[Reprinted from New York State Journal of Medicine, 
 July, 1913 ] 
 
 THE PROBLEM OF CARING FOR THE 
 DEFECTIVES.* 
 
 By WILLIAM T. SHANAHAN, M.D., 
 
 SONYEA, N. Y. 
 
 T his article is intended simply as a brief 
 conservative summary of the subject of 
 defectiveness and degeneracy in general 
 with a broad outline of treatment and not as 
 •an exhaustive treatise. It is presented as a plea 
 to endeavor to prevent some defectiveness at its 
 source rather than waiting helplessly to care 
 for the end product. 
 
 Feeblemindness may be defined as a mental 
 state which has never reached the normal level. 
 Insanity, on the contrary, is a mental state which 
 has changed as the result of various influences 
 acting upon it so that the individual thus afflicted 
 feels, thinks and acts in an abnormal manner. 
 Epilepsy is a chronic progressive disorder char¬ 
 acterized by recurrent abrupt attacks of loss or 
 impairment of consciousness with or without 
 convulsions, and as a rule, accompanied by men¬ 
 tal and ofttimes physical deterioration. These 
 three conditions as well as inebriety, criminalis¬ 
 tic tendencies, vagrancy, prostitution and pau¬ 
 perism frequently go hand in hand in members 
 of the same family. Many of these states have 
 
 * Read before the Medical Society of the County of Allegany, 
 at Cuba, April 10, 1913. 
 
been recognized since a remote period in the 
 world’s history, but only recently has there 
 arisen a due recognition of the importance of 
 their influence upon the social world. 
 
 Persons who have given much study to the 
 matter have arrived at the conclusion that from 
 two or three per cent, of the general population 
 in this country are defective or disordered men¬ 
 tally. Taking the lowest percentage mentioned, 
 you can realize that in the State of New York 
 this would mean that at least 200,000 persons 
 .are unfit to assume a normal place in the com¬ 
 munity. It has been determined that 30 per 
 cent, or more, of the inmates of our various re¬ 
 formatories and prisons are mentally defective. 
 What a farce it is to attempt to reform an in¬ 
 dividual who is absolutely irresponsible in con¬ 
 sequence of a mental impairment, the result 
 either of an incomplete development of his brain 
 •or the destruction of a portion of the brain es¬ 
 sential for a normal development. 
 
 Rosanofif and Orr state that it has been esti¬ 
 mated that about 30 per cent, of the general 
 population, without being actually neuropathic, 
 carry the neuropathic taint from their ancestors 
 and are capable under certain conditions of 
 transmitting this taint to their progeny. 
 
 Conservative estimates made in England give 
 the proportion of feebleminded as i to 248 of 
 the general population and of insane i to 273 
 of the general population. In the United States 
 the proportion in all probability does not differ 
 materially from that in England, although one 
 must ever bear in mind that the personal equa¬ 
 tion of the individual compiling statistics has to 
 be given consideration. In consequence of this 
 personal equation entering into this matter, sta- 
 
 
 .V 
 
 2 
 
• SC.'?'' '2> 
 
 Sh \ 
 
 tistics, as you know, sometimes vary to a marked' 
 extent. Allowing however, for this variability 
 and considering the subject from a most con¬ 
 servative viewpoint, one must realize that in 
 his own community at least one to every three 
 hundred members of that community is defec¬ 
 tive and that if tests could be applied to every 
 member of the community there would be found 
 a much larger proportion than that given. Pause 
 for a moment and think what this defectiveness 
 means in the relations of such individuals with 
 those about them. 
 
 This large number of defectives in our midst 
 brings up the question as to how many annually 
 grain entrance to the country as immigrants. Any 
 one wno has visited Ellis Island, the principal 
 gateway, and witnessed several thousand immi¬ 
 grants pass inspection in one day must realize 
 that with the meager opportunities afforded for 
 properly examining these immigrants a very 
 considerable number of feebleminded, epileptic, 
 insane, criminals, etc., enter undetected, and 
 New York State has to ultimately care for a 
 large proportion of them. 
 
 In 1912, there were in the state and private 
 hospitals for the insane in New York State over 
 34,000 patients, in the institutions for feeble¬ 
 minded and epileptic 6,000, and in the various 
 prisons, jails, reformatories over 14,000, making 
 in all over 54,000. Allowing that there are 200,- 
 000 defectives in the state, one naturally asks 
 where are the other 146,000 and what are they 
 doing. It is true that* some of the remainder 
 are fortunate enough to have relatives who give 
 them careful oversight, protecting them from 
 themselves and from the community and also 
 protecting the community from their irresponsi- 
 
 3 
 
 V 
 
bie acts. Unfortunately, however, the major¬ 
 ity of such defectives are not under the careful 
 supervision of their family or an institution, but 
 are permitted to follow their own inclinations 
 and as a rule, sooner or later, get into various 
 difficulties, many of them exceedingly serious in 
 nature, not only for themselves, but for those 
 about them. Furthermore, one must ever bear 
 in mind that these defectives are found in all 
 races and among all classes of people, in the 
 rural and urban community, at all ages and 
 among the rich as well as the poor. 
 
 Fomierly there was a certain amount of con¬ 
 fusion as the result of various terms applied to 
 feeblemindedness and its different degrees. In 
 consequence of this a few years ago those work¬ 
 ing with the feebleminded in America decided 
 upon a new classification, using the general term 
 feebleminded to include all of those individuals 
 who had never reached the normal stage of 
 mental development for their physical age, and 
 making as subdivisions morons, imbeciles and 
 idiots. The idiot may be defined as an indi¬ 
 vidual who has never passed beyond the mental 
 age of tw’O years, and in consequence, is unable 
 to protect himself from ordinary dangers or 
 care for himself, the imbecile one who has never 
 developed beyond the mental age of seven years, 
 and consequently unable to gain a living, the 
 moron one who has reached a mental develop¬ 
 ment corresponding with a child from seven to 
 12 years of age mentally, and who can under the 
 most favorable conditions maintain himself, but 
 has not the stability of a normal adult. 
 
 Among those who apparently are of the men¬ 
 tal age of twelve years or thereabouts, it is very 
 apparent that there are a considerable number 
 
 4 
 
who approach closely the margin of a normal 
 mental state but who could not be called nor¬ 
 mal, and to such the term borderland or border¬ 
 line cases would apply. 
 
 To further characterize and distinguish par¬ 
 ticular classes of the feebleminded, special ref- 
 'crence to some physical defect or other accom¬ 
 panying condition has been made use of, e. g. 
 Mongolian imbecile, meaning an individual who 
 is mentally between the age of two and seven 
 years and who shows the characteristic signs of 
 ^ broad-fissured tongue, obliquely-placed eyes, 
 a short little finger; the epileptic idiot, or im¬ 
 becile or moron being one in whom the symp¬ 
 toms of epilepsy are present as well as the state 
 of mental defectiveness; the microcephalic idiot 
 is one with a small head, and macrocephalic one 
 with a large head, etc. 
 
 Congenital feeblemindedness as differentiated 
 from acquired feeblemindedness are terms self- 
 explanatory. The cretin is an individual in 
 whom there is a faulty development because of 
 an insufficient functioning of the thyroid gland 
 beyond the stage usually found in the very young 
 child. 
 
 The epileptics may be subdivided into that 
 appearing in early life, including over 8o per 
 cent, of all such patients, and that appearing 
 late in life; the idiopathic or the class in whom 
 the cause cannot be ascertained; classified as to 
 seizures, the grand mal or severe, the petit mal 
 or mild, the complete, the incomplete, the abor¬ 
 tive, the Jacksonian in which type the convul¬ 
 sions are not accompanied by loss of conscious- 
 nes*s; the psychic in whom there is a distur¬ 
 bance of the mind without the accompanying 
 convulsions, etc. There may be any degree of 
 
^combinations of these various types of epilepsy, 
 these combinations varying from time to time, 
 depending on the type of seizures to which epi¬ 
 leptic may be subject. Those who have had ex¬ 
 perience are agreed that these varieties are al¬ 
 most endless. The classification of insanity and 
 its symptomatology cannot be referred to in a 
 paper of this kind as time will not permit. 
 
 It must be remembered in connection with al¬ 
 coholism that persons are difl'erently constitu¬ 
 ted in regard to the effect that alcohol produces 
 on them. One person may with seeming im¬ 
 punity consume large quantities of alcohol over 
 a period of many years without apparent serious 
 results. In another person, appearing to be 
 quite healthy, the continued use of a quantit}’ 
 of alcohol exhibits a marked deleterious effect. 
 It has been advanced by students of the sub¬ 
 ject that the majority of inebriates are iiot such 
 solely from the use of the alcohol, but are pre¬ 
 disposed as the result of a hereditary mental de¬ 
 fect to become victims of the alcoholic habit. 
 Without going into the symptoms of chronic 
 alcoholism in detail, I would state, that there is 
 a dulling of the mental faculties of the individual 
 and accompanying this, there is naturally a 
 marked lowering of the moral tone, so that such 
 persons become more or less irresponsible for 
 their actions and are not to be relied upon. 
 Eventually many of them suffer such a marked 
 degree of mental impairment that it becomes 
 necessary to place them under close and con¬ 
 stant supervision. 
 
 It is the rule of human life to have the nor¬ 
 mal individual develop until a complete stage is 
 reached, at about the age of thirty years and 
 .almost immediately thereafter a gradual decline 
 
 6 
 
to begin, this decline progressing steadily for 
 three or four decades without producing any un¬ 
 toward symptoms. In certain abnormal or de¬ 
 fective people this normal stage of involution 
 brings about the appearance of certain symp¬ 
 toms, among which are those perhaps of a dis¬ 
 turbed mental state, or perhaps convulsive at¬ 
 tacks. 
 
 Another class of people somewhat along this 
 same line are those in whom what might be 
 termed normal senile changes, instead of grad¬ 
 ually occurring and bringing about a readjust¬ 
 ment of the individual’s general condition at the 
 usual period in life, appear much earlier than 
 in the normal individual. 
 
 The causes of degeneracy are many diverse 
 deleterious influences occuring in the antenatal 
 or the postnatal period, or in both. These 
 causes may be divided into those which pave 
 the way, but in themselves, may not bring to 
 light the defective state, these being known as 
 predisposing and added to these potential fac¬ 
 tors are what are known as exciting factors, 
 that is, causes which affect the individual in 
 such a manner as to bring to light the symptoms 
 of the defective condition. What in one person 
 may be a predisposing cause may in another be 
 an exciting cause, and again a predisposing 
 cause long continued may eventually act as an 
 exciting cause. 
 
 Among the active predisposing causes is one, 
 which has much greater influence than is ordi¬ 
 narily thought for by the layman, and upon 
 which I wish to lay as much stress as is possi¬ 
 ble, and that is heredity. Among the conditions 
 presented in ancestors, which seem especially to 
 influence the descendants are feeblemindedness,. 
 
 # 
 
 7 
 
insanity, alcoholism, epilepsy, syphilis, etc. Nu¬ 
 merous theories have been evolved, especially 
 in recent years, in regard to the laws of heredity. 
 Some fifty years ago Gregor Mendel, a monk 
 in Austl'ia, made certain experiments with peas 
 and traced out through many generations the 
 appearance of color, height, etc. Of recent 
 years it has been found that apparently so far 
 as studies have gone that some of these Mendcl- 
 ian laws may apply to the human family. 
 
 The cell from which the human individual de¬ 
 velops is made up of two parts, the germ cell 
 which has to do with the carrying on of the 
 race, and the soma which has to do with the 
 development of the particular individual of the 
 race. At the present day, it is thought by many 
 that the germ cell is passed on from one in¬ 
 dividual to its ofifspring and so on indefinitely 
 through succeeding generations without change,. 
 acquired characteristics in an individual not be¬ 
 ing transmitted to the offspring. Many eminent 
 authorities do not agree with this, but maintain 
 that there are certain influences, e. g. alcohol and 
 syphilis, which may affect the germ plasm so- 
 that in the succeeding generation its deleterious 
 effects may be observed as a state of defective¬ 
 ness. 
 
 Most writers agree that the soma which de¬ 
 velops into the body of an individual member 
 of any one generation may as the result of nu¬ 
 merous influences acting upon it vary in its de¬ 
 velopment. It should be borne in mind that a 
 defect in one generation does not necessarily 
 imply that the defect in the preceding genera¬ 
 tion was exactly the same, there being appar¬ 
 ently an interchange in a way between insanity,. 
 
 8 
 
feeblemindedness, epilepsy, etc., so that one de* 
 feet may be, as it were, substituted for another. 
 
 Our present knowledge of heredity would 
 lead one to feel that in the feebleminded and 
 epileptic there is lacking some element which 
 must be present in the normal individual to 
 bring about a normal state of development. 
 
 It is evident to honest students of heredity 
 that longer continued study is required before 
 enough accurate facts can be presented to sup¬ 
 port what is now partly theory. The offspring 
 of a union of two plainly mentally defective 
 persons is probably always mentally defective, 
 but when one parent is healthy and of good 
 stock, or both parents are healthy but of neu¬ 
 ropathic stock, etc., there must be much further 
 investigation made before what are now but the¬ 
 ories can be recognized as laws governing here¬ 
 dity. 
 
 Just at this point I wish to impress upon you 
 the fact that if the family stock is healthy the 
 offspring from a consanguineous marriage will 
 be healthy, if the stock is tainted the defect 
 will be intensified. 
 
 In ascertaining facts in regard to defective 
 individuals and their families, it is of the utmost 
 importance to have trained field workers, pre¬ 
 ferably carefully selected physicians, persons 
 who can visit the community in which the af¬ 
 flicted person resides and there investigate all 
 facts in regard to the personal and family his¬ 
 tory of the person concerned, making inquiry 
 not only of the members of the family but also 
 of their physician, clergyman and any other 
 persons who may be interested or have any 
 knowledge of conditions. These trained inves¬ 
 tigators should obtain much valuable data, sift- 
 
 9 
 
ing the actual facts from the alleged or coin¬ 
 cidental factors in each particular instance, and 
 can also disseminate through the community in 
 ^ which they work practical information relating 
 to the problem under discussion. 
 
 With regard to the outcome of these various 
 conditions, it must be confessed that with most 
 defectives one can not look for more than a 
 general improvement. In some, e. g. certain 
 types of insanity, there is apparently a recovery, 
 which proves more or less permanent. In others, 
 some epileptics, many of the insane, inebriates, 
 etc., there may be an arrest of the symptoms with 
 a recurrence later. With the feebleminded and 
 'the great majority of the epileptic and a consid¬ 
 erable number of the insane, no hope can be 
 held forth to bring about a restoration to normal 
 health as in these persons there is a congenital 
 defect or there has been an actual destruction of 
 some essential parts of the brain structure, 
 which cannot be replaced by any work of repair 
 such as occurs in some of the simpler tissues of 
 the body. Many of the insane are discharged 
 from hospitals as recovered, but later have a re- 
 'currence of their symptoms and have to be re¬ 
 committed. 
 
 By removing certain exciting factors, either 
 mental, physical or both and making the indiv¬ 
 idual live as simple a life as possible, there may 
 result a marked improvement in the health of 
 many of the defectives. Dietary and other ex¬ 
 cesses, the strenuous life of modern civilization 
 often with improper environment, etc., are con¬ 
 ditions which must be given earnest and active 
 consideration. 
 
 Among a considerable proportion of the insane, 
 the epileptic and others, there is undoubtedly a 
 
 lO 
 
disturbance of the normal relation between vari¬ 
 ous internal secreting glandsy e. g. the pituitary 
 body, the thyroid gland, the supra-renal bodies, 
 the pancreas, etc., this resulting in a chemical 
 unbalance and in consequence symptoms of the 
 disorder appear. 
 
 In all of these persons, but especially in the 
 insane and epileptic, there is an unstable ner¬ 
 vous system, which cannot withstand certain 
 influences as can a normal nervous system. 
 
 The actual cause of many of the symptoms 
 occurring in many defectives, such as convul¬ 
 sions, periods of excitement, depressions, etc., 
 are found to be due apparently to causes beyond 
 discovery by our present methods of research 
 and in consequence are often alleged to be due 
 to certain causes which are not the actual causes 
 but are purely coincidental. 
 
 There is no question but what if the functions 
 of the gastro-intestinal tract, e. g. digestion and 
 absorption, are imperfect that the effect pro¬ 
 duced upon persons with unstable nervous sys¬ 
 tems is exceedingly far reaching. The influence 
 of teething as an exciting factor in the epileptic 
 has in my opinion been greatly overdrawn as 
 this is a purely natural process which all of the 
 human race must experience. What is true is 
 that during the age when the first dentition 
 occurs the delicate nervous system is more sen¬ 
 sitive to various stimuli than later in life. 
 
 The abuse of alcohol, the injuries to the brain 
 after birth, and injuries during birth, paralysis 
 consequent upon encephalitis occurring in in¬ 
 fancy or early childhood, syphilis, the various 
 infectious diseases, such as scarlet fever, meas¬ 
 les, whooping cough, etc., which may be com¬ 
 plicated by meningitis or an inflammation of the 
 
 I 
 
brain substance itself, hemorrhages into the 
 brain, arterio-sclerosis appearing early or being 
 unduly marked produce a more or less severe 
 disturbance of nutrition or actual destruction of 
 some of the essential structures of the central 
 nervous system. The male sex in adult years 
 are more subject to the abuse of alcohol, in¬ 
 fection with syphilis, the receipt of severe in¬ 
 juries to the head, etc., which factors must be 
 considered in making any statement in regard 
 to the probable outcome in any particular case. 
 
 Feeblemindedness is largely due to congenital 
 causes or the result of certain conditions occur¬ 
 ring in early life. Epilepsy is also a disorder of 
 early life, the onset in 8o per cent, of such in¬ 
 dividuals occurring before 20 years of age. In¬ 
 sanity on the contrary, as a rule, does not make 
 itself apparent before the early adult years and 
 in certain types not until the individual is well 
 advanced in years. This means the insane have 
 as a rule the opportunity of securing some edu¬ 
 cation, learning a trade, etc., whereas the feeble- 
 minded and epileptic are frequently deprived of 
 such advantages. 
 
 All defectives have present, to a greater or 
 lesser extent, various malformations known as 
 stigmata of degeneracy. These alone do not 
 have a very important bearing on the state of 
 the person under consideration, unless associa¬ 
 ted with other symptoms, both mental and phy¬ 
 sical. It is a question as to whether any individ¬ 
 ual is absolutely perfect, depending upon what 
 is- recognized as a normal standard. 
 
 The various physical deviations from the nor¬ 
 mal average seen in the different types of defec¬ 
 tives are not peculiar to these individuals, except 
 to show that these persons are not of a normal 
 
 12 
 
physical make up, but have a fundamental de¬ 
 fect. The various injuries received by epilep¬ 
 tics during seizures result in scars and deformi¬ 
 ties in different parts of the body. Paralysis, 
 especially when occurring in early life, interfere 
 markedly with the development of the parts 
 involved. 
 
 After death, examinations made of the vari¬ 
 ous structures show that in many there are ab¬ 
 normal conditions apparent to the naked eye, 
 such as defects in the structure of the brain, 
 changes in the heart, especially in the valves, 
 while microscopically there are found, numerous 
 destructive changes in the essential cells mak¬ 
 ing up the central nervous system and of many 
 of the internal organs, especially the kidney. 
 
 In those mentally afflicted certain symptoms 
 are observed, e. g. hallucinations, which are 
 sense perceptions without external stimulation; 
 illusions or perverted sense perceptions and de¬ 
 lusions, false ideas which may arise from hallu¬ 
 cinations, illusions or other delusions; states of 
 depression or excitement are common conditions 
 but which are much more marked than similar 
 states in the ordinary individual; disorientation 
 or an inability of the individual to locate himself 
 either to time or place; retardation of the men¬ 
 tal processes where the activity of the mind is 
 much slower than in the normal person; flight 
 of ideas where the individual changes from one 
 subject to another without having apparently 
 any definite purpose in view, his ideas not being 
 in an orderly arrangement as in the normal per¬ 
 son ; stupor which may be slight in degree or 
 most profound; impulsions and compulsions 
 which seemingly take hold of the individual and 
 force him to follow out what these ideas sug- 
 
 13 
 
gest; amnesia or a loss of memory of what has 
 transpired during a given period of time, etc. 
 
 Dementia, a term often used incorrectly by the 
 layman to characterize any acute mental upset, 
 is a permanent impairment of the mind and may 
 advance to such a degree as to make an individ¬ 
 ual who has once been exceedingly intelligent 
 pass into condition where he has to be cared for 
 like a new born child. 
 
 In epilepsy there may be seen convulsive seiz¬ 
 ures with loss of consciousness, biting of the 
 tongue, passing of the urine and the receipt of 
 various injuries as the result of falls during 
 these convulsions. There are milder seizures in 
 which there may be no, or but slight, convulsive 
 movements and a very transitory loss or impair¬ 
 ment of consciousness. In epilepsy there may 
 be acute attacks of mental confusion or excite¬ 
 ment, perhaps to the extent of violence during 
 which the individual may assault those about 
 him especially if interfered with in any manner. 
 Some of these periods, often not recognized as 
 epileptic in nature, are known as automatism 
 and follow the mild seizure, being in fact a part 
 of the same but there are other mental attacks 
 which seem to occur independently of any con¬ 
 vulsive seizure, and are then known as psychic 
 seizures or equivalents and may last for days 
 or weeks. 
 
 The natural tendency for the epileptic in con¬ 
 sequence of a progressive destructive process 
 existing in the brain is toward a gradual mental 
 deterioration, which in some continues to most 
 profound dementia and in others is held in abey¬ 
 ance, perhaps for a long period of years. 
 
 Some epileptics are apparently very religious, 
 but do not carry out in practice what they pre- 
 
 14 
 
tend to believe and talk about. Irritability and 
 a tendency toward fault finding is a common 
 characteristic of the epileptic. A loss of mem¬ 
 ory for the period of the attack be it convulsive 
 or psychic is the rule in the epileptic. 
 
 Unrecognized epilepsy, especially that of the 
 mild type, results in great danger to not only the 
 individual but to the community in which he re¬ 
 sides, e. g., when this condition is present in mo- 
 tormen, engineers, chauffeurs, barbers, etc. A 
 considerable percentage of the feebleminded 
 have convulsions in some period of their exis¬ 
 tence ; these then cease and do not recur. 
 
 The feebleminded person has been referred 
 to as an unfinished individual, whose mental state 
 has never reached the normal, while the insane 
 have been described as people who have once 
 been rich and are now poor. The feebleminded 
 person might be termed a person who has al¬ 
 ways been poor so far as his mental equipment 
 has been concerned. 
 
 Many children are‘backward and retarded be¬ 
 cause of lack of opportunity for receiving an 
 education because of some serious illness, often 
 occurring in early childhood, extending over a 
 considerable period of time and also where one 
 or more of the special senses are markedly im¬ 
 paired or entirely absent, e. g. loss of vision, 
 hearing and speech. 
 
 As a result of the careful examination of the 
 mental state of several thousand school children, 
 certain tests to establish the mental age have 
 been elaborated, known as the Binet-Simon tests. 
 These tests when used properly, bearing in mind 
 the environment, nationality, etc., of the child or 
 adult being tested and having the individual at 
 ease are of great value in determining the men- 
 
 15 
 
tal age of any particular person. The illustra¬ 
 tions accompanying this article show the actual 
 and the mental age of several of the higher 
 grade of the feebleminded and demonstrate how 
 such persons’ mentality does not always express 
 itself so as to be recognized at its proper value 
 by the ordinary observer. 
 
 The term for feeblemindness commonly used 
 in England, amentia, explains itself as being 
 something different from dementia so far as the 
 actual state is concerned. These conditions may 
 ultimately be much the same but in amentia the 
 individual has always been below the normal 
 state whereas the dement has ordinarily had 
 this state but has lost it. The feebleminded 
 may, however, and do dement. 
 
 Those who have had the opportunity of observ¬ 
 ing defectives and degenerates have arrived at 
 the opinion that in the majority of instances in- 
 obri'ety, prostitution, vagrancy and pauperism 
 occur in persons who are not normal. The moral 
 responsibility of the mentally defective, whether 
 insane, feebleminded or epileptic, cannot be con¬ 
 sidered the same as the normal; yet many are 
 sent to penal institutions owing to non-recogni¬ 
 tion of their mental defect. 
 
 Remember that the feebleminded may be adults 
 physically in years while mentally they are chil¬ 
 dren and always remain such. In them there is 
 a cessation of mental development at periods cor¬ 
 responding with perhaps 5, 6 or 7 years in the 
 normal child, and although the development of 
 their physical make-up may continue, mentally 
 they remain at a standstill. In consequence of 
 this involvment of the mental state these persons 
 are unsocial beings incompetent to assume a nor¬ 
 mal position in a community by maintaining 
 
themselves or to enter into contracts of any kind,, 
 especially that of marriage. Why should per¬ 
 sons of this type be permitted to marry and bring 
 into the world others of their kind when they, 
 because of their affliction, cannot even care for 
 themselves in a proper manner let alone caring 
 for others. It is easier and more economical to 
 maintain a feebleminded woman in the proper 
 institution than to maintain later a numerous 
 offspring. 
 
 The lack of mental development in the feeble¬ 
 minded and the failure of mental powers in the 
 demented explains why in these persons religious 
 perversions and many contrary actions take place. 
 In an early stage of dementia, before the mental 
 failure has been recognized by the individual’s 
 associates, he may be permitted, as a result of 
 loss of control over natural impulses and desires, 
 to fall into all kinds of difflculties, to waste his 
 property, to abuse alcohol and pass into excesses 
 of various kinds, especially those of a sexual 
 nature. The average person does not realize that 
 in most defectives, not only are the normal pas¬ 
 sions of man present but in many they are exag¬ 
 gerated or perverted, and at the same time the 
 normal control which man may have over such 
 passions is either markedly impaired or entirely 
 lost. 
 
 Give careful consideration to the fact that an 
 exact line of delimitation between the, normal 
 and the abnormal mentally cannot always be ac¬ 
 curately drawn and in consequence there are con¬ 
 siderable numbers of individuals who may within 
 a comparatively short period from the time they 
 are first observed pass into a marked state of 
 dementia or may manifest certain symptoms 
 
 17 
 
EPILEPTIC IMBECILE. 
 
 Actual age, 14 years. 
 
 Mental age, 6 years. 
 
 Esther H.—3557. Admitted to Craig 
 Colony July 2, 1912. Age 14 years.' 
 
 Fourth grammar grade education. Pater¬ 
 nal grandmother paralytic. Father alco¬ 
 holic. Mother and her family negative. 
 Patient fourth in family of seven, all liv¬ 
 ing. Onset of her epilepsy in infancy. 
 Infancy and childhood of patient as given 
 normal other than epilepsy. Ran away 
 from home twice at age of 13 years. 
 Claimed once to avoid a man who an¬ 
 noyed her. Well nourished, good looking 
 girl. Passed Binet test at six years. 
 
 i8 
 
EPILEPTIC MORON. 
 
 Actual age, 20 years. 
 
 Mental age, 9 years. 
 
 Jennie T.—3686. Admitted to Craig 
 Colony Dec. 24, 1912. American-born. 
 
 One year high school. Maternal grand¬ 
 father feeble-minded. Father alcoholic, 
 sexually immoral. One brother feeble¬ 
 minded. Both parents died of tubercu¬ 
 losis. Personal history negative. Onset 
 of epilepsy at 12 or 14 years. Alleged 
 cause, fall from piano stool. Probable 
 cause, puberty in a pre-disposed individual. 
 Both severe and mild seizures, one or two 
 a week. 
 
 19 
 
EPILEPTIC IMBECILE. 
 
 Actual age, 15 years. 
 
 Mental age, 7 years. 
 
 Florence M. S.—3672. Admitted to 
 Craig Colony Nov. 23, 1912.’ Aged 15 
 years. American. Mother German. Mother 
 died at 20 years from pulmonary tuber¬ 
 culosis. Father alcoholic. Patient had 
 convulsions during first dentition, these 
 continuing at varying intervals from 1 to 2 
 daily to 3 to 4 each week. Attended 
 school. Could not advance beyond 2nd 
 grade. Passed Binet test at 7 years. 'Was 
 admitted to Colony from Detention Home 
 in Buffalo, where she iiad been committed 
 for wandering on streets. 
 
 20 
 
EPILEPTIC MORON. SEXUALLY IM¬ 
 MORAL. 
 
 Actual age, 21 years. 
 
 Mental age, 10 years. 
 
 Libbie E. J.—3455. Admitted to Craig 
 Colony Jan. 10, 1912. 21 years of age. 
 
 High school education (?'' American. 
 Family history as given, negative. Puny 
 (?) baby. Began school at 7 years, making 
 fair progress. First epileptic seizure, prob¬ 
 ably grand mal, at 12 years. No cause 
 assigned. Since then seizures recur every 
 two or three weeks, are severe and occur 
 in 'morning as a rule. No history of 
 trauma. Has grown stubborn and will 
 not obey superiors. When admitted she 
 UiU not co-operate well during examina¬ 
 tion. Passed Binet test at 10 years. 
 Shortly after admission was found carry¬ 
 ing on perverted sexual practices with an¬ 
 other female. Repeatedly attempted to 
 make assignations with male patients. Is 
 an excellent worker in cottage. 
 
 21 
 
EPILEPTIC MORON, WITH DEMEN- 
 TIA. 
 
 Actual age, 38 years. 
 
 Mental age, 10 years. 
 
 Ella W.—2794. Admitted to Craig Col¬ 
 ony June 10, 1910. Aged 35 years. 
 
 Widow. German descent. Elementary 
 education. Made poor progress in school. 
 Father alcoholic, mother epileptic. Twa 
 sisters and her own son epileptic. Had 
 to use braces in learning to walk. Said 
 to have been run over by a wagon at age 
 of 12 years. She has been hysterical and 
 threatened suicide, as have also her father 
 and son. Has had delusions that she was 
 being poisoned. Alleged age onset of epi¬ 
 lepsy at 30 years, and assigned cause opera¬ 
 tion for appendicitis. Has severe seizures. 
 Binet test made February 8, 1913, gave 
 mental age as 10 years. 
 
 22 
 
EPILEPTIC IMBECILE. 
 
 Actual age, 46 years. 
 
 Mental age, 8 years. 
 
 Stephen B.—1704. Admitted to Craig 
 Colony Dec. 13, 1904. Aged 37 years. 
 American-born. No education. Father 
 said to have had convulsions. Patient had 
 first attack, a severe one, at age of 22 
 years; assigned cause, la grippe. Violent 
 after seizures. Attended school from age 
 of 11 years to 16 years, but made no prog¬ 
 ress. Married at age of 27 years, had 
 one child, and soon after wife left him. 
 Upon admission he was a well-nourished, 
 muscular individual who appeared men¬ 
 tally deficient. Could not name state, said 
 he was born in 1832, could not name 
 president, said he voted at preceding elec¬ 
 tion but could not tell for whom he voted. 
 Rudimentary school knowledge. Binet- 
 Simon test made Feb. 7, 1913, gave his 
 mental age as 8 years. 
 
 23 
 
EPILEPTIC MORON. CRIMINALIS¬ 
 TIC (?). 
 
 Actual age, 18 years. 
 
 Mental age, 8 years. ' ' 
 
 Orin S.—2074. Admitted to Craig Col¬ 
 ony Oct. 19, 1906. American-born, as also 
 parents. Mother epileptic, died from tuber¬ 
 culosis, as also paternal great-aunt and 
 several cousins; patient fifth in family of 
 six children. Infancy and childhood nega¬ 
 tive. Reached third grade in school. 
 Feeble-minded. First convulsion occurred 
 at seven years. After admission was 
 found to be a sexual pervert. Mischievous 
 and ran away from institution several 
 times, stole chickens from neighboring far¬ 
 mers and money from other boys. etc. 
 Mental age Feb. 11, 1913, by Binet-Simon 
 test was 8 years. 
 
 •i 
 
 24 
 
MORON. VAGRANT. EPILEPTIC. 
 
 Actual age, 20 years. 
 
 Mental age, 10 years. 
 
 Arthur T.—1587. Admitted to Craig 
 Colony Sept. 17, 1904. Aged 11 years. 
 Born United States. Both parents alco¬ 
 holic; father deserted family. Mother in¬ 
 sane at Buffalo State Hospital. Patient 
 second of three children. Early history of 
 
 f )atient unknown. Age at onset of epi- 
 epsy alleged to be eight years; severe 
 seizures recur at long intervals. Upon 
 aamission his mental state was noted as 
 feeble-minded. A Binet test made Feb. 
 10, 1913, gave mental age as 10 years. It 
 is alleged that an uncle was electrocuted 
 for murder of storekeeper in Rochester, 
 1910. Patient has repeatedly run away 
 from the Colony, apparently because of a 
 wani.ering impulse. 
 
 25 
 
MORON EPILEPTIC. 
 
 Actual age. 20 years. 
 
 Mental age, 8 years. 
 
 Charles F. C.—1880. Age 11 7-12 years. 
 Father died at 29 years from tuberculosis. 
 Both grandfathers alcoholic. Two paternal 
 uncles and a paternal aunt died from 
 tuberculosis. Sister of patient died from 
 convulsions at age of 13 months. Patient 
 had “light” convulsions during teething. 
 First severe convulsion occurred at age 
 of 4 years. Have recurred weekly and, 
 again, not for months. Noted as feeble¬ 
 minded on application. Binet test made 
 Feb. 11, 1913, rates his mental age at 8 
 years. These defectives have no proper 
 understanding as to rights of property or 
 person. 
 
 26 
 
EPILEPTIC MORON. 
 
 Actual age, 26 years. 
 
 Mental age, 10 years. 
 
 Walter S. H.—3426. Readmitted to 
 Craig Coiony Nov. 23, 1911. Aged 26 
 years. Common school education. Sin- 
 
 f le. Family history as given is negative. 
 
 irst seizure at 12 years. Assigned cause, 
 injury to foot. Probable cause, puberty. 
 Grand mal. Hesitating speech. Usually 
 ■quiet and well behaved. Passed Binet test 
 at 10 years. 
 
 27 
 
which show that they are not of a normal 
 make-up. 
 
 The treatment of these various defective con¬ 
 ditions must be along the following lines: 
 Prophylactic or preventive, ameliorative and 
 restorative measures. Under the prophylactic or 
 preventive measures must be considered the gen¬ 
 eral care of all persons in a community, especially 
 as relates to a living wage, so that dire poverty 
 will not exist. The environment of all must be 
 made such that, given a reasonably healthy make¬ 
 up to start with, each child born into the world 
 may develop along the best possible lines. In 
 the study of heredity and its influence one must 
 also give due weight to the effect of environment 
 on parents and offspring. It must be borne in 
 mind, however, that with important elements 
 required for development, either imperfect or de¬ 
 stroyed, that the best environment will not pro¬ 
 duce normal individuals. 
 
 The individual care of the expectant mother, 
 of the infant and of the growing child, is of the 
 most vital importance from every viewpoint, as 
 are also the regulation of the diet of the indi¬ 
 vidual, the following out of a hygienic way of 
 living which is governed by rules of common 
 sense and not those of the faddist. Proper school 
 instruction with a sufficient amount of recreation 
 and, when the individual reaches the proper age, 
 the selecting of a suitable employment must be 
 given careful consideration, as also the avoidance 
 of the use of alcohol with the beginning of early 
 adult years and through the balance of the indi¬ 
 vidual’s life and so far as possible the prevention 
 of injury and the occurrence of disease from the 
 moment of birth throughout life. Many of these 
 facts are matters which are difficult to control. 
 
 28 
 
but which must receive as much attention as is 
 possible under given circumstances. 
 
 Medicines are of value in treating certain 
 symptoms especially those seen in the epileptic 
 and the insane, but the use of quack remedies 
 which oftentimes are most damaging in their 
 effects to the person taking them and injurious 
 to his pocket-book as well as those of his rela¬ 
 tives, is a matter which should constantly be 
 brought to the attention of and impressed upon 
 families who have within their home circle an 
 afflicted one who might be induced to use such 
 remedies. 
 
 Surgery may either directly or indirectly bring 
 about an improvement or arrest of seizures in a 
 few cases of epilepsy and may indirectly im¬ 
 prove or restore to a normal state of mind some 
 of the insane but beyond this, it has no place in 
 the treatment of these conditions except as might 
 be applied to any person. Be skeptical about im¬ 
 possible claims being made of surgical interven¬ 
 tion, e. g., trephining, nose and throat work, re¬ 
 fraction etc., curing and making normal a per¬ 
 son primarily defective with an imperfect brain. 
 
 Persons showing feeblemindedness or the 
 milder forms of epilepsy and certain forms of 
 insanity may sometimes be kept at home where 
 they can be given such supervision as may be 
 necessary. As a rule, however, the great ma¬ 
 jority of these mentally afflicted individuals 
 must ultimately be cared for in some kind of 
 an institution, public or private, to which they 
 should be legally committed as are the insane. 
 The antagonistic, critical, unreasonable, and 
 fault finding attitude sometimes assumed by 
 the relatives of a defective toward the institu¬ 
 tion or those seeking to provide proper care 
 
 29 
 
for the afflicted one is due to ignorance or to 
 the fact that relatives are also defective and 
 cannot grasp the situation. 
 
 There is a great necessity for pushing every 
 means of educating the general public and es¬ 
 pecially the relatives of those afflicted in regard 
 to preventive measures and where an individual 
 has been restored to a normal state of mind, 
 pertaining to the after care which is necessary 
 to prevent a recurrence. 
 
 The discipline acquired by proper care in an 
 institution will oftimes enable the afflicted in¬ 
 dividual to live quite comfortably in an institu¬ 
 tion when no hope can be held forth that a com¬ 
 plete arrest of symptoms will result so that the 
 person can return to the life of the outside 
 world. It has been suggested that ultimately 
 it may be possible to have defectives not in in¬ 
 stitutions visited regularly in their homes by rep- 
 sentatives of the state. 
 
 School work for defective children requires 
 careful planning in order that any satisfactory 
 results may be obtained. A comparatively small 
 percentage of defectives are able to carry along 
 the ordinary branches of the school work to the 
 extent of the work done in the higher gram¬ 
 mar or high school grades. The bulk of educa¬ 
 tion given to defectives should be along simple 
 lines and especially the manual branches which 
 will enable these afflicted persons to frequently 
 become adept to such a degree as to enable them 
 to be of material assistance in the life of the 
 community in which they reside. 
 
 It must be remembered that with the epileptic 
 special perseverence is required because of the 
 fact that many of them have blotted out by a 
 seizure the instruction which has just been given, 
 
 30 
 
this necessitating repeating the teaching a great¬ 
 er number of times than is necessary for the or¬ 
 dinary person, who is not an epileptic. It goes 
 almost without saying that tact on the part of 
 the teacher is more necessary with the defec¬ 
 tive than with the ordinary child. 
 
 The relation of the adult defective to society 
 is an exceedingly important matter. Such de¬ 
 fectives if allowed to assume the responsibility 
 of parenthood either by being legally married 
 or by mating or cohabiting without the mar¬ 
 riage ceremony results in a defective progeny, 
 which cannot maintain itself as normal persons 
 should, becoming a burden on those relatives 
 who are able to assume a more or less normal 
 place in the community or becoming entirely 
 dependent on the community. It must be re¬ 
 membered that especially with the epileptic who 
 is thus permitted to assume the responsibility of 
 parenthood that as time goes on deterioration 
 occurs in the majority of instances and there 
 presents itself, the problem of not only caring 
 perhaps for several defective offspring, but also 
 caring for the defective person himself or her¬ 
 self. 
 
 It is a much more common occurrence to have 
 the female ^defective, either taken advantage of 
 or even married legally by a normal male, by one 
 who approaches the normal or by a medium 
 grade defective, than it is for a defective male 
 to be associated with the normal female. This 
 being true, it is necessary that the female de¬ 
 fective be more closely watched over, especially 
 during the child bearing age, than the male de¬ 
 fective. This should not preclude the necessity 
 of also having the male defective under super¬ 
 vision as in certain ways he is more prone per- 
 
 31 
 
haps to develop tendencies which in themselves 
 are not a benefit to those about him, e. g. the 
 abuse of alcohol, stealing, making assaults, sex¬ 
 ual and ordinary, destroying property, etc. We 
 quarantine for a brief period those persons suf¬ 
 fering from infectious diseases; why not quar¬ 
 antine for life those who are always a menace 
 to their neighbors. 
 
 Many have advocated sterilization of defec¬ 
 tives by various methods, in some of which the 
 essential sexual organs are 'entirely removed so 
 it is impossible for a person thus operated upon 
 to procreate; in others an operation is performed 
 to prevent the substance peculiar to the sex, be 
 it ovum or spermatozoon, from passing through 
 the normal channel to unite with that from the 
 opposite sex, but permitting the special internal 
 secretion of the sexual glands to pass into the 
 system of the individual. General sterilization 
 of defectives will never be practicable for self- 
 evident reasons. 
 
 Defectives who have been sterilized are still a 
 menace to the community, notwithstanding state¬ 
 ments to the contrary, as such operations do not,, 
 in the majority of instances, diminish the sexual 
 desires of these individuals to the extent thought 
 by the public. If permitted to have their liberty 
 in the community, females, especially the morons,, 
 who have been thus operated upon will undoubt¬ 
 edly, in the great majority of instances, become 
 common characters, contaminate children and 
 distribute broadcast venereal disease, especially 
 syphilis, in consequence of which a great amount 
 of harm will be done to the community. 
 
 Males who have been operated on, unless made 
 complete eunuchs are also exceedingly danger¬ 
 ous to the community, as they can still commit 
 
 32 
 
sexual assaults, which unfortunately are fre¬ 
 quently perpetrated on innocent young girls. It 
 is well known that perverted sexual acts are 
 commonly practiced by defectives, so that boys 
 are not safe from this class. This phase of the 
 question of sterilization is one which some writ¬ 
 ers scoff at as being immaterial and not of much 
 consequence, but I wish to make a protest against 
 the idea being held that because sterilized it is 
 perfectly safe t# turn such a defective loose in 
 the community. 
 
 To my mind the best method for meeting this 
 problem of defectiveness is that of segregation. 
 Segregation means the placing of these defectives 
 in a community by themselves where they live 
 with their kind, and are educated to the extent 
 that their mental state will permit. They are 
 given the necessary medical care that their health 
 demands and they are allowed every liberty 
 which can be consistently granted. The result 
 of such community life for the defective is that 
 ordinarily they become contented and satisfied, 
 feeling that they have a place in this special 
 community, something which they could not have 
 in the ordinary community in the outside world. 
 
 The ideal method of segregation is that of the 
 colony plan, where the institution is arranged 
 along the same lines as that of a large village, 
 having its own means of recreation and occupa¬ 
 tion as well as the buildings for proper housing 
 and otherwise caring for its inmates. It has been 
 well said that good material cannot be made out 
 of bad material, but fairly good material may be 
 spoiled by bad environment. This truism is fre¬ 
 quently forgotten. There is a great amount of 
 evidence to show that even though an individual 
 is permanently defective, a change to a 
 
 33 
 
proper environment will bring about a material: 
 improvement in the general condition of such 
 person. If this change in environment can for¬ 
 tunately be brought about in early life, the de¬ 
 velopment is not infrequently aided to such a 
 material extent that the defective child, when the 
 adult period has been reached, becomes a help¬ 
 ful part of the family or household in which he 
 is residing, although perhaps his mental state is 
 not sufficiently normal as to ma^e him self-sup¬ 
 porting. 
 
 St. Paul tells us, in his Epistle to the Thessa- 
 lonians, “comfort the feebleminded.” This ad¬ 
 vice if carried out in a broad sense, is all that can 
 be done for this class of individuals. They can¬ 
 not be made normal, as there is a permanent 
 damage to their central nervous system, some¬ 
 thing which cannot be restored by any human 
 means. Recognizing this permanent defect, it 
 seems a preposterous thing to send such irre¬ 
 sponsible persons to reform schools, prisons, etc., 
 with the idea of making them, after a few years" 
 residence, perfectly normal persons to be restored 
 to a free and unrestrained life in the outside 
 world. 
 
 In considering the enactment of legislation re¬ 
 lating to the problem of defectiveness, conser¬ 
 vatism must be ever before us, this to be tinged 
 with a considerable degree of optimism. The 
 task of solving this problem, in part at least, is 
 not entirely hopeless. I do not contend that we 
 can ever hope entirely to remove the defective 
 from our midst, nor would it perhaps be desir¬ 
 able, but I do maintain that it is possible by the 
 use of unobjectionable means to ultimately place 
 the great proportion of the defectives under 
 such a kindly supervision as to prevent them 
 
 34 
 
from increasing their kind and from producing 
 in the ordinary community damage by unsocial 
 acts. 
 
 Many of the hasty, ill-advised measures ad¬ 
 vocated, perhaps by inexperienced theorists, are 
 not only futile but are injurious to the cause of 
 providing proper care for this class. It must not 
 'be forgotten that at no time can we ever hope 
 to have restrictive measures, whether they be 
 custodial laws, marriage laws, laws of preven¬ 
 tion of procreation, etc., that will include all 
 who can properly be called defective. A certain 
 proportion of defectives may be brought within 
 the influence of custodial legislation but a vast 
 number of the higher grade of defectives can¬ 
 not possibly be reached until there is aroused 
 public opinion to the fact that, not only is it a 
 kindness to the individual, but also a duty to the 
 public at large to have such high grade defec¬ 
 tives under proper supervision at all times. This 
 means that provision must always be available 
 for voluntary inmates in our various institutions 
 for the subnormal and abnormal, and perhaps 
 when a Utopia is with us, all of these will re¬ 
 ceive special care and supervision. For the 
 higher grade defectives, especially for those who 
 approach closely the normal, however, this care 
 is something in the future, as the matter of mak¬ 
 ing a positive diagnosis of defectiveness in this 
 type will naturally always meet with much crit- 
 i''ism and objection on the part of the general 
 public. 
 
 Well thought out laws relative to the care of 
 the insane, the inebriate, the epileptic, the feeble¬ 
 minded, including with the, latter the vagrant, 
 a large percentage of the prostitutes, etc., must 
 be given the utmost consideration by all who are 
 
 35 
 
interested in the welfare of humanity. The 
 question of deciding as to mental competency 
 or incompetency of the higher grade defective 
 is something that requires the most careful ex¬ 
 amination and consideration. Until there is 
 aroused a public conscience with a well defined 
 moral sense at the fore we can not expect to 
 accomplish much as to the control of venereal 
 disease and the enforcement of marriage laws. 
 So long as there is a double moral standard for 
 the sexes just so long will many of these condi¬ 
 tions continue to exist. There must be eradica¬ 
 ted false ideas held regarding the necessity for 
 “the sowing of wild oats/’ i. c., incontinence of 
 males. We must remember that laws will not 
 make all persons moral. There must be some¬ 
 thing more before what we desire in this direc¬ 
 tion can be accomplished. 
 
 Health certificates before marriage may in 
 many instances prevent those having venereal 
 disease, either syphilis or gonorrhea, in the in¬ 
 fective stage, from marrying, but from the 
 standpoint of heredity such certificates cannot 
 at present* be of great value for the reason that 
 so far as the vast majority of mankind is con¬ 
 cerned the facts relative to heredity are not 
 available. 
 
 Unfortunately, it is a well-known fact that 
 in many instances a person of some means can 
 seemingly evade any law, no matter what it 
 may be; and another thing to remember, so far 
 as the sexual relations are concerned, is that no 
 law can override sentiment, nor would it be 
 well to have the world ever come to such a state 
 that what we recognize as the normal feeling of 
 affection between a man and a woman who en¬ 
 ter the marriage state should be lacking and 
 36 
 
when those desiring to become such partners 
 should simply be picked out by the state from 
 a standpoint as to whether or not they were 
 perfectly healthy. In our day certain writers 
 go so far as to advocate the sweeping away of 
 the home, marriage. and morality. This being 
 true of people supposedly above the average in 
 intelligence, what can such an example mean to 
 the masses. Transitory matings of the type ad¬ 
 vocated would soon result in the undoing of the 
 race as there would be no restriction of the pas¬ 
 sions of man. 
 
 It is my opinion that proper control of the 
 sexual instinct is not to be obtained by constant 
 detailed harping on the subject in schools, which 
 often results in developing in children morbid 
 ideas regarding the subject, for intimate knowl¬ 
 edge alone of such matters has never proved a 
 means of preventing man from permitting his 
 sexual instinct from controlling him instead of 
 his being its master. In fact, the contrary has 
 been too often the case. There must be incul¬ 
 cated in young and old the fact that the human 
 individual exists for other reasons than satisfy¬ 
 ing every appetite, powerful though such may 
 be. All must learn that continence and health 
 are entirely compatible although some would try 
 to prove the contrary. The arousing of diverse 
 interests in other matters, and from an early 
 age the developing of self-control in the indi¬ 
 vidual as relates to all desires, are of funda¬ 
 mental importance, controlling and directing the 
 various instincts along proper channels. 
 
 In conclusion, I would repeat that all inter¬ 
 ested in the welfare of the race, who give careful 
 thought to the facts and knowledge at present 
 available regarding defectiveness must concede 
 
 37 
 
that all we can accomplish at present is, so far as 
 possible, to segregate those who because of de¬ 
 fective make-up are incompetent to assume a 
 normal place in the community, and in accom¬ 
 plishing this protect both the defective individual 
 and the community. Such partial segregation is 
 worth while and is in the last analysis economi¬ 
 cal. Marriage laws, sensible in nature, will ac¬ 
 complish something; but in order to have any 
 marriage law, no matter how good, enforced, it 
 will be necessary to carry on an active educa¬ 
 tional campaign for a considerable period before 
 the general public will assist in such enforce¬ 
 ment. They must realize what venereal disease 
 means, what mental defect means, what the 
 responsibility of parenthood means, and must 
 be given the results of a long-continued,, 
 thorough study regarding hereditary influ¬ 
 ences before we can hope to secure their ac¬ 
 tive co-operation to meet the problem of de¬ 
 fectiveness. 
 
 Sterilization has its place in selected cases, 
 but I wish to reiterate the fact that even though 
 when practicable, a defective person may be 
 sterilized, it is not safe to turn such an individ¬ 
 ual loose in the community. 
 
 Enthusiasts will, unless held in check, simply 
 confuse the issue at hand. A wise conserva¬ 
 tism, especially by physicians, is demanded if 
 anything lasting is to be accomplished in the 
 matter of the prevention of defectiveness. It 
 is well established that all families and all na¬ 
 tions pass through a cycle of existence or life, 
 as does the human individual. Defectiveness 
 can never be controlled but in part. 
 
 The cost of segregating a considerable pro¬ 
 portion of defectives will be no small sum, but 
 
 38. 
 
think of the amounts of money wasted annually 
 on alcoholic beverages and in dissipation of one 
 kind or another, so common to our day, factors 
 which also increase the number of defectives. 
 If but a part of the amount so expended was 
 made available the problem of meeting the ex¬ 
 pense of providing adequate means of segre- 
 :gation could be easily met. Until the people 
 realize the relationship between mental defec¬ 
 tiveness and crime, pauperism, inebriety, vag¬ 
 rancy, prostitution, etc., there will not result the 
 strict but kindly segregation advocated as the 
 solution of the problem of caring for defectives. 
 
 ^9 
 
BROOKLYN EAGLE PRESS