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2,997. When I say that there were 2,500 physicians not corresponded with, and 20 poor farms not heard from, it will be observed that a conservative estimate of the number of epileptics in Iowa is over 3;360, or 1 to every 600 of population. Reference in detail to this class will be made later.

Heredity. The number of feeble-minded in institutions who are presumed to be capable of reproduction, as presented, is somewhat incomplete; but it is sufficient to demonstrate the advisability of retaining in permanent custody all grades. A strong reason for the modification of the original plan of educating feeble-minded children, with a view of dismissing the higher grades, is that they are capable of and prone to reproduction. This opinion has gradually been confirmed through observation of those who have been dismissed, who were thought to be capable of self-support, but eventually succumbed in the battle of life, leaving, perhaps, a legacy to the world, of degenerate progeny.

Self-support.-The question as to the numbers dismissed who have proved capable of support has been answered from various points of view by different reporters; but I can say that the discrepancy in the percentages noted is more apparent than real, owing to the ambiguity of the question. The consensus of opinion expressed by experienced workers is that none of those dismissed are capable of self-support, in all that the term implies. They never become fit for full citizenship. Although deft in handicraft, the higher powers of the intellect (reason and judgment) always remain markedly and noticeably at fault; and without intelligent and kindly supervision they inevitably become dependants or worse.

Age of Admission. The earlier institutions operated under laws limiting the admissions to children within school age, who were directed to be dismissed at the end of their school period. More recently States have enacted laws admitting feeble-minded persons of all ages, and this is the growing and present sentiment.

Land. Many of the institutions are reasonably well provided with land, and this is of practical importance. Much of the inmate labor can be utilized on the farm, garden, and orchard; and the profits materially lessen the per capita cost. It has been conceded for years that each institution should be provided with at least one acre per inmate; and, as we grow in years, it is thought by some that even more than this is needed. I am not convinced that any fully or

ganized institution for the feeble-minded, which cares for all ages and classes of these deficients, and maintains the present standards of efficiency, can ever be made self-supporting by inmate labor, however much land and other facilities for remunerative labor are provided by the State. Very few of our charges are, or ever will be, capable of performing a full measure of labor. The physical and mental deficiencies of even the best among them are below par; while a large and increasing number, in the asylum division, are incapable of performing any labor that is productive or profitable.

I do not deem it advisable to encourage an anticipation on the part of the public that such an institution can ever dispense with State: aid. My conclusions are that, after utilizing to the best advantage the labor of our inmates, the yearly per capita cost can never be brought lower than $150 or $125, depending on local conditions. It is not only for economy that land is needed, but as an educational field.

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CAUSES AND PREVENTION.

Statistics relating to the defective and dependent classes show that there are in the United States, coming under this category, as many as I in every 100 of the population, or a grand total of 700,000. For their relief various philanthropic organizations are actively engaged in dealing with the problems presented by the many phases of the questions involved. The work of caring for existing conditions has in the past largely engrossed efforts for their amelioration; but latterly thoughts and efforts have turned toward combating the causes of degeneracy, with a view to lessening the number of degenerates, thereby protecting posterity. Here let me mention, briefly, some of the causes generally regarded as potent factors in the production of deficients, which are specifically applicable to the class under consideration :

Congenital.— Heredity, which includes idiocy, epilepsy, insanity, phthisis, general neurosis, intemperance, syphilis, and consanguinity. Among accidental causes may be enumerated: (1) abnormal conditions of mother during pregnancy; (2) accidents to child during birth; (3) accidents and disease after birth.

That heredity plays an important rôle in the production of imbecility, none conversant with the question will be disposed to deny; yet the difficulty of ascertaining positive causation suggests caution in

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formulating percentages due to bad heredity. It is not in all cases absolutely clear that any one condition is the sole factor in determining the mental unsoundness of the child. Many causes may contribute to this result; and, even where there is a distinct neurotic ancestry, there is no conclusive evidence that this ancestral neurosis is the actual cause of imbecility. Other factors may have been the primary cause or may have shared in determining the deficiency. Local conditions at the initial period of the germ lifehave much to do with the subsequent development or retardation of the future child; and later conditions up to the time of birth are full of peril to the unborn, even in mothers free from constitutional taint. It is often convenient to classify cases under the head of heredity; but Seguin says that "everything pertaining to conception, gestation, parturition, and lactation, remains enshrouded behind the veil of Isis."

Of all classes of degenerates, none transmit their infirmities in a greater degree than the imbecile. Where the ancestral stock is properly classed under this head, they must transmit in every case some form of degeneracy to offspring, the majority of whom are noticeably mentally feeble, while many are criminals, inebriates, or prostitutes.

Permanent sequestration is the most efficient and humane manner of reducing the number of the feeble-minded. One writer states that 27 per cent. would thus be cut off.

Epilepsy. The statements already presented show that the number of epileptics is at least equal to that of the feeble-minded, and approaches that of the insane. "It is not an isolated condition. It is a wide-spread disorder, finding its victims among all peoples and in all walks and conditions of life. . . . The great mass of them are wanderers and incumberers, swelling the ranks of the paupers and criminal classes, transmitting their infirmities to their progeny, thereby increasing financial burdens both to the State and its citizens, as well as being a constant menace to the peace and safety of society. Nature seems to place her seal of doom upon the epileptic and his progeny, on one member as an habitual criminal, another as an imbecile, and a third a consumptive, while the fourth may be an epileptic." Lombroso was able to furnish the first edition of "Abnormal Man by taking atavism and epilepsy as a basis. 40 per cent. of epileptics have led either criminal or other forms of

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degenerate life. Official statistics show the proportion of epileptic criminals to be six times greater than of the supposed normal criminal. Of all hereditary factors except feeble-mindedness, none is so prolific in entailing a blight upon succeeding generations as epilepsy. For the reasons stated, I earnestly coincide with the opinion of those who are seeking to establish separate institutions or colonies for them, feeling that this "mild imprisonment" would prove a humane and effectual means of cutting off another source of the production of not only feeble-mindedness, but other forms of mental and physical degeneracy. So far, with the exception of New York and Ohio, no separate and distinct provision has been made for them. Sequestration of epileptics is advocated for the following

reasons:

1. For scientific research, with a view of determining causes and

cure.

2. For the prevention of transmission of infirmities to progeny. 3. For its humane aspect and public safety.

4. For the relief of institutions organized for the care of other defectives and now caring for large numbers of epileptics.

Consumption.— Since it is conceded that one-half or more imbeciles cared for in institutions die of consumption, we may consistently inquire as to what extent it may have been the cause in the ancestry of transmitting a mentally impaired offspring,—a being mentally weak, supported by a correspondingly weak physical organization, ready for the reception of bacilli tuberculosis.

Whatever per cent. of feeble-mindedness may be due to this cause, prevention through hygienic and sanitary measures and environment should not only be advised, but enforced. A disease that prematurely ends the lives of more human beings in the United States than any other known cause, and in its ravages entails many infirmities, should receive earnest attention from the public, and especially from physicians, to control it. Not until the authorities are convinced of the necessity of precautionary measures will this be done. The "anti-spitting" ordinances are finger-boards pointing in the right direction. Patients infected with tuberculosis have no right carelessly to scatter their deadly germs at will. Sanitary quarantine for the consumptive will doubtless be provided in the future. Society has a right to protect itself and future generations. · Intemperance. In an analysis of 848 feeble-minded persons, I

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find that parental intemperance is reported in 81 cases. instance except one the intemperance was of the father. include almost all who used alcoholic drinks to any extent. few would be classed as dipsomaniacs. In 60 per cent. of these there were other causes in the ancestry, such as insanity, idiocy, etc.

Dr. Ireland, in his work on "Idiocy and Imbecility," remarks that "there is a great difference of opinion about the influence of drunken habits in parents in the causation of idiocy." Dr. Langdon Down, of England, and Dr. Ludwig Dahl, of Norway, both consider this factor to be important; while Drs. Grabham and Shuttleworth find a very small per cent. due to it. The experience of other close observers agrees with the latter that it is not as potent a factor in the production of imbeciles as the general public imagine. The danger appears to be that intemperance, added to other conditions, may intensify the results. Whatever the percentage may be, it is in the line of prevention to disseminate information and advocate measures for the suppression of this extensive evil.

Syphilis. Evidences of inherited syphilis appear in so few of the feeble-minded that I refrain from commenting on it as a cause.

Consanguinity.—The prevalent idea that the intermarriage of relations always produces deficient progeny is not sustained by facts. It is a physiological principle that a normal cell under normal stimulus produces a normal cell. If both parents are mentally and physically sound, the danger lies in accidental causes common to all. However, where there is mental instability in parentage, the results in consanguine marriages are intensified, and should be deprecated. In this connection, Dr. Martin W. Barr, after referring to the history of the Jews, and giving other statistics of consanguineous unions which failed to substantiate the common belief that such unions result in a weak progeny, states that in 1,044 cases examined by him he found but 31⁄2 per cent. traceable to this cause. In 848 cases recorded by the Iowa institution I find only 32, or 3 per cent., in which there were such relationships in the parentage; and in a number of these cases other controlling factors were present.

Accidental. Whatever percentage of idiocy may be accounted for by hereditary transmission, the fact remains that accidental causes determine the condition of a large number of the feeble-minded. When we realize the numerous accidents to which the life germ itself is liable, the perils of gestation, the momentous introduction of the

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