STATE PROVISION FOR THE FEEBLE-MINDED.

JAMES WOOD.

I shall not attempt to enter upon a discussion of the general subject of the care and treatment of the feeble-minded. The literature upon that subject is already very extended, and I could not hope to add anything of value to its scientific discussion. It is my purpose to present to you some practical considerations concerning the present situation in our state. I approach the subject from the point of view of a manager of the State Reformatory for Women, where we receive among our miscellaneous commitments an unfortunately large number of those who could be properly classed as feeble-minded, and whose condition is such that we cannot hope to materially benefit them by our educational and industrial training. It becomes our duty to endeavor to place them where they can receive the necessary custodial care without unnecessary expense to the state. We have from time to time made application to the state institutions for the care of the feeble-minded, and in nine years we have been able to obtain admission to these institutions for only two of our inmates, and these were obtained through the officials of the county from which they were committed. We have sometimes had as many as five decidedly feeble-minded inmates at a time, and since it has been found practically impossible to have them cared for in state institutions, it becomes a practical question of great importance to us as to what disposition can be made of them.

Insanity, epilepsy, and feeble-mindedness are the three neurotic diseases that require public care. For this the state of New York has made extremely large outlays. The capital invested in institutions for their care is probably greater than the amount, expended by any other state in the union, and, so far as I have been able to ascertain, is greater than that expended by any other nation in the world. The cost of maintenance of these institutions is very great, and yet our tax-payers, without serious` complaint, approve of the appropriations made for these purposes. It surely indicates a high state of civilization when those who bear the financial burdens of the state are thus willing to sacrifice themselves for the benefit of the needy and suffering. But

manifestly, there must be a limit of these expenditures, and it is the part of true wisdom, carefully to examine the possibilities of attaining the desired end without unnecessary expense to the public. A careful consideration of this subject seems to be eminently fitted for this conference, for while our primary interest is the improvement of the unfortunate, the whole subject, from every point of view, should be thoroughly examined before we reach definite conclusions.

From such consideration as I have been able to give the subject, it appears to me that the first need is the more thorough grading of our present institutions. The managers of these institutions have from year to year in their reports to the Legislature called attention to this need. They have shown with great clearness that the best results cannot be accomplished with a mixed and heterogeneous collection of inmates, and they have also shown the necessity of the complete separation of the sexes. Where they are placed in the same institution much additional care is required, and necessarily there is loss of space in the separate housing and training of them. If all the boys at Rome and Syracuse were placed in one institution and all the girls in another, the number cared for might be somewhat increased. In the treatment and educational work of the inmates at Newark better results could doubtless be obtained if those capable of mental training and development could be placed entirely by themselves, while those who only require custodial care could be maintained at less cost if completely segregated. The plan for the new Eastern New York State Custodial Asylum to be known as "Letchworth Village," with its extended area and opportunity for a large number of detached buildings, seems to provide for that grading which would be most economical and effective. While this new institution is designed for the care of a great number, its capacity will doubtless soon be reached and the state will then be confronted with the same problem it is endeavoring to meet to-day. If these dependent unfortunates were only those who come from our own native population the situation would not be so difficult, but with the tide of immigration of the lower classes of society constantly pouring into our great seaport, New York is compelled to bear much more than its own proper burden, and if this immigration continues the special difficulty which we are considering will be enhanced.

Dr. Martin W. Barr, of the Pennsylvania Training School for Feeble-minded Children, has said: "We must have some clear,

positive standard by which we are to discern and separate the unimprovable from the trainable, lest we deceive the public by false hopes and accept those for whom we can do nothing. Again, the necessity for much individual work--the varied capacity of those to be trained, and the impossibility of bringing all up to one common plane necessitate the arrangement of grades in which very different means of development may be employed to attain very different ends." There are, broadly, two classesthe imbecile trainable and the idiot, unimprovable. The imbecile - trainable are in three grades: low, middle and high, with the moral imbecile in a wretched class by himself. He is sometimes very bright on some lines, but is a most dangerous menace to society, of whom a certain jurist used to say "the kind we hang."

My purpose in calling attention to the need of better grading of the feeble-minded is to suggest that the capacity of existing institutions would be somewhat increased by such a course and the expense to the state could be diminished; but my special purpose at this time is to call attention to another practice that has been found satisfactory in some European countries and which I believe could be employed here to great advantage. I refer to the grading of patients before they are sent to any institution. If all these could be intelligently examined before they are sent from their homes and could then be sent to the special institution designed for their class, much benefit would result. But I specially want to suggest that a considerable portion of the number could be more economically and perhaps advantageously cared for without being sent to any institution whatever.

The feeble-minded are of every conceivable grade; from those but slightly below the normal to those who are completely demented. These are found in all classes of society. Of course, where their families have abundant means they can be cared for without public assistance and, as a rule, only such receive state aid as are pecuniarily unable to provide for private treatment. If such as are in the better grades below the normal could be properly cared for in their own homes or in private homes that may be secured for them by such aid as the state may give, it would be better for the individual patient to have such treatment rather than to be placed in a public institution for however good the public institution may be, it still lacks the peculiar advantages found in proper private families. Of course this must be more than mere "board

ing out" and each patient must have the benefit of frequent official visitation.

Serious difficulties to this proposition will at once arise in the minds of experienced persons: In the first place a sadly large proportion of those homes are not such as to give the best surroundings and care, but it is very easy to magnify this fact into undue proportions. It will also occur to many that state aid for private support of these unfortunates will open a channel for serious abuse and many applications would be made for public funds, where without this provision no claim would ever be made for public support. These and other difficulties are at once admitted, but it is believed that they can all be met and overcome by proper supervision.

There are classes for whom complete segregation is absolutely necessary, such as the idiotic and the moral imbecile. In addition to these are the feeble-minded women of child-bearing age. It is well known that these require protection that can be found only in the isolation of an institution. They very often have. evil tendencies in themselves, but whether they have such or not, they are the easy victims of designing and degraded men. Of those committed to the State Reformatory for Women, many bring with them the sad results of this evil. Such unfortunate women are a menace to any community, because it is peculiarly degrading to take advantage of the weak and helpless. Viewed from another side, such women are a menace to any community because they reproduce their kind with deplorable certainty. Statistics to prove this are abundant. It therefore is at once apparent that all feeble-minded girls from their earliest maturity until they have passed the child-bearing age should be cared for in such isolation as will secure their own protection and the protection of the public. Those whose mental powers are of the lowest grade should be cared for only in custodial institutions. But after we have eliminated all such as require such custodial care, there is a vast number remaining who might be provided for with benefit to themselves, and with relief to the community in private homes.

To accomplish this end a thorough systematic organization on the part of the state would be imperative. We will suppose that the several Judicial Districts be taken as units for this work, and that in each one a properly qualified person be appointed to examine every individual for whom there is an application for state

aid. That official could readily determine whether the patient should be sent to an institution and if so to which one of those available, or whether it is a person suited for private treatment. The same official, or some other, should have the duty of examining the home of the patient, or such homes as may be available for them. The work is very similar to that performed by the parole officer in our reformatories. The parole officer of the State Reformatory for Women visits the homes of all persons to whose care inmates are paroled, and also of all persons who make application for paroled inmates, for domestic service. Practice in this work results in very keen perception and where the officer has sound judgment very few mistakes are made. The amount of compensation to be given in any case must be determined by the individual conditions. Many of the better grades of the feeble-minded are capable of meeting the cost of their support by their service in the household or upon the farm. Others can do this in varying degrees. A skillful adjuster could easily determine these points. In many of the rural districts of our state families would be willing and often glad to have the service of such persons and the value of such service, where necessary, could be supplemented by such weekly payments as may be agreed upon. It may be safe to say that an average of two dollars a week would meet the requirements of most cases, and the result would be a very considerable saving to the state, a great benefit to the individual patient, and a great relief to our institutions from the pressure that is now upon them.

There is another advantage in the system proposed. There are a great many cases where arrangement might be made for the unpaid home care of such as are now unreservedly turned over to the state.

This work can be properly performed only under state supervision and by state agencies. It would not meet the requirements of the situation to turn it over to county officials. The history of our county almshouses and county jails warns us against using county officials for so delicate a work as that we are considering. Some might be qualified for it, while the majority would either be incompetent or would neglect it in various degrees. A state agency would require special qualifications of those engaged in the work, but persons suited for the task can be found and the state can well afford to employ them. The plan we set forth has been employed in some parts of England, with very satisfactory results.