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STATE BOARD OF CONTROL, CALIFORNIA

In addition to this we inclose a list of property valuations of all the institutions for the socially inadequate, fifteen in all, giving you the property valuations of each with the total, so that your figures may conform to the official figures of this office.

STATE BOARD OF CONTROL

EDWIN F. SMITH, Property Agent

The United States Public Health Service, in a letter signed by W. G. Stimpson, Acting Surgeon General, says:

TREASURY DEPARTMENT

BUREAU OF PUBLIC HEALTH SERVICE
WASHINGTON

The Bureau is in receipt of your letter of the 20th ultimo requesting a statement of the activities of the Service in reference to certain forms of social inadequacy.

As the public health agency of the federal government, the Service is naturally interested in the health aspect of all forms of social inadequacy, and considerable attention has therefore been given to the various questions involved. In the statement below, an effort has been made to give a summary review of the phases of these problems which have received most attention. Aside from these activities specifically mentioned, it may be added that the Service is in constant receipt of correspondence from health authorities, civic associations, physicians and other individuals bearing on these questions. In this way, the information available to the Service is transmitted to such persons, and the data they may have is added to those accumulated by this office. In its work, the Service naturally emphasizes the prevention of the conditions enumerated rather than their cure, and advocates the close co-ordination of all the agencies interested, as each and all of these forms of social inadequacy must be considered as forming part of public health as a whole. As showing the wide scope of the work and the more or less close relation it bears to the subjects under consideration, there is inclosed a chart setting forth the organization of the Public Health Service.

Insane and feeble-minded.-The immigration laws specifically provide that physical and mental examinations of all arriving aliens shall be made by officers of the United States Public Health Service to determine the presence of physical or mental defects. Since the passage of the above-mentioned law in 1907, 444 mental defectives were certified for deportation in 1919, 412 in 1910, 403 in 1911, 371 in 1912, 883 in 1913, 1360 in 1914, 606 in 1915. The time and place of examination of aliens are designated by the Commissioner of Immigration. Other matters relating to these examinations are controlled by the Public Health Service whose officers are subject only to the orders of the Surgeon General.

Cases of mental diseases are treated regularly among the beneficiaries of the Service, the number usually exceeding 100 every year.

In addition, the Service is actively interested in all efforts relating to the prevention and control of mental diseases, and a number of officers have conducted investigations and published papers on this subject. In connection with the studies of school hygiene, for instance, mental examinations have been made during the past year and a half of over 18,000 school children in 4 states. The percentage of feeble-mindedness observed in the course of these investigations varied from 0.3 to 1.1 per cent, according to locality. In connection with the studies of pellagra, like attention has been paid to cases of insanity resulting from this disease.

Tuberculous. The activities of the Public Health Service in regard to tuberculosis may be summarized as follows:

Enforcement of laws forbidding the immigration of tuberculous persons. Investigating scientific problems such as the viability of the tubercle bacillus, the effects of climate on the course of the disease, and the value of preparations advocated for treatment of the disease.

Conducting a campaign of education against the disease through bulletins, lectures, exhibits, etc.

Examining government employees suspected of having the disease.

Inspecting government buildings in Washington to see that the provisions for the prevention of the disease are enforced.

Treating beneficiaries of the Service afflicted with tuberculosis, and operating for this purpose the federal sanatorium at Fort Stanton, New Mexico.

Investigating the problems connected with the migration of tuberculous. persons from one state to another.

Blind. Among the activities of the Service specifically aimed at the prevention and control of blindness may be mentioned:

The examination of arriving aliens to prevent the admission into this country of persons afflicted with communicable eye diseases, as, for instance, trachoma. Thus, in the 10-year period ending June 30, 1915, 23,654 cases of trachoma were detected and excluded at immigration stations. As similar inspections are made at foreign ports to prevent the embarkation of diseased aliens, many times greater numbers were undoubtedly prevented from sailing for this country. In one year alone, 1906, for instance, 29,600 immigrants with trachoma were detected at foreign ports and kept from embarkation.

The examinations of persons in this country, especially school children, to determine the prevalence of trachoma and other eye diseases and suggest remedial and preventive measures to the proper authorities. About 200,000 individuals have already been examined in not less than 16 states, the prevalence of trachoma varying from 9.5 per cent to 0.02 per cent. Similar examinations have been made of over 39,000 Indians in 24 states, 22.7 per cent of which were found to be suffering from trachoma.

In order to demonstrate the eradicability of trachoma in the regions found most heavily infected, six small hospitals have been established in the states of Kentucky, Tennessee, Virginia, and West Virginia, where patients may obtain treatments free of charge. Up to June 30, 1916, nearly 13,000 patients had been treated at these hospitals. In connection with the operation of the trachoma hospitals, an educational campaign has been conducted through the entire Appalachian region by means of clinics, lectures, publications, and visits to country homes.

A compilation has been made of the laws relating to ophthalmia neonatorum, thus showing the measures so far taken in this country to prevent infant blindness and the need for further legislation of the same character.

Cases of blindness among beneficiaries of the Service are treated at the stations of the Service. During the year ending June 30, 1915, 2,104 cases of eye disease were treated.

Deaf.-Cases of deafness among beneficiaries of the Service are treated at the stations of the Service.

Inebriate.-Reviews of the legislation on this subject are published at frequent intervals, in connection with the general studies relating to habitforming drugs.

Lepers.-The specific activities of the Service in this direction are as

follows:

Conduct of scientific studies of the disease at the Leprosy Investigation Station maintained in Hawaii.

Co-operation with the Hawaiian authorities in the treatment of the lepers in the territorial settlement at Molokai.

Prevention of the spread of leprosy in interstate traffic.

Periodical compilations of reports of the prevalence of the disease in the various parts of the country.

Drug habitués.-The Service has co-operated with the Internal Revenue Bureau in the enforcement of existing federal anti-narcotic legislation, rendering advice in regard to technical questions. Popular articles in regard to the prevention and cure of this condition have been published, and compilations are periodically made of all the legislation relating to this subject.

Respectfully,

W. G. STIMPSON, Acting Surgeon General

Letters were addressed to 576 state institutions included under the type list given in this paper. Only three of the institutions objected to the classification. One was a United States Naval Home, which objected to being included in the classification. "defective, dependent, and delinquent." Later on, however, when the nature of the study and the full connotation of the term "socially inadequate" was explained, the Secretary of the Navy

withdrew the objection. The other two objections were made by schools for the deaf. However, the principals of most of such schools recognized immediately the fact that they were dealing with persons handicapped on account of their deafness, and did not object to the classification. They understood that in a general survey of social handicap it was proper that their schools be included with other groups of persons whose articulation with the ordinary social life of the community was quite different from theirs.

To sum up the matter, all students of social structure agree that a general non-enumerative title is needed to designate all of those classes in modern society which need special care, restraint, or direction, who as a group do not contribute in net to the general welfare (nor at all except as they may awaken altruistic conduct in their more fortunate fellows), but who on the contrary in net entail a drag upon those members of the community who have sufficient insight, initiative, competency, physical strength, and social instincts to enable them to live effective lives without particular social custody. The general titles suggested for this great division of humanity are the following: anti-social classes; asthenic classes; classes in need of social care, control, or correction; defectively socialized classes; dependent classes; exceptional classes; incompletely socialized classes; public charges; social debtor classes; social debtors; socially handicapped classes; social maladjustments, i.e., the socially maladjusted classes; socially abnormal classes; socially unadapted; socially unfortunate; sub-social classes; subnormal classes; unsocial classes; unusual classes, and the lower or submerged tenth.

Referring back to the census publication, we find that the subgrouping of the ten specific socially inadequate types was retained in its original form; it could not be shaken. For the general title the Bureau of the Census, however, decided

to adhere to the term "defective, dependent, and delinquent classes" because it is conservative, conforming to our previous practice, because it meets with more general approval than any other term suggested, because it is the term employed in the statute under which we collect the data, and because it seems evident that the term "socially inadequate" would call forth criticism and protest in some quarters. . . . . Of the various alternatives which have been suggested, "socially inadequate" seems . . . . fully as good as any. If it was a well accepted term in general use I would not object to it.

What is needed is a term hoary with age, but still venerable on account of its great current service. If there is no term that carries the proper connotation, any one which arbitrarily might be agreed upon and defined would do the work, creep into the dictionary, and ultimately carry the connotation which its more or less arbitrary definition attributes to it. Jack London said the way to prove anything is to say it three times. The continued use of a term in a given connection establishes it in a language. Newly invented terms, if useful, soon set immovably in the linguistic matrix.

"What's in a name," other than a clear-cut designation? A socially inadequate person may properly be defined as one who, by his own purpose, initiative, and efforts, chronically is unable to maintain himself as a self-supporting and useful member of the organized society in which he finds himself. In our modern society this inadequacy is generally the result of personal, mental, physical, or temperamental handicap, either inherited or acquired. It should be, however, provided that the term "socially inadequate" should not be applied to individuals whose personal or social ineffectivenesses are due solely to the normally expected exigencies of youth, old age, or temporary illness, when such ineffectivenesses are taken care of adequately by the respective families in which they occur.

The subclassification may well defer to those medical, social, and legal classes as they are handled now by organized society. As institutions become more specialized, and the eugenical and social sciences have more influence upon practical care and treatment, doubtless other groups will be segregated for social treatment. Law, medicine, eugenics, sociology, and criminology have their special classifications for individuals who, in their social bearings, come within the ken of each particular science, but when one attempts the study of these classes from the standpoint of organized society he must treat them not from the viewpoint of any one science, but from their functioning in and their actual treatment by the social organism. By some the blind and the deaf are grouped together under one class, the cacaesthenic or those with defective sense organs, but for the most part organized society treats them separately, so that they are here made into separate classes.

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