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PRESIDENT'S ANNUAL ADDRESS. (1)

By Martin W. Barr, M.D., Chief Physician, Pennsylvania Training School for Feeble-Minded Children, Elwyn, Pa.

GENTLEMEN: -- To me this year falls the pleasant duty of bidding you twice welcome, for we come together not only for our annual meeting, but also to celebrate the coming of age of our Association. Remembering that Pennsylvania was its birthplace, I count it for myself a most fortuitous concurrence of events that places me on this anniversary in the chair first filled at Elwyn by Dr. Seguin, and that I should be here to welcome back to the work our friend and my former associate, Dr. Alfred W. Wilmarth, of Wisconsin.

Born of the inspiration of the Centennial year, and with such enthusiastic workers as Seguin, Wilbur and Kerlin as its originators, it is no marvel that the association passing the period of youthful inexperience has lived to attain its majority in vigorous proportions, growing in this time from a membership of six to one hundred and sixty-three, with institutions and states falling rapidly into line, and to-day it adds to its list the names of Polk, Pa., and Chippewa Falls, Wisconsin. Gentlemen of the Association, "let us press forward." The day of mourning for our fathers is accomplished, and eulogies and panegyrics have been too long our theme. Forget them! we would not if WE could, as we pursue the paths they opened with such patience and courage, but we must recognize that the plans they proposed have already been fulfilled. Our work broadens and must broaden -- for one hundred years advance in the march of civilization opens to us new fields of which they could only give us the "peradventure."

Both within and without, the work assumes new aspects. Closer classification and growing possibilities, drawing clearer and more definite lines between the trainable and the untrainable, are fast changing our school rooms to work shops and art-rooms. The massing and setting apart in happy, busy life of such numbers once deemed incapables, simultaneous with the movement of the new education to promote better classification in the schools, has presented a much needed object lesson and called the attention of the public to the study of the mental defectives in their midst, and of its bearing upon practical pedagogics.

Classes in sociology, physiology and psychology, come to us to observe, compare, and report likenesses and differences between normal and abnormal minds. This interchange of thought cannot but be conducive to progress and must influence both their work and our own.

The recognition as defectives of those backward and feebly-gifted children who have hitherto so embarrassed the work of the teacher has already led to new and better grading of the schools on the Continent and in London, while with us, Providence, Rhode Island, is taking the lead in a movement which must soon become general.

The new schools made up of this backward class, will naturally seek to be benefited by our experience in classification and training, and we shall draw largely from them if indeed we do not absorb them altogether; and it is just here that our work in its second half century takes a new departure. Relegating many of the occupations and means of development first employed by our pioneers to asylums, which may or may not be attached to future training schools, we shall press forward on the same lines to broader operations with possibilities of the ultimate establishment of communities of skilled artisans working in the various trades and applied arts. Here the imbecile, separated from the world and forbidden to marry, shall become a self-supporting, self-respecting citizen, who in the possession of an assured freedom -- always under careful direction and supervision -- enjoys happiness and protection in lien of ignorance, degradation and ignominy.

In addressing ourselves to work under these new conditions which are rapidly shaping around us, there are several points which conference may simplify and united action accomplish.

History already classes the rescue and training of the imbecile among the wonderful achievements of our wonderful age, and society, aroused not only to the knowledge of the existence of such numbers, but of the rapid increase, and agitated by questions which affect its very being, will soon demand of our century of experience some authoritative teaching as to remedy and redress. Are we prepared to answer the inquiries which must, and indeed, do, come to us frequently, many times throughout the year. For what are you preparing the imbecile? How can you secure the greatest happiness to the greatest number? How best render the imbecile harmless to himself and to the world? -- are but a few of the many problems we are called upon to consider; to which might be added a discussion of how to meet the inevitable demand of the future for trained professional workers -- physicians, teachers and attendants, and the advantages to be gained in establishing communities of the feeble-minded, and the advisability of seeking national aid in averting general and wide-spread calamity. These are the plain questions before us if we are to grasp and prepare for the momentous issues of this new era, which, I might almost say, calls anew for pioneer work. Results obtained from training, and also the grade of many applicants seeking training, plainly show that the day of the mere housing and self-help of the imbecile is no longer our one object, while on the other hand over-crowded conditions prove that we must educate the public to the difference between idiocy and imbecility. We must make some protest against the forcing into our institutions of the untrainable; and to this end might not an established sequence of manual work, following out the same line of development which we find so helpful in both kindergarten and sloyd for the benefit of those who can enter upon it, be also a means of protection against those who cannot, and thus the legitimate work of the training school be not lost in that of the asylum.

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Lest I absorb valuable time better spent in conference and discussion, I will not detain you by elaboration of these topics beyond a mere presentation.

For the first oft-repeated: For what are you preparing the imbecile? As to returning him to his friends after a few years of training, as the law in some states provides, the objections are manifold. In many cases our waifs and strays have neither home nor friends and the short period, allowed hardly suffices for permanent practical results. After training they have no will to work unless apprenticed to people who understand how to govern without hurting them: and where are they? Again, the shifting conditions of American life forbid, often, any certainty as to locality of friends or stability of occupation. We cannot as they do in European institutions send the child out assured of that environment for which he has been trained. Indeed, we are assured of but one thing when he passes from our care; namely, that his return to the world in almost every instance insures an increase of population not conducive to national prosperity.

As to the second proposition: How can you secure the greatest happiness to the. greatest number? Whether within or without an institution, congenial employment that shall prevent deterioration and preserve the self-hood to which he has attained is the sine qua non. To him, as for the normal, must be given "honest work for the day, honest hope for the morrow " -- that brief to-morrow of completed toil without anxious care, which is all he may know.

The benefit of such a training as above outlined would be not only the perfecting of our work, but by commanding the attention and respect of the public, tend also to aid in their work of eliminating the feeble-minded from the common schools.

Already our ADVANCES along these lines has removed greatly the sense of obloquy formerly associated with institutions, and this appreciation must increase in proportion as the public comes to understand us. Thus in time we may find their "slow pupils" sifted out and tested in these unclassified ranks already past rudimentary work, coming to form our middle and high-grade classes, and we can then train competent artisans in the various trades and crafts in sufficient numbers to really reduce expenses, and solve in a natural way the problem of how to secure the greatest happiness to the greatest number? But this, you will say, concerns only the imbecile for whom in low, middle and high grades may be found such occupation, while the future condition of the moral imbecile, the idio-imbecile and the idiot, demands equally our consideration. For these last, who, together with the epileptics, crowd upon us and impede so largely our work, filling the places of the imbeciles who, as I have shown, working at trades might materially diminish our expenses, we trust the future may yet free us. It is to be hoped that the day is not far distant when they shall here, as in Europe, be gathered into asylums quite apart and distinct from training schools upon whom they are simply a burden, neither receiving nor contributing benefit.

As to the moral imbecile it has become an accepted fact that he cannot be trained or properly cared for without greater restraints than those belonging to the ordinary training school. To confine him with idiots far below his intellectual grade is equally an injustice to him and a cruelty to those weaker brothers for whom he makes life miserable. A scape-goat for the sins of others, an inevitable enemy of society who must be forever set apart, this unfortunate victim of heredity seems doomed to a life-long penitentiary. The question for us is, how to lessen this isolation and atone to him for the unremitting and rigid surveillance necessary.

Enlarged bounds, suitable amusement and constant employment, together with proper facilities for control, should constitute an important department for this class in every institution. Entirely separated, yet sharing to a limited extent -- conditional upon a good record -- in its general privileges, these unfortunates, while contributing by valuable labor to the support of the institution, might yet find compensations, and a life service of comparative happiness.

How best render the imbecile harmless to himself and to the world?

This question, so nearly akin to the case of the moral imbecile, touches also the whole race of weak-wills and animal propensities.

The consideration of this, above all others, marks advanced thought; the effects of heredity becoming recognized in theory at least, are fast maturing in Legislative enactments regarding marriage.

New York and Connecticut have taken steps toward forbidding the marriage of epileptics, and Pennsylvania records the following act of assembly: "No insane or feeble-minded person and no person who from natural causes as distinguished from accidental causes shall have been insane in the past, and no person who shall hereafter have been twice convicted of felony as defined by the laws of the Commonwealth, shall be capable of marriage in wedlock, and any clergyman or civil officer who shall knowingly solemnize such marriage, and any person who shall knowingly assist in procuring or abetting the same, including the parties to such marriages, shall be guilty of a misdemeanor and shall be subject to imprisonment for six months and a fine of five hundred dollars, both or either, at the discretion of the Judge before whom the offence shall be tried."

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This law, assuredly not stringent, will have its place as a check upon the law abiding, and will call the attention of the public to further needs of protection against the lawless; for history shows that the attempt to legislate for conscience is a vain one.

In nations, as in communities, wherever stringent marriage yaws are enforced, the inevitable result has been free-love, concupiscence and prostitution. In dealing with the low and the bestial, with the ignorant and weak, the silly and the irresponsible, with utter incapacity to comprehend any law but that of self-will, there is nothing to convert or convince, for the moral sense is not there to appeal to.

To such a class asexualization would come as a double release, freeing them from the power of harming themselves and society, and granting in all else greater personal freedom to the individual, whether without or within institution walls. Once rendered harmless, he is free to gather all he can from life.

With imbecility and its many phases of sexual perversion, recognized as a disease -- a sure means of transmitting inherited taint -- it does seem absurd that while we wage war upon microbes and bacilli, we turn loose this worse than leprosy to poison the very springs of life in more ways than one, forgetting, "The evil which men do lives after them." Why do we not more closely follow Nature's law? All seeds, all buds, do but perpetuate their kind, and we but follow the lesson taught when we shake the bough from which falls defective fruit. We choose and set apart with care the animals best fitted for procreation, and by castration render more docile, because less passionate, the beasts of burden who are to mingle in the common herd. They rove at will free and unrestrained -- because harmless. I need not point the moral nor draw further analogy.

Separate the love of one's kind and the consequent desire to project one's individuality upon the onward current of humanity, and procreation has no element above the mere animal. We all know that with imbeciles the first is impossible. Then do we not best serve them when in loosing them from the thraldom of the second, we release them from restraints thenceforth needless, and therefore open to them greater happiness in individual and in community life?

Sir Thomas Moore says: "The world is undone by viewing things at a distance." Let not this mistake be ours.

Here even more than in previous questions it behooves us to prepare to speak authoritatively and to give when sought, as will surely be of us, an answer that cannot be misunderstood. I say will! The issue is even now upon us.

That which was spoken of with bated breath and behind closed doors already begins to be the subject of open discussion, and to appear in reputable journals. I quote from the July number of the Altruist: "Besides being prevented from propagating their kind, the feeble-minded need constant care and training in order that they may use their limited faculties to the best advantage and get some pleasure from their blighted lives. This means complete isolation and special training and supervision, the expense and trouble of which could be materially lessened by the asexualization of those who were decided, by a committee of medical men appointed for the purpose, to be fit subjects for the operation.

From this severe measure the mind instinctively shrinks, though it is now advocated by many of those best acquainted with the subject; and when calmly considered in the light of modern science, and as a choice of two evils, will probably be accepted as a necessary evil by all right-thinking persons. Further, increasing surveillance would be necessary unless asexualization were legalized. But, under any circumstances, isolated and cared for, they would be safe from themselves and society, in congenial company, under no danger of ridicule, using their limited powers for their own benefit, and, in some cases, for that of the community, and in no danger of transmitting their misfortune."

The courageous attitude of Dr. Pilcher, of Kansas, as pioneer, strong to face ignorance and prejudice, has already had its good effect.

The report of the Trustees thus sustains his action: "A great deal has been said in the political press and medical journals of our country about the unsexing of eleven boys by Supt. Pilcher, the political papers censuring and the medical journals sustaining him. As all forward steps have brought criticism to the person who had the courage to take them, so this humane act has brought criticism to Doctor Pilcher. All that would be necessary to convince those most horrified by this act, of the wisdom of it, would be to have known the boys before and after the operation. Those who are now criticising Doctor Pilcher will, in a few years, be talking of erecting a monument to his memory."

One of my own board, Dr. De Forest Willard, of Philadelphia. has already taken steps toward bringing this subject before the public in a circular letter, which, together with the replies received, he has kindly allowed me to use, and which I here present:

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"DEAR DOCTOR: -- Will you kindly give me your opinion upon the following points. Please indicate your desires in regard to the publication or non-publication of your name in connection with these sentiments and your wishes will be strictly observed:

1. In what proportion of the inmates of your Institution do you consider procreation advisable?

2. In what proportion of the inmates of your Institution do you consider procreation possible?

3. What would he the probable effect of asexualization upon their mental and moral conditions?

4. What effect upon their physical conditions?

5. What operation would you advise upon the male; removal of the testes, ligation of the cord, or ligation of the vas deferens?

6. What operation would you advise upon females?

7. At what age would the operation be most effective?

8. Have you had practical clinical experience in this matter?

9. Should a State law be enacted to legalize the operation? If so, what would you suggest in regard to such a law?

Yours truly,
DE FOREST WILLARD.

From the fifty-nine institutions -- twenty-five American and thirty-six foreign including those of Great Britain, France, Germany, the Scandinavian countries, Austria, Russia, Switzerland and Finland -- he received but twelve answers, nine American, one German, one Scotch and one English. But nine could give definite answers, and while all agree that procreation is not advisable, they are slow to express an opinion, except that asexualization should be performed only on those of the highest grade, considering that the class to be most feared.

The first question is unanimously answered "none;" the second, an average of 80 per cent. The non-committal tenor of the replies to the third and fourth, as to mental, moral and physical effects, evidences the limited opportunities for collecting sufficient data, or timidity in expression of opinion. The fifth, sixth and seventh, as to the modus-operandi and proper age, are more explicit -- the majority favoring testiectomy in the male, and ovariectoiny in the female, at or before the period of puberty.

To question eight, five state frankly that they have had no practical experience, and the others give but indifferent answers.

To the ninth, as to Legislative aid, two-thirds are of accord, two see no cause, and one is doubtful of success.

That the replies amounting to but one-fifth of the whole should be almost exclusively American, and in the main favorable, show our confidence in both subject and leader; while the conservatism of the Europeans, and their consequent carefulness in the adoption of new ideas, may account for the meagre response from abroad.

My own experience, although limited, has been decidedly favorable; three cases of ovariectomy and one of testiectomy have resulted in improvement, especially marked in a boy, who has grown mentally, morally and physically.

My preference, therefore, inclines to ovariectomy in the female, and testiectomy in the male, pure and simple; but if one objects to this, a harmless and almost painless operation, (although the temperature after it does run alarmingly low) vasectomy is less heroic, and it is said quite as effective as castration.

Pavone (2) reports thirty-four cases where he had performed vasectomy for other reasons, in normal persons and with marked success.

On the whole, the result of Dr. Willard's investigation shows a readiness to advance, wherever united action shall ensure encouragement, in the more difficult task of educating the public mind.

It remains, therefore, for us to confer upon a subject so vital, and as I doubt not that we are of accord, to devise ways and means by which, in addition to mere official utterances, we may best further Dr. Willard in legalizing methods which shall benefit alike society, these unfortunates and ourselves, the custodians of the race.

We cannot hope to convert the public in a single day, nor to secure Legislative enactments in a single year, but patience and indomitable perseverance in presenting the subject must finally overcome mere prejudice and prove conclusively that this can bring but gain to society and the individual, without loss to either.

Colonel A. C. Holt, (3) a Southern legal authority, says that we have no clause in the Federal or State constitution which forbids emasculation where necessity demands it. (vide note page 14).

Dr. Willard has drawn up for suggestion the following outline of a resolution for an act:

"An Act for the Prevention of Idiocy."

"Whereas: -- Heredity plays a most important part in the transmission of idiocy and imbecility;

"Therefore, be it enacted by the Senate and House of Representatives of the State, that on the first day after the passage of this bill it shall be compulsory for each and every institution in the State, entrusted with the care of idiots and imbecile children, to appoint upon its staff at least one skilled neurologist, and at least one surgeon of recognized ability, whose duty it shall be, in conjunction with the Chief Physician of the Institution, to examine into the mental and physical condition of the inmates.

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"If, in the unanimous judgment of this committee of experts, procreation is unadvisable, and there is no probability of improvement of the physical and mental condition of the inmate, it shall be lawful for the surgeon to perform such operation for the prevention of procreation as shall be decided safest and most effective.

"This operation shall not be performed except in cases that have been pronounced non-improvable, after a year's test; and in minors, the consent of both parents, or the guardian, if living, shall be procured in writing, if possible.

"Penalty, $100 fine for the non-fulfillment of any of the provisions of this Act."

The future has for us yet another question -- another work in which we are called to press forward.

What are we doing for those who are to follow us? For what are we training our assistants? The trend of the times shows a demand for specialists.

We take a young man fresh from a medical college, filled with theories, with little, or no practical knowledge, into the weary rounds of institution duties which in the best are yet the same -- and with the idea of specializing uppermost in our minds -- we immure him, bend him, break him, impose our personality upon him, and let him have no thought beyond that of the superintendent and the senior assistant. Train him? We violate the law of personal liberty, destroy his manhood, teach him that life as well as nature has its night-shade berries, and what have we at the end of ten years? A man in years and a dwarfed mind, despite nature's original purpose. In fact he ceases to be a man and becomes an automaton, a lay-figure -- the creature which in our arrogance we pride ourselves upon having made -- blindly ignorant of having perverted from natural channels the gifts of God.

I can remember in one hospital, (where I gleaned my experience, literally by the sweat of my brow and the work of my hands) when I occupied an anomalous position, not having the authority of the supervisor nor the personal liberty of the attendants, being left entirely out of the superintendent's confidence, cut off from all society with only study for a recreation. How can a a man's mind flourish, his faculties live in this refinement of cruelty? Let us cast aside these musty ideals and learn a better lesson from the creative Florentine artist of the Renaissance, to whom art meant the "embellishment of the daily life."

There should be better opportunity for choice of material, unfettered by personal or political influence. Then, with good men and women to work with, we should see to it that there be no case of arrested development or crushing out of individuality. Would it not be well to bear this in mind in training our assistants who are to lead the future medico-pedagogic schools, and equally so with all assistants in the various departments, both higher officers and attendants, whenever we recognize earnest, devoted purpose, not only permitting but encouraging a freedom which shall further this, and, even at the cost of a few mistakes, go to build up a true motor force?

The enlarging of existing institutions, the growth in numbers, the possibilties -sic- demonstrated in methods of training and the recognition of a class who will surely come to us, bringing to a much higher figure the one hundred thousand which late statistics give -- all these, coupled with the need of greater facilities for training workers for all departments, point to a third epoch in our history. Having developed first School, second Institution, we now come to add the more extended sphere of Community Life.

Assuredly if we are to rise to the responsibility of the times, to grapple with this enemy one hundred thousand strong, which enters all homes alike and threatens the very life-blood of the nation, we must enlarge our borders and extend our operations. We need space, and yet more space, and who than we better fitted to claim it?

United and persistent warnings on our part must convince the most sceptical, and in less than another decade the return of the imbecile to the world will be deemed almost a crime, and opposed to all ideas of sound policy.

The wonderful Colony of Mercy at Bielefeld, Hanover, the efforts of the industrial Colony associations with us, and the inauguration of the various child republics following close upon the success of W. R. George's philanthropic experiment, should command our attention and generous emulation, knowing as we do that these must number of our class not a few.

The National government has provided for the Mute, the Negro and the Indian-then, why not for this branch of population increasing as rapidly as they, and becoming yearly more inimical to national prosperity. A reservation set apart, affording facilities for agricultural pursuits as well as all the varied industries of a town, would provide an outlet for the surplus population of our institutions, to find there a home with definite life aims constantly realized. Such a colony, under such restrictions and protective care as our experience has proven is essential, a congregate number of institutions, so to speak, each with its own corps of officers and supervisors, might in time draw largely upon us for its inferior force -- sub-assistants, attendants and foremen in shops and work rooms -- which we, if relieved of extraneous burden, and training, with definite aim, could readily supply. A community, not of paupers but of honest laborers, living under a system of "wise protection," insuring the personal liberty and personal responsibility which alone renders permanent the moral tone.

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It was an axiom of the Romans that purity of descent preserved the harmony of both public and private life.

To the Greeks we ever turn for pure ideals, and in the light of the nineteenth century, Spartan customs, far from cruel, by preserving the integrity of moral law, forbade the filching of the great gift of life -- granted according to the will of the gods -- divine; clutched at and hurled through ignorance or passion-infernal.

"The sable land-flood from some swamp obscure,
That poisons the glad husband-field with death,
And by destruction bids its fame endure,
Hath not a sense more sullen, stagnant and impure."