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Charles Richmond Henderson.

Introduction to the study of the dependent, defective, and delinquent classes, and of their social treatment online

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than self-supporting, for a man must support several persons by
his labor. " If a feeble-minded laborer does one-third of a full
man's work, or just as much more as will make up for the extra
supervision required because he is feeble-minded, then he earns
his own living."

8. Public Opinion. — It is of the first importance to create an
intelHgent public judgment, based on knowledge, in respect to the
entire system of agencies necessary to diminish the evils of feeble-
mindedness. Facts must be more generally understood as a
condition of improvement in the situation. Such enlightened judg-
ment will slowly modify the customs and habits of family Hfe. It
will, in some slight measure, tend to prevent foolish marriages
between persons physically unfit to become parents. It will tend
to induce mothers to remove their feeble-minded children, even
though it costs them many a pang, to institutions where they can
enjoy suitable educational advantages and the society of those like
them, without being exposed to the sufferings and humihations
incident to Hfe with normal children and youth. It will tend to



Education and Custody of the Feeble- Minded. i8i

diminish the pressure and nerve fatigue caused by the feverish
haste to be rich, to shine in the wasteful ways of fashionable
society, which result in imperfect births. It will tend to emphasize
the social value of physical culture of boys and girls with refer-
ence to their future functions as parents.

An instructed public judgment will demand and provide for
educational and custodial establishments for all the feeble-minded
whose presence in families and communities is a perpetual source
of danger and injury. The unfortunate and helpless persons of
this character who are at present kept in jails, county poorhouses,
or left to wander about as the butt of ridicule and thoughtless
sport, or the victims of lust, will be provided with permanent
homes in isolated agricultural colonies, held in gentle and safe
custody, enabled to produce their own food, and so to live happy
and contenteei lives, without becoming the irresponsible progeni-
tors of a miserable posterity.

A movement has begun to enact laws prohibiting the marriage
of defectives. This may help to educate pubhc opinion, limit the
number of mock and immoral marriages, and compel the forma-
tion of permanent asylum colonies. But the prohibition of legal
marriage and the penalizing of illicit intercourse are not adequate
remedies, because many of this class do not understand morality,
law, or penalty any more than animals. Custodial institutions will
still be necessary to prevent the propagation of degenerates.

The earlier efforts to provide for the feeble-minded aimed
chiefly at education and training for independent Hfe. The insti-
tutions were simply temporary schools for preparing children to
return to free hfe in the world of competition. But now all com-
petent authorities agree that the former hopes of education for
normal life were far too optimistic. Very few can be developed
to the point where they can elbow their way in competition with
vigorous, strong, and capable persons and protect themselves from
harm and deep degradation. This expert judgment lays a moral
obligation on legislatures to make permanent provision for most
of the seriously defective in custodial institutions. A few common-



1 82 Relief and Care of Defectives.

wealths have already adopted this principle, and with the others
it is simply a question of time and earnest effort when they will do
their duty.

A few private schools have been erected for the care of unfortu-
nate children of wealthy parents, and the demand for them seems
to be growing ; but voluntary enterprise is a mere incident, and
no power short of the state government can supply the need and
protect the community. Whether relatives who have means should
be required to pay in state institutions is a question which will re-
ceive diiferent answers according to the customs of the state. It
would seem that the same principles which govern the asylums
for the insane are valid here ; and that the state should care for
all gratuitously without class distinctions of any kind.

9. Is it Best to provide for Epileptics together with the Feeble-
Minded ? — Authorities differ in judgment on this point. Prece-
dents exist for both methods. Where the public has as yet been
unable to discriminate between these two radically different kinds
of defect, and has not yet been educated to make full provision
for separate care, it is sometimes possible to secure legislative
appropriations for one institution, while an attempt to found two
schools would almost certainly fail and postpone the entire enter-
prise. Medical, educational, and custodial requirements seem to
compel at least separation in the same colony, even if under the
same management. In the process of specialization it is probable
that the separation will occur when the numbers of each class be-
come too great for a single management.

10. Slow Children. — Children who are simply slow to under-
stand and backward in learning, but sound in brain, should not
be classed with dependents, although they require special methods
of teaching in pubhc schools and separate instruction. Many can
be taught to work, through sloyd and manual training methods,
who profit little by learning to read and write, and who even for-
get the arts of reading and writing. Rural life is far more favor-
able for them than rapid, exciting, and stimulating city life ; and
parents are wise who train such children, as early as possible, for
horticultural or agricultural pursuits.



CHAPTER III.

SOCIAL TREATMENT OF THE INSANE.

1. Nature of the Defect. — Insanity is a very vague term and is
not capable of exact definition. In popular thought and speech
there is great confusion. The word connotes a serious disease of
the nervous system, especially of the brain, which is manifested
by abnormal expressions of the intellect, emotions, and will. The
term "insanity" is not with accuracy applied to those temporary
mental disturbances which accompany intoxication or fever, trance,
ecstasy, or catalepsy ; nor to the effects of arrested development
seen in the feeble-minded.

2. Forms. — In the census of 1890 the forms are distinguished
as acute mania, dementia, epilepsy, chronic mania, paresis, mono-
mania, and melancholia. The kinds of mental disturbances vary
at different times and stages even with the same patient, and one
form passes into another and comes back again. There is no
absolute line of distinction at certain points. Dr. Hammond,
following Esquirol, found the following definitions useful for pro-
visional statement. Melancholia is marked by perversion of the
understanding in regard to one object or a limited number of
objects, with predominance of sadness or depression of mind.
Monomania is perversion of understanding, limited to a single
object or small number of objects, with predominance of mental
excitement. Mania is a perversion embracing all kinds of objects,
and is accompanied with mental excitement. Dementia is inca-
pacity for reasoning, from the fact that the organs of thought have
lost their energy and the force necessary for performing their
functions. Imbecility or idiocy implies such an imperfect devel-
opment of the organs that the persons afflicted cannot reason

183



184 Relief and Care of Defectives.

correctly. These distinctions are based primarily on the psychical
manifestations of disease ; but another classification might be made
which would rest on variations in the character of the nervous
injuries which cause the mental defects and disturbances.

3. Causes. — All that hurts the nervous system, enfeebles the
body, drains the energy, has some tendency to produce brain dis-
order. Among the external causes may be chosen for illustration,
insufficient nutrition, frights, shocks, strokes upon some important
nervous branch or mass. Inflammation, pressure, lesion, and
degeneration of tissues are internal causes. Indirect stress
includes the mental changes occurring at puberty and the meno-
pause, abnormal sexual activity, excesses, child-bearing, and fevers.

Social circumstances unfavorable to health are often influential.
Here may be cited all that affects the livelihood, as exhausting
employment, fluctuations in business, precariousness of income ;
unfavorable conditions in the family, as quarrels, disgrace, fear,
neglect, jealousy ; disturbances in social order, riots, war, strikes,
the excitement of campaigns ; morbid and irrational methods of
conducting religious revivals.

The weakness and defects on which these forces play are inher-
ited ; and if both parents are feeble or imperfect in structure, the
tendency to transmit the defect is increased, especially if the
parties are near of kin.

4. The Social Situation of the Insane. — The psychical peculiar-
ities and abnormal states of the insane, if serious and prolonged,
have certain important social consequences. There is frequently
a danger to the other members of the family and to neighbors
from the actions of the insane ; not so frequently as is popularly
imagined, but still often enough to require attention and in all
cases suitable measures of defence. Life and property are imper-
illed by those who have a homicidal tendency, or who are violent
and destroy furniture, clothing, and other goods. Even if there
is not serious menace to person and property, the entire life of a
family may be disturbed by the peculiar habits of those who have
become mentally diseased.



Social Treatment of the Insane. 185

In various degrees the health and property of the patient are in
peril from this misfortune. His industrial, domestic, and other
civil relations demand of him conduct which he is unable to mani-
fest. He is more likely to become dependent on the community
for support than are persons of normal health. He requires medi-
cal help, and that of a kind which cannot be enjoyed outside of a
hospital specially devoted to this form of disease.

5. Popular Instruction. — Information in relation to the nature^
manifestations, and causes of insanity should be popularized in every
possible way in order to lead people to know and avoid the causes
of nervous disease ; to make it possible to recognize such diseases
in the very beginning, when hope of prevention or cure is greatest ;
to diminish the absurd, unreasoning, and superstitious horror
with which insane persons are often regarded ; to render the
services of magistrates, lawyers, and jurors in trials involving the
insane more competent ; and to induce the public to provide for
all the insane in such institutions as are demanded by modern
science.

6. Private Hospitals and Retreats. — These agencies supply a
legitimate want. Private physicians, specialists in this class of
diseases, can treat many cases better by having control of hospi-
tals built expressly for treating nervous persons. Sometimes a few
weeks of quiet, under the care of a specialist, will restore health and
ward off permanent insanity, especially if the neurotic symptoms
are observed and properly interpreted in the premonitory stages.
In the nature of the case these private hospitals can serve only a
small class, chiefly those of independent means, and it is almost
entirely a private affair. The state, however, must supervise and
inspect such establishments in order to prevent illegal confine-
ment, and assure scientific administration and treatment, with
secure and sanitary conditions in the houses.

7. Theory and Practice of Support of Public Hospitals. — The
social motives for supporting hospitals and asylums, are social pro-
tection, benevolence, communal rights of taxpayers, and mutual
insurance. The necessity for social protection alone is sufficient



1 86 Relief and Care of Defectives.

to justify state provision for the insane. The idea of charity is a
factor also, because it is ever present in the complex of incentives
which actuate a civihzed community, and because many of the
patients are dependents.

But those who pay taxes may reasonably claim that they are not
paupers, when they are cared for at pubUc expense, since they
have paid their share for the support of such institutions in health,
and, if they have property, they continue to pay taxes. There is
no reason in justice for making them pay twice for the protection
and treatment which they receive. Even working people who
have no assessed property have indirectly paid taxes to the gov-
ernment in the form of revenue tariffs and taxes on rented houses.
In reality all effective producers are taxpayers and have social
rights as such. The analogy of the public school is here sugges-
tive ; all pay and all have a right to enjoy the privileges of this
educational provision.

Patients in the hospitals who are able to pay for extra attention
and comforts sometimes receive them. But this introduces in
state institutions a difficulty in administration. There is danger
of showing partiality and arousing the sense of injustice. The
extension of the colony system of cottages or detached wards, or
of the boarding-out system under state supervision, may aid in
overcoming this obstacle. It is difficult to make any distinctions
in treatment, even when required by the needs of a patient, if all
are living together in a long corridor.

It has been urged in favor of requiring the competent to pay,
that the income received would provide for many of the poor
insane who are now crowded out of state institutions and imper-
fectly treated in almshouses. But this is a mere evasion of the
plain duty of the commonwealth to furnish suitable care and cus-
tody for all its insane citizens. Relief should rather be sought by
prohibiting counties to retain dependents in unsuitable places, and
by supplying adequate facilities at common expense, and not by
double taxation of those who have property.

8. Legal Regulations. — Insanity is so often the cause of ex-



Social Treatment of the Insane. 187

treme poverty or its effect, that legal provision for the dependents
must touch at points the hfe of this class.

Frequently the law makes a distinction between the dangerous
and harmless insane. Most commonwealths provide for cases
of acute, violent, and dangerous insanity. With few exceptions
the idiotic, harmless, and intoxicated are expressly excluded from
these legal provisions.

Mode of Coimnitmenf. — There seem to be four different prin-
ciples governing commitment : arraignment and trial before a
court, without any medical examination or testimony ; trial with
examination and medical certificate ; or commitment directly
upon medical declaration, the function of the court being confined
to registration of the finding ; and inquisition and finding of a reg-
ular commission. This is the actual basis of legislation in various
states, and the conflict of ideas is obvious.

Support. — The indigent insane are ordinarily supported at the
cost of the state, or of the county, or of both. Few states have
made adequate legal provision for all the harmless and chronic
insane.

Regulative Principles of Legislation. — The entire community
is interested in the legal regulations, procedure, and institutional
treatment of the insane. According to very high authorities the
following principles ought to dominate legislation and administra-
tion, all of them being intended in some way to defend the public
against irrational conduct, to protect the helpless from unjust dep-
rivation of hberty, to safeguard the personal and property rights
of the patients, and to provide humane medical treatment and
necessary custodial care.

The law should be distinctly based on the modern scientific
conception of insanity as a disease, and not a crime. This prin-
ciple requires that the board of inquest, appointed to examine
into the fact of insanity, should be composed of physicians of
recognized standing in their profession. This process of inquiry
should be uniformly and consistently called an '^ inquest," and never
a "trial"; the former term connoting disease, the latter, crime.



1 88 Relief and Care of Defectives.

It should be made illegal to confine an insane person in any jail
or prison, and thus local authorities should be compelled to pro-
vide proper accommodations for the temporary detention and
restraint of dangerous persons, pending an inquest. The present
general custom of detaining the violent insane in local prisons,
near to criminals and under charge of sheriffs and turnkeys, is an
outrage.

The personal and property rights of the insane should be
guarded by commissions and courts, since the insane are incom-
petent to protect themselves. Personal freedom should be se-
cured by legal definition and rule so far as is consistent with
public safety. All confinement should be the result of a judicial
investigation whose findings are recorded. The property of the
insane should be under guardianship for his benefit. The taint
of a pauper should in all cases be avoided. The law should for-
bid county authorities to keep the insane in almshouses, as pau-
pers ; or, if this is temporarily tolerated, should fix the rules
governing the buildings and treatment and provide for inspection
and control by a state board of administration or commission.

The judge of the court should have full legal power to use dis-
cretion in selecting the treatment which will best promote the
interests of the patient. A trial by jury should not be absolutely
obligatory in all cases. Unless some right is menaced or a de-
mand is made, a quiet inquest is better for the health of the
patient. The insane should be permitted to go voluntarily to the
hospital, on medical advice, in the early stages of the malady,
without the expense and publicity of a trial. The judge should
have power to maintain quiet and to exclude curious sight-seers
from the room where the inquest is held.

The law should confer power upon certain designated public
officers to prevent or remedy, by summary process, any wrong
which may be done to an insane person by those who have him in
charge.

The central administration of the commonwealth should have
legal power to transfer persons from one institution to another,



Social Treatment of the Insane. 189

according to the best interests of the patients and the state, espe-
cially from county to state institutions, where county care is still
tolerated. The law should provide for a frequent census of all
the insane in the state.

The social treatment of the insane must recognize two general
classes of cases, the acute and the chronic. The physician does
not permit himself to think of any who are " incurable." That
hopeless word should not be admitted to our vocabulary, for it
carries with it dangerous practical consequences. Acute insanity,
especially of recent origin, is presumably curable, and for this a
hospital is required, with all modern equipment, material and per-
sonal, for remedial treatment. Since insanity displays itself in
many ways the public must provide buildings and grounds for the
separation of those who need restraint, the dangerous, disturbed,
violent, untidy, and obscene, relatively few in number, from those
who do not require restraint, but only quiet, nursing, and medical
treatment.

The chronic insane call for the same classifications and conven-
iences. If there are enough attendants, almost all can enjoy a
large degree of freedom and many can perform useful work.

9. Methods of Dealing with the Dependent Insane. — While we
have taken the position that in a really ideal condition there
would be no distinction between the pauper insane and others,
such a distinction is actually a part of the law in many states, and
we must deal with it as a present fact. What is relatively best
under these conditions ? There are three alternative methods :
outdoor relief, local care, state asylums. Family care is ordi-
narily out of the question ; it is dangerous to permit the insane
to live scattered about the country in custody of inexperienced
persons and without supervision ; and support of the dependent
by outdoor reHef is costly and pauperizing in tendency. Board-
ing out a Hmited and select number of the harmless insane is
practicable and desirable, and is already known in this country
and abroad. But this method is of very limited range, and must
be kept under strict control of a central administrative body.



190 Relief and Care of Defectives.

The County Plmi of Caring for the Chronic Pauper Insane, — It
is still, unfortunately, the custom in many commonwealths to keep
these afflicted people in jails and poorhouses, because the legis-
latures refuse to provide adequate facilities at state expense.
Those who venture to defend this custom claim that it is cheaper,
and that the county poorfarm is not a bad place for the harm-
less insane to live. But a vast amount of pathetic evidence from
eye-witnesses is on record to prove that local care is apt to be
parsimonious, mean and ignorant. Even where there is state
supervision abuses persist beyond belief, and where competent
inspection is neglected the horrors of a barbarous age are
repeated near centres of culture.

Examples of such neglect and inhumanity may be cited from a
certain state report of the investigating agent.

The insane man still continues to wear the ball and chain when outside, to
prevent him from running away, when not locked in his room. There are
two insane men, who are locked in their cells. One of them is almost entirely
nude. Two of the cells in the insane department have been lined with iron.
Of the insane, five were in seclusion, all of them clothed except one, it being
found impossible to keep clothing upon him. , . . Two men were observed
in their cells, lying naked on their beds, with only a blanket for a covering.
One of them has irons on his legs and handcuffs on his wrists. He is chained
to a ring in the floor, and sleeps upon straw. ... In consequence of the
large number of insane inmates, it is impossible to give them the care which
they require. There are no personal attendants. They are accordingly
locked in their cells and in the corridors, and when in the airing court are a
law unto themselves. . . . One is chained to a tree. . . . One woman is in
a cell without furniture or bedding. . . . The condition of the outhouse is
bad, and the dormitories are totally unfit for human beings. . . . Some of
the patients are inclined to remove their clothing, but the superintendent, when
they do this, turns the hose upon them, so that the sight of the hose in the hands
of the keeper is sufficient to make them dress themselves with all possible
speed, . . . Bed bugs are in the walls, and there is an offensive odor. The
pest-house is occupied by three women who are in the worst stages of syphilis
and by a chronic insane woman. There is great danger of the insane woman
becoming infected with the same disease. . . . Too many locks and bars on
the insane department, which gives it the appearance of a jail or dungeon.
The rooms throw out a villainous odor. In the rear building there are two



Social Treatment of the Insane. 191

insane women, one epileptic girl, and two male idiots, who are also epileptics.
The idiots are disgustingly filthy, and the rooms are in the same condition. . . .
In one county three idiots, one of them an epileptic, were cared for by an
insane woman. ... In another county there were two steel cages for the
insane, six by seven feet in size.

Several counties did not provide a physician, or medical care
was let out to the lowest bidder. Many of these same counties
do better now, under state inspection, and many evils have been
corrected. But the examples given illustrate the danger of
county care.

In states where the insane are permitted to remain in poor-
houses, the least that can be asked in the name of modern science
and humanity is, that the state board of charities should be
required to appoint local boards of visitors to inspect county insti-
tutions, report abuses, suggest needed improvements, and awaken
public attention ; to transfer insane patients not properly cared for
on county farms to the state hospital for the insane ; and to re-
quire that plans for county asylums be submitted to the state board
before permission to build can be given. State inspectors, in
sufficient numbers, should travel and visit the county poorfarms
and asylums. When mechanical restraints are required, an insane
patient should be sent to a state hospital. Harmless patients,



Online LibraryCharles Richmond HendersonIntroduction to the study of the dependent, defective, and delinquent classes, and of their social treatment → online text (page 16 of 35)