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PRESIDENT'S ADDRESS -- AMERICAN ASSOCIATION ON MENTAL DEFICIENCY
E. ARTHUR WHITNEY, M.D.
Elwyn Training School, Elwyn, Pa.

THE honor and privilege of addressing you as your 69th President is one which I very deeply appreciate. My predecessors, both recent and remote, have left but little in the way of new thoughts to place before you. Yet, I expect that like each of my predecessors, I would like to offer some suggestions that may stimulate thought, research and investigation.

It is quite noteworthy that we in our day are discussing in our regional and annual meetings many of the same problems as to etiology, diagnosis and prognosis that were subjects of papers in the early days of this Association. Dr. William C. Dickerman has expressed this thought by saying: "Man, as part of his sublime folly, takes it for granted that the infinitesimal segment of time with which he is concerned is the most important in the entire world's history, that his problems and the problems of his world at that time are the most complex ever faced by mankind, and that what has gone before is of little importance in the awful immediacy of the present and future."

We are now in the birth period of that long-awaited era of peace. Newspapers, magazines and the radio have heralded this as the beginning of the new scientific age; the atomic age. Yet there are many misgivings abroad about this new scientific age. Raymond Swing, in his broadcast on Friday, September 21, 1945, has expressed his feelings about the situation in what seems to me to be a challenge to both scientists and politicians: "Among the numerous consultants of the U. S. delegation at the San Francisco Conference, selected and invited by the State Department, was not a single scientist invited because of his knowledge of science. Among the men so far invited to attend the educational meeting in London for the U. S. government, a meeting that is to set up an international education office under the United Nations Organization, is not a single scientist invited because of his knowledge of science. These two facts are about as symbolic as anything that can be said about the release of atomic energy having caught this country and its leaders incredulous and unprepared." This association with its colleagues in the field of education and science are vitally interested in the era that lies ahead. We have a very deep concern for that future.

Dr. Raymond in his Presidential Address last year ably demonstrated the fact that marked progress has been made in every phase of our problems from the early beginnings to the present. He also suggested future fields of investigation that may yield valuables returns within the seeable future.

It is highly desirable for us to try to project ourselves into that future and to make plans. Progress is always the result of care and planning. Many plans for intensive research in this special field have been held in abeyance because of the war. Others are still in a nebulous state and perhaps there are others not as yet contemplated.

I should like to discuss with you tonight that future and for want of a better title have chosen the subject of "Our Horizons." In trying to get a glimpse of our horizons it seems to me that these horizons cover in a general way one or more panoramas of distinct interest to us.

The first has to do with the prospects of this association. It has gone through many vicissitudes in the past and some of its most serious dilemmas were experienced during the depression of the 1930's. That is behind us. What does the future hold? To me the possibilities of this association for the future are limited only by the degree of effort we as individual members put forth in its behalf.

Our scope of influence should be both national and international. In this postwar world the problems will be many and our particular field may be lost in the shuffle unless we become a wide-a-wake aggressive authoritative mouthpiece for the retarded child. We could and should become the nucleus of a world-wide organization. Here I would like to offer a suggestion which could be incorporated with the plans made in Philadelphia last year. I refer to the plans for the annual convention of 1948 to be held in Boston in order to celebrate the centennial of America's first schools for retarded children.

The suggestion is this: Plan now to make the 1948 meeting one of an international congress on mental deficiency. This could be the first of regular congress meetings to be held in different countries once every decade. I would like to suggest that here in Cleveland we appoint a committee to plan for the First International Congress on Mental Deficiency with 1948 as the tentative year for the meeting.

In visualizing the future along this same line of thought, our energetic editor, Ed Humphreys, in a memorandum to several of the officers of the Association, dated January 5, 1945, suggests regional subdivisions of a worldwide association. He lists the following regions and associations:

1. North America
2. South America
3. British (with European liaison)
4. European
5. Near East
6. Asiatic
7. Anzac

We have seen in our own association that regional meetings can be, and are, not only successful but highly desirable. So might also world regional meetings be successful with definite scheduled plans for an international congress each decade. These are not ideas of grandeur but rather plans to meet the practical needs of the world's forgotten folks, the mental defectives.

We are the one national and international organization of individuals interested in the various fields of service for the subnormal child. As an organization we should be a potential force in shaping a policy best suited for the ultimate good of retarded children. At the present time we actually have comparatively little influence in political subdivisions because our membership is relatively small and our basic policies are perhaps not clearly crystallized even in the minds of the membership.

What then does the future have to offer in membership? In this field we have but scratched the surface. This association should have at least 5,000 members. In the seeable future this probably will be realized. At present not every institution for the subnormal is even represented in our membership roll. I doubt if all the eligible members of the staff of any one institution are enrolled. What school will be the first to proudly boast of 100 per cent membership of its staff?

We have an increasingly large number of special class personnel in our enrollment but there are many school systems with good special class directors and teachers who are not even aware of this association.

State and City Departments of Welfare are represented in our membership but such representation is relatively small. School physicians, school psychologists and school counselors are all potential material.

The objectives of the Association are published repeatedly but they are rather long and some are becoming obsolete. We need to do a bit of streamlining. They might be condensed and briefly stated something like this: The purpose of The American Association on Mental Deficiency is to study and investigate all phases of the complex problems of mental retardation. Some of the objectives are:

1. Thorough research into the causes.
2. Thorough research into the care and training required.
3. Thorough research into the prevention.
4. Complete examination of all retarded children.
5. Complete registration and census of all retarded children.
6. Complete community programs of care and education.
7. Adequate institutional facilities.
8. Selective sterilization of hereditary types.
9. Parole for suitable cases after adequate training.
10. Adoption of simple but uniform statistical tables for use in, schools and institutions.

Here again I would like to suggest that during 1945-46 the Committee on Standards and Policies undertake two different tasks. One, the streamlining of our objectives and, two, the possibility of revision and simplification of the statistical tables with a view towards making them usable both in institutions and public schools.

Suppose the future does bring us the minimum of 5,000 members. Then the first logical step would be to acquire an executive secretary and publicity director. The potentialities for the good of the field are almost limitless. Next our journal, which thanks to Dr. Humphreys, is attracting wider and wider attention, should become a monthly journal. As such it could wield an ever increasing influence on public thought and thereby yield effective results.

Dr. Humphreys, in his memorandum referred to above, goes a step further. He visualized an international Journal of Mental Deficiency as a result of extension and further differentiation of our journal. Such an extension might well become the logical result of the First International Congress on Mental Deficiency.

There are many ways in which a large and influential American Association on Mental Deficiency could help the retarded individual as well as the nation as a whole. For example, thanks to the cooperation of the United States Bureau of Census, the directors of several state departments, as well as the superintendents of a number of institutions, certain data have been made available to me in order to conduct a partial statistical study of the trends in the institutional population with regard to racial background. This study is incomplete and many of the statistics are not entirely reliable. Nevertheless, certain factors seem to be indicative of positive trends.

First, the rate per 100,000 population in institutions in 1923 was 46.7. This figure has increased to 77.9 in 1941. This is 40 per cent increase during a time when the actual increase in our national population was but 20 per cent. This naturally raises the question: "Where are they coming from?" There are several answers to this question. First it will be said that this was a period when several institutions were built, hence, the increase in numbers. This is true but these new institutions were only a partial answer to the public demand for more facilities. There were long waiting lists in 1923 and there are longer waiting lists in 1945 when the average intelligence level of institutional admissions is on the decline. This then is not the answer.

From the answers to a questionnaire sent to all institutions in Massachusetts, New Jersey, Pennsylvania and Ohio it would appear that certain definite trends predominate. First, we have admitted to this country and to our institutions a proportionately large number of mental defectives from abroad. Secondly, we have admitted into this country a relatively large number of mentally defective producing stock. Without casting reflections on racial or national immigration but simply to show what available statistics seem to imply this study indicates that relatively few mental defectives or individuals of mentally defective stock are from:

1. Scandinavian
2. French
3. Spanish
4. Welsh
5. Scotch
6. German
7. English

On the other hand a relatively large number come from the following groups:

1. Negro
2. Italian
3. Hebrew
4. Irish
5. Polish
6. Russian
7. S.E. Europeans

This study is too incomplete to offer as an answer to the problem of increased mental deficiency yet the trends indicated seem to be of importance. A thorough screening by the immigration authorities would eliminate, not only the mental defectives, but those of mental defective or psychopathic stock who will be clamoring for admission now that World War II is at an end.

The second answer to the question: "Where are they coming from?" is well-known to us in this field. We are cognizant of the fact that those of the lower strata of society as far as mentality is concerned are tremendously outproducing in offspring those of normal or superior intellectual capacity. In this fact we are faced with a dilemma. How to curb the reproductive activity of the one and at the same time to increase the fertility of the other. Both need to be done. Adequate legislation incorporating the known principles of preventive medicine can help reduce the numbers of the first group. Yet legislation will be of little avail to the second. Families of the normal and superior intelligence are wont to raise only the number of children they feel they can properly care for and educate. European countries have tried subsidies with some success as to increased population but this applies to all levels of intelligence.

If the political powers could offer normal members of society a decent and peaceful world in which to live no doubt the birth rate would soon reach desirable levels.

Thus far in trying to gaze into the future I have dealt largely with the potentialities of this organization and its functions. It has been frequently stated that we have been standing at the crossroads for humanity. An Axis victory would have meant a severe setback in man's ultimate upward progression. Now that this calamity is averted we can, with a degree of confidence, face the future. In recent years we have noted certain trends in our field. Some will be followed to the good of all concerned and others should be abandoned. Let us examine a few of these trends.

It is twenty-five years since our association held an annual meeting in this lake city of Cleveland. Let us survey the changes in special education in these intervening years. Dr. Frank E. Spalding, superintendent of schools here in Cleveland in 1920 presented a paper on "Some Questions Concerning the Care of the Feeble-Minded in the Public School System."

The first question Dr. Spalding raised was on the desirability of segregating these children from their normal brothers and sisters. The second question concerned the curriculum for the retarded child in the public school. The third question was on the kind and degree of handcraft to be taught. The next question he raised was: "Is it possible to arrange any kind of legal or semi-legal control of the feebleminded when they pass out from the control of the school?"

As a general answer to his own questions Dr. Spalding stated: "It would seem to me that it is the function of the public schools as far as these children must be handled in public schools, to go the limit in giving them some kind of appropriate and suitable vocational skill, or semi-skill or partial skill, or whatever you please to call it, by which they can either earn their living or contribute to some extent to their support."

Isn't Dr. Spalding's aim basically that of special education today? The final question that Dr. Spalding asked is one that is being asked today: "How much can we afford to spend on the education of the feeble-minded?" Dr. Spalding did not attempt to give concrete and concise answers to his questions nor were they answered in the discussion which followed. Are we prepared today to give concrete and concise answers to the same questions?

A few years later at the Detroit Convention in 1923 Dr. Charles Scott Berry gave a partial answer to some of Dr. Spalding's questions in his paper on "The Mentally Retarded Child in the Public Schools." Dr. Berry stated: "Our aim in the education of the special class child is to make him a law abiding member of society and to enable him to become wholly or partially self-supporting through engaging in unskilled labor. The folly of attempting to make skilled laborers out of this type of individual when twenty per cent of the normal population gainfully employed are engaged in unskilled labor, is self-evident."

Dr. Berry then outlined the Detroit plan in 1923 of departmentalized special education for groups "A" and "B." Group "A" being pupils under 13 years of age and group "B" 13 to 16. One of the essentials of the special class training was habit training. Dr. Berry stated that the habits which were fundamental to success in any vocation are the very ones that are essential to success in schoolwork. He went on to say: "Through the formation of right habits he may do what is right and refrain from doing what is wrong without being able to give any reasons why certain acts are right and certain other acts are wrong. With the mentally retarded child the habits he forms determine his future to a much greater extent than does the knowledge he acquires while in school."

It seems to me that the situation which confronts the special classes today contains many of the same questions that were troubling Dr. Spalding twenty-five years ago and that the basic aims are essentially those of that day. Methods are changing. Two leaders in this field have discussed in detail modern concepts and to a degree the postwar era. They are Mr. John Tenny and Dr. Elizabeth Kelly writing in the March, 1944, issue of the Journal of Exceptional Children.

Mr. Tenny favors a plan whereby the special class child may participate in a cooperative plan of special education with special classes housed in regular schools. The value of the plan being to free the child from stigmatization. In handling the mentally retarded under this plan Mr. Tenny recommends:

"Pupils should not be placed in a group by themselves but treated as a part of the class. Favors, such as less work, should not be granted. Social adjustment should be considered the basic goal." Dr. Kelly in her analysis of the situation states: "If the individual is found, according to accepted scientific measures, to fall below the standard set for potential community adjustment, it may be concluded that he is non-salvageable. If on the other hand, by the use of the same scientific technique, the individual gives promise of development along the lines of social competence and personality adjustment, the school receives a challenge."

The last statement is perhaps the most hopeful for the special class child. Dr. Kelly's plans call for:

1. A complete analysis of the individual case.
2. A period of trying-out of discovered bents and capacities.
3. A prevocational period.
4. A complete guidance program.
5. Preparation for actual work situations.
6. Job placement.
7. Follow up.

The seven points I feel might well be the basic aims of all public school special education in the postwar world. In order to prepare the child to meet the world Dr. Kelly ascertained what personnel managers and directors of employment desired most in the retarded children placed in job situations. These people considered the following work habits as essential:

1. Alertness.
2. Ability to follow directions.
3. Safety-First.
4. Accuracy and neatness.
5. Steadiness and reliability.
6. Ability to take orders.
7. Good character, honesty and good disposition.

It would be of more than academic interest to know the number of special class pupils who have participated in the war effort, both in the armed services and in war industry. It would be of greater value to know how many succeeded and how many failed and what were the essential factors in their success or failure. Such information would be of inestimable value in shaping the future curricula.

Our present problem has to do with what is to become of these special class pupils who return from the war or are released from war industry. Will a place be found for them in civilian life and activity? Will they become a part of the population living on relief?

Dr. Spalding twenty-five years ago raised the question of the cost of special education. That is still under discussion. We have become inured to high figures for war expenses. Perhaps now the time is ripe to present to the public the need as well as the value of an adequate program of special education. It will not be a minor expenditure but it need not be exorbitant. The thoroughness and the adequacy of the program will achieve the results most desired-self-respecting useful members of society.

Next I should like to look with you toward some of the horizons for the institutions. There are many facets to this picture but I shall attempt to view only a few.

First of these are the institutional opportunities for research. It seems to me that it is logical for the major part of research in this field to come from institutions where there are ample facilities for controls and where there is always the factor of twenty-four-hour supervision. The factors that have been lacking in the past are time, men and money to do the work.

A number of institutions have in recent years augmented their facilities for research. At a recent meeting of this Association held in Boston we had the pleasure of being present at the formal dedication of the George L. Wallace Laboratory. Already a great deal of valuable research knowledge has materialized from that institution. Connecticut's newest school at Southbury has made excellent provisions for research. Vineland, Northville, Sonoma, American Fork, Faribault and Letchworth all have given a great deal to the research literature in this field.

In surveying the literature of recent years one finds several factors that are lacking and perhaps some that have received undue emphasis. Perhaps the greatest single deficiency in research has been in pathology. To be sure there have been many excellent studies made but the number of investigators have been few and the scope of their investigations have been quite circumscribed. At the meeting in Philadelphia last year Dr. Temple Fay suggested certain fields of pathological investigation that may have a profound bearing on the etiology of some cases that have been neglected or overlooked. I refer to his work on the size of the cranial foramena.

In investigating this subject one can work with living persons by means of X-ray studies of the cranium and comparing the sizes with known normals. Since the function of the brain cells is directly dependent upon adequate blood supply it is easy to understand the meaning of subnormal sizes of the foramena through which the blood vessels must pass. Here is a fertile field of investigation for every institution equipped with a Roentgen-Ray apparatus.

Dietary studies in mental deficiency have been made but the application of the newer knowledge of vitamin-therapy has not as yet been adequately studied when applied to the subnormal.

The use of endocrine products for mental defectives, particularly by physicians in private practice, has been overdone. They have been used as "shotgun prescriptions" with the hope that they might do some good. Inaccuracy of diagnosis leads to the indiscriminate use of endocrine therapy resulting in failure to improve the individual case with resultant waste of time, material and money. It is a rare case that needs endocrine therapy and such preparations should only be used when the diagnosis definitely points to endocrine deficiency.

There is great need for further intensive research into the etiology of obscure cases of mental retardation. Why for example, to cite a case with which I am familiar, should one member of an otherwise brilliant family be a nonsalvageable mental defective? W. M.'s parents were both superior types of individuals with excellent university training. His paternal grandfathers were on the one side a college president and on the other side a famous surgeon. His maternal grandparents were both endowed with more than average intelligence. No evidence of mental deficiency or other psychopathic conditions were to be found in a thorough search of the family tree. A sister was dean of women in a New England college; one brother a physician, one a lawyer and one a successful business man. The history of the gestation and birth were without clues as to the etiology. The history of the infancy and early childhood were likewise without factors which might cause retardation. Yet W.M. never progressed beyond the level of a low-grade moron. Why? That is a question with which we are frequently confronted and for which we have no definite answer. Such cases are indeed calamities for normal families to face. Medical science is perhaps remiss in not as yet having provided a definite answer.

Unfortunately it is families such as W.M.'s that become the victims of charlatans in the profession and also in some of the schools for retarded children. They spend small fortunes to find a cure and pay exorbitant fees to some of our schools for the retarded, only to learn by sad experience that there is no cure and they are faced with the problem of life-time care and support for the unfortunate member of the family.

Let us hope that research may be intensified toward the end of finding an adequate answer to such problems in etiology.

The application of the newer knowledge and newer techniques in surgery to mental defectives is definitely lagging. Dr. R. M. Klemme of St. Louis has developed a technique of brain surgery which he has applied largely to acquired motor disorders but which may find wide application in cases of birth injury. Most of the birth palsy cases are of normal intelligence and if surgery can offer them a marked degree of physical relief they should most certainly have the advantage of this new method of therapy. This is, of course, a highly specialized field of neuron surgery but it is one that has a practical application to a relatively large group of cases.

Out of the surgical advances during the war will undoubtedly come not a few techniques applicable to the physical defects found in mental defectives. We should be on the lookout for and be prepared to utilize such advances for the benefit of the children entrusted to our care.

I might go on further in the possibilities for medical research but I must touch upon other forms of investigation open to the institutions. In 1941 our Committee on Education and Training in cooperation with the United States Office of Education made a very intensive study of the educational programs in residential schools for the mentally deficient. This was a monumental piece of work and it has given the institutions a basis for comparing their facilities and curricula with others. This report contained a summary with some significant questions for study. A good deal of follow-up work along the line of this report has been done by the Committee on Education and Training. Perhaps the future will bring us a model outline.

From time to time small private schools for the retarded spring up. Some states investigate such projects before giving licenses or approval. This is not universal, however. This Association at present is not equipped or financially able to investigate and report on such schools. Perhaps at some future date we can assume this responsibility to the public and investigate these projects. Minimum standard for approval might be within the scope of the Committee on Education and Training.

Psychological research in this field has perhaps made the greatest progress and contribution to the accumulated knowledge. For this we are indeed indebted to several of our own members. Out of these studies have come a wide variety of tests most of which have been well standardized. It is no longer felt that a simple Binet test is an adequate psychological study. Not that the Binet has lost its intrinsic value but it needs supplementation and confirmation by a battery of other manual, verbal and non-verbal instruments of psychological measurement.

Of these advances our Association may be justly proud. This work will continue and other tests will be developed. Perhaps we may hope for psychological methods of analysis that will be less time consuming. A critical analysis of the tests proposed and in use seem to be in order. Overlapping is unavoidable and yet it would seem that certain condensations might be made in the effort to produce an economy of time without disturbing the value of results.

Lastly, it seems to me that we are going through certain phases of transition. There was a time when institutions received all gradations of defectives from the profound idiot to the borderline types plus a goodly number of defective delinquents, pre-psychotics and epileptics. There is developing certain, quite clearly, demarcated trends whereby the higher grades of defectives who are perhaps more salvageable are considered chiefly a community problem for the jurisdiction of the special classes. Most of us feel that is a sound policy basically, yet some of these cases can and do do better with a few years of institutional care and training. It is an unwise policy which draws hard and fast lines of demarcation for institutional placement.

This trend means to the institutions a need for reorganization of the curricula gearing it lower to meet the needs of the lower grades of defectives. The end result will be that fewer cases will be eligible to parole and the institutions will require more employed help to care for those less capable of self-aid. All of this will have a bearing on costs. Legislators will need to be made aware of this shift and the accompanying need for additional appropriations to meet the added financial burden.

The war and particularly the war industries made the institutions more conscious of wage scales. It has been proverbial knowledge that institutional personnel are poorly paid. During the war some attempt has perforce been made to raise the level of the compensation for institutional help. In spite of this it is safe to say that many institutional employees are still underpaid, it is to be hoped that we may be able to see the time when institutional salary scale will attract a better class of individuals, particularly in the attendant group.

In considering the horizons as far as institutions are concerned there are, or were, certain trends in the decades between the wars that seemed good in theory but have proved to be poor at best in practice. For example, in the 30's there was considerable agitation for civil service examinations and appointments for all institutional positions. Such laws or regulations were put into action in several states. Perhaps the Board of Directors of Letchworth Village in their reports in 1942 and 1945 have best told the story of such rules of practice.

In the 1942 report from Letchworth Village we quote: "The State Civil Service Commission is doing its utmost to cooperate and to facilitate the employment needs of the Village. The Commission deserves all sympathy, for the task laid upon it is an impossible one. Some day, unless we miss our guess, the parents, relatives and friends of our children will demand of their representatives that they secure the repeal of regulations which instead of benefiting the inmates of Letchworth are having just the opposite effect. We urge the speedy repeal of these unworkable regulations."

The Board of Visitors at Letchworth Village in their 36th Annual Report discuss at some length New York's Civil Service. They state: "With the Civil Principle there is universal accord. The administration of Civil Service is, however, quite a different matter and if we achieve the goal which Governor Dewey sets before us there is a real fight ahead, for the tentacles of the civil service octopus never let go."

"An entrenched bureaucracy, not familiar with the details of administration in our state hospitals and schools is, however, so obsessed with the fetish of uniformity that the farther down one goes, the administration of civil service becomes less and less human and more and more a mechanical thing. It is not possible to fit people into categories and expect equally satisfactory results from all."

This idea of regimentation has been fostered in a number of states. New Jersey, Maryland, New York and others have worked out employment classifications with salary ranges for each classification. All agreed that in theory the idea was excellent. What was the result? To quote again from the Letchworth report: "The Feld-Hamilton Act struck a cruel blow at the welfare of the inmates and patients committed to the care of the state. Uniformity and standardization of positions, titles and salaries is a laudable goal in administrative departments, in clerical and other positions in governmental offices but what is best for the patient should be the goal to be sought in our state hospitals and schools."

"The unrest, dissatisfaction and resistance which has resulted from putting into effect classifications worked out by bright boys in Albany offices, seeking to reshuffle positions in order to make unrelated services fit into comparable categories without considering the effect of their actions on morale and the ultimate good or ill of the patient has been heart-rending and bodes no good as far as developing incentive, attracting ability and raising the standard of care and treatment."

Dr. Storr in his report says of the Feld-Hamilton Act; "The changes in titles, the abolishing of certain positions, the disappointment of a large number of most dependable employees in their classification and salary almost completely disrupted the morale of the institution."

We know that many states are seriously considering the extension of civil service laws to include institutional personnel. I would heartily recommend to all such legislatures and civil service Zealots that they read, learn, mark and inwardly digest the contents of the 36th Annual Report from Letchworth Village.

For further enlightenment on the question of civil service I would heartily recommend that the article "Shall we go back to the Spoil System?" condensed from Harper's Magazine in the November, 1945, issue of The Reader's Digest. It is, to be sure, headed with the caption "A not unbiased report on the civil service by one who has struggled for seven years in its red tape." Nevertheless it throws a good deal of light on the serious inadequacies of the "vaunted federal civil service. It is a truism that the lower down in the political scale one goes the poorer the civil service. If the federal civil service is as bad as the Reader's Digest pictures it then we can not expect state, county and city versions to be as good.

This brings us to the question of central control. A great deal has been said and written for and against central control of institutions. Just what is in store for the institutions in this connection is anyone's guess. Yet the history of the growth and development of institutional services for the mentally retarded should be thoroughly studied before complete central control is considered. That history gives us such dynamic, rugged individualists as Seguin, Kerlin, Wilbur, Fernald and Little without whose keen insight and vision few of our institutions could be what they are today. Their contributions are real and lasting.

With the growth of centralized control the Boards of Directors have been stripped of much of their legal authority and value. This is unfortunate. A conscientious Board of Directors is the biggest asset a superintendent of an institution can have. The Board should in the future be again made more potent in power and still be kept free from political stigma or domination. As such they can again truly represent the public in the control of the institutions as well as to aid, support and direct the superintendent and his staff. Their personal direct control and interest is of far more value to the state than the indirect bureaucratic impersonal supervision of a centralized agency. It is to be hoped that the future will bring to institutions more autonomy and less bureaucracy.

Those of us who are charged with the care and welfare of large numbers of mental defectives are almost uniformly wholehearted advocates of selective sterilization, from the standpoint of preventive medicine. In the August, 1943, Medical Woman's Journal, Dr. Frances I. Seymour of New York City raises the question "Can this Nation afford Hereditary Disease?" She presents her thesis as an original report of a Family of Hemophilics but goes into considerable detail regarding hereditary disorder, one of which is mental retardation and states in 1928 it cost this nation $1,002,097,145.00 to care for hereditary types of institutional cases and states further: "This figure has become greater since 1928." She concludes by stating: "My stand on this subject is, that if we can afford the perpetuation of hereditary disease, then we must be prepared to support the offspring in a humane and suitable manner."

And so, my Fellow Members, I have tried to visualize with you a few of the horizons that lie in front of us. That there will be changes in many phases of our problems is to be anticipated. To make these changes really worthwhile as well as real improvements, instead of mere changes, will require the thoughtful guidance and leadership of members of this association.

In trying to envision the future one can't help but take a fleeting glance at the past and in so doing one comes to the conclusion that this association has accomplished much. It has reached its present stature in the field of science over the accumulated discoveries and knowledge of the past century. Actually, it is still on the lower rungs of the ladder and the upward climb is perhaps uncertain but never were the horizons more challenging.

Some of our recent leaders, have been what might be called indirect casualties of the war. They have gone on and perhaps now see clearly the horizons we can but dimly visualize. If so, I am sure that Mary Vanuxem, Fred Willhite and George MacPherson would say through me to you -- CARRY ON!!