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The Origin And Nature Of Our Institutional Models
The census-derived data reported here are somewhat at variance with those tabulated by Best (1965, p. 274) for the years 1922-1960. Apparently, Best combined maintenance and capital expenditure costs for some years, and costs for retarded and epileptic residents in years where a distinction between these was possible.
Cost data derived from noncensus sources are likely to contain some errors: (1) Such data were sometimes reported in informal conferences, or as estimates. (2) I computed some cost estimates indirectly by dividing total maintenance costs in a state as reported in one reference by the total number of institution residents for the same state and year as cited in another. (3) Early reports did not always make a distinction between costs and expenditures: since many residents were partially supported by fees and subsidies, the true costs were sometimes higher than the appropriated expenditures. (4) Early maintenance figures sometimes did not include some costs later subsumed under maintenance, such as clothes. However, most of these errors are likely to result in underestimates for the early years, and thus accentuate the trend this appendix is trying to document, viz., the decline in expenditures from the institutions to the end of the indictment period.
The cost data are presented in two tables. The first one breaks costs down by state between 1878 (when data apparently first began to be reported in national publications) and 1931. In some instances in Table 1, the figures apply only to one of several institutions within a state. The second table reports costs between 1926 and 1966 for the country as a whole because 1926 marked the beginning of annual nationwide cost surveys. In both tables, mean or median costs are listed both in reported dollar values, as well as in dollar value equivalents as derived from cost of living indices. The reason for the conversion of costs into 1967 dollar values was to obtain a truer picture of cost trends. It should be pointed out, however, that the conversion has its shortcomings, and that the 1967 equivalents increasingly underestimate as one goes back in time. However, the general trends apparent in Figure 2 are probably valid. Finally, be it noted that crossed out spaces in Table 1 indicate that an institution did not exist in the year indicated.
A special word is in order on costs in Howe's institution, the first one to be publicly support (Third and Final Report, 1852). Massachusetts granted $7500 for a 3-year period, additional receipts being $3,808. Apparently, only a fraction of the total of 32 residents admitted were in residence more than one year. I would estimate from the somewhat vague wording of the report that the average daily census might have been 20. This means that annual per capita maintenance costs must have been about $188. Whether any of this was used for capital expenditure is doubtful, transition from the experimental to the permanent phase, items that had been bought were sold again. Also, Howe (p. 21) clearly states that the money expended was equivalent to that required to teach "hundreds of children in the common schools."
When we look at our institutions today, we are sometimes baffled by certain features we perceive. In the review of historical material relevant to Chapters, I came across material that explains many of these features. Appendix 2 will present some of this material which underlines several of the points made in the chapter.
The incredible catch-all nature of the institution developed in the pity period; as usual, it was rationalized to be of benefit to the resident: "The probability is that, because of the peculiar adaptation of feeble-minded persons to a community organization. State institutions may be created to embrace the care of all whose dependence needs it, and inclusive, too, of all the multiform grades; for it seems despotic to omit those who are epileptic, paralytic, or choreic, permitting a physical impediment to bar the individual from beneficial influences to which he is as responsive as any. This all-comprehending care has been contemplated in Pennsylvania under the suggestion of an asylum village to be developed from the nidus already existing at Elwyn" (Kerlin, 1884, p. 259).
Monotony of design was advocated by Sprattling (1903, p. 265): "...at the Craig Colony, in New York, under the advice of eminent architects, thirty-seven cottages, comprising the main groups in the male and female divisions, are similar in exterior design and internal arrangement..." Sprattling also advocated elimination of risks in the environment, such elimination being characteristic of the sub-human and medical models: "Some special constructional features should be incorporated, the more prominent of these being stairways broken by landings, to prevent patients from falling the entire length. All woodwork should have the sharp corners and angles broadly rounded to lessen the danger of cuts from falls during attacks; and all steam and hot water pipes and radiators should be effectually covered or guarded, to prevent burning during coma following a seizure" (Sprattling, 1903, p. 266).