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UDOC
L 5.20:48
U. S. DEPARTMENT OF LABOR

CHILDREN'S BUREAU
J U L IA G

L A T H R Ö P . C h id

MENTAL DEFECT IN A RURAL COUNTY
A MEDICO-PSYCHOLOGICAL AN D SOCIAL STU D Y
O F M E N T A LL Y DEFECTIVE CHILDREN IN SUSSEX
COUNTY, DELAW ARE

A study made through the collaboration of the United States
Public Health Service and the Children's Bureau

By

—

W ALTER L, TREADW AY
Passed Assistant Surgeon, United States P u blic H ealth Service
and
EM M A O . LUN DBERG

‘

D irector o f Social Service Division, Children’ s Bureau

DEPENDENT, DEFECTIVE, AN D DELINQUENT CLASSES SERIES No. 7
Bureau Publication No. 48

WASHINGTON
GOVERNMENT PRINTING OFFICE


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PUBLICATIONS OF THE CHILDREN’S BUKEAU.

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Report o f the Chief, ® W r e n % Bureau, to the
Labor, for the fiscal year ended June 30, 1918. | g g PP- auu x um8

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Care o f Children Series:
No l . Prenatal Care, by Mrs. M ax W est.

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87 pp.

1915.

4th ed.

Bureau

1914, »Bureau puhrteatiouV

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No. 8.
N0-

Mrs. Max W o « .

41 pp,

tart f dThe''preschool Age, by Mrs. Mar: W e s t .88 pp. aud 8 diagrams.

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denhall, M. D.

32 pp.

1918.

Bureau publication No. 35*

Dependent, Defective, and Delinquent Classes Series:

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N o ' T k e S D e fS R e s -S S t t f S t r i r t o f Columbia§ A brief . « f c ^ t t a u
N o(2ioral conditions aud-the need for custodial care aud training. 89 pp.
in New Castle County, D e l, .

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U. S. DEPARTMENT OF LABOR

CHILDREN’S BUREAU
J U L IA C . L A T H R O P , Chief

MENTAL DEFECT IN A RURAL COUNTY
A M EDICO-PSYCHOLOGICAL AN D SOCIAL STU D Y
OF M E N T A LL Y DEFECTIVE CHILDREN IN SUSSEX
COUNTY, D E LAW ARE

A study made through the collaboration of the United States
Public Health Service and the Children’ s Bureau

By

W ALTER L. TREAD W AY
Passed Assistant Surgeon. United States P u b lic H ealth Service
and
EM M A O . LUNDBERG
D irector of S ocial Service D ivision, C hildren’s Bureau

DEPENDENT, DEFECTIVE, AND DELINQUENT CLASSES SERIES No. 7
Bureau Publication No. 48

WASHINGTON
GOVERNMENT PRINTING OFFICE
1919


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CONTENTS.
Page.

Letter of transmittal......................... *................ . ...................................................................
7
Introduction........................
9-23
Character and purpose of study.............................................................. ............
9
General conditions in the county......................... .............................................. 10-22
Location and local government...................................................................
10
Bacial composition and distribution of population..............................
10
Economic conditions........................................................................................
12
Means of communication................................
14
Health.................................................................................................... .,............
14
Literacy................................................................................................................
16
Schools..................................: ..............................................................................
17
Social life and general educational activities.........................................
19
Care of the dependent, delinquent, and defective...............................
19
Measures for social improvement.................................... ....................................
22
Section I . Prevalence of mental defect.................................................................... . ....... 24-40
Chapter I . The diagnosis of mental defect............................................................... 24-25
Mental defect a medical problem....................................................
24
Belation to retardation......................................................................
24
Formal tests................................................................................................................
25
Belation to other mental disorders................................................................. ....
25
Chapter I I. Prevalence of mental defect in Sussex County schools. ............26-31
Scope of survey...........................................................................................................
26
Method of examination......................................................
26
Enrollment and attendance........................................................
26
Number given intensive examination................................................................
27
Prevalence of mental defect among white school children........................
27
Prevalence of mental defect among colored school children............. : . . .
28
Besults with Binet scale..........................................................................................
28
Placed-out children........ ...................................
30
Mental defect in public schools a menace.......................................................
30
Chapter I I I . Mental condition of inmates of the almshouse............................. 32-33
Mingling of sexes................................................
33
Sanitation and medical care..................................................................................
33
Absence of special training.................
33
Cost of maintenance..........................................................................................
33
Chapter IY . Mental defectives examined in their hom es............................... .. 34-36
Sources of study....................................... .......... ............................... .......................
34
Besults based on social history............................................................................
34
Distribution of mental defectives found in homes........ ................................
35
Chapter Y . Prevalence of mental defectives in general population...............37-40
Sex and color distribution, by groups studied...............................................
37
Distribution, by sex and color, according to population of county.........
37
Prevalence among children............................
38
Age distribution of white mental defectives...................................................
38
Prevalence of mental defect in children of general population, esti­
mated from prevalence in schools.................... .............. ............ .............. ....
39
Belation between prevalence of feeble-minded in schools and in
general population.........................
40

3

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CONTENTS.

Page.
Section II. Social study of mentally defective children............................................. 41-94
Chapter I . General considerations......................................................... .. — ........... . 41-47
Scope of study................................................................ ........................... - ............ .
41
The problem a rural one.........................................................................................
42
Color, age, and sex distribution of children studied...................................
42
Nativity and length of residence on peninsula and in county.................
43
Mentality and physical condition of children studied................................
44
Types of homes in which the children lived.............................................. - .
46
Chapter I I . Adequacy of care given mentally defective children living in
their parental homes........................ — .................................... - - ............ ............ 48-58
Parental condition----------1 .......................................- - ......................... - ..............
"48
Economic, status of fam ily......................................... .............. - .............. ............49-52
49
Occupation of father...... ............................................ . . . — .......................
Employment of mother..................................................................................
50
51
Families dependent on others than parents. . . . ................................ ..
Income of family...............................................................................................
51
Social and intellectual status of family............. .............................................. 52-54
52
Housing conditions............................... ................ - - .......... .......................- Mentality and character of parents.................................... ..
53
Characteristics of mentally defective children.. . . . — ............. .......... ..
54
Children in special need of ca re... — .......- . . . . ................ •------ ------- -------55
Chapter I I I . Adequacy of care given mentally defective children not living
in their parental homes........................................................... .............. ............ .. — 59-65
59
Children cared for by relatives or in foster h o m e s ..........................
Children in the almshouse or having no home — ................... ...................
63
Chapter I V . The mentally defective child and the community..................... 66-77
The mentally defective child and the school..........................
66
The mentally defective child in industry...............................
70-74
Kind of work done.................................................... - ............................... - .
70
Capacity for self-support................................. ..............................................
72
74
Mentally defective children as offenders against social standards..........
Chapter V . The recurrence of mental defect and the coincidence of defect,
degeneracy, and dependency..................................................................
78-88
Consanguinity of mental d e f e c t i v e s . -................ ..........................................
78
Mental defect and degeneracy.............................................................................. 80-83
Alcoholism and im morality.. . . . . . ................... ................ ....................... ..
80
Illegitimacy............... - ................................................................. . . . . . . . . . .
81
Mental defect and dependency........................................................................... 83-86
Dependent families.................................................................- ...................- 83
Mental defectives in the almshouse...........................................................
84
• Some results of failure to provide proper care for the mentally defective. 86-88
Group A . ... ................ ................ .................. ...................................................86
Group B ...................................................................................... - - - .......... ........
87
89-94
Chapter V I. Summary of findings and provision needed........................ .
Summary of social study.................................................................- - - - ..............
Cases needing c a r e .................................................... ............ - .............................
Kind of provision needed. . ^------. . . ------ . . . . . . . .........................................
General conclusions................... ................................................................. .....................95


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91
92

CONTENTS.

5

TAB LE S.
Page.

Table I. Enrollment and attendance of white school children during holly­
gathering season and in January compared............................... ......................... ........
Table I I . Prevalence of mental defect in white school children............— ..........
Table I I I . Results of grading 66 white feeble-minded school children by Binet

' 27
27

scale.......................................... .. — ........................ ............................................ ..............
Table IV . Results of grading 29 colored feeble-minded school children by Binet

29

scale................................................. .................. ......................... ..............................................
Table V . Mental age of white and colored feeble-minded school children..........
Table Y I. Mentality of inmates of almshouse, by specified age groups.................
Table V II . Sex and color distribution of 181 cases suspected of mental deficiency
on the basis of social history........................................... ■..................................................
Table V I I I . Age and sex distribution of feeble-minded cases seen in home, by

29
29
32

source of case..............................................................i - .......................................................
Table I X . Sex and color distribution of feeble-minded cases in county, by

36

groups...................................................... ...................................................................................
Table X . Distribution by sex and color, with percentage of population.. . . ----Table X I . Age and sex distribution of white feeble-minded cases and of general
population, with percentage of population that feeble-minded constitute----Table X I I . Place of residence of mentally defective children and of general
population 10 years of age and over............ ............................... ............ - .....................
Table X I I I . Color, age, and sex of mentally defective ch ildren ........ ...................
Table X I V . Place of birth........................................................... ............. ........... - ..............
Table X V . Length of residence on the peninsula........................................................
Table X V I . Length of residence in Sussex County.......................... .............. ............
Table X V I I . Capacity for self-help, grade of defect, and physical condition of
children studied....................................................................................- ...................
Table X V I I I . Types of homes in which mentally defective children live,
according to color, age, and sex of children.................................................................
Table X I X . Types of,homes according to legitimacy or illegitimacy of birth . . .
Table X X . Parental condition.............................................................. ...............................
Table X X I . Heads of families of mentally defective children living in their
parental homes................................. ................ .....................- ..............................................
Table X X I I . Occupations of fathers of mentally defective children living in
their parental homes ........................................ ............................................ .......... * “ - - Table X X I I I . Employment of mothers of mentally defective children living in
their parental homes.........................................................................................
Table X X I V . Incomes of families of mentally defective children living in their
parental homes.....................................................................................................
Table X X V . Mentality of parents of mentally defective children living in their

37
37

parental homes.................
Table X X V I . Home conditions of mentally defective children living in their
parental homes................................................................................ - ............ - .......................
Table X X V I I . School attendance of mentally defective children according to
color and age....... ....................... .............................................................................. ••............
Table X X V I I I . School attendance of mentally defective boys and girls...........
Table X X I X . Mentally defective children who had ever attended school,
according to number of years in school and last grade in which enrolled.........
Table X X X . Mentally defective children attending school during year,
1916-17, according to age and grade in which enrolled...........................................
Table X X X I . Type of work done by mentally defective children........................


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38
42
42
43
44
44
45
46
47
48
48
49
50
51
54
55
07
67
68
69
71

6

CONTENTS.
Page.

Table X X X I I . Capacity for work of mentally defective children..........................
Table X X X I I I . Capacity for work of mentally defective children according to
type of home and income of family................................................................ •...............
Table X X X I Y . Mentally defective children: who were reported as being
delinquent or uncontrollable according to color, sex, and nature of offenses
reported........................................................................................................ .............. ..............
Table X X X V . Character of mentally defective children according to type of .
home.................. .......... ............ ......................................... ................................. .....................
Table X X X V I . Families having mentally defective children 6 to 20 years of
age, according to mentality of parents and older children, and number of
mentally defective children of age group studied................. ........................... ..


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74

75
77

78

L E T T E R O P T R A N S M IT T A L .

U.

S.

D

epartm ent

op

L

abor,

C h il d r e n ’ s B

ureau

,

Washington, March 25, 1919.
Sir : I transmit herewith a report on mental defect in a rural
county, the result of a study made through the collaboration of the
United States Public Health Service and the Children’s Bureau.
Reports on a county in the same State containing a large urban
population have already been published by the Public Health Service
and the Children’s Bureau.
This report demonstrates the importance of medical and psycho­
logical examinations combined with social investigations in a study of
the prevalence of mental defect. The seriousness of the problem in
rural communities is indicated b y the findings, which confirm the
evidence as to the individual hardship and the injury to society caused
b y the lack of proper care for the mentally defective. The study
emphasizes the necessity for an adequate program including not only
institutional provision for those requiring custodial care but, equally
important, the development of facilities for the special training and
the proper protection of defective individuals who can safely remain
in the community.
The examinations to determine mentality were made b y Walter L.
Treadway, Passed Assistant Surgeon of the United States Public
Health Service, who prepared the section of the report entitled
“ Prevalence of Mental Defect.” The social investigations of children
found to be mentally defective were made by Miss Ethel M. Springer
and Miss Alice M. Hill of the Children’s Bureau. The introduction
and the section entitled “ Social Study of Mentally Defective Children”
were prepared b y Miss Emma O. Lundberg, assisted b y Miss Katharine
F. Lenroot and the agents who made the social investigations.
Respectfully submitted.
J u l i a C. L a t h r o p , Chief.
Hon. W. B. W ilson,
Secretary o f Labor.


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MENTAL DEFECT IN A RURAL COUNTY.
INTRODUCTION.
CH ARACTER AND PU R PO SE OF STUDY.

The past few years have witnessed a tremendous growth of interest in the significance of mental defect. This has been evidenced
particularly by the great number of special investigations and sur­
veys bearing on the need of adequate provision for the care of mental
defectives. Most of these studies have been made since 1914, the
number increasing yearly. Investigations vary from those State­
wide in scope and under the auspices of State commissions to limited
studies made by local groups. The methods of study are as varied
as the contents, yet all are of general interest as touching upon one
phase or another of the many-sided problem of meiital defect..
Although few comprehensive surveys of mental defect in rural com­
munities have as yet been made, the data already obtained indicate^
the seriousness of the problem in isolated districts.
This report is the result of a study made in Sussex County, Dela­
ware, b y the Public Health Service in collaboration with the Chil­
dren’s Bureau. Its purpose was to secure additional data as to the,
prevalence of mental defect in a rural population, to analyze the social
conditions surrounding mentally defective children, and to discover
the extent of the need for public provision for their care. The work
of the Public Health Service included mental examinations of the
children in the rural and town schools of the county, and the
determination of the mental conditions of all inmates of the county
almshouse. The Children’s Bureau made a general survey for the
purpose of locating mentally defective children not in the schools*
and those who were thus reported to be possibly feeble-minded
were examined in their homes by the Public Health Service after
the consent of parents or guardians had been secured. A social
study was made by the Children’s Bureau of the conditions sur­
rounding the children who were diagnosed mentally defective..
Investigations of this nature had been made previously b y the
Public Health Service and the Children’s Bureau in New Castle.
County, Del.1
J u l i a n , E . H ., Passed Assistant Surgeon, U . S. P ublic H ealth Service: Mental Status of Rural School
Children. R eport of Preliminary Sanitary Survey Made in N ew Castle County, Del., with a Description,
of the Tests E m ployed. U . S. Public Health Service, P ublic Health Reports, N ov. 17,1916.
Lundberg, Em m a O .: A Social Study of Mental Defectives in New Castle County, D el. Children's.
Bureau Publication N o. 24. W ashington, 1917.

9


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10

M E N TA L DEFECT IFF A RURAL COUN TY.

Delaware has as yet no institution for the mentally defective.
A t the legislative Session of 1917 an appropriation was made for
such an institution, and a commission was appointed to take the
necessary steps toward its establishment and to make rules regulat­
ing the admission of feeble-minded persons. Although Delaware
had for a number of years maintained at State expense 14 mental
defectives in the Pennsylvania Training School for Feeble-Minded
Children, no mental defective from Sussex County was being cared
for in this way at .the time the study was made. Provision was
being made in the county almshouse and the State hospital for the
insane for a very small number of the most urgent cases from the
county. The schools of the county provided no special training
for backward or mentally defective children.
G E N E R A L C O N D IT IO N S IN T H E C O U N T Y .

Location and local government.
Sussex County, the southernmost of the three counties of Delaware,
is located on lower Delaware Bay and the Atlantic Ocean, occupy­
ing an almost central position in the peninsula which Delaware
shares with the eastern sections of Maryland and Virginia. The
land is part of the Atlantic coastal plain and as a whole is level,
sandy, and easily tilled. The climate is mild. The area of Sussex
County is 913 square miles, or 584,320 acres. About four-fifths of
the area is devoted to farm land. The. coast line is very extensive
in comparison with the size of the county, owing to many deep inlets.
Four of the rivers flowing through the county are navigable for from
6 to 20 miles. Numerous streams and creeks, with the addition of
a considerable number of artificial drains or ditches, irrigate the
land. Part of the area is unclaimed swamp land, an extensive swamp
located in the southeastern part of the county comprising its most
desolate and undeveloped section.
Sussex County is divided into 13 hundreds— ancient divisions
corresponding to townships in other States, and said to have orig­
inated in an allotment of the land to every 100 families. Recently,
for greater political convenience, the county has been redistricted
into 10 representative districts, which correspond as nearly as
possible to the old division by hundreds. There is also a political
division of the county into 5 senatorial districts.
The government of the county is vested in a levy court, consisting
of three commissioners, elected at large. It has the direction,
management, and control of the business and finances of the county,
and appoints the three members of the board of assessment, who
make up the tax fists, subject to revision by the court. •
Racial composition and distribution of population.
The population of Delaware has been extraordinarily static; the
increase very slow; the amount of immigration slight. The United

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M E N TA L DEFECT IN A RURAL C O U N TY.

||

States Census of 19101 gives the population of Sussex County as
46,413— white, 38,473; negro, 7,938; other, 2. Only 401, or 0.9 per
cent, were foreign born, and 611 more, or 1.3 per cent, were native
white of foreign or mixed parentage. The negro population of the
county comprised 17.1 per cent of the total.
The white population of the county is comprised chiefly of Ameri­
cans of English descent, whose ancestors came to this section before
the Revolution. Their names and some of their idiomatic terms
suggest their Anglo-Saxon origin. Interrelationship among families
is prevalent.
The negroes are scattered fairly evenly through the county, with
the exception of the central southern section, where there are very
few colored families and no colored schools.
An interesting section of the population is a community of persons
who term themselves “ Nanticokes ” and are popularly known as
“ Moors.” 2 They are of mixed blood from white, negro, and In­
dian stock. These people are located in Indian River Hundred in
Sussex County and number about 500.3 They maintain an exclu­
sive tribal existence, with their own schools and church, and have by
their own action secured from the State legislature the legal status
of American Indians. Their physical appearance betrays their
mixed origin; some are as fair as Caucasians;.some have the coppercolored skin and high cheek bones of the American Indian; while
others can scarcely be distinguished from the ordinary negro. As
a people the “ Moors” have proved themselves thrifty farmers.'
Their land includes some of the best cultivated farms of the county,
and many of the families are prosperous.
The population o f Sussex County is scattered and rural in char­
acter. The 1910 census reported the density of population as 50.8
persons to the square mile.4 The census classifies cities and incor­
porated towns of 2,500 or more inhabitants as urban territory. Ho
town in Sussex County had a population of 2,500, though the town
of Milford, located partly in Kent County and partly in Sussex
County, had slightly more than this number of inhabitants in 1910.
The Sussex County population of this town, 1,414, was therefore
classified as urban, and constituted 3 per cent of the total popula­
tion of the county. Twenty incorporated towns or villages were
listed in the census; of these 1 had less than 100 inhabitants, 11 had
1 Thirteenth Census of the U nited States, 1910, V ol. n , Population, p. 281.
Estimate made b y Bureau of the Census for July 1,1917: Population of Sussex County, 49,432.
2 Speck, Frank G.: The N anticoke C om m unity o f Delaware. Contributions from the Museum o f the
Am erican Indian, H eye Foundation, V ol. II , N o. 4. N ew Y ork , 1915.
Scharf, John Thomas: H istory of Delaware 1609-1888, V ol. I I , p p . 1270-1271. Philadelphia, 1888.
Conrad, Henry C.: H istory of the State of Delaware, V ol. II , p p . 724-725. W ilm ington, D el., 1908.
3 The U nited States Census does not classify these people separately, b ut includes them as w hite or
colored.
* Thirteenth Census of the U nited States, 1910, V ol. II, Population, p p . 274,281.


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12

M E N TA L DEFECT IN A RURAL COUN TY.

between 100 and 500; 2 bad between 500 and 1,000; 3 bad between
1,000 and 2,000; 3 between 2,000 and 2,5001 Fourteen other settle­
ments, not incorporated, were reported as having 50 to 100 inhabit­
ants, and 12, as having from 100 to 500.2 Twenty-six per cent of
the total population of the county lived in towns having 500 or more
inhabitants; 14 per cent in communities of 50 to 500; and the remaining 60 per cent on scattered farms.
Economic conditions.
The only important industry in the county is agriculture, the
chief product being cereals. Vegetables and fruits are raised to a
large extent. Recently fruit growing has increased, and large
farms are being bought and managed by corporations or syndicates
interested in scientific apple growing. The county is especially
noted for its strawberries, and has the largest strawberry shipping
market in the United States.3 There is very little dairy farming.
Much of the farm land is owned by absentee landlords and worked
b y tenant farmers. The 1910 census4 reported 3,488 farms operated
by owners and 2,007 by tenants. Share tenants constituted 92
per cent o f all tenants. Under this form of tenancy the incomes
from fixed portions of the crops are turned over to the owners. The
portion paid the owner varies in different sections and with different
kinds of produce— one-half, one-third, or two-fifths of the crop, as
the case may be. Only occasionally is a farm rented on a cash
basis. The value of farm property increased 86.1 per cent from 1900
to 1910.5
Hired help is difficult to secure. On many of the larger farms the
owners provide small dwellings for their employees and necessary
wood and produce for their families, in addition to small wages for
actual labor. Some families who own their homes hire out b y the
day. During the rush seasons, especially at berry-picking time,
many persons and often entire families come into the county from
outside the State— on the east side from Chincoteague Island and
the lower peninsula, on the west side from Baltimore and other parts
of Maryland. These “ foreigners,” as they are called by the local
people, often constitute undesirable elements. A t the end of the
season some usually remain as permanent residents of the county.
Supplementing the hired help, the system of taking placed-out
children from agencies and institutions or from relatives is common.
According to data secured in a survey of dependent children in
1 T w o com m unities in the above list are located on the boundary of Sussex County.
m ent only their Sussex population is taken in to consideration.
2 Rand-M cN ally Indexed Pocket Map and Shippers’ Guide of Delaware, p p . 8-12.
3 Thirteenth Census of the U nited States, 1910, V ol. V I , Agriculture, p . 268.
* Ib id ., p . 267.
6 Ib id ., p . 266.


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In the above state­

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M E N TA L DEFECT IN A RURAL COUNTY.

13

Delaware, made b y the Children’s Bureau,1 there were over 400
placed-out children located on farms in Sussex County, the majority
of them being boys between the ages of 10 and 18 years.2
Next in importance to farming among the industries of the county
is canning, providing short-time seasonal employment for a large
number of men, women, and children. Many of the cannery workers
come in from surrounding States for the season. There are about
50 canneries in the county, most of them canning vegetables and
fruits. Only one of them is operated throughout the year. Several
are planned for général canning and are busy throughout the entire
summer, but in the majority the season lasts onTy a few weeks.
There are a few manufacturing establishments in the towns,
employing small numbers of workers. Among the other industries,
lumber is perhaps the most important. Cutting, hauling, and ship­
ping wood is carried on in all parts of the county. Lumbering does not
affect the local population Very much, for the work is carried on chiefly
by gangs of men who locate temporarily in a timber section, set up
their own camps and portable engines, and do all the work themselves.
Allied to both the lumber and the fruit-growing industries is basket
and crate making, which is carried on in many of the towns and is
a very common home industry of women and children. Making
holly wreaths is a general preholiday occupation throughout the
county. The wreaths are made at home and are sold to men who
drive through the districts collecting them for town dealers.
Industries arising through proximity to thé ocean and inlets are
sailing, shipbuilding, fishing, making fish nets, and oyster shipping.
On the eastern coast there is a community of pilots and tugboat
captains, including about 75 families. The railroads also furnish
employment for a few men whose families live in the county.
Child labor is prevalent in Sussex County, the greatest amount of
employment of children being on the farms. The canneries employ
a considerable number during the season. Children are engaged in
crate and basket making, and in berry picking and various other
kinds of work connected with the agricultural and fruit growing
industries. The State laws governing conditions under which children
are employed in manufacturing and mercantile establishments have
been greatly improved in the past year. However, the children of
Sussex County do not come under the protection of the State childlabor law to any extent, because of the character of the industries
in which they are employed. The Delaware child-labor law of
1917 3 forbade, for the first time, the employment of children under
1 Study not com pleted at the date this publication went to press (O ctober, 1918).
2 Including children whose original residence w as Sussex C ounty and those brought in from outside
and including those placed b y agencies, institutions, and relatives.
2 R evised Code, 1915, sec. 3171, as reenacted b y acts of 1917, ch. 232.


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M E N TA L DEFECT IN A RURAL CO U N TY.

12 years of age in canneries preserving or canning perishable fruits
and vegetables, but did not limit the hours of labor in these
establishments.
Means of communication.
No single factor in the conditions of the county plays a more
important part in fostering isolation than the difficulty of trans­
portation. The natural sand roads have no resisting power against
the varying weather; during the wet seasons they are mires of deep
slush, and in the dry seasons, drifts of loose, finely pulverized sand
through which it is almost as difficult to make headway as through
mud. A t times traffic must be entirely abandoned. Improvement
of the roads has begun, and the construction of the new “ stone
road,” crossing the county from north to south, is of the greatest
importance; it will open up adjacent sections, making them accessible
to one another and to the northern part of the State.
Railroad facilities are very inadequate in some sections of the
county, notably on the eastern side. Many farms are 10, 12, and
15 miles from the railroad and depend upon mule teams to transport
their produce to the shipping markets. There is no trolley line in
the county, nor in any part of the peninsula south of New Castle
County.
Many families are 2 or 3 miles or even farther from the nearest
telephone. However, the use of the telephone is spreading very
rapidly. The Bell Telephone Co. reports an increase in the number
of telephones of 500 per cent from 1906 to 1916.
Health.
The State board of health consists of seven members— two physi­
cians from each county, and a secretary also a physician, who acts
as executive officer of the board and is the State registrar of vital
statistics. The board is required to enforce the laws of the State
governing the public health and to make such additional rules and
regulations as it may deem necessary. Such rules and regulations
have the authority of law.
The board maintains a laboratory at Newark in New Castle County
which is open to physicians, dentists, and veterinarians for diagnostic
purposes related to the public health of Delaware. Mailing con­
tainers for sending specimens to the laboratory are furnished free of
charge at 12 different stations in Sussex County. The board also
furnishes diphtheria antitoxin to the inhabitants of Delaware at a
noniinal sum; but in order to take advantage of this reduction in the
cost the attending physician is required to make a report of the
case to the State board. This antitoxin may be obtained at any one


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MENTAL, DEFECT IN A RURAL CO UN TY.

15

of the distributing stations in the State. Eleven such distributing
stations are located in towns of Sussex County.
.
Since 1913 the State laws have required all marriages, births, and
deaths to be reported to the State registrar of vital statistics.1 To
facilitate this registration, local registrars have been appointed in
each of the three counties. Sussex County is divided into three regis­
tration districts. For the purpose of issuing burial permits each of
the three districts is provided with subregistrars.
During 1914 there were 287 white and 54 colored marriages in
Sussex County, and during 1915, 293 white and 57 colored. During
the same periods the number of births registered in the county was
as follows: 1914, 472 males and 425 females; 1915, 533 males and 464
females. The total number of deaths in the county for 1914 was 702
and for 1915, 804.2
The mortality rate per 1,000 inhabitants in 1914 was 15 and for
1915 was 17.3 This rate is somewhat higher than that for the deathregistration area of the United States for the same years— 13.6 for
1914 and 13.5 for 1915.4 The infant mortality rate for Sussex County
in 1914 was 125.9 and for 1915, 138. These infant mortality rates
are considerably higher than the rate, 100, for the United States
birth-registration area in 1915.5
Physicians practicing in Delaware are required to report the occur­
rence of certain* communicable diseases to the State registrar of vital
statistics. In all cases unattended b y physicians, heads of families,
persons in charge of cases, school-teachers, or officers of schools are
required to give immediate notice of the occurrence of such diseases.
The county as a unit of local government has no health organiza­
tion. The majority of incorporated towns of Sussex County have
health boards and part-time health officers. Quarantine against com­
municable diseases in incorporated towns of Sussex County is ad­
ministered by the local health officer when such an officer exists, or
by the mayor of the town. When such diseases occur in the country
districts the attending physician is required to enforce the quarantine.
The State board of health requires that children with communicable
diseases shall not attend school. Certain regulations governing the
sanitary conditions of school grounds and school buildings have been
promulgated by this board, but are not enforced in rural districts
because of the lack of local health agencies. The medical supervision
of school children is not required b y State law, a bill for this purpose
having been defeated in the legislature in 1917.
1 A cts of 1913, eh. 85; R . C. 1915, secs. 797,798, 798a as added b y A cts of 1917, ch . 49.
* Eighteenth Biennial R eport of th e B oard of H ealth of th e State of Delaware, 1912-1915, p p . 298, 316.
» Based on estimated population for A p r. 15,1914 a n d A p r. 15,1915.
* Bulletin of the U . S. Bureau of the Census, M ortality Statistics, 1916, p . 12. W ashington, 1918.
6 B ulletin of the U . S. Bureau of the Census, B irth Statistics, 1915, p. 10, W ashington, 1917.


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M E N TA L DEFECT IN A RURAL COUN TY.

The character of the soil and the method of sewage disposal in
Sussex County lend themselves to soil pollution and the possible
contamination of water supplies. The local production and sale of
milk is not supervised, and no attempt is made to prevent the dis­
tribution of diseases conveyed b y this commodity.
There is a concerted effort to combat tuberculosis in this county.
The Delaware State Tuberculosis Commission, created by legislative
enactment, maintains three dispensaries for diagnostic and advisory
purposes in Sussex County. This commission also employs a nurse
who makes home visits to tuberculous cases and advises those ill
with the disease as to how to care for themselves and to protect others
in the same family.
There are no hospitals in Sussex County. The nearest hospitals
are in that part of Milford which is in Kent County, on the northern
boundary of Sussex County, across the border in Maryland, and in
New Castle County.
Physicians practicing in the county are generally located in towns.
During certain seasons of the year, because of bad roads, doctors are
not readily accessible to the rural districts. There were 65 registered
physicians located in Sussex County at the time of this survey, a
rate of 1 physician for every 714 persons. Because of the inaccessi­
bility of medical attention in the more remote districts, midwives
are commonly employed. Usually these midwives are women who
have had no training in the care of confinement cases. The State
does not require midwives to be licensed, though physicians and
midwives must be registered.1
Since 1909 nurses in Delaware have been required to register
before practicing their profession.2 A number of so-called practical
nurses are available in Sussex County. Trained graduate nurses
are usually brought in from adjoining States.
Literacy.
The percentage of illiteracy in Delaware is relatively high. In 1910
only 14 States showed a higher percentage of illiterate persons among
those 10 years of age and over.3 The State was thirty-second in order
in the rate of illiteracy of its native white population of native
parentage. The percentage of illiteracy is appreciably higher for the
population of Sussex County than for the State as a whole, 10.6 as
compared with 8.1. As in the State at large, b y far the greatest
amount of illiteracy occurs among the colored population, the rate
for Sussex County for negroes being 30.1 and for the State as a
whole 25.6. The percentage of illiteracy among the native white
1 A cts of 1913, ch. 85, sec. 9; R .C . 1915, secs. 810,817.
2 R . C., 1915, secs. 876-883.
a Thirteenth Census of the U nited States, 1910, V ol. II , Population, p . 281.

245.


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Ib id .; A bstract, pp . 239 and.

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M E N TA L DEFECT IN A RURAL C O UN TY.

17

population of Sussex County is 6.8, while the average among the
same group for the United States is only 3.
Schools.
Two outstanding features characterize the school system of
Delaware 1— the large extent of local control, and the dual school
system whereby white and colored school districts are entirely
independent of each other, though under the control of the same
county and State authorities. Each school district determines for
itself the amount of taxes that shall be raised for school purposes
and the way in which the funds shall be distributed. Until 1917
assessment for school purposes covered real property assessed at
rental value and personal property assessed at actual value, placing
a heavy burden upon the tenant farmers. This naturally dis­
couraged large appropriations for school expenditures, especially in
rural districts. The school term and the period when the State
compulsory education law shall be in effect are determined b y each
district. The State law provides for a compulsory period of attend­
ance of children between the ages of 7 and 14 years of not less than
three nor more than five months. Within these limits, each district
may use its own discretion.2
The county is divided into 186 school districts, of which 154 are
for white children and 32 for colored.
This proportion of colored
schools is about the same as the proportion of colored in the popu­
lation, but the fact that the colored school districts cover practi­
cally the same amount of territory as the white school districts in­
dicates the difficulties in the way of a high average attendance.
Most of the schools of the county have only one room and one teacher,
79 per cent of the white rural schools and 78 per cent of all the
colored schools belonging to this class.3
The compulsory education law provides that no child living more
than 2 miles b y the nearest traveled road from the schoplhouse of his
district shall be compelled to attend unless a free conveyance is pro­
vided.2 Many children could claim exemption for this reason. In
the colored districts, especially, they often have to go long distances,
sometimes 3 or 4 miles, because of the sparseness of the colored popu­
lation. No transportation is furnished, and since the compulsory
period is usually in the depth of winter, bad weather often prevents
attendance.
The enumeration of children of school age is made by the clerk of
the school committee of each district. The State commissioner of
1 W eeks, Stephen B .: H istory of P ublic School E ducation in Delaware.
N o. 18. W ashington, 1917.
® It.C . 1915, sec. 2313.
3 Educational Directory of the State of Delaware, 1915-16.

97685°— 19-------2


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Bureau of E ducation Bulletin

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M E N TA L DEFECT IN A RURAL CO U N TY.

education has practically no control over the enumeration. The
county superintendent is charged with the enforcement of the at­
tendance law, hut has no assistants. He must depend upon the
reports of absences made by teachers at the end of each month,
and owing to the size of the county it is impossible for him to follow
up violations in an effective way. The law is poorly enforced be­
cause of the absence of central State authority and lack of local
interest. The State commissioner of education of Delaware pub­
lished a report setting forth the conditions for the year 1912—13,
and there gave the percentages of attendance in Sussex County,
based on total number of children enrolled, as follows: White schools,
incorporated, 70 per cent; rural, 55 per cent; colored schools, 48.7
per cent.1
The effect of the seasonal occupations in the various sections of
Sussex County is evident in the length of the school terms and the
time of beginning the compulsory attendance period. Gathering of
holly before Christmas, husking corn, packing sweet potatoes.in the
late autumn, setting out strawberry plants in the early spring,
plowing and fertilizing, all have an important influence on school
attendance in the county. In 66 (60 white and 6 colored) of the 186
(154 white and 32 colored) school districts the compulsory attend­
ance period in 1915-16 2 was three months. Thirty of those schools
did not require attendance until December, and 12, not until Janu­
ary. Most of the rural schools were actually in session seven or
eight months. In the town schools a nine-month term was the
most common.
Several laws were enacted by the 1917 legislature which were
epoch making for the schools of Delaware.3 The funds available for
school purposes were greatly increased, and the system of local taxa­
tion improved by the change in method of assessment. County
superintendents’ salaries were increased, and salaries of white teachers
were standardized and a minimum established. Another law,
designed to raise the standard of teaching, provided for the pay­
ment b y the State of the traveling expenses and board of teachers
attending the summer school for teachers at Delaware College. A
law was passed permitting the consolidation of rural schools. An
appropriation of $15,000 was made for agricultural and industrial
education in high schools, thus securing an equal amount for Federal
appropriations under the Smith-Hughes Act. A commission to
study the entire school system was provided for. It is expected
that this will result in greater centralization and in otherwise raising
the standard of education in the State.
i Wagner, Chas. A .: Public School Attendance of Delaware Children in the Year of 1912-13: A S tu d y and
an Appeal,’ pp. 22, 23, and 29. W ilm ington, D el., 1914.
* Data com piled from records in the office of the State commissioner of education of Delaware.
» Revised Code 1915, ch. 71, sec. 2292 amended b y Laws of 1917, ch. 178; sec. 2300 amended b y Laws of
1917, ch. 180; Laws of 1917, ch. 186.


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M E N TA L DEFECT IN A RURAL COUNTY,

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Social life and general educational activities.
Living conditions throughout the county, except among the more
progressive townspeople, are very primitive. In rural districts the
remoteness of the home from town and market makes it imperative
that the family should be socially and economically as independent
as possible, and in a few homes spinning and weaving is still done on
old-fashioned wheels and looms handed down from pr.e-Revolutionary
times.
There is little organized recreation in the county. School and
church “ socials” and the yearly camp meetings are the principal
social gatherings in the rural districts. In the towns there are
periodic entertainments and motion-picture shows.
The State library commission of Delaware makes provision for
the establishment of free public libraries in the school districts of
the State, appropriating the amount proportionate to the sums
raised for library purposes by taxation in the districts. The estab­
lishment o f a library is determined b y vote of the qualified electors
of the school district.
As a matter of fact, the people of Sussex
County have not availed themselves to any great extent of this
privilege. Only five school districts reported libraries of this type.
Several of the schools have taken advantage of small circulating
libraries sent out by the State federation of women’s clubs with a
small amount of State aid.
•
Parent-teacher associations ate not very strong in this county,
though the educational authorities have been assiduous in their
efforts to establish them. In 1916, out of a total of 186 schools,
only 41 reported such organizations. The county branch of the
State grange, with its local groups, is an active force both in the
economic development of the county and in the improvement of
social conditions. In the towns the women’s clubs, though small
in membership, are very active. They are an important influence
in the social and civic life of the county. The State federation of
women’s clubs, with which the Sussex clubs are affiliated, can be
accredited with the initiation and accomplishment of some of the
most progressive legislation in the State.
Care of the dependent, delinquent, and defective.
The Sussex County almshouse is the only public institution in the
county. The trustees of the poor, who have the management of the
almshouse, give no outdoor relief. There are no private relief
organizations, with the exception of small neighborhood groups.
The 1917 session of the legislature passed a mothers’ pension a c t 1
providing for aid to be given to “ any widowed or abandoned mother
of a child or children under fourteen years o f age, who is unable
1 R . C. 1915, sec. 3071a as am ended b y A cts of 1917, cb . 227.


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M E N TA L DEFECT IN A RURAL COUN TY.

without aid to support, maintain, and educate her child or children,
or any mother whose husband is permanently, either physically or
mentally, unable without aid, to support, maintain, and educate
such child or children/’ The administration of this act is placed in
the hands of a commission consisting of nine women, three from each
county. The payments are not to exceed $8 a month for a single
child, and $4 for each additional child in the family, except that the
allowance may be increased in case of sickness or unusual circum­
stances. The State contributes a sum equal to one-half the amount
paid out by the county, the total amount to be paid to any county
in one year not to exceed $2,500. The commission was not appointed
until January, 1918, consequently the law did not affect the situation
in the county during the time included in this investigation.
Children who are received by the almshouse are placed in families,
unless so physically defective that this method of care is impossible.
A small number of children, perhaps not more than one or two a
year, are indentured. These children are bound out “ in considera­
tion of $1” until they are 18 or 21 years of age. Agreement as to
schooling to be given the child differs for each individual case. I t
is stipulated that two outfits of clothing shall be given to each child
on the date of his legal release from indenture. Most of the children
from the almshouse are placed informally in families, the almshouse
keeping no record of their disposition and assuming no responsibility
for their welfare.
Because of the scarcity of farm labor, families in Sussex County
have welcomed the opportunity to secure the assistance which placedout children can give. Certain of the large home-finding agencies
in other States have been sending children to this county for the past
40 years. Others have begun to use this territory more recently.
Until 1917 there was no State supervision or control over dependent
children in Delaware. In that year the legislature passed a law
regulating the bringing into the State of children from other States.
A bond of $3,000 must be filed with the comrifissioner of education for
each child so placed to insure against the child’s becoming dependent
upon the public for support.1
Two children’s agencies with headquarters in Wilmington work
throughout the State, one of' them prosecuting parents for neglect
of their children and removing children from detrimental surround­
ings, and the other placing and supervising children in free homes.
Both these societies are private, one of them being subsidized by the
State. Some of the children removed from their homes are placed
in institutions within or outside the State 5 others are placed in farm
homes.


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M E N TA L DEFECT IN A RURAL COUNTY.

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Both adult and juvenile offenders come before the county court.
Offenders receiving sentences of six months or less serve their terms
in the county jail; longer term offenders are sent to the New Castle
County Workhouse. Whipping is still a punishment for larceny,
but since 1909 Sussex County lawbreakers have been sent to New
Castle County to receive their lashes. Minors guilty of petty mis­
demeanors are dealt with by local authorities. Those under 18 years
of age guilty o f serious offenses are committed to the two industrial
schools in New Castle County. These institutions are under private
control but are granted State appropriations and receive per capita
payments from the levy court of the county from which the children
have been committed. During the two years from November 1,
1915, to November 1, 1917, 11 children from Sussex County were
received by the industrial schools. These children constituted 7
per cent of the total number admitted during this period.
The Delaware Commission for the Blind has supervision and control
of the education, training, and welfare of the blind, and also visits
institutions outside the State wherein the indigent deaf, dumb, and
feeble-minded children of the State are being maintained and in­
structed. The State pays for the training of 10 blind and 15 deaf
children in institutions outside Delaware. The field worker of the
commission for the blind visits all blind persons in the State, keeps a
record of all cases of blindness, and teaches adults in their homes to
read embossed type. The workshop conducted by the commission
in Wilmington provides training in handicrafts and supplies employ­
ment for blind men and boys; women are given work in their homes.
The commission reported in August, 1917, that there were 44 blind
on their Sussex County list, 2 of whom were in schools for the blind,
and 4 deaf and dumb pupils from this county in schools for the deaf
and dumb.
Delaware was the second State in the Union to adopt State care
of the insane. The State hospital for the insane is under the control
of a commission consisting of three members from each county.
On August 1, 1917, 66 of the 500 inmates of the institution were from
Sussex County. Because of the lack of provision for the mentally
defective there were a number of feeble-minded patients in this
institution, six of the inmates from Sussex County being mentally
defective.
Only 3 of the 35 inmates of the Sussex County almshouse at the
time of this study were found to be normal mentally, 19 of the
inmates being diagnosed feeble-minded. Examinations of inmates of
the reformatory for boys by a psychologist of the University of
Pennsylvania Psychological Clinic did not reveal any mentally
defective boys from Sussex County in that institution. Two girls


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M E N TA L DEFECT IN A RURAL CO UN TY.

from this county who were inmates of the industrial school for girls
were reported by the superintendent as being feeble-minded, but were
not included in this study because not diagnosed by the Public
Health Service.
M E A S U R E S F O R S O C IA L IM P R O V E M E N T .

The situation in Sussex County indicates that the old-time stand­
ards are rapidly proving inadequate, and the progressive element in
the county is awakening to the need of improving general social con­
ditions, especially educational facilities. Fundamental to the
development of the county along economic and social lines is the
improvement of means of communication, especially of roads. With
improved methods of farming will come reduction in the proportion
of share tenants and a general betterment of economic conditions.
The extension activities of the Delaware State Agricultural College
and the farmers’ institutes, arranged under the auspices of the State
board of agriculture, have aroused a growing interest in scientific
farming that has already brought results.
The need for improvement in school conditions has already been
emphasized. The reform in taxation methods secured in the last
legislative session, and the beginning made toward increasing the
salaries of teachers and school officials and making the assistance of
the State college easily available to teachers, can not fail to bring
better school facilities and higher standards of instruction. The
need for such consolidation of the schools as the optional consolida­
tion law permits is evidenced by the fact that, in 1915-16, 79 per
cent of the white rural schools and 78 per cent of ail the colored
schools in Sussex County were one-room schools, with one teacher.1
No provision can be made for the proper instruction of retarded or
mentally defective children in rural districts until this condition is
changed. A very considerable proportion of the children, especially
the colored, live at distances that are almost prohibitive, even under
the present system of small, scattered schoolhouses. Essential to
making education available are means for transporting children to
schools that are at a distance from their homes. Consolidation of
school districts necessarily implies some special arrangement of
this kind.
Even with the improvement of school facilities, not every child will
receive the education which is his due unless provision is made for a
school census, secured by a thorough canvass and an effective com­
pulsory education law. It is the State’s responsibility to provide
some training adapted to the child’s needs for every child of school
age. The State is not released from this duty because a child is
subnormal or defective, but must make a place for him in the general
i Educational D irectory o f the State o f Delaware, 1915-1#.


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M E N TA L DEFECT IN A RURAL COUN TY.

23

educational scheme, unless he is physically unable to take advantage
of any training that might be devised. Physical and mental examina­
tions are requisite in many cases to the proper understanding of
children in the schools, and will lead to the correction of physical
defects that handicap mental development.
The increase o f general educational and recreational facilities, such
as libraries, clubs, or similar bodies, and organized community
activities of various kinds, will result in raising the general level
of intelligence and social life. The appreciation of the importance of
mental hygiene and o f the seriousness o f mental subnormality from
the social and eugenic points of view will create a body o f public
opinion demanding and supporting constructive effort on the part o f
the State toward the solution of these problems.


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SECTION l .1

PREVALENCE OF MENTAL DEFECT.
CHAPTER I.

THE DIAGNOSIS OF MENTAL DEFECT.

M E N T A L D E F E C T A M E D IC A L P R O B L E M .

Until recently mental diseases were regarded apart from medicine
and but little attention was paid to their scientific study. Happily,
this opinion has gradually lost ground, and psychiatry is now re­
garded as a special and important branch of medicine, while mental
hygiene has taken prominence in preventive medicine.
As a matter of fact, though the problem of the insane and men­
tal defective is of great medico-legal, educational, and sociologic
interest, it is primarily a medical problem of increasing importance.
Under present-day conditions the physician in general practice is in
contact almost daily with some type of mental disorder and is often
called upon to diagnose mental deficiency. A t times he must give
an opinion as to the necessity for institutional care for certain indi­
viduals and must prescribe specialized training suitable to the needs
of others. He is quite frequently called upon to give a scientific
opinion as to the criminal responsibility of an individual. As medical
inspector of schools he must consider the relationship of certain cases
of physical disorders to mental development, point out the children
not able to profit b y the usual courses of study, and give advice in
respect to their care and training.
Furthermore, the special knowledge of the physician is necessary
for the diagnosis o f mental deficiency. Familiarity with types of
delirium, mental disorders involving deterioration, mental diseases
in which emotional adjustments determine the mental attitude, and
the relationship of associated physical disorders to mental develop­
ment, especially in children, make a physician with psychiatric
training more competent to interpret the results of formal tests for
grading intelligence than are those whose training is purely psy­
chological. On the other hand, it is not intended to minimize the
necessity of psychological training and experience in diagnosing such
C & S6S

R E L A T IO N T O R E T A R D A T IO N .

Mental deficiency or feeble-mindedness is a condition in which
mental growth is so much slower than normal that, in adult life,
mental development can not progress beyond that of a child. ^In
diagnosing the condition, therefore, it is important to differentiate
between retardation due to a physical disorder which will disappear
1 Section prepared b y the U . S. P ublic Health Service.

24


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M E N TA L DEFECT IN A RURAL COUN TY.

25

if the disorder is corrected, and retardation due to a primary mental
defect which is incurable, though not necessarily inherited.
FORM AL TESTS.

If the results of formal mental tests could be relied upon abso­
lutely, the diagnosis of mental deficiency would be a simple matter
for any intelligent person. Studies conducted by the Public Health
Service and others, however, have shown wide variations in the
results obtained by the Binet-Simon scale in apparently normal
children. These studies have led to the conclusion that psychologi­
cal tests can not be relied upon as the sole method of diagnosing
mental deficiency. Emotional reactions and attitudes of the indi­
vidual while under examination, together with his entire mental
make-up, must be taken into account in the interpretation of the
tests.
R E L A T IO N T O O T H E R M E N T A L D IS O R D E R S .

There is a tendency to include higher and higher grade cases in the
feeble-minded group. It must be recalled, however, that other mental
disorders may resemble feeble-mindedness. The examiner must,
therefore, be certain of the primary mental defect before diagnosing
these high-grade cases as mental defectives.
One familiar with psychoneurotic individuals must have been
impressed with their childlike manner of emotional adjustments.
Moreover, an individual with retiring and ‘ ‘shut-in ” tendencies,
who may eventually develop dementia prsecox, might be mistaken
by the inexperienced for a high-grade mental defective. This con­
fusion is still more likely in well-developed and markedly deteriorated
cases of dementia prsecox.
Certain cases of mental disorders of the excitable or manic type
and the epilepsies are occasionally noted in mental defectives.
When such cases are under observation the examiner should deter­
mine whether they are primarily mental defectives, and to do this
he must have a knowledge of the organic mental diseases. This is
particularly necessary if he is dealing with persons past middle life.
Furthermore, it is well known that the feeble-minded are often
public dependents, immoral, prone to acts of violence and to criminal
and sexual offenses, disseminators of communicable diseases, and not
infrequently addicted to the use of alcohol and drugs. It must be
borne in mind, however, that the majority of the individuals whose
social reactions are of this type are not feeble-minded. The social
and moral reactions alone, therefore, can not be relied upon for the
diagnosis of mental deficiency. This statement will be in a measure
confirmed by the results obtained in this investigation, one phase
of which was a psychiatric examination of persons who appeared,
from a study of their social reactions, to be feeble-minded.1
1 See p. 34.


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CHAPTER II.

PREVALENCE OF MENTAL DEFECT IN SUSSEX
COUNTY SCHOOLS.
S C O P E O F SU R V E Y .

During the course of a survey b y the Public Health Service of the
prevalence of mental deficiency in Sussex County, studies were made
at 181 of the 186 schools listed in the official report of. the com­
missioner of education of Delaware (1915-16). One school was
inaccessible, and four were not in session. Of the 181 schools,
151 were for white children and 30 for colored.- A t each of
these schools, in connection with the mental hygiene studies, ob­
servations were made of the sanitary conditions of the buildings and
their environment. These observations will be embodied in a later
report. Physical examinations of the school children were not made
in this county.
M E T H O D O F E X A M IN A T IO N .

A t each school the examiner interviewed all the children for sus­
pected mental deficiency and selected a varying number of them for
a special examination. This selection was determined by the history, general appearance, general mental attitude, emotional reac­
tions, and mental adjustments of the individual child. A second
group held for an intensive examination consisted of those that the
teacher pointed out as peculiar or unusual, as problems in the school
or in the community life, or as chronologically much too old for their
grade.
This method of selecting children for intensive examination was
chosen because it was not time consuming and was apparently con­
sistent with accuracy. It utilized the professional knowledge of
one experienced in estimating the mentalities of normal and sub­
normal children, supplemented b y the opinion of teachers who had
observed the children closely for one or more years. This method
is similar to the one employed b y officers of the Public Health Service
in examining immigrants.
EN RO LLM EN T AND ATTEN DAN CE.

The percentage of enrollment in attendance during the earlier part
of this investigation (in November and December, 1916) was some­
what lower than that found during the later month (January, 1917).
In some sections of the county the number of children attending
school is subject to seasonal variations, due to the temporary em­
ployment of children in certain local industries.1 For example,
i See p. 13.

26


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27

M E N TA L DEFECT IN A RURAL C O UN TY.

from late in November until near Christmas the inhabitants living
in the country districts are engaged largely in gathering holly,
which grows in great abundance in this section, and in weaving
wreaths for the Christmas trade. Many children are kept from
school during this period to assist in the work.
The attendance in the two periods is compared in Table I :
.
T

able

I .— Enrollm ent and attendance o f white school children during holly-gathering

season and in January compared.
Attendance.
Enroll­
ment.

Season and locality.

Holly-gathering season, N ovem ber and December
(east side of cou n ty ):
January (west side):

Total
present.

P er cent
of enroll­
ment.

Boys
present.

2,423
1,866

1,858
1,371

76.7
73.5

1,000
679

858
692

1,977
1,237

1,719
1,056

86.9
85.4

815
520

904
536

Girls
present.

N U M B E R G IV E N IN T E N S IV E E X A M IN A T IO N .

Of 6,004 white and 855 colored school children observed during
the course of this survey, 299 of the former (4.98 per cent) and 93 of
the l&tter (10.88 per cent) were given intensive mental examinations.
P R E V A L E N C E O F M E N T A L D E F E C T A M O N G W H IT E S C H O O L C H IL D R E N .

Sixty-seven, or 1.1 per cent, of 6,0041 white school children in­
spected were mental defectives. Of these 10 were from 6 to 10 years
old, 39 from 11 to 14, 15 from 15 to 17, and 3 from 18 to 20. Table II
gives the prevalence of feeble-mindedness in the schools in more detail.
T

able

I I .— Prevalence o f mental defect in white school children.
Num ber inspected.

N um ber and per cent m entally deficient.
.

Boys.

Total.

Locality.
Total.

B oys.

N um ber.
W hole county
East Side:
C ountry..
Towns___
W est Side:
C ountry..
Towns___

Per
cent.

Num ber.

Per
cent.

N um ber.

Per
cent.

6,004

3,014

2,990

67

1.11

46

1.52

21

0.70

1,858
1,371

1,000
679

858
692

27
11

1.45
.80

18
6

1.80
.88

9
5

1.05
.72

1,719
1,056

815
520

904
536

19
10

1.11
.95

15
7

1.84
1.35

4
3

.44
.56

1 Eighty per cent of the total enrollment of 7,503.


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Girls.

Girls.

28

M E N TA L DEFECT IN A RURAL COUN TY.

In this study it has been possible to determine the prevalence of
mental defect among white children enrolled in school, as well as
among# those in attendance when the mental examinations were
made. In the survey of the homes 19 feeble-minded cases were
found who were enrolled in school but were absent when the school
examination was made. In other words, out of a total enrollment
of 7,503, eighty-six feeble-minded cases were found, or 1.1 per cent.
The result is found to be identical with that obtained in the case of
the children inspected in school.
PREVALEN CE O F M EN TAL D EFEC T A M O N G CO LO RED SCH O O L
C H IL D R E N .

Twenty-nine, or 3.4 per cent, of the 8551 colored school children
inspected were mental defectives; 5 of them were from 6 to 10 years
of age, 18 from 11 to 14, and 6 from 15 to 17, the greatest number
falling in the 11 to 14 age group, Of 431 boys inspected, 13 were
mental defectives (3 per cent), and of 424 girls inspected, 16 (3.8
per cent) were mental defectives. This was one of the few groups
where the rate was higher in the case of girls than in that of boys.
In addition, there were found in the homes 15 cases who were
enrolled in school but were absent when the school was visited.
Therefore, out of 1,478 enrolled, 44 mental defectives were found,
or 3 per cent.
It is not to be assumed that the results of this study in the colored
schools represent accurately the prevalence of mental defectives in
this class of the population in the county, because of the small
number of children inspected.
R E S U L T S W IT H B IN E T SC A L E .

Although formal tests were not the main reliance in determining
mental defect in Sussex County,, they were used in each intensive
examination of school children and the mental age of the child was
determined. The mental age was then considered in forming an
opinion as to whether the child suffered from a mental defect.
As a matter of information, Tables III, IV, and Y are given to
show the number of feeble-minded children in each chronological
and mental age group.
1 Fifty-eight per cent of the total enrollment of 1.478.


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29

M E N TA L DEFECT IN A RURAL COUN TY.
T

T

able

I I I . — Results o f grading 66 white feeble-minded school children by Binet scale.

I V .— Results o f grading 29 colored feeble-minded school children by Binet scale.

able

T

able

Y .— Mental age o f white and colored feeble-minded school children.

Mental age.

Total.

Total..............................
3 ..................................
4 ..................................
5 ......................................
6 ...........................................
7 ................. \ ..............................
8 ................... -......................
9 ...................
10.............................................

...........................................
...................................
...................................
......................
............................

W hite.

Colored

95

66

29

i
5
10
13
14
26
21
5

1
4
7
7
7
19
17
4

1
3
6
7
7
4
1

The average retardation was 3.4 years for the 7 to 10 year age
group, 5.3 for the 11 to 14 age group, and 7.3 for the 15 to 17 age
group.1
1 The number of cases involved was 15 for the first age group, 57 for the second, and 21 for the third.


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30

M E N T A L DEFECT IN A RURAL C O U N TY.
P L A C E D -O U T C H IL D R E N .

Previous studies conducted by the Public Health Service have
shown a somewhat lower percentage of mentally defective children
in the general school population than in Sussex County, where
the average for white school children was 1.1 per cent.
The higher percentage in Sussex County is due to the number of
feeble-minded dependent children placed out in the county. For
several years certain agencies in adjoining States have had a policy
of placing children in farm homes in this State. The system has been
fostered by the demand for child labor created by the character of
the farming in southern Delaware. The fact that until 1917 no bond
was required b y the State for the purpose of preventing these depend­
ent children from becoming public charges has resulted in the placing
out of many mentally defective children in the county.
An analysis of the data obtained in this survey of the schools
shows that of the 67 (46 boys and 21 girls) feeble-minded white
children noted, 10 (9 boys and 1 girl), or 14.9 per cent, had been
brought into the county and placed in family homes.
The presence of these children raises the percentage of feeble­
mindedness. Exclusive of them, 0.95 per cent (1.23 per cent of the
boys and 0.67 per cent of the girls) were mentally defective. As
noted above, including the placed-out feeble-minded group, the feeble­
minded composed 1.1 per cent of the white children inspected.
The percentage of defective children found in Sussex County,
exclusive of the feeble-minded placed-out children, was the same as
that found in the rural schools of Porter County, Ind., by the Public
Health Service during intensive individual examinations.1 In Porter
County 14.3 per cent of the population was foreign-born white.3
M E N T A L D E F E C T IN PU B LIC S C H O O L S A M E N A C E .

The feeble-minded boy or girl is a misfit in the public schools,
particularly when kept in the regular classes. The feeble-minded are
unable to profit by the usual course of study in the schools and should
be segregated either in special classes in the regular schools or in
separate schools. The extra time and energy the regular teacher
devotes to such children is wasted, because they require a more
special and intensive form of instruction than can be given in the
regular classes. Furthermore, the necessity of constant supervision
and discipline of children of this type interferes materially with the
teacher’s discharge of regular classroom duties.
iC lark, T ., Collins, G. L ., and Treadway, W . L .: “ Rural school sanitation, including physical and
mental status of school children in Porter County, In d .,” P ublic H ealth Bulletin, N o. 77, p. 110. Wash­
ington, 1016.
* Thirteenth Census of the U nited States, 1910, V o l. II, Population, p . 560.


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M E N TA L DEFECT IN A RURAL COUN TY.

31

Not only are the feeble-minded children misfits in their classes,
but they are equally so in their association with other children.
Older children often treat them unkindly and subject them to all
sorts of abuse and ridicule. Responsive to degrading influences and
prone to vicious practices, the feeble-minded child is not a suitable
associate for younger children his equal and often his superior in
mental attainments. For example, the free association of a 16year-old boy, whose mental development is that of a 6-year-old child,
with children of the latter age, especially girls, or the free association
with young boys of a 16-year-old feeble-minded girl without selfrestraint who has considerable knowledge of debasing practices, will
lower the moral standards of the school.
The segregation of the mentally defective child in special classes,
besides being of decided advantage to other children, is of material
benefit to the child himself, because of the opportunity afforded for
individual and specialized training. The consolidation of schools in
the rural communities of Sussex County will make it practicable to
adopt measures for the segregation, classification, and training of
the mentally inferior.
0


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CHAPTER III.

MENTAL CONDITION OF INMATES OF THE
ALMSHOUSE.

Although the mentally defective child is a misfit in the environ­
ment of childhood, the condition is more easily controlled during
this period. The feeble-minded adult is unable to comprehend laws
made for adults whose minds continue to develop until the retro­
gressive changes of old age begin. He is unable to recognize the
rights of others, control his acts, or adjust himself to the standards
of the community and society. He is responsive to vicious influences
which tend further to weaken his already inefficient self-control. He
is unable to provide against adversity, and not infrequently becomes
dependent upon private or public charity. Unfortunately, many such
eventually are committed to the county almshouse.
In December, 1916, there were 35 inmates (21 white and 14 colored)
in the Sussex County almshouse, located near Georgetown, Del. The
distribution as to sex was as follows: Females, white 6, colored 5;
males, white 15, colored 9. Three of the inmates were young children,
two being illegitimate colored boys (one 10 months old and the
other 8 years old) and one being a 14-year-old white boy.
The mentality of the inmates of the almshouse is given in Table V I,
according to specified age groups.
T

able

Y I .— Mentality o f inmates o f almshouse, by specified age groups.
Inmates of almshouse.
Mental condition.

35
17
£
7
3

13

5

2

4

2

1

4
31

2

1

1

1

1
1

1

4

4

1

4

4

O r g a n ic fo c a l le s io n
(aphasia).

Paresis.

Dementia due to arterio­
sclerotic conditions.

Senile dementia.

Imbeciles.

Idiots.

o3

Epileptic.

D oubtful mental defective.

Other mental defectives.

'
Total.............................

Normal.

Total.

Age group.

Dementia prsecox.

Other mental disorders.

Feeble m inded.

1

1

1

1

1

a One, in the age group 40 to 49, had loeom otor ataxia.
.
b The doubtful case was 10 months old; the other four were in the 6- to 20-year age group, one being
8 years old , one 14, one 18, and one 19.

32


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M E N TA L DEFECT IN A RURAL COUNTY.

33

Of the 35 inmates of this almshouse, therefore, 19 were mental de­
fectives. Of these, 3 were white females, 8 white males, 3 colored
females, and 5 colored males. It will be noted that but 3 of the 35
inmates were of normal mentality.
No records are available as to the number of mentally afflicted
persons who have been admitted to, have died in, or have been dis­
charged from this almshouse during its existence.
M IN G LIN G OF SE XE S.

The various sexes and races mingle freely during the day, though
housed in separate departments. That there is little supervision over
them is shown b y the fact that a white woman with the mental
capacity of a small child was without protection from the sexual ad­
vances of men. As a result she has given birth to two illegitimate
colored children during the past nine years. The father of one of
these children is reported to have been an inmate and the father of
the other an employee of the institution.
SANITATIO N AND M EDICAL CARE.

The Sussex County almshouse not only fails to keep the sexes
segregated, but it fails to give the inmates sanitary conditions or
proper medical care. The institution grounds are flat and the drain­
age is only fair. No attempt is made to abate the fly nuisance. The
institution is not sewered and the privies are insanitary. The pa­
tients use buckets for urinals and commodes'. The probabilities of
soil pollution at the institution are great.
A hospital department is said to have been maintained at this
institution, but such a department does not now exist. There is no
modern equipment for the care of the sick. Not only do the inmates
have irregular medical advice and practically no medical super­
vision, but they are subjected constantly to the danger of contracting
communicable diseases.
ABSENCE OF SPECIAL TRAININ G .

As at all other almshouses, the mentally defective inmates are
given no special training designed to make them self-supporting.
COST OF M AIN TEN AN C E.

The annual per capita cost of caring for the inmates of the alms­
house (April, 1915, to March, 1916) was $156. For this amount,
in an institution under State supervision, clean sanitary surroundings,
proper medical supervision, continuous daily medical attention, kind
treatment, and training in self-control and self-support may be had.
87685°—19-----3


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CHAPTER IV.

MENTAL DEFECTIVES EXAMINED IN THEIR
HOMES.
SOURCES OF STU D Y.

In addition to the examination of the school children and ^the
inmates of the almshonse, a certain group of persons were examined
whose reported social reactions were suggestive of seme mental dis­
order. These suspected cases were obtained through the investigators
of the Children’s Bureau. The social histories of the cases were
obtained b y these investigators from the following sources:
1. Families of school children, previously diagnosed by the Public
Health Service investigator as mentally defective. Through visits
to these families other cases whose social history suggested feeble­
mindedness were observed, either in the immediate family group or
among near relatives. Some of these cases were so low grade mentally
as to be unable to attend school, and others had passed the age of
compulsory school attendance (14 years).
2. Families and friends of almshouse inmates who had been found
to be feeble-minded. While the records at the almshouse were
meager, they provided a certain entering wedge for further study by
the Public Health Service investigator.
3. Public school records. Among the relatives of these cases,
furthermore, were found a few cases suspected of being mentally
4 . Reports b y school-teachers of cases living in their vicinity.
Among the relatives of these cases several more suspected of mental
defect were found.
,
„
. . . ^
5. List of suspects furnished b y the Delaware Commission tor the
Blind. As before, a few of the suspects in this list had relatives who
were suspected through their social histories of being feeble-minded.
6. County officials, chib women, certain individuals interested in
social betterment, and friends of persons 'having feeble-minded
children.
j
.
Individuals 21 or more years of age whose social history pointed
to the possibility of mental defect were net investigated, as a rule,
if unrelated to cases less than 21 years of age. Forty such cases were
not investigated for this reason.
RESULTS BASED O N SOCIAL H IST O R Y .

From these sources 181 suspected cases Were found, out of a large
number investigated. On psychiatric examination 142 of these
proved to be mentally defective; 2 of the suspected cases had essen
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35

M E N T A L D EFECT IN A R U R A L C O U N T Y .

tial or idiopathic epilepsy; and 4 possessed certain constitutional
traits which warranted their being classified as psychopathic indi­
viduals. In addition, 14 cases were classed as retarded mentally.
These, although below the normal in mental attainments, could not
be regarded at the time of the investigation as certainly feeble­
minded. The future alone will determine whether they were retarded
from lack of opportunity or actually had a mental defect. Of the
181 suspected cases, 162 were, therefore, mentally abnormal, thus
leaving 19 who were mentally normal.
It has been previously stated that social history alone is not
sufficient for a diagnosis of mental deficiency. In this instance it is
to be noted that of the 181 suspected cases examined, 142 proved to
be actually feeble-minded, leaving 39 which would have been wrongly
diagnosed on the basis of social history alone. In other words, the
diagnosis would have been inaccurate in 21.5 per cent of the cases.
Some of the cases which would have been wrongly diagnosed b y the
social-history method were normal mentally; others had, mental ail­
ments which could be distinguished from mental defectiveness only
b y an exacting psychiatric examination, and still others were classed
as “ retarded ” mentally.
The sex and color distribution of the cases suspected of feeble­
mindedness are given in Table V II:
T

able

V I I . — S ex and color distribution o f 181 cases suspected o f mental deficiency on the
basis o f social history .<*

Cases suspected o f m ental deficiency.
Colored.

W hite.

M entality. Total.
Total.

Male.

Female.

Total.

Male.

Female.

T otal..................................................

181

108

69

39

73

41

32

Feeble-m inded..........................................
R etarded......................................................

142
14
2
4
19

85
9
2
4
8

55
7
1
2
4

30
2
1
2
4

57
5

31
4

26
1

11

6

5

Psychopathic constitution......................
N o rm a l..................................... .................

« T w o white and one colored case, related to school cases, were found in the almshouse. Since they are
included in the statistics for that institution (see p . 32), they arc om itted from the above record.

D ISTRIBUTION OF M E N TA L DEFECTIVES FO UN D IN H O M E S.

Turning now to the cases which were actually feeble-minded,
it seems well to point out that 41 (27 boys and 14 girls) out of the
142 were 6 to 14 years of age, the period during which schooling is'
required.1 Some of these cases were idiots and imbeciles unable to
attend school.
i Delaware com pulsory school attendance law requires attendance from 7 to 14 years.


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( R . C. 1915,

36

M E N TA L DEFECT IN A RURAL COUNTY.

The details in regard to the age and sex distribution of the feeble­
minded cases are given in Table V III:
T

able

V I I I .— A ge and sex distribution o f feeble-minded cases seen in home, by source

o f case.
Feeble-minded cases seen in homes.
Female.

Male.

Source o f case.

T otal................................—
W hite cases.................. ........... ...; .
Related to almshouse c a s e s ...

Delaware Commission for the

Colored cases............... ................ .
Related to almshouse cases. . .


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Age.

A ge.
T o­
tal.

T o­
tal.

6
15
21
Un­
to years
to
der
14
and
20
6
years. years. years. more.

T o­
tal.

15
21
Un­
6
to years
to
der
20
and
14
6
years. years. years. more.

142

86

3

27

31

25

56

2

14

20

20

85

55

1

16

19

19

30

2

10

9

9

13
5
13
10
11
5

8
5
8
5
6
2

1

2
2
4
1
2
1

2
2
3
1
1

3
1
1
3
3
1

5

2

2

1

3
1
3

2

14
1
13

12
1
8

1

5

6
1

2

3

5

1

1

2

57

31

2

11

12

6

26

4

11

11

26
3
14
6
6
2

15
2
8
2
3
i

2

6

5
2
3

2

11
1
6
4
3
1

2

3

6
1

3
1
1

2

5
5
3

5

2
2

1

3
2
2

1
2

1

2
4
3
1

CHAPTER V.

PREVALENCE OF MENTAL DEFECTIVES IN
GENERAL POPULATION.

When the three groups of cases discussed in the three preceding
chapters are combined, it is seen that at the time of this survey there
were at least 257 cases of mental defect in Sussex County. In other
words, at least 0.52 per cent of the population a were feeble-minded.
There were, no doubt, many additional cases, since little effort
was made to secure histories of cases not related to those under 21
years of age. Although no estimate of the actual number of cases
appears possible, an analysis of those cases found has some value
and is therefore given herewith.
S E X A N D C O L O R D IS T R IB U T IO N , B Y G R O U P S S T U D IE D .

The distribution of these cases of feeble-mindedness, by color anp
sex, in the three groups of the population studied is indicated in
Table I X :
T

able

I X .— S ex and color distribution o f feeble-m inded cases in cou nty, by groups.
Feeble-minded cases in county.

Color and sex.
Total.

School
popula­
tion.

Alm s­
house.

Cases
examined
in homes.

Total...............................................................................................

257

96

W hite.........................................................................................................

163
109
54

67
46
21

19
11
8
3

142
85
55
30

94
49
45

29
13
16

8
5
3

57
31
26

Female..............................................................................................
Colored......................................................................................................
Female...............................................................................................

D IS T R IB U T IO N , B Y S E X A N D C O L O R , A C C O R D IN G T O P O P U L A T IO N O F
COUNTY.

Table X gives the distribution by sex and color in comparison with
the population:
_
,
T

able

X .— D istribution by sex and color, with percentage o f population.

Color and sex.

W h ite............................................................................................................................

Fem ale..................................................................................................................

Number
feeble­
minded.

Popula­
tion,
Jan. 1,
1917.5

Percent­
age of
popula­
tion.

257

49,222

0.52

163
109
54

40,801
20,789
20,012

0.40
0.52
0.27

94

8,421

1.12

49
45

4,320
4,101

1.13
1.10

a Based on an estimate b y the Bureau of the Census, Jan. 1,1917 (see Table X ).
b Estimates b y the Bureau of the Census.

37


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38

M E N TA L DEFECT IN A RURAL COUN TY.

/

One of the striking f aots brought out by Table X is the higher rate
o f feeble-mindedness among the white males as compared with that
among the white females. This ratio has been found to be true in
previous investigations b y the Public Health Service. Of 11,622
boys and 11,217 girls examined in the schools of four States 127
boys and 78 girls were mentally defective, or 1.08 per cent of the
former and 0.69 per cent of the latter.1
PREVALENCE A M O N G CHILDREN.

. In the age group from 6 to 20 years, inclusive, 192 cases of feeble­
mindedness were found in the schools, the almshouse, and the homes.
The population for this group was estimated to be 15,840 on July 1,
1917.® The percentage of feeble-mindedness in this group was there­
fore 1.21. As every effort was made to locate cases in persons under
21, the above percentage may be considered fairly accurate.
AG E D ISTRIBUTION O F W H ITE M E N TA L D EFECTIVES.

The age and sex distribution of the white feeble-minded cases
found in the county and the relation the cases bear to the population
i n specified age groups are as shown in Table X I :
T able X I .— A ge and sex distribution o f white feeble-minded cases and o f general popula­

tion, with percentage o f population that feeble-minded constitute.
General popula­
tion.«Sex and age.

Per cent
W hite of popula­
tion
that
feeble­
feeble­
m inded
m
inded
cases.
consti­
tute.

Num ber.

Per cent
distri­
bution.

20,494

100.00

415
1,444
5,599
1,197
11,839

2.02
7.05
27.32
5.84
57.77

1
67
15
26

0.07
1.19
1.25
0.22

Female......................................................................................................

19,984

100.00

54

0.27

Under 1 year.....................................................................................
1 to 4 years........................................................................................
5 to 17’ years..................................................... ................ .
18 to 20 years........................ ...........................................................

374
1,520
5' 073
1,086
11-921

1.87
7 61
25.38
5.49
59.65

2

0.13
0.69
0.46
0.10

U nder 1 yea r...................................................................................
1 to 4 years......................................................... _.............................
18 to 20' years.....................................................................................

109

0.53

5
12

a Estimated as of A pr. 15,1917 (based on 1910 census).

It will be observed in Table X I that in the general population the
percentage of feeble-mindedness among the males is greater than that
among the females. Between the ages of 5 and 20 years the per­
centage of feeble-minded males is twice that of the females and cor­
responds with the percentages obtained in the school survey.
1 Porter County, In d ., Frederick County, M d., Arkansas generally, and Nassau County, N .
? Estimate b y the Bureau of the Census.


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Y.

M E N T A L D EFECT IN' A R U R A L C O U N T Y .

m

4

39

It will be observed that 102 of the 163 eases fall within the ages
5 to 17. The comparatively low rates noted in the lowest age periods
are due in part to the difficulty in diagnosing mental deficiency in the
very young. Such diagnosis is often less difficult where an organic
defect is present, and, therefore, attention must be paid to such
defects during the examination. On the other hand, malnutrition
and disease in the very young child may arrest mental development
temporarily. In many of these cases there is no method b y which the
eventual mental outcome can be determined.
Because of the higher mortality among the feeble-minded 1 and
because no effort was made to locate all such cases among adults, the
rates in the 18 to 20 and adult age groups, both sexes being consid­
ered together, are also lower than those in the intermediate groups.
Of the 163 white feeble-minded cases found in the county, 38 were
21 or more years of age. These 38 cases, or 23 per cent of the total
white feeble-minded cases, were found in a population of persons 21
years old or more estimated to number 23,760 persons, or 59 per
cent of the total white population.
PREVALENCE OF M ENTAL DEFECT IN CHILDREN O F GENERAL POPU­
LATIO N , ESTIM ATED FR O M PREVALENCE IN SC H O O LS.

Since in this investigation a systematic attempt was made to locate
all feeble-minded children, it has been possible to secure an idea of
the accuracy of estimating the prevalence of feeble-mindedness among
all children from the prevalence among inspected school children.
In a general white population 122 feeble-minded children from 5
to 20 years, inclusive, were found. As the total white population at
these ages was 12,965, 0.94 per cent of this number were feeble­
minded. It will be found that this corresponds very nearly to the
result obtained in regard to children actually in school— 0.95 per cent,
excluding placed-out children. In other words, an inspection in
schools of 14.8 per cent of the total white population gave the same
results as an inspection of all children in the general population sus­
pected of being mentally defective.
The conclusion may be drawn that the percentage of white feeble­
minded determined by actual inspection of a large number of school
children may be taken as an index of the prevalence of mental de­
fectives in the white general population between the ages of 5 and
20 years, inclusive.
In the case of colored school children, the small number inspected
and the few feeble-minded cases found make it impossible to estimate
the number in the general population from 5 to 20 years.
i See p. 40.


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40

M E N TA L DEFECT IN A RURAL COUN TY.

RELATION B ETW EEN PREVALENCE OF FEEBLE-M IN DED IN SC H O O LS
AND IN G ENERAL POPULATION.

There is also a fairly constant relation between the prevalence of
feeble-mindedness in the whole population and that in the schools.
If the mortality among feeble-minded and normal-minded were the
same, the rate in the general population would be about the same as
that in the school population, since feeble-mindedness is either in­
herited or acquired in early childhood, and since a person who is
feeble-minded never recovers from the condition. However, the mor­
tality rate among feeble-minded is higher than among normal-minded.
This is probably due to failure to understand the principles of personal
hygiene, to irregular employment, improvidence, and bad housing,
and to the constitutional inferiority and physical disorders, which are
associated with mental defects. How much higher the death rates
among feeble-minded at the different ages are than those among
normal-minded is not ascertainable.
The data secured in this study were not of a nature permitting an
estimate of the relationship just pointed out between school and
general population feeble-minded rates, since no effort was made to
locate all feeble-minded cases in the adult population. All that can
be shown is the lowest probable rate in the general population when
there is a certain rate in the schools. This estimate must again be
limited to the white population, since so few colored children were
inspected.
As above indicated, no estimate of the number of adult cases of
feeble-mindedness can be made. It is evident, however, that there
were more than enough to bring the rate up to one-half that found in
the schools, 0.48 per cent, since it is 0.40 per cent when only the
known cases are considered.1 It has already been shown that 0.95
per cent of the white school children, excluding those placed out from
outside the county, were feeble-minded. It may, therefore, be con­
cluded that where a large number of school children are examined
the rate in the general white population will be at least half that in
the white school population.
1 There were found 163 white mental defectives, and the census estimate of the white population on Jan.
1,1917, was 40,801, giving a feeble-minded rate of 0.40 per cent.


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SECTION II.

SOCIAL STUDY OF MENTALLY DEFECTIVE
CHILDREN.
CHAPTER I.

GENERAL CONSIDERATIONS.
SCOPE OF ST U D Y.

In the course of the mental examination of children in the schools
of the county, the Public Health Service diagnosed 96 children as
mentally defective. They found 4 more mentally defective children
as a result of examinations of almshouse inmates. The general
survey made by the Children’s Bureau resulted in the location of 92
additional children 6 to 20 years of age, inclusive, who, on examina­
tion by the Public Health Service, were found to be feeble-minded.
Information concerning home conditions and personal histories
of these 192 children was secured by the Children’s Bureau, visits
to the homes of the children being supplemented by school records and
by interviews with persons having special knowledge of the children
or the families. The Public Health Service furnished diagnoses of
the mentality of persons under 6 or over 20 years of age who were
related to the children included in the study, and whose histories,
therefore, aided in the interpretation of the hereditary and social
factors affecting the children studied. The points covered in. the
social study included economic status and character of the family;
family history; physical condition and developmental history of the
mentally defective child; personal characteristics; school history and
attainments; occupational history and economic efficiency; social
reactions, including delinquencies and other antisocial tendencies;
ability of the family to care for and safeguard the defective indi­
vidual; and the need for public care and protection.
Data regarding mental defectives under 21 years of age do not give
an adequate picture of the problem of mental defect as related to
dependency, delinquency, immorality, and other social manifesta­
tions. It must be borne in mind that statements as to dependency
and delinquency are representative only for the group studied, and
would be a considerable underestimate if applied to the whole number
of feeble-minded in the community. Mental defectives become more
serious problems as they reach the years of adult life. As family ties
are broken, they are likely to become public dependents, and as
parental control is weakened, those who have delinquent tendencies
or who are incapable of protecting themselves against aggression
become more of a menace to society. Mentally defective children
are more amenable to training and discipline, and it is with this
group that the best results from constructive work can be obtained.


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42

M E N TA L DEFECT IN A RURAL C O UN TY.
T H E PRO BLEM A RURAL O N E .

All but 3 per cent of the population of Sussex County is classed, by
the United States Census as rural. Environmental conditions vary,
however, according to the degree of isolation, and may be differ­
entiated into three groups: Farm districts, small settlements, and
towns. As towns are included places having a population over 500;
those with a population of from 50 to 500 are classed as small set­
tlements.
The distribution of the mentally defective children included in
this study showed 73 per cent living in farm districts, as compared
with 60 per cent of the general population in similar localities. Five
per cent of the mentally defective children lived in small settlements
and 20 per cent in towns, while of the general population 14 per
cent lived in small settlements and, 26 per cent in towns. The
remaining 2 per cent were in the almshouse at the time of the
investigation.
T

able

X I I .— Place o f residence o f m entally defective children and o f general population

10 years o f age and over.

Place o f residence.

Mentally defective
children 6 to 20
years of age.®

Population 10 years
of age and over in
1910.6

Num ber. Per cent. N um ber. Per cent.

T o ta l.......... .

192

100.0

46,413

100.0

F a r m s ..................
,Small settlements
T o w n s ................ .
A lm shouse............

140
10
38
4

72.9
5.2
19.8
2.1

28,007
6,444
11,962
(<0

60.3
13.9
25.8
( c>

a Includes 1 child aged 20 years and 11 m onths and considered 21 b y the P ublic Health Service.
b T h e Rand-M cN aliy Indexed County and Township Pocket Map of Delaware. W hite and colored
were not shown separately.
.
.
.
.
c There were 35 almshouse inmates, form ing one-tenth of 1 per cent of population of county.

COLOR, A G E, AND SEX D ISTRIBU TIO N OF CHILDREN STU D IED .

The 192 mentally defective children were distributed by color,
sex, and age as shown in Table X II I:
T

able

X I I I . — Color, age, and sex o f m entally defective children.

Color and age.

Mentally defective children
6 to 20 years of age.
Total.

T otal........... t ..................................... ........................... *.................................

6 to & ...................................................... ............................................................
14 to 17

6 to 9

. . . ............................................................... ................................... .

............................ ................ ................................................. .

14 to 1 7 ........................ - ............................................- ........................................


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B oys.

Girls.

192

120

72

123

83

40

16
44
42
21

11
29
27
16

515
15
5

69

37

32

4
24
31
10

3
15
12
7

1
9
19
3

M ENTAL

DEFECT

IN

A

RURAL

43

COUNTY.

The census reports do not include figures for white and colored
separately for the age group studied. Figures for the total popula­
tion of the county show 83 per cent white and 17 per cent colored,
while of the mental defectives 64 per cent were white and 36 per cent
were colored. Boys comprised 63 per cent of the total and girls 37
per cent. The color and sex distribution has been discussed in
Chapter V of Section I .1
Of the mentally defective children studied, 46 per cent were under
14 years of age. The range of years included in the study, 6 to 20,
inclusive, may be divided into two groups— the 8 years from 10 to 17r
inclusive, comprising 73 per cent of all the children, and the 7 years
under 10 and over 17, comprising 27 per cent. The reasons for the
large proportion in the intermediate group were considered on page 39.
N A TIV IT Y A N D L E N G T H OF RESIDENCE O N PENINSULA A N D IN CO UN TY.

Analysis of the place of birth and length of residence in the region
shows that in Sussex County the problem of mental defect is almost
entirely indigenous to the county and the Delmarvia Peninsula. All
the children were born in the United States, 181 of the 192 studied
having beeh bom on the peninsula, 158 of them in Sussex County, 6
in other counties of Delaware, and 17 on the peninsula outside Dela­
ware. Only 11 were born in other parts of the United States, and
they were all children who had been placed in Sussex County by
home-finding societies. These children had been brought from New
York, Pennsylvania, and New Jersey. They constituted almost 6 per
cent of all the mentally defective children included in the study.
T

able

X I V .— Place o f birth.

Mentally defective children
6 to 20 years o f age.
Place of birth.

T o ta l.

W hite.

Colored.

T otal............... .....................

192

123

69

Sussex C ounty..................................
Other counties in Delaware.........
Peninsula outside Delaware____
U nited States outside peninsula

158
6
17
11

100
4
9
10

58
2
8
1

The data as to length of residence on the peninsula and in the
county indicate a very static condition, with practically no shifting
from one environment to another of a different nature. The few
families who had been out of the county at any time previous to the
investigation had moved back and forth across its boundaries, remain­
ing on the peninsula. All but 10 of the white and 1 of the colored
children had always lived on the peninsula.


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44

M E N TA L DEFECT IN A RURAL COUNTY.
T

able

X V .— Length o f residence on the peninsula.
Mentally defective children
6 to 20 years of age,

Length of residence on the peninsula.
Total.
Total....................................................................
Always.............................................................
10 years and over........................... .................
5 tò 9 years..........................................................
Less than 5 years........................................................

White.

192

123

181
3
4
4

113
2
4
4

Colored.

Ninety-eight of the 123 white children and 56 of the 69 colored
had always lived in Sussex County.
T

able

X V I .—Length o f residence in Sussex County.

Mentally defective children
6 to 20 years o f age.
Length of residence in Sussex County.
Total.
Total............................................................................

192

Always..... ............................................................................
10 years and over.............................................................
5 to 9 years............ ....................................................
Less than 5 years.....................................................
Not reported.....................................................

154
9
19
9
1

White.

Colored.

The locality studied represented a strictly rural, native-Ameriean
population, with little admixture of new elements even from other
sections of the peninsula of which the county forms a part. The
problem of mental defect was not complicated by such factors as
prevail in a section affected by the tides of immigration.
M E N TA LITY AN D

PHYSICAL CO ND ITIO N OF CHILDREN STU D IED .

The problems involved in the care of mentally defective children
differ with the degree of their mental defect and their physical
condition. In considering the circumstances under which the
mentally defective live, and the adequacy or inadequacy .of the care
they receive, the types of cases must be borne in mind.
Fourteen per cent of the children studied were unable by reason
of their very low mentality or because of physical handicaps to
attend to their own personal wants. This type of defective presents
problems of physical and medical care which are very difficult to
meet, unless the family is in comfortable circumstances and can
afford to hire an attendant or to devote practically the entire time
of one member, of the family to the care of the defective child. In
contrast to this type is the higher grade defective who can attend
to his personal wants and can sometimes be taught to be partially

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M ENTAL

DEFECT

IN

A

RURAL

45

COUNTY,

self-supporting, but who requires industrial training and supervision,
and whose energies need direction into social and away from antisocial
channels.
Table X V II gives the degree of mental defect, the capacity for
self-help, and the physical condition of the children studied. The
children diagnosed as idiots or imbeciles were classified as low grade.
Children were classed as incapable of self-help if they were unable to
dress themselves or to attend to other personal wants. No defects
were included as serious unless they constituted pronounced handi­
caps.
T

able

X V I I .— Capacity fo r self-help, grade o f defect, and physical condition o f children
*
studied.

Mentally defective children 6 to 20 years o f age.
Capacity for
self-help.

Idiots and
imbeciles..

Other feeble­
m inded.

Physical condition.
Total.
Good.

Total................................................

192

165

127

126

Serious physical disability....................

65

39

Crippled or paralyzed “ ...................
Epileptic b .........................................
Defective vision, hearing, or speech

5
18
10
25
7

9
6
17

T

Poor. Total.

Capa­ N ot
Capa­ N ot
capa­
capar
ble
ble
ble
ble
Total.
of
of
of
of
self.
selfselfselfhelp.
.help.
help.
help.

40

20

11

10

26

29

10

19

5
9
4
8

5
9
3
12

4
1
5

5
5
2
7

27

1

'

20

1

152

145

116

116

36

29

7

9
7
13
7

5
5
12
7

4
2

7

1

a Including 5 also epileptic, and 11 also having defective vision, hearing, or speech.

b Including 4 also having

defective vision, hearing, or speech.

The 40 mentally low-grade children constituted 21 per cent of the
total. Twenty of the low-grade cases were absolutely helpless or so
handicapped that they required constant care. Serious physical
disabilities existed in 29 cases. Seven of the 152 high-grade cases
were incapable of self-help because of physical handicaps, making a
total of 27, or 14 per cent of the children studied, who presented
serious problems of physical care. The other 86 per cent represented
various degrees of ability to care for themselves and to help in the
household or on the farm. However, 39 of these children were badly
handicapped by physical defects.
Physical disabilities classed as serious existed in 34 per cent of the
cases. Often there was a combination of two or more physical
defects. Nearly two-fifths of the 127 children who had no serious
physical disabilities had minor defects, usually of vision, hearing,
or speech.


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46

MBNTALr DEFECT IN A BUBAL C O UN TY.

The high-grade cases who were able to help themselves and had no
physical handicaps constituted 60 per cent of the total number.
These 116 children represented the greatest possibilities of training
as well as the most serious problems of conduct.
T Y P E S O F H O M E S IN W H IC H T H E C H IL D R E N L IV E D .

A considerable number of mentally defective children were living
in other than their parental homes. Only 150, or 78 per cent, were
with their own families, 22 per cent being cared for in other ways.
Relatives other than parents cared for 10 children, and foster parents
cared for 27. Four children were in the county almshouse, and a
girl 19 years of age had no home, but lived illicitly with different men.
Only one of the mental defectives under 21 years of age had married,
and she had left her husband and returned to her parents.
T

able

X V I I I .— Types o f homes in which m entally defective children lived, according to
color, age, and sex o f children.

Mentally defective children 6 to 20 years of age.
Living in—

Total.
Color and age.

Parental
homes.

£

>>
M.

sO í3 ffl

192

120

72

*03

T otal...........................................

Relatives’
homes.

H
o

£

n
«

•G
O Is
+■»
Ü

IS

m
>>

Jj
O

«

59

10

5

5

27

21

6

»5

3

2

35

4

3

1

18

14

4

2

2

....

1
5
8
4

1
3
7
3

2
1
1

1
1

1
1

9

7

2

3

1

1

1

99

5
15
15
5

15
37
31
16

10
25
17
12

5
12
14
4

2
2

1
2

1

14 to 17“ . .......................................
18 to 2 0 ..........w.............................

il
29
27
16

Colored..................................................

69

37

32

51

27

24

6

2

4

6 to 9
.........................................
1ft to 13
14 to 17
18 to 20.

4
24
31
10

3
15
12
7

1
9
19
3

3
20
22
6

2
13
7

1
7
15
1

ft tn 9

Tj
o

91

16
44
42
21

W h i t e . . . . . . . . . . . . ----- .......................

>>
«

150

64

123 ~ & r 40

Foster
homes.

3
3

1
1

2
2

1
6
2

1
4
2

2

2
2

2

a Includes 4 in almshouse and 1 having no home.

A larger proportion of white children than of colored were living in
their parental homes— 80 per cent of the white to 74 per cent of the
colored. Of the boys 76 per cent and of the girls 82 per cent were in
the homes of their parents. Only 2 of the 20 children under 10 years
of age were living in other than their parental homes. One of them
was in a foster home, and one in the almshouse. Sixteen per cent
of the children 10 to 13 years of age were cared for by others than
their parents. Twenty-eight per cent of those 14 years of age and
over were in foster homes, in the homes of relatives, in the almshouse,
or, in one case, had no home.


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47

M E N TA L DEFECT IN A RURAL COUN TY.

All but 8 of the 150 children living in their parental homes were
legitimate. Almost one-third of those cared for b y others than their
parents, 13 out of 42, were of illegitimate birth. One child in a
foster home was a foundling. Illegitimate children constituted 11
per cent of the total number studied. Most of these children, 17 out
of 21, were colored.
T

able

X I X .— Types o f homes according to legitim acy or illegitim acy o f birth.

Mentally defective children.6 to 20 years of age.
T ype o f home.

Legitim acy or illegitim acy.
Total.
Parental.

Kelatives.

Foster.

Other.

T otal......................................................’ ....................

192

150

10

27

W h ite.....................................................................................

123

99

4

18

2

Legitim ate.....................................................................
Illegitimate....................................................................
Foundling.....................................................................

118
4
1

97
2

3

i

16
1

1

2
**

Colored............... ...................................................................

69

51

6

9

%

Illegitimate....................................................................

52
17

45
6

2
4

5
4

3

5

The 42 mentally defective children studied who were cared for by
relatives other than parents, or who lived in foster homes, in the
almshouse, or were without a home, were less likely than children in
their parental homes to receive for an indefinite period of time the
care made necessary by their condition. The burden imposed by
mental defectives on those having the responsibility for them is
usually so heavy that the strongest ties are needed to insure the
patient care, guidance, and supervision required. Only 4 of the
children not in their parental homes were classed as incapable of
self-help, and 2 of these were being cared for in the almshouse. The
children credited with ability for self-help included a considerable
number who were giving a great deal of difficulty, and who needed
much attention. It is probable that many of these children who
were cared for outside their own families will sooner or later become
dependent upon the public for support, as are those now in the
almshouse.


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CHAPTER II. ADEQUACY OF CARE GIVEN MENTALLY
DEFECTIVE CHILDREN LIVING IN THEIR PARENTAL
HOMES.
P A R E N T A L C O N D IT IO N .

The adequacy of the care given mentally defective children in their
parental homes depends primarily upon whether or not both parents
are present in the home. One hundred and fifty children included,
in this study were living in their parental homes. Both parents were
living and at home in 84 per cent of these cases. In 16 per cent there
were abnormal conditions in the home on account of the death,
desertion, or permanent absence for other reasons of one parent.
The parental condition was considered normal even though one
parent was dead, if there was a step-parent.
T

able

X X .— Parental condition.
Mentally defective children
6 to 20 years of age living in
their pareiital homes.

Parental condition.

Total.
T otal...................................................................................................................

150
126
9
6
4
4
1

White.

Colored.

99
85
6
5
2
1

51
41
3
1
2
3
1

Abnormal conditions due to absence from the home of one parent
were found in 14 per cent of the white, cases and 20 per cent of the
colored. The father was absent (dead or deserted) from the home
in 13 cases— 8 white and 5 colored. Ten other children, 6 white and
4 colored, lacked the care of the mother.
The total number of households represented by the 150 children
living in their parental homes was 116, 81 white and 35 colored. In
73 of these white families the fathers provided for the family; in 3,
the mothers; in 4, brothers of the defective child; and 1 was sup­
ported b y charitable aid. In the colored families the maintenance
was provided in 30 cases by the fathers, in 4 b y the mothers, and in
1 by a brother.
T

able

X X I .— Heads o f fam ilies o f m entally defective children living in their parental
homes.

Head o f family.

Families o f m entally defec­
tive children, 6 to 20 years o f
age, living in their parental
homes.
Total.

T o ta l......................... ...............................
Father head of fa m ily.................... ...............
Mother head of fam ily....... .........................
Brother head of fa m ily...................................
Other head of fa m ily ......................................

W hite.

Colored.

116

81

35

103
7
5
1

a 73

6 30
4
1

3
4
cl

M entally defective children,
6 to 20 years o f age, living in
their parental homes.
T otal.
150
136
8
5
1

W hite.

Colored.

99
91
3
4
1

a Includes 1 fam ily w ith 2 defective children, stepfather head.
b Includes 3 families w ith 4 defective children,,step fathers heads.
c stepfather deserted; grandmother head o f fam ily; no one working; neighbors supporting.

48


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Federal Reserve Bank of St. Louis

51
45
5
1

49

M E N TA L DEFECT IN A RURAL COUNTY.
ECO NO M IC STATUS OF FAM ILY.

Occupation of father.
The best index of economic status is afforded by the occupation of
the head of the family. In Sussex County agriculture is the main
industry, and income can not usually be stated in terms of money.
The status of a family living on a farm is mainly determined by the
form of tenure of the farm— whether it is owned, rented on a cash
basis, or worked on shares.
T

able

X X I I .— Occupations o f fathers o f mentally defective children living in their parental

homes.

Occupation o f father.

Families o f m entally d e f e c ­ M entally defective children
tive children, 6 to 20 years o f
6 to 20 years o f age, whose
age, whose fathers were the
fathers were the heads o f
heads of the families.
the families.
Total.

W hite.

T o ta l........................................................

ol03

73

Father had no occupation..............................
Father engaged in agricultural pursuits___

1
80

1
54

Father farm owner—retired...................
Father farm ow ner...................................
Father farm renter...................................
Father share tenant.................................
Father farm laborer.................................
Father engaged in farm ing of type not
reported..................................................

3
20
2
40
14

3
16
2
27
5

1

1

Father engaged in other occupation.............

22

18

Colored.

Total.

W hite.

Colored.

30

136

91

45

26

1
111

1
72

39

13
9

' 4
22
2
53
29

4
18
2
35
12

18
17

1

1

4

24

18

4

4

6

a Includes 4 stepfathers: 1 white (2 children), 3 colored (4 children).

Of the 73 white fathers reported as being the heads of their fami­
lies, 54 made their living by agricultural pursuits, 3 of them as
retired farm owners, 16 working their own farms, 2 as cash renters,
27 as share tenants, 5 as farm laborers, and 1, type of farming not
reported. The low economic status of the white families in which
the breadwinners were engaged in agriculture was indicated by the
small number of farm owners. In almost two-thirds of these fami­
lies the fathers were tenants or farm laborers. A still greater pro­
portion of the colored fathers, 26 out of 30, made their living by farm
work; all but 4 of them were share tenants or farm laborers. * Several
of those engaged in farming did other kinds of work part of the time.
Eighteen white and 4 colored fathers made their living by occu­
pations other than farming, such as seafaring, fishing, carpentry,
unskilled labor of various types, and other miscellaneous employ­
ments. One-half were in low-grade occupations.
Three-fourths of the 136 mentally defective children whose fathers
were the breadwinners were in families of low economic status, the
fathers being engaged in tenant farming or in low-grade occupations.
97685°—19---- 4


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m

M E N TA L DEFECT I N A E UEAL C 0 ¥ N T ¥ .

Employment of mother.
Seven mothers, 3 white and 4 colored, having 8 mentally defective
children included in the study, were reported as being the heads of
their families. One of these white mothers had sufficient income
to support her family without engaging in gainful work. Another
owned a farm which she cultivated with the aid of two young sons.
The third white mother added to a small income from a pension by
washing and ironing away from home; her two daughters helped
her. Three of the colored mothers did daywork, washing, and
cleaning. One of them had the help of three young daughters, and
another had two sons who assisted in the support of the family.
The third mother had been deserted by her husband six years before,
and was dependent entirely upon her own earnings at housework.
She was compelled to be away from home all day, leaving her four
children, the oldest a mentally defective girl of 14, to take care of
themselves. The fourth colored mother who was the head of her
family worked a farm on the share-tenant basis with the aid of her
16-year-old son.
Twenty-four mothers who were not the heads of their families
had found it necessary to engage in gainful work. These, with the
6 mothers who were heads of their households and gainfully employed,
constituted a total of 30 of the 116 mothers of mentally defective
children living in their parental homes who were gainfully employed.
Fourteen of these mothers were white and 16 colored. The majority
of the mothers were engaged in daywork away from home or in
gainful employment at home, usually as laundresses.
T able X X I I I .— Em ployment o f mothers o f mentally defective children living in their

parental homes..

E m ploym ent of mother.

Families of mentally defec­
tive children 6 to 20 years
of age -living in their pa­
rental homes.
White.

Total.

Colored.

Mentally defective children 6
to 20 years of age living in
their parental homes.

W hite. ; Colored.

Total.

51

116

81

35

150

99.

Mother not gainfully em ployed....................

78

62

16

98

76

22

Mother gainfully em ployed..........................

30

14

16

42

17 :

25

27
7.
6’

8
4.

5'

19
3
1

10'

6

4

T otal...................................... ................

Mother em ployed at daywork, whole
tim e....... ................................................
Mother em ployed at daywork, part
tim e........................................................
Mother em ployed at hom e w ork ........
Mother em ployed at other w ork ........
Mother dead or deserting..............................

2
15
7
8
85

5
4
5

10
3
1
3'

2

2-

There were 42 children in the families of mothers who were gain­
fully employed. The mothers of over one-sixth of the white and
almost one-half the colored mentally defective children living in
their parental homes were engaged in gainful work. It is significant

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51

M E N TA L DEFECT IN A BUBAL COUN TY.

o f the economic conditions of this county that, considering white
and colored children together, more than one-fourth of those living
in their parental homes had mothers who were unable to give much
attention to the care and supervision of their children, because
forced to engage in gainful work.
Families dependent upon others than parents.
In 4 of the white and 1 of the colored families the fathers of which
had died or deserted, a brother of the defective child was the prin­
cipal breadwinner. One, a 19-year-old boy, earned the entire family
income as a farmer’s helper. Another boy of the same age worked
a farm with the assistance of his 15-year-old brother. In 2 other
families, 1 white and 1 colored, older sons worked the farms alone
or with the assistance of younger boys. One family was maintained
by 2 sons, who were tenant farmers and also helped on other farms.
A 70-year-old grandmother took the responsibility for a house­
hold which included an imbecile girl and her imbecile mother.
The mother did daywork occasionally, but was very inefficient.
The family was practically dependent on the assistance of neighbors
and relatives.
Income of family.
Information _in regard to income could be secured in most cases
only according to a general standard of adequacy. No effort was
made to state this in terms of money, but the family incomes were
classified as “ high,” “ adequate,” “ inadequate,” and “ very low.”
This classification was based largely on the obvious standard o f
comfort maintained by the family.
T

able

X X I V .— Incom es o f fam ilies o f m entally defective children living in their parental
homes.

Fam ily income.

Families o f mentally defec­
tive children 6 to 20 years
o f age living in their pa­
rental homes:
Total.

T o ta l.......................................................
Fam ily incom e adequate................................
Fam ily incom e inadequate............................
Fam ily incom e very lo w ................................

116

*

4:
47:
46 J
19

W hite.
81:
4
36
32
9

Colored.
35 •
11
14
10

Mentally defective children 6
to 20 years of age living in
their parental homes.

Total.

W hite.

Colored.

150

99

51

5
56
59
30

s
41
42
11

15
17
19

The majority of the families of these mentally defective children
had incomes classified as inadequate or very low. The parents of
54 per cent of the white children and 71 per cent of the colored had
insufficient means to provide adequately for their families. The
burden of the defective children, some o f whom were incapable of
self-help, and few of whom could ever hope to become self-supporting,

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52

M E N TA L DEFECT IN A RURAL COUN TY.

was especially heavy under such circumstances. Although a few of
these families were providing fairly well for their defective children,
they were doing so with difficulty, and their[poor economic condition
made the future uncertain.
SOCIAL AND INTELLECTUAL STATUS OF FAM ILY.

Housing conditions.
In Sussex County the usual type of dwelling among families of mod­
erate or low incomes is a one-family frame house without a cellar or
inside conveniences. Foundations in many instances consist of low
brick piers located at the corners of the structure, supporting the
flooring at a distance of about 18 inches from the ground. The sur­
rounding yard, especially among the humbler homes, is oftenest a
stretch of bare soil neatly swept. The toilets are chiefly surface
privies, located not far from the houses. Many homes in the more
remote sections have no toilets of any sort. The water supply is
usually derived from a shallow driven well, easily constructed in
the sandy soil. Because of the character of the soil, sanitary drain­
age is difficult.
Measured by housing standards usually adopted, overcrowding
did not exist to any serious extent in the homes of the white
families studied. In the homes of only four of the white children
were there more than two persons to each room. In these cases there
were 11 persons living in five rooms. The housing of the colored
families, on the other hand, presented serious problems of con­
gestion— 18 of the 51 colored children were in homes in which there
were more than 2 persons to a room; 2 families, having 2 defective
children each, lived in three-room houses, though there were in each
case 8 persons in the family group; 5 families, 1 having 2 defective
children, lived in four-room houses, there being 9 persons in each
family; 1 family of 10 lived in two rooms, and another family of the
same size, having 2 defective children, occupied three rooms; 4 de­
fective children, belonging to the same family, lived in a four-room
house, the family group comprising 10 members. Another defective
child was one of a family of 12 living in a four-room house.
A comparison of the number of rooms and the number of persons
in the family does not give a correct picture of conditions in many
cases. In the winter especially) because of the scarcity of fuel, the
family herds together in two or three rooms that can be heated. Many
of the homes are of flimsy construction and do not give adequate
protection from the elements. In many cases the defective child
shares his bed with some other member of the family. Especially in
the case of low-grade children, or children having bad personal habits,
the presence of the feeble-minded child in the overcrowded home is
a detrimental influence to the other children, and the defective him­
self can not receive the care most conducive to his well-being.

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M E N TA L DEFECT IN A RURAL COUNTY.

53

Ten of the white and 14 of the colored children lived in houses
which were in notably bad repair. An index of bad sanitary condi­
tions was the absence of toilets of any kind in connection with the
homes of 19 children. About one-fourth of the children were living
in homes which were clean and well kept. The other three-fourths
were living under conditions of cleanliness and sanitation ranging
from fair to bad. Some of the bad living conditions are illustrated
by the following descriptions:
A family of 11 lived in a two-story frame house of five rooms.
There was no toilet on the premises. Water was obtained from a
driven well in the yard. The barnyard was near the house. The
house was in very bad repair; the plastering had peeled off, and
cracks let in the cold; the house was very dirty, and the living con­
ditions were wretched. The farm was rented on shares and yielded
a very small income. The nearest store was 8 miles away, and the
school 2 miles distant. The parents were very poor and ignorant.
Two children were feeble-minded.
A one-story frame shanty of rough boards, comprising three rooms,
housed a family of eight. The cracks were so large that it was possible
to see through them from one room to another. The house was dirty
and disorderly. The mother and two children were feeble-minded.
A four-room house was occupied b y a family of 10. The house was
in bad repair and very dirty. No toilet was provided. There were
holes in the floor and parts of the walls were covered with newspapers.
The only beds were piles of rags, and there were no chairs. The whole
family, with the exception of 2 .children too young to be diagnosed,
were feeble-minded.
A family of four lived in an old two-story house that was in very
bad repair. There were three rooms downstairs and one upstairs.
The plastering had fallen off the walls in places. The house was dirty
and disorderly. Water was obtained from a well in the yard. There
was no toilet. All the members o f the family were feeble-minded.
A shabby two-story frame house with six rooms housed a family
of 11. The mother was a poor manager, and the house was very
dirty. Two girls were feeble-minded. The mother was stupid, easy­
going, and almost childish, and depended mainly upon one of her
feeble-minded daughters for help about the house. The family was
poor and lived on an isolated farm.
Mentality and character of parents.
In a small proportion of the families studied diagnoses of the men­
tality of parents were made b y the Public Health Service, in cases
where the children were examined in their own homes instead of in the
schools. In seven families, having 13 mentally defective children
included in the study, one or both parents were feeble-minded. In
these families the conditions in the homes were most unfavorable,

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54

M E K TA L DEFECT IK A RURAL C O UN TY.

because of the inability of the parents to give the children proper
care. In one of the seven families the father was feeble-minded, in
four, the mother; and in two, both parents.
Parents reported as weak-minded and those who were obviously
illiterate or very ignorant were classified as ‘ 1illiterate or ignorant.”
In 28 families, 18 white and 10 colored, one or both parents were so
described. These 28 families had 47 children included in the study—
29 white and 18 colored. In 19 families both parents were illiterate
or ignorant.
T

able

X X V .— M entality o f parents o f m entally defective children livin g in their parental
homes.

Mentality of parents.®

Families of m entally defective
children 6 to 20 years of age
liv in g in their parental
homes.
Total.

Colored.

Total.

116

81

35

150

6 81

60

21

6 90

T o ta l........................................................
Parents normal m entally......................... —

W hite.

M entally defective children 6
.to 20 years of age living in
their parental homes.

Parents not normal m entally........................
One parent illiterate or ignorant...........
B oth parents illiterate or ignorant........
One parent feeble-m inded......................
B oth parents feeble-m inded........... .

35
c9
19
c5

2

21
5
13

2

1

W hite.

•Colored.

99

51

66

24
27
7
11
5
4

14

60

33:

4
6
3
1

c.14
33
c7
6

7.
22;
2
2

a Or parent and step-parent.

6 Including 17 families, 18 children—1 parent dead or deserting,
c Including 2 families, 3 children—1 parent dead or deserting.

The feeble-mindedness or ignorance of the parents was accom­
panied in 14 families by drunkenness, immorality, or neglect or abuse
of children. Five of these families, including 8 feeble-minded children,
were white; 9 families, including 19 children, were colored. The
mentally defective children having parents who were feeble-minded,
illiterate, or ignorant constituted 40 per cent of those living in their
parental homes. In 4 families, having one defective child each, the
parents were normal mentally, but were alcoholic, immoral, or other­
wise of poor reputation.
C H A R A C T E R IS T IC S O F M E N T A L L Y D E F E C T IV E C H IL D R E N .

Mental or physical handicaps so serious as to make the children
incapable of self-help existed in the cases of 23 children living in their
parental homes. The situation was further aggravated by the inade­
quacy of the income in the families of 13 of these children. In 3 of
these cases the poverty was extreme. The care required b y these
helpless children was such as to tax the family resources to the utmost.
A factor of the greatest importance in considering the adequacy of
the care that can be given mentally defective children in their own
homes is the amenability of the child to parental discipline. Children
who are handicapped b y defective mentality frequently demand,
because o f their lack of judgment and self-control, more careful

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55

M E N TA L DEFECT IK A RITUAL COUN TY.

guidance and supervision than the average child of normal mentality.
Some defective children, because of their violent tempers, uncon­
trolled impulses, or their tendencies toward brutality or destructive­
ness, present particularly serious problems o f conduct. The.se children
require closer supervision than can be given in most family homes.
Of the 150 children living in their parental homes, 18 had exhibited
marked tendencies toward delinquency or waywardness, or had
proved to be vicious or ungovernable. Only 4 of these children were
in good homes. The other 14 were living under conditions which
tended to increase rather than to correct their antisocial tendencies.
C H IL D R E N IN S P E C IA L N E E D O F C A R E .

The factors resulting in home conditions which are favorable or
unfavorable to the proper care in their own homes of mentally defec­
tive children may be classified as follows: Economic status of the
family; housing and sanitation; intelligence and character o f parents;
and the supervision the parents exercise over their children. This
does not take into consideration the complications arising from bad
physical conditions or delinquent tendencies o f the defective children
themselves. Neither are general environmental factors, such as
isolation, taken into account. In classifying the homes special effort
was made to be conservative, and where there was any question, to
give the home the benefit o f the doubt.
A home was classified as unfavorable if one or more of the factors
affecting home life were detrimental. Homes were not classed as
unfavorable because of poverty alone unless the income was so low
as to make decent living impossible. If both extreme poverty and
some other bad condition existed, the other condition was pre­
ferred in making the classification as being the more detrimental.
If insanitary conditions existed in combination with ignorance or bad
character of parents, the home was classified as unfavorable because
of ignorance or bad character rather than by reason of insanitary
conditions.
T

able

X X V I .— Home conditions o f m entally defective children living in their parental
hom es.

Hom e conditions.

Mentally defective children 6
to 20 vears o f age living in
their naronta-1 hom es.
Total.
150

inadequate supervision............................................ ........................................
Insanitary-conditions........................................................................................
L ow mentality o f parents................................................................ ................
L ow m entality and bad characte r o f parents..............................................
B ad character o f parents................................... — .........................................


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71
79
6i
2
71
33
27
4-

W hite. : Colored.
99
46
4
5
25
8;
2,

51

.

18
33
2
2
8
19
.2

56

M ENTAL

DEFECT

IN

A

RURAL

COUNTY.

Fifty-three per cent of the children in their parental homes were
living under unfavorable conditions. The percentage was higher for
the colored than for the white, 65 per cent for the former and 46 per
cent for the latter. In four-fifths of the cases in which the homes
were classified as unfavorable the reasons for this classification were
the feeble-mindedness, illiteracy, or ignorance of the parents, com­
bined in a large number of cases with drunkenness and immorality.
Extreme poverty -with no other detrimental conditions was found in
the homes of only 2 children.
Fifteen of the 71 children living in favorable homes were found to
be so handicapped mentally and physically that they were incapable
of self-help. Three of them constituted such a drain upon their
families, whose incomes were inadequate, as to make some other
provision for their care necessary. Four of the children living under
favorable home conditions were delinquent or uncontrollable and in
need of a stronger discipline than was being given by their parents.
Eight children who were physically helpless lived in homes classed
as unfavorable. These children were not receiving the care required
by their condition, and were in urgent need of custodial care. The
14 ungovernable children in unfavorable homes were doubly in need
of protection.
A total of 86 children living in their parental homes, 57 per cent of
all children so cared for, were in special need of care by reason of bad
home conditions, or because of their own delinquent tendencies or
physical disabilities. Of these 86 children, 79 lived in homes classi­
fied as unfavorable, 14 of them being also delinquent or uncontrollable.
Four children lived in favorable homes, but were delinquent or un­
controllable, and 3 others living in favorable homes imposed too
heavy burdens on their families because o f their helpless condition.
Over half the 86 children in special need of care lived under such
detrimental conditions that immediate provision for them outside
of their own homes was imperative. The following brief summaries
indicate the urgency of their needs:
W h it e :

Imbecile girl 13 years of age. Serious defects of vision and
speech. Unable to care for self. Family income inadequate.
Parents illiterate.
Feeble-minded1 girl 15 years of age. Income of family inade­
quate. # Parents illiterate. Child did not receive proper care.
Feeble-minded boy 6 years of age. Serious speech defect.
Feeble-minded mother deserted family. Income inadequate.
Father could not give child proper care.
Feeble-minded boy 11 years of age. Income of family very low.
• Parents ignorant and illiterate. Imbecile girl 14 years of age. Illegitimate child of feeble-minded
mother. Family dependent on aid of neighbors.
i In these summaries “ feeble-minded ” refers to mental defectives above the grade of imbecile.


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M ENTAL

DEFECT

IN

A

BUBAL

COUNTY.

57

W h i t e — Continued.
Two feeble-minded sisters, 14 and 18 years of age. Family income
very low. Parents ignorant. Bad home conditions. Girl of
18 had had an illegitimate child.
Feeble-minded boy 12 years o f age. Income of family inadequate.
Mother feeble-minded. Bad home conditions.
Feeble-minded boy 11 years of age. Income of family inadequate.
Father alcoholic. Mother illiterate. Poor home surroundings.
Idiot boy 8 years of age. Never talked. Incapable of self-help.
Father dead. Income of family inadequate.
Imbecile boy 13 years of age. Epileptic. Serious speech defect.
Mother dead. Income of family very low.
Imbecile girl 16 years of age and her feeble-minded sister 9 years
of age. Income of family very low. Both parents feeble­
minded. Father alcoholic. Family received charitable aid.
Four brothers and sisters: Feeble-minded and epileptic girl 18
years of age; feeble-minded girl 16 years of age; feeble-minded
boy 12 years of age; feeble-minded boy 11 years of age, almost
blind and having defective speech. Both parents ignorant.
Mother an invalid. Home life on low plane. Income inade­
quate.
Idiot boy 18 years of age. Never talked. Incapable of self-help.
Income of family inadequate.
Idiot girl 17 years of age. Helpless. Mother dead. Income
of family very low.
Imbecile boy 15 years of age. Epileptic and crippled. Incapable
of self-help. Income very low. Home conditions poor.
Feeble-minded girl 14 years of age. Income of family inadequate.
Family degenerate. One sister epileptic. One sister delin­
quent. Father alcoholic. Parents neglected the children.
Imbecile boy 20 years of age. Crippled. Defective vision and
speech. Income of family inadequate. Parents illiterate.
Older brother feeble-minded.
Feeble-minded girl 13 years of age. Mother dead. Lack of super­
vision of feeble-minded child. Income inadequate.
Feeble-minded girl 8 years of age. Home conditions poor. Income
very low.
Co l o eed :

Family with four feeble-minded children: Girl 16 years of age;
boy 13 years of age; boy 12 years of age; boy 10 years of age.
Income of family very low. Parents illiterate. Home condi­
tions poor. Low-grade family.
Feeble-minded girl 17 years of age and her feeble-minded brother
11 years of age. Income of family very low. Father dead.
Mother feeble-minded and immoral. Children neglected. Mother
did daywork away from home. Older brother feeble-minded.
Family partly dependent on charity.
Feeble-minded girl lOyearsof age and her feeble-minded and crippled
sister 9 years of age. Income of family very low. Mother did
daywork away from home. Parents ignorant. Children poorly
kept and inadequately supervised.
Fe
1
' “"
| age. Crippled. Serious speech
Income of family inadequate.


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58

MENTAL BEFECT I jST A RURAL C0TJ2ÎTÏ.

C o l o r e d — Continued.

Feeble-minded girl 14 years of age. Badly deformed. Income ol
family very low. Father had deserted. Mother did daywork
away from home.
Feeble-minded boy 12 years of age. Illegitimate child. I eeMeminded mother was living with a man illegally. Income very
low. Child neglected.
Feeble-minded girl 14 years of age. Income of family very low.
Mother worked away from home all day, leaving child in charge
of a blind uncle. Mother immoral. Home filthy and disorderly.
Two feeble-minded sisters, 14 and 16 years o f age. Income of
family inadequate. Father feeble-minded.
Feeble-minded boy 10 years of age. Income of family very low.
Parents ignorant.
Feeble-minded girl 14 yearn of age. Income of family very low.
Parents not legally married. Mother illiterate. Lack of super­
vision over feeble-minded girl.
Four feeble-minded brothers and sisters: Girl 20 years of age;
boy 14 years of age; girl 13 years of age; boy 12 years of age.
Income of family very low. Both parents feeble-minded.
Children neglected. Girl of 20 immoral.


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<*

CHAPTER III. ADEQUACY OF CARE GIVEN MENTALLY
DEFECTIVE CHILDREN NOT LIVING IN THEIR PARENTAL
HOMES.
CHILDREN CARED FO R B Y RELATIVES OR IN FO STER H O M E S.

A total of 37 of the 192 children included in this investigation had
been removed from their own homes and placed with other f amilies, 27
with families not related to them, and the other 10 with relatives.
All the children cared for by relatives were bom in Sussex County.
Twelve of the 27 placed with others than relatives had been brought
into the county from other States, 3 of them having been informally
placed by relatives or friends, and 9 having been placed by homefinding societies. Three children had been brought into Sussex
County from other counties of the State, 2 of them having been
placed by agencies, and 1 having been taken informally. Twelve of
the children in foster homes belonged originally in Sussex County.
Delaware agencies had placed 5 of these children, a home having been
found for 1 by a child-caring society, and 4 having been bound out
from the almshouse. The other 7 Sussex County children had been
taken informally from relatives or friends.
Two of the 22 white children who were being cared for by relatives
or in foster homes were illegitimate, and 1 was a foundling. Eight of
the 15 colored children provided for in this way were illegitimate.
The mothers of 4 of the illegitimate children were dead; the mother
of 2 was in the almshouse; in 2 cases the mothers had married and
left their illegitimate children with relatives; the mother of 1 illegiti­
mate child was maintaining a home for her 2 other illegitimate
children, but was unable to assume the care of all 3; the whereabouts
of 1 mother was not reported. Both parents of 2 legitimate children
were dead; in 4 cases the death of the mother, and in 6 the death of
the father, had made it necessary for the child to be provided with
another home. The mother of 1 child and the father of another had
deserted. The parents of 3 children were separated, and the mother
of 1 child was in an institution for the insane. In 5 of the remaining
8 cases no information was obtained about the parents; in 3, the
parents were living together, other conditions being responsible for
the child’s dependency.
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60

M ENTAL

DEFECT

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COUNTY.

Legitimate children:
Both parents dead............................... --.............................................
Mother dead...... .............. - ...................................................................
Father d e a d ................................ - .......... - ..........................................
Mother deserted...................................................... ; ...........................
Father deserted . ........... .......................................................................
Mother in institution for insane...........
Parents separated.............................................................
Parents living together.......................................................................
No information regarding whereabouts of parents..................

2
4
®
1
1
1
3
3
5

T o t a l....................................................................... .................- .................' 26
Illegitimate children:
Mother dead............................................................................................
4
Mother in almshouse............................................................
2
Mother married and child left with relatives.............................
2
Mother maintaining home for 2 other children......... .................
Whereabouts of mother not reported............ .............. - .......... - -

1
1

Total............................................................................................. ..

10

Child a foundling....................- .........................................................- .................
37

Fifteen of the 22 white children living in foster or relatives’ homes
were on farms owned by the head of the household; 2 lived with farm­
ers who were cash renters; 2 lived on share tenant farms; 2 in other
than farm homes; in 1 case the occupation of the head of the house­
hold was not reported. Six of the 15 colored children living with rela­
tives or in foster homes lived with farm owners; 3 lived with farmers
who had retired from active work; 3 were on share tenant farms, in 2
cases the heads of the households were farm laborers; 1 lived in a town
home.
Classified according to the economic conditions of the homes in
which they were living, 3 white and 5 colored children were in families
having high incomes. The 5 colored children were all living in white
families. Sixteen white children and 6 colored, 1 of them having a
white guardian, were with families having adequate incomes. Three
white children and 3 colored lived in families whose incomes were in­
adequate, and 1 colored child lived with relatives under conditions
of extreme poverty.
Thirty-two children were living in homes classified as favorable, and
5 (1 white and 4 colored) in homes classified as unfavorable. The
white child living in an unfavorable home was under the care of foster
parents who were uneducated, ignorant, and slovenly, though kindhearted and trying to do well by the child. The child was a low-grade
imbecile incapable of self-help. The foster parents were finding the
burden of her care too great and were most anxious that some other
provision be made. The four colored children were living with rela­
tives. In two cases the homes were classified as unfavorable because
of inadequate supervision; in one, because of extreme poverty; and

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M ENTAL

DEFECT

IN

A

BUBAL

COUNTY.

61

in one, because of the low mentality of the guardian. One of the white
children living in a favorable home was incapable o f self-help. It is
significant, that six of the colored children in foster homes were living
with white families. The conditions in all these six homes were classi­
fied as favorable, but obviously the children were not taken with the
intention of making them members of the family, but rather with a
view to the help the children could give.
More than one-third of the mentally defective children cared for by
relatives or in foster homes, 13 out of 37, were delinquent or uncon­
trollable. All but one of these ungovernable children were living in
homes classified as favorable.
The cases studied indicated clearly that many of the families who
had taken children into their homes had done so in ignorance of the
existence of. mental defect. The children proved to be incapable of
doing the work that was expected of them in payment for their main­
tenance, and they were kept by the family merely out of kindness of
heart or because no other solution presented itself. In nine cases
the guardians were especially anxious to be relieved of the responsi­
bility of caring for their mentally defective charges. In one of these
instances the home conditions were bad, and in six cases the children
were delinquent.
A total of 19 of the 37 children living with relatives or in foster
homes were in special need of care. Five of these children, including
one who was delinquent, and one incapable of self-help, whose guard­
ian was unwilling to keep him longer, were living under unfavorable
home conditions. Twelve other children were delinquent or uncon­
trollable, and in six of these cases the guardians were endeavoring to
have the children removed. In two additional instances the children
were in need of care because of the unwillingness of foster parents
longer to provide for them.
The following case is illustrative of the difficulties often involved in
caring for mentally defective children in foster homes:
A boy 11 years old was brought by an agency from another State
when he was about 6 years of age and placed in a well-to-do, intelli­
gent farmer’s home where he had all the privileges of a regular mem­
ber of the family. Not long after his placement, however, he began
to show delinquent tendencies, proving himself to be untruthful, dis­
obedient, untrustworthy, sulky, and malicious. His guardians had
been conscientious in attempting to educate him, but in spite of fairly
regular attendance at school he learned nothing. He showed such
dangerous tendencies that the family was afraid of the results of bis
association with their own children. The guardians were nearly dis­
tracted with the boy, and they had appealed to the placing-out agent
to have him removed. The boy was obviously in need of special care
and training.

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$2

M ENTAL

DEFECT

IN

A

RUSAL

COUNTY.

Two or three instances were'found of children being received in
unusually desirable homes with the expressed intention of giving them
good educational opportunities, which mental incapacity prevented
them from utilizing. The forbearance and charity of the foster
families in which these defective children had been placed was an out­
standing feature of the situation.
A Delaware agency placed a foundling boy in a Sussex County fam­
ily when he was a little more than 3 years of age. The family in­
tended to adopt the child, but from the very beginning he proved to be
a disappointment, manifesting abnormalities that caused the family
to hesitate about legal adoption. They had given him a free home
under agency control, and he was IS years o f age at the time of the
investigation. The boy was nervous and restless. He was untruth­
ful, stubborn and headstrong, destructive, and cruel to animals.
Quick and active about his tasks providing some one was with him to
direct him, he would not work at all if not supervised. He disliked
work so much that he once ran away, remaining over night, rather
than do something asked of him. During a period of eight years of
school attendance he had managed to reach the third grade, but was
very dull and had great difficulty in doing the work. The older boys
tormented him and imposed on him and took away his possessions.
The boy was too cowardly to defend himself or take the offensive.
The guardians realized his condition and were very anxious that some
other provision be made for his care.
A boy of 15 was placed five years ago by an agency o f another State
with a f amily, the head of which was a man who himself had been
brought up outside his own home. Because of his sympathy with
orphan children, he especially requested the home-finding society
to give him a bright boy, in order that he might treat him so far as
possible as his own son. He was greatly disappointed when the child
sent to him proved to be not only mentally but physically defective.
The boy was inclined to be stubborn and was not always truthful.
He was slovenly about his work, and required constant supervision.
He had to be forced to go to school, and in spite of having attended
for 10 years could not do third-grade work. The guardian, however,
was trying to make the best of the situation. He recognized the boy’s
defects, and was dealing with him intelligently. Should this home
fail, the boy would undoubtedly become a public charge.
Children whose heredity showed marked strains of degeneracy and
defect, and who were themselves mentally defective, had been placed
out from the almshouse. They proved burdensome to the families
into which they were taken and dangerous to the community. Two
imbecile boys, 18 and 20 years o f age, who had been placed out from
the almshouse, were the illegitimate children of an imbecile colored
woman admitted to the almshouse when she was 10 years old, about

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M E N T A L DEFECT IN A RURAL COUN TY.

m

47 years ago. Since that time she had been in and oqt of the alms­
house. The father of her first illegitimate child was a placed-ont
boy living in the family with which she had been placed by the alms­
house. Several other illegitimate children were bom during her
periods o f residence in the almshouse. Information concerning three
of these children was secured, the two boys in question and a feeble­
minded daughter 33 years of age. The older son had been taken from
the almshouse b y a white family when he was 3 years of age. He had
never shown any bad traits but was unable to work except under
close supervision. The younger son was taken from the almshouse
at the age of 2, also by a white family with whom he remained until
a year before the investigation was made. A t that time he was
transferred to another family because he was so troublesome. He
was morose, impatient, and cruel, and could do only the simplest
farm work. He was in urgent need of custodial care.
These 19 mentally defective children who were without natural
guardians and dependent on the generosity and good will o f the fami­
lies b y whom they had been given homes were in very special need of
protection. Even though most of them were living in homes classified
as favorable, and were in many cases receiving adequate care at the
time of the investigation, these temporary homes could not be depended
upon for permanent care. Many of the children were taken into the
homes for the work they could do. When they were found to feeya
burden instead of a help, or when they proved to need unusual
supervision or protection, their guardians wished to relinquish them
to other care. The five children living under unfavorable home con­
ditions and the eight others Whose guardians were unwilling longer
to bear the burden of caring for them, were in very great need of
care and protection by the State.
C H IL D R E N IN T H E A L M S H O U S E O R H A V IN G N O H O M E .

The only institution in Sussex County to which children are ad­
mitted is the almshouse, which cares for them both in the institution
and by placing out in families. Pour mentally defective children
between the ages of 6 and 20 years, inclusive, were in the almshouse
at the time of the investigation—a white hoy of 19, a white boy of
14, an 18-year-old colored girl, and an 8-year-old colored boy whose
mo ther was also an inmate. The white children were both incapable of
self-help. The histories of the four children present a picture o f the
types of families that populate the almshouse and constitute the
lowest grade in the county. The almshouse is not adapted to the
proper care of these cases and fails to give the constant supervision
needed. The appeal for their protection is the more insistent because
their condition is not only one of present misery but involves danger
to the community.

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64

M E N TA L DEFECT IN A RURAL COUN TY.

The white boy of 19, a low-grade imbecile, was taken to the alms­
house at the death of his father, when he was 10 years of age. He
had a younger brother, also feeble-minded, in a foster home. The
boy was handicapped physically, being badly crippled and unable to
talk. He had remained in the almshouse ever since his admission
and will probably be a public dependent until his death. The family
history showed numerous cases of mental defect, degeneracy, and
physical handicaps.
The boy aged 14 years, a helpless idiot, began his career in a public
institution when he was 6 years old. A type of custodial case which
meant an absolute drain on the public exchequer during his entire
life, he was so low grade that he could hardly make his wants known
by grunts and signs. He was blind, being afflicted with a double
congenital cataract. Only such elementary commands as “ stand
up,” “ sit down,” “ come here,” addressed to him in a loud voice,
brought response. He was unable to talk— grimaced, held his mouth
open, twisted his head restlessly, and kept his hands in almost con­
stant motion. The family history showed bad strains on both sides.
The mother had been a placed-out girl. She died eight years before
the investigation. The father had married again but took no interest
in his children.
A third inmate of the almshouse, an 8-year-old colored, boy, was
the Son of an imbecile white woman, also an inmate of the almshouse.
Born in the almshouse, the boy had been placed out from there
several times, but was always returned shortly because of his thievish
and destructive tendencies. His mother had been cared for in the
almshouse for 17 years, having come there pregnant at the age of 19.
Although never married, she was reported to have had seven children.
An 18-year-old imbecile girl was the illegitimate child of a colored
woman who had had seven other illegitimate children, one of whom
was obviously weak-minded, and five of whom died in infancy. This
girl was born in the almshouse, and at the age of 2 years was bound
out to a white family. She was returned to the almshouse a few
years later because of a gangrenous sore on her leg, which finally
necessitated amputation. On recovery from this operation she went
home with her mother. The child had a vicious temper and had so
much trouble with the children in the neighborhood that the mother,
who was away from home during the day, was obliged to return her
to the almshouse, where she had remained ever since. She had never
had any schooling. Although her hearing and speech were defective
and she was very low grade, she was able to do some work around
the almshouse. She had been victimized at the almshouse and had
given birth to a child.
The history of the 19-year-old colored girl, who had no home but
lived illicitly with different men, is as follows: One of two illegitimate

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M E N TA L DEFECT IN A RURAL COUNTY.

65

children, at the age of 11 she was left, because of her mother’s death,
in charge of her grandparents, who were below average intelligence.
The whereabouts of her father, a white man, had been unknown /
since before her birth. The girl was stubborn, had a bad temper,
and required supervision, though she could do housework well. At
the age of 17 she left her grandparents’ home to do housework. She
remained at service for only a short time, and since then had lived
arodnd at various places, her whereabouts being unknown to her
grandparents. She had been very immoral, living with a number <5f
different men. This girl was in urgent need of custodial care.
97685°—19----5


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CHAPTER IV.

THE MENTALLY DEFECTIVE CHILD AND
THE COMMUNITY.

Mental defect is essentially a community problem. It is ^the
inability of the defective to hold his own in school, in industry, and
in his contacts with his fellow men that makes his condition of social
as well as of individual concern. Society must make special pro­
vision for those incapable of meeting their responsibilities, or it
must suffer the consequences. The presence of the feeble-minded
child in the regular school grade not only results in comparatively
little benefit to him but retards the whole class by requiring an undue
proportion of the teacher’s time and attention. ' The untrained
defective is an industrial inefficient, capable at the best of doing only
work very simple and routine in character. The delinquent or uncon­
trollable defective is a menace to his associates and a source of corrup­
tion to the neighborhood.
T H E M E N T A L L Y D E F E C T IV E C H IL D A N D T H E S C H O O L .

The short terms, poor school facilities, lack of effective compulsory
attendance, and the distances between the farm homes and the
district schools made it difficult for even normal children to receive
adequate education. Mentally defective children, often also physi­
cally handicapped, could derive little benefit from the one-room
school where the teacher’s ingenuity was sorely* taxed in dealing
with children of many ages and grades In spite of the difficulties
and the little advantage to be gained, the school attendance of
mentally defective children was surprisingly high. Sixty-eight per
cent of the children studied attended school during the year 1916-17.
Twenty-one per cent who were not attending that year had previously
had some schooling. Eleven p e r , cent of the children had never
attended school. The white and colored showed about the same
proportion who had never attended. Of the 62 not in school during
1916-17, 48 were 14 years of age or over, leaving only 14 who were
within the compulsory attendance age.
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M E N TA L DEFECT IN A RURAL COUNTY.
T

able

XXVII .— S ch ool

attendance o f m en ta lly defective children, according to color and
age.

M entally defective children 6 to 20 years of age.
N ot in school, 1916-17.

Color and age.
Total.

In school,
1916-17.a
Total.

*
T ota l...........................................................................

Attended
N ever
previ­
ously. attended.

192

130

62

41

21

,123

86

37

23

14

6 t o 9 ...............................................................................
10 to 13............................................................................
14 to 17............................................................................
18 to 20............................................................................

16
44
42
21

12
39
31
4

4
5
11
17

2
9
12

4
3
2
5

Colored...................................................................................

69

44

25

18

6 to 9 ...............................................................................
10 to 13............................................................................
14 to 17.............................................. ............................
18 to 20...........................................................................

4
24
31
10

2
21
21

2
3
10
10

W h ite ....................................................

7
2
2

1
10
7

3

a Children enrolled. Thirty-four of these children were not present in school when th e P u b lic Health
Service exam inations were m ade, b ut were later diagnosed in their hom es. One of these had never
attended pu blic school, b u t ha d attended private school.

Sixty-six per cent of the boys and 71 per cent of the girls were
attending school in 1916-17. Thirteen per cent of the boys and 8
per cent of the girls included in the study had had no school training
whatever.
T

able

XXVIII .:— S ch ool attendance

o f m en ta lly defective hoys and g irls.

M entally defective children
6 to 20 years of age.
School attendance.
T otal.
T ota l................................................................................. ..................

i

In school, 1916-17.......................................................................................................

Boys.

Girls.

192

120

72

130

79

51

N ot in school, 1916-17............................................................................................

62

41

21

Attended previously......................................................................................
N ever attended........................................................................
. .

41
21

26
15

15
6

Although many of the children had attended a number of years,
few of them had attained grades above the third. Forty-three of
the 109 white and 41 of the 62 colored children, who had ever attended
school had not progressed beyond the first grade. Eighteen of these
white children and 15 of .the colored had attended school five years
or more without advancing beyond this grade, 6 of them being so
defective that they were unable to do even primary work. Three
white children had attained the seventh grade, the highest grade in
which any defective child was found, but according to the teachers’


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68

M ENTAL DEFECT IN A RURAL COUN TY.

statements, these children had been so graded merely to encourage
them, or to put them with children nearer their own age. One of
them had attended for 11 years. Two children had reached the
sixth grade, but one of them had been promoted only because of his
long attendance— 10 years— and not because he was able to do the
work. A total of 10 white children had attained grades above the
fourth. The lowest number of years attended by any of these was 7,
and most of them had been in school 10 years or morfe. None of the
colored children had reached grades above the fourth.
Fifty-eight per cent of the white children and 77 per cent of the
colored were reported as having been in the first or the second
grades during the last year they attended school ; almost half the
white children in these grades, and two-fifths of the colored, were
reported as having attended school at least 5 years; two white
children in the second grade were reported as having attended,
one for 11 years, and the other for 14 years. The colored children
did not show as long terms of school attendance as the white, although
three of them in the first or second grades had been enrolled for 9
years.
T able X X I X .— M entally defective children who had ever attended school, according to
number o f years in school and last grade in which enrolled .
Mentally defective children 6 to 20 years of age, who had ever attended school.
Last grade in which enrolled.

Num ber of years in
school.
Total.

Prim ary
Second. Third. Fourth. Fifth.
and first.

N ot re­
Sixth. Seventh. ported.

' T otal..........................

171

84

27

26

15

5

2

3

9

W h ite...................................

109

43~

20

19~

12

5

2

3

5

3 years...........................
4 years...........................
5 years...........................
. 6 years...........................
7 years...........................
8 years...........................
9 years.......................
10 or more years..........
N ot reported...............

6
6
12
6
7
15
10
10
8
15
14

6
6
8
2
4
5
3

Colored.................................

•62

2years...........................
3 years.. - - ....................
4 years..........................
5 years...........................
6 years...........................
7 years...........................
8 years...........................
9 years...........................
10 years.........................
N ot r e p o r t e d .............

2
3
7
8
5
5
5
6
4
2
15


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Federal Reserve Bank of St. Louis

1

1

3
3
3

2
3
1
4
1
3
1
2
3

1
4
3
3
2
2
3

41

7

7

3

1
3

1

1
1

1
1
2
2
2
1
3

...
i
1
3

...............
1
1

1
2

1
1
2
4

2
>

3
6
8
4
3

2

1

1

7

1

5

2
1

1

M ENTAL

DEFECT

IN

A

RURAL

COUNTY.

69

Nearly three-fifths of the white children and four-fifths of the
colored children attending school during the year 1916-17 were in
the first or second grades. Only 3 white children and 1 colored
child in the first grade were under 8 years of age. Seventeen of the
31 white children in the first grade were 11 years of age or over, 1 of
them being 13; 2, 14; and 3, 15 years old. Twenty-four of the 32
colored children in the first grade were 11 years of age or older; 3 of
them were 13 years old; 7, 14; 5, 15; and 1, 16. With the exception
of 1, all the children in the second grade wfere 11 years of age or
older. Attending school during 1916-17 were 20 white and 12 colored
children 14 years of age; only 7 of tjje white and 2 of the colored
children of this age had reached the fourth grade or above. Five
of the white and 9 of the colored children 14 years of age were in
the first and second grades.
T

able

X X X .— M entally defective children attending school during year 1916-17, according

to age and grade in which enrolled.

All but 2 of the 14 white children who had never attended school
were classified as incapable of self-help; these exceptions had serious
speech defects. Twelve white children who were so low grade men­
tally or physically that they could not attend to their personal wants
had attended school for longer or shorter periods. The difficulties
encountered in attempting to teach them in the same classes with
normal children are obvious. Two of the 7 colored children who had
never attended school were incapable of self-help. None of the


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70

M ENTAL

DEFECT

IN

A

RURAL

COUNTY.

colored children who had attended was incapable of self-help, though
many of them had serious physical handicaps.
Both the white children who were almshouse inmates were in­
capable of self-help and had never attended school. One of the
white children who had never attended was living in a foster home.
Of the 8 colored children who had never attended school, 4 were
living in other than their parental homes, 2 of them in foster homes
and 2 in the almshouse.
One of the most important factors in school attendance in the
county was the distance children lived from the schools of their
districts. Almost one-fourth of the mentally defective children
under 14 years of age lived more than 2 miles from the schoolhouse,
and were therefore exempted by law1 from school attendance. Half
the children under 14 years of age lived more than 1 mile from school.
Distance from school is a rural problem, and therefore the figures
on the attendance of the 140 children living on farms are most signi­
ficant. Twelve white and 10 colored children living on farms had
more than 2 miles to go to school. Living over 1 mile from school
were 31 of the 48 white children under 14 years of age, and 18 of the
24 colored children of the same ages. Considering the difficulties, it
is surprising to note the number of mentally defective children who
trudged long distances to school year after year, though making little,
if any, progress.
It is generally recognized that the regular school curriculum is not
adapted to training the mentally defective child. Sensory and
manual training must be relied upon to a far greater extent than in
the case of normal children. The small number of children who had
attained grades beyond the first or second, even after long years of
school attendance, indicates the futility of attempting to fit these
children into the ordinary school routine. The menace of the presence
of mentally defective children in the regular classes, and the need for
special classes for the training of these children, have been previously
discussed.2
T H E M E N T A L L Y D E F E C T IV E C H IL D IN IN D U S T R Y .

Kind of work done.
In the farm districts of Sussex County practically every child able
to perform any work helps on the home farm. A considerable num­
ber of children work during short periods for other farmers, especially
during corn-husking and berry-picking time. Often the father hires
out by the day, and takes his children— boys and girls—with him.
Very young children are engaged in berry picking. Children are emi R . C. 1915, sec. 2313. Section 2311m o f the R evised Code as added b y chapter 164 of the A cts of 1915
empowers local boards o f education to make contracts for the free transportation o f children.


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M ENTAL

DEFECT

IN

A

RURAL

71

COUNTY.

ployed, in canneries during the season. They also make peachbasket tops and berry baskets, much of this work being done in the
homes. Owing to the primitive conditions and the simple character
of most of the industries, it is possible for mental defectives to perform
gainful work, and even to become self-supporting, in a greater pro­
portion of cases than would hold for more highly organized communi­
ties. Most of the work is done for employers who work with their
helpers, hence little initiative is required. Only very young children
or those of very low-grade mentality are not engaged in some form
of work, either for their own parents or for hire.
Most of the work done by the feeble-minded children studied was on
the farm or around the house. In a considerable number of cases this
was combined with seasonal work, such as berry picking and wreath
and basket making. Several of the children were reported as having
worked in canneries during the season. Work at home included any
kind of help around the house or farm. Many of those who were
badly handicapped physically and some of those who were classified
as incapable of self-help were performing a few simple duties. Of the
mental defectives 12 to 20 years of age, 87 per cent of the boys and
81 per cent of the girls were reported as doing some kind of work
other than simple tasks. Many of the children worked only after
school hours, or when they were not attending school.
T

able

X X X I .— Type o f work done by mentally defective children.

Mentally defective children 12 to 20 years of age.
T ype of work done.

Total.

W hite.

Total.

Boys.

Girls.

Total.

Total................................

144

87

57

W ork at hom e..........................
Hom e and hired ......................
H ired .........................................
Simple tasks.............................
Incapable of w ork....................
N ot reported..................... .......

71
35
16
8
10
4

43
24
9
2
7
2

28
11
7
6
3
2

Colored.

Boys.

Girls.

Total.

Boys.

89

61

28

55

26

29

47
19
4
5
10
4

32
15
3
2
7
2

15
4
1
3
3
2

24
16
12
3

11
9
6

13
7
6
3

Girls.

A larger proportion of colored than of white children were found
employed away from their own homes. Ninteeen white and 16
colored children worked intermittently for others and in their own
homes, and 4 white and 12 colored worked for others only. Thus, a
total of 26 per cent of all the white children, and 51 per cent of the
colored, were reported as working away from their own homes to some
extent. The greater proportion among the colored may indicate that
economic stress had, forced these families to utilize the labor of all
members of the family capable of doing even low grade and inefficient
work.


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72

M EN TAL DEFECT IN A RURAL COUNTY.

Capacity for self-support.
In attempting to classify these children according to their capacity
for earning their own living, the type of work offered by the environ­
ment under which they were living was taken as the criterion. The
work the mentally defective children from 12 to 20 years of age were
capable of doing was grouped as follows: (1) Independent or almost
independent work, including factory work, farm labor, or housework
away from home, for the average wage paid in the locality, and highgrade work on the home farm or own household. (2) Good work
under supervision, including work for others at less than the average
rate of pay, and corresponding work at home. (3) Work of low grade
under close supervision. This included the simpler'kinds of farm and
housework, berry picking with the parents, cutting wood, and similar
occupations. (4) The simplest kinds of tasks, such as carrying wood
or water and going on errands. Class (5) included those incapable
of doing any work.
T

able

X X X II .—

C apacity f o r w ork o f m en ta lly defective children.

Mentally defective children 12 to 20 years of age.
Total.

W hite.

Total. B oys.

Girls. Total. B oys.

Capacity for work.

Colored.
Girls. Total. B oys. Girls.

T otal..................................................

144

87

57

89

61

28

55

26

Independent or almost independent
w ork .........................................................
G ood w ork w ith supervision.......... ........
P oor w ork needing m uch supervision..
O nly simplest tasks..................................
Incapable of any w ork..............................
N ot reported............................................. .

27
38
57
8
10
4

19
24
33
2
7
2

8
14
24
6
3
2

15
20
35
5
10
4

11
17
22
2
7
2

4
3
13
3
3
2

12
18
22
3

8
7
11

4
11
11
3

The percentage of children reported as capable of doing independent
work or good work under more or less supervision was high— 39 per
cent of the white and 55 per cent of the colored. However, it must
be borne in miiid that many of those classed as capable of doing
indepéndent work probably would not have been so graded if judged
according to other standards than the simple requirements of the
industries in this locality. All the work performed was unskilled and
simple in character. Of the 144 mental defectives 12 to 20 years of
age, 65 were classed as doing independent or almost independent
work, or good work under supervision. These children were able,
under the conditions in which they were living, to make a considerable
contribution to their own maintenance. Probably few, if any, of
them would have been able to conduct their own affairs independ­
ently. A number of the boys were working at farm labor earning $1
a day or more during busy seasons. Many of them, however, were


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M E N TA L DEFECT IN A RURAL COUNTY.

73

unable to do any tasks that required initiative or responsibility, and
in most cases the work depended upon physical strength, and was
routine in character. A somewhat larger proportion of boys than of
girls were capable of good work. This difference may be partly ac­
counted for by the fact that household duties are more varied and
exacting than the work engaged in by boys. Many of the tasks in
the household require close muscular coordination, which is usually
poorly developed among the feeble-minded. A larger proportion of
colored than of white children were reported as capable of good work,
probably on account of differences in standards and kinds of work
done.
The largest number in any one class fell into the group described as
capable of doing only low-grade work under close supervision, 40 per
cent of all the children in the specified age group being so described.
The economic waste involved in the poor work of these children and
the time spent in supervising them indicates the need for special
industrial training to develop whatever trainable abilities these chil­
dren, possess. Many of them could undoubtedly be helped by such
training to perform higher grades of work. The proportionate num­
ber of girls in this class is slightly higher than that of boys, again
indicating the necessity for giving these girls training in household
duties and handwork.
The lowest grades included 8 children who were able to perform only
the most rudimentary tasks and 10 who were incapable of any work.
These 18 children, 13 per cent of all between 12 and 20 years of age,
were too low grade to make any appreciable contribution toward
their own support.
A comparison of the industrial efficiency of these mentally defec­
tive children and the economic status of their families is of the
greatest interest, indicating the extent to which these children are
burdens that can not be borne without serious damage to the family
life. The children living in their parental homes— 108 of the 144
children 12 to 20 years of a ge-in clu ded 55 who were reported as
doing low-grade work or as being incapable of assisting in their own
maintenance. Thirty of these children, 9 o f whom were incapable of
doing any work or could perform only the simplest tasks, were in
families in which the incomes were inadequate to meet the needs of
a proper standard o f life, even without the unusual demands imposed
b y the care of the defective child.
Of the 32 children 12 to 20 years of age living with relatives or in
foster homes, only 15 were reported as able to do good work. Fifteen
were classed as doing low-grade work and two as able to do only the
simplest tasks. Four of these economically incompetent children
lived in families having incomes inadequate for their needs. One


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74

MENTAL. DEFECT IN. A RURAL COUN TY.

of the children able to do only poor work, and two incapable of any
work were in the almshouse.
T

able

XX XIII. —

C apacity f o r w ork o f m en ta lly defective children, according
hom e ana in com e o f fa m ily .

to typ e of

Mentally defective children 12 to 20 years of age.

In parental homes.
Capacity for work.
Total.

T ota l....................................................
W hite.............................................................

In relatives’ or foster
homes.

In
alms­
house
Family Fam ily or no
Fam ily Family
income income Total. income income home.
Total.
ade­
inade­
inade­
ade­
quate. quate.
quate. quate.
58

144

108

89

69

37

55

39

13

12
18
22
3

10

Independent or almost independent
w ork....................................................
Good w ork w ith sup ervision ...........
Poor w ork .............................................
Simplest tasks..................... ...............
Incapable........................ *....................
N ot reported.........................................
Colored
Independent or almost independent
w ork.....................................................
Good w ork w ith supervision............
Poor w ork ............................................. .
Simplest tasks.......................................
Incapable..............................................
N ot reported..........................................

14
14

1

26

14

10
2
2

2

4

.................

5

1

1

2

1

1

1

..........

The work done by these mentally defective children is of especial
interest in connnection with the provision of training or custodial
care. The fact that only 7 per cent of all of the children 12 to 20
years of age were reported as being incapable of doing any work indi­
cates large opportunities for development by proper training. A
surprising number of the children had done work outside their homes,
and with suitable training many of them could undoubtedly have
become fairly capable workers, under proper direction.
M E N T A L L Y D E F E C T IV E

C H IL D R E N A S O F F E N D E R S A G A IN S T
STAN DARDS.

S O C IA L

The nature of juvenile offenses against established order depends
very largely upon the environment and the temptations offered. In
rural communities and small towns boys and girls are rarely known
as delinquents. If misdemeanors are committed they are likely to be
spasmodic in character rather than habitual, and discipline is left to
the parent or guardian of the child instead of becoming a matter for
the courts. The cases studied illustrate strikingly the types of anti­
social outbreaks of mentally defective children in rural communities.
There were comparatively few offenses committed, but personal
characteristics and tendencies were found demanding correction and


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M E N TA L DEFECT IN A RURAL COUNTY.

75

control through proper education and discipline. Many of these
characteristics were such that in a more complex social organization
they would inevitably have brought the children into conflict with
the law.
The misdemeanors reported were mainly exhibitions of violent tem­
per or viciousness, running away from home, cruelty to animals, petty
thieving, or minor depredations. Thirty-five of the mentally defective
children studied had exhibited tendencies toward wrongdoing more
or less serious in nature. Sixteen of them were markedly disobe­
dient or unruly, and were classified as uncontrollable. Fourteen had
committed offenses against person or property. Five girls were
reported as sex offenders, three of them being mothers of illegitimate
children.
T able X X ^ J V .—

M en ta lly defective children w ho w ere reported as bein g delin qu en t or
u n con trolla ble, according to colo r, sex, and nature o f offen ses reported.

The largest number of the 30 children classed as offenders against
person or property or as uncontrollable had violent tempers and
vicious tendencies. These wild impulses were often of such a charac­
ter that the safety of others demanded custodial care of the unfortu­
nate children. Brutal cruelty to animals and attacks upon other
children were frequently reported. Three boys had attempted to
set fire to buildings. Others were reported as destructive, unruly,
obscene, given to fighting, and as runaways. The reported cases of
stealing varied from appropriating things wanted for play to taking
small amounts of money from home or theft of merchandise. In some
cases classed as uncontrollable the difficulty appeared to be due to
nervous irritability or other detrimental physical conditions. In
some of the lower-grade cases the instinct for noise and destruction
seemed quite uncontrollable; in the higher grade cases the bad be­
havior often appeared to be the result of lack of proper discipline.
Two of the girls classified as sex offenders had led very immoral lives
for an extended period of time. The three who were mothers of
illegitimate children were rather offended against than offending.


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76

MENTAL. DEFECT IN A RURAL COUNTY.

The special need for protection of these defective children with un­
controlled instincts is illustrated by the case of an 8-year-old idiot
boy, the son of a widowed mother. This boy was thoroughly de­
moralizing' the household. His senseless, brutal activity and his
propensity for running away made him a menace to his family and
the community. Moreover, he lowered the economic level of his
home by requiring constant attention. Unless he was watched con­
tinually he would smash windows or throw the dishes off the table,
apparently for the pleasure he obtained from the noise and commo­
tion. He was brutal in his treatment of animals, and unless pre­
vented would wring the necks of fowls. The family was in very poor
circumstances and the boy was a great burden to them. He was in
urgent need of custodial care.
A boy 6 years of age, not. yet able to talk, was very stubborn and
high tempered. He would fly into a rage and attack a chi$gi or adult
with a stick or other weapon. His mother had deserted the family
when the boy was only 2 months old. The maternal grandmother,
ignorant and inefficient, was attempting to manage the household.
The father was crippled with rheumatism, and had other physical
disabilities that made him almost helpless. The family made a scant
living from the farm they owned.
Lack of proper training and discipline made custodial care impera­
tive for an 11-year-old boy who was being cared for by relatives
because his mother was in the hospital for the insane. He had a
violent temper and at times worked himself into a passion in which
he would bite his own arm until the blood ran. He fought with other
children, was cruel to animals, and had a propensity for building
fires in dangerous places. He was distinctly unsocial in nature and
was a great source of worry to his family.
The guardians of a 19-year-old feeble-minded boy had implored
the agency, that placed him to remove him. He was depraved, un­
bearably filthy, and obscene, and his character had curious contra­
dictions, ranging from religious fervor to destructiveness and bru­
tality. Although he had attended school for 10 years he had made
no progress whatever. He had to be watched continually and could
not be trusted to work alone a minute. He went to town every night
and became furious if an attempt was made to keep him at home.
The moving-picture theater had debarred him from attendance
because of his obscene behavior.
In considering delinquent tendencies, it is significant to note the
types of homes in which these children lived. Almost one-half of
the children who were classified as offenders were living in other than
their parental homes, whereas less than one-fourth'of all the mentally
defective children studied were not living with their parents. Many


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77

M E N TA L DEFECT IN A RURAL COUN TY.

of the foster home children presented particularly serious problems
of conduct.
T

able

X X X V .—

Character o f m en ta lly defective children , according to typ e o f hom e.

M entally defective children 6 to 20 years o f age.

T yp e o f home.

O f good character as f ar as
know n.

R eported as being delin­
quent or uncontrollable.

Total.

Colored.

Total.

Total.
W hite.

W hite. Colored.

T otal..................................................

192

157

100

57

35

23

12

Parental...................... .................................
Foster or relatives.....................................
Alm shouse or no h om e.............. ..............

150
37
5

132
24
1

85
14
1

47
10

18
13
4

14
8
1

4
5
3

The proper care and training of mentally defective children who
have propensities toward delinquent conduct has been generally
recognized as of the utmost importance. The problem of control
becomes increasingly difficult as the child becomes older. If the
defective child be taken in hand at an early age, antisocial tenden­
cies may be lessened by training so directed as to form fixed habits
of right conduct. Society pays a heavy penalty for the neglect of
those who are unable by reason of defective mentality to exercise
ordinary judgment and self-control.


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CHAPTER V. THE RECURRENCE OF MENTAL DEFECT
AND THE COINCIDENCE OF DEFECT, DEGENERACY,
AND DEPENDENCY.
The investigation revealed a considerable number of families in
which more than one member was feeble-minded, and a startling
amount of intertwining of defect and degeneracy among certain
family groups. Defective individuals intermarried or lived illicitly
with others of like characteristics, each generation producing an in­
creasing number of defective or degenerate members. The related
factors of degeneracy, illegitimacy, and dependency aggravated the
problems involved in the care of mentally defective children and
greatly increased the danger and burden to the community.
C O N S A N G U IN IT Y O F M E N T A L D E F E C T IV E S .

In the immediate families of 82 mentally defective children— 15
white and 37 colored, 43 per cent of the total studied— other mem­
bers had been diagnosed feeble-minded. In 1 white and 2 colored
families both parents had been diagnosed feeble-minded, and in 3
white and 5 colored families 1 parent was feeble-minded. These
families included.19 feeble-minded children— 5 white and 14 colored—
between 6 and 20 years of age.
T

X X X V I .— F a m ilies having m en ta lly defective children 6 to 2 0 years o f age,
according to m en ta lity o f parents and older children, a n d nu m ber o f m en ta lly defective
children o f age grou p stu died.

able

Families having m entally defective children 6 to 20 years of age.
Colored.

W hite.
M entality of parents and older
children.
Total.

N um ber of m entally
N um ber of m entally de­
defective children 6
fective children 6 to 20
to 20 years of age in
years of age in fam ily.
fam ily.
T otal.
T otal.
One. Two. Three. Four.

One. Two. ThreS. Four.

T o ta l...................................
B oth parents feeble-m inded . . .
B oth parents and older child
One parent and older ch ild
Parents and older children of
norm al m entality so far as
k n o w n ......................................

151
2
1
7

101

37

10

a3

1
4

2

1
2

1
4

3

1
1

39

32

5

86

3

2

1
9

5

5

131

92

78

9

50

3

2

a One of these families had another feeble-minded ch ild under 6.years of age.

78

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3
1

1

1

1
3

10

2

M E N TA L DEFECT IN A RURAL COUNTY.

79

The 192 children studied represented 151 family groups. There
were 15 white and 13 colored families in which there was more than
one feeble-minded child between the ages of 6 and 20 years, inclusive.
In each of 10 of the white families there were two of these children;
in 3 families there were three each; and in 2, four each. Ten o f the
colored families each contained two feeble-minded children 6 to 20
years of age/and in 3 families there were four each. In addition to
children included in the study, 5 of the white and 6 of the colored
families had older children who also had been diagnosed mentally
defective. Four mentally defective children, 3 white and 1 colored,
had an insane mother or father. Two of these white children be­
longed to the same family.
This investigation showed a recurrence of feeble-mindedness in 23
of the 101 white families and in 18 of the 50 colored families included
in the study. More than one-fourth of all the families studied had
more than one feeble-minded member. In other families there were
insane parents or members of the family group reported weak-minded.
In 7 white families having 15 mentally defective children included
in the study, and in 9 colored families having 18 mentally defective
children, 2 or more members of the immediate family groups and also
more distant relatives had been diagnosed feeble-minded. Of the
78 white and the 32 colored children who were the only defective
members of their immediate families 9 white and 10 colored had
feeble-minded relatives. Thus, only 69 of the 123 white children and
22 of the 69 colored children had no feeble-minded relatives so far
as known. The proportion of white children having no feeble-minded
relatives is considerably higher than that of the colored. The inter­
twining o f the family groups of the mentally defective children was
very significant. Families united and reunited, forming a complex
interrelationship, in which feeble-mindedness and low mentality were
common.
The following cases of defective children included in the study
illustrate recurrence o f mental defect in the same family or in related
family groups:
Two white girls, 9 and 16 years of age, were the only children in a
family in which both the mother and father were feeble-minded.
Two white boys, ages 9 and 19, had two sisters reported weakminded, an uncle who had been diagnosed feeble-minded, an
aunt reported weak-minded, two cousins and a nephew diag­
nosed feeble-minded, a grandaunt and a great-grandaunt who
had been insane.
Two white boys, 15 and 20 years of age, had a grandparent and a
great-grandparent who had been insane.
A white boy 19 years of age had a sister and two brothers who
had been diagnosed feeble-minded, an epileptic grandparent, an
epileptic cousin, a niece and a nephew diagnosed feeble-minded,
a second cousin diagnosed feeble-minded, and a great-grandparent
who had been insane.

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80

M E N TA L DEFECT IN A RURAL COUNTY.

A white boy 20 years of age had a feeble-minded brother, a feeble­
minded uncle, an aunt reported weak-minded, two first cousins
who were feeble-minded, and two who were reported weak-minded,
a feeble-minded nephew, and a great-grandaunt who had been
insane.
Two colored boys, 11 and 16 years of age, belonged in a family
in which both parents were feeble-minded, an older half brother
feeble-minded, a half sister reported weak-minded, another half
sister epileptic and reported weak-minded, and an aunt reported
weak-minded.
A colored boy 9 years of age had an insane father, an uncle reported
insane, a first cousin who had been diagnosed feeble-minded, two
granduncles reported insane.
A colored girl 15 years of age and her 18-year-old brother had an
older feeble-mmded brother, a grandparent reported weakminded, two feeble-minded nieces, two feeble-minded nephews,
and an epileptic niece.
.
A colored boy 14 years of age had six third cousins diagnosed
feeble-minded and one reported weak-minded; four of his
mother's second cousins had been diagnosed feeble-minded, one
of them also being epileptic.
A colored boy 18 years of age and his sister 15 years of age were
the children of a woman reported weak-minded. One of their
grandparents was insane; a first cousin was feeble-minded and
another was reported weak-minded; a cousin of the mother was
epileptic.
Four colored children ranging in age from 12 to 20 years had feeble­
minded parents, the mother being also epileptic. Two children
of the family were too young to have their mentality determined.
The oldest of the four feeble-minded children had an illegitimate
child who was feeble-minded. A grandparent was reported weakminded; two aunts, a first cousin, a third cousin, and a second
cousin o f the mother had been diagnosed feeble-minded.
A colored boy 8 years of age was the child o f a feeble-minded
woman. His uncle was diagnosed feeble-minded; another uncle,
an aunt, and a cousin were reported weak-minded; a granduncle
was insane, and a third cousin had been diagnosed feeble-minded.
A colored boy 12 years old had a feeble-minded mother, a half
sister reported weak-minded, two feeble-minded aunts, one of
whom was also epileptic, four feeble-minded first cousins, one
aunt and one first cousin reported weak-minded, two second
cousins and a third cousin of the mother diagnosed feeble-minded.
M EN TAL D EFEC T AND D E G EN ERAC Y.

Alcoholism and immorality.
The coincidence of mental defect and alcoholism or immorality
creates most serious conditions of degeneracy. However, it was
difficult to discover the facts concerning the prevalence of alcoholism
and immorality in the families studied because the information was
mainly secured from interviews with the mothers. Alcoholism might
be presumed to be of small proportions in this county because it has
been for some years no-license territory. That 20 of the 123 white


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M EN TAL DEFECT IN A RURAL COUNTY.

81

children and 7 of the 69 colored had parents who were reported as
alcoholic at the time the investigation was made, or as having been
alcoholic formerly, indicates, however, that this problem is by no
means nonexistent. Information concerning immorality of parents
was secured usually only in cases where the children were illegitimate.
In 4 white families having 6 mentally defective children, and in 18
colored families having 25 mentally defective children, one or both
parents were reported as having been immoral. Occasionally the
immorality of another member of the family was a detrimental influ­
ence in the home.
The following cases illustrate the coincidence of mental defect and
alcoholism or immorality:
Alcoholism was prevalent in a white family in which there were
two feeble-minded boys, 12 and 17 years of age. The paternal
grandfather, paternal granduncles, and nearly all the mother’s
people were excessively alcoholic. The father had been a heavy
drinker formerly. The 17-year-old boy and two brothers living
away from home at the time of the investigation were reported
as drinking a great deal. The fact that all the mother’s relatives
on both sides and a number of the father’s relatives were re­
ported to have died of tuberculosis, suggests the poor physical
stamina of the family stock.
A white boy, 15 years old, had several paternal relatives who were
reported alcoholic. The father had always been a heavy drinker,
and had deserted the family two years before the investigation.
The paternal grandfather was a drunkard, and a cousin of the
father was reported as having used alcohol excessively.
Three feeble-minded children came from a white family in which
alcoholism and immorality were common. The father of the two
oldest children was an inmate of the hospital for the insane.
The mother was living illegally with the father of the youngest
child. The paternal grandfather of two of the children had been
insane and several relatives were feeble-minded, some of them
being inmates of the county almshouse. All the known male
aternal relatives of the older children were reported as having
een drunkards. A sister of the three feeble-minded children
was the mother of an illegitimate child.
A girl 15 and a boy 18 years of age belonged in a colored family,
several members of which were feeble-minded. The father
treated the mother so badly that she was obliged to leave home,
after which he maintained illicit relations with a very immoral
woman of the neighborhood. Four children remained with the
father, and were living under very detrimental conditions.

E

Illegitimacy.
The problem of illegitimacy complicated that of mental defect in
the cases of only 4 white children 6 to 20 years of age, but 17 colored
children, 25 per cent of the total number of colored, were illegitimate.
One white child was a foundling. The greater number of colored
illegitimate children is due to the different standards of morality
97685°—19----- 6

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82

MENTAL, DEFECT IN A RURAL COUNTY.

which prevail in general among the two races, and the greater laxness
of the marriage relation among the colored. The mothers of seven
of the illegitimate mental defectives were also feeble-minded. In one
of these cases the father was also mentally defective. The lack of
normal home surroundings, in addition to their bad heredity, makes
this group of children peculiarly likely to become subjects for public
protection, as illustrated by the following cases:
A feeble-minded colored girl 14 years of age was an illegitimate
child whose mother had disappeared. The girl was thrust upon an
older half sister who mistreated her. A kind-hearted Colored woman
asked for the child, took her in, and was giving her a comfortable
home. She was disappointed to find that the child was defective,
and in spite of the fact that she was treating the girl well she may
find it impossible to care for her permanently.
A 14-year-old imbecile white girl was the illegitimate child of an
imbecile mother, for a short time an inmate of the almshouse. The
mother was a woman of good physical condition, clean, and attrac­
tive looking. She worked irregularly at farm or house work, at which
she earned $1 a day, but she secured very littie employment because
of her inefficiency. She and her child made their home with her aged
mother in a small house that was given them rent free by a well-to-do
neighbor. The three lived a shiftless life, incapable of self-manage­
ment, dependent on the assistance of neighbors and relatives for food,
clothing, and fuel. The mother had had two legitimate children, one
of them dead and the other cared for by relatives. The family was
notorious in the section in which they lived. The entire neighbor­
hood felt the burden of their presence, and recognized the need for a
suitable institution for these defective individuals.
A feebie-mmded boy, 17 years of age, was the third of four ille­
gitimate children of a mother who deserted the children when this
boy was about 6 years old. He and his older half sister had always
lived with their grandmother, the mother taking no responsibility
for them. The mother married and had been living in a home of her
own for the past 11 years. The boy was diagnosed as an epileptic
imbecile. He was physically able to work, and could cut wood and
help around the farm at simple tasks, but could not be trusted to
work alone for fear of his seizures. The grandmother had an ade­
quate income and expected to provide for the boy always. The half
sister of this boy, also living with the grandmother, repeated her
mother’s history. She was 20 years old when her illegitimate child
was born.
In connection with this study a special effort was made to secure
information regarding cases of feeble-minded women who had had
illegitimate children. Seventeen in all were found, 3 of these mothers
being girls under 21 years of age. These 17 mothers were known to

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have had 51 illegitimate children. Of these children, 10 died in in­
fancy, 6 died later, 1 had disappeared, and 34 were living at the time
of the investigation. The mentality of these children was as follows:
Ten examined and found feeble-minded, 1 epileptic and retarded, 5
reported weak-minded, 2 examined and found normal, 16 mentality
not known. Thus, nearly a third of the living children were known
to be feeble-minded. How high the percentage of mental defective­
ness actually was can only be conjectured, since only those who were
reported as being of doubtful mentality were looked up. The large
number of mental defectives among the illegitimate children of this
group of mothers may be presumed to indicate a high heritage of
degeneracy. It is interesting to note that 5 of the 17 feeble-minded
mothers of illegitimate children were themselves illegitimate.
M ENTAL DEFECT AND DEPEN DENCY.

Dependent families.
With the exception of a very small amount of charitable relief given
to families in their homes, usually through church or neighborhood aid,
dependents in Sussex County are provided for in two ways— by admis­
sion to the county almshouse or in the case of children often by removal
from their homes and placement with other families. It is significant
rather of the absence of available sources of relief than of the lack of
need for aid that only three of the white and five of the colored families
studied were known to have received charitable assistance. Consid­
ering only the children 6 to 20 years of age, inclusive, who were living
in their parental homes— a total of 150— it was found that 89 of them,
53 white and 36 colored, belonged in families whose incomes were
below that required for maintaining a decent standard of living under
the comparatively simple conditions of life in their home communities.
It must be remembered, however, that the “ share tenants” make up
largely the 11inadequate income ’ ’ group. These families usually man­
aged to scrape along and provide themselves with sufficient food for
existence. Many of them lacked proper clothing, their dwellings were
poorly constructed, and they suffered for the ordinary comforts, but
they did not seek or receive aid.
Among the families which demanded constant assistance was a
colored family consisting of a feeble-minded mother and seven chil­
dren, two of whom, a girl of 17 and a boy of 11 years, were also feeble­
minded. The family was living in dire poverty and filth. The father
of the two oldest children, both of whom were illegitimate, was a
worthless drunkard, who had never contributed to their support. The
other five children were the legitimate offspring of an unskilled laborer
who had died from lung trouble contracted through cement poisoning.
After his death the wife and the oldest girls worked irregularly at
housework, but were so inefficient that the family had been largely

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dependent on charity. They lived in a small village, occupying a
very tiny unplastered shanty of three rooms, so small and so loosely
built that it had the appearance of a woodshed. The place was
filthy. The condition of the family in winter, when they were prac­
tically unprotected from the cold, was pitiable, and at all seasons the
children were running the streets thinly and raggedly clothed. The
mother was about 40 years old and was diagnosed feeble-minded.
She was incapable of keeping her house in order and unable to control
her children. The oldest girl, 18 years of age, was reported by the
local school-teacher as “ not quite right.” The second child, a girl
17 years old, was diagnosed feeble-minded. A girl of 12, the oldest
of the legitimate children, was normal mentally. A boy of 11 was
diagnosed feeble-minded. The three youngest children, 6, 4, and 2
years old, showed no marked defect. With a feeble-minded mother
as head of the household and three of the older children known to
be below the average, the situation was such that the family would
remain a steady burden on the community.
Mental defectives in the almshouse.
The almshouse of the county, the only institution which can be
used as a refuge, is the home of the unfortunates who because of
mental or physical infirmities are unable to provide themselves with
subsistence even under the most simple conditions. It serves as an
emergency shelter for the incompetents who drift back and forth from
the almshouse to the community. It is significant of conditions in
the county that only 3 of the 35 inmates of the almshouse at the
time of this study were found to be normal mentally. Nineteen of
the inmates, 13 males and 6 females, were diagnosed as feeble-minded.
Five of the males and 3 of the females so diagnosed were colored.
Most of the feeble-minded inmates represented very low grades, men­
tally, physically, and morally.1
The almshouse refugees afford an interesting study into the con­
tinuity of degeneracy, representing as they evidently do in this county
a marked degree of social deficiency. It is interesting to note that
six of the present almshouse inmates had mothers who had also been
inmates. Various relatives of others were present or former in­
mates. The four feeble-minded children who were inmates of the
county almshouse have been previously described. The following
histories of older almshouse cases illustrate the burden involved in
the care of these unfortunates.
An imbecile white woman 37 years old had been an inmate of the
almshouse since the age of 19. The binth records o f four of her ille­
gitimate children appeared on the almshouse register. The oldest of
the four, 17 years old, had been “ bound ou t” from the almshouse,


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and had proved himself an industrious and capable boy. The second
died when 4 days old. The third was a feeble-minded colored hoy,
whose history has been given in a previous chapter. A colored in­
mate was the father of the fourth child, a 10-months-old baby being
cared for by the mother in the almshouse. The mother was horn of
poor parents, and was one of a numerous family who lived in a tiny
house in a remote district and were employed by farmers in the
vicinity. Both parents of this woman had had children by other
matings, and her father was an old man when she was born. The
father was regarded by his employers as a good, industrious man,
but he was always in rags and very poor. By his neighbors he was
considered unusually self-complacent and egotistical. The mother
was shiftless, inefficient, and had had illegitimate children by a man
with whom she lived illegally. She was an inmate of the almshouse
at the time of her death.
An imbecile woman 70 years of age had spent the greater portion
of her life in almshouses, having been an inmate of five different ones
in Maryland and Delaware. A t the time of this investigation she
was an inmate of the Sussex County almshouse, to which she had been
taken for the first time 20 years before the time of the investigation.
She had been taken from there at different times by families who
wanted her to work for them. Capable of doing sufficient work to
support herself, her violent temper made it impossible to endure her
long. She had been in and out of the almshouse a great many times
for longer or shorter periods. She was known to have had eight ille­
gitimate children, two of whom died in infancy. Her mentality was
so low that she could not care for her children, and all of them were
placed out when young. One of the children was reported weakminded and one was said to have been in an institution for delinquents.
One of the worst features of this type of almshouse is the lack of
protection of the inmates. The absence of supervision and the lack
of legal control over the inmates makes the almshouse a breeding
place of degeneracy and defect. An imbecile woman who had given
birth to six children in the almshouse illustrates the danger of this
lack of supervision. When she was 8 years old her mother died of
tuberculosis, and the girl was placed out at service. At the age of 18
years she first appeared at the almshouse, where she gave birth to an
illegitimate child. Four years later twins were born in the almshouse,
the father being an inmate. Within two years another illegitimate
child was bom , the father of this one also being an almshouse inmate.
She left the almshouse and went to five with relatives, but within a
year returned to give birth to twins. Only one of her five children was
living at the time of the investigation. He was epileptic and men­
tally retarded. After the birth of the last child the mother remained
in the almshouse for three years. She then married a man who was

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M E N TA L DEFECT IN A RURAL COUN TY.

about her mental equal, unable to do any but the lowest grade of
work, at which he could barely eke out an existence. She had fits of
violent temper, had attempted murder, had stolen, and was grossly
immoral.
The family history of a 73-year-old feeble-minded man in the alms­
house at the time of the investigation illustrates the degenerate
type of family that contributes heavily to alcoholism, pauperism,
and low living. The man’s mother died in an almshouse at the age of
45. Her mind was slightly affected. His father had been a very
heavy drinker, but was considered an intelligent man. The man had
three brothers. The oldest died when a young man. The second
brother lived to be 74 years old. He was a decided alcoholic, and
was in and out of the Kent County almshouse for about 20 years, and
finally died there. The third brother was a moderate drinker, and
though he had succeeded in keeping out of the almshouse he was
extremely poor and was dependent on the charity of neighbors.
A cousin was in the Sussex County almshouse, and had the distinction
of being one of the few inmates who were not feeble-minded or
insane. He was a heavy drinker, and through shiftlessne^s had been
compelled to seek refuge in the almshouse in his old age.
S O M E R E S U L T S O F FA IL U R E T O P R O V ID E P R O P E R C A R E F O R T H E
M E N T A L L Y D E F E C T IV E .

Two groups of related families, embracing a large number of
mentally defective children included in the study, were striking
illustrations of the intertwining, through marriage or illegal relation­
ships, of a number of different families with strains of degeneracy.
The families united and reunited, forming complex interrelationships
in which feeble-mindedness, pauperism, and other phases of degen­
eracy were common.
Group A .— This group comprises white families descended from a
common ancestor five generations back, and resident in the county
as far back as the history goes. Members of four generations were
living at the time the investigation was made. The known data
begin with a marriage between a drunkard, who had a serious speech
defect, and the sister of an insane woman who died in the county
almshouse. Her parents, nevertheless, had considerable position in
the community, and strongly objected to the daughter’s marriage.
As a result of this union, nine children were bom, two of whom died
in infancy. Two daughters died of tuberculosis and one of cancer.
One daughter had so serious a speech defect that she never attempted
to attend school. One son was diagnosed feeble-minded. Two of the
children, a daughter and a son, married and had children who were
diagnosed mentally defective. Their families were described as
follows:


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There were nine children in the daughter’s family. One of them
died in infancy. One son was alcoholic, two had serious speech
defects, one was an idio-imbecile, and another was an imbecile and
afflicted with tuberculosis of the spine.
The son married his first cousin, in whose heritage on both sides
were alcoholism and insanity. As a result of this marriage, eight
children were born. One of them died at 14 months of tuberculosis.
The father died at the age of 40, and after his death one of the sons
was placed out and three of the children went to the almshouse.
The placed-out boy, 9 years old at the time of the investigation, was
diagnosed feeble-minded. Two sisters, reported very low grade
mentally, died in the almshouse, and a brother, a low-grade imbecile,
was an inmate at the time of the investigation. Three of the children
were apparently normal mentally. One of them married her first
cousin, described above as having a serious speech defect. Two
children had been born to them. The oldest was 3 years of age at the
time of the investigation, and had been diagnosed as an organic case
of feeble-mindedness.
The group of families described shows the degeneracy resulting
from the marriage of persons whose heredity had strains of alcoholism
and insanity, and from the intermarriage of their descendants. Par­
ticularly did the two marriages of first cousins result in mentally
defective progeny. Some of the normal members of the second
generation held prominent places in the community and an occa­
sional member of the later generations was of good standing, but the
majority were economically inefficient, shiftless, or dependents on
public or private charity.
Group B .— This group of families represents a number of colored
families who became interrelated through marriage or illicit relation­
ships. During the course of the investigation 14 families belonging
to this group were found to have mentally defective members, 9
of whom were children between the ages of 6 and 20 years, and
represented nearly one-seventh of all the colored mentally defective
children enumerated in the county. A total of 16 members of the
interrelated groups were diagnosed as feeble-minded. Six were
known to have been insane. A number of the members of. the group
had histories of alcoholism, and a larger proportion were reported
as tubercular victims of unwholesome living conditions. Illegiti­
macy was very common among them.
Ten of the 16 known mental defectives of this group of families
were descended from a weak-minded woman reported to have “ no
more sense than a 2-year-old baby.’ ’ She had six illegitimate children
by six different men. Four of her daughters were located, and three
of them were diagnosed as feeble-minded.


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MENTAL, DEFECT IN A RURAL COUN TY.

One of the feeble-minded daughters, at the age of 15, had an
illegitimate daughter by a feeble-minded man, whom she later mar­
ried. She had nine legitimate children, four of whom died in infancy
or early childhood. Two of the legitimate children were too young
for determination of mentality, and the other three were diagnosed
feeble-minded. Her illegitimate daughter, also feeble-minded, at the
age of 15 had an illegitimate child by a man having a criminal record,
who was distantly related to her, and who had a feeble-minded sister.
This child was 5 years old at the time of the investigation and was
diagnosed as feeble-minded. She had a second illegitimate child,
who died in infancy.
The second feeble-minded daughter of the weak-minded woman
was once married, but had no children by this marriage. She had
had seven illegitimate children by two different men, one of whom
had a sister reported weak-minded. One of the seven children, a
boy 12 years of age, was diagnosed feeble-minded. His half sister,
who was found to be of doubtful mentality, had had an illegitimate
stillborn child.
A first cousin of the weak-minded woman first described had a
grandson, 15 years old at the time of the investigation, who was
diagnosed feeble-minded, and three other grandchildren, who were
retarded.
A family related by marriage to the weak-minded woman first
mentioned had a heritage of insanity, alcoholism, and tuberculosis.
One of the members of the family had five illegitimate children by
five different men. Two of her children died in infancy. One of the
children, whose father was alcoholic, was diagnosed as feeble-minded.
This child, 13 years old at the time of the investigation, was being
brought up by her maternal grandparents. Her first cousin on her
father's side was a 19-year-old feeble-minded boy who had been unable
to learn anything at school, but was getting along fairly well in the
community. Two of his maternal uncles were insane; one of them
was the father of a feeble-minded son, an 8-year-old boy, who had
physical as well as mental defects. In another related family there
was a man who was a low-grade imbecile. He had been an inmate
of the county almshouse for over 35 years.


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CHAPTER VI.

SUMMARY OF FINDINGS AND PROVISION
NEEDED.
S U M M A R Y O F S O C IA L S T U D Y .

This social study of mentally defective children in a rural, nativeAmerican population included 192 cases, or about 12 in every 1,000
children in the county between the ages of 6 and 20 years.
Fifty-eight per cent of the mentally defective children studied were
not receiving physical care and support under favorable home con­
ditions, were delinquent or uncontrollable, or were under the care of
guardians unwilling or unable to continue to provide for them. The
need for other provision in the immediate future was imperative in
35 per cent of all the cases studied.
Fourteen per cent of the children studied were unable by reason
of their very low mentality or because of physical handicaps to attend
to their own personal wants, and presented serious problems of
physical care. Physical disabilities classed as serious existed in 34
per cent of the cases.
Only 78 per cent of the mentally defective children were li v in g
with their own families. Most of the remaining 22 per cent were
living with relatives or in foster homes. Only four children were
receiving institutional care, being inmates of the county almshouse.
Three-fourths of the children living in parental homes in which the
fathers were the breadwinners belonged in families of low economic
status, the fathers being farm tenants or unskilled laborers. The
mothers of over one-fourth of the children living in their parental
homes were gainfully employed all or part of the time.
The parents of 54 per cent of the white children and 71 per cent of
the colored children living in their parental homes had insufficient
means to provide adequately for their families. Although some of
these families were giving fairly adequate care to their defective
children, they were doing so with difficulty, and their poor economic
condition made the future uncertain.
Fifty-three per cent of the children in their parental homes were
living under unfavorable conditions. The percentage was higher for
the colored than for the white. The large majority of these homes
were classified as unfavorable because of the feeble-mindedness,
illiteracy, or ignorance of the parents, combined in a number of cases
with drunkenness and immorality. Extreme poverty with no other
detrimental condition was rarely found.
Nineteen per cent of the mentally defective children studied had
been removed from their own homes and placed in other families, in
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M E N TA L DEFECT I F A RURAL COUNTY.

the majority of cases in families not related to them. More than
one-third of these children were Hying under unfavorable home con­
ditions or with guardians unwilling to continue caring for them.
No special training whatever was provided in Sussex County for
retarded or defective children. Lack of adaptation of school training
to their capacities made it impossible for mentally defective children
to derive benefits commensurate with the time spent in school.
More than two-fifths of the children 12 to 20 years of age were
capable of doing independent work or good work under supervision,
but this was made possible by the simple character of the industries
of the county. All the work performed was unskilled, and was
usually routine in character, requiring little initiative. Two-fifths
of the children in this age group were capable of doing only very poor
work under close supervision. Many of them undoubtedly would
have been helped by industrial training to perform higher grades of
work. That less than one-fifth of the children were incapable of
doing any work or were able to perform only the simplest of tasks
indicates great possibihties in industrial training.
Eighteen per cent of the mentally defective children had exhibited
tendencies toward wrongdoing more or less serious in nature.
Almost half these children were living in other than their parental
homes. Many of the children in foster homes presented particularly
serious problems of conduct. More than two-thirds of the children
classed as uncontrollable or delinquent were living under unfavorable
conditions or with guardians unwilling longer to provide for them.
In the families of 43 per cent of the children studied, other members
of the immediate families had been diagnosed feeble-minded. The
investigation revealed a large amount of intertwining of defect and
degeneracy among certain family groups.
’
Eleven per cent of the mentally defective children in Sussex County
were illegitimate. Most of the illegitimate children were colored.
The mothers of one-third of the illegitimate mental defectives were
also feeble-minded.
•Although a majority of the mentally defective children living m
their parental homes belonged in families whose incomes were inade­
quate, and a considerable number were living under conditions of
extreme poverty, only a few of the families were known to have
received charitable assistance. This is significant rather of the
absence of available sources of relief than of the lack of need for aid.
The county almshouse is the only institution which can be used as
a refuge by those who can not provide themselves with subsistence
even under the most simple conditions. The almshouse is not
adapted to the proper care of these cases and has not the legal control
necessary to insure proper protection.


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M E N TA L DEFECT IN A RURAL C O UN TY.
C A SE S N E E D IN G C A R E .

This and other similar studies have shown that the mentally
defective individual is often a social misfit “ incapable of competing
on equal terms with his normal fellows, or managing himself or his
affairs with ordinary prudence.” 1
It is readily conceivable that an adult whose mind has not developed
beyond that of a child is likely to come into conflict with social customs
adapted to persons whose mental development is normal. It is also
conceivable that children whose physical development far ex­
ceeds their mental growth may need different care and guidance
from that required b y normal children. The problem of the care of
the mentally defective child becomes more complex the nearer he
approaches adolescence. Even children who are mentally normal
are in special need of watchful guardianship at this time of life. The
burden on the family imposed by the care of a mentally defective
child is necessarily greater and more prolonged than in the case of a
child of normal mentality.
Home conditions are a fundamental consideration in determining
need of care. The type of home, the economic status of the family,
and the ability of the parents to give proper care and supervision are
factors which- must be taken into consideration. In this study a
number of cases were found in which conditions were such as to
require institutional care at the earliest possible moment. In other
instances the situation required constructive work whereby unfav­
orable conditions would be removed or the family burden so lightened
that the child could be given proper care-in his own home. In many
cases the parents were unwilling that their defective child be put in
an institution, but they would have welcomed assistance in meeting
the child’s needs in the home.
The grade of mentality, physical condition, need of training, and
industrial efficiency of the mentally defective individual must be
considered in deciding what provision should be made for his care.
Special schooling and special industrial training are needed for all
except the lowest grade of mentally defective children.
Mentally defective children lack judgment and self-control and
are easily led into wrongdoing. Many of them exhibit at an early
age traits of character with a potential trend in the direction of
conflict with the customs of society. A psychiatric examination
often reveals such traits of personality, and the decision as to whether
a given person requires institutional care is often dependent upon
1 Included in the definition of the term “ feeble-minded ’ ’ adopted b y the American Association for the
Study of the Feeble-minded. Journal of Esycho-Asthenics, March and June, 1911, p . 134. (See also
R eport of the R o y a l Commission on th e Care and Control of th e Feeble-m inded, vo l. 8, p. 324. London
1nno \


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M E N TA L DEFECT IN A RURAL COUNTY.

the results of such examinations.1 It is apparent that the problem
of dealing with such cases is a medico-legal one, analogous to that
involved in the care of the insane. For no other class of the mentally
defective is the need for care and protection so urgent from the point
of view of the public welfare as in the case of those who are offenders
against the accepted standards of social conduct.
It is difficult to determine in advance of the establishment of a
system of public care and supervision how many cases will require
the various types of provision. The characteristics of each mentally
defective child and the ability of the family to give proper care and
training under favorable conditions must be taken into account.

^

K IN D O F P R O V IS IO N N E E D E D .

Although the second State to adopt State care of the insane,
Delaware has not yet provided for the care of mental defectives,
with the exception of appropriating a small sum yearly for the main­
tenance of 14 Delaware children in a Pennsylvania institution. In
1917 the legislature made an appropriation of $10,000 for the
establishment of an institution for the feeble-minded.
Under this
act a commission of nine members was appointed b y the governor,
consisting of two members from each county and three at large.
The commission was empowered to take the necessary steps toward
establishing an institution, employing a superintendent, and making
rules regulating the admission of feeble-minded persons.
With a field practically untouched, Delaware has an excellent
opportunity to adopt a comprehensive plan for the care of mental
defectives, taking into consideration conditions existing in the State,
and utilizing to the fullest extent the experience of other States in
dealing with various phases of the problem. The State covers an
area of only 1,965 square miles, and therefore lends itself readily to
a centralized system of care. However, the problem is complicated
by the largely rural conditions which prevail outside of Wilmington.
Except for the extreme northern section the population is scattered,
means of communication are poor, and strongly individualistic ten­
dencies prevail. Organizations for constructive relief work with
families, and for dealing with problems of child welfare, do not exist
in the central and southern sections, except as two or three childcaring societies, with headquarters in New Castle County, work into
this region to some extent. The schools outside the one large city
have no specialized work for subnormal children.
The primary feature of State care is the development of an institu­
tion adapted to the treatment of mental defectives of various grades.
1 Treadw ay, D r. W alter L .: “ Some observations on th e personality of feeble-minded children in the
general population,” in P u b lic H ealth R ep orts, v o l. 33, N o. 20 (M ay 17,1918), p . 760.
2 A cts of 1917, ch . 172.


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For those mental defectives who can not he given proper care and
protection in the community, and for those who are a menace to
society because of delinquent tendencies, institutional care is essen­
tial. An institution does not wholly meet the problem unless it is
the focus for various activities concerned with the mentally defective.
The modem type of institution includes a custodial department for
the low-grade cases demanding constant care and attention, a school
department for the development of the capacities of the mentally
defective to the fullest possible extent, an industrial department for
training the patients in productive activities and for directing them in
work necessary to the maintenance of the institution, and a farm or
farm colony. Agriculture is particularly adapted to the capacity of
the higher grade mental defectives, providing an opportunity for the
fullest measure of self-support of which they are capable. The cost
of maintenance of an institution can be greatly reduced if the inmates
raise their own stock and farm and garden produce under competent
direction.
Many mental defectives for whom it is necessary to provide institu­
tional care and training may be helped to become capable of work
outside the institution under supervision similar to that used in
parole systems. Since agriculture is the principal industry in
central and southern Delaware, the possibilities of training for farm
work under supervision are particularly promising. The investiga­
tion in Sussex County brings out the great need that exists for
increasing the efficiency of the mentally defective boys and girls who
are in so great a proportion of cases living under conditions of economic
stress.
A system of extension work may be planned to include a series of
clinics for mental examination throughout the State held by the
institution psychiatrist in cooperation with local agencies, and an
out-patient department through which certain types of mental defec­
tives may be given proper care and training in their own communities.
Determination of mentality is essential to classification of children in
school, and to proper treatment of dependent and delinquent children.
Through supervision in the community the expense of institutional
care to the State can be reduced and greater justice done to defective
individuals and tlieir families.
In considering the practicability of giving certain mental defectives
adequate supervision in the community, the need for special legal
protection for these socially incompetent persons is not to be lost
sight of. All the States have recognized the fact that children can
not be held responsible for wrongdoing to the same degree as adults,
and that the law must give children special safeguards. Feeble­
minded persons of any age have the mentality of children, and are
in as great need of protection. With few exceptions the States have

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94

M E N TA L DEFECT IN A RTJKAL COUNTY.

fixed the age below which the consent of a girl to an immoral act is
not recognized, and the man is therefore subject to a very heavy
penalty. In the majority of'the States, this age is 16 or 18; in one
State, it is 21. Some of the States have set down the analogous
legal principle that an insane or feeble-minded woman of any age
is to be classed with children in this regard.1 A provision somewhat
similar in intent is that prohibiting marriage with an insane, idiotic,
or feeble-minded person.2 The greater number of the States have
such a clause in their statutes, though many, among them Delaware,3
by the terminology used, probably include only the lowest grade
feeble-minded. These laws are of the greatest importance, not only
from the point of view of safeguarding the feeble-minded themselves,
but also from eugenic considerations. Supervision of mental de­
fectives in the community can be effective only if legal means can
be devised of preventing the increase of defective stock.
The training of mentally defective children who remain in the
community can best be given through special classes in the public
schools, or in special schools where the instruction is adapted to their
needs. In the rural sections the problem of providing such training
is a difficult one. In the consolidated schools, which are beginning
to be established in the State, and in towns of any size, special classes
would be entirely feasible. In connection with the possibilities of
training and supervision for the mentally defective, it is of interest
to note the work that has been done in Delaware in connection with
the education and supervision of the blind.
With a comprehensive program combining mental examinations,
special classes, and supervision in the community, with institutional
care and training, the early recognition of mental defect and the
proper treatment of individual cases will be possible. By this means
the needs of all types of mental defectives may be met with justice
to themselves and their families, and the interests of society safe­
guarded.

h

Í
\

1 See for exam ple Laws of Indiana—B um s, Annotated Statutes, 1914, sec. 2250; Massachusetts R evised
Laws, 1902, eh. 212, sec. 5, as amended b y 1913, ch. 469, sec. 3; Connecticut, General Statutes, R evision of
1902, secs. 1354-1356.
2 A Sum mary of th e Laws of the Several States Governing I.—Marriage and D ivorce of the Feeble­
m inded, the E pileptic and the Insane. B ulletin of th e U niversity of W ashington N o. 82, May, 1914.
» R . C. 1915, sec. 2992.

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GENERAL CONCLUSIONS.
The following conclusions are based upon the results of this study.
Sections 1 to 9, inclusive, have been furnished by the Public Health
Service; sections 10 to 17, inclusive, are based on the findings of the
social study.
1. A study of social and moral reactions is not sufficient to deter­
mine mental defect, but should always be supplemented by a medico'psychological examination.
2. The percentage of mental defectives in the white school popu­
lation of the rural county studied, which is practically untouched by
foreign immigration, parallels that observed in a similar group in a
rural county receiving a heavy foreign immigration.
3. In this county the percentage of feeble-mindedness among white
males in both the school and general populations from 5 to 20 years,
inclusive, is greater than that among white females. This corrobo­
rates previous observations made by the United States Public Health
Service in regard to school populations.
4. The percentage of mental defect among colored school children
in this county is greater than that observed among white school
children.
5. The practice of placing out dependent children in communities
tends to increase the percentage of mental defectives in the school
population, unless regulations are in force preventing the bringing
into the State of defective children from other States.
6. Almshouses are not suitable places for the care of mentally
defective persons.
7. In Sussex County the percentage of feeble-minded among
white school children was practically the same as in the white general
population between the ages of 5 and 20 years, inclusive.
8. In Sussex County the percentage of feeble-minded in the white
general population of all ages was at least half that in the white
school population.
9. The problem of the care of mentally defective persons is neglected
and generally little understood in rural counties in States making no
provision for the care of such persons.
10. The State must make provision for mentally defective children
whose families can not give them the care and protection necessary,
and for those who, by reason of lack of self-control or tendencies
toward delinquent conduct, constitute a menace to the community.
11. For many mentally defective persons, institutional care is
essential.
95

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96

M ENTAL

DEFECT

IN

A

RURAL

COUNTY.

12. For certain classes of mental defectives institutional care is
not necessary, if a system of supervision and training in the commu­
nity can be provided.
13. The characteristics of each mentally defective child and the
ability of the family to give proper care and training under favorable
conditions determine the kind of care needed.
14. The placing of dependent feeble-minded children in family
homes is most undesirable, unless the child and the family are pro­
tected by constant and careful supervision.
15. The training of mentally defective children must be adapted to
their needs and possibilities of acquirement.
16. The higher grade mentally defective children are capable of
doing simple routine work, and may be trained to become more
efficient and at least partially self-supporting.
17. Public protection demands recognition. of the relation be­
tween defective mentality and pauperism, degeneracy, crime, alco­
holism, and other forms of social ills.

o


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[Continued from second page of cover.]
In d u stria l Series:

v

’

No. 1. Child-Labor Legislation in the United States, by Helen L. Sumner
and Ella A. Merritt. 1131 pp. and 2 charts. 1915. Bureau publication
No. 10. Bureau supply o f complete volume exhausted, but reprints can
be obtained as follows :
Child-Labor Legislation in the United States: Separate N o / 1. Ana­
lytical tables. 475 pp. and 2 charts. . "
'
Child-Labor Legislation in the United States : ; Separates NoS. 2 to 54.
Text o f laws for each State separately.
: ^
;
§ Child-Labor Legislation in the United States: Separate No. 55.
Text of ¡federal Child-Labor Law. 1916.
,N o . 2. Administration of Child-Labor L a w s:
'
Part 1. Employment-Certificate System, Connecticut, by Helen L. Sum­
ner and Ethel E. Hanks. : 69 pp. and 2 charts. 1915, Bureau pub­
lication No. 12. |
•
'
'
Part 2. Employment-Certificate System, New York, by Helen L. Sum­
ner and Ethel E . Hanks, 164 pp. and 3 charts. 1917. Bureau pub­
lication No. 17.
•
I .
' ■
Part 3. Employment-Certificate System, Maryland, by Francis Henry
Bird and Ella Aryillâ Merritt. 127 pp. and 2 cliarts.:; 1919. / Bureau
'■ publication No. 41.
/
*, :
■■
No: 3. List of References on Child Labor: 161 pp: 1916. Bureau publica­
tion No. 18.
N o. 4. C hild Labor in W a r rin g C ou n trie s: A b rie f review ox foreign re­
ports, by A n n a R ochester. 75 pp, 1917. B u reau publication N o. 27.

Rural Child-Welfare Series:
No. 1. Maternity find Infant Care in a Rural Coujnty in Kansas, by Eliza­
beth Moore. : 50 pp., 4 pp. illus., and 1 chart.' 1917, Bureau publication
No. 26.
‘
‘
ffiÿ
No. 2. Rural Children in Selected Counties of North Carolina, by Frances
Sage Bradley, M. D ., and Margaretta A . Williamson. 118 pp. and 16 pp.
illus. 1918. Bureau publication No. 33. £
S
i
'
No. 3. Maternity Care and the W elfare of Young Children in a Homestead­
ing County in Montana, by Viola I. Paradise. 98 pp. and 16 pp. illus.
1919.' Bureau publication No, 34.
No. 4 . Maternity and Infant Care in Two Rural Counties in Wisconsin,
by Florence Brown Sherbon and Elizabeth Moore. — pp. and — pp.
illus. 1919. Bureau publication No. 46. (In press.)

Legal Series:

■■

fj|

N o. 1. N orw egian L a w s Concerning Illegitim ate Children : Introduction and
tran slation b y L eifu r M agnusson.
37 pp.
1918.
B u reau publication f

111

No. 31.
"
m M m SÊ É Ê m
No. 2. Illegitimacy" Laws of the United States, by Ernst Freund. — p p .*j
1919. Bureau publication No. 42.. (In press.)
'
No. 3. Maternity Benefit/SystOins in Certain Foreign Countries, by Henry J.
Harris, Ph. D . — pp. 1919. Bureau publication No. 57 . ,(In press.)

Miscellaneous Series :
No. 1. The Children’s B ureau: A circular containing the text of the law
establishing the bureau and a brief outline o f the plans for Immediate
work. 5 pp. 1912. , Bureau publication No. 1. (Out o f print.) .
No. 2. Birth Registration : An aid in protecting the lives and rights o f chil- f .
dren. 20 pp. 3d ed. 1914. Bureau publication No. 2.
No. 3. Handbook of Federal Statistics o f Children: Number of children in
the United States, with their sex, age, race, nativity, parentage, and geo­
graphic distribution. 106 pp. 2d ed. 1914. Bureau publication No. 5.
No. 4. Child-Welfare E xhibits: Types and preparation, by Anna Louise
Strong. 58 pp. and 15 pp. illus. 1915. Bureau publication No.. 14.
No. 5. Baby-W eek Campaigns (revised edition) . 152 pp. and 15 pp. illus.
1917. Bureau publication No. 15.
^ §11
-U;
No. 6. Maternal Mortality from All Conditions Connected with Childbirth In
the United States and Certain Other Countries, by Grace L. Meigs, M. D .
66 pp. 1917. Bureau publication No. 19.
No. 7. Summary o f Child-Weifare Laws Passed in 1916. .7 4 pp. 1917,
Bureau publication No. 21.
(Continued on fourth page o f cover.) :


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Continued from thirdp&ge o f cover.)

Miscellaneous Series— Continued.
No. 8. Facilities f< r, Children’s Play in the District o f Columbia. 72 pp.,
25 pp. illus., and 1 map. 1917. Bures^u publication No. 22.
No. 9. How to Conduct a Children’s Health Conference, by Frances Sage
Bradley, M. D ., and Florence Brown Sherbon, M. D. 24 pp. 1917. Bu­
reau publication No. 23.
No. 10. Care o f Dependents o f Enlisted Men in Canada, by S. Herbert
W olfe. 56 pp. 1917. Bureau publication No. 25.
No. 11. Governmental Provisions in the United States and Foreign Coun­
tries for Members o f the Military Forces and their Dependents, prepared
under the direction o f Capt. S. Herbert W olfe, Q. M.,- U. S. R., detailed by
the Secretary o f W a r. 236 pp. and 4 diagrams. 1917. Bureau publica­
tion No. 28.
No. 12. An Outline for a Birth-Registration Test. 13 pp. 1919. Bureau
. publication No. 54.

Children’s Tear Leaflets:
No. 1. Children’s Year, April 6, 1918, to April 6, 1919, prepared in collabo­
ration with the Department o f Child W elfare o f the W om an’s Committee,
Council of National Defense. 8 pp. 1918. Bureau publication No. 36. *
No. 2. Children’s Year, Weighing and Measuring Test :
Part 1. Suggestions to Local Committees. 8 pp. 1918. Bureau pub­
lication No. 38.
Part 2. Suggestions to Examiners. 4 pp. 1918. Bureau publication
No. 38.
Part 3; Follow-up Work^v 7 pp. 1918. Bureau publication No. 38.
No. 3. Children’s YeaTr W orking. Program, prepared in collaboration with
the Department o f Child W elfare o f the Wom an’s Committee, Council o f
National Defense. 12 pp. 1918. Bureau publication No. 40.
No. 4. Patriotic Play W eek.
Suggestions to Local Committees. 8 pp.
1918. Bureau publication No. 44.
No. 5. Children’s Health Centers. 7 pp.v1918. Bureau publication No. 45.
No. 6. The Public-Health N u rse: H ow she helps to keep the babies well.
7 pp. 1918. Bureau publication No. 47.
No. 7. Back-to-School Drive, prepared in collaboration with the Child Con­
servation Sectioh o f the Field Division, Council .of National Defense.
8 pp. 1918. Bureau publication No. 49.
No. 8. Suggestions to Local Committees for the Back-to-School Drive, pre­
pared in collaboration with the Child Conservation Section o f the Field
Division, Council o f National Defense. 8 pp. 1 9 1 8 .' Bureau publication
No. 50.
No. 9. Scholarships for Children, prepare'1 in collaboration with the Child
Conservation Section o f the Field Division, Council of National Defense.
8 pp. 1918. Bureau publication No. 51.
No. 10. Advising Children'in Their Choice o f Occupation and Supervising
the Working Child, prepared in collaboration with the Child Conservation
Section o f the Field Division, Council of National Defense. 14 pp. 1919.
Bureau publication No. 53.
o. 11. The Visiting Teacher, prepared in collaboration with the Child
Conservation Section of the Field Division, Council o f National Defense.
7 pp. 1919. Bureau publication No. 55.
o. 12. The Employment-Certificate System : A safeguard for the working
child, prepared in collaboration with the -Child Conservation Section of
the Field Division, Council of National Defense. 12 p p ,' 1919. Bureau
publication No. 56.,
No. 13. The States and Child L abor: Lists of States, with certain restric­
tions as to ages and hours, prepared in collaboration with the Child Con­
servation Section o f the- Field Division, Council of National Defense. 46
pp. 1919. Bureau publication No.. 58.

Child Labor Division Series:
Circular No. 1. August 14, 1917. Rules and Regulations for Carrying Out
the Provisions o f the United States Child-Labor Act. (The circular in­
cludes the text o f this act.) 10 pp. 1917.
Circular No. 2. June 30, 1918. Decision of the United States Supreme
Court as to the Constitutionality of the Federal Child-Labor Law of
September 1, 1916. 16 pp. i918.


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