schedule of the hospital for the week ending April 21, 1901. The dishes are given for breakfast, dinner, and supper of each day. Those for the inmates are such as may be ordinarily found in a wellmanaged institution; but, besides these, there are the "attendants' extras" for nearly every meal. They include such things as fried ham, cold meat, muffins, beef hash, coffee cake, potatoes, fried eggs, toast, fruit sauce, buns, and the like. This does more than please the employees. It is a shrewd way of securing better service without increase of salary.

Dr. Hurd says:

While we cannot say that all this is due entirely to the food investigations, and while some of it is due to care and vigilance in buying, yet we think a great deal of it is attributable to the extra care and attention which have been paid to the cooking, distributing, service, and prevention of waste which are the outcome of the investigations.

He adds:

The co-operation in this work has not been a burden or drag on the institution, but has, we think, resulted in a direct benefit to the dietary of the inmates, the satisfaction and contentment of all concerned, and has been a marked source of economy.

A large part of this saving in cost, while the diet has been improved, Dr. Hurd attributes to the reduced waste of food. In this connection he has a rather amusing story. As the care in this respect gradually began to make itself effective, complaints began to come from the man in charge of the piggery that the feed was getting short. The result was that corn-meal was bought, and the number of swine reduced. The economy that was so fruitful in the hospital was inconvenient in the piggery, but it was a good deal cheaper to buy pork or fatten pigs on corn-meal than to use bread and meat for the purpose.

Improvement of Dietaries.- Hygienic and Humanitarian Considera

tions. In the same report to the New York Commission in Lunacy I have ventured to make the following statements:

The reduction of cost is not the only object, nor, from my own standpoint at least, is it the chief object of an inquiry such as this. The humanitarian considerations, it seems to me, should be uppermost. Some of the inmates of the hospital may be cured. Whatever can be done to facilitate their cure is certainly desirable. Of the

incurables, a large number have a keen appreciation of the comforts and discomforts of their situation. They are men and women like ourselves. Some of them are our relatives and friends. It is not due to either their fault or our virtue that they are there instead of us. To do away as far as possible with their discomforts, to provide as much as possible the things which contribute to their happiness, is our plainest duty. One of the encouraging features of modern philanthropy is found in the increased attention given to just such considerations as these in the care of the dependent classes.

What I wish to urge here is that the fitting of the food to the demands of health on the one hand, and the making of the dishes palatable and the table attractive on the other, are a proper part of the general policy of hospital improvement.

If this investigation shall be continued in fitting ways, I believe it will be possible to learn much of the methods by which the food may be better adapted to the actual needs of the patients of the different classes. I believe also that it will be possible to devise improvements in the cooking and serving of the food which will fit it better to the varying tastes of the hospital population and at the same time make the tables more attractive. The advantage of this will be threefold. It will help to make the hospital life less wearisome to the patients. It will be hygienically beneficial. And it will help to the better economizing of the food supply, and thus reduce the cost.

Although I have had little experience in other charitable institutions, such as hospitals for the sick, poorhouses, and asylums and reformatories for children and youth, it seems to me that the same general principles apply in them also.

As regards prisons and reformatories for adults, I speak with less assurance of the æsthetic side of the question, for I do not know whether the experience of the penologist would justify the sympathies of the layman. But, as regards the economic side of the question, I cannot see why there should not be as much room for improvement in prisons as in other institutions. Nor do I quite see why improvement in prison diet may not be one of the corrective rather than the punitive features of prison life. Considerable attention has been paid to prison dietaries in Europe. Is the subject not worthy of more careful attention than it has yet received in the United States?

May I not also make a special plea for the study of this subject in connection with orphanages, asylums, and other institutions for the care of dependent children? From what some of my friends in your association tell me of their experience in such institutions, it seems to

me that they represent an especially promising field for effort in this direction.

Conclusion. Here, as elsewhere, we are trying to improve. The improvement must be gradual. To make it most successful will require careful and long-continued experiment and observation. The methods of experiment and practical application of the result can, I believe, be gradually developed in the institutions themselves, so that their own officers and employees will be able to accomplish the desired object in the most economical, useful, and satisfactory ways. Steps already taken in these directions are bringing results gratifying in themselves and promising for the future. There are several reasons for anticipating success in this effort. One is the hearty interest shown by the officers and managers of public institutions. Another is the fact that a great deal of attention has been given to the study of dietetics and food economy during the past few decades. A large part of this inquiry has been carried on in Europe, but of late it has been introduced quite actively in the United States. An especially favorable circumstance is the provision by the United States government of an appropriation for special inquiry in this direction, which is being carried out under the auspices of the United States Department of Agriculture, and in co-operation with scientific, educational, and philanthropic institutions in the United States from Maine to California and from Minnesota to Alabama. The larger investigations have made a foundation for these inquiries such as would otherwise have involved a large amount of labor and expense. The most encouraging thing of all, however, is the spirit which is being developed in the community at large, and is so very prominent in the labors as well as in the meetings of this association, a spirit which combines two of the notable features of our modern thought and life. One of these is careful study of our great economic, social, and ethical problems the other is the self-sacrificing labor of philanthropy. This union of the spirit of science and the spirit of service is doing wonderful things and doing them in many ways. One of the ways of thus helping to the better care of the dependent and delinquent classes is the study and the improvement of their food and nutrition.

VIII.

Care of Feeble-minded and Epileptics.

THE EVOLUTION OF THE CARE OF THE FEEBLEMINDED AND EPILEPTIC IN THE PAST

CENTURY.

BY WILLIAM A. POLGLASE, M.D.,

MEDICAL SUPERINTENDENT, MICHIGAN HOME FOR THE FEEBLE-MINDED AND EPILEPTIC, LAPEER, MICH.

A humane and remedial treatment of the defective obtained in very ancient times. It is recorded that in Egypt the temples of Saturn, and in Greece the Asclepia, were resorted to by lunatics; and the treatment was not markedly different in principle from that of the present day. How long the influence of the classical medical writers, and especially of Hippocrates and Galen, continued it is difficult to say; but in the Middle Ages, and up to the middle of the eighteenth century, little attention was paid to the care or cure of the mentally defective. Objects of contempt or fear, they were more often brutally treated than tolerated for their buffoonery. There is good reason for believing that many were executed as criminals or witches. The lot of the idiot was, indeed, a hard one until the past century. Supposed to be possessed of devils, the Church condemned him to eternal punishment. A riddle to his physician, he was left to his fate. The law deprived him of his property, and the populace jeered and cursed him as an unhuman object.

But in the seclusion of the stricken home the broken heart of many a devoted mother, who, loving and hoping and believing from the faint response of appreciation to her devotion that her child was human, and that there must be a way to straighten out the tangled senses, anticipated faintly our present methods. Occasionally, a great heart, inspired by the spirit of humanity and soft

ened by Christ-like zeal, extended the hand of charity. It is related that a devoted monk, far back in the sixteenth century, collected about him a dozen of these harmless beings and cared for them.

Whether the essential spirit of mankind progresses at an even pace with improved environment is an open question; but, beyond all comparison, the nineteenth century is the most notable period in the history of progress in the treatment of the defective, as in other respects. Though houses of detention or bedlams were instituted in the sixteenth century, yet even in the beginning of the nineteeth century no progress had been made in the humane care of lunatics, who were chained, caged, flogged, and starved; and no more tender care was given the epileptic or feeble-minded. The science that now mitigates and cures 20 per cent. of cases of insanity, the humanity and love that have established schools and homes for the feeble-minded and colonies and hospitals for the epileptic, are the product of the nineteenth century.

It is not strange that the defective classes did not earlier have humane care, for ignorance and intellectual darkness was the prevalent condition. Everywhere knowledge was dear and hard to acquire. Curiosity and certain opinions held regarding primitive man, and the possibility of man under certain conditions to revert to that state, led to the study and observance of several types of socalled wild persons, and evolved the fact that idiocy was a mental defect.

Itard, physician of the deaf-mute institution, for his studies and experimental researches with idiocy, was commended by the French Academy. With the publication of his studies in 1801 really began the literature on the treatment of idiocy. Other zealous students and keen observers soon took up the study of idiocy, and the work received more or less prominence in France. During the first onethird of the century several efforts were made to teach idiots; but the greatest success was attained by Edward Seguin, a pupil of the noted Itard, who opened a private school in the year 1837. Afterward he came to the United States, where his work and writings became standards for all interested in the training of idiots. Within a short period, several schools were opened in different parts of Europe.

Our own country, however, was the first to make a systematic attempt at the education of idiots in a school. In the year 1818, and