PRESENTED TO THE LIBRARY BY M i 6 e ...JE t Hurlb s 1 1 M ? QILL UNIVERSITY LIBRARY "■ m 242183 ""‘1929 SOUND BY WCGUL UKWLHSlTY CONTENTS 1. 2 . 3 , 4 , 5 . 6 . 7 . a. 9 * 10 . l b 12 . 13 '. 14 . 15 . 16 . 17 . 18 . 19 . 20 . 21 . 22 . 23 . 24 . 25 . 26 . 27 . 28 . 29 . 30 . 31 . 32 .. Introduction Brandon Hospital for the Insane Selkirk Hospital for the Insane Portage La Prairie Gaol Brandon Gaol Winnipeg Gaol Grace Hospital,v;innipeg Misericordia Hospital, Winnipeg, Industrial Training School, Portage La Prairie. Salvation Army Industrial Home, Home of the Good Shepherd. Children's Aid Society, Winnipeg. Juvenile Court Detention Home, Winnipeg. Juvenile Court, Winnipeg, Social Welfare Commission, Winnipeg, Maison St. Joseph, Otterburn, The Huetterite Colony. East Kildcman Home for the Feeble-Minded. Home for Incurables and Old Folk’s Home, Portage La Prairie, Strathcona School, Winnipeg, Elmwood School, Winnipeg. Laura Secord School, Winnipeg, The Home for the Friendless, Winnipeg, Immigration, Prostitution . Re c ommendat ions , Admi s s ion . Prevention and After-Care The Psychopathic Hospital, Winnipeg. The Gaols . Care of Defective Classes (and Care of Mental Defectives ) , Conclusion I INTRODUCTION Pages 1-12 INVITATION TO MAKE SURVEY In July 1C1S Lieut, , Col, Colin K. Russel. Chair- man of the Executive Committee of the Canadian national Committee for Mental Hygiene, received a letter from the Public Welfare Comnissior of the province of Manitoba, ! • stating that the Honourable Thos , H. Johnson, Attorney General and Chairman of the Public Welfare Commission had asked that the Canadian National Committee for Mental Hygiene should make a study of conditions in Manitoba, particularly in reference to hospitals for 'the insane and other institutions where mental defectives were housed. The study was also to cover such questions as the exam- ination of child delinquents. Juvenile Courts, etc. It was Indicated that the Committee would be given a free hand to make a survey in any way in which it desired and every facility would be placed at its disposal for the purpose. The Executive" of the Canadian national Com- mittee when assured that this was being undertaken with the full sanction and approval of the Manitoba Government instructed the Medical Director, Associate Medical Direc- tor, and the Social Worker to go to Manitoba and undertake the survey as soon as possible. Some time was lost in completing arrangements, but early in October the survey was commenced and pursued diligently until finished. The scope of investigation originally outlined, will be submitted, and although it was not found possible to cover all or tie programme as at first arranged, still a mass of interesting information was gleaned, part of which will be included in the following report. ,It tvould make the survey too bulky to include all of the facts and figures obtained, but these ?/ill be available for the purposes of the Canadian National Committee for Mental Hygiene . ■H Scope of Investigation . 1. Survey of Hospitals for Insane, (a) The Selkirk Hospital for the Insane. (b) The Brandon Hospital for the Insane. 2. Survey of ’’The Portage La Prairie Home for Incurables". 3. " '■ "The East Kildonan Home for Feebleminded Children", 4. 11 " Gaols, - Winnipeg and portage La Prairie (if time permits, also gaols at Worden, Brandon, Minnedosa and Dauphin) , 5. Survey of Reformatories : (a) The Home of the Good Shepherd (K,C.) (b) The Sal Vatican Army Industrial Home. (c) Portage La prairie Industrial School. (d> Detention Home - Winnipeg. 6. Survey of Stony Mountain Penitentiary. 7. Examination of 50 consecutive cases appearing before Juvenile Court . 8. Examination of 50 consecutive cases appearing before Police Court. 9. Survey of Institutions for Normal Children and Primary Schools . (a) St, Joseph's Orphanage. ( bV C hi Id r en ' s Home . (c) Home for the Friendless, (dn any rational basis, the majority of people look on the insane simply as a burden to the State, there is l_ttl- real sympathy shown for them, and expenditures for the betterment of this unhappy class are grudgingly and unwil incrlv made. It is rarely that the average man can x induced to re card the insane as sick and diseased, and the humm svmoath^ so lavishly squandered on patients cared. for in nar oral* hospitals , is seldom conveyed to the mentally afflicted If this be the case in old and supposedly well organised* communities , it is easily understood that condi- tions are apt to be far from ideal in newer centres, and custodial care in Canada has apparently been tha^mrx to which governments have been willing to rise. , tl _„ q-na^modic but feeble efforts were made ten years ago^ in ^he Hast to make definite advances along broader lines, cut politics and lack of sustained interest soon suppressed these manifestations of an awakening public conscience. - 5 - Governments feel the strain of supplying funds to maintain the incurable insane, and it is a difficult matter to make them see that money can be saved by adopting a vase policy of prevention or early cure. If it is true, as can be easily demonstrated, that every incurable patient detained in the Provincial Hospital for the Insane in the long run costs that Government $5000. to $7000, it is not a diffi- cult problem to calculate the saving to be effected by V de'aling as intelligently with insanity as we do with smallpox or other preventable diseases . Of course, we are at once met with the argument that nearly all cases of insanity are incurable from the outset. We do not know that. It is a most unfair argument lacking proof* Surely if preventive medicine ever had a sphere in which its justification can be placed beyond question, it must be in this particular field, and the policy of locking the stable door after the horse is stolen, is particularly obnoxious in this age of social reforms. Medicine has not performed its duty in most hospitals for the insane, which are so frequently merely houses of detention for herds of diseased humanity, where the individual is lost sight of, and where little is done to save him from sinking to the deadly level so easily reached by those who have not had the helping hand extended to them. Contrast the well equipped up-to- date hospital for the insane with the depressing and poorly organized detention houses of the province of Manitoba, and the truth of the statement will be at once apparent * Then again, if it is true that prevention is to play the most important role in the elimination of one of the blots on our civilisation, surely every effort made to study and o\re for the children showing manifestations of a I tendency to develop insanity, must not only prove commen- dable but essential in a progressive province. Recent investigations make it plain that while hospitals for the insane are a necessity under present conditions, it is only a matter of time when preventive medicine will greatly lesson the burden to be carried by the people in the way of supplying maintenance. The hope of the Canadian National Committee is to point the way along which progress is to be made. At present the public rarely has confidence in hospitals for the insane, and no one can ignore the attitude of hostility which is the result of creUulcas people listening to the distressing accounts of what recovered patients thought they experienced while under detention. It is difficult not to believe such accounts 6 ~ although the majority of them are strangely distorted; and yet on the whole , the attitude of the public is right. While general hospitals have been placed, ordinarily, on a high place of efficiency, many asylums for the insane have not kept pace with the hospital movement. he use the wordr "asylums 1 ' here , advisedly, as the majority of these institutions cannot by any stretch of imagination be called hospitals. The problem of State care has been beyond the ken of most Governments , and when politics have been allowed to supplant education, and experience, the results have been tragic as far as the unfortunate insane are concerned. If asylums for the insane were designed simply with the idea of taking crre of so many hopeless dements at the cheapest rate possible, all well and good - a retired boarding housekeeper with plenty of political "pull" would probably make a more successful manager then a third -rate physician whose ambition is personal comfort and a sinecure, rather than the scientific zeal to "do his bit" and add something to the world '■ s knowledge of the most subtle and difficult of all diseases to understand. Of course, many will argue that it makes little difference what kind of scientific training the head of an institution has , where the population is chiefly made up of chronics. The main ideas under such an organization are to feed, the inmates at the cheapest rate possible, to raise plenty of vegetables ar.d fruit, to develop a fine herd of Holsteins and to boast of the largest collection of fat hogs in the country. Of course, these things are commendable, as the doing of them furnishes splendid outlets for occupation of the inmates, but they should not becloud, the true function of a hospital for the insane , which is the scientific treat- ment of the patients. Leaving this argument for a moment, what do re find in the Province of Manitoba in the way of advanced treatment of its insane population? Possibly the simplest way of dealing with conditions as they are there, is_ to make suggestions regarding what should be done to make conditions as they ought to be. It is scarcely fair to criticize those in charge for the existence of manifest abuses which are the out come of a defective and incomplete organization, which is so constituted that it must of necessity provoke loss of confidence on the part of the public. ' As is pointed out by the Superintendent of the Brandon Hospital for the Insane in his report for 1916, the methods of commitment of a natient are inhuman, and the gaol system an abomination. Surely It is clearly understood 7 V/' that insanity is a disease, not a crime, and everything that can be done to minimize mental suffering should ha cheerfully undertaken by a sympathetic Government. Many of the insane dread the stigma of having to endure public examination before a magistrate, and why thsyishbuld be denied the privilege of voluntary commitment, when they have enough insight to ask for it, is a mystery. Volun- tary commitment should be a part of an improved system which aims at cure rather than custodial care. In other words, the first step necessary in getting away from the ’’herd idea" is to give the individual who has an apprecia- tion of his condition, an opportunity to help himself. Of course, the majority of patients admitted to hospitals for the insane will have to be certified to, but to this, why add the humiliation of having to appear before a magistrate to be committed to a common gaol? Po argument can convince those who have had experience, that gaol guardianship is ever necessary with the insane. Such a system simply perpetuates a wrong and antagonizes every thoughtful person in the community . however, when we come to deal with the problem of the acutely insane, we shall have much more to say on this subject. The hospitals for the insane in Manitoba are organized without the slightest regard to the demands of modern science; they have neither staff nor equipment to make them anything more than custodial institutions, and proper medical treatment is not provided. It may be argued that with the building of a Psychopathic Department in connection with the General hospital at Winnipeg, the necessity of further equipment at Brandon and Selkirk is obviated". Such an impression is erroneous. The Psycho- pathic Department will of course be an excellent one, but if it is to have but twenty-five beds , it will not begin to meet the requirements of a province in which the popu- lation is over five hundred thousand. One hundred beds for acute cases are necessary to provide proper accommo- dation, and it follows that the hospitals for the insane should be equipped to meet the overflow from what must inevitably become simply a reception hospital of limited capacity. 'That inducement can there be to any accomplished young psychiatrist to join the staff of either Brandon or Selkirk at the present time, where they are without facil- ities for the accomplishment of necessary work? -n a hospital for the insane, laboratories are just as essential as they are In a general hospital, and it must he remembered that the advances in psychiatry are inevitably to be the outcome of elaborate, chemical, physiological and psychological * 8 *■* studies, and clinical investigations are only a part of the necessary organization* With the staffs as limited as they are in Brandon and Selkirk, what possible chance is there of even ordinary clinical investigation? Even a casual glance at the histories taken will show that not even the faintest attempt at scientific accuracy has been made, and the class- ification adopted belongs to an era long past.. How could it be otherwise though with such a small staff of physicians? C ond it j ons f ou nd in the Home for In curables at Portage ha Prairie It is almost inconceivable that such a state of affairs as vie met at the Home for Incurables could exist in the present age; things which go to show what can develop where adequate inspection and supervision are not supplied. Truly the old adage "out of sight, out of mind" seems to have been reversed to read "out of mind , out of sight". Think of the cruelty of herding these poor creatures together in small rooms, without occupation, without classification or the slightest attempt to inject a single ray of happiness into their lives. This in itself is reprehensible, but what must we say of the inhumanity which consigns human creatures to a living death in solitary confinement. It is all very well to say tt 17hat are you going to do with such unmanageable creatures?". The reply is that such creatures would never have reached the level to vihich they have sunk, had they been intelli- gently cared for in the early stages of disease. They are not to be found in institutions properly managed, where the individual is carefully considered. We found this hopeless mental attitude nearly everywhere we went in Manitoba, and yet it is evident that just as soon as a progressive people are shown their sins of omission* they will insist on a complete reconstruction of the whole system of the care of the insane and defective. There was a tendency on the part of some, too, to use the ‘‘tu ciuoque" argument, forgetting of course that the only reason for the existence of the National Committee is that of pointing the way to remodel any Canadian institution that is failing in its duty. It is not provincial but national in its aims, and is oblivious of the interests of politicians who have an eye to the advantage to be earned by their friends through political patronage* If faults exist, we are anxious to see them remedied, and the officials who made the survey are more than persuaded, that the Manitoba Government is intensely anxious to lift the - 9 - whole question of the proper c&re of its insane and defective population far above the plane that so many polit leans would relegate them to, in their anxiety to profit by any opportunity that may enable them to advance their selfish interests’. Manitoba is ripe to make perhaps greater advances than any other Province in the Dominion, and now that it realizes its defects, will remedy them and institute reforms that must have their effect on the whole of Canada. The fact that a Psychopathic Hospital is being erected in Winnipeg today, shows the progress iveness of the Western people and marks the beginning of a new era in the history of osychiatry in this country. It simply means that suen an institution if properly officered and managed, will educate the people and the medical profession to regard mental disease from a new point of view, and as the present Provincial Government has already proved itself keenly / a!3ive to the importance of non-political supervision of various social institutions, the danger from scheming politicians will, to a large extent, be obviated. ^ Rapidly changing Governments, no matter how willing or anxious to do the right thing, cannot be depended on to get tne best results, unaided, and they must call on expert advice to guide them in the right path. The c a re and treatment of the Defectiv e Clas ses . A perusal of the different reports appended, _ will show conclusively that Manitoba has not dealt satis- factorily with the defective classes, and has not made the best kind of provision for their care. Uhis criticism might fairly be applied to almost every province in Canada). Idiots are, in many cases, housed in the Home Jor Incur a- bles at Portage La Prairie, but defectives of d^iierent grades are found in almost every institution examined, gaols . homes, schools, industrials schools, etc. lo t, a ir** ores once col icy seems to exist in regard to them, anc their presence in such institutions as the industrial schools s*mpl„ negatives any attempts made to achieve results worth working for." A community not alive to the importance of dealing intelligently with its defectives is a c orrnuni ^y bound to suffer greatly in the long run, the of the defectives is perhaps tne most important cu ail social questions. The reason why, is ^ arrive at as the majority of criminals come unde* this heading. Sven a glance at the figures compiled in the institutions visited in Manitoba shows the truth^ox tnis _ 1 rY- statement. Then, again, prostitution is, to a great extent, carried out by the high and 3.ow grade defectives. In our own experience more than sixty per cent of the prostitutes examined, and the number is large, have proved to be mentally defective. As these women are accountable for fully seventy-five per cent of the venereal diseases rampant, it is not difficult to understand why it is so important to segregate defectives in colonies, at an early age. If this policy were carried out with intelligence and courage by the State, the tide of criminality and specific disease would ebb at a rapid rate. Even from the dollars and cents standpoint the saving to be effected is enormous. Then again, the presence of defectives in public schools is baneful to the defectives themselves and the scholars, who are normal. Children are quick to learn either good or evil, and the presence of even two or three defectives of certain type in a large school, is apt to demoralize a number of the pupils. This is not theory, but a statement founded on instance after instance in well-known public schools which have come under the observation of those making the Manitoba survey. Of course, these children should be v,reeded out by competent / psychiatrists, and the proper disposition of the weaklings determined on. V/e say psychiatrists rather than psycho- logists because no matter how competent a psychologist may be, he is invariably at fault when called on to investigate certain types of school children, who are never understood by their teachers and who need special treatment. The children referred to are those who constitute a consider- able per cent of the abnormals found in s chools , They are suffering from various psychoses, chiefly dementia praecox. Unless diagnosed and placed in environment of suitable character, their doom is soon sealed, and it is cruel and inhumane to force them to attempt tasks vdiich easily prove their undoing. The more we saw of Manitoba and its problems, the more vie realised that the need of‘* help from well trained psychiatrists was urgent. Appar- ently the profession of the province has not made psychiatry a live issue in medical education, and young men have not been attracted to its study. With the advent of a psychopathic hospital and the absorption of the medical school by the University of Manitoba, psychiatry will assume its proper place in the curriculum of medical studies and the importance of this branch of medicine be recognized by the public as well as the profession. Fortunately, the Province of Manitoba is young enough and alert enough to > take advantage of the possibilities, and no doubt will adopt a progressive policy in dealing with the defective problem that will be. a model for other provinces to imitate . Venereal Dlne&ees We were not able to get much material or more than general statements on which to base conclusions regarding the prevalence of venereal diseases in different centres in Manitoba, as apparently the hospitals have not taken steps to gather elaborate statistics as yet. From the medical profession though it was learned that conditions similar to those in the east, probably exist, and as prostitution is common in large centres, we can easily make reasonable deductions. While some public officials ¥rere unwilling, for reasons best knovjn to themselves, to tell us what facts they possessed regarding this problem, others were more frank and ga^/e information which made it evident that a Venereal Disease Act is desirable in Manitoba, That prostitution flouishes vigorously in Winnipeg, was abundantly plain, but it is less conspicuous on the streets than in the large eastern cities, and is, on the whole, probably under better control than in Montreal and Toronto. At the same time, we feel that a careful investigation of certain types of hotels would provide much interesting study and lead to a betterment of conditions. 12 BRANDON HOSPITAL POM THE INSANE, MANITOBA J*' B. Chambers, M.D. , Medical Superintendent, Description of Building . The main hospital is a red "brick building of striking appearance, built on a bench overlooking the Assiniboine River, about one mile and three quarters from the centre of the city. Its construction is evidently satisfactory, but the plan does not conform to modern ideas, as it pays little or no attention to classification, and the wards are altogether too large to enable the medical staff to give the individual patients opportunity to receive necessary treatment. The wards are dark, dismal, and without anything to vary the monotony of the patients* lives. Even on a bright day, such as that on which we made our visit, artificial light was necessary to relieve the darkness of the wards , The walls are bare and devoid of pictures, and the lack of employment leaves the patients without meana of making use of their time satisfactorily, the result being a deadly apathy of most distressing character from one end of the institution to the other; The absence of balconies is to be regretted. The amusement hall is large and, like the rest of the institution, scrupulously clean and. well kept, but we could not get away from the fact that Brandon Asylum was simply an exaggerated development of the ''herd 11 idea of the treatment of the insane. The building lends itself to that method of care. No adequate provision for the acutely insane exists, but what need of such provision with a staff of trained workers far too small to deal satisfactorily even with a limited number of admissions of acute character. This is not to be construed into a criticism of the present manage- ment, as Dr'. Chambers is evidently keenly alive to the necess- ities of a different form of organisation. He has but recently taken charge of this asylum, and being alone in an institution caring for 7GO patients, cannot be expected to do much more than attend to the thousand and one demands of administratin'! . Date of Visit: October 16, 1918.- Number of patients provided for: 700, 13 That this Asylum is splendidly managed from the point of administration is evident at every turn, and if cleanliness andgood order were the acid test of ins titut icnal efficiency in the care of the Insane, Brandon could be given 100/$. Custodial care was apparently the idea prominent in the minds of those who planned the institution, but even from that standpoint, the buildings are open to criticism. There are no laboratories in Brandon, and even the post mortem room has been taken over to provide sleeping accommodation for employees. These facts alone show defects in organization suroris-ing in the light of modern demands, Many minor faults in construction exist, and while two small hospital wards are used, they are not of the type to command themselves, being poorly equipped, etc. Medical Staff The staff at the time of our visit consisted of one medical officer. It is difficult to understand how one man, no matter how well qualified, could be expected to attempt, much less succeed, in carrying on the work of an institution as large as that of Brandon. It is unfair to the patients, and. more than unfair to the Medical Superin- tendent - that is, if the Asylum is to rise to a higher level than that of a glorified poorhouse. The present Superintendent is a man of many accomplishments, but cannot do the impossible, and the wonder is that serious complications have not arisen, as no human being is capable of carrying on twenty-four hours work a day. As we view the situation, it is undoubtedly wrong to allow such an inadequate staff to attempt to do work that will tax the energies of say four men at the very least. It may be urged that the war has made it impossible to obtain young male practitioners who will be tempted to occupy Asylum positions at the small salaries offered. _ The remedy is comparatively simple, and will oe referred to in another part of the report.. Mur sing Staff The trained nurse is not largely in evidence, although there are two individuals with some qualifications one in charge of the hospital ward, the other on night duty. In other words, the work of the institution is being do re by y an untrained staff. It :>.s so know lodged everywhere that the specially trained nurse ha« been the greatest factor in humanizing hospitals for the insane, and it is to be regretted that this arrangement had not been adopted in. Brandon, Then again, no attempt is made io have female nurses in the male wards - a reform likely to produce the most beneficial results , The male attendants are of the class so commonly found in asylums for chronics, apparently doing their work with some degree of efficiency, but having little esprit de corps. Although most of them wore uniforms, yet the absence of collars in nearly every instance left an unpleasant impression on us, as in a military age such as this, an attempt at neatness seems necessary when a uniform is 170m. Evidently the night service is carefully done, as the number of attendants provided is adequate, providing their knowledge is sufficient. Restraint The amount of restraint used is comparatively small, although serious objection must be taken to some of the forms employed, the cage-likc restraint beds being open to severe criticism. They are not only hideous in appearance, !/ and out of keeping- with the spirit of the age, but in our opinion unnecessary. It would be difficult to supply any adequate argument to justify their continuance. Seclusion is commonly resorted to, and the rooms used for this purpose are offensive, dark, and practically without light. Possibly there are cases of insanity in which seclusion must bo resorted to, but they are by no means common, and with the advent of the wall-trained nurse, seclusion will disappear, and the muff and camisole be^ relegated to the scrap heap. Restraint is abolished in the best of modern institutions. Employment and hydro- therapeutics are found to be the answer to the statement that restraint i 3 a necessary evil. V/e would state that, in our opinion, restraint is an unnecessary abuse. - 15 Department of patients The large number of patients sitting about the wards idle, uninterested, and unemployed , made a most unpleasant impression on us. T .7e felt that the true function of the hospital was being overlooked and that the inmates were not being induced to make the best of 1 their lives. Again the advent of the trained nurse will remedy all the evils attendant on this method of caring for the insane. Very few patients were excited or noisy, and while two or three black eyes were in evidence, there was no reason to believe that they were the outcome of violence on the part of the attendants. hone of the patients, complained of cruelty, and as far as we could ascertain, / there was little or no criticism by the patients of their supervisors . Airing Courts The airing courts at Brandon have the faults these conveniences for apathetic attendants invariably possess. Airing courts, to be justified, must be several, acres in extent, well wooded, and so arranged that the patients must have constant supervision and care from attendants. The moment an airing court is so constructed that an attendant can sit comfortably at a gate and leave an unruly mob of patients to its own devices, the court becomes a centre of demoralisation and disorder. Well wooded grounds without gaol-like fences and walls ere far preferable to such arrangements as those we found at Brandon, Treatment ‘ ‘ ■ ' ■“ 1 ■ 1 1 a A few continuous baths and one electric bath arc available for treatment, Without specially trained nurses and. an alert medical staff, continuous baths are apt to be of questionable value, as they may easily become sources of danger and abuse. However, it is encouraging to find v that they are installed in Brandon, and will be available when the institution is put on a more advanced footing. Employment . A large farm of nearly a thousand acres makes it a simple matter to furnish occupation to a number of patients, but the opportunity is to all appearances not taken advantage of to -the fullest extent, if we are to judge by the number of inmates sitting unoccupied in the wards for men. In the women's wards little industry was in evidence, although -;e found sdmo twonty-tv;o patients at work in the laundry. Admissions At Brandon we learned of the method of admitting patients to all of the institutions for the insane in Manitoba, This method, to which extended reference will be made in another part of the report, is not to be commended, as it really classifies insanity as a crime rather than a. disease, and humiliates both friends and patients. Nationality of Patients It was interesting to learn that of a population of 711 patients resident on June 30th, 1918, only 261 were Canadians - slightly over 36/. 27/ were British by birth, 37/ of foreign birth, 9/ of these being of Scandinavian origin, and 12/ from Austria-Hungary. Discharges Discharges are made largely by the probat imal method, which is an excellent one, although it makes the classification of recoveries. Improved and unimproved, somewhat difficult, as the Superintendent bases his conclu- sions largely on the reports of the friends of patients, a method not conducive to scientific accuracy. After all, what constitutes a recovery from an attack of insanity is a matter of difference of opinion, even among psychiatrists. - 17 Ho spital for the In sane Bate of visit: October lB,19'l8. bolkVrk, This Asylum, which has been in ex I c bonce many year:; , is much smaller than that at Eranrion . It cares for aa. insane of the city of Winnipeg an^ the patients coming from that section of Manitoba lying east of Portage a Prairie. The district from which the Asylum draws its cases can be more accurately defined as a line running not •* 1 at Poplar Point, the northern limit being at Gimley, CAPACIT Y. Accommodation for J+OO patients* At the date of visit 357 innates were being cared for, and during the year there had been 24.0 admissions, and between 240 ana had been discharged as cured or improved. As the p . g bational system of discharge - an admirable one employed, the diagnosis of "cured" is largely maoe in the statements of friends, and cannot be regarded as scientifically accura Two hundred and twenty-three of the cases under rea ■ were males. Bui lding . The building was erected more than thirty years but was well planned as a home for the chronic insane -amply lighted and with corridors which are of good width. tr . and attractive balconies are a feature to be greatly commende , just as the absence of these indispensable adjuncts was to be regretted at Brandon. They are as greet a necessity in hospitals for the insane as they are in jpneral hospitals, and when they do not exist the health and happiness of £he o~ tiente are greatly interfered with. The floors of the hospital were clean", but so much worn that many of tnem should be replaced. Staff. At present Hr. Rice is act in as edical Fuper intendent, 0W «ng to the absence of the former Fuperintendent Dr. Chambers, who has been transferred to Brandon. Br. nice, who was most kind in his endeavour to show us everything about the institution, receives daily assistance ^°m a visit- inc ohvsician, but of course such an arrangement is inadequ. t and unsatisfactory. - 18 - fSA W.fcJ Un ■Mil in wiw n imianH'iiiww* IHHMHHHMiMHIHMMi G r minds . There are about lj.00 acres of land in connection with this institution, and evidently the patients are extensively employed in agricultural pursuits. Occupation. It was p] easing to find a majority of the patients at t Selkirk employed in different occupations, and it was apparent that this institution 3 a a fulfilling its function as an asylum where custodial care was being carried on successfully and with due regard to t he comfort and welfare of those placed there for treatment , 01 course, under such a system many recoveries will take place, specially when the individual is not completely lost sight of, Medical Staff . One Superintendent, and ordinarily one Assistant, con- stitute the medical staff* It goes without saying that such a staff is inadequate where the admissions reach such a large total as 250 in the year* Nursing Staff , This is made up of 3k rials attendants and 23 female / attendants. The trained nurse does not exist here, and the method of supervision is simply that of caring for the patients without a knowledge of the methods of producing the best re- sults with the individuals most likely to be benefited by scientific care and nursing. Histories and Record s. No attempt is made to keeptac curate histories and com- plete records of cases and no stimulus for research exists. Airing Courts . The airing courts are comparatively free from objection as they are large and well wooded, V.'hy It should be "found necessary to use fences is a mystery, as the only function a fence can perform 13 that of enabling the attendants to re- 19 - .j. their vigilance in caring for troublesome and restless patients » Restraint " ■ ■ ' — i> Restraint was not much in evidence. Dr. Rice stated, however, that in selected cases seclusion in small, well- lighted rooms was resorted to, and that a restraint sheet and camisole were sometimes employed. Restraint and se- clusion were under the immediate control of the Superintendent. Treatment. gf The continuous bath is used pretty constantly in cases of restlessness and excitement,- admirable under trained assistants - but of questionable value with employees who have no intelligent conception of itF function, and who are apt not to realize its dangers and abuses. Classification of Patients . In the men's section the patients were divided into four groups; in the women's section into two grouos. / No routine examinations of patients are made on ad- mission. No laboratory equipment exists, and post mortem examinations are rare - six being performed last year. Admissions . Dr. Rice severely condemned the form of admission through the gaol, and after what we saw in the Winnipeg Gaol of the treatment of those unfortunate enough to have to pass through its dreary portals, we can easily understand the cruelty and worry imposed on them by an ill -devised law. Dr. Rice felt that recovery was often prejudiced and retarded by such in- humane treatment, and we concurred in his conclusions. Relationship with Brandon . The Selkirk Hospital is under separate management from the Hospital at Brandon, but since the monthly admissions to the latter institution are small, (only 2 in the last month), many patients are transferred from Selkirk to Brandon. - 20 - Nationalities of patients , During the year ending De cember 1 , 1917* the nationality of patients was as follows Canadian . 71 Russia 15 English. . . Austrian 49 Scotch. . . . 25 Iceland 10 Irish Norway . . . . 4 Ind i a * • . - * 2 Sweden 9 France .... 2 Holland 1 Belgium .. U. S. A*. ......... 12 Germany. . . 5 Since December 1st, 1917* the nationalities represented are as follows:- Canadian 77 Austrian ♦ 50 Holland. . . . . Great Britain 77 Prance 5 Denmark. . . . , Iceland io China .......... 5 Sweden Russia 15 Italy . 2 Roomania ... U * S f JrLm****** + *»* 12 Germany 2 Finland....* Poland ...... Belgium Social Service . Social Service - none. Recreation The patients are provided with 4 pianos, billiard tables, and it was noted that in all the corridors there were pictures on the walls. General Remarks. In some rooms an arrangement of two beds in a room was found. This is a most dangerous practice, and has led to many tragedies in asylums for the insane. IJo matter how quiet the patients, the practice is open to criticism. In small rooms where seclusion is employed the radiators should be covered with locked wire screens, easily removed for purposes of cleaning radiators. HHHNWHM • * Selkirk is on the whole admirably managed as a custodial institution, but totally unfitted to meet the modern demands of a hospital for the insane of advanced type. The manage- ment are to oe heartily congratulated on having achieved such excellent results with such meagre equipment and resources. Portage La Prairie Gaol On October 15th we made a brief survey of the Portage La Prairie Gaol, a clean and well kept building built after a rigid penitentiary plan, the general airing room for men being grated over giving a most dismal and depressing effect, The department for women is little better than a dungeon, depending on electricity for light. Fortunately there was but one female prisoner, a defective girl who is already the mother of two illegitimate children and who should be removed to an industrial school. Her mental age was seven by the Blnet-Simon tests. About a dozen male prisoners were seen, five of them boys, one of whom was a low grade imbecile who had come to Canada as a Barnardo boy; one Austrian was markedly insane and evidenced illusions and delusions. Four boys were reported as having been in the Industrial Home and some of them expressed a preference for gaol life, feeling that idleness was better than being employed. Cer- tainly gaol was not the proper place for these lads and it seemed unfortunate that they should be detained in an environ- ment unsuitable for their treatment. Fine prisoners were examined as to their mental status,- five were defective, one a borderline case, two apparently normal and one insane. Restraint is used with the violent insane, muffs being the form chiefly in evidence, although a tome, what novel and ingenious but cruel apparatus was exhibited as having been employed on at least one occasion. Again it was explained to us that the detention of the insane is but for brief periods . The sanitary arrangements of the cells are excellent, but the lighting is deficient, twelve small windows for seven- teen cells. The prisoners seem happy and are evidently well cared for. There are 34 cells and the punishment con sists of bread and water from three to six weeks. Nationality of prisoners during last year* 1 - Canadian 23 Russian. 3 U. S. A 3 Austrian 10 English 4 Irish 1 Swede 2 Welsh 1 :b t . » r IV* ;'i V. it i ■ « t * r i* r BRAND OK GAOL, Page 24 OCt, 15,1918 Brandon Gaol, Brandon Gael is a much brighter building than that at Portage La Prairie, is well kept and under intelligent manage- ment, The same polite treatment accorded us in almost every institution visited in Manitoba was given us here. Fourteen prisoners were in residence, all males, and of these eleven were examined as to their mental status. Two were insane, one a murderer, the other a chronic case of dementia praecox suffering from sexual delusions which let to his incarceration and the others were defectives of marked character. Perhaps the most severe reflection on the gaol system of Manitoba was the finding of three little boys nine years of age in one of the cells. These children were being detained for a week until some legal process could be gone through. To make matters worse these children were somewhat defective. Brandon gaol has accommodation for I05 male and 7 fe- male prisoners. The same story as that told in the other gaols regarding the detention of the insane was repeated here, and muffs were used where restraint was thought necessary. 21 2 1 5 1 (U4) 84 VI. WINNIPEG GAOL. Pages 25 - 26 Winnipeg Gaol A brief sur-vey of the Winnipeg Gaol was undertaken large- ly with the idea of obtaining information regarding the care and treatment of insane prisoners. In view of the fact that a statement had been made to the effect that, while in theory all insane persons must pass through the gaol as a matter of form, in reality few were submitted to this indignity, it was better to know the truth. Apparently the requirements of the law are lived up to with a rigidity that must impose hard- ships on those unfortunate enough to lose their reason, and when it is stated that sixty-four insane prisoners were committed to the Winnipeg Gaol in the three months prior to our visit, little comment is necessary. Multiply that number by four and compare the total with the admissions to the various asylums during the year, and the belief grows that the great majority of insane persons are passed through the gaols. True, they are as a rule detained for a comparatively short time, but the shock and disgrace imposed on persons who have not even been suspected of committing crime can scarcely be described as a humanitarian method of treating mental disease. Just what happens to the persons incarcerated pending their remov- al is of interest. If they are fortunate enough to be quiet, nothing unpleasant, beyond the humiliation of being confined in a gaol, will occur. If they are disturbed they will be restrained by mechanical means, which are objectionable, offen- sive, and unjustifiable. In other words, we are strongly of the opinion that the gaol authorities should not be called on to undertake the care of mental cases requiring intelligent treatment in a Psychopathic Hospital. Much as we deprecate the conditions as found, we realize that it is scarcely fair to censure the officials who have a task imposed on them which they are not trained to undertake. They simply do their best to meet an awkward situation. In order to arrive at an idea of the mentality of some of the 80 prisoners confined in the gaol at the time of our visit, the officials kindly gave us opportunity to talk with eleven, or as many more as might be desired. Of these eleven, seven were palpably defective and four suffering from different psychoses. One poor girl, markedly insane, was confined in a cell without a bed, the matron apparently not realising that she was dealing with a mentally unbalanced patient for whom punishment was not the proper treatment. Just why this girl was not sent to an asylum, rather than to a gaol where she was serving a sentence, was difficult to under- stand, as there could be no question regarding her insanity. She had Illusions, hallucinations and delusions. Nationality of Prisoners, Tha figures showing tha nationality of the confined in the Winnipeg Gaol for a period of th: furnish some food for thought in connection with of immigration. They are as follows:** Canada Prance Iceland 77 Scotland 2 Wales , . 3 England 110 Italy . . 2 Poland . 21 Galicia 6 Holland 8 2 21 Austria * * . , . Belgium United States Ireland Sweden Russia Assyria 1 Germany 3 Bulgaria Finland Norway Roumania ro h H GRACE HOSPITAL, WINNIPEG One of the most ^leasing surveys mado jn Manitoba was that of Grace Hospital', an institution under the jurisdiction of the Salvation Army, While this hospital is d) ing maternity work in general, incidentally it looks after a very large number of unmarried mothers and their illegitimate children. Only those who have had a broad ^ experience in social field work and in clinics, can realize how difficult it is to accomplish much with the classes to be dealt with, especially when the legal point of view is so different from that of medicine in regard to responsibility; and frames its laws accordingly. The Lady Superintendent of Grace Hospital has a clear knowledge of the problems with which she has to deal, and with the facilities at hand, has accomplished wonders . She fully realizes how important it is for the welfare of the state to isolate the majority of the mothers of illegitimate children and to keep the others under the most constant supervision. The attitude of the general public to the girl who has gone astray is that of antipathy and aversion; few realize that a large percentage of these J are deserving of the deepest sympathy and pity, to say nothing of practical assistance which will prevent them from being exposed to further temptations, and save the state from the care of an increased number of defectives. How important that is from the social and economic point of view, only those who understand the situation can tell. To illustrate this, no better method than reporting the analysis of the mentality of twenty-four mothers of illegitimate children in Grace Hospital at the time of our visit can be suggested. Of these*, twenty-one proved to be mentally defective, one was insane and two were on, the borderline, - truly a striking showing to anyone not familiar with the situation, and yet not surprising to those who know the facts as ordinarily observed in lying— in institutions. As is so often the case, too, the nature of the employment of these girls was similar to that found, in other centres. Sixteen were domestics in towns, four from factories, one a waitress, and three farm domestics. In other words, practically all, if not all, were from poorly paid occupations, and of course some were habitual prostitutes. At once the inexperienced theorist is likely to jump to the conclusion that low wages were the contributing cause in the downfall of these girls, but those who are familiar with the 27 - facts, are vxell aware that these unfortunate are forced by mental disability to choose poorly paid vocations. They cannot do otherwise as they are not in a position to compete j with those of better mentality. For the most part, the twenty-four girls examined belonged to the low grade moron group. The outlook after discharge is therefore dark, unless suitable provision can be made for the patients in farm colonies for the feebleminded. As is apparent, these girls are a manace to themselves and the community as they are likely to add to the number of defectives and also to become active centres for the spreading of venereal diseases. None of those examined evidenced the slightest shame in regard to their condition, and some were mothers of several illegitimate children. The majority were between the ages of fourteen and twenty-one. The foreign born largely outnumbered the native born. Function A considerable number of patients are unmarried mothers. On date of Investigation, of 160 cases cared for 37 were the mothers of illegitimate children. Before admission, a stipulation is made with the patient by means of which at least help support the baby after that . The Lady Super- intendent, Major Paine, has perfected a system by means of which the patient is, when possible, made to fe$l a sense of responsibility for her child, and on leaving the institution, a suitable situation is sought. If the child is in good mental and physical health, adoption is sometimes secured. 24 mrses, There is a training school in connection with the hospital - three years constituting the course. i i^pi ipur J. 4 mi V,. *>£ , it : t »3 je ■ '' i 10 1 ?- $A a ;■!# ■i ■ Building The hospital building is largo, commodious, and well -equipped for the work in hand. In addition to public wards, there are private and semi-private rooms, Tlie tariff for the latter is $2,50 per day and $3 *00 for private. There are excellent facilities for the care of artifically fed babies - breast feeding being adopted for all cases in which this is prudent. Admiss ion The Lady Superintendent confers with all cases seeking admission end satisfies herself concerning the personal history. \ Follow-up work ■V* There is no Social Service Department connected with the hospital, but, as has been stated, suitable situa- tions are sought for unmarried mothers , and salvation Army Corps officers in their respective localities attempt to exert a guiding influence over returned girls in their territory. Correspondence is also employed in some cases. Infant Mortality During the last year, 153 illegitimate babies were born, and there were 7 deaths. The causes of the latter were as follows Stillborn 1 premature 6 pneumonia 1 Nationality of unmarried mothers During the past year the records show the following results : - Scotch . 16 Welsh. . . . Pol \ s h * < . 1 French. . . Icelandic . . . . 3 Finnish. . T r* 1 fsh 6 Danish. , . Canadian. . . . • . 48 Norwegian Arm^v'i nnn . . . A , . 11 Russian, , English . 42 Rut he ri an Pennon . 7 Tndi an . . . Austrian . - 29 - H h h, ■■ si Ages of unmarried mothers during past year h Age 14 « • • 2 Age 24 a * • 9 Age 34 15 • * « 2 25 » • t 7 35 16 m ■ * 10 26 1 i * 6 36 17 * * • ll 27 t ■ • 2 37 ■if 18 » * • 11 23 * t f 5 38 i 19 * ■ ft 19 29 4 * * 4 39 i • * 20 ■ ■ * 16 30 • * * 6 40 21 • • * 20 31 • • • 2 41 i)T* 22 * • * 9 32 * ft 4 1 23 * * * 5 33 ft ft » 1 Survey of Individual Casas Humber of cases examined 24 Mental Defectives . 21 Dementia Fraecox 1 Borderline 2 Nationality of Cases Canadian 10 French 1 Irish 3 English 4 Scotch ... I 3 Icelandic 1 U. S. A 1 Austrian 1 Occupations Domestic 15 Restaurant Waitress 1 Farming 3 Factory 2 Candy 2 C hildren's Annex In a separate building upwards of 25 children are being cared for by the hospital authorities. These children were for the most part illegitimate, and born in the institution. Some of them will be eventually adopted. These children were neatly dressed, clean, and in the best of health and spirits. Apparently every care is furnished. 30 VIII MISER ICORDIA HOSPITAL Fag^js 32 - 33 October I?,l?l8, . - Misericordia Hospital ,Winnipeg. Function A general hospital with 50 beds and an obstetrical division with accommodation for 75 patients. Contagious diseases are not treated. Maintenance. The hospital was built by the Roman Catholic Church, but has really become undenominational although the Sisters of the Misericord© are in charge. The hospital is financed by the provincial and municipal grants for public ward patients and pay patients contribute $1.75 P e r da Y for public ward, and from $ 5,50 to $5-00 per day for private wards. Officers and Management . Mother St, Fortunate is in charge and 15 sisters f act as supervisors of wards. Some of them have had a nurse s train- ing. Nurses . There is a Superintendent of Nurses and a staff of 28 pupils and graduates. Probationers serve 5 months and those desiring a general training remain three years in the train- ing school and receive flp.OO per month. There is provision for a special obstetrical training of a year's duration. Medical Staff . Public ward patients are attended by Dr. Kogan, who lives indoor, but has an outside practice as well, and by Dr. Meindl, who resides outside. Unmarried mothers . At the present time 15 unmarried girls, ranging in age from lip to 50 are receiving obstetrical care. These patients remain in the hospital for 5 weeks following confinement, and are then often sent to St. Herberts Home with their infants, where they remain for 6 months. For others an attempt is - 32 - made to find employment when needed. According to the Winnipeg City Guide of 1918 the mothers of illegitimate children must either pay $100. ,for the adoption of the in- fant or must stay and nurse the child for 5 months, after which time the patient is free to take or leave the Infant. At the present time 6 babies are in the hospital without their mothers. In due course they will probably be sent to Aisle Ritchot Foundling Institution. Social Service . No social service work is done either in locating father of child, or in follow-up work. Building . The hospital building is a well built structure and the wards and operating rooms are clean and fairly well equipped. Survey of Individual Cases . Of the fourteen cases examined, 7 were mentally defective, 4 borderline, and J apparently normal. The borderline oases demonstrated mild defect. Nationality of Cases . Canadian ,8 Scotch 2 English ...2 Irish ............... 1 U. S. A. • • • m • ■ > < ■ 1 Occupation of patients , Domestic 5 Schoolgirl ••••.*., 1 At home 5 School teacher .... 1 Cook 1 Farm 1 Not determined .... 2 Inn- l$r ■ >* . V . .. . Cone ius iohs ~and "fte'eommondat' i o'ns Since the great proportion of unmarried mothers cared for are of defective mentality It Is evident that farm colony care is needed after departure from the hospital. Note, No yea r iy report is made.. * 35 Survey of Industrial Training School Portage La Prairie. This institution was visited on two occasions, October 8th and October 15 th, 1918. Function The training school receives boys committed by the courts, for delinquency, from Manitoba, Saskatchewan, and Alberta. The beys range in age from 10 to l8. The usual sentence is 3 years. The institution is a correction- al and custodial one. Maintenance, etc . The institution was built by the Manitoba Government at an expense of upwards of $300,000. It is maintained by the Manitoba Governmeht , but Saskatchewan and Alberta pay the per capita cost of their cases. The latter amounts at present to approximately $2*5^ dayj Staff J A principal is in Change. At the present time Rev, F. W. McKinnon holds office; Mr* McKinnon was a Baptist clergyman and is thoroughly interested in the boy , problem. He keeps in touch with recent developments iil other parts of Canada and the United States. ke has been par- ticularly influenced by the work of Mr. Osb orhe ; formerly df Sing Sing Prison, and believes In self-governmerit and the granting of a large measure of freedom, with the boys pladed upon their honour. Mir. McKinnon deplores the fact that, owing to the nature of his main building, he is unable to segregate the boys according to age, mental capacity, and nature of delinquency. He holds that for the purpose of his school the present plant is unsuitable, a nd that an organiz- ation built upon the cottage plan would be much superior. The principal has a staff of 21 assistants. At present he has but one teacher; formerly he had two. There are in- structors in tailoring, carpentry, baking, farming and dairy- ing. 34 Buildings . The plant consists of a large, modern, attractive-look- ing administration building, a modern, well equipped school, a building devoted to occupational teaching, a barn, stables, and a covered rink. The main building contains offices, waiting-rooms for visitors, private quarters for the staff, kitchen, a dining- room for the boys, reading-rooms, dormitories, assembly hall, etc. There is accommodation for 175 boys, but at the pres- ent time only 8l are cared for. On this account a number of the dormitories are not used. The school building contains 1+ class-rooms, but only two of these are used. In fact, one cla ss-room is all that is necessary for the present number of boys who are receiv- ing instruction. In the basement there is a swimming pool and the boys are given an opportunity of using this every Saturday. On the top floor there is a large assembly hall. This was in- tended primarily for entertainments such as concerts, moving picture shows, etc. The building devoted to occupations contains rooms for tailoring, carpentry, and boot-making. In addition there is a heating plant in the building. The barn and stables are modern structures, and the latter houses many horses and cows. Ground s . The school is situated on the outskirts of Portage La Prairie, with a large artificial river in front. Some 300 acres belong to the institution and are used for gardening, farming, and pasturing. Instruction, discipline, &c . Most of the boys who have not completed the 8th grade in the schools receive instruction for half of each day in the primary school. The teacher in charge takes a keen int- erest in her work, and was able to give a good account of the various characteristics of her pupils. As has been mentioned above. Instruction is given In tailoring, carpentry, baking, farming, and dairying. Until recently a boot -maker was also on the staff. Fince the boys are committed to the institution for 3 years, it is possible for many of them to leave the institution fairly well trained in one of the various occupations mentioned. The principal feels, however, that the 3 year limit should be ex- tended to 3 years. As far as discipline is concerned, the principal resorts to the plan of giving boys the utmost freedom, and, as has been said, he places them on their honour. Occasionally boys escape, and it is stated that when they return the measures taken are not sufficiently harsh. It was interesting to learn, however, that two boys who recently escaped and who were again charged with burglary, requested the Judge to send them to the jail in Portage La Prairie rather than return to the Training School. Unfortunately this was done. The apparent reason for the attitude of the boys lay in the fact that they would be made to work at the school, whereas the jail seemed to offer chances for idleness. A boys' court is held in the school, with the boys acting as judge, attorney, jury, etc. Survey of Individual Cases . Number of cases examined 26. (Only boys suspected of mental abnormality were referred for investigation. ) Classification of Cases Apparently normal 4 Mentally deficient 10 Borderline, ( cases so classed because of in- tellectual retardation, emotional or volit- ional defect, but in whom abnormality is not sufficiently pronounced to definitely class with data on hand as mentally deficient or insane 9 Primitive 1 Epilepsy * Dementia Praecox ? 1 - 36 M J Austrian . 3 Indian 1 English 2 Nature of delinquency among abnormals Incorrigibility 2 Bu.rg7.ary , ... 1 Theft , S Horse stealing .... 2 Vagrancy 5 Murder. ............ 1 Assault 1 Summary and Conclucicris Twenty-six decimal sixty-six percent, of the cases cared for are abnormal mortally . It Is evident that these boys should not be sent on parole at the expiration of a 3 year sentence. Undoubtedly these cases should not be allowed to mix with boys of sound mentality* It also seems wise to segregate the majority in an institution caring for mental abnormals . The nationality of seventeen of the twanty-six abnormals was determined, and demonstrated that eleven were foreign- born, The attention of the Federal authorities dealing with immigration should be brought to bear upon this important finding. Since the institution is less than one-half full, since it Is unsuitable, according to the Principal, for the partic- ular needs of delinquent boys, since the per capita cost of $ 2.50 per day Is prohibitively high for the nature of the work In hand, and since there is reluctance on the part of Winnipeg, Saskatchewan, and Alberta, to commit further cases, it there- fore seems prudent to consider the advisability of using the institution as a training-school for the feeble-minded. The lay-out of the buildings reminds one of the training-school for the feeble-minded at Waverly, Massachusetts, and it would appear that a comparatively small amount of money would make it suitable for the care of the defective class. This matter will be fully discussed when making recommendations for the improvement of conditions a t this school. - 37 October 1st. SURVEY OF SALVATIGI ARMY INDUSTRIAL HOMS Function An Institution for the reception of delinquent girls referred to it by the Courts, the Children's Aid^ Society, various other organizations and also by individuals . Building and grounds The building is a modern brick structure, four and a half storeys in height, with fire escapes and other devices to secure the safety of the inmates. Six acres of, land constitute the grounds which furnish a certain amount of occupation for the girls under detention. As the Home is comparatively near to the city, and the gnonnds are unfenced, it is difficult to have proper supervision of the inmates and escape is a simple matter. Accommodation There is accommodation for forty girls. Present number of inmates Sixteen. Occupation Those who are able, do a little farming, knitting, needle and laundry work for the Home, but there is no systematic attempt to teach useful industries. The laundry is located in a small, cold room, and is not equipped, for 'work on a largo scale. The sta.il is made up of a matron and. three assistants . 38 - Summary of investigation (a) Mental defectives discovered..,.*. 6 Borderline cases, (These are cases in whom intellectual defect is not pronounced hut who could not he considered normal because of immoral tendencies and who need constant supervision/..., 4 Apparently normal. (Cases that might he placed on prohat ion under supervision) 4 Drug Habitue (who is probably also suffering from a psychos is 1 Dementia Praecox and defective... 1 (b) Mentally abnormal girls who are immoral * 4 (c) Mentally abnormal girls who had illegitimate children. 4 (d) Mentally abnormal girls who are guilty of theft. 3 (e) Mentally abnornal girls who are disobedient and incorrigible 3 (f) Mentally abnormal girls who are vagrants... 1 (g) Nationality of mentally abnormal. British born 4 Welsh (Barnardo Home girl)l Other data not included in above Organized 8 years ago. There are voluntary admissions. Parole is granted. Statement is made that sane are kept indefinitely if a home is not available. Institution is not self-supporting. Saskatchewan contributes 50£ per day per girl. Manitoba contributes $10. per month per girl. Winnipeg contributes $1500. per year. 39 - ivnowaw^ 'wnttai . ft. * l- r>w(i Salvation Army Headquarters contributes $45. per month. Knitting produces an income of from $7. to $8, per month. Sleeping rooms - 1 to 2 beds , One workroom, approximately 15’ by 20'. One very small reading room equipped with a library of a do sen books . Wo facilities for recreation. i [■>) 1 , Conclusions and recommendations (a) The Home is unsuitable to give the training and care needed for its six mental defectives. (b) The case of mental deficiency where insanity also exists should be cared for in a hospital for the insane. This patient is violent at times, and on one occasion attempted to strangle an inmate. She is suicidal, is locked in her room, and is apparently without occupation. (c) The drug habitue (morphia), although 3een occasionally by a physician, should be treated elsewhere. She Is a bed patient and locked in a small room. (d) One of the mental defectives discovered was a low grade bed-ridden epileptic imbecile. She was also locked in her room, and needed medical care in a hospital for the feebleminded . (e) Since 75# of the 16 inmates are abnormal mentally, it is evident that all future admissions should be subjected to a psychiatric examination. In the past, such an examination has not been available for this or other institutions in or around Winnipeg. (f) While this institution is not suitable for mental cases, nevertheless, abnormal girls are better cared for here than would he the case if allowed to roam at large. Provision is not made, however, for continued care. Court cases are discharged at the termination of their sentence, and thus it happens that one girl (mentally deficient), convicted for theft, leaves the institution tomorrow. She will probably return to delinquent practices . - 40 - (g) All othar mentally deficient cases will no doubt sooner or later be sent adrift from the institution. It is not difficult to anticipate the result in such cases . — - XI home op the good shepherd. Pages 42 ~ 43 Survey of "The Home of the Good Shepherd" October 5th, 1918. Function, A Home maintained and operated by the Roman Catholic Church, for delinquent girls. The cases are referred by the Juvenile Court, Children's Aid Society, other organiz- ations, and individuals. Building and Grounds . The building is a fairly modern structure with accommo- dation for at least a hundred cases. In addition to dormit- ories, sitting rooms, kitchen, etc., there is a large assembly hall, and a work-room equipped with motor driven sewing machines . There are several acres of grounds surrounding the building, and these are used for growing vegetables, flowers, etc. The grounds are most attractive, being situated on the shores of the Red River, Instruction W" 1 - J.l Survey of Individual Cases. Number of cases examined 1^.0 Number of mental defectives found 8 Number of borderline cases "A" ( so classified be- cause of abnormality in emotional and volitional field, and needing close supervision and training for an ex- tended period > 12 Number of borderline cases "B" ( so classified be- cause of marked mental retardation, but backwardness not sufficient to definitely class at present as feeble- minded - cases needing special training and continued supervision 6 Number of cases suffering from Dementia Praecox.* 1 Number of cases apparently normal 13 Nationality of fcentally Abnormal Cases . Canadian 16 Austrian 3 U. S. A. 2 Scotch 1 Ruthenian * 1 Not determined 3 Nature of delinquency of mental abnormal s . Vagrancy Theft Incorrigibility Immorality Dependency Forgery Illegitimacy ......... Undetermined Summary and Conclusions Fight of the children in the home are definitely feeble- minded, and probably a considerable proportion of the border- line cases will eventually prove to be feeble-minded. There is one case of Dementia Praecox. Special orovision should be made for the above cases in institutions designed for their special care. There is also need for a routine psychiatric ex- amination of all cases admitted to the Home. - 43 ra SSIfe / XII C H ILEHEH ' S AID SOCIETY, W I N N I PE G . Page 44 BWI— Children’s Aid Society, Winnipeg, Object of Soci ety: To protect children from neglect of parents, to remove children by order of the Juvenile Court when nec- essary, to find homes in good families for homeless , neglected or destitute children when made wards of the society, and so long as warns of the society to supervise the foster homes in which they are placed. Financed by Provincial Government, Municipal grants, and pri- vate contributions. Secretary - IV. A. Weston. Building : The shelter is located at 301 Mayfair Avenue and is an old building in a poor state of repair. It was noted, for instance, that the ceiling in the hospital section was leaking, and we learned that the plumbing had needed attention for some 6 months. The Board of the Society has recognized for some time the inadequacy of the present plant, and has advocated the purchase of a suitable parcel of land situated on the outskirts of the city, where a permanent and suitable shelter could be erected on the cottage plan. Managemen t: The matron had been newly appointed, and apparent ly was not familiar with the work. She had 2 nurses assist- ing her. Schoo l : The children attend the Fort Rouge School during the day time. General Condition of the children: The children were for the most part poorly clad and neglected looking. This may be accounted for to some extent by the fact that the matron had been newly appointed and was not familiar with her work. Study of Individual Cases . Apparently normal 15 Borderline 5 Backward 1 Undiagnosed 2 ■ asps jk -• — October 2nd., 1918, SURVEY OF JUVENILE COURT DETENTION HOME, WINNIPEG. Building This Homs is part of a structure built for the Care of the. Deaf and Dumb of the Province, It is located in the heart of the city at the corner of portage Avenue and Sherbrooke Street. The building provides rooms for the Detention Home and the Juvenile Court, end the University of Manitoba uses a portion of it. While the building is old, the quarters for the Detention Home are commodious and attractive . The basement contains boys 1 play room, locker room, class room, & c, The ground floor is taken up by a kitchen, school room, dining room, and office for the Superintendent, On t.Le first floor, there are work rooms, dormitories, lavatories, for the girls, while the third and fourth floors are devoted to dormitories for the boys , Grounds The grounds are of fair size and provide sufficient space for various outdoor sports, such as baseball, football. Sec. A high fence surrounds the property in the rear. Staff Superintendent Matron Boys 1 Worker Girls' Worker 2 teachers (supplied by the Board of Education) 2 maids The Superintendent and his wife (the matron), show capacity and ability in dealing with the children under their care. They and the Boys' Worker are Officers in the Salvation Army, Religious exercises play a prominent part in the daily routine. - 45 - u Maintenance The Kerne is maintained and supervised by the Manitoba Government. 4 Function of the Home The Detention Home receives cases from the Juvenile Court, and aims at being a correctional Institution. Length of sta y in Heme For the most part cases are placed in the Home by the Judge of the Juvenile Court, for indeterminate sentences. Length of residence is determined more by the needs of the individual than by the nature of the offence. Boys are generally detained from six. 10 nine months, while girls are Occasionally detained for as long a period as two years. Educational facilities Practically all of the children attend school during the morning and afternoon. (The sexes are mixed in the classes). Because cases are detained for a period of months, it is possible to make the school classes effective. particular attention is given in the school to those of foreign birth, so that a knowledge of the English language can be obtained. In the basement there is a carpenter and cobbler shop. Definite instruction, however, is not provided- The girls are taught in the household arts, so that when they leave the institution, they can take up domestic work. Parole System When children leave the Home they are placed on parole, and at the present tine about sixty report weekly. Survey of individual cases Forty-nine., children (23 girls and 26 boys) were studied, and results are as follows Summary of me nt. al exsminat i ons Mental Defectives. 20 Borderline cases 13 Apparently normal is Proportion mentally abnormal 69*38^ Number of girls apparently normal 6 " " 11 mentally abnormal 23 Immorality atfeong girls who are mentally abnormal 13 Immorality among girls who are mentally abnormal and under 16 years of age . ,12 % Number of boys apparently normal iq " " mentally abnormal 16 Mentally abnormal guilty of theft ....16 II II " " shopbreaking 3 „ vagrancy 6 ” " " setting fire 1 „ ' 'I II incorrigibility 3 unemployment 1 !l suffering from venereal disease .... 1 Nationality of Abnormal s Canadian 12 British 1 Polish. 3 German 1 Austrian 7 Russian... 5 Scotch 3 U.S.A 1 Proportion of mental abnormals who are born outside of Canada Recidivism among mentally abnormal delinquents First offence 11 11 *' 11 Sumnary and Conclusions The institution is well conducted and is sufficiently equipped to perform a useful service for juvenile delinquents . The plan of having the Home in the same building with the Juvenile Court, and having it centrally located, works out advantageously. The growing heeds of the institution, however, demand in the near future much larger quarters than are at present available , and a site should be sought at an early date on which a building suited to the exact needs of the organization could be erected. Since 63.33/' of the cases cared for are mentally abnormal, and since methods suitable for the reformation of normal childrem will be of little avail for this class, it is evident that a Home of temporary detention is not suitable for the majority of the inmates. The Detention Home could, however, be used to advantage as a clearing house for the abnormals referred to. There is urgent need for routine psychiatric examination of all inmates of the Home, and there should, of course, be provision for the abnormals in suitable institutions throughout the province. It is learned 'with satisfaction that in the near future, psychiatric examination will be obtainable. It is pleasing to note that all children are medically inspected from the physical standpoint, and in the space of one month, some dozen or more cases were sent to the Hospital for needed surgical treatment . At the present time, no attempt is made to segregate the cases, except that the sexes outside of school hours are placed in separate quarters. It seems unwise to have a girl suffering from Venereal Disease kept in close contact with others. In addition, some of the mental abnormals examined should be separated from the normals. The survey also brings forcibly to attention, the large proportion of mental abnormals who are of foreign birth (63.63/j). The Federal authorities should be apprised of this startling fact. Of the twenty- three girls in the institution, twelve under sixteen years of age were mentally abnormal, and 48 guilty for the most part of grave acts of immorality. Most of these cases should be classed as actual prostitutes. There is little doubt that when they are again freed from the institution, they will continue lives of vice. This again v ' points to the urgent need of suitable farm colony care for the feebleminded. XIV ffy ■ c jri JUVENILE COURT, "'INNIPEG pages 50 - 52 Juvenile Court, Winnipeg. Established in 1908 Jurisdiction - Department of Education and Provincial Govern- ment . Judge: Hon. D. W. Mclierchar . Associate: F. J. Bllliarde. Individuals dealt with: any children under 16 years of age, and adults contributing to juvenile delinquency. Sittings of Court: Court sits at Detention Home on Monday and Thursday at 2 .JO p.m. Object of Dep ar tme nt: The enforcement of the Juvenile Act in the city of Winnipeg and of the Children's Act throughout the province. These Acta are devised to protect children from vice, crime, ignorance and cruelty. Number of coses dealt with in year ending June 30 , 1918 : 879. Percentage of recidivists among delinquents appearing be- fore the Court during year ending June 30,1918: 18#. Tne Juvenile Court, under the direction of Judge McKerchar, is doing useful work in the city of Winnipeg. (During the last year its sphere of influence has been ex- tended by law to half the Province of Manitoba). To determine the mental s tatus of juvenile offenders appearing before the Winnipeg Juvenile Court, 65 consecutive cases were given a mental examination in October 1918 , with the following results: - Girls examined 10 Boys examined . ... 55 Mentally deficient found .... l£p Dementia Pr&ecox 1 Borderline 21 Apparently normal 27 Nation ality of cases examined Canadian English , Austrian Brazilian Scotch . , 29 5 9 1 5 Irish 2 Russian American Polish . k 7 1 Nature of Offences . Theft Vagrancy .... Shop-breaking Truancy Trespassing . It will be noted that 2 ?% of the children examined were mentally deficient, and in need of farm colony care. There Is no doubt that these children are unsuitable for the or- dinary method of probation adopted by the Court. It is pro- bable that of the l8>;. of repeaters appearing before the Court during the year ending June 30,1918, that a considerable proportion were of the defective class. Judge McKerchar draws attention to the fact that during the first year that the Manitoba Temperance Act was in force the number of neglected and dependent children dealt with Immorality .... Incorrigibility 1 Number of Offence s 1st offences Repeaters . . Summary by the Juvenile Court was less than the number dealt with during the last year of the licensing system. When Manitoba makes provision for feeble-minded delinquents the number of cases appearing before the Court will be still further re- duced. Twenty-one of the 65 children examined were classed as borderline. These children were not mentally defective or insane, but were psychopathic In that they were for the most part of an unstable irresponsible make-up. These children are in need of constant supervision and individual attention. Under such a regime some of them could be con- verted into useful citizens. It is interesting to note that over 55# of the 65 consecutive cases examined were children of forelgh birth. XV SOCIAL WELFARE C (mil S SION , WINNIPEG Pages 53 - 54 SOCIAL WELFARE COMMISSION; An arrangement was ma.de with Mr. G.B. Clarke, Sec'y of Social Welfare Commission to make mental examina- tions of various individuals receiving financial aid from the City of Winnipeg. The studies made, indicate that feeblemindedness is one of the problems confronting Winnipeg in its city relief endeavors. A striking example is that of the family. Report of e. f&frily : - This family came to Winnipeg from Le Pas in 1916. Since November 1916 to September 1918, $1,168.81 had been spent on this family by the City of Winnipeg. Every method has been used by the social agencies interested, to make the B's. self-supporting, but all efforts have been in vain. The home conditions have invariably been dirty and unhygienic. Report of individual members of the family Mrs. B . Nationality Canadian; mental condition feebleminded. She is a careless woman, neglects her children, and has no idea of housekeeping. Mr. B » Age 49, Canadian, has been unemployed for two years because of "Rheumatoid Arthritis". Has always been unsteady, lasy, indifferent, but is a somewhat higher type intellectually than his wife. Is at present on a homestead. Beatrice g . Age 17. She is a careless girl, irresponsible'," and has been unable to keep a position as housemaid. -Mental condition feebleminded. Recommehdat ion - needs instituti onal c are . Margaret B. Age 15, epileptic and mentally deficient, and has been in the Detention Home because of sexual immorality for which money was received. Apparently she is devoid of moral sense. Recommendation ~ institutional care . deficient Elsie B. Age 11, intelligence quotient 75, mentally . :v* . . . w . . i M ' i . 53 Bessie 3 . Age 7, left internal strabisums , sneech defect, r at he r s t up i d looking, intelligence quotient 75 plus; diagnosis; borderline case. Kat hleen B . Age 5, cari walk and talk and partially dress herself. Diagnosis - judgment postponed. Charlotte 3 . Ago 19 months, apparently normal. T. family This family receives £40, a month from the City. Report on individual cases. Mr. T . On June 14, 1918, Mr. T. was committed to the Penitent i ary at Stony Mountain for a period of three years According to his wife, he has been alcoholic and subject to attacks of great depression. !To mental examination of Mr. T. has been made. Mrs, T . a somewhat neurotic woman, but with no evident signs of mental abnormality, Ralph T . Aged 9. Walked, at 5, talked at 5. At present cannot dress himself. Diagnosis - Mongolian Imbecile Recommendation - special farm colony care, Murmyn T . Age 15. Reached grade VIII at school, and is at present employed by a druggist as messenger at $8. per week. Ho is of the seclusive, restless and unstable type. Is possibly developing Dementia Praeco::* Recommen- dation - Psychiatric supervision Burdette T. Age 10. Reached grade V in school. This boy is active, restless, boisterous, and is quite uncontrolled by his mother. Intellectually is alert and has an intelligence quotient of 75 plus. Diagnosis deferred. Summary of T. case. It is quite probable that Mr. T. is insane, and this may account for the appearance of mental abnormality in the children. The City of Winnipeg would be spending its money to better advantage by maintain- ing Ralph in an institution for the feebleminded, and by supn lying psychiatric supervision for Murmyn, rather than supplying Mrs. T. with money as it has in the past. SURVEY OF October 12th, 1918. MATSON SAINT JOSEPH, OITERBUftTS, KAN. Function This Horae cares for boys between the ages of 12 and 21* It receives its cases from the St, Joseph Orphanage (one half the cases), and from Roman Catholic homes that desire to give their sons religious instruction. In addition, boys who have been placed in homes after leaving St, Joseph's Orphanage and who have not made good, are cared for in this institution. The school attempts to furnish an education in primary school work, and to give the boys farm experience. Two boys are engaged in the blacksmith shop, two in the bee industry, and six in dairying. It is hoped than when the boys leave the Institution at the age of 21, they will be able to engage in the industries mentioned* Maintenance, etc . The Home was built and is maintained by the Roman Catholic Church. The staff is recruited largely from the St. Viateur Order of Quebec. The Home does not receive any support from the Manitoba Government, Staff A Father of the St* Viateur Order is in charge. There are two male teachers for the primary school. There is a staff of clerical and lay Brothers who attend to religious instruction and farming. Building and Grounds The main building was originally a wooden structure, but has recently been given a brick veneer. The interior is slowly undergoing reconstruction. At the present time, it is In a state of baroness and Is in poor repair. This building contains private quarters for the staff, one school room, chapel, one dormitory for more than 34 hoys, a recrea- tion room, kitchen, etc. The schoolroom and chapel are poorly ventilated, tout measures are toeing taken to remedy this. The dormitory is too small for the number of boys. Five hundred and fifty acres of land, with 300 acres under cultivation are attached to the school. Some $12,000. has been spent on modern agricultural implements. Instruction Thirty- two boys are given instruction in school work. An interesting feature in this connection lies in the fact that all instruction in the morning is given in French, and in the afternoon in English. Since some of the boys can speak neither French nor English when they enter the institution, the present system presents obvious disadvantages. Two-thirds of the boys who receive instruc- tion have had very little previous education. After a boy reaches 14, it is optional whether he attends school or not. Veryfew choose to remain in school, because if they work in the fields they receive $26. per month, although one-half the salary is kept for past maintenance. There is no actual instruction given in farming or any other occupation. The boys, however, have an opportunity of becoming partially trained by actual work on the farm, in the dairy, the blacksmith shop, and in the bee industry. Parole Boys leave the institution at 21 years of age, and after that there is no supervision, although correspondence is kept up in certain cases. Survey of individual cases At present 6? boys are wards of the Home. Of these, 18 are engaged in farm work, while 34 live in the Home. The 34 boys were classified as follows - 56 - Apparently normal intellectually Mentally Deficient ............. Backward Borderline 15 10 6 3 Nationality of mentally abnormal g Canadian 6 1 1 1 1 1 2 English French Canadian TT R L Conclusions and R e c onmendnt 3 on e Ten of the thirty-four cases examined were found to be mentally deficient „ and it is recommended that the majority of these individuals be placed in a suitable farm colony for the feebleminded. The present system of train- ing is unsuitable for this class . 57 The Euetterite Colony. A survey was made of the Euetterite Colony at Bernard. It was felt that these people might furnish an Interesting psychological study, and from the information furnished it wss supposed that the amount of inbreeding said to exist would show a defective and weak type of people. We were accompanied in our visit by the Secretary of the Manitoba Public Welfare Commission. The community v-e visited is located on a part of the 9J4.OO acres recently acquired by the Colony, and con- sists of about one hundred individuals. ” T e met the "Boss" Farmer, and the Read Preacher who are in authority in this particular community, and from them and others gleaned much interesting information. Contrary to expectations the colonists oroved to be of fine physical type, and alert ment- ally, They live in communities, are conscientious objectors, and the individual subordinates everything to the demands of the community. The Huetterltes are expert farmers, and as their religious ideas discourage all earthly pleasures, the greatest expendit- ures of money made are for the welfare of their horses and cattle, of which they own large numbers. They are evidently thrifty and were able to pay f 500,000 in cash for their pro- perty. The children, whose name is legion, are brourht up to speak German and English, and German is evidently the language preferred by these new importations to Canada, originally they emigrated from Russia, near Odessa, in 187 ^-, because of their objection to undergo military service. Evidently they left the United States to come to Canada for a similar reason - and it is apparent that they expect to avoid con- scription here. Their community sleeping home is not calculated to give one the impression of comfort or reasonable privacy, and when it is found that eight persons are assigned to „ r> nnm lg y 20, it can be understood that the sanitary con- ditions are far from ideal. These people are anxious to conform to the laws of the land as far as they can consistently accommodate tneir re— + theories to the whims of legislators who demand that the Huetterlte children shall be educated in Public schools. As all amusements are forbidden, the children are abnormally grave ana serious, and as their dress is the exact counterpart of that adopted by their parents, the Colony seemed peopled with a most serious minded populace. These good horses machinery - discussions hot neglect Intel l igent immigrants have magnificent barns and stables and caws, find up-to-date f arming imulements and in other words, in spite of their never ending on the subject of the joys of heaven, they do° the material prosperity to be achieved by an tilling of the soil „ + , community idea is carried out consistently, but s ?£ la i s g? oture 01 thls Colony is not calculated to develop the beet type of Canadian, as it is so out of touch with the traditions and aspirations of our race. M The men and women are baptized and married when ey are eighteen, and as they are a comely race the children ar S abt T activs and Pleasing. Inbreeding is denied although it is difficult to see how it Is avoided where the whole Huetterlte sect only numbers about a thousand individ- uals. At all events we saw no marked evidence of defect or mental disease, and very few physical imperfections. t . fl " e that i-t was a mistake for Governments to allow the community system to prevail, as it is so opposed to the + n lc.«?i?T e +I S + £ f ” ur .P e °P le ana makes It much more difficult to assimilate the Immigrant. 59 , XVIII EAST KILDONAN HOMS FOR THE FEEBLEMINDED pages SO - 32 SURVEY OP EAST KILDONAN HOME FOR THE FEEBLEMINDED Administrat Io n The Home is maintained and supervised by the Manitoba Government. History of Home The Home was opened on December 1st 1916. Previous to that time there had been no institution set aside in the Province for the care of the feebleminded. At present this is the only institution for defectives in the Province. Function The Home receives cases of feeblemindedness only which have been duly certified by one physician and committed by the courts. All the cases at present in the Home have been referred by the Children’s Aid Society. Staff The staff consists of a matron, a cook and a gardener. The matron is an intelligent woman who has had previous experience in caring for normal children as matron of the Knowles Home (an undenominational institution for the care of dependent and neglected children). The matron has had no previous experience with the feebleminded, but has adapted herself very well to the work in hand. Building and Grounds The building is a small brick house which was erected several years ago by the Presbyterian Church as a Women's Home. On the ground floor, there are a sitting room used as a workroom by the girls, the Superintendent's office, a dining room for boys and girls, and a kitchen. On the 60 second floor there are several bedrooms for the girls (one to three beds in. a room), a bedroom for the c o oh and one for the matron, also a washroom. The boys have a washroom to them- selves and their bedrooms are on the third floor. Ten acres of ground surround the Home and for the most part is tilled by the boys. It is used as a vegetable garden. Education and Occupation No regular classes in public school subjects are conducted in the Hume, the matron, however, attempts on odd occasions to instruct the brighter children in primary school subjects. The girls are taught needlework and general house- work. Specimens of the former were presented for inspection and demonstrated that the girls had made excellent progress along this line. For the most part, the boys are occupied in gardening and chores around the Home . Separation of the Sexes The boys and girls eat at separate tables in a common dining room. Arrangements are made, however, for them to eat at separate time. As far as possible the sexes are kept apart but there are no facilities in the Home to absolutely insure this. Survey of Cases At the present time fourteen children are cared for and apparently there is not room for further admission (7 boys and 7 girls ) . Summary of Cases The fourteen children cared for are all defectives, eight are imbeciles and six morons. The number of girls who were immoral - two. One girl was guilty of setting fire to a building. 61 Nationality of Cases Canadian . . H English . . . , g French i Summary and. C or. c Ins ions An inspection of this Home gives one the impression that it was inaugurated simply as a temporary expedient. It accommodates but 14 cases and. facilities are meagre for adequate training. The six morons present in the institution.'' should be given the advantages of primary school education, but this unfortunately is not afforded in the Home. yhen the weather is inclement and it is impossible to allow the boys to go out-of-doors, there seems to be no place for them except their own bedroom or the dining room. No attempt is made to teach the boys a trade; this seems unfortunate. Since two of the girls have been guilty of immorality and as all are over 17 years and under 23 years of age, it seems unwise to have no definite precautions except the vigilance of the three attendants to keep the sexes separate. It would be quite possible under the present arrangements for a boy to enter a girl's room at night unnoticed. Even if no actual immorality were to occur, it does not seem fair to have the sexes in such close proximity. Apparently cases have never been received as voluntary admissions . Mention was made of the fact that primary school education is not available for the higher grades and that trades are not taught the boys. If the reverse were true, it might be possible to discharge a percentage of the cases referred to when adult life is reached. Under the present system, custodial care for life is the prospect. The present Home cannot even be considered a nucleus for a larger undertaking on the present site. The Manitoba Government would be well advised to start afresh on extensive property with buildings erected for the definite needs of the special class under consideration. H HCMS FOR INCURABLES AND OLD FOLK'S HOME PORTAGE LA PRAIRIE Tiie 1 ? os ^' painful and. distressing survey undertaken Tri"' 0 w? w6r f in -Manitoba was at the so-called Home for ” t he U f Sst “ nT'rl^ aS 6 o La Pralrie * Two visits were made, as we tlv + c b j:>e f 3 j ISIS, the second on October 15, 1918, nwt L ' 13h t0 labour under any misapprehension in blSg d ,^ Jff! seen there «, .The name. Home for Incura- + *■> i loadixig, aiid the Institution has beccsne a r^cen- ex£eS <, ,? 0r 4 Very ’ Clnti ° f ailmont ’ - as of our party expressed, it, from eczema to dementia". Apnarentlv anv * old 1 or ln !ianit ? oa ' 7 hich had a troublesome member, either untii thi™^ pass3d dt on to the Home for Incurables of 1 idiot l po ? SSSS3d an ^hapoy conglomeration ldlots > imbeciles, epileptics. Insane, seniles, and men - i-^lly normal people suffering from incurable diseases Of course this state of affairs is the outcome of the waAt of Px op m institutions in the Province to care for the different classes represented, but it is difficult to realize the affnfl°f ir 5 Spe ? tim Whlch all °^ such a condition of ^r/this • That insane Pe«Ple should be housed 0 au i nn “ tUt 1 f 1 l % astonishing, as it is devoid of any equipment . or caring for cases of insanity. The result has been tragic in the extreme, and we may Bell pass by -t ? m b~ 8 ..S e + ails o: ”•'** might be the unpleasant task of sc. ibing v.'hnt '.e saw, knowing that the Government will take immediate steps to put an end to the abuses existing. General. 33 7 ^ ’° r L ° maae here, drawing attention to the fact that many w inn Ip =g school chilaren have spent their early years on the f??m and have not had adequate school advantages. In many cases the public school has been many miles distant and it fre- - 68 - I-* H< VNvji.fr- quently happens that a child of 10 or older comes to innipeg without having received any previous schooling 6. Language . . a11 the children present in Elmwood School can speak English although the great ma jority come from f ore ign ^ homes ♦ In days before the war, when immigration . was active, this school and many others received children who were unfamiliar with the English language. 7* School Buildin g. The school Is a wooden structure, and quite below the standard of the average school building in w innipeg. Until recently it was outside the city limits, and was built by the county. 8 . Investigation of individual cases . Number of children inspected 2l+ J Number of individual cases given a mental e xam ina t i on 1 6 * ■ Intellectually deficient; (included under the head of intellectually deficient are those children who are dull, backward in their studies, and whose intelligence quotient is less than 75. An investigation into family and personal history may reveal the fact that the children are actually mentally deficient. Home investigations will be made in these cases, and data supplied) ,7 5 Emotionally deficient ( psychopathic person- ality, possibility of Dementia Praecox 1 Borderline, ( intellectual retardation marked, but not sufficient to class as intellect- ually deficient) 1 Backward 11 Percentage of mental abnormal s - approximately 2% 9 • Nationality of Cental Abnormals. Canadian 2 Galician , , , . . 2 Polish l 1 0 . Conclusions and recommendations . presence oi five mentally abnormal children in a school of 21; 7 warrants a routine psychiatric examinat- r ° d& te no psychiatrist has been attached to the .Winnipeg Public Schools, although there is medical insoect- lon. . ft i«Pst three of the five abnormals should receive instruction in a special class for backwards and aeiectives. Two such classes already exist in the Winnipeg s c no ( ) l s . i« . 'i ■ v i , "■ v. i ■“ ■ Laura Pecord School Principal - Mr. a. G. McArthur School population - 776 Nati^llt^j^^school Children - Canadian for the most part. F§i l s C " n | ~ Z th ® children come from better class of an^siiccessful business ^ ^ Purvey of 495 cases. Number of children examined 25 Apparently normal Backward , 7 Mentally deficient 3 Borderline g Percentage of children mentally deficient ? The Home for the Friendless ,7/innipeg •p October j.8th, 1918, we paid a visit to the Home i or t.ie rnenoless, but our receotion was not what it might have been, as the ladies in charge of the institution, after keeping us waiting outside of the door for twenty minutes, decided that they did not care to allow us to make a survey of the children and the Home, The attitude was in such glaring contrast to that adopted by the heads of all other institutions visited that we found it diffi- cult to understand, unless the management feared inspection and fair criticism. Under the circumstances we retired as gracefully as possible, feeling that as far as we were concerned the institution should be named the Home of the Unf'riend-ly, 79 Immigration A careful study of the figures regarding the nation- ality of the various persons examined makes it more than evident that Canada has received an undue share of immigrants, who, under a proper system of inspection would not have been allowed to enter this country. Those familiar with social conditions among the defective classes realize that the welfare of the nation is seriously threatened by the influx of undesirables, and a brief survey of the facts obtained in Manitoba is of interest. Let us consider those in regard to illegitimacy, defectives, and delinquents, as under these three headings we shall find grouped the worst of the imported classes. In considering these facts it must always be remembered that the Canadian population of Manitoba is of the whole. In other words, the foreign born outnumber the native bom by 8#. (The figures are taken from the Census returns of 1911 and are as follows )- Canadian British Others French German Austria Hungary Belgian Bulgarian A Roumanian Chinese Dutch Greek Hindu Indian Italian Japanese Negro Jewish Polish Russian Scandinavian Swiss Unspecified 209,186 w 57,229 ,.53 50,944 34,530 39,665 2,455 53 123 885 2,853 62 31? 06 13 oofi 7,876 1.07 972 5 209 10,741 2.35 12,310 7,76i 16,41? 396 20,727 14.55,614 266,415 Total population 1911 British origin 73 t:. -tv Delinquency Taking four hundred consecutive admissions to the gaols '^hat do we find? 23$ are of Canadian birth, while the Austrians, who should under normal conditions only number ri/o rise to 33$ of the total; and the Russians, who should number 1% contribute 11$. The following figures give an accura te analysis of the 1+00 cases Nationality and Percentage of Total Gaol Population Total Nationality Canadian "I 93 ...... U. « A. .............. 43 ...... Austria . . . 134 29 2 England . . . Greece .... Germany . . . • 1 Scotland .. 11 France .... 3 Assyria . . . Russ ia f . . t 2 47 7 Ireland . . . Sweden .... 7 Hales 3 Iceland . . . 3 Belgium . . . 2 Roumania . . 5 Italy 3 Poland .... 4 Galicia ... 3 Holland . . . 1 Finland . . . 1 Total % 10.75 33.50 7.25 .50 .23 2.75 • 75 .30 11.75 1.75 1. .75 .75 .50 • 75 .75 1. .75 .25 .25 74 Illegitimacy Possibly no more interesting study can be undertaken than that of illegitimacy, and the records available in Grace Hospital and the Misericordia are most striking be- cause, as hae been remarked before, the greater proportion of these women are mental defectives, and a certain pro- portion, by no means email, recruit the ra nks of the prostitutes . As a matter of fact, of those we examined 73*68$ were defectives, 15.52$ borderline cases and 10,52$ insane. This percentage of abnormal? is of course much higher than would ordinarily be the case, but under any circumstances the proportion would be high. Nationality of 269 unmarried mothers in Grace and Mtserl- cordia Hospitals during past year:- British ..... Canada United States Austria . . . . Germany ..... Poland ...... Russia- Prance ...... Iceland ...... India Finland Norway ....... Belgium Sweden Denmark ..... Ruthenia .... 119 ... .U+.23; 77 ... 2k ... 10 . . . 3.84 9 8 5 4 ... 3 ... 2 2 ,76 2 1 1 .36 1 • .38 1 It is somewhat surprising to find such a proportion of British born among these mothers of illegitimate children, but comparing the figures with those of a study of 266 cases in the last two years in one Ontario hospital, we find the most striking similarity* In Manitoba 44$ - Ontario 4o$- ’''hen we study the character of much of the immigration we are in a position to make clear some reasons why such burdens - have been imposed on a long-suffering public. In the craze for numbers -re have allowed quantity rather than quality to be the slogan, and no better illustration can be brought for?:ard than that furnished by a brief survey of the 2o6 Ontario cases. Eighteen (22,75$) of the British born mothers were brought to Canada by one well-known Home which has already foisted an immense number of defect- ives °n the Canadian public, as the records of criminality and deficiency will show. Surely this one fact should be worthy of serious study by the Dominion Immigration author- ities.^ hen it is stated, too, that only 26 of the 266 could, oe classified as normal - Ij_5 borderline cases, 19I feeble-minded, and 4 insane and feeble-minded- further comment Is unnecessary * Both in Ontario and Manitoba the majority of the mothers of illegitimate children belong to the class of domestics - 45 f in Ontario, 56$ of the girls examined in Manitoba. In Ontario, however, the cheap labour in factories furnishes a large percentage. The girls would be in domestic service under normal circumstances, but war conditions have enabled them to earn larger wares than is ^usually toe case. As pointed out before, small wages ano mental defect have a much closer connection than super- iicial students of social conditions suspect. Apparently foreign born mothers of illegitimate children do not frequent the hospitals during their trouble, or possioly illegitimacy is not so common among the foreign born population. At all events, the foreign born in Manitoba and Ontario show a very small proportion from these classes. No doubt some satisfactory explanation of this apparen - discrepancy will be .found. Ins anity The insane who escape detection by the immigration authorities are generally mild cases of dementia praecox, whose condition has not been correctly diagnosed by their friends. They have simply been regarded as failures, and have been asked to come to Canada, where a new country, new ideals, and new inspirations, will work wonders for them. The result is generally the reverse, and the strain imposed on these persons often ends* in an acute attack of mental excitement or depression shortly a fter their arrival. - 75 r^t^v 0:P f a rf ion ! fas » before the war, commonly resorted to. plain/’ ° f deportatlon statistics makes this abundantly ciart ls ~ rne that insani ty plays no unimportant considered J+v ™ f , it is insignificant when considered with nefect and other abnormalities, HYGIEFE Dr Anr?T >n iQ?Q G1 »o Ck> fw T exa:n P le * writing in MENTAL niuitLE, April 191S, 'Concerning Prisoners" , says "Thus 608 cases le in W addit^ th ? t n °< le f s than 59 per cent of our the direct ?? J° ® vin ? in S various conduct disorders form ° f their imprisonment - also exhibited some fSSth^ Srr" US a?r/ nen i al abn « rrr i®lity, which in one way or another had conditioned their behaviour. Twelve oer cent Zrt ^riorated, aAotherlstl^er'cSnt "-I fl _ Q ^J , Ji lectuall y defective, while 18,9 per cent were classified as psychopathic." ^ X ? look ~ n S °Y er the nationalities of the insane in b ~ (,v ^ nce Manitoba it will be observed that immigration has not been responsible f 0 r as great a disc roportion as with 1uch S stati h f 5 he d ? fectives - This, to those familiar eaev fnS^ i?k St k * not sur Prising, as it is much more _ llt ? n +£ h grade defective to pass the immigration authorities than amanifeetly insane person. Relatively tn 1S S 1?n Portance, as the country is not so likely DreseJc? nf 2 presence of an insane person as from the presence of a Defective one. The Insane come from higher fn^undir 11 ? 1 ^?^ 11 * 1 the7 ar ® not ordinarily -anti-social, ^nc under intelligent care and treatment may, in a proportion f^Z S X\ P /T & US ® ful c3tlzens * Then, aglin, with them nature s. tendency is not to perpetuate the disease, but under suitable environment and conditions to eradicate it. Tnus tne problem of heredity becomes greatly simplified - although it would be well if immigrants who have, had defin- ite attacks of insanity could be excluded. Prom a study of immigration statistics it is evident that some nationalities have contributed for more than their share to the defective and insane classes. Now that we appreciate this fact it is evident that the attention of the Federal authorities should be asked to make a careful study of the whole problem, and provide the proper remedies. The following tables tell their own story:- ) > ) 76 u Population of Manitoba Canadian British Others French German ! . [ Austria Hungary , Belgian Bulgarian & Roumai an Chinese Dutch Greek ........... Hindu Indian Italian . Japanese . , Jewish Negro Polish Russian ......... Scandinavian .... Swiss Unspecified Na tio nal ity of Insane Patients ■ in B randon and Selkirk Asylums 209,186 * * 338 57,229 * * 12.5 273 i-S8 ■ 1 * * *55 6 . 79 93 16 54,530 # V 7.57 18 ...... 59,665 m *> 8.70 115 2 , 1+55 • * .55 8 125 * * .02 5 885 * * .19 4 *••••. 2,855 a * .62 b 517 1 e ,06 1 15 7,876 * » * « . 002 1.07 5 972 , 5 10 , 71+1 209 * * • « • * • w .10 . 001 2 :ll 5 12,510 m • 2.6+ 1 7,761 • » i*d+ 38 16, U9 * • 3.60 596 » * 1.08 22 20,727 4-05 15 1.55 - 77 - PROSTITUTION PROSTITUTION It was difficult to got as complete information as was desired. In regard to prostitution in Winnipeg, although from facts furnished, it was made evident that the optimism shown by the Chief of Police regarding the subject, was scarcely justifiable. He, however, admitted that there might be ten professional prostitutes in Winnipeg, most of whom were feeble-minded, but he would not care to admit a larger proportion. Being a canny Scot, it was evident that he had developed the national characteristic to an unusual degree, and his conclusions were not borne out by the observations of others who were not so optimistic and apparently not so canny. Apparently the police are most careful to give the narrowest definition of prostitution possible, and do not class what might be called the semi-prostitute as coming under the broad heading adopted by social workers. From many sources, though, we learned that street soliciting is not nearly so common as in Montreal and Toronto, that houses of ill-fame are not numerous, that most of the traffic is centred in certain hotels which do not receive the attention they merit from the police, that prostitution is just as common in Winnipeg as in other cities of the same size. We interviewed a number of girls belonging to this class - all were young, nearly all mentally defective, and their stories were similar to those we are accustomed to hearing in the east. Most of the girls were receiving meagre wages as domestics or working In factories (candy factories In particular). - - recommendations In making our recommendations regarding the development of a new order of affairs in the Province of Manitoba, we are cognisant of the fact that the suggestions will only provide the machinery to deal with a situation bound to become more complex as the population in many of the institutions in the province grows . At the present time, the numoer of institutions is small; and the work of inspection will prove a comparatively small matter not consuming too much time by the inspector. It is plainly _ apparent to those who are familiar with the history of institutions in Canada and the United States that the first / thing to do is to get away from the system of State control unaided by any independent body. In other words, a Commiss- ion responsible to the Province and yet given a large amount of responsibility, should be developed and empowered to inspect, control and direct the activities of all institu- tions supported by Government aid. This, in the province of Manitoba would, of course, cover hospitals for the insane, general hospitals, industrial schools, and gaols, as well as any other institutions which might be added. The Commis- ^ s.ion should have at its head, a well trained and competent "" man of high character in whom the people would have confi- dence. Associated with him, should, be a well trained i psychiatrist, and at least one other man of high type, probably from the legal profession as so many points of law keep coming up from time to time in connection with all institutions. This Commission should have, of course, la paid secretary. Its duties would be manifold and possibly no better illustration of the advantages of having such Commission could be found than a perusal of the history of the State Commission in New York State. This Commission was founded in 1889, and revolutionized the affairs of hospitals for the insane in the State n Of course, the Commission was unpopular at first because it interfered with the patronage which had been largely controlled prior to its establishment by petty politicians, but it more than justified its existence from the standpoint of economy, humanity and general progress. Almost immediately after its development, it effected a gross saving of $408,000 in one year, and that was done without any perceptible lowering of the high standard of care which had always been maintained in the hospitals for the insane for New York State. - 80 - Before^ their* advent, the neglect of many important things from the standpoint of efficiency was only too apparent, and wonders have been accomplished. The medical service of the hospitals for the insane in Hew York State is of the ; best character possible, and the appointments made are from those who reach the high standard demanded, by competitive civil service examination. Training schools for nurses have been established, a psychiatric hospital institute at Sard's Island, where in addition to the work done in pathology and clinical psychiatry, special courses of instruction are arranged for the benefit of the medical officers of the various hospitals. Some of the reforms which took place as the immediate result of the appointment of this Commission can be summed up in a fe?j words. Mechanical restraint was abolished, seclusion was carefully guarded, provision was made for the segregation and special treatment of the tuber- culous insane in large pavilions, tents, or inexpensive one storey frame buildings. Industries of many kinds were * established in the different hospitals and many of these have helped to reduce the per capita cost very materially, e.g. at the Utical State Hospital all of the coffee required in the different institutions is roasted, and the printing and binding of books and blanks is done at the same insti- tution, while at Kochester State Hospital soaps of many descriptions are manufactured and distributed. After-care of the insane has been developed in collaboration with the ^ State Charities Aid Association and the welfare of patients discharged is safe guarded and relapses prevented in many cases. ^ A Bureau of Deportation has been established, and in this way the State has been relieved, of the burden of supporting” alien and non-resident patients. The statistics of* all of the hospitals have been stabilised. The proper ratio of nurses and attendants of patients has been care- ful ly w or ka d out , and c ons ul t ing phy s i c I an s and surgeons appointed for each hospital where patients require special attention. The proper feeding of patients in all insti- tutions is controlled in a scientific way, and a system of joint purchase of all hospital supplies through a purchasing agency' was established by the Commission itself. As a result of the excellent work of this Commission, the treat- ment of the insane has advanced in a remarkable way. Evi- dently the difficulties which exist in Manitoba at t he present time were encountered when the Commission undertook its labours, e.g., if an insane person needed immediate care and 81 treatment lie could not always reach the hospital at the earliest pose ib; ^moment . as an order of* commitment bad to he Detained, arid a great, beat ox valuable time lost. That has been changed and in addition voluntary patients are received just as we have suggested they should be accented in our preliminary report, This, of course, only indicates in a general way the i unctions of a Commission, and does not attempt to outline the specific duties it would undertake. " As far as the Government is concerned, this body would remove from the Department of Public Works, the anomalous duty of ' administration of institutions which obviously should not come under the care of that Department. Now taking it for granted that such a Commission is established at once, the question arises what are some of the most insistent of the problems with which it should deal? To us, it seems that even before the Commission is developed, the Government should proceed at once to remedy some of the most glaring weaknesses in the Manitoba system. ^ The first of these refers to the admission of insane persons to hospitals for the insane. In looking over the problems • connected with the insane in Manitoba, we could not help but form the opinion that with the development of a clearing house such as the Psychopathic pavilion will afford, it would be possible to reduce maintenance expenses by segre- gating the chronic insane in the institution at Brandon, which if not ideal may at least be wonder fully improved at a small expense. The present wards should be better lighted, and if possible, subdivided so that fewer patients would occupy each ward. Balconies and sun rooms should, of course, be at once built and expansion be provided for by the erection of small and well designed units such as those which have been built at Whitby during recent years . This policy would allow of gradual development, and too great a burden would not be imposed on the Government in any one year. If the Psychopathic Pavilion remains at its present size, it is obvious that special provision must be made at the Hospital for the Insane for the further treatment of many acute cases. This being the case, almost the first unit required will be 1 a reception ward with proper facilities for hydro therapeutic abd. electrical treatment and laboratories for research and scientific investigation. Here would be placed all new cases, many of whom would be voluntary admissions. A farm colony, too, should be one of the first improvements attempted. It should not be too near the main hospital and migght be so designed that it would accommodate fifty male patients. In time, a second unit could be erected, near at hand to the first, etc. These farm colonies are a cheap and most desirable method of caring for many of the chronic ins ana who develop an interest in their surroundings and are cheaply cared- for in the comparativelv inexpensive but homelike buildings provided . The Medical Staff The medical staff should be of ample size, preferably of young and enthusiastic psychiatrists who are well paid and who owe their appointments to merit rather than political pressure brought to bear ill their favour. Under ideal conditions they would win their positions through competitive examination, and would receive promotion as a result of achievement both in scientific and administrative attainment. The staff should include a pathologist, who should also be fully qualified in serology and bacteriology and imbued with the necessity of research in these fields as well as the field of metabolism. Every case admitted should be the subject of elaborate study and discussion at staff meet- ings held at least twice a week, and. the histories taken should be recorded by a staff of stenographers. Bedside records are of the greatest importance and the physicians, who should spend the greater part of their time in the wards, should not be called on to do much detail in the way of cherical work. The stenographers should do all of* - this from dictation. The presence of the physicians in -She wards is for the protection of the patients, and the dissipation of the “herd idea H in treating the insane, Bocal Physicians following specialties should be asked, for consultation from time to time, and physicians sending patients to the hospital should be invited to be present when the cases they have sent to the hospital are being discussed. Hursi ng ^L'he nursing staff should, be made up of qualified nurses of good education who thoroughly understand the fact that, custodial care alone, is not the ideal to be worked for in a hospital for the insane. These nurses should be comfortably housed in a nurses' home at some distance from ohe hospital. At best, the care of the insane is a trying vocation and full of petty irritations and annoyances not met with in general nursing. In view of this, mental nurses should be treated with the greatest consideration and made to realize the dignity of their profession. With the advent of the Psychopathic Hospital, the best ideals to be held, out to the nurses selected, for leaders or head nurses will be developed. In a very short time, an esprit he corps will arise that will simply revolutionize affairs psychiatric in Manitoba. Female nurses should be intro- ducted in the wards for males as they have a most human- ising influence on all but a few cf the troublesome types of insanity, and their usefulness is everywhere acknowledged. This nursing situation should receive immediate attention as it involves one of the most important reforms to be made . The Superintendent of nurses should be a woman of superior type who has had, if possible, the advantage of a training in a general hospital in addition to the special training in a psychopathic' institution. Such a woman invariably has the highest ideals and is invaluable from the teaching* standpoint , She is able to keep the hospital point of view constantly before the nurses in training and imbues them with the idea of cure rather than custodial care being the "ultima Thule" in all cases of insanity. Male nurses should also be educated, and in developing this whole nursing scheme,, the physicians attached to the hospital should deliver the greater part of the lectures, and' do their best to develop an enthusiasm for a profession which has been sadly neglected. Great care, too, should be exercised in outlining a course of instruction, and emphasis laid on the fact that practical nurses for the care of the insane are being developed rather than nurses to attempt general nurses. Too often these courses have been described as producing nurses qualified to do general nursing; this is a serious mistake, although it must be admitted that nurses who have had a - 84 training in mental nursing supplemented by training in general hospitals make the most efficient of all nurses. The reason is not far to seek. In nursing the insane, machine methods which are the bane of so many general / hospitals, tire impossible, and the nurse in training is forced to study the individual rather than the patient . In other words, she has to give a great deal of attention to the psychology of the person placed under her care. Of course, we cannot outline in a report such as this, the thousand and one details which occur as necessary in making reforms, but these will suggest themselves to the Commission if appointed. What we are attempting to do though, is to point out some of the most important problems with which your Commission will have to deal. One of the first of these, is in connection with the convalescing patients both in the Psychopathic Clinic and the Hospital for the Insane. As far as the former are concerned, it is a pity that ample grounds had not been arranged for vrhen the hospital was designed; however, it is too late to make a change in that particular*, and nq doubt in a country where land, is not too expensive, it may be found possible to arrange for a Convalescent / Home at not too great a distance from V/ inn i peg where ideal conditions for the complete restoration of the patients will exist. - Such a Home is a necessity, where your bed list is as small as it is in the Psychopathic Hospital at Winnipeg, and some method of relieving pressure on bed space must be found. When, too, it is remembered that convalescence is generally slow, and that mental ^ cases in particular require quiet, rest, sunshine, fresh air and light employment, during this period, the reasons for the development of such a Home are apparent . Now in regard, to the Hospital for the Insane. It seems to us that a Home for Convalescents Is a necessity, and would save the Government money, as it would prove no mean factor in preventing relapses which are so common among those recovering from mental attacks. This applies especially to those who are too suddenly plunged into conditions at home where they are exposed once more to strains which played a role in the development of their disease. The -whole question of the after-care of the insane is discussed in another section of this report. 85 It is probably one of the livest issues Tie have to face, anc. tiie fact that it has generally been so much neglected, is no reason why its importance should not be recognised, ihis is a progressive age, and the earlier we undertake the problems that are so obviously awaiting us, the earlier will real progress be made. The care and treatment of the insane have so long been relegated to the pigeon hole labelled '’neglect” , that it is difficult to make them a live issue now. I 86 XXVII h D M I S S I 0 Parses 87 - 90 ADMISSION The whole system of admission %'o the hospitals for the insane in Manitoba should be revised and an effort made to remove the stigma undoubtedly placed on anyone who has to be sent to such an institution under the present law. The only argument we heard urged in favour of the system in vogue, is that it provides a proper safeguard against sane persons being improperly placed in confinement. The argument is a fallacious one, as magistrates are just as prone to make mistakes as physicians. After all, what does practical experience teach us in communities where the services of a magistrate are not required? Theroetically, scandals might be possible in private sanitariums, but in public institutions they are practically unheard of. Occasionally a patient suffering from acute delirium such as that connected with fevers or meningitis has been sent to a hospital for the insane by mistake, but the deliberate incarceration of a sane person for improper and dishonest reasons is practically impossible. In the first instance, the magistrate would not be able to make a fine medical diagnosis; in the second, his usefulness would be doubtful, and the officers of the hospital vrould be the persons to correct the abuse. Stxch cases, however, exist largely in the minds of a credulous public. Now, the intelligent method of admissions seeks to remove the suspicions of the public in regard to institutions and to recognize that insanity is a disease, not a crime. The methods employed in the province of Ontario as a A whole, are simple and satisfactory, and might be adopted with some modifications and improvements. First of all, voluntary admissions properly safeguarded should be provided for and employed as frequently as possible. The form attached works out very well indeed in every-day practice, and is a comfort to patients who have jsome insight. into their mental condition. This does away with a certain amount of publicity and. criticism dreaded by the hypersensitive sufferers from various forms of depression, or even mild excitement. 87 u . T ' ] ® ordinary admissions should be made on the certi- ficates of two properly qualified physicians, after the superintendent of a hospital for the insane has made an examination of a preliminary form of history to be filled in by the physician in attendance. .. , J he Preliminary form of history need not require the elaborate details which should be obtained subsequent to admission. This useless delay in obtaining admission + s Provinces takes place during the gathering of facts to , ^ i in . the cumbersome forms supplied. The information asked for is invaluable after the patient has been admitted, but not necessary men admission is urgently required. Such a form as the following might be used in grant- ing samission to voluntary patients. Form of Application. For the Admission of a Voluntary Patient to the Hospital for the Insane at z > of the of ........ in the County of being request the Superintendent of the Hospital for the Insane at to admit me as a Vol- untary Patient, and I hereby pledge myself to remain in the said Hospital at for a period, not exceeding one year, which the said Superintendent may deem, necessary to effect a cure in my case and I further pledge myself to give at least ten full days' notice in writing to the said Superintendent of my intention to leave the said Hospital for the Insane; and I furtler pledge myself to submit to the rules and regulations of the said Hospital now in force or which may hereinafter be enacted and to carry out or assist in carrying out all the directions which the said Super- intendent may give for my treatment. Signed this day of A.D. 19 at in the County of in the presence of I hereby testify that the above named person is as stated in the above application a and that he is a reasonably hopeful subject for treatment with a view to effecting a cure of his malady. M.D. Dated at . A.D. 19 Address pangeivnis Insane Person a Fhen it is found necessary to apprehend persons who are dangerous to the community or themselves, the following method might be followed - of course, amplified to meet all the necessary details* The point to be brought out is that of avoiding bhe use of gaols as places of detention. However, the whole of che Manitoba Act relative to insane persons needs careful r evision. (1) Where an information is laid before any justice of the peace that any person, within the limits of his juris- diction, is or is suspected or believed by the person laying the information to be insane and dangerous to be at large, such justice may issue his warrant, to apprehend such alleged insane person and to cause him to be brought before such justice or any other justice having jurisdiction in the locality (2) Any person apparently insane and conducting him- self in r manner which in a sane person would be disorderly may be apprehended without warrant by any constable or peace officer and detained in some saiFe and comfortable place, not being a gaol, lock-up, prison or reformatory until the quest- ion of his sanity is determined as prescribed by lav:, (3 ) ’"'here the person alleged to be insane has been apprehended under a warrant or in the manner provided in the next preceding section, he shall be brought before a justice having jurisdiction in the locality in which such person was apprehended, and the justice may thereupon by his order, direct that such alleged insane person be confined in some such safe and comfortable place, or in the custody of the constable or other person who apprehended him or such other safe custody as the justice deems fit, until the question of his sanity is determined; but in no case shall such alleged insane person be committed to any gaol, lock-up, prison or reformatory. PREVENTION AND AFTER-CARE As has been stated elsewhere in this report, hospitals for the insane do not fulfill their whole duty to the community by merely providing oust tidy and treat- ment for sufferers from mental disease. In addition to the programme of work carried on in the past, these institutions must incorporate a continuous campaign for the prevention of mental disorders, amd must place e.n increasing number of patients on parole. This can best be carried out by means of out-door mental clinics and social service. As far as parole is concerned, it is interesting to note that in New York State since the establishment of mental clinics and socia.l service, the number of patients on parole has increased from 783 to 1504 in If 17. Since the average cost of maintaining a patient in a Nev; York State Hospital has been estimated at $220, a year. New York saved in 1S17 approximately $350,880. by having an average of 1504 patients on parole. The value of mental clinics and social service in connection with prevention and after-care may be taht'J ed ' as follows ; 1 . Mental Clinics (a) They furnish a means of detecting early cases of insanity, and often advice can be given and methods employed to ward off an actual mental breakdovrn. In this way, preventive work is accomplished, and the Province saves money because of smaller admissions to hospitals. ft) The mental clinic is a e ounce of enlightenment to. social workers and the general community in matters pertaining to mental abnormality. If the clinic is really active in its work, individuals attached to courts, schools, philanthropic and religious organisations will refer suspected cases for examination and will thereby become informed concerning mental disease and the principles of mental hygiene. This fact has been demonstrated by the Psychiatric SI wm Clinic of the Toronto General Hospital, 1549 cases had been examined during the year 1917, and of these, 662 had been referred by the Juvenile Court, 8S7 by such organiza- at ions as the Haven, Industrial Refuge, Presbyterian Home, Protestant Orphanage, Boys' Horae, Girls' Home, Out-patient Dept., and In-patient Department of the Hospital, Medical Inspector of Schools, Children's Aid Society, Department of Public Health, Military authorities, and private sources. Workers connected with these various bodies had themselves accompanied cases to the Mental Clinic, and their interest and usefulness in the field are to some extent demonstrated by the large number they brought for examination. (c) Cases needing institutional care are often seen at the mental clinic at an early stage of their mental disease, and because of their consequent immediate admitt- ance to the hospital, recover more quickly, (d) The Psychiatric Clinic furnishes excellent clinical material for medical students. In the past, students in medical schools have been given the opportunity of seeing only the pronounced cases of mental disease in hospitals for the insane. It is fundamental, however, in the education of the physician that he be taught to the Clinic gives him an opportunity for such study. (e) Superintendents for Hospitals for the Insane are justified in placing on parole improved cases that would, in the absence of mental clinics, require continual re. Such patients as have been referred o their own homes, provided they report the Clinic, where observations can be made on. ychiatric Clinic forms a natural connecting pitals and the general community. The as been deep-rooted in the public mind is to a great extent, broken down when d friends of mental cases meet members of ff in the Out-door Clinic. They are there sanity is a disease - not a crime, and they ment consists not merely in restraint and an attempt, at least, to give active medical observe the early manifest at ions of mental disease, and. 92 mm U treatment. This contact between the community and the hospital staff has a beneficial effect on the latter, hospital physicians need the opportunity of studying mental abnormality, not only as a problem in institutional care, but as a social problem related to crime, prostitu- tion, and illegitimacy, II . Social Servic e To be effectual, the Mental Clinic must have attached to it at least, one trained social worker , The scope of her activities can be outlined as follows: (a) It is her duty to make arrangements for the appearance of cases for examination. She is a connecting link between the clinic and the community. It naturally falls to "her to keep in- tpuch with social, agencj.es and the homes of patients. She' arranges’ to have’ certain cases re-appear at stated intervals for further study ‘and supervision. (b) As a field worker, she secures information concerning the environment, the developmental anc! family history of cases. This data is often indispensable for the psychiatrist in arriving at a diagnosis, (c) In the question of after-care, the s ocia\ worker is of undoubted value. She follows up examined crises into their homes, supervises the carrying out of tftf physicians 1 instructions with regard to occupation, and general hygiene, '.Then patients are found to be making unsatisfactory progress, a social worker arranges foil a consult at i cn with the psychiatrist. (d) The point must here be emphasized, that safety in the parole system can only be assured by an intelligent following up of eacn case by the social worker. The hospital cannot with safety expect to increase the number of patients placed upon parole unless the Social Service organization is sufficiently efficient to make frequent inspections to exert what amounts to continuous supervision. In connection with parole. It frequently becomes a question 93 - Hi of paramount importance to secure for the patient a suita- ble environment, and this obligation naturally falls to the field worker. (e) Prevention of relapse car. often be secured through the agency if the social worker. This can be accomplished by the work outlined above in securing a suitable environment , in giving instructions concerning occupation and hygiene, and in referring cases who show signs of beginning failure of adapt at ion- to, the* psychiatrist. (f) The social worker can perform a useful role as instructress in the homes visited in connection with the many problems relating to mental disease. Relatives are informed cor. periling the inadvisability of the marriage of mental abnormaLo. and are otherwise instructed con- cerning the prevention of mental disease end the need for early treatment of developing cases, ( g ) It often happens that a family becomes discour- aged when a case in the home does not show signs of recovery. The social worker can in some cases give such help and encouragement that the family will continue with a reasonable measure of success to care for the patient. By such action, the Province is saved the cost of institutional care. SUOGJSSi'ICJHS HSKTAL CONCKVilNG aiOAKiZATiair csf two CLTNTCS ?OK MAAITHBA Manitoba needs at the present time, at least two mental clinics to cover the work in this field. One Out-door clinic should naturally be attached to the Psychopathic Pavilion of the Winnipeg General Hospital, This Clinic might be directed by the psychiatrist in charge of the psychopathic Pavilion, and. should have attached to it a trained social field worker. The Winnipeg Clinic could deal with city cases, and patients referred from St. Boniface, Selkirk; ana other nearby places. It may be found advisable to have the medical staff of the Selkirk Hospital for the Insane associated with the staff of the Psychopathic pavilion in connection with the work of the Clinic. In addition to the Winnipeg Clinic, an organization of a similar nature 94 should, be established in connection with the Hospital for the Insane at Brandon, with the staff composed of the Superintendent and bis medical associates, together with a social worker. This clinic might cover the field in Brand cm, and could make arrangements at stated intervals to visit centres of population hot covered by the Psycho- pathic Hospital at Winnipeg. Itinerant clinics have been used with marked success in Her York State, and are the best means of reaching individuals who live at a distance . 95 THE PSYCHOPATHIC HOSPITAL IN WINNIPEG Manitoba has done wisely in building a Psycho- pathic Hospital in Winnipeg, thus dairying the right to congratulate it.seif as having the pioneer hospital of this type in Canada. It is a surprising thing that the value of such hospitals has been overlooked so 3.ong in a country which delights in considering itself progressive, and yet it has been impossible to stir up enthusiam in Governmental circles to the point of providing funds to carry on this important work. Almost any one can supply the arguments which make it plain that a general hospital, perfectly equipped without regard to cost, is a necessity in every community; it is more difficult to make the people realise that a psychopathic hospital is just as necessary as the general hospital. The chief arguments in favour of such institu- tions are to be summed up in a few wards . 1. They make public the fact that insanity is a disease requiring early and careful treatment. 2. 4 By receiving acute and recent cases of insanity, which may be treated with success in the early stages, they save many from commital to hospitals for the insane. In this way, they lessen the burdens to the State in a material way as well as save unnecessary mental pain and worry. 3. By providing a proper Out-Door Department, they do an inestimable service to the province, as patients who v.’ould. not face the ordeal of treat- ment in a hospital for the insane, do not hesitate . to seek advice in an Out-Patient Department. 4. In large centres like V/innipeg Psychopathic Hospital will do away with the gaol system of detention of insane persons, and thus remove one of the darkest blots on Manitoba's escutcheon. 5. They furnish important centres for the scientific 93 study of early cases of insanity, and enable medical students to receive education in txie moat important branch of medicine known as psychiatry. Many other advantages might be mentioned, but we v/ould lay particular stress on the value of the out- door department of a psychopathic clinic. Preventive medicine is particularly useful in psychiatry, and prac- tical experience has taught us that a psychiatric clinic working in connection with a well organized social service department is in a position to confer endless benefits on an important part of the community requiring help. Nowhere else can the advantages of intelligent mental hygiene be so clearly demonstrated. In the Toronto General Hospital, an out-patient psychiatric clinic was established a fev; years ago in connection with a Social Service Department, and has already dealt with some thousands of patients, no less than fifteen hundred appearing for consultation and advice last year. With carefully made home investigations, a study of life histories and extensive psychological research, it has been possible in numerous instances to do both the individual and the community a good turn. After a study of the plans of the new Psycho- pathic Hospital at '.'innipeg, v e are inclined to think that it will scarcely prove large enough to meet the needs of the situation, but its usefulness will so soon demonstrate itself that there will be little difficulty in obtaining funds to enlarge the present plans. Of course, the great danger to be faced in the organization of such a Department, is that of letting it drift, into the position of becoming simply an establishment where people who are able to pay large maintenance rates will be able to keep their friends under treatment a much longer time than should be this case, Y7hen that happens, an institution immediately loses its value, and degen- erates into a private hospital for the insane, departing from its true function. The people not able to pay large maintenance rates are thus deprived of their rights, and eventually the State suffers. This criticism is called forth by the large number of single rooms appearing on the plans. It is universally conceded that, many single rooms are a mistake, and in the best psychiatric clinics it has been found that dormitories providing for three or more patients give the best results , They are much more desirable too from the nursing standpoint. The question of pathological and research laboratories should be carefully considered too. - 98 - THE GAOLS. — *-—r " The gaols visited are much the same as the gaols of other provinces, better in some respects than some, and commendable if detention and custodial care are the sole objects to be desired. Probably few suggestions are to be offered as we believe the government has already decided on a progressive policy in regard to the development of gaol farms with reformation as the chief aims of the institutions < We would urge on the government the necessity of having prisoners carefully studied from the psychiatric and psycholog- ical points of view, as the great fault of nearly all gaol systems is that of neglecting what is obviously the most im- portant phase of reformation, viz* the proper study of the in- dividual. At present there are so ifiany prisoners, so many cells, so many guardfe, a common exercise room. It is taken for granted that all prisoners are alike - all standard beings- and so the mistakes of the past are perpetuated with the usual results. By a careful system of weeding out defectives and insane from the normal classes and prescribing proper treatment and care wherever necessary, gaols and penitentiaries might become "moral hospitals'* rather than institutions for the education of the recidivist, who under a proper plan of or- ganization would never develop v called guards in modern gabis and reformatories is just as live a question as that of the education of nurses and atten- dants in hospitals for the insane. It goes without sayitlg that the education of the so 9S - : i XXXI CARE OF DEFECTIVE CLASSES ( AND CARE OF MENTAL DEFECTIVES) Pages 100 - 108 Care of Mental Defectives In presenting a plan that might be adopted in the Province of Manitoba for the care of mental defectives it may be prudent at the outset to emphasize certain principles that should be adhered to. These principles may be dis- cussed under the following heads: - I . Segregation In reviewing the report of such institutions and or- ganizations as the Children* s Aid Shelter, Convent of Good Shepherd, Salvation Army Industrial Home, Industrial School (Portage La Prairie) Maison St. Joseph, ( Otterbourne ) Detention Home, and the Juvenile Court it is evident that the plan of caring for feeble-minded and normal children under the same roof is wrong from every standpoint. As an illustrat- ion let us consider the condition of affairs at the Industrial School, Portage La Prairie, This institution receives boys committed by the courts, and attempts to perforin the function of custody and correction. The boys are not classi- fied or segregated either according to age, type of offence, or mentality. Our survey reveals the fact that of the eight boys cared for, 22 are mentally abnormal, constituting 26.567, Among the abnormals is one boy guilty of murder, 5 of theft, 1 of assault, 1 of burglary, 2 of horse stealing, 5 of vagrancy, and 2 of incorrigibility. according to the Principal, Rev. F. W* McKinnon, it is an injustice to the boys of normal mentality to be intimately associated with defective delinquents. It can readily be understood that with a fair chance, the Principal and his staff could exert, in the cour se of 3 years, a correctional and uplifting influence, on the normal charges. The school, however, saddled as it is with the abnormals referred to, is throttled in its efficiency. Experience has demonstrated the fact that, as soon as the abnormals leave the institution they readily succumb to evil practices, and the boys of normal mentality, because of their 3 years association 'with these Incorriglbles, upon release likewise give in many instances a poor account of themselves. In other words the training school at Portage La Prairie is not fulfilling the function for which it was built, because of the impossibility of successfully training a mixed population of abnormals and normals. 100 - ■"'hat has been said in regard to the Industrial Training School applies to the other correctional institutions of the Province. Indeed, it has been known for many years in Canada, the United Ftates, Great Britain, and elsewhere, that a system wherein mental defectives are not completely segregated invariably breaks down . The principle of segregation applies not only in institutions, but also in the general community, When mental d efectives are at large they often fall into evil practices and are responsible in many instances for having a sinister moral effect on their companions of normal mental- ity. As an illustration, take the B. family of Winnipeg. This family consists of a mother, father, and children rang- ing in age from 17 years to lii months . Mr, and Mrs. B. are mentally deficient, and at least I4. of the children are of a feeble-minded type. what has been the effect of not segregating certain members of the family? In the first place, it has cost the city of Winnipeg £ll68.8l in providing relief from November 1916 to September 1918. In spite of this assistance and additional help afforded by various social agencies, the B.'s are not self supporting, and home condit- ions are bad. One of the daughters, aged 15, is devoid of moral sense, has led the life of a prostitute, and has served a term in the Detention Home of the Juvenile Court. The whole family exerts a baneful influence on the environment in which it lives - a bad effect hygienically and morally. The only solution. -consists -in segregating the .defectives of the household in' suitable farm colonies, II . Instituti o ns and Farm C ol onies. The best method of dealing with mental defectives is the caring for these abnormals in Institutions of the farm colony type . The Training School for the Feeble-Minded at Waver ly, Massachusetts, and the Vineland Training School in New Jersey are splendid examples of farm colonies, that are doing efficient work. These schools segregate in separate cottages the defectives cared for. The classification is based upon phy- sical age, sex, and mentality. Facilities are afforded for education in primary school subjects, hand-work, and farming. Ip connection with education, it should be said that each 101 - case is educated to the limit of its capacity, even though idiocy he the condition. If high grade cases are secured at an early age, and kept in the training school until adult life, it is possible during that period to teach boys a trade., and the girls, housekeeping. The farm colony principle has worked out well in connection with both Waverly and Vineland. These institu- tions have attached to them, colonies situated at a distance that receive selected cases that have been in the training schools for several years. The patient population of the colonies construct the buildings, clear the" land, and do farm work under this system, and thus the overflow population of the Training School is cared for at small expense. It would bo prudent for the Manitoba Government to develop the farm colony principle in connection with training schools established for the feeble-minded. * Incurability of Mental Deficiency TThen it is recognised that feeblemindedness is an incurable condition, it becomes evident that individuals must in many cases be cared for for life. . Facilities must therefore be made for the continued supervision of these wards of the Province. Dr. Fernald and other American authorities have found by experience, however, .that certain high grade cases, who have hud the advantages of several years institutional training, can at adult life be turned back into the community with safety. Classification of Feeble-Minded in Institutions Adequate provision must be made for the segregation of cases cared for in institutions, according to sex, degree of mental defect, and reason for commitment. It is self -evident, for example, that male and female patients need separate quarters, and arguments need not be put forth as to the wisdom of providing separate care and training for idiots and morons, preferably in distinct institutions. The specialized care of defective delinquents may need some discussion. Heretofore, defective delinquents - 102 - in Manitoba have been cared for either in gaols or reform- atories, but, according to such students of criminology as Dr, Bernard Glueck, Director of the Psychiatric Clinic at Sing Sing Prison . defective delinquents cannot receive adequate care and instruction in the ordinary penal institu- tion, Dr. Glueck states that mental atanormals not only fail to benefit themselves in a prison or gaol, but exert a baneful influence on tneir fellows. As far as training schools for the non- delinquent , feeble-minded are concerned, it has been emphasized by Dr. Walter Fernald, Dr. Thomas W . Salmon, Dr. K. rL Goddard, and other psychiatrists and psychologists that even these institutions are unsuited, to the needs of the defective delinquent. It has been found by experience that defectives with criminal instincts, disturb the discipline and - morale of the training schools referred to. In fact, it has been found necessary to dismiss such cases shortly after admission. Authorities in criminology, psychiatry, and psychology, agree that provision should be made for the defective delinquent in a specialized institution. In the State of Mew York, arrangements are now under way to provide institutions of the type referred to for the defec- tive delinquent class. Care of Female Delinquents Probably the most acute of all problems connected with the feeble-minded related to the defective a -moral girl, A reference to the report on such institutions in Manitoba as the Sal vat-ion Army Industrial Home, Convent of the Good Shepherd, Detention Home of Juvenile Court, i Grace Hospital and Misericordia Hospital indicates that from the ranks of defective girls comes a large proportion of the mothers of illegitimate children and prostitutes. These findings, together with reports from other parts of Canada and the United States demonstrate that approximately 50>o of the mothers of illegitimate children who receive obstetrical treatment in hospitals are feeble-minded, and from 60 to 70^ of the prostitute class are likewise defec- tive . In order that prostitution and illegitimacy should be at all adequately dealt with, it is essential that - 103 - 1 provision be made for defective girls in suitable institu- tions, This is necessary, only only because these girls are a source of moral contagion to their fallow citizens, but because they are responsible in no small measure for the enormous annual increase of our feeble-minded popula- tion, The children born of such girls are often defective, as has been stated in another part of the report. Public Schools ► It had been hoped in connection with the Manitoba survey to make mental examinations of several thousand children attending Winnipeg and rural schools- It was found possible to investigate the mental status of 2223 pup: Is attending Strath?- ona, Laura Secord, and Elmwood Schools in Winnipeg, The epidemic cf Spanish Influenza prevented a survey of rural schools, and therefore the report is incomplete. Sufficient .data, however, has been collected to show that the school situation in Manitoba with regard to mental deficiency is similar to the problem in other parts of the world , It was found that approximately 2 . 06 % of the children examjned were intellectually defective. (The term 'intellectual iy defective 1 indicates that the children so designated are unable, through inherent mental enfeebleraent to adequately cope with the curriculum of the Manitoba school system. It is probable that a fair proportion of these children will prove eventually to be mentally defective - in other words, unable not, only tp cope with conditions in a public school, but wf-.il be unable in future years to earn an independent living or conduct personal affairs with ordinary prudence ) . If 2 . 06 % is representative of all schools in Manitoba, and we can fairly judge that such is the case, there are In attendance 2075 cases of intellectual deficiency in the schools of the province, (The total number of children in school attendance in Manitoba, ending June 1917 was 100,294.) Since the presence in the public Schools of intellectually defectives Is a source of disturbance to class-room routine and is accountable often for the spread 104 of moral contagion, it 'becomes necessary to make provision for this special class, In the Winnipeg school system there have been established three special classes for retarded and. defective children. Inch classes are effective when they serve merely as clearing-houses . In other words, the classes should be used as observation centres, and only such pupiis retained as are found suitable for the specialized instruction and care afforded. Those children with criminal tendencies, girls of a- moral type, and imbecile children, should be transferred to training schools for the feebleminded, and be under constant care. The reasons for such procedure are self-evident. Arrangements should be made to have all the children attending Manitoba schools receive a mental and physical examination at stated intervals. Mo public school system as complete without such psychiatric observation and supervision. In cities and communities where this method is put into effect excellent results have ensued, and arrangements are being made, not for the curtailment, but for the enlargement of such work. Psychiatric Clinics It is necessary to provide means in Manitoba to ascertain the actual r ember of mental defectives in the province, their method of living, and their effect on the general population. Unless such, facts are gathered, it will be impose able tod sal adequately with the whole problem of" feebo.e-mu.de dues s . It is evident that, unless the dimensions of the problem are ascertained, a comprehen- sive policy in connection with treatment cannot be mapped out . The best means of collecting data referred to, is through the operation of Psychiatric Clinics. In another part of the report, these clinics have been dealt with, but it must be pointed out that such agencies, to be effective, shall take into consideration mental deficiency as well as insanity. Definite Proposals con cerning the pare of t he peeble-minced — ~ in the Trc j_nce oTT anil (7b a With the above considerations in mind, the following proposals concerning the care of the feeble-minded in Manitoba - 105 are submitted. if the inmates of the Hospital for the. Insane at Selkirk were transferred to the enlarged Sr and on Insti- tution, it wound be possible to utilize Selkirk for the feeble-minded- This institution might at small expense be so remodelled as to accommodate idhbta , low-grade imbeciles, and defective a -moral girls , Provision would be necessary, of course, for the complete segregation of the two classes referred to. Portage La prairie The Industrial Training School at Portage La Prairie could, if other provision were made for delinquent boys, care and treat defective delinquents are best cared for in a distinct and separate institution, but arrange- ments could be made at Portage La Prairie for cemplete segregation of this class. It would also be possible to establish a colony at some little distance from this institution for boys suited; to farm work. Classes for backward and. defect ires in public schools, based on some such system as is shortly to be operative in the State of Hew York might well be applied to Manitoba. CARS OF THE DEFECTIVE CLASSES The care of the defective classes is a much more complicated, problem than that of the care of the insane. The variations in mentality, all the way from idiocy to the high grade moron with criminal tendencies, require carefully devised machinery in order to provide proper treatment. Prom what has been said in the preceding reports, it will be gathered that in the Province of Manitoba, no regard has been paid to the necessity of separating defectives from insane or even normal individuals, with results that are in some instances almost tragic. In the first place, little or no effort has been made to find how many defectives exist in the Province and those who have been discovered have been treated in the most haphazard fashion. Schools, Juvenile Courts, etc., have been without psychiatrists, and in such an institution as the Industrial School at Portage La Prairie, there is a hopeless jumble of all kinds of "cases which do not fit in with the scheme of reform as originally intended. The result is just what might be anticipated under the circumstances, as no matter how capable the management , it cannot be expected to achieve the impossible. If this school has not been an unqualified success , it is not difficult to ascertain the reasons v/hy. In our opinion, the Commission will have no easy task to elaborate suitable plans to accomplish a revision of the situation. If it were decided to aband.cn Selkirk Hospital for the Insane when expansion at Brar.don takes place in the lines referred to, when discussing the problem of the care of the insane, Selkirk might easily be adopted for the supervision of two classes. One wing might be devoted to the idiotic, and lowest grades of imbeciles, the other occupied by girls of the moron type, who are to be found among the mothers of illegitimate children . and prostitutes, as well as at the Juvenile Court. These girls would, to a large extent, support themselves, as they are capable of a good deal of development along industrial lines, such as laundry work, etc. It is essential, too, that they be cared for in an institution far .removed from a similar abode for delinquent morons of the male sex. Oirls of this type, readily adapt themselves to institution life, are easily made happy, and generally speaking, are not at 107 all resentful of the restrictions imposed, especially when the management is well educated in regard to their idiosyn- crasies and peculiarities. They are by no means a difficult class to please. At Portage La Prairie Industrial School, a colony for male morons of the delinquent class might be established at a safe distance from t he main building, with suitable outlets for industrial energies and pursuits. Such an establishment should be most carefully planned in order to produce satisfactory results. The school itself, and Its various buildings would easily lend themselves to the development of such an- institution for defectives as that found at Waverley, Massachusetts, and could be added to as required, at comparatively small expense, rlo more profit- able Investment can be made by a State than by putting its defectives under control and intelligent management. When it is remembered what the administration of justice costs, and it is acknowledged that the majority of criminals belong to the defective classes, it can easily be understood that to eliminate them from society before they have opportunity to begin criminal careers, is a wise and profitable procedure. It is in the interests of society and the defectives them- selves. It Involves no real hardship to t he individual, and gradually reduces the proportion of defectives in the community. We should never forget that defectives ordinarily select defectives for partners, and in this way, the propor- tion of this class in the country is always kept up. We have received an abnormal number of defectives from abroad, as has already been pointed out, and. has been shown in our figures, through careless inspection of the immigration from Europe. This can, of course, be prevented in the future by intelligent action on the part of the Federal authorities, but at present we are face to face with conditions which already exist. - ice - m » ? U' : 3 XXXII CONCLUSION ?PL3S ICC - 111 ■H In concluding this report, we wish to congratulate the Manitoba Government on the courage and farsightedness shown in appointing a public Welfare Commission made up of persons of high intelligence, who have the interests of the people at heart, and who appreciate the importance of improving the social conditions .of the province. This Commission has gone about Its task in the most progressive manner possible, and it has been a pleasant task for the representatives of the National Committee for Mental Hygiene to co-operate, and to suggest reforms which we feel satis- fied, if adopted, will put Manitoba in the front rank in Canada, In brief, then, the programme as outlined would be as follows 1, A Commission responsible to the Province should be developed and. empowered to inspect, control, and direct, the activities of all institutions r ;j-v t supported by Government aid. 2, Segregation of the chronic insane in the institu- tion at Brandon, The wards of this institution should be better lighted, and if possible, sub- divided so that fewer patients would occupy each ward. Balconies and sun rooms should be built and expansion be provided for by the erection of small and well designed units. A reception ward is required with proper facilities for hydrother- apeutic and electrical treatment, and laboratories for research and scientific investigation. 3, A farm colony should be one of the first improve- ments attempted, so designed that it would accom- modate fifty male patients, 4, The medical staff should be of ample size, prefera- bly of young and enthusiastic psychiatrists. It should include a pathologist, who should be fully qualified in serology and bacteriology. 5, Bvery case admitted, should be the' subject of elaborate study and discussion at staff meetings held at least tTrice a week. The histories taken, should be recorded by a staff of stenographers. The physicians sending patients to the hospital should be invited to be present when the cases 109 they have sent to the hospital are being discussed, 6. The nursing staff should be made up of qualified, nurses of good education. They should be housed in a nurses ' home at some distance from the hospital. Female nurses should be introduced in the wards for males. The Superintendent of Nurses should have had, if possible, the advantage of a training in a general hospital in addition to the special training in a psychopathic institu- tion, The physicians attached to the hospital should deliver the greater part of the lectures , 7. A Convalescent Home at not too great a distance from Winnipeg, for complete restoration of the patients, should be established. Admissions (1) to hospital for insane (2) Voluntary admissions properly safeguarded should be provided for and employed as frequently as possible. The ordinary admissions should be made on the certificates of two properly qualified physicians after the superintendent (if a hospital for the insane has made an examination of a preliminary form of history to be filled in by the physician in attendance. Gaols should be avoided as places of detention for dangerous insane persons, and the method as outlined mjght be followed. Immigration The Federal authorities should be ashed to make a careful sutdy of the problem of immigration, and provide the proper remedies. Prevention and After-Care Two mental clinics should be organized, an out-door clinic attached to the Psychopathic Pavilion, and a clinic established in connection with the Hospital for Insane at Brandon. The latter would act as an itinerant clinic. Gaols Careful study of prisoners from the psychiatric and psychological points of view, and thus the defective and insane would be weeded out. Care of Mental The segregation of feebleminded in suitable befectives ' institutions of the farm colony type. Adequate provis ion should be made for segre- gation according to sex, degree of mental defect, and reason for commitment. A, special institution should be provided for defective delinquents . Publ ic Schools All children attending Manitoba Schools should receive a mental and physical examin- ation at stated intervals . Backward classes should be used only as observation centres, and only such pupils retained as are found suitable for the specialized instruction and care afforded. Children with criminal ten- dencies should be transferred to training schools for the feebleminded * Proposed Divi - Selkirk Bospital for the Insane - into two sion of - wings, one devoted to the idiots and. lowest grades of imbeciles , the Other occupied, by girls of the moron type , Pro posed Divi - Portage La prairie Industrial School - a sion of '- colony for male morons of delinquent class might be established at a safe distance from the main building with suitable outlets for industrial energies and pursuits. No one expects that all of these reforms can be accomplished at once, but doubtless, now that the pressure caused by the war is to an extent recovered, several important advances may be initiated at once. Again thanking the different members of the Manitoba Government and the Public ’"elf are Commission for the many courtesies extended. We are Yours faithfully. — CABS OF THE ^EnOJAlLY UNFIT a Tbc nroblem of the insane, imbecile, idiot and defective classes has been considered by your Committee and much material obtained for information and perns Attached to this report are sections of the report of the Canadian national Committee for Mental Hygiene, who made a thorough survey of the Province from a mental standpoint, and therefore should be read carefully in conjunction with this report. Based upon that report and other information your Committee desire to make the following observations and definite re c oinmen&a t i o ns : THE IKSAEE 1, Hospitals for the Insane should be regarded as being on the same plane as other hospitals and no longer as mere custodial institutions. Hospitals for the insane in Manitoba are at present organized without regard to the demands of modem science. They have neither adequate staff nor equipment to make them anything more than custodial institutions. TThile the Winnipeg General Hospital, for example, has seventy- too attending Physicians and Surgeons, and eighteen internes in addition to that of the Laboratoxy and Pathol- ogical Departments, the Brandon Hospital for the Insane, of approximately the same size, has only one Physician. His duties are practically all administrative, view of the fact that the diseases treated at Brandon require exceedingly skillea and close attention this lack of staff is wrong. Therefore, in placing Hospitals for the Insane on the same plane as other Hospitals in the matter of equipment and staff we consider the following to be essential:— (al Adequate Laboratory accommodation with facilities for complete and thorough clinical investigation should be provided at Brandon as soon as possible. [•{j} Provision for proper professional care of the patients, both rae> and nursing, should be made. rec " the (c) In "both the Medical and Hursing fields there should he close co- operation with all the General Hospitals of the Province. Id) Internes should be provided as in other Hospitals and the necessity of some Psychiatric training for Medical Students in 'Iasi lota should, te emplias iced. This training has not as yet been developed in this Province 2, Diagnosis of all supposed cases of insanity should in future bo made by competent Psychiatrists, either at the Psychopath! c department of tne Winnipeg gen- eral Hospital or at the reception department which is recommended as an addition to the Hospital for the Insane at Brandon. Commitment from those reception departments to the Insane Hospitals should be made direct, and not as at present by a Magistrate through the gaols. In this connection we must express regret that the new Psychopathic Ward now being erected at the Winnipeg General Hospital is not of sufficient size to meet the requirements. The need of graduate muses in the r^dhlat.cio aerwtees has been pointed out. A larger PsychopaMiic Department would permit of the training or a larger number of pupil nurses, who mi^it subsequently engage in this wifi:. 3> diagnosis is established all insane patients should bo referred to the Hospital at Brandon. The practico of sending insane patients to institutions obviously unfit for their care cannot be too strongly deprecated. Segregation and suitable al- location from the beginning is essential. On arrival at Brandon there should be a further specialised segregation ivith a view to appropriate occupational treatment. To provide facilities for the suggested changes, re-arrangement present space at Brandon with some additions should be undertaken. -e of the suggest that these should be,- la) Re-arrangement of the present building to provide additional wards, re c reation rooms, sun rooms, and laboratory facilities, having m view tae removal of the Dining quarters to a separate building. — u _ 3 ~ The erection of a separate reception ward. The erection of centralized dining and kitchen aoooranodation. Adequate quarters for the staff. Occupational buildings and equipment. buildings and equipment need not be complicated or expensive and farm colony cn the cottage plan, for from fifty to one hundred Special accommodation for tuberculous patients. The matter of diversified occupation both from a curative and economic standpoint cannot bo too strongly drawn to your attention. Mined farming, as opposed to grain raising, provides suitable occupation for female as well as male , patients, 6. Convalescent patients should be discharged through a central clearing station. This should be situate in the outskirts of Winnipeg, and from it there should bo a gradual return to normal life. History shows a great number of recurrences are due to too abrupt return to unsuitable surroundings together with the total withdrawal of the supporting agencies to which tho patient has grown accustomed. The establishment of n competent Social Service Department in connection with this Clearing Station is so important as to bo classed as a necessity. The discharge of patients should be controlled from the Psychopathic Ward of the General Hospital and the Medical Staff should bo identical. , Having- outlined a plan for the care and treatment of the insane on modem, humane, and scientific lines, based on the opinions of leading experts on the subject, your Committee feel that the outlay required vail be justified on economic grounds, apart altogether from the duty which the state owes to its less fortunate citizens. tb) to) (a) (e) These v/ould include a patients. If) 1 1 1 v J IDIOTS AMD L077 SHADE IMBECILES Humane custody £l car a . The treatment of the insane is an e-^tiiely ant proposition from the care of idiots and imbeciles, and tne two present entirely different problems. The one is a case of scientific treatment, the other simply a cc^e Oa humane care. From the very nature cf their unfortunate condition and their inabil ity to complain, the supervision of the care of idiots and imbeciles should be continuing and thorough. Z. They should be cared for in a separate institution or in a completely isolated wing of an institution. It has been s BS gested in the report of the Canadian National Cormdttee for Mental Hygiene that a section of tha present Selkirk institution oould be ased xor this class and we endorse this recommendation, in view of the fact that it is Pro- posed to dedicate the balance of the Institution to the care of girls of the Moron type, and such of the .domestic duties for the whole institution as could be done without bringing the two classes into any contact whatever, could be efficient!* and economically performed by these girls, thus sustaining the principle of segreg- ating the two groups • r.flua n v D5FEC