The general measures of treatment are: (a) Training and education. (6) Segregation, (c) Boarding out and employment under supervision.

(a) The training and education may be carried out either in special ungraded classes in public schools or in institutions for the feeble-minded, depending on tendencies or degree of manageableness of the given case, home conditions, etc. The aim is mainly to train the patient to dress and undress, to be of cleanly habits, to behave decorously, to read and write and know something of numbers, to tell time by the clock, to keep track of days of the week and month, and to do some useful work.

"It is safe to say that over 50% of the adults of the higher grade who have been under training from childhood are capable, under intelligent supervision, of doing a sufficient amount of work to pay for the actual cost of their support, whether in an institution or at home." l

(b) Permanent segregation is necessary for idiots, imbeciles, defective delinquents, and feeble-minded women of child-bearing age.

"This lower class of idiots, many of them with untidy, disgusting, and disagreeable habits, feeble physically, perhaps deformed and misshapen, often partially paralyzed or subject to epilepsy, cannot be given suitable care at home. There is no greater burden possible in a home or in a neighborhood. It has been well said that by institutional care, for every five idiots cared for we restore four productive persons to the community; for, whereas at home the care of each of these children practically requires the time and energies of one person, in an institution the proportion of paid employees is not over one to each five inmates."

"Requiring permanent care are also the moral imbeciles and the adults of both sexes who have graduated from the school department, or are past school age, but cannot safely be trusted, either for their own good or the good of the community, where not under strict and judicious surveillance.

"The brighter classes of the feeble-minded, with their weak will power and deficient judgment, are easily influenced for evil and are prone to become vagrants, drunkards, and thieves." "As a matter of mere economy, it is now believed that it is better and cheaper for the community to assume the permanent custody of such persons before they have carried out a long career of expensive crime."

"The tendency to lead dissolute lives is especially noticeable in the females. A feeble-minded girl is exposed as no other girl in the world is exposed. She has not sense enough to protect herself from the perils to which women are subjected. Often sunny in disposition and physically attractive, they either marry and bring forth in geometrical ratio a new generation of defectives and dependents, or become irresponsible sources of corruption and debauchery in the communities where they live. There is hardly a poorhouse in this land where there are not two or more feeble-minded women with from one to four illegitimate children each. There is every reason in morality, humanity, and public policy that these feeble-minded women should be under permanent and watchful guardianship, especially during the child-bearing age. A feeble-minded girl of the higher grade was accepted in the Massachusetts School for the Feeble-Minded when she was fifteen years of age. At the last moment the mother refused to send her to the school, as she ' could not bear the disgrace of publicly admitting that she had a feeble-minded child.' Ten years later the girl was committed to the institution by the court, after she had given birth to six illegitimate children, four of whom were still living and all feeble-minded. The city where she lived had supported her at the almshouse for a period of several months at each confinement, had been compelled to assume the burden of the life-long support of her progeny, and finally decided to place her in permanent custody." 1

1 Walter E. Fernald. The Growth of Provision for the Feeble-Minded in the United States. Mental Hygiene, Jan., 1917.

A good deal of segregation can be accomplished in colonies maintained by the parent institutions at distances of from 20 to 50 miles:

"During the past decade this form of care has rapidly grown, so that now there is general approval of the formation of colonies for adult male feeble-minded persons in good physical condition. Such colonies, when connected with ' parent' institutions, can be made self-supporting and seem to offer a most hopeful means of providing for a greatly increased number of cases at a minimum expense to the state." 2

(c) The success of institutional training and discipline is such that many patients can eventually return to their homes or be boarded out and employed in the communities.

"The next step, it seems to me, in state care for mental defectives will be the development of plans for the supervised care of suitable cases, usually those who have had a period of institutional observation and training, in the communities. Many such patients can get on in their homes, while others may be ' boarded-out' in carefully selected families in rural communities, subject of course to strict supervision by officers of the parent institution." 3

1 Walter E. Fernald. Loc. cit.

2 Walter E. Fernald. Loc. cit.

3 Walter E. Fernald. Loc. cit. - See also C. Bernstein. Self-Sustaining Feeble-Minded. Ungraded, Nov., 1917.