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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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who may safely be given considerable freedom, are the only pa-
tients which it is permissible, under any circumstances, to leave
in local almshouses.

The state of Wisconsin led the way in the method of provid-
ing for the chronic pauper insane in county asylums, but placed
these local institutions under supervision of the Board of Con-
trol. The advocates of this system claim that it is more economi-
cal than any other; that the patients are nearer their relatives
and friends ; that they have greater freedom and happiness than
they could enjoy in a large institution ; that cures are frequently
effected ; and that the abuses of local management are suppressed
by the regulations and inspections of the officials of the state.
All these claims are controverted by many medical authorities,



1^2 Relief and Care of Defectives.

and the method must still be regarded as an experiment, although
it is an experiment tried under hopeful auspices, and other states
are adopting its principle.

Plans for State Hospitals. — Without trespassing upon the spe-
cial province of the architect we may indicate some of the essential
material factors in a state institution for the insane. The ten-
dency of expert opinion is now in favor of the cottage or detached
building system. This system has certain characteristic features :
two-story houses, large associated dormitories on the second floor,
with living rooms on the first floor ; all in contrast with the huge
edifices of three or four stories formerly built for the purpose,
with separate rooms for many hundreds of persons under one roof.
Where the buildings are somewhat removed from each other, there
is less risk of general conflagration, and this means reduced loss of
life, greater sense of security, and diminished rates of insurance.
The windows on all sides are unobstructed and admit abundance
of light and air. There are fewer occasions of friction and con-
flict between persons of an irritable and excitable temperament,
because the population is not so crowded. Hence there is
greater freedom and sense of personal liberty, fewer cases of con-
finement under lock and key. There is more variety in the life
of the patients, since they can be transferred occasionally from
one house to another, and each house has its own characteristic
furniture and arrangements. The invalids can more easily and
safely enjoy open air life, the living rooms being on the first floor.
Attendants have an increased sense of responsibility, since most
of the physical means of forcible restraint are removed. The
patients are more likely to be treated according to their individ-
ual needs and with less routine. In the large dormitories it is
easier and less expensive to provide for nursing at night. For all
these reasons the public gains confidence in the institution, regards
it with less of dread and suspicion and more of good will. The
air of terrible mystery is not present and the homelike village
appearance is attractive. It has been found that patients who
were restless and troubled with fear, so long as they were kept in



Social Treatment of the Insane. 193

separate rooms at night, improved in health and slept quietly
when they felt that they were surrounded by others and cared for
by nurses.

The economical reason may now be added. The immense
structures formerly built for the insane were very costly. It was
necessary to spend for each person in the building from one thou-
sand to fifteen hundred dollars. The detached cottages furnish
better accommodations at a cost ranging from five hundred to
nine hundred dollars for each patient. It was estimated that to
transfer ten thousand insane from jails and almshouses to an insti-
tution of the old corridor type would cost the state twelve million
dollars, while with the system of detached buildings the cost
would be only six milUon dollars. If ever the states are induced
to care for all the insane, the cost must be reduced to the lowest
amount consistent with humane care.

10. Detention Hospitals. — The general public seems to be
unaware of the cruelty and injustice sometimes inflicted upon
innocent persons suffering from nervous disease by their arrest
and incarceration in local lockups and jails. They are sometimes
carried by the police in the same wagons with drunkards, prosti-
tutes, and thieves, and are shut in with the shameless and lawless.
Public and personal security require restraint, but morality forbids
the disgrace, humihation, and physical injury which attend such
incarceration. The insane should never be brought near the rav-
ing inebriate. Separate and specially adapted hospitals should be
provided by health authorities in every community for the tempo-
rary detention of the insane until a permanent disposition of them
can be made. Persons who have been found wandering aimlessly
about, or interrupting pubhc meetings, or doing any irrational act,
or attempting to commit suicide, may thus be humanely confined,
in care of personal attendants and watchers, until the physicians
can examine them and give advice as to their treatment.



W. P. Letchworth urges the establishment of small hospitals near cities.
" Instead of adding to our already overburdened institutions, or constructing



194 Relief and Care of Defectives.

more like them, why not provide for the acute insane small hospitals near the
large cities, where they may have the advantages which such institutions so
located are capable of affording? It is claimed by high medical authority that
more cures can be effected in the small institution under an individualized
system of treatment than in the large one, where the medical superintendent is
overwhelmed with the innumerable details incident to its business affairs. . . .
The Lunacy Commission estimates that the ultimate average charge for every
patient admitted to a state hospital who is not discharged, recovered or im-
proved, amounts to about $6000. Surely we are warranted in exhausting
every reasonable resource in treating the acute insane, and in dealing with
insanity in its earlier and premonitory stages."



CHAPTER IV.

FURTHER SPECIALIZATION OF INSTITUTIONS FOR DEFECTIVES.

1. Epileptics. — The nature and manifestations of the disease of
epilepsy determine the most suitable forms of treatment. The
term " epilepsy " is popularly used to designate various morbid con-
ditions which in origin and nature should be considered sepa-
rately. There is true epilepsy; epilepsy following poisoning,
especially by alcohol ; cortical epilepsy, which results from local
disease of the motor cortical area; and reflex epilepsy, which
originates in irritation of a peripheral nerve.

The chief feature observed by the public is a sudden loss of
consciousness, complete or partial. Frequently spasms occur.
The convulsions do not last long, but they tend to occur more
often with progress of the disease. There is no such regularity
in their occurrence as to give certain warning, and the surprise
of the attacks is one of their most dangerous features. The
patient may be at the edge of a roof, or over deep water, or near
a fire ; and his fall may plunge him into death. After the con-
vulsion is over stupor follows, and then the patient may be able
to attend to work or affairs of business. The more serious form
is called gj-and mat, and there are lighter forms called petit
mat. If the patient does not lose consciousness and fall, his
facial contortions or other partial loss of muscular control will
reveal his trouble. Epileptics frequently become insane, and at
last become exceedingly wretched in their physical and mental
state.

Epilepsy is most apt to develop at an early age, the highest
ratio being during adolescence. This fact indicates special pro-

195



196 Relief and Care of Defectives.

vision for children, since hope of cure is much greater in the first
stages. The disease has been traced in all climates and among
many races, and thus the causes must be sought in conditions
common to all races and climates.

Exte7it. ' — Statistics fall below the real number, because the
afflicted persons and their relatives are under strong temptations
to conceal the malady. Perhaps the ratio of 1.5 in one thousand
inhabitants may be accepted as appproximately correct, and from
this may be estimated the number in any particular state. In the
United States there are thought to be about 113,000. But it is
not claimed that all of this vast number need to be placed in
institutions for their own good and in the interest of society.

Social Disadvantages, — These arise from the nature and effects
of the malady. In industry the epileptic is unreliable where ma-
chinery is employed. Costly machines must run steadily and with-
out interruption. One workman waits and depends upon another.
The spasms interrupt continuous work, often at critical moments.
There is much danger to the patient as well as to the others. In
sociable intercourse the epileptic is an object of dread, and no one
who has witnessed the person in a convulsion can quite escape
from the haunting memory of the spectacle and entirely free his
mind from terror or disgust. Hence there cannot be that free,
unconstrained, and natural converse which gives pleasure to
society.

The hereditary nature of the disease makes the person unfit for
marriage and parenthood. There seems to be a popular supersti-
tion to the effect that marriage may cure the malady, but this is
quite opposed to the scientific fact, and it must lead to vicious
consequences.

Instihitional Treatment, — Many epileptics, even serious sufferers,
are permitted to wander about, in constant peril and a menace to
others. Jails and county poorhouses shelter many of this unfortu-
nate class. Some are thrust into jails because they are dangerous
to life and property, and there is no other place to send them.
Those found in poorhouses among paupers are accorded inade-



Specialization of Institutions for Defectives. 197

quate and often shameful treatment. Hospitals and asylums for
the insane care for many of them, either in isolated buildings,
special wards, or mingled with the insane. In the schools for
feeble-minded children and youth are many epileptics, although
the tendency at such places is to set apart separate buildings and
grounds for members of this class.

Last of all there are special farm colonies, for epileptics alone,
with all the arrangements particularly designed to heal their
disease, to give them employment and recreation, and to make
them self supporting by their own labor and as happy as they can
be in this world.

There are good reasons for separate treatment of epileptics, at
least to the extent of isolated houses and grounds. The diet
must be specially adapted to the physical requirements of persons
of this class. It must be largely vegetable food. IntelHgent epi-
leptics, children and adults, are sensitive to being classed with
idiots, imbeciles, and the insane. In their conscious periods they
are often as bright as other people. Special institutions can give
better industrial training and employment suited to the peculiar
needs. Epileptics ought not to be placed with the insane, if for
no other reason, because the terrible'spectacle of convulsions dis-
turbs the nervous patients. Hence many of the epileptics are
rejected from asylums for the insane because there is no proper
accommodation for them. Pubhc safety is more certainly insured
by having institutions devoted to this class alone. Inheritance of
defect can be prevented only by segregation and close custody.

Dispensary treatment of epileptics in cities is very unsatisfactory.
No disease requires more special skill and careful seclusion of
patients, with constant watchful care of skilful attendants. Poor
families are utterly unable to give such patients the proper and
necessary attention. Industrious families are burdened by the
pressure of anxiety occasioned by an epileptic member, and are
more surely rendered dependents on public charity.

It seems probable that medical science would be more rapidly
and surely promoted by a higher degree of specialization, by the



1^8 Relief and Care of Defectives.

study of causes and cure on the part of medical men devoted to
a single field of research and clinical experience. Not only the
entire class, but all society, will receive benefit from such investi-
gations. In a colony where persons suffering from a common
malady are neighbors, none are pained by the strange looks of nor-
mal people, and it has been noticed that a feeUng of brotherhood
soon grows up, and the companions in trouble show to each other
the most tender, delicate attention.

The National Association for the Study of Epilepsy and the
Care and Treatment of Epileptics was formed in 1898, and is a
good illustration of the tendency to grouping of experts. This
society states as its objects : the scientific study of epilepsy ; the
rational treatment of the disease ; the best methods of caring for
the dependent epileptics, including the construction of proper
homes based upon a study of the epileptics' needs as to classifica-
tion and environment ; the study of the utilization of the epilep-
tics' labor, for economic, scientific, and ethical reasons ; the study
of the best educational methods to be employed, including man-
ual, industrial, intellectual, and moral forms and forces.

Buildmgs and Grounds. — Many problems of architecture, land-
scape gardening, sanitation, horticulture, and agriculture are in-
volved, too technical for treatment here ; and as they belong to
special arts and crafts, the necessity of securing expert advice is
apparent. It is of general importance to educate the pubhc to
understand the need of purchasing ample and rich grounds at the
very beginning of the institution. This is most economical, because
the price of land rises when it is known that the state wishes 10
purchase. It admits of forming a large plan, a design which will
be of value to coming generations, and it provides for a variety
of industries demanded by an isolated and self-supporting
community.

It has been recommended to enact legislation making the mar-
riage of epileptics illegal ; and medical men are unanimous in
advising against the union of persons afflicted with this disease.
Perhaps such laws may have a certain limited effect in educating



specialization of Institutions for Defectives. 199

the public mind and affecting sentiments and customs. But, as
in the case of the insane and the feeble-minded, it is not enough
to make such unions illegal ; they must be made impossible by
segregation and strict custody by officers of the state. County
care cannot be trusted, as wide experience demonstrates.

2. Inebriates. — Drunkards come to poverty, and to such pov-
erty as leads to beggary. Under present conditions in this coun-
try there are various legal and administrative methods of treating
the inebriates : sometimes they are committed to hospitals for the
insane, but are usually discharged as soon as the delirium is tem-
porarily over; sometimes they are sent to special, private, or
public hospitals, or to hospitals connected with workhouses. Few
states provide care of any kind, or distinctly recognize in law the
existence of this class of dependents.

Social policy is wavering, uncertain, and without principles.
Usually the inebriate is neglected until he commits some pub-
lic offence. Then he is arrested by the bold policemen, and
committed by a court to jail or bridewell on a short sentence.
This incarceration subjects him to the intimate companionship of
thieves and vagabonds, gives even the occasional offender a crimi-
nal record, tends to extinguish the ambitions and hopes which
might, under proper treatment, fortify his vacillating and enfeebled
will.

Of the various " gold cures," in private institutions, the writer
does not venture to express an opinion, since " doctors differ."
They are at best inadequate to cope with this evil, and they come
too late.

Public asylums, with voluntary residence, have been tried, and
with discouraging results. They become merely '^sobering up"
places of retreat where the drunkard gathers strength for a new
spree.

A more adequate treatment by society must rest on a consistent
set of principles. Alcoholism is a disease akin to insanity, and
is at once the effect of antecedent causes, and in turn produces a
long series of evils to body and mind. It is closely connected with



200 Relief and Care of Defectives.

poverty, both as cause and effect. Sometimes this dreadful mal-
ady first arises fi-om an inherited diathesis, and often from the
personal indulgence in a pleasant but dangerous habit, which be-
comes a merciless and unsparing despot. Frequently this disease
leads to other vices and crimes, and when crime has been com-
mitted the man is passed over from the charity to the penal
branch of government. But in many cases the inebriate is just
a sick man, whose will power is broken, who does not respond to
ordinary motives, and who requires medical care and nursing as
truly as the insane, the epiletic, the cancerous, and consumptive.

The inebriate is not always a criminal, and therefore the prison
system does not meet the demand. The inebriate is not insane,
for all definitions of insanity exclude him until the toxic forces
have permanently impaired the brain tissues and set up a serious
and specific brain disease. The inebriate cannot be classed with
the feeble-minded or epileptic. No existing institution is founded
for his treatment or can be adapted to his needs.

And yet society, which permits the manufacture and sale of
alcohol, which derives immense revenues from the traffic, which
tolerates and makes fashionable the customs which encourage the
use of stimulants, must hold itself responsible for the natural and
inevitable results of these customs and fashions. The inebriate
must have his own share of accountability, and must dearly pay,
under the best of conditions, for his error and his sin. But the
community also is under obhgations to help him, if possible, to
secure his health.

We may insist upon the public duty of founding and supporting
charitable institutions for certain classes of inebriates, neither
criminal nor insane ; and we place the argument in this Part
devoted to charity, rather than in that devoted to crime, because
it is the just and logical place for the plea.

Since the disease of alcoholism is deep seated, persistent, and
difficult to cure, such an institution must belong to the state, with
legal poHce power of restraint and control, on the same principle
which secures such powers to the officers of a hospital for the



specialization of Institutions for Defectives. 201

insane or epileptics. Permanent cure of chronic alcoholism is
ordinarily impossible without several years of enforced abstinence
from intoxicants. A private asylum cannot detain and restrain
its patients long enough to effect a real cure and eliminate the
poison and its products from the system of the victim, and to form
new and regenerated tissues. The patient must be required to
exercise and employ himself usefully in the open air, and this no
private asylum can compel. The courts should send only those
of otherwise good character, and of whom there is hope of cure,
to such a hospital. But even vagrant drunkards and vicious vaga-
bonds could be treated in compulsory colonies.

The problem of relief for the innocent families of confirmed
drunkards is full of perplexities. When persuasion has failed after
fair trial the man should be placed under restraint, required to
labor at some industry, and the wages earned by his work should
go to support his wife and children. From this standpoint, again,
the necessity for a public and compulsory institution can be made
apparent. Such compulsion and restraint are based on the same
principle as that on which restraint of the insane and the epilep-
tic rest, — the welfare of the patient. It is not of the character
of penal coercion.



CHAPTER V.

STATE BOARDS AND FEDERAL FUNCTIONS.

1. Charitable Institutions of the State ; Initial Steps of Organ-
ization. — Our country has not developed a complete and ade-
quate system of public charitable institutions, even according to a
moderate standard of humane treatment, and we must constantly
study the best methods of estabhshing the means of proper and
rational care. If there is a demand for an entirely new establish-
ment, the primary step is the preparation of pubHc opinion.
Under our popular government permanent and cordial support
of the legislature depends on general intelKgence and conviction.
Assuming the existence of a group of persons in the common-
wealth who realize the need of a special institution, and who
understand the essential requirements, these persons must collect
and arrange the data for a community judgment. They would do
well to ascertain the approximate number of the class which it is
desirable to help ; obtain reliable descriptions of their condition
and sufferings, and their influence on social welfare ; obtain
expert statements of the best-known methods of caring for the
persons under consideration, and the reasons for a special arrange-
ment for their relief; and be able to give ^estimates of the cost of
founding and maintaining such an establishment as is proposed.

A state board of charities is naturally the proper body to under-
take this preliminary task. In the absence of such a body, or if
it declines to act, the interest of a society professionally most
entitled to consideration should be invoked to prepare for the
agitation, as a board of health, a medical society, a bar associa-
tion, or a conference of charitable people.

202



State Boards and Federal Functions. 203

Then this material should be given the widest possible public-
ity, so that thousands of citizens will be set to thinking. The
legislature is to be informed, urged, influenced, by a steady, dis-
creet, patient presentation of the facts. Sometimes many years
will elapse before a hearing can be obtained. Ignorance, apathy,
dread of higher taxation, political fears, erect high and steep
barriers in the way of the pioneers of progress.

Then comes the stage of legislative action, with a commission
of investigation and inquiry, consideration in committee, prepara-
tion and discussion of bills, and final action. The function of the
legislature is to enact mandatory laws creating an administrative
board, with instructions and power to found and maintain an
institution, and to require reports which will enlighten voters
and furnish a basis for further legislation. The statute may also
determine the powers and duties of the executive branch of
government in relation to the movement.

Then follow the measures of the board. It organizes under
the terms of the law, elects officers, makes by-laws, forms plans.
Experts are consulted, and especially the secretary of the state
board of charities. Superintendents of similar work are asked to
give advice. The plans involve many technical details which can-
not here be considered : as the selection of a site, improvement
of grounds, architectural devices, provision for food, faciUties for
education and worship, occupations, recreations, and training of
attendants.

Functions of the Board. — Where there is a board of directors
over a state institution, its duties and powers are defined in the
law creating it ; and usually it is required to outline a general
policy, inspect the workings and condition of the establishment,
determine plans of keeping accounts and records, compare results
and cost with those of similar institutions, and report faithfully to
the people and governor all the data required for a judgment.
The best results are obtained where the members of the board
are appointed for their distinguished abihty and fitness, without
expectation of pecuniary rewards, the expenses of travel alone



204 Relief and Care of Defectives.

being paid for them. Ordinary mercenary office-seekers are not
tempted to invent devices and play tricks to secure such positions
which require labor but do not give pay. Each state supports
charitable institutions for the insane, the blind, the deaf mutes,
the feeble-minded, and for others.

There are two different systems of management : one by the
kind of board just mentioned, voluntary, unpaid, and specially
interested in a single establishment ; and the other system, found
in a few states, under which all the state schools and asylums are
placed under a single board of salaried officers who control the



Online LibraryCharles Richmond HendersonIntroduction to the study of the dependent, defective, and delinquent classes, and of their social treatment → online text (page 17 of 35)