OF he 152 TWENTY-SECOND NATIONAL CONFERENCE OF CHARITIES But It does not alter the obligation that our results are meagre from They are meagre, looked at from any an intellectual standpoint. point except that of comparison with the same class untrained. 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 hopelessness of trying to imitate intelligence or common sense, just as we know that, when a child of feeble mind needs hospital care, usually Yet that does not prevent our the most welcome message we can send to his parents or guardian is that his days are numbered. 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 The end is to secure the best gained by a person of feeble mind is comparatively insignificant. That is simply a means to an end. results in caring for a class who are found in every condition in life,—— That we have a burden upon the home, a tax upon the community, a responsibility which must be met by the State, whether or not. 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 tremendous 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 benefits for an imbecile child of even the most fortunate parentage. What it needs and must have for any development is what it can 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 employment 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 nothing 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 protected, 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 uld be content to 154 TWENTY-SECOND NATIONAL CONFERENCE OF CHARITIES 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 legislation such a series of laws as shall prevent the tremendous increase 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. I We cannot, at present, secure the legislation which shall prevent the marriage of epileptics, that most prolific source of imbecility. 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 Cæsar 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 reformation 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 fullfledged 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 Feebleminded Women stated that about twenty per cent. of the whole number of inmates received had borne illegitimate children. A faithful E 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 supporting them. 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 disgrace at the birth of an illegitimate child among their charges which any superintendent of an institution would feel under like circumstances? THE TRAINING OF AN IDIOTIC HAND. BY SAMUEL J. FORT, M.D., ELLICOTT CITY, MD. There is no part of the human anatomy that challenges more admiration than does the hand. There is no more remarkable organ, not vital. Its sensitiveness, suppleness, delicacy of movement, beauty of form, its marvellous range of adaptability, make it one of the most wonderful parts to be found among animal organisms ("the consummation of all perfection," as Sir Charles Bell describes it), the anatomy at once simple and complex, the mechanical arrangement of the wrist, joint and fingers, the completeness of its muscular complement. The normal hand, while capable of far more than has yet ever been developed, represents the sum total of its owner's accomplishments; and upon it we depend in great part for our daily bread. The hand of the idiot, of whatever his grade, marks the limit of his deficiency. There may be, and probably are, the same general anatomical components going to make this hand as make the normal hand; but rarely do we find it without some anomalous conditions, showing only too clearly the intimate relationships between physiological and organic disorder. We shall find short, stumpy fingers with thickened joints, or long, slender, and clawlike fingers; instead of the flexible, dextrous, smooth, and frictionless movements of the OF he 156 TWENTY-SECOND NATIONAL CONFERENCE OF CHARITIES trained hand, stiffness, tenseness, and even rigidity, or in its place a soft, flabby, cartilaginous mass of apparent pulp, with here and there the faint suspicion of bones. Combined with these conditions, of course,- for we are speaking of a class of deficients, will be found the inability to move the hand freely from one object to another or even directly toward an object when the will speaks to it through the sluggish motor sysThis hand must be trained, first, to prehend, to tem of nerves. grasp, and, having the object in possession, to retain it and relinquish it at command. This is evidently the first use of the normal hand, and we must begin at the very bottom with our abnormal hand. It must be taught, first, the simple movements that combined will prove useful; and in this teaching it must be borne in mind to start always from the lowest to the highest, to go from the It must be purely automatic movements, such as the grasp of the new-born babe upon the extended finger, up to the more intellectual movements which start from and depend upon the ability to grasp. gradually taught to become aggressive, in that it is to be used to assist, to protect, to bring into active association with all external objects, the ego back of it,-to carry things to the nose to smell, to the mouth to taste, to utilize the wonderful sense of touch so especially developed in the skin of the hand, to become useful to itself and others, and at last to be able to work, to accomplish some definite object, the reward being the support of the individual. Now, how is this to be done? It would furnish material for a book to cover thoroughly this part of my subject; and I may only glance briefly over the field of work as pursued in our institutions for the feeble-minded, and perhaps be able to mention some original work as carried out in my own home school. The elder Seguin suggests the use of a ladder to bring out prehension, but I have found with many cases it is better to use a table or window ledge. In this lesson the child is placed first by the table, with its hands upon the edge, the feet firmly upon the floor, the back being supported by the two hands of the trainer placed beneath the arms of the child (a point in lifting or supporting any child that should be insisted upon by all mothers). The table is always high enough to demand some exertion of the arms to maintain the erect position and just see over the edge. Then, if in no other way, the attention of the child can be drawn to flowers or cake |