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DELIVERED AT THE TWENTY-EIGHTH ANNUAL SESSION OF THE ASSOCIATION OF MEDICAL OFFICERS OF AMERICAN INSTITUTIONS FOR IDIOTIC AND FEEBLE-MINDED PERSONS HELD AT FARIBAULT, MINNESOTA, JUNE 23-25, 1904.

E. R. JOHNSTONE, VINELAND, N. J.

LADIES AND GENTLEMEN, MEMBERS OF THE ASSOCIATION: -- I wish to thank you heartily for the great honor you have conferred upon me by making me the President of your Association. I feel it all the more deeply because I am not a physician, and this gathering is named an Association of Medical Officers.

Your kindness in this matter but goes to show that the spirit of the Great Physician is in and thruout the work for the feeble-minded, and therefore you give without partiality, honor to all who shall use their best endeavors to forward the cause lying so near the hearts of all of us.

It is with diffidence that I present my address to you, feeling that I have but little to offer that is new, and recognizing the fact that most of you have been much longer in the work than I. There are, however, some things that are so pertinent to the cause that they will bear repeating, and then, perhaps as much as anything else, this Association must stand as the central bureau from which must emanate information so greatly needed concerning the feeble-minded. Thruout the history of the work, this idea appears: at times dominating all others, and again as a strong undercurrent, but ever present. Separated as we are by thousands of miles, and coming together but once a year, we find it hard, as an Association, to disseminate the knowledge as widely as we would wish, but as individuals bound together in a common cause, we have large local opportunities. While I would not be understood as an advocate of "rushing into print" I do feel that it is a duty we owe to society to keep our doings constantly before the public. The magazines and many of the better class of newspapers will give space to such information of a general sociological character, and it is only by taking advantage of these opportunities and recognizing the general ignorance on the subject that we can awaken the public to the needs of the feebleminded, and the others of the great family of neurotics.

The interest is growing. The medical societies thruout the country, the Conference of Charities and Corrections and the National Educational Association are all doing their share, but it is to our Association and its members individually that the world looks for definite, expert information.

We must lay before them our aims and our results. We must work in harmony with every movement of a social as well as of a medical or educational character, for among our inmates we find types that point toward the road which leads to the solution of pathological, psychological and sociological problems.

We dare not work in a corner -- we dare not be too busy with the routine of the day. We must make the citizens of our states acquainted with our doings. They must be, in-so-far as possible, familiar with what goes on in our institutions, and have facts, not merely hazy ideas, in order that we may help the cause and successfully combat the criticism of disgruntled employes, parents who fancy their children abused and quacks who make wonderful cures, transforming idiots into geniuses, etc., for these people invariably "rush into print."

Our JOURNAL is a valuable publication, and I should be glad to see some action taken at this meeting leading to its wider distribution.

The various steps taken during the last hundred years have been so often outlined that I need not speak of them here. On every hand further progress is evident. New institutions are being established each year. New buildings are being added in the established institutions. Pennsylvania has been taking giant strides and will establish a third great institution this year. A village for epileptics is under consideration in Virginia, and so the movement is noticeable on all sides. The outlook is brighter than ever before, and now while the iron is hot we must strike and strike hard amid often, if we shall weld together the interests centering in our work.

One of the significant facts is that in those states where there are already established schools for the feeble-minded more rapid steps are taken than in those having none -- thus showing the good influence of the schools themselves.

Our Association and our institutions have a number of serious problems constantly presented to them, and to the solution of these problems we must give our best endeavors and call to our aid the hardest workers, the deepest thinkers, the most careful students and the strongest men and women in political and social life.

Our great aim is to eliminate this class, and in order to do this we must of necessity consider the elimination of the neurotic, blind, deaf, and consumptives, tramps, paupers, petty criminals, prostitutes, etc., as well as the hereditary insane, epileptics and imbeciles.

This aim is the same as it was in the days of Egypt's greatest civilization, and Sparta's glory, and probably for many generations to come there will be striving in the same direction.

Nature is kind to this class. They really survive conditions which we should expect to cause a quick wiping out of the stock, but many have physical powers out of all proportion to their mental condition. The power and desire for procreation is strong and of all of the human weaknesses which go to cause the dying-out of a race physically, this almost seems to be the least important, for families of this class are notoriously large.

Many plans for elimination have been proposed. About a year ago one of the large dailies of New York printed serious editorials and communications advocating a painless death. But who was to decide where to stop? How was the plan to be reconciled to present day ideas of humanity and Christianity? The whole thing caused but a temporary flutter and died out.

Unsexing has been suggested and many strong arguments brought in its favor, but as yet the public knows too little of advantages of the operation and of the social dangers from this class, and so will not agree to the idea.

There is, however, one method of elimination upon which we may all agree. It is easier for people to understand, -- and even only partially understanding it, -- they will agree to it. That is permanent custodial care, it is slow, costly, requires infinite patience, watchfulness and constant urging, but it is certain if followed out. It will appeal to the great public who stand back of us -- it shocks no one's ideas of propriety, humanity and Christianity.

Our great hope lies in preaching permanent custody again and again, and we shall probably go thru the three stages which fall to virtue as well as vice, and the world will "first pity, then endure, and finally embrace," -- our ideas.

To education we offer more perhaps than to anything excepting society at large.

It is only of late years that the public schools have begun to realize how much we have to offer them. For the knowledge of much that now forms a regular part of the curriculum we are directly or indirectly responsible. Manual training, physical culture, nature study and child study were carried on in the schools for defectives for many years before the public school men realized not only their value, but their necessity for correct and effective training, and of late there has been taken a step still further in advance, and attention is being given the backward child in the public school -- the child who with individual training, sanitary surroundings and proper environment will advance to take his proper place among normal children, but who neglected, subjected to disease and ignorance will fall an easy prey to degenerative influences and become in fact feeble-minded.

Medical examination of all public school children is reaching this class, but what is to be done with a child who at the age of twelve has the drawback corrected, - adenoids removed, glasses given or defective hearing remedied-if he knows no more than the child of six or seven. For him there is but little hope if he cannot have special instruction for a while.

We must encourge -sic- these movements -- medical inspection and the establishment of special classes, or as they are called in Germany 'hüeftschülen" or "help-schools." Here euphemy is of great value, for parents are quick to take offense.

I need say but little to this Association on this subject. You know too well the advantages of permanent custodial care.

Every effort must be made to get these defectives out of society, where they are a constant burden; from the families they are constantly dragging down and whose stock they are weakening; from the almshouses from most of which they may go out when they please, spreading the taint, and often bringing back newborn or soon-to-be-born babies worse than themselves; from the children's homes, where they are as much out of place as in their families, and from the public schools, where at last their presence is being more intelligently recognized, and where the really feeble-minded child has no place. Indeed, they must be removed from every place from which they might at any time return to society, -- and be put in suitable institutions from which they shall never depart.

This is our problem -- to be solved by persuasion if possible, by law, if necessary. Parents will call it cruel; taxpayers, expensive, but we must prove to both of them that it is really cheaper to hire a watchman and put up safety gates along the railway line than to maintain an ambulance, a hospital and a corp -sic- of physicians to care for those injured while crossing the tracks, -- perhaps, even, we may in time convince them of the value of raising the grade of the railroad, -- but that is in the mind of those who believe in unsexing. Therefore, for society as a whole, if they will but let us we shall -- even tho it be in the far future -- rid them of this class. We shall lessen crime and the costs of courts and prisons -- we shall decrease pauperism and encourage a truer charity -- we shall diminish inebriety, too often the result of weakened will and judgment, as well as the cause of it. Our houses of refuge, hospitals for the insane, villages for the epileptics, and almshouses, will no longer be crowded because of the ignorance and inability of the incapables, and the stock of humanity shall grow stronger and healthier.

Did you think I said millenium? I believe in it, -- because it seems far away is no reason for giving up the fight for it, and surely we who see most clearly the evils that prevent its coming must strive the harder, that many generations hence our work shall have the approval of posterity.

So much for what our work offers society at large. To religion we offer a wider and clearer idea of what charity really means -- the raising up of those who are lowest: the combination of what is most thoughtful with what is most religious, "the strength of the strong and the wisdom of the wise ministering thru God's own laws to help the weak and the foolish."

To the State we offer an intimate knowledge of the fruits of the violation of its laws. We ask its co-operation where ignorant Opposition menaces the social body. We, who know, offer suggestions for the prevention and quarantine of this social disease, which insinuates itself into all classes of its citizenship. We ask for laws which in no uncertain way shall put this class into permanent custody and prevent the marriage and propagation of defectives.

To medicine we offer our institutions as laboratories. Here we have a host of pathological conditions which may be studied under the most advantageous circumstances. The neurologist finds here a field almost second to none for his study. The study of the etiology of feeble-mindedness is but in its infancy and as we "thread its devious paths" great vistas open before us, showing even more clearly the solution of many of the problems of life. For many years the thoughtful physician has availed himself of these opportunities, realizing more and more the value of the knowledge of the abnormal in the treatment of the normal.

I hope to see soon the establishment some one of our great institutions of a pathological laboratory, which shall receive from all of our schools, material to be carefully studied and reported upon, to the advancement of our knowledge and work. It has been talked of for many years. Is not the time ripe now to take it up? We have among our number superintendents who stand high in the ranks of neurologists and pathologists. Where better than with them? It would seem that some young man might be found who as a member of the staff of one of the larger institutions could give sufficient time to this work if we shall all contribute our share, - sending only what we really believe is worthy the study and time of such a man. Time goes rapidly, and it would be but a few years until we as an Association might receive information of inestimable value to the cause.

More careful examinations of the public school children are being held constantly, and on every hand it is found that from two to four per cent of the primary scholars need special treatment and instruction, and that under it some of them may regain their places with children of their own age.

But this examination is bringing to light many other cases who are truly feeble-minded and for them our institutions must open their doors. Many defectives never get into the public schools or at best remain but a few days. These are, particularly, the deaf and blind or the idiotic. But it is those of the imbecile and feeble-minded classes who need weeding out and the influence of our Association and its individual members must be exerted strongly, not only to help single them out, but to take them right away from the public school and give them not only the training they may receive, but the custody' they require.

As we offer a pathological laboratory to the physician so do we offer a psychological laboratory to the child student and the educator. The philologist would find much of value in the evolution of the primitive language of these children, and the ethnologist might see much to interest him even in the original designs of basketry which often closely approximate those of the Indians.

As has been said, our children are, so to speak, under a microscope. Their mental processes are so slow that the careful student finds the solution for many acts which the rapid brain processes of the normal child prevent his understanding.

But few of our institutions are without their staff of consulting physicans. -sic- I plead for a staff of psychologists also, and thus we may hope to give to education as we give to medicine, and like the bread upon the waters, it will return to us, bringing like the good seed in good ground, even an hundred fold.

And now, -- the child. During the past thirty-five years great changes have taken place in education. Girls have been admitted to the schools of all grades. The kindergarten has become a fact, schooling not only little children, but mothers as well. Evening schools, special classes have been formed, until, as Earl Barnes says: "It would be literally true to say that to-day a child could begin school, in a state like California, when two and a half years old; and pass on thru kindergarten, primary, elementary, high-school and university courses which would occupy him until he died of old age, and all the time he would be in schools supported and directed by the State." He might have added: "Here, too, the defectives receive all of the education and training of which they are capable."

Here again our Association must take a bold stand and demand for the feeble-minded the education to which every child in the union is entitled- whatsoever is best fitted for it.

Training is not all, however. Our defective child gets at our hands much more. He is not only ignorant beyond complete training -- he is diseased beyond cure, and often bad beyond reformation. In society his life is a failure. He must be cared for, fed and clothed, prevented from interfering with his neighbors, and from procreating his kind -- the degeneracy must cease here. We offer such a child play, work, comfort, opportunity and happiness, to make a true home until he is called to that higher one in which there is no weakness and inability, and as the modern surgeon, without the letting of blood, draws the distorted and withered limb into its place to grow as strong and useful as it may, so here the kindly teacher, without tears or sorrow or pain, shall draw the darkened mind from its deep place of hiding, to feel and understand the stimulation of nature's beauties and treasures, and the love and sympathy of human hearts.

From my heart I thank you for the honor of presiding at the meeting of such an Association, and I thank God that he has seen fit to place me in the ranks of those who are, I truly believe, doing a work which in the great cause of humanity has no superior.