will, we hope, facilitate an education such as is here described, followed by employment and occupation of healthy and useful nature, which is now entirely beyond the reach of the mentally defective. For neither does their education at present, however careful and costly it be, fit them for it, nor has the community heretofore recognised the necessity of making provision for them after childhood in any organized or systematic manner. This all goes to show that America is in the forefront in her treatment of the defectives, and that England, appreciating the fact, is desirous of following in her lead. In 1907 a law was enacted providing for an adjudication of the mental status of any inmate of the school whose commitment to, or continuance in, the school has been questioned. (The law in full is quoted at the end of this report.) This law was passed upon the recommendation of the trustees, but under it the trustees do not seek to avoid responsibility for the. detention of each and every inmate of the institution. Hitherto not more than half of our children have been committed to our charge by judicial proceedings. Indeed, it was only when the custodial department had become established as an important part of the school that any of our inmates came to us under an order of a court. But the trustees have always re tained the power of discharge. exercised. This power they have freely Pupils in the school department and individuals in the custodial department are frequently taken home on vacation. When the time comes for the return to the school often application is made for the discharge of the inmate. This request in many instances raises questions difficult to answer. If the trustees accede to the request, it is because they feel that no harm will result and good may follow from the release. If the trustees are in doubt, but feel that they ought to refuse the request, they may now bring the question before the probate court of Middlesex County for judicial determination. Many a case that might safely be taken home for a short vacation would, if returned to entire freedom, become a menace to the community, and not infrequently would become an applicant for readmission. Again, not every inmate is a proper person to be taken home for vacation. This is particularly the case with many young women in the school, whose behavior here, under the discipline of the school, thoughtfully and kindly administered, is most excellent. A trustee would redden in the face to say before any one of the girls waiting upon him at the luncheon table that she is feeble-minded. Their parents come and find their girls have a quiet, gentle manner that comes from association with persons of refinement. They wish to take them out of the school, and feel that they are deprived of their rights when the trustees decline to discharge them. But they lose sight of the fact that the girl who came to us dirty, dull and listless, and has become in the months, or years, of careful nurture and training neat, clear eyed and interested in her work, would soon drop back to her former condition if the supports which we have placed about her were removed. In other words, the apparent gain that has been made can be maintained in many cases only under the forms of life which exist at the school. The trustees are not unmindful that human liberty to those who can appreciate it is the sweetest of all blessings, and so they have provided, in framing this law, that every kind of a case may be brought before the court. They feel, however, that their responsibility, which is in a sense the responsibility of experts, is great. Have they not a duty to the public as well as to the parent and the child in the attitude they shall take on each case as it arises? We think they have, and that it is the paramount duty. CHARLES FRANCIS ADAMS, 2D. FRANCIS J. BARNES. FRANCIS BARTLETT. LUANN L. BRACKETT. THOMAS W. DAVIS. CHARLES E. WARE. JOSEPH B. WARNER. FRANK G. WHEATLEY. SUPERINTENDENT'S REPORT. To the Trustees of the Massachusetts School for the Feeble-minded. I hereby submit the following annual report for the year ending Nov. 30, 1908: a Of the admissions, 137 were young, improvable pupils; 53 males and 42 females were over fourteen years of age, large proportion of these adults being cases capable of much improvement; 28 were feeble physically and of the idotic type; 15 were cases of spastic paralysis; 11 were of the Mongolian type of idiocy; 6 were insane and not feeble-minded; 5 were totally blind; 4 males were of the semi-insane criminal type; 4 boys had shown mania for setting fires; 4 were hydrocephalic; 2 were cases of sporadic cretinism; 1 was a case of pseudo-muscular hypertrophy; 1 was totally deaf. Some of the cases appeared in several of the above groups. Of the 180 cases discharged during the year, 48 were kept at home by their friends for various reasons; 4 were kept at home to attend public school; 2 went to work for wages; 4 ran away and were not returned; in 4 cases the parents moved to another State; in 2 cases the family went to Europe; 1 was transferred to the new Maine school; 1 was discharged as insane and not feeble-minded. Fifteen cases 1 male and 14 females were committed to insane hospitals. Six of these cases were admitted during the year, and were insane and not feeble-minded when admitted. The other cases illustrate the fact that the imbecile is very likely to develop quite typical forms of insanity as a part of his life history. were Epileptics at Palmer by These epileptics, all over classify with the feeble Sixty-two epileptics 37 males and 25 females transferred to the State Hospital for order of the State Board of Insanity. ten years of age, were difficult to minded, and their removal has greatly improved the classification of our patients. The epileptic patients themselves can be treated with much greater success in a hospital for epileptics. Forty-five of the older boys were transferred to the Wrentham school by order of the State Board of Insanity. These boys were at once put to work assisting in the development of the new institution. For another year the inmates and employees have enjoyed remarkably good health. As in previous years, for weeks at a time there has been no serious case of acute illness. This immunity from disease is largely due to the active outdoor life, well-ventilated buildings, simple, wholesome food and especially to efficient and thorough hygienic supervision by the medical staff. The small number of cases of tuberculosis is especially noticeable. - 40 In the early summer there were 50 cases of measles, children and 10 employees. One very feeble patient died as the direct result of the disease, and 3 others were so enfeebled that they succumbed to other diseases within a few weeks. In the autumn 21 cases of scarlet fever developed, with 1 death. One of the detached hospital blocks is always kept in readiness for the care of the cases of contagious and infectious disease which are certain to occur at frequent intervals among a large population of children. The new hospital block, or ward, was occupied in September. It is roomy and sunny and affords ideal accommodation for ordinary cases of illness. We now have room in the hospital for 44 sick people. The small number of cases of acute illness has allowed the hospital wards to be used largely for the care of little children who are exceedingly delicate and feeble but not actually ill. Some of these are cases of helpless, bedridden idiocy, who need constant nursing and tender care. The attached diet kitchen makes it easy to serve nutritious and appetizing food. On sunny days the beds of these little patients are drawn under the shade of nearby trees, or into the adjoining outdoor pavilion. Our present hospital facilities enable us to secure almost ideal care for these most helpless children. There were 24 deaths during the year, a very small number considering the large population and the feeble physical condition of many of the inmates. Five deaths were from acute pneumonia, 3 from epilepsy, 2 each from measles, organic disease of the brain and pulmonary tuberculosis, and 1 each from gangrenous stomatitis, influenza, exhaustion of idiocy, septic endocarditis, rheumatic fever, chronic heart disease, gastro-enteritis, tubercular meningitis, scarlet fever and acute peritonitis. The following table shows the ages of the 1,311 inmates in the institution at the close of the year ending Nov. 30, 1908: |