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cordant elements, suddenly brought together, placed under the guidance of untrained attendants, and with only the scantiest means at hand for assorting them into harmonious groups. Especially will this be apparent when it is remembered that each of these patients had in private life been permitted to have his own way in his family and the community in which he resided. The nature of his disease had made him an object of pity and indulgence to his parents and relatives; while his irascible temper, and, as a rule, his unreasonable disposition, made him a citizen with whom argument was considered anything but desirable by his neighbors. Many of the patients came from almshouses, many from the lower walks of life, and were uncouth in their manners and dress, filthy in their habits, and rude in conversation. The improvement most noticed by visitors has been the wonderful change in their deportment. Association with others afflicted like themselves has taught them forbearance and patience. Unusually affectionate in their dispositions, they have come to realize their own infirmities and temper by observation of others similarly afflicted; and pity joined with counsel have so promoted self-control that personal encounters are not now nearly so frequent with 700 as they were with the first 50. This improvement has been aided materially by mild discipline, such as a temporary deprivation of liberty and enforced absence from the ordinary The change for the better is also apparent in the matter of general deportment and dress. Politeness has taken the place of boorishness in those to whom politeness was an unknown quantity prior to their admission. The social influences of the institution are manifest, even in the most degraded, and especially in the younger patients. The day-school, Sabbath-school, and regular religious services in the chapel, the prayer-meetings in the cottages, as well as the social enjoyments of the amusement-hall, have all contributed to the upbuilding of the polite as well as the moral character of the inmates.
The question has frequently been asked if the effect of witnessing seizures in others is prejudicial in causing undue excitement and in cultivating the habit of the epileptic attack through imitation. Our experience at Gallipolis shows conclusively that such is not the Indeed, the matter-of-fact manner in which attacks in others are witnessed by the epileptic is wonderful. A seizure in the amusement hall or chapel, while of a character to cause the greatest
excitement and consternation in an ordinary assembly, is scarcely noticed; and it does not at all interfere with the attention of the audience. The cry, so terrifying to the ordinary congregation, excites here but a passing glance, simply to satisfy curiosity as to the identity of the sufferer; and that is all that is thought of it.
Perhaps the strongest argument in favor of the congregation of epileptics lies in the safety insured by their association. No sooner is the premonitory cry, which so often ushers in a seizure, heard than willing hands fly to the sufferer's assistance. Everything is instantly dropped, so that no time may be lost in reaching him before he falls. Many times have I heard this cry, and witnessed the rush of patients to reach their fellow in time to catch him and prevent injury from falling; and, as they usually walk together, serious accidents are very infrequent. No serious accident has happened in Gallipolis for more than two years, during which time more than eight hundred patients have been treated; while, of less than two hundred patients temporarily visiting their friends at home during that time, fourteen have met with fatal accidents and several others with very serious ones.
Among the most important means of treating epilepsy, regulation of the diet occupies the front rank. Many experiments have here been made in diet. Bills of fare have been made out, with varying quantities of different foods, for each day in the week, and have been carefully compared with the number of attacks following. A free meat diet has been found to exercise a prejudical influence, and we only allow it for the mid-day meal. Care is taken to encourage deliberation in eating; and, to that end, meals are served in courses. Fruit is given freely at all seasons. When fresh fruit is not in the market, it is supplied in canned or evaporated form. It forms the principal article for breakfast and supper, supplemented by some cereal and milk. The only meats permitted are fresh beef, either roasted or boiled, mutton, fowls, and fish. All pastry is tabooed. No articles of diet are allowed to be fried. The bread is usually served stale, the only exception being occasional allowances of cornbread, which is served hot. Coffee is allowed for breakfast, and
milk ad libitum for the other meals. Singularly enough, many of the vegetables accounted as indigestible, such as cabbage, cucumbers, and the like, have been found to exercise no deleterious influence upon the disease.
Perhaps one of the most important problems presented is that of employment. In a congregation of persons having such a divergence of tastes, habits, education, age, physical strength, and mental acquirements the question of employment becomes a very intricate To meet it successfully, a great variety of occupations must be provided. Fortunately, the requirements of a large colony are such as to furnish suitable employment for a great number of persons of different conditions. After all the necessary branches of labor have been fully filled, however, a large surplus of patients is found to be still unemployed. Housekeeping, including the care of the kitchen, dining-rooms, laundry, sewing and mending rooms, together with that of the farm, gardens, and grounds, gives employment to about onethird of those capable of manual labor; while the offices, store-rooms, drug-room, etc., furnish clerical work for a few who possess the necessary education and skill. For the large remainder, shops are to be constructed for carrying on various trades. Some industries, such as basket-making, mattress-making, book-binding, etc., have already been fairly started; and an industrial building is almost completed, in which about two hundred may be employed in various other occupations suitable to their condition. It is the intention of the management to establish a manual training school for the benefit of the youth, in which useful trades may be taught, so that the patient in the case of recovery may be able successfully to compete with others in the struggle for existence, or, in the event of his disease remaining permanent, he may lessen the burden of the community taxed with his support.
I have not sufficient enthusiasm to believe that this or any similar institution will ever be self-supporting. I do believe that the cost of maintenance can be brought to a much lower standard than that of any other eleemosynary institution. The best type of epileptic colony in the world is doubtless to be found at Bielefeld, but a study of its reports will show a very wide gap to be filled before it has a self-supporting revenue. Other industries are to be introduced as rapidly as possible: a dairy farm for supplying all the butter and milk; and brickyards and joiner shops for providing new buildings for the future needs of the institution.
Much importance is attached to regularity of habits, encouraged by a residence in the hospital. Patients are expected to go to their meals at exact hours, to retire for the night and rise in the morning
at the same hour, day by day, and to have all their other habits regulated with perfect exactitude.*
Of the medical treatment, I can only say, in a general way, that many remedies have been tried, and that all new suggestions, from whatever source, have been given a patient trial with varying results. Epilepsy has ever been regarded by medical men as one of the least hopeful of diseases, so far as the expectation of complete recovery is concerned. Those who have had the largest experience rate the percentage of recoveries very low, while the great majority of physicians regard this disease as practicably incurable. It is, therefore, with no little gratification that attention is called to the remarkable improvement in the large percentage of patients received at Gallipolis, and to the probably permanent recovery of a reasonable per cent. of those treated. There has been a reduction in the number of attacks by more than three hundred per cent., while in lessened severity the proportion has been relatively as great. At the close of the fiscal year, ending Nov. 15, 1896, fifteen patients were discharged as recovered. Patients are considered recovered after a residence of two years from the time of the last attack. These patients have been corresponded with since, and up to the present time have continued well, the majority without any return of the attacks for three years. From present indications we expect to
send out more than double that number next November.
I cannot too strongly emphasize my convictions, based upon nearly four years' experience, of the efficacy of making separate State provision for the epileptic. We shall not find, in any State institution, a parallel to the establishment at Bielefeld, for the reason that religious zeal can never be supplanted by State labor, no matter how consecrated the efforts of the management may be; but, with such an example before us, we may hope to bring lasting benefits to a hitherto neglected class of unfortunates, and to provide much better care than they are now receiving, at a greatly reduced cost.
* A well-equipped laboratory, supplied with the best direction we have been able to procure, has been instituted for scientific investigation of the disease; and it is confidently hoped that new light may be shed upon its causation, character, and treatment.
A day-school, which we consider one of the important adjuncts in treatment, has been in successful operation for three years; and we are now on the eve of occupying a new and commodious building constructed for the purpose, and furnished, in addition to the ordinary style, with comfortable retiring-rooms in case of attacks. Much benefit has also been derived from the kindergarten and classes for physical training.
INDUSTRIAL EDUCATION FOR EPILEPTICS.
BY WILLIAM P. SPRATLING, M.D.,
MEDICAL SUPERINTENDENT, CRAIG COLONY, SONYEA, N.Y.
An American physician of note, delegated some years ago to attend a meeting of the British Medical Association held in England, while speaking before the Association, said, "It seems hardly worth our while to attempt to put a five-thousand dollar education into a five-hundred dollar brain." His remark was intended to apply
to students of a certain class; and, while we may regard it as somewhat harsh, candor compels us to admit that it contains a grain of homely truth, applying not only to one class of students, but to a contingent of many classes to whom we are trying to give highly specialized knowledge far in advance of their needs or of their individual receptive and assimilative capacities as fixed by the inexorable laws of nature.
I am not opposed to giving an education that educates, that puts into an individual's possession an instrument fitted to his capacity to wield, which, if properly used, will make him a producing and self-supporting agent. This should be the aim of education. A man may not always be obliged to wield the club that is put into his hands; but it is there, if he needs it. And the club must be fashioned according to his strength, his needs, his power to use it.
The generation just passed has witnessed radical changes in our system of education, and the progress has only begun. The newer educational methods have come as the logical result of a better knowledge of the human forces as learned through a study of psychology. We are trying to go hand in hand with nature in the teaching and acquisition of better things, trying to expand all that is good and to dwarf and subdue the evil.
We have not yet learned to teach what it is always best for an individual to know. We do not properly weigh and determine individual qualifications and needs; and, from the vast amount of educational work to be done, it is not likely, except in individual cases, that we ever shall.
The colony system in the care and treatment of epileptics forms an exception to the rule of limitations, and makes a circumscribed