SOME DEMANDS MADE UPON THE STATE FOR

THE CARE OF THE FEEBLE-MINDED.

By T. B. Lacey, M. D., Third Assistant Physician, Institution for
Feeble-minded Children, Glenwood, Iowa.

The legislature of Iowa convening in the year 1876 passed an act providing for "the organization and support of an asylum at Glenwood, in Mills County, for feeble-minded children," the object of which was "the care, support, training and instruction" of this unfortunate class of persons. Upon examination of the report of this institution we find that at the end of the first year the enrollment consisted of 85 children; 52 males and 33 females. In those days the term "feeble-minded" was perhaps not well known to all, yet when used it did convey to the mind of the hearer the thought of idiocy and foolishness; that the afflicted family bore a certain stigma which made them conspicuous in their neighborhood. There surely must have been a sigh of relief to those families, in the heart of which dwelt one of these pitiable creatures, as the state extended its arms to them in its offer of what aid and help could be offorded in those times.

Since the establishment of the institution there has been a continual onward and upward growth, agreeable to the increase in general population, until to-day instead of a few children we have a total of 1,466 inmates of varying degrees of mentality ranging from the high-grade moron to the idiot. Instead of a building or two, the state of Iowa is the owner of a large and well-known school, consisting of some twenty buildings, all substantial and fitted eminently for the purpose of housing this ever-increasing family of deficient children.

You noticed I used the word "ever-increasing," and perhaps this conveys to your mind the thought that feeble-mindedness is increasing. If you please, I do not wish to give the impression that our race is degenerating, but rather that science has made such rapid strides that the detection of our weaker members is made with much more facility. Without doubt there existed at that time a percentage of feeble-mindedness somewhere near the percentage of to-day, but our population was not so great and the means of ascertaining feeble-mindedness were not as well advanced as they are to-day.

Let us see for a moment what science has done for us. The question of feeble-mindedness has been moulded until now the authorities have agreed upon a certain classification. The Binet-Simon tests have enabled the

special worker to give a mental age acceptable to working institutions, and physical examinations have aided in overcoming certain difficulties, until to-day we stand well above the thoughts of the past and look forward,-not to a smooth highway of action, but to perhaps far rougher roads than those our predecessors traveled.

The identification of the idiot, the medium and low-grade imbecile has been advanced and a great deal has been done for them, but what about the high-grade moron, the border-line cases? Has this puzzle been solved? We regret to say that it has not been solved, and it will be perhaps a long time before a solution is accomplished that will rid the state of this dread proposition.

Perhaps I should make myself plainer in regard to the class of which I am speaking. I refer to that class of individuals who infest the streets, the large department stores, the large manufactories, where labor is in demand and small wages prevail, the individual of fast habits and slow reasoning powers.

Mind you, I do not make the statement that all who participate in these industries are of this class. Let me cite, if you please, a single instance referable to them. I have in mind a large retail department store, employing a number of clerks.somewhere near the thousand mark. Now it is a known fact that the business of this concern amounts to less during the morning hours than during the afternoon hours. The result is an increased number of clerks during the afternoon. Where do these clerks come from, and what can their condition be that an afternoon's work suffices to clothe, feed and house them? We know that the wages paid for such service is not in itself a living wage. Upon close questioning a number of these clerks we found that some of them sometimes paid for the privilege of their afternoon employment, relying solely upon the hope of attracting some man and securing from him money wherewith to provide themselves with the necessities of life. Personal attraction, playing a large part in their existence, is carried along until we see them the dernier cri'' of fashion, if their living has been anywhere near successful.

Our cities naturally furnish the greater proportion of such a population. Coming from parents of perhaps fair mentality we catch our first glimpse of the future trouble-brewer in the public schools. The lessons are always incomplete so far as the public school is concerned, but the lessons furnished by the streets and side alleys are well and wonderfully mastered. The hesitation in accepting the teaching of the grades stamps the child, in the mind of the teacher, who is not trained in the detection of the deficient, as one who is a sluggard, a dull specimen, incapable of mastering the simple problems presented. What happens? This teacher has neither the time nor perhaps the inclination to devote to this dullard. She must produce results. She is a cog in one of the wheels which must produce. She must show up our new and terrible word, efficiency. What can she do? Why, pass the member on to the next higher grade and let some other teacher handle the problem. Can you blame her?

Time passes and our future citizen, responding nicely to the teachings of the low grade, back room pool hall, and the saloon around the corner, becomes quite proficient and starts out on the highway of life. The graded school is shunned now, as he feels that only the foolish stay and ponder over book problems.

Perhaps some minor employment is taken up during the day but at night our pseudo-man is down among the boys. The public park, and free and easy dance hall, the secret drinking resort, each contribute to the false education and it is only a short course, in the case of a boy, to petty thievery, criminal assault, and disease, which lead on to the police court. In the case of a girl, the path takes the usual way of early and illegal maternity and disease, and in a short time ends also in the stall before the city police judge.

If the boy or girl happens to be below the legal age, the authorities have recourse to the industrial schools or the reformatory, but if above legal age the court may decide that the person is feeble-minded and therefore he or she is forthwith committed to the Institution for Feeble-minded Children at Glenwood, to which transportation is duly furnished.

We have at this institution a general class capable of being easily impressed, and when this product of the city comes into this impressionable class his or her superiority is soon recognized. As the ones who have been with us longer and who are larger in number become acquainted with the new arrival, they recognize a natural leadership in the newcomer. They listen with avidity to the recital of deeds which to them are strange and wonderful and the newcomer, seeing his influence, seeks to strengthen his position and stands now as a leader. You cannot imagine the baneful influence exerted by these new arrivals. The minds of our children become stimulated to a certain degree by the stories of the streets and soon little plans, little schemes, are concocted with the aid of the self-appointed leader, and no little trouble results.

Is this fair to the new, high-grade moron? Is this fair to those lower in mentality? I believe you will bear me out in the statement that it is not. There is no doubt but that our high-grade morons are capable of receiving higher instruction than the medium-grade, not alone on account of a probable school course previously accomplished, but also from the fact that they are border-line cases and much brighter than the medium-grade. Being used to a more or less free life, they chafe under such restrictions as our institutional care demands and such discontent they aim to spread. It is plain to be seen that this class demands more close confinement and more discipline than is usually afforded at an institution for feeble-minded. It seems that such cases could be handled more easily, and that more progress could be made if they might be held at some institution in which reformatory or semi-reformatory methods prevail. Among boys at such an institution as the feeble-minded, there seems to be the continual desire to run away and mix with the world. And should they return, either of their own free will or with the company of a parent or an officer, the entire act is repeated at a time not far distant from their readmission.

If not detected in crime and sentenced, this type usually live in illegal wedlock, after having betrayed a number of like specimens of the opposite sex. Sad to relate, they propagate with unusual regularity, six or seven children being a frequent number, and these six or seven go through the same process as those before them, adding to the woes of life the care of city and state.

What is the outcome? What will be the result? What solution can be offered? Obviously state supervision and restriction can play but little part in the starting of relief. Since manufacturing conditions, living conditions, and social conditions vary in different communities, just so much must the ways of working differ. A river city has problems to overcome that the inland town does not face, and the opposite holds true. Perhaps the different societies for the promotion of civic welfare can do some solving. The large number of social workers here have a problem to clear up, but they must keep in mind that the state of Iowa is doing as much, if not more, than any other state in taking care of its dependents. We frequently find that such social workers complain and say that we do not evince as much interest as our neighboring states, but if they will study the annual reports of institutions of like character, in any of the states, they will be surprised to learn that Iowa stands among the very first in taking care of her needy.

In dealing with the high-class moron let Iowa make an advance to a problem not confronting this state alone, but all other states, particularly those to the east of us. Read your reports of vice commissions, read your reports of welfare organizations, and, finally, read the action taken by the various legislatures. They all deal with this subject. They have tried to master the question, but have accomplished naught. Huxley says, "The great end of life is not knowledge, but action." Then let such action be the watchword of this state, let the various cities or counties organize, and let such organizations include workers, not drones. Let them investigate conditions in their own communities, and take such general action as will be of benefit to them. Let them suggest constructive legislation. We all know that destructive legislation is accomplished with a certain amount of work, and we also know that constructive legislation is gained only with an amount of labor far in excess of that needed in the former class.

I believe that the last census of the United States states that Iowa has a less percentage of illiteracy than any other state in the union. Surely a good step in the right direction.

When a builder wishes to insure stability to a structure he is erecting, he first makes firm in his mind that the ground upon which he places his foundation is more than able to sustain the load he will impose upon it. Just so in our case. Let the foundation or the educational element stand forth preeminent in the growing child's life.

If the builder finds some material that varies ever so little from its right alignment, he lays it aside in the thought that it may be used elsewhere in his structure. Just so with us. If we find an individual varying a little from the normal line, let him be given another place, perhaps with

some responsibility, yet with a stronger element overshadowing him and keeping him in his proper station.

For the building stones of no value the builder removes from the site that they may not mar the aspect of the completed structure. We are doing that in taking from your towns and cities those unfortunates who, through no fault of their own, are unfit mentally or physically to go toward the upbuilding of the structure of this commonwealth.

Innumerable propositions have been offered as dealing with our highgrade morons, but the probable beginning will be in separating them from the normal individual at such an age as their deficiency first manifests itself, that is, before they acquire their vicious habits and before they have an opportunity to reproduce. Such action can only be reached by having trained psychological workers as an integral part of our school system.

After segregation the problem becomes deeper, for what can we do with them. Plainly this class is so large that they would demand an institution of their own, as their mental attitude prohibits them from proper classification and treatment in any of our existing institutions.

The old saying is that Rome was not built in a day, and we likewise cannot hope for the much desired solution in such a corresponding time. My only hope is that perhaps what little I have given you here may serve as an incentive to you to press forward and be one of the foremost in the van to solve this urgent question.