classic history of the generation of criminals called the "Jukes," by Dugdale, and ponder seriously over the portrayal of the progress of minddefect, uncared for and unchecked. Seguin, in his classic volume upon the treatment of idiocy, thus sums up the results which may and have been attained by the efforts to educate idiots: "True idiots have been improved, educated, and even cured; not one in a thousand has been entirely refractory to treatment; not one in a hundred who has not been made more happy and healthy; more than 30 per cent. have been taught to conform to social and moral law, and rendered capable of order, of good feeling, and of working like the third of a man; more than 40 per cent. have been capable of the ordinary transactions of life under friendly control, of understanding moral and social abstractions, of working like two-thirds of a man; and 25 per cent. have come nearer and nearer to the standard of manhood, till some of them will defy the scutiny of good judges when compared with ordinary young men and women." The principal means at our command in the treatment of idiots and imbeciles lies in the institution, be it public or private, because of the peculiar adaptation of feeble-minded persons to a *Report of Dr. I. N. Kerlin. community organization; and as American institutions have been in existence 30 years, it is fair to believe that the experimental period is passed. The distribution of feeble-minded and idiotic persons among communities is detrimental not only to themselves, but to the interests of the public at large, so that, sooner or later, State institutions will be created to embrace the care of all those whose dependence needs it, embracing those who are epileptic, paralytic and choreic. "This all-comprehending care has been contemplated in Pennsylvania, under the suggestion of an asylum village, to be developed from the nidus already 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 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 dormitories, day-rooms, and conveniences 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 attention 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 50 acres of good land devoted to garden and pleasure grounds, and more. in proportion to the proposed growth and the special location. The State institution on the scale proposed should have a very |