MENTAL HYGIENE 
IN INDIANA 
State of Indiana 
Department of Public Welfare 
141 South Meridian Street 
Indianapolis, Indiana MENTAL HYGIENE 
IN INDIANA 
Division of Medical Care 
George C. Stevens, M.D. 
Director TABLE OF CONTENTS 
Page 
The Problems of Mental Illness and Mental Deficiency 4 
Introduction 4 
The Mentally 111 9 
The Mentally Defective 17 
The Epileptic 26 
Duties of the Division of Medical Care 29 
Supervision of Institutional Care 29 
Mental Hygiene 44 
Indiana’s Mental Hospitals 50 
Introduction 51 
Central State Hospital 53 
Richmond State Hospital 54 
Logansport State Hospital 55 
Evansville State Hospital 56 
Madison State Hospital 57 
Indiana’s Institutions for the Feeble-Minded 58 
Introduction 59 
Fort Wayne State School 60 
Muscatatuck Colony 62 
Indiana Village for Epileptics 64 
2 INDEX OF CHARTS 
Chart Page 
I. Institutions for mental cases: number of patients present at the 
end of each fiscal year, 1849 through 1940 6 
II. Institutions for mental cases: number of patients admitted dur- 
ing each fiscal year, 1849 through 1940 8 
III. Location of state institutions for feeble-minded and districts 
served by each, April 1, 1940 23 
IV. Annual per capita costs of mental institutions, 1925-1940 36 
INDEX OF TABLES 
Table Page 
1. Personnel employed in Indiana state hospitals during year end- 
ing June 30, 1940, compared to requirements under American 
Psychiatric Association standards 34 
2. Average per capita cost of operating Indiana’s mental hospitals 
compared with that of other states 37 
3. Type of problems referred to Indiana’s mental hygiene clinics.... 47 
4. Capacity and population of Indiana state hospitals, June 30, 1940. 51 
5. Inventory of Indiana state hospitals, June 30, 1940 52 
6. Institutions for the feeble-minded, capacity and population, June 
30, 1940 59 
7. Institutions for the feeble-minded, inventory, June 30, 1940 59 
3 THE PROBLEMS OF MENTAL ILLNESS 
AND MENTAL DEFICIENCY 
Introduction 
The Human Tragedy 
Amid all the ills that beset human beings, none is more 
tragic than derangement of the mind. No physical disease is 
more incapacitating, for when the mind is gone the one 
quality which is distinctively human is swept away. None 
is more disturbing to the loved ones of the afflicted, for in 
place of the man that was, with his wit, his personality, his 
memory and all its associations, stands a stranger, unpre- 
dictable and unreal. Shunned and feared by his former 
associates, he is protected and sheltered by his family, who, 
in turn, avoid their friends in shame. A pall of gloom is cast 
over that household where one of its members is cut off from 
reality by derangement of the mind. Such is the fatalistic 
attitude adopted by the vast majority of the public toward 
mental disorders. 
Actually, control over mental disease is increasing with 
the development of newer methods of treatment, and pre- 
vention now* is practiced both by treatment of cases before 
complete mental collapse and by continued emphasis upon the 
factors which make for mental health. Yet the surface has 
hardly been scratched so far as prevention is concerned. One 
of the greatest stumbling blocks is getting the public to 
change its fatalistic and condemnatory attitude toward mental 
disease. First and foremost, mental illness is a disease, differ- 
ent only in its manifestations from any physical illness. To 
many persons, however, mental illness is something remote 
and fantastic. They have had no first-hand contacts with 
persons so afflicted. They know nothing of the tragic conse- 
quences that flow from mental disorder. Consequently, they 
are likely to minimize the importance of this type of disorder. 5 
The Numerical Importance of the Problem 
If mental illness were confined to a relatively few indi- 
viduals, even the seriousness of the disease to those individuals 
and to their immediate families might be passed over lightly 
when dealing with the varied troubles that beset the life of 
man. Unfortunately, such is not the case. Mental illness is 
much more prevalent than most persons suspect. Throughout 
the nation, more hospital beds are devoted to the care of the 
mentally sick than to the care of all other classes of hospital 
cases combined. There are almost half a million persons in 
public mental hospitals in the United States, and the number 
of patients in such hospitals is rising at the rate of approxi- 
mately 14,000 a year. Thus, in the United States there are 
about four persons in such institutions for every 1,000 persons 
in the general population. Alarming as these figures are, there 
is no reason to believe that mental disease is on the increase. 
The increase in mental hospital population simply reflects a 
growing awareness of the problem and a willingness to pro- 
vide more adequate hospital accommodations. 
Studies have been conducted in various parts of the country 
to show how many persons may be expected to suffer from 
mental illness. One such study made in New York state 
revealed that approximately 4.5 per cent of the persons born 
there may be expected to succumb to mental illness in one 
form or another and to become patients in hospitals for such 
disorders. In other words, about one person out of every 22 
born in New York state will become a mental patient at some 
time during his or her life. 
In Indiana, on June 30, 1940, there were 8,433 patients in 
mental hospitals, or 246.8 patients for each 100,000 persons 
in the population of the state. During the year ending June 
30, 1940, there were 1,928 patients admitted to these hos- 
pitals. This is an admission rate of about 56 patients for 
each 100,000 persons in the state population. Chart I shows 
the number of patients in each institution for mental disease 
at the end of each fiscal year from the opening of each insti- 
tution to the end of the current fiscal year. 6 
HUNDREDS 
OF PATIENTS 
CHART I 
INSTITUTIONS FOR MENTAL CASES 
NUMBER OF PATIENTS PRESENT AT THE END OF EACH FISCAL YEAR 
1849 THROUGH 1940 
HUNDREDS 
OF PATIENTS 7 
It will be seen that the number of mentally diseased pa- 
tients in state hospitals in Indiana has steadily increased 
from 1849 to the present year. Likewise, the trend of ad- 
missions has been on the increase since the establishment of 
the various state hospitals. The following chart shows the 
number of new admissions to the mental hospitals in Indiana, 
year by year, since the establishment of each institution. 
Over the past ten years, the average number of new 
admissions each year to the mental hospitals of the state was 
1,595. The average daily population of these hospitals over 
the same period was 7,649. There is a complete turnover 
of the population of the mental hospitals in the state once 
in about four and a half years. 
The Mentally III and the Mentally Deficient 
Considerable confusion exists in the minds of many persons 
as to the difference between mental illness and mental de- 
ficiency. Mental illness is derangement of a mind which had 
previously functioned more or less normally. Mental deficiency, 
or feeble-mindedness, is a lack of intelligence, evidenced 
from an early age, which is either the product of heredity 
or the result of arrested mental development because of 
disease or injury. Because the problems created by these 
two types of mental disorder differ widely, each will be 
discussed separately. 
Madison State Hospital, “Cragmont”, is the last of the five hospitals 
established by the state for the care and treatment of mental cases. 
The 30 principal buildings house more than 1,600 patients. 8 
HUNDREDS 
OF PATIENTS 
CHART II 
INSTITUTIONS FOR MENTAL CASES 
NUMBER OF PATIENTS ADMITTED DURING EACH FISCAL YEAR 
1849 THROUGH 1940 
THE LEGISLATURE OF 1933 CHANGED THE FISCAL YEAR TO END JUNE 30 INSTEAD OF SEPTEMBER 30. THE DATA FOR THIS YEAR, THEREFORE, COVER BUT NINE MONTHS. 
HUNDREDS 
OF PATIENTS 9 
The Mentally 111 
Definition 
In the past, persons suffering from mental illness were 
grouped together under one term, the “insane”. Today the 
use of this term is discouraged, partly because of the odium 
which attaches to it and partly because it is more properly 
a legal instead of a medical term. Strictly speaking, we 
ought to refer to mental diseases rather than to mental disease, 
for mental disorders constitute a class or group of diseases. In 
the more serious types of mental disorder, known technically 
as psychoses, there are at least a dozen distinctly recognizable 
forms, some described in terms of their symptoms, others 
described in terms of their cause. On the other hand, there 
are less serious types of mental illness ranging all the way 
from psychoneuroses to the malajusted personality. In fact, 
there is a school of thought which regards psychotic persons 
merely as cases in which the traits and tendencies exhibited 
in disordered personalities are carried to such extremes as 
to make these individuals unfit for social intercourse. 
Early Treatment of the Mentally III 
The history of the care of the mentally ill does not pre- 
sent a pleasant picture. Identified with notions of demonology, 
the insane were from a very early time thought to be pos- 
sessed of evil spirits. Their disorders thus diagnosed, their 
treatment consisted of exorcising these demons by such 
methods as were available to the representatives of the re- 
ligion of the day. The tenacity with which such an idea 
persists is witnessed by the fact that this notion is still 
current today among some religious sects. But what is more 
important is the still widely prevalent attitude, derived from 
this notion, of fear of the insane. 
When treatment of the insane passed from the hands of 
the clergy, their lot was not greatly improved. When re- 
moval from society became necessary, they were housed in 
jails and poorhouses. Shackled hand and foot, they were 
left to rave until such time as death delivered them from 
their misery. Toward the close of the eighteenth century, 10 
the problem of housing such persons became so acute in this 
country that a beginning was made by the erection of build- 
ings expressly for the purpose of keeping the insane. Through- 
out the nineteenth century, there was an era of building these 
“madhouses” by the counties, towns and cities. 
The first American institution designed solely for the 
housing of mentally ill patients was opened at Williamsburg, 
Virginia, in 1773, Not only was this the first institution of 
its kind in this country, but it remained the only state hos- 
pital for the insane in America for a period of fifty years. 
It is doubtful, however, if anything more than custodial care 
was given patients even in this institution. 
In 1821, the Bloomingdale Asylum was opened as a separate 
unit of the New York Hospital, and the opening of this institu- 
tion marks a turning point in the treatment of the mentally 
ill. Founded through the initiative of Thomas Eddy, a Quaker 
philanthropist, it was probably the first institution for the 
insane in America operated primarily on therapeutic principles. 
Spread of this conception of the care of the mentally ill 
was slow indeed. A century ago, there were in the entire 
country nine asylums or hospitals for the insane, seven of 
which were supported in whole or in part by state funds, 
founded upon what has been called the “cult of curability”. 
The fundamental belief of members of this “cult” was simply 
that mental disease is first and foremost a disease and is 
curable—truly a radical departure from current thinking on 
the subject. Members of this group labored to put their 
theory into practice by developing new methods of treatment 
of the insane. Half a century passed and little progress was 
made in converting new followers to this point of view. In 
the fifty years, however, other changes did take place. This 
period saw the fruits of the crusade of Dorothea Dix. By 
the time of her death in 1887, directly as the result of her 
efforts, 20 states had established or enlarged their mental 
hospitals. 
By the turn of the twentieth century, the insane were 
housed in elaborate buildings called “hospitals”. They were, 
for the most part, removed from jails and almshouses; they 
were segregated in institutions designed especially for the 11 
care of the mentally ill. Unfortunately, the expansion of the 
“cult of curability” did not keep pace with the development 
of mental hospital building. Many of the old methods of 
care were carried over into these new institutions in slightly 
modified form—chains, strait jackets and padded cells. Fre- 
quently these new institutions were operated by men who had 
no scientific notions of mental disease, who regarded their 
task as custodial in character and their function as that of 
caring for the animal needs of their patients and seeing that 
they did as little damage to themselves and to others as 
possible. 
Several factors operated to retard the progress in the care 
and treatment of the mentally ill which looked so promising 
before the end of the nineteenth century. By about the 
middle of this century, the practice of nonrestraint was widely 
adopted in England. This meant that the use of mechanical 
means for restraining disturbed patients, such as the use of 
chains and fetters, was discarded by many of the institutions 
in England, In its place was substituted interesting diversions 
such as occupational pursuits and recreation. In America, 
however, authorities in the mental field carried on a long 
and acrimonious debate on the subject of restraint versus 
nonrestraint. The advocates of nonrestraint pointed to the 
success of this method of care in England. Their opponents 
emphasized the point that freedom-loving Americans, sane 
or insane, could not be coerced except by mechanical means. 
The long-drawn-out character of this debate is evinced by 
the fact that during the first fifty years of its existence the 
Association of Medical Superintendents discussed this subject 
at nearly every one of its meetings. Eventually, there came 
the dawning recognition that mechanical restraint stimulated 
and encouraged the very conditions it was supposted to elim- 
inate. Some of the very superintendents who were loudest 
in their opposition to the principle of nonrestraint were at 
the same time busy reducing the use of mechanical coercion 
in their own institutions to a minimum. 
While nonrestraint is a method of care of the patient and 
may broadly be viewed as a means of treatment, treatment 
of mental illness, in a medical sense, was almost nonexistent 12 
in the latter part of the nineteenth century. The plain fact 
of the matter is that medical science, up to this time, had 
made little contribution to knowledge about mental disease. 
The state of knowledge of mental disorders was chaotic at 
this time. Order was brought out of this chaos by Kraepelin, 
who devised a new classification of mental diseases which laid 
the groundwork for a scientific approach to the problem. This 
classification was first introduced into America in a modified 
form in 1896 by Adolph Meyer, and the system still serves 
as the basis for classification of mental disorders in most 
American hospitals today. 
Development of Psychiatry 
More than mere classification was needed, however, before 
methods of treatment could be devised. A complete theory 
of the cause of mental disorder was lacking. It was not until 
Sigmund Freud published his work entitled “Studies in Hys- 
teria” in 1895 that we get the beginnings of such a theory. 
Freud had become interested in the phenomenon of hypnotism 
and had been able to observe that when under the influence 
of hypnosis patients were able to recall ideas and incidents 
which in their normal waking state were beyond their ability 
to recall. Theorizing on this, Freud concluded that mental 
maladjustments and their expression in faulty behavior or 
faulty thinking can be the expression of mental conflicts 
existing at a deeper, or unconscious, level of the mind. He 
was able to show that when, through hypnosis, these conflicts 
were brought into the open, or to the conscious awareness 
of the individual, frequently remarkable cures resulted. 
Finally, Freud arrived at the conclusion that the personality 
of the individual is largely derived from the interaction of 
two opposing forces: inherited, instinctive drives or tendencies 
which are not at all social in their aim and which largely have 
the goal of seeking pleasurable satisfactions for the individual 
and the constantly molding influence of the environment 
operating on the individual and his drives from the moment 
of birth onward. 
From all of this came a full-blown theory, not merely of 
mental illness, but of all forms of mental and personality 13 
disorders ranging from the most serious forms to the minor 
maladjustments of personality. In substance, this theory 
states that the cause of such disorders lies in emotional con- 
flict at the unconscious level, which conflict may have been 
generated by experiences reaching back to childhood or in- 
fancy, and that the cure for such disorders lies in the dis- 
covery and resolution of this conflict. As applied in treatment 
of functional mental disorders, that is, those which have no 
known organic cause, the searching out of such conflicts and 
the resolving of them is known as psychotherapy. 
Another theory of mental disorder, American in origin, is 
that set forth by Adolph Meyer, and known as psychobiology. 
Somewhat less explicit and more difficult to explain than that 
of Freud, it has this in common with psychoanalysis, that 
personality is the product of constitutional or inherent bio- 
logical factors of makeup as modified by the effects of past 
experience. This total experience must be reviewed to discover 
the particular experiences which produced the present malad- 
justments. 
Likewise, some advance has been made in other forms of 
treatment. In 1913, Noguchi and Moore discovered the pres- 
ence of the syphilis germ in the brain of persons suffering 
from the form of mental illness known as paresis, or general 
paralysis. Thus, the organic cause of this particular psychosis 
was definitely ascertained. In 1917, a promising remedy was 
supplied by the discovery of Wagner-Jauregg that in paretic 
cases a remarkable recovery was noted following an attack 
of erysipelas. This disease produced a high fever, and it was 
soon ascertained that it was the fever which effected the cure. 
Today, fever therapy, for the most part induced by the use 
of malaria, is in common use in the treatment of paresis, with 
very good results. 
Two forms of “shock” therapy have been introduced in 
recent years in the treatment of dementia praecox cases with 
surprising results. How permanent the recoveries in these 
cases will be it is still too early to determine. In 1983, Sakel 
accidentally discovered that the shock induced by large doses 
of insulin resulted in the social recovery of a high percentage 
of dementia praecox cases. He stated his results from this 14 
treatment cautiously when he said “. . . the net result (of 
his experiments in insulin shock treatment) is a percentage 
of remissions which is at least four times greater than the 
most optimistic figures for spontaneous remissions.” 
Miller and Medune experimented with another form of 
shock therapy, induced by a camphor derivative, which has 
come to be known as metrazol treatment. Results comparable 
with those obtained from insulin treatment were obtained. 
Today, both insulin and metrazol are being used in the treat- 
ment of other forms of functional psychoses. While good 
results are reported, it is still too early to attempt to evaluate 
them. 
Both insulin 
and metrazol 
shock therapies 
have been in use 
at Richmond 
State Hospital 
for over a year. 
Central State 
Hospital is a pio- 
neer in the use of 
fever treatment. 
Importance of Early Diagnosis and Treatment 
All of this marks progress which has been made in the 
treatment of the mentally ill. At last, definite steps are 
being taken actually to treat these patients. However, one 
great handicap remains to be overcome if significant results 
are to be achieved from these efforts. This obstacle is the 
attitude of the public toward mental illness and the mentally 
ill. Such illness is still regarded as a disgrace, something 
which should be concealed as long as possible; the mentally 
sick person is one who should be feared or, at least, regarded 
with suspicion. The result of this is that frequently mental 
illness is not brought to treatment until it has reached an 
advanced or acute stage. Too much emphasis cannot be laid 15 
upon the necessity for early diagnosis and treatment to assure 
best results. The time has come when the public must be 
made to realize that mental disorders are forms of disease, 
differing only in their manifestations from physical disease. 
Another result of the public attitude of suspicion is that it 
makes the lot of the recovered or improved patient increas- 
ingly difficult when such a patient returns to society. He is 
denied employment; his friends behave strangely toward him; 
acquaintances shun his companionship. In a patient already 
unduly sensitive this makes complete recovery difficult and 
even sometimes impossible, for we are all social beings who, 
denied social contacts, develop new conflicts and the psychosis 
may recur. 
Indiana Hospitals for the Mentally III 
There is no reason to believe that the problem of mental 
illness is any more or any less serious in Indiana than in the 
country as a whole. On June 30, 1940, there were 8,433 
patients in the five mental hospitals in this state. Details of 
those institutions and their operation are given in another 
section of this report. If the ratio of persons suffering from 
mental disease to the whole population computed for the 
entire country holds for Indiana, between 15,000 and 25,000 
persons in this state are at present suffering from such 
illness. No actual count, however, has ever been made, so 
such figures are merely estimates based on the incidence of 
the disease in parts of the country in which more or less 
complete studies have been made. Whatever the actual num- 
ber of cases in this state may be, this much is certain: only a 
fraction of the total number of cases is admitted to our 
mental hospitals. Until recently, many were excluded be- 
cause of the overcrowded condition of those institutions. It 
will be only a matter of time until the increased facilities re- 
cently provided under the 1939-40 building program will be 
occupied to capacity. Sooner or later, the state will be faced 
with the necessity of making provision for some of those cases 
outside the mental hospitals. 16 
Commitment Procedures 
Admission to a state mental hospital in Indiana is obtained 
through commitment by a court. The court takes this action 
on the certification of two or more physicians that the patient 
is insane. After commitment, the patient is transported to 
the institution by the sheriff or other police authority. This 
system is, of course, a relic of the days in which the insane 
were housed in jails. This procedure is rationalized by claim- 
ing that the legal rights of the patient must be protected, 
but it does seem as if these legal rights could be safeguarded 
without the abuses which such a system fosters. In spite 
of all efforts to emphasize that mental illness is a disease 
and should be treated as such, the moment the state steps 
in to assist a mental patient it does so through the machinery 
of the courts, which are associated in the minds of most per- 
sons with the prosecution of criminals. Then, as if to complete 
the identification of the criminal and the insane, we admit 
these patients to the hospitals by court commitment, we may 
detain them in jail during trial if they are violent and we 
transport them to the hospitals in police cars in the custody 
of the sheriff. It may be that some of this procedure is 
necessary to safeguard the public and to assure that no person 
is detained in a mental hospital because someone wants him 
out of the way. As far as the latter point is concerned, how- 
ever, the persons most capable of judging the mental con- 
dition of the patient are the members of the medical staffs 
of our state hospitals, yet the present system does not make 
adequate use of this resource. 
To remedy some of the defects in the commitment pro- 
cedure, the Division of Medical Care advocates revision of 
the commitment statutes to provide admission to Indiana’s 
mental hospitals for a 30-day period of observation, this 
temporary commitment order requiring simply the signature 
of the judge when a petition for such an order is presented 
to him signed by two physicians. 
It is also felt that transportation to the hospital should 
be the responsibility of the hospital and not of the sheriff, 
and that trained attendants should have the care of mental 
patients while en route to the hospital. 17 
The Mentally Defective 
Definition 
Authorities differ in their use of the term, “mental de- 
fective”. In general, there are a broad use of the term and a 
narrower use. The Subcommittee on Problems of Mental De- 
ficiency of the White House Conference on Child Health and 
Protection adopted the broader definition of the term and in- 
cluded under it all persons who are intellectually subnormal, 
that is, all physically mature persons who have the mentality 
equivalent to that of a child of 12 years of age or less, regard- 
less of the degree of social adjustment which such persons have 
attained. The narrower definition limits the use of the term to 
persons who, besides being subnormal intellectually, are socially 
inadequate. This last definition makes mental deficiency 
synonymous with feeble-mindedness, which, like insanity, is a 
legal term denoting the inability of a person to care for himself 
through lack of intelligence and who requires some measure 
of supervision and guidance, if not actual custody. This last 
definition, therefore, excludes the group of persons who are 
only slightly handicapped mentally. 
Throughout the following discussion, this narrower mean- 
ing of mental deficiency will be used. The use of the term 
has been arbitrarily decided upon for practical reasons. The 
broader use of the term would involve discussion of educa- 
tional methods and the public school system that would carry 
the problem far beyond the scope of the Department of Public 
Welfare. At the same time, it is well to bear in mind that 
this criterion of social inadequacy which separates the mildly 
mentally handicapped from those seriously handicapped is 
dependent upon the social environment, which is not always 
constant. In a changed environment, the mildly handicapped 
may become seriously handicapped. Consequently, when the 
time comes to talk of preventive measures in a mental health 
program, the definition of the mentally defective will have 
to be enlarged to include the mildly mentally handicapped 
cases. 18 
Extent of Mental Deficiency 
Estimates of the number of mental defectives in the gen- 
eral population vary greatly, ranging from 0.4 per cent to 15 
per cent of the population. Part of the difference between 
these estimates lies in whether the psychological or the socio- 
economic criterion for determining mental deficiency was 
used. There is good reason to believe that somewhere near 
15 per cent of the general population has a mental age of 12 
years or lower, or, in the case of children, an intelligence 
quotient of less than 75. The portion of the population which 
is feeble-minded, in the sense that they are socially incom- 
petent as well as of low intelligence, is probably close to two 
per cent. 
On the basis of this two per cent estimate> Indiana has 
somewhere between 60,000 and 65,000 severely handicapped 
mental defectives in its population. The population of the 
institutions for mental defectives in this state at the end of 
the fiscal year was 2,851. 
Even more startling than these figures is the estimate 
made of the proportion of low-grade types of mental defectives 
in the population. Following the psychological criteria set 
forth by the American Association on Mental Deficiency in 
1934, persons having a mental age of less than three years 
and children with an intelligence quotient of less than 20 are 
grouped as idiots. Persons having a mental age of three 
years and under eight, or an intelligence quotient of from 20 
to 49 inclusive, are classified as imbeciles. A moron is a 
mentally defective person usually having a mental age of eight 
years or upwards, or, if a child, an intelligence quotient of 
50 or more. According to this Association, the upper limit 
for a diagnosis of mental deficiency, as a rule, should be an 
intelligence quotient of 69, but this limit should not be adhered 
to in cases where medical, social and other factors clearly 
indicate that the patient is mentally deficient. Although 
this definition of mental deficiency is based on mental tests, 
it should be remembered that, while such tests are useful and 
important, they are not an infallible index of mental ability 
in all cases. The Subcommittee on Problems of Mental De- 
ficiency already referred to estimates that approximately half 
of the feeble-minded are of the idiot or imbecile type. In 
terms of the population of this state, such a figure means that 19 
there are between 30,000 and 32,600 idiots and imbeciles among 
the population of Indiana. 
Too much emphasis cannot be laid on the fact that these 
figures are estimates, based on figures for the country as a 
whole, which were derived from sample studies and data 
covering psychological examinations of the draft army during 
the World War. Application of these figures to Indiana can 
be justified, however, by the close correspondence to the figures 
arrived at by the Indiana Committee on Mental Defectives in 
its 1922 report. This committee reported, after studying 11 
representative counties, three courts and various institutions, 
that at a conservative estimate 1.74 per cent of the general 
population of Indiana was feeble-minded. 
Development of Institutional Care 
The early history of the treatment of mental defectives 
closely parallels that of the insane. As early as the fourteenth 
century the term “idiot”, or natural fool, was in existence and 
covered all classes of feeble-minded then recognized. Such 
“idiots” have traditionally been regarded as objects of ridicule 
or disgust. Perhaps they have not suffered quite as much as 
the insane, for, while they were regarded at some periods 
as persons possessed with a demon, they do not seem to have 
been subjected to much religious persecution. When they 
were regarded as dangerous to society, they were thrown into 
prisons; otherwise, they were simply neglected and forgotten. 
Because of their handicap, many of them were unable to earn 
a livelihood and, consequently, gravitated to almshouses and 
workhouses. 
The first separate state institution for the training of 
mental defectives in the United States was established in 
Massachusetts in 1848, with Dr. Samuel G. Howe as director. 
In 1851, a similar institution was opened at Albany with 
Dr. Hervey B. Wilbur as director. The success of these two 
institutions did much to stimulate the building of separate 
institutions for the mentally defective. By 1866, there were 
seven such state institutions in as many states. 
In 1879, Indiana gave recognition to this new movement 
by establishing the institution which later came to be known 
as the Fort Wayne State School as an adjunct of the Soldiers’ 
and Sailors’ Orphans’ Home at Knightstown. In 1887, the legis- 20 
lature gave the institution a separate existence, and a sepa- 
rate institution was built and occupied in Fort Wayne in 1890. 
The history of the study of mental deficiency is marked 
by two developments of major importance. The first of these 
is the publication by Richard L. Dugdale in 1877 of his study 
of family degeneracy under the title, “The Jukes”. The 
second is the development of mental testing and the mass 
application of such tests to the draft army during the first 
World War. The significance of both of these developments lies 
in the controversies which they precipitated. 
Dugdale’s work was followed by at least half a dozen other 
important studies along similar lines, all of which purported 
to show that mental deficiency was, for the most part, heredi- 
tary. What was more, they expressed the view that such 
deficiency was the major, if not the sole, cause of all social 
ills. The hopelessness of this point of view was depressing. 
It served to retard the development of institutions for the 
training of mental defectives, and many of them became mere 
custodial institutions. If the problem was one of heredity, 
and as serious as these writers had indicated, the only thing 
to do was to seek ways and means of preventing reproduction 
among the feeble-minded. From this thought sprang later 
attempts to control the problem by means of sterilization of 
defectives. 
Mental Testing 
A much more constructive approach to the problem was 
made when means were devised to measure . intelligence, 
although application of this discovery caused great consterna- 
tion when the results of the draft army tests revealed a 
greater proportion of persons in the general population with 
subnormal intelligence than had ever been anticipated. 
An excellent opportunity presented itself for testing a 
generous sample of the population of the United States at the 
time of the first World War. This opportunity was seized 
upon and intelligence tests were administered to virtually the 
entire draft army. Results of these tests were published with 
little interpretation. Alarmists hastily concluded that almost 
half of the population was mentally defective. This mass 
testing program, however, was experimental and was carried 
on at an early stage in the development of a new field. The 
experiment revealed defects in the testing methods which 21 
would not have been uncovered for years without this vast 
experience. Since then, mental testing has been subjected to 
many refinements, and the limitations of these tests have 
become better known. The total result is that today mental 
testing is now a relatively accurate method of determining the 
degree of intelligence. It should be emphasized again, how- 
ever, that mental testing must not be regarded as the sole 
criterion of feeble-mindedness. Such testing must constantly 
be subjected to close scrutiny and related to the degree of 
social adjustment achieved by the person tested. Mental test- 
ing is a guide, not a final and irrevocable pronouncement on 
the mental capacity of an individual. 
Causes of Mental Deficiency 
Causation of mental deficiency is a highly controversial 
subject. There are, however, two general classes of causes 
which are commonly accepted. One class may be termed 
primary, indicating that the causes are largely hereditary in 
origin. The other class may be called secondary, indicating 
that the causes in this group operate before, during or soon 
after birth. As knowledge in the field increases, more types 
of deficiency are being removed from the primary group and 
placed under the secondary. 
From an early date, mental deficiency has been attributed 
to familial transference through the medium of the germ 
plasm. Theories of heredity are undergoing modification, and 
less emphasis is being placed upon the importance of heredity 
as a factor in the production of feeble-mindedness. At one 
stage in his career, Dr. Walter E. Fernald laid complete 
emphasis upon the heredity aspect of such deficiency. Before 
his death in 1924, after 38 years of experience, he concluded, 
as the result of his studies, that fully half of all cases of 
mental deficiency were of the secondary, or nonhereditary, 
type. 
The secondary type of mental deficiency can be attributed 
to certain physical causes. Dr. Abraham Myerson lists the 
following causes of such mental deficiency: 
1. Trauma at birth or severe head injuries during early childhood. 
2. Infectious diseases during childhood affecting the nervous system. 
such as encephalitis, meningitis, etc. 
3. Malfunctioning of the endocrine glands. 
4. Toxic conditions. 
5. Syphilis. 
6. Malnutrition. 22 
No figures are available to indicate the relative importance 
of any of these causes. Research along these lines will throw 
light on this problem in the future. 
There is considerable debate carried on at the present time 
as to the influence of environment on mental capacity. Until 
quite recently it was generally accepted that once the mental 
level of a person was established, barring the onset of diseases 
which might produce mental deterioration, the mental ability 
of that person would never change, regardless of any amount 
of education or training or any other social circumstance. 
If mental tests given at different times showed variations in 
their results, the explanation was to be found in the test 
situation. This hypothesis of the unchangeability of the 
mental level has been questioned in recent years by a number 
of persons. Studies have been undertaken which showed that 
children coming from an unfavorable home environment tested 
at a higher level when they were placed in a more favorable 
home situation. Conversely, the I.Q. of children placed in 
less favorable environments decreased. The conclusion drawn 
from these studies has been that cultural factors influence the 
I.Q., particularly such factors found in the home situation. At 
every turn when this evidence has been presented, some 
psychologists have disputed the conclusions. While the evi- 
dence at present is too fragmentary to draw definite conclu- 
sions, there does seem to be some support for the contention 
that there may also be social causes of mental deficiency. 
Indiana Institutions for the Feeble-Minded 
At the present time, Indiana maintains two institutions 
for the feeble-minded, the Fort Wayne State School, at Fort 
Wayne, and Muscatatuck Colony, near Butlerville. Originally, 
Muscatatuck Colony was a custodial institution for adult males. 
Over the past two years an extensive building program has 
been carried on at this institution and the character of the 
Colony has been changed to that of a school for the training 
of mental defectives who come from the southern half of the 
state. From the beginning, Fort Wayne State School has 
been operated as a training school for mental defectives. At 
present, the Fort Wayne school serves the northern half of 
the state. Chart III is a map which shows the counties served 
by each of these two institutions. Further discussion of these 
schools for the feeble-minded will be found in another section 
of this report. 23 
CHART III 
LOCATION OF STATE INSTITUTIONS FOR FEEBLEMINDED 
AND DISTRICTS SERVED BY EACH 
APRIL 1,1940 24 
It hardly need be emphasized that the results obtained 
from training the feeble-minded depend primarily upon the 
degree of mental deficiency in each case. Often admitted are 
patients of extremely low mentality who cannot clothe or feed 
themselves or otherwise perform simple services for them- 
selves. In such cases, maximum training is probably reached 
when they are taught to care for their own simple needs. On 
the other hand, high-grade morons can be taught difficult man- 
Inmates of Muscatatuck Colony are schooled in academic 
and vocational subjects. 
ual skills. Training, therefore, is preceded by determination of 
the probable degree of trainability of the patient. Academic 
education is not neglected in teaching the feeble-minded in this 
state, but it should be remembered that only a portion of the 
population of these institutions can profit by such training. 
It is recognized that an illiterate person is severely handi- 
capped in present-day society, so that patients are taught 
to read and write whenever it is possible to do so. 
Community Responsibility 
The problem of mental deficiency is really a community 
problem. The state never can build enough institutions to 
house all of the mental defectives in the state, nor would such 25 
a program be advisable even it were feasible. Many persons 
who are below the average in mental ability make a successful 
social adjustment. The responsibility of the community to 
such handicapped persons is to make sure that they have 
opportunity to develop such resources as they possess. Ob- 
viously, early discovery of mental incapacity is essential if 
adequate training is to be provided. The logical place for 
such a program to be carried out would be in the public school 
system. Some method of mental measurement of all children 
should be developed, preferably in the early grades of school. 
Cleveland, Ohio, for example, tests all its school children 
mentally. Instead of labelling each with an intelligence 
quotient, school authorities there speak of the “probable learn- 
ing curve” of the child. All subsequent training is geared 
to the ability of the child to learn. Not only would this serve 
as a means of training many of the mentally subnormal chil- 
dren right in the community and at an age when such training 
should be undertaken, but it would prevent the development 
of grossly maladjusted personalities from which most behavior 
problems spring. 
Commitment Procedures 
Under the present system in this state, persons are ad- 
mitted to the feeble-minded institutions on commitment by 
the court. The procedure is similar to that used for the com- 
mitment of psychotics. On certification by two or more 
physicians that the patient is feeble-minded the court orders 
commitment to such an institution. In cases in which the 
feeble-minded person has become a community problem, that 
person not infrequently is held in jail until commitment is 
obtained or until there is a vacancy in the institution to which 
he is committed. Considerable delay has been experienced in 
the past between commitment by the court and admission to 
the institution. This has been because of the greatly over- 
crowded condition of these institutions. Only this year has 
this condition been improved. Prior to this time, each insti- 
tution had long waiting lists for admission. With the com- 
pletion of the new buildings at Muscatatuck Colony, these 
waiting lists have beer? absorbed. But present indications are 
that both institutions will shortly be filled again to capacity, 
and now waiting lists will have to be started. 26 
The Epileptic 
Institutional Care 
The epileptic is the last group to have been removed from 
the poor asylums and, latterly, from mental hospitals and 
institutions for the feeble-minded. Only within the last half 
century has a serious attempt been made to place epileptic 
patients in a separate institution designed especially for their 
care. In general, the colony type of institution is the type that 
has been developed in this country for the care of such 
patients. The first separate institution for epileptics built in 
the United States was “The Asylum for Epileptics and the 
Epileptic Insane” opened at Gallipolis, Ohio, in 1891. The 
growth of separate institutions for the care of this type of 
patients has been slower than that for the care of the 
psychotic or the feeble-minded. By 1933 there were only 11 
such state institutions in this country, one of them being the 
Indiana Village for Epileptics at New Castle, which was opened 
in 1907. 
Commitment Procedures 
As in the case of the mentally ill and the feeble-minded, 
the method of admission to the Indiana Village for Epileptics 
This is one of the new buildings at the Indiana Village for Epileptics, 
where scientific treatment, education, employment and custody are pro- 
vided for persons afflicted with epilepsy. 27 
is by court commitment upon the certification of two or more 
physicians. For some years the institution has suffered from 
overcrowding. On June 30, 1940, it had a population of 931 
patients, while its normal capacity is 915 patients. At the 
end of the last fiscal year, there was a waiting list of 136 
patients. 
Nature of Epilepsy 
Epilepsy is a disease which is characterized by attacks of 
loss of consciousness which may or may not be accompanied 
by convulsions. The irregular occurrence of these attacks ana 
the brief warning, or entire absence of warning, of the onset 
of an attack seriously handicaps the sufferer in employment 
in particular and in social activities in general. 
As in the case of mental disease, there has not been estab- 
lished any one cause which is responsible for all epilepsy, nor 
is there agreement among authorities as to the causes of 
epilepsy. The American Psychiatric Association classifies 
epileptics into two groups, symptomatic cases and idiopathic 
cases. Symptomatic epilepsy means that the epileptic seizures 
are symptoms of a definite disease. Idiopathic epilepsy covers 
that group of cases in which the underlying cause is unknown 
or where the epilepsy can not be shown to be associated with 
or caused by any known disease. The cause of idiopathic 
epilepsy is believed by some to be the instability of the chemical 
structure of the nerve cells of the brain. However, others are 
inclined to the view that in the functional type of epilepsy there 
is evidence of emotional pathology. There seem to be some 
definite emotional patterns related to the convulsive states. 
In the more obvious cases this is termed histero-epilepsy. In 
the less obvious cases the emotional disturbance may be quite 
deep-seated. Thus it is possible that some cases of idiopathic 
epilepsy, in reality, may be emotional disorders. 
Figures are not available at the present time to show the 
relative importance of these two types of epilepsy. Various 
governmental and medical agencies have urged the need for 
research along this line and it is expected such figures will 
be available for Indiana next year. 28 
It is extremely difficult to obtain reasonably accurate 
figures on the extent of epilepsy. Figures for epileptics in 
institutions merely reflect the capacity of the institutions and 
tell nothing of the incidence of the disease. The only available 
index of the incidence of epilepsy was established when over 
2,000,000 men were examined for the draft army during the 
World War. As a result of those examinations, it was found 
that 515 in each 100,000 of the drafted men were epileptic. 
Because these men were between 18 and 30 years of age and 
because the rate of epilepsy is high among children and 
relatively few epileptics live to an advanced age, this figure 
is not representative. The Subcommittee on Problems of 
Mental Deficiency of the White House Conference previously 
referred to estimated for persons under 20 years of age a rate 
of 800 or 900 epileptics to each 100,000 of the total population. 
On the basis of Indiana’s population as given in the 1940 
census, this means approximately 10,000 persons in this state 
under 20 years of age suffer from epilepsy. By adjusting for 
the prevalence of this disease at various age levels, a figure of 
16,000 epileptics can be arrived at for the total population 
of Indiana. This estimate seems high in comparison with the 
findings of the study of the Indiana Committee on Mental 
Defectives covering the years 1916 to 1922. This committee 
made what was termed a conservative estimate of 0.15 per 
cent of epileptics in the population as the result of a study of 
11 counties and several institutions. This percentage would 
show a total of approximately 3,000 epileptics in the state on 
the basis of the 1940 census figures. Assuming that the one 
estimate is high and the other low, the probability is there are 
somewhere in the vicinity of 10,000 epileptics in this state. 
Medical Control of Epilepsy 
In recent years, considerable research has been conducted 
in search for a drug with which to control epileptic seizures. 
Some measure of success has been achieved by the use of 
phenobarbital. More recently, some excellent results have 
been reported from the use of dilantin for this purpose. 
Although it is still too early to evaluate the results of this 
latter treatment, it does look promising, and at least a begin- 
ning has been made in the medical control of such seizures. 29 
DUTIES OF THE 
DIVISION OF MEDICAL CARE 
The functions of the Division of Medical Care were set 
forth in Section 9 (c) of the Welfare Act of 1936 in the follow- 
ing words: 
“The division of medical care shall have immediate charge of 
the supervision of the several public benevolent institutions of the 
state and of all non-institutional care connected therewith, the opera- 
tion of the Central, Logansport, Richmond, Evansville and Madison 
state hospitals, the Fort Wayne state school, the Muscatatuck 
colony, the village for epileptics, the soldiers’ home and the state 
sanatorium, all agencies and institutions of the state caring for 
dependent or mentally or physically handicapped or aged adults and 
the approval of the incorporation of charitable agencies.” 
Supervision of Institutional Care 
In attempting to carry out the terms of the Welfare Act, 
which allocates to this Division the responsibility for the 
supervision of certain state institutions and the noninstitu- 
tional care connected therewith, the Division has stressed the 
introduction of the most progressive type of care and treat- 
ment known to medical science and has sought to initiate a 
state-wide program of prevention. 
In connection with the development of this program, cer- 
tain features of the relationship between the Division of 
Medical Care and the institutions need explanation. By way 
of clarifying the use of the term “supervision” in the Welfare 
Act, the Attorney General gave an opinion in which he in- 
terpreted this term as conferring upon the Department of 
Public Welfare, through its various divisions, something more 
than the power to inspect and recommend, yet implied that it 
was something less than complete control over the institutions. 
Subsequently, the institutions were transferred by executive 
order from the state welfare department to the Executive 
Department, under the supervisor of state institutions. Thus, 
the Division of Supervision of State Institutions obtained 
direct supervisory authority over the institutions. 
In this situation, the Division of Medical Care co-operated 
closely with the Division of State Institutions and, through 
the establishment of co-operative relationships with the super- 
intendents, worked with them towards improving institutional 30 
standards. Since the relationship between the Division of 
Medical Care and the institutions depends, at present, very 
much upon the willingness of the individual superintendent to 
co-operate, situations arise from time to time which might be 
met more adequately if the Division of Medical Care possessed 
more definite authority. 
Central guidance of institution programs, through qualified 
medical and professional personnel, is a pattern rapidly being 
adopted in other states. In the past, where such plans have 
been put into operation, there has always resulted more 
efficient, more advanced and more economically sound mental 
health programs. At present, the Division of Medical Care 
possesses the organization and qualified personnel to assume 
more direct responsibility in administering the institution 
program. This could be brought about by placing the institu- 
tions under the Department of Public Welfare and by some 
change in the Welfare Act more adequately defining the 
responsibility of this Division. 
Treatment Versus Custody 
One of the first steps taken by the Division of Medical Care 
was to carry on a campaign for the reduction, if not entire 
elimination, of restraint and seclusion in the mental institu- 
tions. It is not enough to take the shackles off the disturbed 
mental patient. Something must be done to relieve that dis- 
turbed condition. The use of hydrotherapy for this purpose 
has been found to give excellent results. Its use in this state 
has been greatly increased in the past few years. The chief 
bar to its greater use lies in the fact that these institutions 
are greatly understaffed. It requires more personnel to give 
adequate medical care to these patients than it does to give 
them custodial care. The mental institutions in this state are 
struggling to become treatment centers at approximately the 
same per capita budget level as they operated on in the days 
when little or no treatment was attempted. Much credit is due 
them that they have been able to effect as many improvements 
as they have in view of this obstacle. The time has come, 
however, when further improvements hinge upon whether or 
not they are provided with additional funds to increase their 
personnel. Considerable improvement has already been 
effected in decreasing the use of restraint and seclusion, but 
there is still much to be achieved along this line. 31 
The patient is taking a Rorschach test, results of which 
will help the psychiatrist to understand the mental sufferer’s 
imaginative processes. 
Fever Therapy 
As already indicated, certain methods of treatment have 
been found to give promising results. Use of these methods 
has been encouraged in Indiana’s institutions. One method of 
treatment, the use of fever therapy for paretic patients, has 
long been in use in this state. Research in this field carried 
on over many years under the direction of Dr. Max A. Bahr 
at Central State Hospital has won nation-wide acclaim. 
Shock Therapy 
Use of the shock therapies, insulin and metrazol, has been 
increased and some excellent results have been obtained. Many 
extravagant claims have been made for these methods of 
treatment, but one would do well to scrutinize carefully all 
figures quoted on the subject. Both insulin and metrazol have 
been in use at Richmond State Hospital for over a year. A 
total of 67 patients was treated by the insulin method and 114 
patients by the metrazol method, with improvement noted in 
approximately 40 per cent of the cases. 
It has now been definitely established that best results are 
obtained when treatment is given in the early stage of the 32 
disease, particularly in cases where the illness has been of less 
than six months’ duration. It should be pointed out that the 
great majority of the cases treated at Richmond were cases 
whose illness was of two to five years’ duration. In those 
cases where the illness was of less than six months’ duration, 
as much as 58 percent recoveries were reported. 
The Problem of Adequate Personnel 
The problem of proper care of patients in the mental hos- 
pitals of this state is largely a matter of the ability or inability 
of these institutions to employ adequate personnel, adequate 
both in training and in numbers. Most persons employed as 
attendants at these hospitals have not had previous experience 
in this line of work. To overcome this handicap, the Division 
has instituted a training course given by its supervisor of 
nursing to all attendants. However, it is felt that the amount 
of training it is possible to give in this way is inadequate. 
An effort is being made to have this work done by graduate 
nurses in each institution. The Division has also prepared 
and distributed an Attendants’ Manual, which is a handbook 
of instruction on the care of mental patients. Gradually the 
limited amount of instruction is helping to improve the stand- 
ards of care. There is a great need, however, to have well- 
trained personnel in the institutions to supplement these 
instructions. It is felt that there should be a sufficient number 
of graduate nurses in each institution so that each would have 
a director of nursing, who would be directly responsible for all 
nurses and attendants, and graduate nurses in all key positions 
on both male and female services. 
The need for improvement in the quality of personnel can- 
not be emphasized too strongly. All along the line, from the 
superintendent and staff physicians to the attendants, each 
should be fitted for his job by training and experience. Only 
by employing capable personnel can full advantage be taken 
of the new buildings recently acquired. Without such per- 
sonnel, the program in the institutions must be severely 
limited, for modern methods of care and treatment demand 
greater skill and knowledge than is necessary for custodial 
care. If the programs in these institutions are to be pro- 
gressive and abreast of the times, the men and women who 
operate these programs must themselves be abreast of the 33 
This patient 
doesn’t like the 
idea of even a 
painless intra- 
venous injec- 
tion. 
Basket - weav- 
ing, rug-making 
and embroidery 
work are some of 
the forms of oc- 
cupational ther- 
apy used to 
provide employ- 
ment for the 
hands of the 
mentally ill. 
Many products 
are of great 
beauty. 
Indiana’s hos- 
pital plants and 
equipment are 
u n r i v a led by 
those of any 
other state. 34 
times. Buildings themselves do not cure or heal, nor is there 
any mechanical way by which recovered patients can be turned 
out. The human element is still vitally important. 
As to numbers of personnel, a comparison may serve to 
make this situation clear. The American Psychiatric Associa- 
tion has set up a series of standards showing the numbers of 
various types of personnel required in mental hospitals to 
provide adequate care for the patients. Standards are given in 
terms of a ratio of the number of personnel to patients. For 
physicians (exclusive of the superintendent), this is given as 
one physician for every 150 patients; for nurses, one nurse 
to every 60 patients; for attendants and nurses combined, 
one attendant or nurse to every eight patients. While some 
few states have attained these standards, they are somewhat 
idealistic. Their use, however, will serve to show how far 
Indiana’s mental hospitals fall short of the ideal. Table 1 
shows the average number of physicians, nurses and attend- 
ants employed by these institutions during the fiscal year 
ending June 30, 1940, as contrasted with the number called 
for under the American Psychiatric Association standards. 
TABLE 1 
PERSONNEL EMPLOYED IN INDIANA STATE HOSPITALS 
DURING YEAR ENDING JUNE 30, 1940, COMPARED TO 
REQUIREMENTS UNDER AMERICAN PSYCHIATRIC 
ASSOCIATION STANDARDS 
Institution 
Physicians 
APA Standards 
Employed (1 in 150) 
Nurses 
APA Standards 
Employed (1 in 60) 
Nurses and Attendants 
APA Standards 
Employed (1 in 8) 
Central 
4 
13 
0 
34 
154 
254 
Logansport 
5 
12 
4 
31 
145 
237 
Richmond 
4 
11 
5 
27 
151 
203 
Evansville 
5 
8 
3 
20 
85 
148 
Madison 
5 
10 
1 
26 
126 
197 35 
It should be mentioned that some of the hospitals have 
increased the number of graduate nurses employed since the 
beginning of the 1940-41 fiscal year. From these figures, it 
will be seen that the greatest inadequacy in Indiana’s mental 
institutions today is the lack of sufficient personnel. Thanks 
to the recent building program, the hospitals have adequate 
facilities in this respect, but buildings themselves do not effect 
cures. There is great likelihood that the advantages gained 
in the improvement in plant and equipment will be lost through 
the inadequacy of the staffs which will make use of these. 
Some thought must be given to the hours of duty required 
of nurses and attendants. The 11-hour day, seven-day week 
is still in operation in this state. Some time off is allowed, 
of course, but attendants work approximately 70 hours a 
week. The trying character of the work of these state 
employees, complicated by long hours, imposes a strain on 
them which is not conducive to the best type of care of the 
patients. 
The problem of adequate personnel is at bottom a financial 
problem. Institutions can operate only within the limits of 
their budgets. Chart IV shows the per capita cost of operat- 
ing the mental institutions in this state over the last fifteen 
years. In general, the trend in expenditures for operation has 
been downward, which is explainable, in part, by the drop in the 
cost of living during the depression years. In this same period, 
methods of care and treatment have changed, calling for a 
switch from custodial care to medical treatment, a program 
which is avowedly more costly. This is reflected in a compari- 
son of per capita operating costs of Indiana’s mental hospitals 
with those of other states where this progressive program has 
been put into full force. Table 2 shows this comparison. 
The whole issue of adequate care for the mentally ill can 
be reduced to the question of whether economy of operation 
or restoration of the patient to mental health and to his com- 
munity is the paramount consideration. Yet there is another 
economic consideration which must be weighed. Unless it is 
possible to return mental patients to their communities at a 
faster rate, Indiana shortly will be faced with the necessity for 
spending more millions for the building of additional mental 
hospital accommodations. 36 
LOGANSPORT STATE HOSPITAL 
EVANSVILLE STATE MOSPJTAL 
RICHMOND STATE HOSPITAL 
MADISON STATE HOSPITAL 
FT WAYNE STATE HOSPITAL 
STATE OF INDIANA 
ANNUAL PER CAPITA COSTS OF MENTAL INSTITUTIONS 
1925 - 1940’ 
PER CAPITA COSTS OF ALL MENTAL INSTITUTIONS 
CHART IV 
MUSCATATUCK COLONY 
VILLAGE FOR EPILEPTICS 
CENTRAL STATE HOSPITAL 
'data FOR 1933 ARE OMITTED BECAUSE the FISCAL 
year * as changed at that time and resulted 
IN A FISCAL YEAR OF ONLY NINE MONTHS. 37 
TABLE 2 
AVERAGE PER CAPITA COST OF OPERATING INDIANA’S 
MENTAL HOSPITALS COMPARED WITH THAT 
OF OTHER STATES 
State 
Average Annual 
Per Capita Cost 
Indiana (1940) _ 
- . _ 8198.57 
Illinois (1938) . _ ...... 
265.63 
New Jersey (1934) _ _ 
388.00 
New York (1939) 
402.96 
Massachusetts (1939) 
.... .... 420.37 
Comparison of the number of patients admitted for the 
first time to a hospital in any one year with the number dis- 
charged from that hospital in the same period affords a fair 
index of the efficiency of its treatment program. In 1937, this 
ratio of first admissions to discharges in Indiana was exceeded 
by 36 states, placing Indiana in the 37th position in rank of 
states, or 12th from the bottom of the list. 
After making allowances for the difference from state to 
state in the cost of mental hospital operation because of local 
conditions, it must then be considered significant that Indiana 
in 1937 ranked 34th in the list of states in its per capita costs 
in its hospitals. This comparison strongly suggests that hos- 
pitals enjoying a higher per capita allowance also tend to show 
a higher first admission-discharge ratio. 
These figures indicate all too clearly that in 1937 Indiana’s 
mental hospitals did not return to the community as large a 
proportion of their patients as would be expected by reference 
to the figures for all states. Since the institutions were filled 
virtually to capacity in 1937, this failure to discharge did 
not in that year result in an appreciable increase in the 38 
hospital populations, but certainly it forced hospitals to deny 
admission to many who, had there been a more active treat- 
ment program, could have been admitted. If the 1937 first 
admission-discharge ratio for Indiana is maintained now that 
increased hospital accommodations have been provided, it is 
obvious that a large yearly population increase can be ex- 
pected. This means that chronic patients again will accumu- 
late in the hospitals and, even with the provision of new 
buildings, a saturation point in admissions will soon be reached 
again. 
Social Service for Mental Institutions 
Case Studies of Patients 
In line with what has been said earlier on the theories 
concerning the causes of mental illness, considerable emphasis 
is being laid on the need for a social work program in the 
mental institutions of this state. Both psychoanalysis and 
psychobiology insist that to understand and ultimately to treat 
each individual case of psychosis it is essential to know as 
thoroughly as possible the social history of the patient. The 
task of collecting all this information is enormous. In the past, 
attempts were made to secure as much of this data as possible 
by the use of an elaborate commitment paper on which the 
court was supposed to record information on the patient and 
the patient’s family in answer to specific questions. This placed 
a burden on the court which the court was not in every instance 
able to assume. The total result was that such social informa- 
tion supplied by the court was often inadequate and not infre- 
quently incorrect. 
With the growth of social work as a profession in the past 
decade, and in particular those trained in the psychiatric field, 
there are now available persons with special techniques for 
obtaining and recording this information. Three of the five 
mental hospitals and both institutions for the feeble-minded 
now have a social worker on their staffs. Obviously, this 
handful of workers could not perform this task themselves. 
Plans have been worked out, therefore, to utilize the workers 
on the staffs of the county departments of public welfare to 
prepare histories for cases committed from their own county. 39 
In this way, ultimately for every new patient committed, a 
complete social history will be available. 
Returning the Recovered Patient to the Community 
Return of the recovered or improved mental patient to his 
community is a problem which presents many difficulties. The 
precipitating cause of the individual patient’s mental break- 
down almost always lies in his social environment. In releasing 
a patient, the question inevitably comes up as to whether the 
situation which was responsible for the previous break still 
exists, and, if it does, how much such a situation will con- 
tribute to the retardation of his recovery or possible recur- 
rence of the mental illness. On the positive side, there is the 
question of what community resources are available to stimu- 
late the recovery of the patient. Naturally, the institutions 
are remote from all communities, excepting possibly the one 
in which the institution is located, so that information on the 
community and family environment into which a furloughed 
Least disturbed patients and those nearing recovery work 
and play at pursuits approaching the normal life of any 
community. Below, a group is presenting an amateur play. 
Dances and movies are other forms of recreation. Work on 
the farms or in the upkeep of the institution also has its 
place. 40 
patient returns is sadly lacking. In the interests of an efficient 
furlough system, some liaison between the new environment 
and the institution had to be developed. This function has 
been allocated to the institution social worker, whose task it is 
to learn all pertinent facts about the social situation into which 
a prospective furlough patient will go. In addition, this 
worker keeps in contact with the patient while on furlough 
and assists the patient in adjusting again to the outside 
world. 
If the mental institutions in this state are to be protected 
against the overcrowding which existed prior to the develop- 
ment of the recent building program, some means must be 
found to effect a more rapid turnover of the patient population. 
The Excess Per Capita Evil 
However, there is a factor which makes for some resistance 
on the part of the institutions to a too active furlough program. 
There are two methods of appropriating funds for the opera- 
tion of state institutions in use in this state. The one method 
is that of the approval by the legislature of a biennial budget 
for each institution. This is supplemented by another method, 
known as the “excess per capita allowance”. Briefly stated, 
this is part of the state budget which authorizes the payment 
of an additional appropriation to specified state institutions 
calculated upon the excess in average daily population for 
any given month over a fixed base population. If the base 
population for any given institution is fixed at 1,000 patients, 
and the institution had an average daily population in July of 
1,500, an additional appropriation would be made available 
to that institution of 500 times the annual amount fixed for 
payment per patient, usually $200, divided by 12 (since the 
amount is set up on an annual basis, but payments actually are 
computed on a monthly basis). In other words, this institution 
would be entitled to an additional appropriation of $8,333.33 
because its population during July exceeded its base population 
by 500. It would be entitled to additional amounts for every 
other month in the year, depending upon how much its average 
daily population for the month exceeded its base population. 
This method of determining the budget of institutions is 
open to some objections from the standpoint of the operation 
of the institutions. In the first place, the superintendent never 41 
knows exactly how much money he will have available for the 
operation of his institution because of the chance factor, 
namely, the unpredictability of the size of his population. This 
makes it difficult to plan his program in advance. On the 
item of personal service, this results in unnecessary hardship. 
The budget of the institution is cut so closely that the superin- 
tendent does not know ahead of time whether he can employ 
three physicians or four, 100 attendants or 125, without 
gambling upon his excess per capita allowance. If he employs 
the larger number, his population may remain fairly constant 
and no difficulty result, but, should his population drop in any 
one month, part of his anticipated appropriation vanishes and 
he may have to discharge some of his employees. With a 
subsequent rise in population, the whole process has to be 
repeated. 
In practice, what happens is that some measure of control 
may be exercised over the population. Some patients may be 
ready for furlough, but their release might reduce the insti- 
tutional budget and thus jeopardize the rest of the institutional 
program. Development of an active furlough program is too 
much to expect, therefore, if that program is going to curtail 
the already limited institutional budgets necessary for main- 
tenance of the institutions. 
The excess per capita allowance method of appropriation is 
a vicious system tending toward the development of a static 
population at a high level, resulting in overcrowding in the 
institutions. It should be abolished, and a fixed appropriation, 
based upon the needs of the particular institution, substituted. 
Sterilization 
As already pointed out, there was a period in the history 
of the study of mental deficiency when it was believed that 
virtually all social ills were the product of feeble-mindedness. 
In the wave of resentment which followed the preaching of 
this doctrine, there was considerable agitation for the sterili- 
zation of all the feeble-minded for eugenical reasons. This 
resulted in the passage of sterilization laws in many states, 
Indiana being the first state to pass such a law. In subse- 
quent revisions, this law was extended to cover the sterilization 
of psychotic patients as well as feeble-minded. 42 
The situation as it stands in this state at present may be 
summed up in three points: (1) Sterilization for reasons of 
mental condition can be performed only on persons committed 
to one of the state institutions for the feeble-minded or to one 
of the state hospitals. There is no provision for sterilization, 
on those grounds, of persons in the general population. (2) 
The court may, at time of commitment, order a patient steril- 
ized after admission to the institution. (3) Sterilization may 
be performed on patients not ordered sterilized by the court 
provided certain rules concerning the filing of a petition and 
holding certain hearings are observed. This petition must be 
approved by the State Board of Public Welfare before the 
operation legally can be performed. 
In practice, social considerations weigh heavier in deciding 
whether or not to sterilize a patient than does the question 
of the transmission of an hereditary taint. Before feeble- 
minded patients are released on furlough, consideration is 
given to the question as to whether they are socially adequate 
and are likely to be able to support a family. The matter of 
probable sex delinquency is also considered. If there is likeli- 
hood that the patient will not make adequate adjustment on 
these two points, he is sterilized before being released on 
furlough, as are all those whose feeble-mindedness is definitely 
shown to be of familial character. Thus, selective sterilization 
of the feeble-minded is practiced in this state. 
The situation is somewhat different with regard to the 
sterilization of psychotics. On the form on which the physi- 
cians report their findings to the court concerning the mental 
condition of a patient for whom a petition to commit to a 
mental hospital is being heard by the court is a question which, 
in substance, inquires if the patient is likely to have offspring 
who will be mentally impaired. To this question the physician 
must answer “yes” or “no”. On the strength of an affirmative 
reply to this question, the court orders the sterilization of the 
patient within a given time after admission. If the order is 
not complied with within the stipulated time, it lapses and 
sterilization may not be performed. In practice, what happens 
is that many physicians answer this question routinely in the 
affirmative, and many judges routinely order sterilization. In 
the institutions there is variation in the practice. Some 43 
superintendents sterilize all patients so ordered by the court 
routinely. Some permit all orders to lapse. Others make a 
selection for sterilization and permit the rest to lapse. 
The difficulty in the situation is that in scientific circles 
the value of eugenical sterilization is being seriously ques- 
tioned. Gradually, the importance of heredity is dwindling 
and greater emphasis is being laid on environment. The 
American Neurological Association appointed a committee to 
make an exhaustive study of the subject of eugenical steriliza- 
tion, and the report of this committee is one of the best pieces 
of work in the field. This committee made four general 
recommendations, which may be summarized as follows: 
1. Any sterilization law passed in the United States should 
be voluntary and regulatory rather than compulsory. 
2. Such a law should be applicable not only to patients in 
state institutions, but also to those in private institu- 
tions and those at large in the community, 
3. Sterilization should be determined by a board consist- 
ing of persons with training and experience in the 
problems involved. 
4. Adequate legal protection should be approved by statute 
to the members of this board and to the surgeons carry- 
ing out its recommendations 
On the matter of whom should be sterilized the committee 
recommended sterilization in selected cases of certain diseases 
and with the consent of the patient or those responsible for 
him. They recommended that such selective sterilization be 
considered in cases of the following diseases: 
(1) Huntington’s chorea, hereditary optic atrophy, familial 
cases of Friedreich’s ataxia and certain other disabling 
degenerative diseases recognized to be hereditary. 
(2) Feeble-mindedness of familial type. 
(3) Dementia praecox (schizophrenia). 
(4) Manic-depressive psychosis. 
(5) Epilepsy. 
Together with those recommendations, the committee sub- 
mitted some carefully worded notes on each of these diseases 
In the case of dementia praecox, they remark that this disease 
will need little attention from the surgeon because the disease 44 
itself results in lowering of the sexual urge. Further, 
they warn that the recommendation of the use of sterilization 
does not apply to cases of schizoid personality. As for manic- 
depressive psychosis, the decision to sterilize such patients 
will tax the judgment of the wisest board, for the temperament 
found in these patients is frequently the source of the highest 
achievement and ability of which mankind can boast. With 
respect to feeble-mindedness and epilepsy, they point out that 
the major consideration is social rather than biological. 
Sterilization, then, to be effective, should be selective, 
and the decision to sterilize or not to sterilize should not be a 
function of the court, but should be the considered judgment, 
after adequate study of each individual case, of persons quali- 
fied to pass upon such a matter. 
Mental Hygiene 
Medical science has created for itself an enviable record in 
the past quarter of a century. That record reveals itself in 
the reduction of the death rate, but such reduction tells only 
part of the story; it neglects that portion which tells of the 
avoidance of suffering from illnesses which are not always 
fatal. Part of this record is due to the discovery of remedies 
for specific diseases. The remainder is attributed to the em- 
phasis upon and the development of a program of prevention of 
disease. So successful has this program been that in the 
thinking of the medical profession prevention of disease is as 
much a part of their service as cure. 
This emphasis has been slow to develop, however, in the 
field of mental disease. In the very nature of the case, pre- 
vention was impossible until there was some knowledge of the 
causes of mental illness. From the beginning, the National 
Committee for Mental Hygiene envisaged a program of pre- 
vention, yet 12 years slipped by during which scant effort was 
made toward entering the field of prevention. It was not until 
the groundwork of an adequate theory of mental illness had 
been laid that light was shed upon the problem of where to 
begin with prevention. It had to be shown that apparently 
minor personality maladjustments were of the stuff of which 
psychoses were made before there could be organized effort 
to treat such maladjustments. In 1922, the National Committee 45 
formally launched its campaign of prevention by opening, in 
conjunction with the Commonwealth Fund, its five-year pro- 
gram of mental hygiene clinics. This marks the beginning 
of organized effort at prevention in the mental health field. 
Establishment of Mental Hygiene Clinics 
Early in 1939 the Division of Medical Care of the state 
welfare department opened its first mental hygiene clinic at 
Columbus. From that time, the number of the clinics in opera- 
tion has increased to 14. These are located at strategic points 
throughout the state, so that mental hygiene clinic service is 
available to virtually every county. 
Operation of Mental Hygiene Clinics 
Each clinic team consists of a psychatrist, who is director 
of the clinic, a psychologist and a psychiatric social worker. 
The social worker also serves as secretary to the clinic and 
acts as liaison officer between the local community and the 
clinic. The clinics operate from Indianapolis, making a one- or 
two-day visit every other week, the number of clinic days’ 
service given to each area being determined by the needs of 
the area. The Marion County clinic is an exception in that a 
full-time clinic is maintained here because of the population 
of the area served. 
Because a clear understanding of the problems facing in- 
dividuals who come to these clinics cannot be secured without a 
fairly complete knowledge of their historical background, a 
complete social history for every patient is insisted upon. 
Collection of this material and presentation of it in usable 
form requires a considerable amount of work. Obviously, this 
work could not be undertaken by the small staff operating 
from the central office. The co-operation of the county 
departments of public welfare and other local agencies in the 
preparation of these histories actually makes possible the ex- 
tensive mental hygiene program in this state. The clinics 
utilize those services which are already established in each 
community. Local physicians make the physical examinations; 
the clinics co-operate with the local medical societies; advisory 
committees are established in many clinic areas. In this way, Children who have diffi- 
culty in adjusting to the 
rules of modern life may 
now be brought to mental 
hygiene research clinics 
for expert diagnosis and 
treatment. Modern psy- 
chological tests frequently 
discover the causes of 
truancy, undue timidity or 
other undesirable social 
traits. 
many times the number of persons employed in the state clinic 
units are actually working throughout the state on mental 
hygiene problems. In other words, the clinic personnel has 
been increased by utilizing trained and lay workers in each 
community. 
Each patient attending such a clinic is examined by the 
psychiatrist after the report of the medical examination of 
the patient by a local physician has been studied. This 
psychiatric examination brings to light the emotional conflicts 
and maladjustments which underlie the patient’s behavior. 
Whenever it is deemed necessary, the psychologist gives the 
patient a series of intelligence tests designed to reveal the 
mental equipment of the patient and to uncover any intellectual 
traits or abnormalities which might have a bearing upon his 
problems. At the close of each clinic day, a staff conference is 
held to discuss the findings of the various members of the 
clinic staff in relation to the social history. As the result of 
this conference, recommendations are formulated, citing 
methods and suggesting changes which will enable the patient 
to overcome his difficulties. The carrying out of these recom- 
mendations is left to the agency or the person referring the 
case, except where the emotional disturbance is so deep- 
seated that psychiatric treatments are called for. In such 
cases, whenever possible, arrangements are made to have the 
patient returned to successive clinics to receive these treat- 
ments. In general, therefore, mental hygiene clinics in this 
state are chiefly diagnostic, though some treatment is under- 
taken in special cases. 
Cases are referred to the clinics by county departments 
of public welfare, by private agencies in the community, by 
schools, by courts, by local physicians, by parents or other 47 
interested individuals and, in some cases, by the patient him- 
self. When the person or agency referring a patient has no 
facilities for preparing a social case history, such a history 
is prepared by the clinic social worker. 
Roughly 70 per cent of the patients who come to these 
clinics are children. Among them are children who have 
become problems in school, either because of behavior or 
because of educational difficulties; there are delinquent chil- 
dren, referred by the courts or by parents; there are cases of 
problem homes and problem parents adversely affecting the 
development of children; there are cases turned over by local 
physicians or public health nurses who feel that further 
adjustment on a physical level cannot be attained until some 
adjustment is made at the emotional level; there are cases 
verging on psychosis, as well as definitely psychotic cases. 
Table 8 shows the distribution of the types of problems which 
are brought to the attention of these clinics. 
TABLE 3 
TYPE OF PROBLEMS REFERRED TO INDIANA’S 
MENTAL HYGIENE CLINICS 
Type 
Per Cent 
Total 
Placement - - 
School problems 
Behavior problems 
Delinquency 
Mental deficiency . - 
100.00 
22.28 
20.34 
12.84 
9.77 
_ 7.84 
Sex irregularity — -- 
Mental disturbance 
Physical illness with accompanying mental disturbance 
6.02 
5.68 
4.77 
3.18 
Domestic difficulties 
Speech defects - - - 
Alcoholism 
3.07 
2.16 
2.05 48 
Services of the Mental Hygiene Clinics 
It is difficult to evaluate the results of this clinic service, 
because as has been pointed out, the clinics are chiefly diag- 
nostic. A system of follow-up reporting has been devised, 
however, and at stated intervals these reports are requested on 
every case in order to determine the progress made. A study 
of these progress reports shows that in approximately half of 
the cases there was a remission of the problem or some signifi- 
cant improvement. In the remainder of the cases, some 
improvement was noted in many instances. Of this last group, 
in a large percentage of the cases, the recommendations were 
not carried out or it was found impossible to control some 
situation which had an important bearing on the problem. 
Mental Health Education 
Another feature of the clinic program is that a definite 
effort is made to utilize these clinics as an educational center 
for the dissemination of information on mental health. At 
each staff conference, persons referring cases, with other 
interested individuals, are invited to attend. In connection 
with many of the clinics, advisory committees have been 
established which serve as centers for imparting information 
on problems of mental health to key persons in the community. 
From time to time, members of the clinic teams speak before 
civic and other groups on various aspects of mental hygiene, 
and thus an educational program is carried on as a part of 
the work of the clinics. 
Indiana State Advisory Council on Mental Hygiene 
Prevention, however, does not begin nor end with those 
who are already suffering some maladjustment. Mental health 
should begin with the healthy in mind in order to keep them 
so. For that reason, this Division has sponsored two groups 
at the state level, outside of the welfare department. The 
State Board of Public Welfare has established the Indiana 
State Advisory Council on Mental Hygiene. This Council is 
made up of a group of outstanding public-spirited citizens 
interested in mental health. Its function is to advise the state 
welfare department on matters pertaining to mental health 
and to inform the public of the problems involved. On the 
strength of a recommendation made by the Council, Governor 49 
M. Clifford Townsend invited Dr. Samuel W. Hamilton, mental 
hospital advisor for the United States Public Health Service, 
to make a study of the five mental hospitals, the two institu- 
tions for the feeble-minded, the Village for Epileptics and the 
Hospital for Insane Criminals in this state. To date, Dr. Ham- 
ilton’s report has not been released, but it is expected that 
it will be available shortly. 
The Council, through its legislative committee, has made 
a study of a number of phases of Indiana’s laws dealing with 
mental cases, and some recommendations on legislative changes 
are expected to result from this. 
Indiana Society for Mental Hygiene 
The Division of Medical Care has also sponsored the re- 
organization of The Indiana Society for Mental Hygiene. This 
Society was organized in 1916 and carried on an active cam- 
paign stimulating interest in problems of mental health until 
1936. From 1936 to 1939 the Society ceased to function, 
although it did not go out of existence. In September, 1939, 
it was reorganized and the purpose of this new Society was 
stated to be: 
“To work for the conservation of mental health; for the pre- 
vention of mental diseases and mental deficiency and for improve- 
ment in the care and treatment of those suffering from nervous or 
mental disease or mental deficiency.” 
One activity of the Society was the holding of a two-day 
annual conference in Indianapolis in May, 1940. Able speakers 
were brought from various parts of the state as well as from 
outside the state. The conference was held in conjunction with 
the observance of “State Institution Week”. In addition, a 
quarterly journal, the Mental Hygiene Review, has been pub- 
lished by the Society. Plans are now under way for the 
next annual conference, when persons trained in special phases 
of mental hygiene will be brought in to discuss their 
specialties. Indiana's 
Mental Hospitals 51 
INTRODUCTION 
Indiana operates five hospitals for the care of the mentally 
ill. These institutions are strategically located to serve the 
various sections of the state. That such was the purpose in 
deciding upon the location of these institutions is indicated by 
the names which were originally given to them. Richmond 
State Hospital was formerly known as Eastern Indiana Hos- 
pital for the Insane and Madison State Hospital as Southeast- 
ern Hospital for the Insane, while the institution formerly 
known as Central Indiana Hospital for the Insane still has its 
location indicated in its present name of Central State Hospital. 
The capacity and the population of these hospitals as of 
June 30, 1940, are shown in Table 4. 
TABLE 4 
CAPACITY AND POPULATION OF INDIANA STATE HOSPITALS 
JUNE 30, 1940 
Institution 
Capacity 
Population 
Total _ _ . 
- _ 8,448 
8,433 
Central State Hospital 
2,141 
2,090 
Logansport State Hospital 
__ 2,027 
1,939 
Richmond State Hospital 
1,500 
1,629 
Evansville State Hospital 
1,200 
1,199 
Madison State Hospital__ ... 
1,580 
1,576 
It should be noted that the capacity of several of these in- 
stitutions has been increased since the close of the fiscal year 
because of the opening of some new buildings. The average 
daily population of all mental hospitals during the 1939-40 
fiscal year was 8,323 patients. 
Indiana had an investment, at the close of the last fiscal 
year, of over 13*/2 million dollars in these five institutions. 
Table 5 shows the value of land, buildings and equipment at 
these institutions. 52 
TABLE 5 
INVENTORY OF INDIANA STATE HOSPITALS 
JUNE 30, 1940 
Institution 
Total 
Land 
Buildings 
Equipment 
and Supplies 
Total 
$13,629,189.55 $1,083,217.03 $10,455,663.47 $2,080,309.05 
Central State 
Hospital 
4,154,929.07 
360,000.00 
3,033,000.00 
761,929.07 
Logansport State 
Hospital 
2,843,680.64 
180,935.71 
2,108,421.29 
554,323.64 
Richmond State 
Hospital 
. 2,458,464.50 
137,596.25 
2,049,550.79 
271,317.46 
Evansville State 
Hospital 
1,830,575.17 
280,930.07 
1,388,798.65 
160,846.45 
Madison State 
Hospital 
2,341,540.17 
123,755.00 
1,885,892.74 
331,892.43 
Cost of operating these institutions for the 1939-40 fiscal 
year was $1,652,580.71, an average per capita cost for current 
expenses of $198.57. This figure does not take into considera- 
tion receipts for individual support paid into the state treasury 
of $99,705.38, or a per capita of $11.98. If these receipts are 
deducted from expenditures, this leaves an average net per 
capita operating cost of $186.59. 
Indiana’s five state hospitals offer care and treatment to 
mentally ill residents of the state. Admission is obtained 
through commitment of the patient by the court. Provision is 
made for the admission of patients on a voluntary basis, with- 
out court action, but only a negligible part of the mental hos- 
pital population is received under this procedure. 
Release from these institutions is by direct discharge, in 
cases where the patient has completely recovered, or by fur- 
lough. A furlough is a conditional release of the patient to the 
community. If the patient adjusts successfully, he is dis- 
charged, but, should his adjustment be unsatisfactory, he may 
be returned to the hospital for further care and treatment with- 
out the necessity of another court commitment. The right to 
discharge or furlough patients is vested in the superintendent 
of the hospital. 53 
CENTRAL STATE HOSPITAL 
Central State Hospital is the oldest of Indiana’s mental 
hospitals. An act of the 1844-45 legislature provided for “a 
suitable site for the erection of a State Lunatic Asylum”. Con- 
struction was begun on May 5, 1846, and the institution re- 
ceived its first patients on November 21, 1848. From time to 
time the legislature has increased the capacity of this hospital 
by addition of new buildings. During the past year a male per- 
sonnel building has been completed and occupied, and a new 
cottage, similar in design to other cottages on the grounds, has 
been completed and put into use. 
This is a view of the 
imposing entrance to 
one of the new build- 
ings of Central State 
Hospital, oldest and 
largest mental institu- 
tion in Indiana. 
Central State Hospital is located in Indianapolis on a 
160-acre site. It receives patients of both sexes from the fol- 
lowing counties: Boone, Clinton, Hancock, Hamilton, Howard, 
Marion, Tippecanoe, Tipton and Warren. In addition, it re- 
ceives female patients from Benton, Carroll, Jasper, Miami, 
Newton, Wabash and White counties. 
As well as being the oldest, this hospital is also the largest 
of its kind in the state. During the year ending June 30, 1940, 
its average daily population was 2,036 patients, the highest 
population in its history. 
The old men’s building, which is more than 90 years old, is 
being demolished, and in its place a cottage-type building has 
been erected. While Central State Hospital now has five of 
these modern buildings, many of its buildings are old and the 
style of their architecture does not lend itself readily to mod- 
ernization. 54 
RICHMOND STATE HOSPITAL 
Richmond State Hospital was one of the three mental hos- 
pitals authorized by the legislature in 1883. Some of the build- 
ings were completed and occupied by the School for Feeble- 
Minded Youth in 1887. This school was moved to Fort Wayne 
on July 8, 1890, and on August 4, 1890, the first patient was 
admitted to the hospital for the insane. 
This hospital is located in Richmond and occupies a site 
of 1,100 acres. During the past year a new auditorium was 
completed, which is so constructed that it serves as an audi- 
torium in which religious services are held, as well as other 
social functions, and as a gymnasium for the patients. The 
second floor of the medical building was remodeled and made 
into offices for the physicians. The cold storage building was 
remodeled and a new milkhouse was constructed. 
Richmond State Hospital serves the following counties: 
Adams, Allen, Blackford, DeKalb, Delaware, Fayette, Grant, 
Henry, Huntington, Jay, LaGrange, Madison, Noble, Randolph, 
Rush, Steuben, Union, Wayne, Wells and Whitley. 
During the year ending June 30, 1940, the average daily 
population of this hospital was 1,627 patients. 
The new 
surgery a t 
Rich mond 
State Hos- 
pital. Since occupational therapy is 
a valuable part of any mental 
hospital treatment program, pa- 
tients at Logansport State Hos- 
pital are encouraged to engage 
in useful tasks. This woman is 
busy at a loom. Much of their 
crafts work is startlingly beau- 
tiful; all has therapeutic value. 
LOGANSPORT STATE HOSPITAL 
In 1883 the legislature provided for the location and erec- 
tion of three additional hospitals for the insane. Logansport 
State Hospital was the first of these three to be completed and 
occupied as a mental hospital. The hospital was opened for 
the reception of patients on July 1,1888. 
Located one and one-half miles west of Logansport, the 
hospital occupies a site consisting of 909 acres of land. During 
the past year four new buildings have been completed: a medi- 
cal and surgical unit, a hydrotherapy and X-ray unit, a male 
infirmary building and a women’s ward. These new buildings 
have done much to relieve the overcrowded condition which 
existed for years at this hospital. 
This hospital receives patients of both sexes from the fol- 
lowing counties: Cass, Elkhart, Fulton, Kosciusko, Lake, La- 
Porte, Marshall, Porter, Pulaski, Starke and St. Joseph. In 
addition, it receives male patients from Benton, Carroll, Jasper, 
Miami, Newton, Wabash and White counties. 
During the year ending June 30, 1940, the average daily 
population of this institution was 1,897 patients, which, as in 
the case of Central State Hospital, is the largest population in 
the history of the institution. This represents an increase 
over the population of 10 years ago of 35 per cent. 
Studies made at this institution show that the average 
length of residence of patients in this hospital in 1939 was 
9.59 years. Many of the patients whose physical condition permits find agree- 
able and useful employment in cultivating some of the 879 acres of land 
which constitute the grounds of Evansville State Hospital. The products 
contribute largely to the subsistence of the institution, a general view of 
which is shown above. 
EVANSVILLE STATE HOSPITAL 
Evansville State Hospital was the third mental hospital 
authorized by the legislature of 1883. Because of difficulties 
and delays in construction, the first patients were not admitted 
until October 30, 1890. 
The hospital is located on an 879-acre tract about four miles 
east of Evansville. The district served by this hospital is com- 
prised of the following counties: Clay, Dubois, Fountain, Gib- 
son, Greene, Knox, Montgomery, Owen, Parke, Perry, Pike, 
Posey, Putnam, Spencer, Sullivan, Vanderburgh, Vermillion, 
Vigo and Warrick, 
During the year a new building was completed and occu- 
pied, providing sleeping quarters for 102 employees. The 
building housing the main kitchen was modernized, and other 
minor improvements were made. 
During the year ending June 30, 1940, the average daily 
population of this hospital was 1,187 patients. The population 
of this institution has remained fairly stable over the last five 
years. 
Evansville State Hospital is the only mental hospital in the 
state operating an outpatient clinic. This clinic is held in 
downtown Evansville and is utilized by nearby counties as well 
as by residents of Evansville. 57 
MADISON STATE HOSPITAL 
Madison State Hospital was authorized by the legislature on 
February 21, 1905. It was opened for the reception of patients 
on August 23, 1910. 
The hospital is located on a plateau 400 feet above the Ohio 
River and about one and one-half miles from North Madison. 
It consists of 30 buildings located on a 1,234-acre site. The dis- 
trict served by this institution is comprised of the following 
counties: Bartholomew, Brown, Clark, Crawford, Daviess, 
Dearborn, Decatur, Floyd, Franklin, Harrison, Hendricks, 
Jackson, Jefferson, Jennings, Johnson, Lawrence, Martin, Mon- 
roe, Morgan, Ohio, Orange, Ripley, Scott, Shelby, Switzerland 
and Washington. 
During the year ending June 30, 1940, the average daily 
population of this hospital was 1,577 patients. This is a de- 
crease from 1939 of 100 patients. Capacity of this institution 
is 1,580 patients. Reduction of population was obtained through 
some changes in the hospital district, relieving Madison State 
Hospital somewhat of its overcrowded condition. No new build- 
ings were constructed at this institution during the year. 
The picture shows the administration building at Madison State Hos- 
pital, last of the five institutions established by the state for the care 
and treatment of mental cases. Each year a fair number of patients 
are discharged as improved or recovered. The fever treatment is used 
in cases of general paresis and the institution has used hydrotherapy 
with success. Indiana's 
Institutions for the 
Feeble-Minded 59 
INTRODUCTION 
Indiana operates two institutions for the care and training 
of the feeble-minded, the one serving the counties in the north- 
ern half of the state and the other serving counties in the 
southern half of the state. The capacity and population of 
these two institutions as of June 30, 1940, are shown in 
Table 6. 
TABLE 6 
INSTITUTIONS FOR THE FEEBLE-MINDED 
CAPACITY AND POPULATION 
JUNE 30, 1940 
Institution 
Capacity 
Population 
Total 
2,801 
2,851 
Fort Wayne State School 
1,900 
1,966 
Muscatatuck Colony 
901 
885 
The daily average population of these two institutions dur- 
ing the 1939-40 fiscal year was 2,815 patients. Since this is an 
average figure and since Muscatatuck Colony was expanding 
during the year, this figure is not representative. The popula- 
tion present on June 80, 1940, was 2,851 and even this figure 
is low, because new buildings have been completed and occu- 
pied since the close of the fiscal year. 
At the close of the last fiscal year, Indiana had an invest- 
ment in these two institutions of almost five million dollars. 
Table 7 shows the value of land, buildings and equipment at 
these institutions. 
TABLE 7 
INSTITUTIONS FOR THE FEEBLE-MINDED 
INVENTORY, JUNE 30, 1940 
Institution 
Total 
Land 
Buildings 
Equipment 
and 
Supplies 
Total 
$4,911,609.42 
$911,607.90 
$3,589,178.38 $410,823.14 
Fort Wayne State 
School 
2,187,358.49 
773,271.70 
1,183,478.38 
230,608.41 
Muscatatuck Colony 
__ 2,724,250.93 
138,336.20 
2,405,700.00 
180,214.73 60 
The cost of operating these institutions for the 1939-40 
fiscal year was $614,498.33, an average per capita cost for cur- 
rent expenses of $218.33. This figure does not take into con- 
sideration receipts for individual support paid into the state 
treasury of $11,483.46, or a per capita of $4.08. If these re- 
ceipts are deducted from expenditures, this leaves an average 
net per capita operating cost of $214.25. 
The purpose of these institutions is to provide education 
and training for the feeble-minded of the state and also to 
provide custodial care for such cases as cannot benefit by edu- 
cation or training. 
Admission is obtained through commitment by the judge 
of the Circuit Court upon petition of any reputable person in 
the county. Feeble-minded persons six years of age and over 
may be admitted, provided they are bona fide residents of the 
state. 
FORT WAYNE STATE SCHOOL 
Fort Wayne State School was first organized in 1879 as an 
adjunct of the Soldiers’ and Sailors’ Orphans’ Home at Knights- 
town. It was given independent existence in 1887 and con- 
struction was started on the present site in Fort Wayne. Be- 
fore these buildings were completed, a fire at Knightstown 
necessitated caring for the feeble-minded children in buildings 
completed for the Eastern Indiana Hospital for the Insane at 
Richmond. In July, 1890, buildings were completed at Fort 
Wayne, and the new institution was opened by the transfer of 
300 patients from Richmond. 
The school is located in Fort Wayne on 54 acres of land. In 
the vicinity are 849 acres of land owned and cultivated by the 
school. This school serves the northern half of the state, 
receiving patients from 43 counties. Chart HI on page 23 
shows the counties served. 
During the year ending June 30, 1940, the average daily 
population of this institution was 1,948 patients. Population 
has increased each year since the establishment of the school 
and is directly related to the capacity of the institution, since 
the institution is usually filled to capacity. The normal capacity 
of this school on June 30, 1940, was 1,900 patients. 61 
The school department of the institution was established in 
1891 and has operated ever since as an educational unit. This 
department affords instruction in the following subjects: 
kindergarten, primary academic, advanced academic, domestic 
science, wood and metal, physical education, sense training, 
sewing, basketry, weaving, piano, voice, violin, orchestra, boys’ 
band and drum corps. The industrial departments offer train- 
ing in the following industries: for boys—shoemaking, tailor- 
ing, carpentry, woodworking, painting, printing, broom, mop, 
and brush making, mattress making, baking, meat cutting, 
dairying, poultry raising, and general farm work; for girls— 
kitchen training, dining room work, loom weaving, general 
housecleaning, beauty parlor, occupational therapy, bed mak- 
ing and assisting nurses in care of the ill. 
Under the teacher’s close supervision, two members of 
a boys’ academic class at the Fort Wayne State School 
work on a geography unit. 62 
MUSCATATUCK COLONY 
Muscatatuck Colony was originally established in 1920. In 
1925 the legislature transferred jurisdiction of the Colony to 
Fort Wayne State School, and it was operated as an adjunct 
of that institution until July 1, 1937, when it was established 
as an independent institution. 
Beds for the feeble-minded at Muscatatuck Colony make 
a study in black.and white. 63 
Located about six miles east of North Vernon, the mail 
address of the Colony is Butlerville. The site of the institu- 
tion contains 2,071 acres. 
In 1937 an extensive building program was started looking 
toward the expansion of the Colony into a school for the feeble- 
minded comparable to the Fort Wayne State School. Prior to 
this time, the Colony had been utilized as a custodial institu- 
tion for housing males over 16 years of age. This building 
program was completed in 1940, and the institution now serves 
the same function as the Fort Wayne State School for resi- 
dents of the southern half of the state. Chart III on page 23 
shows the counties served by this institution. The major 
building program included the construction of 24 new buildings 
and a large dam. This program was undertaken to provide 
adequate housing and facilities for the care of approximately 
1,400 feeble-minded patients. 
The school department of the institution was opened during 
the year, and all trainable children are receiving instruction. 
A well-rounded program of training is under development, and 
it is anticipated that both in equipment and program this will 
be one of the most modern institutions of its kind in the 
country. Indiana 
Village for 
Epileptics 65 
INDIANA VILLAGE FOR EPILEPTICS 
The Village for Epileptics was established by legislative 
enactment in 1905. Male patients were first admitted in 1907 
and female patients in 1925. Indiana was, therefore, one of 
the earliest states to make provision for the separate care of 
its epileptics, there being very few institutions of its kind in 
this country at the time the Indiana Village was established. 
Patients helped with the construction of this new administration 
building at the Indiana Village for Epileptics. Improvements were also 
made on the grounds, including the addition of walks and curbs. 
The Village is located on a 1,334-acre tract three miles north 
of New Castle. As the name indicates, it is constructed on the 
“village” plan, with the entire institution made up of small 
units for the segregation of age groups, sexes and types of 
patients. 
From time to time additions have been made to this institu- 
tion. The Village was planned for an ultimate minimum capac- 
ity of 1,250 patients, but, by the addition of one or two build- 
ings in each group, the capacity may be increased to 1,500 or 
1,800 without altering the general plan. The Village has grown 
very slowly to its present capacity of 915 patients. 66 
During the past year, construction carried to completion 
included a new administration building, two brick cottages for 
physicians and a men’s infirmary building with a normal capac- 
ity of 120 patients. Most of the work on these buildings, with 
the exception of the bricklaying, sheet metal, plastering and 
tile work, was done by the patients. In addition, a new 300 
k.w. turbine generator was installed, a 150,000-gallon steel 
water tank and a 140-foot steel tower for the tank, were 
erected. 
On June 30, 1940, the population of this institution was 931 
patients. Average daily population for the year was 926 pa- 
tients. Total value of the land, buildings and equipment as of 
June 30, 1940, was shown by the inventory to be $2,159,813.86. 
Total cost of operation for the year was $236,735.38, a per 
capita operating cost of $255.78. 
Purpose of this institution is the care and treatment of 
residents of the state suffering from epilepsy. Admission to 
the Village is obtained through commitment by the Circuit 
Court. Petitions for commitment may be filed by relatives or 
any responsible person living in the same county. This institu- 
tion serves the entire state. Patients are discharged when in 
the judgment of the superintendent their mental and physical 
condition justifies it. Selected patients are released on visit to 
relatives who are able and willing to accept responsibility for 
their care.