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In the annual discourse for 1907 Dr. Adams said: "A medical practitioner is, to a greater or less extent, a missionary. He is always finding and doing some work, unpaid or underpaid, for his fellowman, because his training and his position make such work possible and natural. In all philanthropic measures he is to be relied upon as a helper, and in those pertaining to public health he is naturally a leader. He has unequaled facilities for disseminating knowledge, for awakening interest and for guiding benevolence. The evidences of this influence are to be seen on every hand."

The imminent problem of dealing effectively with this burden of feeble-mindedness presents a fertile and pertinent field for the exercise of these extra professional activities and obligations of the medical practitioner. The community looks to him for education and guidance on this subject. Concerted action by the medical profession will surely create the strong public sentiment which will demand a prompt and effective plan for the proper care of all the feeble-minded, and for the elimination of feeble-mindedness so far as that is possible.

Dr. Charles Bernstein: Mr. Chairman, this paper of Dr. Fernald's has been very instructive to all of us and he has very carefully covered the subject of feeble-mindedness, especially borderline feeblemindedness. I am more than glad to have two or three of our managers here today. I don't know of any better place that I could have brought them to get the benefit of this matter. In New York State at the present time under the auspices of the State Charities' Aid Association there exists a position as County Agent. There are about twenty, I think, of these agents in New York State at the present time. They originally had only the placing out of children from the orphan asylum. Then they found children who should not be placed out. They wanted to know whether they were normal or abnormal and they have asked us to take them. They were committed to us originally as feeble-minded, which we felt was very wrong. If they were not feeble-minded they should not have had that stigma attached to them. As a result the legislature last year passed a law, giving us power to take these cases, as they say, voluntarily for the purpose of examination to see whether they are feeble-minded or not, thus avoiding the stigma of commitment when there is doubt as to diagnosis. We have only operated under the law a couple of months, though we have operated in a measure under the theory of it for a couple of years. I am more and more convinced that we must have these cases for a year to know them and to determine whether they are feeble-minded or not. Of course we know we have no laboratory test to help us with certainty in these borderline cases today. Just at the present time we are facing the question what to do with these borderline cases which have already been committed to us and who, we feel, are not actually feeble-minded. Are we to let them go? Are we to have a placing-out system or to hold them in the institution? They have committed no crime. They have done nothing to warrant our holding them there indefinitely for fear they may do something. Three cases have been refused and this action the courts have sustained.

I have been interested in the matter of placing out boys and I have been trying to convince our managers of the advantage of that for a year or more. One of them heard something about the Kentucky system, and thought it was pretty fine in the way in which it worked out. As I understand it, under the Kentucky system the parent of the feeble-minded child (Dr. Rogers will correct me if I am wrong) is said to take care of it. I would not recommend that. We propose to do as Dr. Fernald has done, let these boys go out on the farm. We know the difficulty in New York of finding labor, and the farmers are very much in need of this class of laborers. We have a few boys out at the present time and I would like to see more of them placed out. I don't know but what I would like to see some of the girls sent out if the families could be well picked and we could have a supervision over them.

Then another matter that I was glad to hear Dr. Fernald discuss is that of sterilization. The very cases which most need to be sterilized can never be reached. Therefore, the place for them is in the institution or on the farm; but on the other hand, in our experience in placing these boys out, I have had three or four come back in the last few months with infectious and social diseases. Of course they did not have proper supervision, though we have picked out families very carefully. Two or three boys work in the mills and they have the privilege of coming back and seeing the entertainment every Friday. These boys have money that they have saved and placed in the saving bank, but the danger from social diseases makes their employment in the country advisable instead of in the city. Those that we have in the country are the ones that are getting along the best.