is in a position to do. There is a certain idealism, or, as the preceding gentleman has said, a prophecy in the paper, and I should like to say that I hope this prophecy will become a fact, the same way as the first prophecy that Dr. Peterson made years ago about the Colony for epileptics has become a success in so very few years. That sort of ideal which is realized in experience I think ought to obtain the ear of every rational person.

There is surely a great difficulty involved in the arrangement of psychopathic hospitals and colonies, as Dr. MacDonald pointed out, and it would seem that for some time there will be a sort of a transition stage, but we should not allow it to be more than a transition or less than a transition stage. Surely the present asylums, or hospitals, as they really deserve to be called, are doing a great deal that makes them ready to take up the acutely insane, and they will for a long time go on in the same capacity in which they are now. But there is a field for a certain number of institutions and I should say there is even a duty in making a certain number of small institutions, and for a further reason. Those of us who are engaged in the scientific investigations of insanity have so far had an opportunity only in the very large hospitals. Personally, I began in a hospital with 2,200 patients, and now I am in a hospital with 1,100 patients, and I think I can see that the attempt to do scientific work under the pressure of so much opportunity and duty is almost crushing. I believe that scientific work, if it is to be done on that most difficult topic of psychiatry, must not be overcrowded from the very start by too bulky material, and since the State monopolizes all the care of the insane, and since only the care of the insane teaches us what insanity is, I think it is the duty of the State to see that those who get the training shall also communicate their knowledge to the practitioner, in whom, after all, the greatest opportunity rests with regard to the prevention and early recognition of insanity. On the plan of large asylums, it will be always very difficult to get together that material of facts which is necessary for teaching; and I should

suppose that a recognition of our need for more accurate facts for purposes of teaching will form an additional impetus toward the foundation of at least a small number of psychopathic hospitals.

It was in one small Scotch institution that I observed the importance of moderate size, during an extensive trip in Europe this last summer, and that I saw these conditions brought clearly to my mind. In the German clinics, which are made mainly for investigation and teaching, or, at least, are located essentially with that purpose in view, you have all the advantages; and in Great Britain and Ireland and Scotland, I had an opportunity to see at least in one place the fruits of having a relatively small hospital in the hands of a man who is anxious to do work. He told me that from 10 to 2 he is able to do the administrative work. The rest of the day he finds time to devote to his scientific investigation. The reason is that the hospital is one of only 300 beds for acute and chronic cases; 80 patients are admitted every year; consequently there is a certain proportion within reasonable possibilities of keeping up accurate records and making investigations. What is actually done in that place I should like to see done in more places; but I am afraid it would be exceedingly difficult to do it in any large hospital.

It is with a plea that the interest of the State in the education of the physician should be an additional impetus toward the promotion of the grand plan of Dr. Peterson, that I thank you and Dr. Peterson for the opportunity of this afternoon.

Mr. JAMES F. JACKSON, Assistant Secretary, Charity Organization Society, New York city. In the first place, Mr. Chairman, I would like to express, as a former resident of Minnesota, the appreciation which that State has for the New York system of caring for the epileptics; also the appreciation which it has for Dr. Peterson's scheme of the cottage system of construction for the care of the insane, the epileptic and the feeble-minded. It is as impossible to obtain an appropriation in Minnesota for the con

struction of any institution for the care of the mentally defective except on Dr. Peterson's plan as it is for water to run up hill.

You may be interested in knowing that because of legislation recently passed it is unlawful to put a person in a prison in Minnesota because he is mentally sick. It is necessary that other provision be made for detention and care. Dr. Peterson will be interested in knowing that detention hospitals must be provided in Minnesota cities having more than 40,000 population.

The particular thing I desire to speak about is a method of care considered from the standpoint of the taxpayer. It has been my business for the past three or four years to study these questions from that point of view, and I am convinced that the psychopathic hospital is an economy. I believe it is the cheap as well as the scientific way to care for the acute insane. Give the most expert specialist whom you can find an opportunity to deal only with the acute insane; of course, have at the hospital enough of the chronic insane to perform the ordinary labor. Then let this skilled specialist devote his abilities to curing the acute cases and see what he can accomplish. The physicians say they can cure a certain percentage of the insane if they have an opportunity; it will pay to give them a chance. I am told that the average hospital life of the insane in New York State is twelve years. Aside from its being humane, it certainly is economical to cure a man in a year or less at an annual cost of $400 or $500, rather than to keep him twelve years at an annual cost of $130. No one will pretend to keep him decently at a less per capita cost.

I am satisfied that after full investigation the taxpayers will stand by Dr. Peterson's plan, and I congratulate New York State on the humane and economical system which she is developing for the care of her insane.

Mrs. M. C. Dunphy, Superintendent of Randall's Island Asylums and Schools, New York, read a paper on "The Training and Employment of the Feeble-Minded."

TRAINING AND EMPLOYMENT OF THE FEEBLE-
MINDED.

The first consideration in the training of the feeble-minded must necessarily be to elevate this dependent class and make them less burdensome to their friends and to society.

Undoubtedly one of the most important preliminaries to the training of the feeble-minded is the selection and assignment of the teacher. To be a successful teacher of this defective class one must possess not alone those qualities essential to the teacher of normal children, but exceptional degrees of patience, perseverance and tact.

During my experience I have been enabled to observe the attempts of several teachers of normal children to assume charge of feeble-minded classes for short periods. These attempts were invariably failures the teacher expecting too much from some of the children and concluding, too hastily, that nothing could be taught to others. They simply lacked sufficient experience with this class to realize and appreciate the varying moods of these children.

There is one fact which should be borne in mind, and it is this: There is no cure for feeble-mindedness. This unfortunate condition is, in most instances, born with the individual, and while the condition may be changed in varying degrees, something useful taught and retained, there never is effected a transformation to the level of the normal. This fact is well understood by all of us who have had real experience in the arduous labor of educating, training and caring for the feeble-minded. But there are those among us who, while interested philanthropically in this work, possess and express the belief that much can be accomplished with this class, that we, the initiated, know to be entirely outside the range of the possibilities.

While they have often expressed the belief that many of these defectives, after several years of training in an institution, may be sent out into the world to be self-dependent, the fact has been well

stated by Dr. Martin W. Barr, Superintendent of the Pennsylvania Training School for Feeble-Minded, of Elwyn, that they need at all times to be under supervision, that they may be "protected from the world and the world from them."

The visitors to the institutions see the inmates at their best. They see the results of years of patient training in the work that is being then accomplished by the pupil and conclude that the worker is fitted to enter the world and seek employment in whichever trade he or she may be skilled. We have seen universal fail'ure result in the many cases that have come under our observation.

Experience has shown that it requires years of patient training by the best methods applicable to develop partially the moral and intellectual faculties of this class and, as these defective mental powers are generally accompanied by an imperfectly developed physical organization, the training of the physical powers is of the utmost importance, as on this enfeebled physical condition largely depends the retarded growth of the intellectual power.

The mental effort of which a child is capable comes first with physical activity and observation through the senses. With the advancing development of the senses there develops a corresponding use of the body and limbs; at the same time feeling must be aroused, for feeling is the foundation of all thought and action, after which the will comes into play, and finally the intellect.

To arouse these dormant powers in the feeble-minded, it is urgent that a system of combined physical and mental training should be begun at a very early age, as it is noticeable that the habits formed during the plastic and impressionable periods of their lives are difficult, I may say almost impossible, to eradicate. It is therefore most important to correct undesirable habits before they have become deep-rooted by years of practice, and so also should the hands be trained to intelligent movements as soon as the first departure from the normal is discerned.

Such training is rarely to be attained in the home, where most frequently the unwise though natural indulgence of the parents leads to the production of selfishness and difficulty of control.