The Care And Training Of Feeble-Minded Children
By F. M. Powell, M.D.
A Presentation at the National Conference of Charities and Correction, at the Fourteenth Annual Session Held In Omaha, Neb., August 25-31, 1887
Editor’s Note: F. M. Powell, M.D. was the Superintendent of the “Iowa Institute For Feeble-Minded Children.” This institute was established by an act of the Legislature passed during the session of 1875-76. It provided for the organization and support of an Institution at Glenwood, Mills County, Iowa, for the care and training of feeble-minded and idiotic children of the State. Any child between the ages of five and eighteen, residing in the state were eligible for the benefits of the Institution subject to the discretion of the Board of Trustees. The institution was designed to care for two classes: (1) Those whose mental deficiency is slight, but sufficient to prevent advancement in the common school; and (2) Those who are not capable of much or any improvement, but whose care here relieves an oppressive burden from many homes of the state. For the former a thorough course of training and instruction is provided, based upon the most advanced ideas of the subject.
It is not the object of this paper to attempt a full discussion of any one branch of this subject. If, in reproducing facts and methods previously presented to the Conference, it shall be the means of increasing your interest in the direction of inquiry and action pertaining to this work, its purpose will have been accomplished.
The innumerable forms or types of defective mentality congregated in institutions for the care and training of the feeble-minded suggest the propriety of referring to the definitions of idiocy, imbecility, and dementia. Esquirol is referred to as being the first medical writer approaching accuracy in defining idiocy. He says: “Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested, or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge as persons of his own age, and placed in similar circumstances with himself, are capable of receiving. Idiocy commences with life. What they are from the first they are doomed to be during the period of their existence.”
Imbecility is a term used to denote a minor degree of mental deficiencv than idiocy. In comparing dementia and idiocy, the writer observes: “In one case, the individual is deprived of advantages which he formerly enjoyed. The other has always been in a condition of want and misery.”
The superintendents of American institutions for feeble-minded persons, in their session of I878, submitted the following: “Idiocy and imbecility are conditions in which there is a want of natural or harmonious development of the mental, active, and moral powers of the individual affected, usually associated with some visible defect or infirmity of the physical organization or with functional anomalies, expressed in various forms and degrees of disordered vital action. There is frequently defect or absence of one or more of the special senses, always irregular or uncertain volition, and dulness or absence of sensibility and perception.”
Whatever may be the most accurate defining term, modern usage is adopting the more popular term, “Feeble-minded,” to include all types or grades of mental, moral, and physical inaccuracies characterizing this class of defectives, from the profound idiot up to individuals possessing attributes but little below the normal standard of human intelligence. This term is used, being more agreeable to parents and relatives of the afflicted. An acceptable classification of the varied phases of the feeble-minded is fully as difficult to determine as a definition. Reference to this will be briefly considered subsequently.
What the conditions of this class must have been prior to the earliest records of attempts to ameliorate their condition we can only infer from scraps of history and a knowledge of the life of many of them to-day, without public or parental protection. The history of earlier ages seems to indicate that the condition of the defective classes must have been freighted with greater neglect and consequent misery than can be found anywhere at the present time. The lot of the idiot must have been indeed a solitary one, as indicated by the term used to designate them, except in the recognition of the efforts of devoted mothers, clinging with maternal affection to their blighted progeny, or with a few who fortunately possessed a degree of wit sufficient to play the role of a professional jester, or, being marked with hideous deformities, were sought as prizes by tyrants and rulers, which at least secured for them food and raiment. As understood by primitive definitions, it was generally accepted that these beings must carry their infirmities for life, without hope of improvement. As the rubbish of humanity, they were neglected, and left to subsist with animals or perish from want and exposure.
Passing from the unwritten record of these lives, we find that it was about the beginning of the present century that public and private tests began to be made, analyzing the nature of idiots, whether from scientific or philanthropic motives is immaterial, since successful results followed. The seed was planted and germinated. Although apparently dormant for a quarter of a century, the leaven of Christian philanthropy lifted the environing prejudices of these darkened minds; and from this time on both public and private schools began to be established in Europe and America for their benefit.
The initial efforts for this class appear to have been especially aimed in the direction of education, notwithstanding the per cent. of lower grades must have been as great as we find it now, appealing to the deepest sympathies of humanity.
As yet, comparatively few were ready to accept the experimental conclusions of these early tests. Hence the necessity and wisdom of selecting only the most suitable types of imbeciles for the primitive schools, that their improvement might more aptly be developed, thereby more readily securing the attention, confidence, and support of the people.
In accord with this view, we find the organic laws governing the schools in Massachusetts and New York rejecting epileptics, paralytics, and others properly belonging to the asylum wards, explicitly avoiding custodial charges, so prominently considered in our institutions to-day. It is due, however, that these pioneer workers be credited with early recognizing the claims of the non-improvables, as indicated by some of their earlier reports.
At the present time, with a knowledge of the extensive provision for the defective classes and the experience of forty years in caring for the feeble-minded, it is not easy to realize the hopelessness with which efforts to better their condition were regarded by the people and scientists at the period when Drs. Seguin, Wilbur, and Howe commenced their labors, respectively at Bicetre in France and Barre and South Boston in Massachusetts.
Gradually the work progressed, being recognized and encouraged not only by the patrons of schools and medical opinion, but by legislative bodies, first in Massachusetts and New York, followed by Pennsylvania in I853 and other States at later intervals. In all, we now find thirteen institutions supported by public appropriations and caring for more than three thousand of these ungifted children.
Thus we find very firmly established the claims or rights of another branch of the large army of dependants to be fostered by our various commonwealths, numbering, as indicated by the census of i880, in the United States 76,895, ” of which 2,429 were in training-schools, I,14I in hospitals for the insane, 5,429 in almshouses, 241 in benevolent institutions, and 41 in jails, leaving a remainder of 67,200 at home or in private care,” regarding which Mrs. C. W. Brown says, “where, if properly cared for, the duty of society ceases. But, as it has been found necessary to enact laws for the protection of young children from abuse and neglect in their own homes, so should these life-long children be protected, when necessary. In the homes of the very poor, society must always protect itself, lest these weak-minded paupers become criminals or the begetters of criminals.
“The duty of first educating the educable is no longer a question; and such schools, as proved above, must be especially organized, with preparatory or trial departments, that every one may have a chance. But after this education, reducing the aggregate as we may by retaining in each institution all graduates needed as helpers, returning to their homes those suitable, and distributing in the private houses those capable, there still remains an indefinite number, largely of the unimprovable, to be provided for.”
Having briefly referred to the history of the early efforts in the reclamation of this branch of defectives, we are brought directly to the consideration of their condition and methods adopted for their care and training at the present time.
Recurring again to the defining terms in use, we find that idiocy, generically used, covers the whole range referred to, but is frequently used specifically to denote only the lower forms; while imbecility has reference to the higher grades and dementia to a class having at some period subsequent to birth, lost their mental power. Comparatively few of the latter find their way into our wards. This I understand to be the more popular idea of distinction.
Here we are forced to say that so far we have no scientific classification wholly acceptable. The most desirable one is that which assists most in prognosis and treatment, and is based on etiology. But not enough is yet known of the multiple causes to complete a classification on this basis, neither has there been sufficient pathological work done nor clinical observation noted to group from either of these headings.
Classification from a psychological point has been submitted, based on the phenomena or external features of idiocy, and is therefore imperfect. Dr. Seguin very ably supports his theory for a classification based on physiological principles; while Dr. Ireland presents strong reasons for the distinctions he makes, from pathological causes. Either of these would require a lengthy paper to properly consider them.
The classifications generally adopted are from necessity based upon the requirements of the inmates and facilities at our disposal more than from scientific distinctions. The majority of institutions make two general divisions,-the school and industrial department and custodial or asylum division, the former including children who are susceptible of mental and moral improvement. In the latter will be found unimprovables, collected from the lower forms of idiocy and imbecility, often complicated with epilepsy, paralysis, and other physical infirmities common to the lower grades.
The range of capacity characterizing the pupils in the educational department may be almost as varied as their number, each possessing an individuality; but, in a school with two hundred or more children, a satisfactory gradation of classes can be made, by leaving a remnant, possessing more than ordinary peculiarities or eccentricities, to be assigned to special classes for instruction through individual methods. In the graded division, class training is resorted to, more especially in groups made up of pupils nearest the normal standard of intellect, individual methods being more necessary as we approach the lower grades.
Where feeble minds exist, we conclude that it is dependent upon some physical imperfection, either congenital or acquired; and, while it may be beyond our power to fully develop or restore these deficiencies, we may, by a careful analysis of these conditions, determine to what extent medical or educational means may be applied. We can then intelligently direct our efforts in remedying the abnormal condition.
In the ratio that the child possesses the attributes of normal persons, so far we adopt the usual methods practised in common schools. Hence you will find in all our institutions for this class pupils being taught the elementary branches of the English language with a fair degree of success. But, says Dr. Wilbur, in one of his reports, “physical training will form the basis of all well-directed efforts for the education of idiots.” That is, through bodily training, or, as Dr. Seguin terms it, “physiological education,”- mentality acquired through the medium of the senses. For this reason gymnastic and kindergarten exercises enter largely into our training-schools, not so much for physical benefits as a means of mental discipline. Through this medium, the most valued attention and imitation lessons are impressed.
The lack of power of attention is very prominent, and requires numerous devices to reach the varied degrees of deficiency in this respect. As aids to stimulate the birth and growth of this faculty, kindergarten and object lessons are liberally utilized. All through the school training, mechanical means constitute a reliable factor for developing the special senses. The simplest kind of labor, with many, offers valuable lessons in fixing the attention and inculcating will power over the defective nervous organizations so uniformly present.
As stated previously, some are marked with such idiosyncrasies as to require more than ordinary attention. Their mental and moral characteristics are queries not readily solved. One type are termed moral imbeciles by the profession, but by the public are looked upon as vicious or wicked beings, because of their tendency to commit criminal and moral offences. There is a lack of proper moral impulse, or a perversion of the sense of right and wrong. This class of boys and girls is a source of great anxiety and trouble to parents and others with whom they may come in contact. The cunningness displayed in gratifying their unnatural propensities could scarcely be acquired. They apparently consummate their designs instinctively, with no manifestation of feeling for others, seeking only means and opportunity to indulge their vicious inclinations. *
Some show extraordinary aptitude in certain directions, displaying a fair degree of intellectual ability, yet appear to be wholly incapable of comprehending the effect of their conduct, although repeatedly resulting in their disfavor. Their capacity being enlisted in gratifying their present inclinations, they fail to analyze consequences liable to follow. When in trouble, they are penitent enough, or appear to be so, and make solemn promises to reform, only to repeat the same offences again at the first opportunity.
What to do with them is the question. If not interrupted while young, their life will be a record of crime, as the tendency is for them to fall more deeply into vice. If taken young and surrounded by proper influences and discipline, where their vicious propensities will be intercepted and checked and their better tendencies fostered and encouraged, they may at least pass the formative period of life safely, leaving them with a fairer prospect of self-control the remainder of their lives. Dr. Kerlin says of them: “Such children, although often precocious in the power to acquire school learning, should be withdrawn from the community before they reach crime age, and are best cared for under the discipline of institutions for the idiotic and feeble-minded.”
There are numerous psychological puzzles to be found among the feeble-minded, some of them termed by Dr. Langdon Down “idiot savants.” Examples of this character will serve to illustrate: J. S., admitted to the Iowa Institution in I883, aged twelve. His faculty for remembering dates and names is unusually developed. Will state accurately the date of visits and names of all who visit the institution and converse with him, naming the day of the week, month, and year of previous visits. In the shoe-shop where he works, he can tell the time when shoes for inmates have been made or repaired, although the work had been done years before; will calculate dates with astonishing rapidity, extending into the past or future; can draw a map of the United States, with boundary lines of all the States and Territories, in three minutes’ time; learned the manual for deaf-mutes in less than two hours’ time while at work in the shop; when asked how he calculates or remembers, almost invariably answers, “I don’t know.”
W. B., companion in the shoe-shop with J. S., exhibits a degree of mechanical ingenuity beyond normally balanced faculties; will take apart complicated machinery and put it together correctly, succeeding with first efforts as well as by repeated trials. An intimation or illustration of a piece of mechanism wanted will be readily executed by him with surprising accuracy, although never having seen or heard of it before.
These boys are successful shoemakers in our shop. They are “self-supporting, but not self-controlling.” Visitors are sometimes impressed with the belief that prodigies of this character are wrongfully detained.
In the July number of the Alienist and Neurologist, I find a selection on this subject by Dr. Down, illustrating examples of anomalous development of some of the faculties of the mind, from which I quote: –
“…Extraordinary memory is often met with associated with very great defect of reasoning power. A boy came under observation who, having once read a book, could evermore remember it. He would recite all answers in Magall’s Questions without an error, giving in detail the number in the astronomical divisions with greatest accuracy. I discovered, however, that it was simply a process of verbal adhesion. I once gave him Gibbon’s Rise and Fall of the Roman Empire to read. This he did; and, on reading the third page, he skipped a line, found out his mistake, and retraced his steps. Ever after, when reciting from memory the stately periods of Gibbon, he would, on coming to the third page, skip the line, and go back and correct the error with as much regularity as if it had been part of the regular text. Later on, his memory for recent reading became less tenacious; but his recollection of his earlier readings never failed him. Another boy can tell the tune, words, and number of nearly every hymn in Hymns, Ancient and Modern. Often memory takes the form of remembering dates and past events. Several children under my observation have had this faculty in an extraordinary degree. One boy never fails to be able to tell the name and address of every confectioner’s shop that he visited in London,-and they have been numerous,- and can readily tell the date of every visit. Another can tell the time of arrival of all the children at the institution, and could supply accurate records in relation to it, if needed. Another knows the home address of every resident who comes undei his observation, and they are by no means few….”
In one of the earlier reports of Dr. George Brown, superintendent of the private institution for the education of feeble-minded, located at Barre, Mass., I find the following concluding remarks on this subject:
“…There is a truth taught by these anomalies, which all teachers would do well to consider; i.e., every undue culture of an intellectual faculty or a bodily power to the neglect of correlative faculties and powers is a fatal mistake, tending to the increase of insanity and deficiency. The possessor of a single faculty abnormally developed to the suppression or extinction of other faculties equally essential to symmetrical culture, though he may be styled a genius, is as truly a monster as any dwarfed being whose huge head perhaps so o’ertops the body as to stunt its growth, and cripple forever its power of locomotion.
“If we would aid in restoring the lost harmonies of the universe, we must seek for ourselves and our children that uniform culture of the whole being in its triune nature, physical, mental, and moral, which in its completeness shall conform to the lines of perfect symmetry without excrescence or depression. When every man and woman secures such culture, transmitting it to their seed after them, there will be no further need of hospitals for bodily or mental diseases nor prisons for moral offenders.”
Returning to the methods in use for the mental culture and discipline of the feeble-minded, I cannot enlarge upon what has already been presented to the Conference by our committees at previous meetings. The importance of increasing and combining manual training with the daily routine of school-work is being encouraged, not only for the purpose of fitting our wards for degrees of usefulness, but as a factor in developing and increasing mental capacity. We have already learned that it is principally through the special senses that intellect is aroused and quickened in these imperfect children. They cannot deal successfully with the abstract. Work lessons, to cultivate the hand, eye, and ear, are indispensable as a part of their school training proper. We seek, then, to organize and utilize industries adapted to their capacity. Hence you will find connected with these schools the shoe-shop, broom-shop, carpenter shop, brush and mat making, chair factory, farm and garden work, wood-carving, hammered brass and copper work, classes in drawing, fancy and common needle-work, domestic duties, orchestra and band classes, all in the line of productive labor, leaving the participants qualified partially, at least, to support themselves, and with ability to assist in the care of their less fortunate companions.
As an indication of the result of this course of training, the following recent analysis of the improvement made by I95 inmates in the school department at the Iowa Institution at Glenwood is submitted: 28.3 per cent. made active progress in learning, 44.6 per cent. made medium advancement, while 21.5 per cent. improved very slowly, a part of the remaining 5.6 appear to have remained stationary, while others retrograded, physically and mentally, requiring their transfer to the asylum wards. Structural changes in the organs of the body, more especially the nerve centres, had left irreparable lesions. Out of 68 dismissals, during a period of two years, 82 per cent. of them are recorded as improved.
To the extent, then, that this training has tended to elevate these wards of the State, by having corrected improper habits, increased their will power, developed a sense of moral obligation, quickened the intellectual faculties, and left them with a knowledge of how to perform some kind of useful labor, so far the public may be said to have bestowed all that is required of it, leaving them as near the normal sphere of mankind as their capacity permits. But the number becoming self-supporting independent of supervision is small, ranging probably from o1 to 20 per cent.
This leaves the greater portion needing lifelong guardianship. To what extent is the public under further obligations to those requiring life direction? We leave an opinion to be expressed hereafter.
But this analysis has reference to the more favorable subjects. What can be done for the asylum charges gathered from the lower forms of idiocy and imbecility, many of whom are dependent upon others to anticipate and supply their most simple wants? In this division will be found the characterizing features of idiocy, as understood in a specific sense. Here also are found shades of disability, numerous as in the school department. In this family, we find the profound idiot, who, having eyes, sees not; ears, but hears nothing; neither tastes, smells, manifests sensation, nor recognizes articulate sounds, though in possession of all the organs governing the senses, – apparently in a healthy condition, but lacking in sensorial power to interpret impressions; a being wrapped in the solitude of unconsiousness, though in possession of all the inlets of knowledge, but leading to an undeveloped brain power. Associated with these deficiencies may be found pathological anomalies: the head may be unnaturally large or small, supported by an abnormally large or dwarfed body.
Here are the esthenic forms with undue nervous impulses, the asthenic with a want of normal activity, aggravated cases of epilepsy, and the helpless paralytic. Others with partial loss of the senses. The motor functions may be abnormal, causing defective co-ordination, interfering with purposive acts, but tending in the direction of automatic movements. It is with these marked forms that medical and hygienic means are largely required to assist in correcting existing vices. They are taught some of the simpler drills in calisthenic exercises, and learn to perform some kind of labor, the rate and extent of development being very slow and limited. It is with this character of inmates that wants must be created, that development may follow.
The influence of directed exercise, work and habit training, favorably affects them. They are brighter and happier for it. Although termed “unimprovables,” there are but few who will not admit of improvement. “Not one in a thousand,” says Dr. Seguin, “but what is susceptible to treatment; not one in a hundred who has not been made more happy and healthy.” Occasionally, transfers are made from this department to the better grades.
The public in extending her mantle of charity to these, the lowest and most helpless of mankind, is not only aiding and protecting suffering humanity, but relieving the community of an exhausting burden that in many families is overtaxing the parents and preventing prosperity and care of other members of the family.
Pennsylvania is providing generously for this class; while Massachusetts, Ohio, Iowa, and Minnesota are extending the same protection. Associated with the custodial plan, we have provision for adult imbeciles, a large per cent. of whom fail to possess adequate mental or moral convictions to cope successfully with the realities of life, and are unfortunate in being without guardianship of kindred ties to direct them. This brings up the social problem,- ” What to do with them?” Although education may have done much to ameliorate their condition, but few can rise out of a condition of dependence. They may become self-supporting, with friendly guardianship, but not self-controlling. Under the direction of kindly persons, they will labor successfully as assistants in household duties and as helpers in the care of the more dependent ones. Most of the older institutions are successfully testing the plan of providing separate buildings for their constantly accumulating adult wards and directing the labor of the males in farming and shop work.
New York has made provision for adult females independent of the parent institution. When we consider their life record, as shown by enfeebled and illegitimate progeny, consequent upon want of protection from dangers to which they are exposed in refuges not provided with facilities for separating the sexes, the wisdom of this plan at once commends itself to a thoughtful public. Pennsylvania adds to the building at Elwyn a ” Girls’ Cottage ” for eighty of this class. Ohio provides liberally for these divisions, aggregating over seven hundred inmates. Illinois follows with an appropriation for a building to be used as a home for one hundred girls.
In the practical results following the advance step taken in New York, in providing permanent and separate homes for her ” men and womenez children,” may be found a solution of the question, “What to do with them?”
To explain more fully: Institutions extending a permanent home and supervision to adult wards have either added departments for this purpose or built “detached cottages” on the grounds near the original structure, making the division for these and asylum charges a part of the one system under the same management, with its families participating in such affairs of the institution as may be suitable. The various entertainments, exercises, and industries connected with the several departments afford recreation, discipline, and employment for them during life.
In connection with efforts to modify the infirmities of idiocy, cause and prevention merit more than passing notice. Data on these subjects are being tabulated by more experienced workers, to be presented, I trust, hereafter.
With this casual reference to a subject worthy of more careful inquiry, we briefly conclude that the history of the experience in developing the condition and methods of care and training of the feebleminded indicates fruitful results, beyond the sanguine expectations of the early devotees of this charity, not only in their central idea of education, but other phases of the work, more especially protection for life.
It cannot be expected that the maturest thinkers can have organized a system complete in detail and adapted to every emergency that time and change must develop; but that they built on a basis founded on the great and underlying principles of divine sympathy and compassion, to protect the “weak and lowly,” no one will be inclined to question.
For the further care of this vast family, relying unconsciously on the strong to shield and protect its members, your deliberation, counsel, and assistance are solicited.
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Source: Proceedings of The National Conference of Charities and Correction, at the Fourteenth Annual Session Held In Omaha, Neb., August 25-31, I887. pp. 250 -259. https://quod.lib.umich.edu/cgi/t/text/text-idx?page=browse&c=ncosw