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the individual case record. Sentiment defeats sense oftentimes when the question of marriage of an epileptic arises. Too much stess cannot be laid upon the fact that lack of the proper degree of gentle direction of the handicapped defective, whether insane, feebleminded or epileptic, with inability of the physicians to exercise tact, caution and a reasonable degree of common sense results so often in failure to succeed satisfactorily in the care of these classes. The utmost diplomacy is required oftentimes to not only secure the co-operation in treatment of the epileptic himself but also that of his family.

Experience in various parts of the world in the treatment of epilepsy in its multiplicity of phases, has demonstrated clearly that for selected patients without too great mental defectiveness or deterioration, suitable change of environment, the directing of the energies along new channels, preventing too much self-centering of interests and readjustment of any disturbing factors which might tend to cause undue psychic upset, proper refraction, dental therapy and correction where possible of abnormal function of parts, placing the individual at a congenial occupation with sufficient recreation during hours of leisure, allowing a reasonably restricted diet and a common sense hygiene, the life processes become so harmonized that there occurs marked improvement in many epileptics in whom no sedation of any kind has been resorted to. Sedatives such as bromides too often but mask symptoms in epilepsy, tending to arouse false hopes as to complete recovery, and commonly to omit the basic readjustment of living conditions necessary to demand of an epileptic. Individualization is mandatory for success in treatment. Relief, so far as possible, from disturbance from environment must be secured to make socialization possible for epileptics with little or no lowering of the intellectual level. Music, artistic pursuits, re-education, must be made use of for epileptics of mentality sufficient to grasp same. Mental and physical recreation and rest in proper proportion for the abnormal physical and mental endowment which exists are required.

We must coincide with Clark's expression that "No essential epileptic will ever recover from his Grand Mal attacks until he has found that life level to which he can fully adapt or adjust

himself. Even though this level be attained and seizures cease, it will still remain an unsolved problem to meet a more demanding environment of ordinary everyday life without the return of seizures. "The arrested cases cannot stand the stress of a normal individual, therefore gradual cessation of all therapy is of vital importance and following up of arrested cases necessary.”

Because of his tendency to complain and not readily adjust himself to his environment the average epileptic is out of place in an institution for the feebleminded. It seems strange that so many among the general public, even those who have some knowledge of the symptoms observed in epileptics, fail to realize that the earning capacity of epileptics as a class, has been over estimated. Because of recurring periods of impairment or loss of consciousness, more or less prolonged, often associated with convulsive attacks, frequently resulting in the occurrence of serious injury or disease such as pneumonia, the epileptic is handicapped to such a degree as to require in an institution for epileptics an allowance of from four to five patients to do an ordinary day's work. The epileptic, whose condition is the exception to the above but proves the rule. Under no circumstances can a community of epileptics, a great number of whom are naturally more or less defective mentally be made self-supporting. A selected occupation for the inmates of our public institutions is primarily valuable as considered for its moral and medical worth and secondarily for its financial value to the State. A carefully regulated and supervised occupation for those epileptics able to work the regular hours of employment and recreation, the reasonably restricted diet and the carrying out of a hygienic life along broad lines so fundamentally important in the treatment of this condition can best be carried out in a special Colony where every action, if need be, can be regulated in a reasonable manner to meet exigencies of the individual case. In the treatment of many conditions, but especially that of epilepsy the inculcating of habits of personal discipline and self-control are of the utmost importance. In many instances epileptics previous to their admission to the special institutions have been allowed to do as they wished, the result being a material increase in the number of their seizures and progressive damage to their mentality. The epileptic of average

mentality, who after a brief residence at the Colony properly readjusts himself to the simple rules of living demanded of colonists, can then co-operate to the best advantage in the general plan outlined for his treatment. It cannot be reiterated too often that regular occupation under proper conditions is not only of much benefit to the general health of a patient for the physical exercise thus given, but it also keeps healthy interests aroused and tends to retard, if not stop for a considerable period, mental deterioration. Those epileptics who are congenitally defective to a considerable degree or who are markedly demented cannot of course be expected to improve materially as result of any treatment, no matter what it may be, but the average epileptic does, if proper adjustment to Colony living conditions takes place and is adhered to, show after a reasonable length of time a certain degree of improvement.

It has always been the custom at the Colony, so far as possible, to impress upon the relatives of patients newly admitted or about to be admitted that he or she should come prepared to remain for a long period of time as one must appreciate that the number of improvable cases among those admitted to the Colony is not very large therefore if an improvement results within two or three years the patient should consider him or herself fortunate.

In the Colony system as already mentioned there is provided a means of existence which permits many to be made comfortable and have various privileges which they would be deprived of in the outside world. Many of the colonists realize and appreciate these facts, others, as is but natural to expect, constantly criticise and find fault with conditions when these are, in most instances, better than would be the case elsewhere. Relatives and friends are many times to blame for this spirit of discontent and dissatisfaction. They criticise the institution adversely not appreciating the difficulties which are presented in endeavoring to take care of nearly 1,500 individuals all of whom are epileptic, coming from all walks of life and of many nationalities and so arrange that these persons, in many respects dissimilar, may live together without friction. Some of these objecting and critical relatives and friends remove the patient from the Colony, but shortly after are exceedingly anxious to have him or her readmitted confessing that they cannot care for the patient at home.


Although more than 20 years have elapsed since the first patient was admitted to the Colony, there has not been made available, as mentioned repeatedly in earlier reports, a sufficient amount of money to permit of progressive development of the Colony among the lines of scientific research referred to in the law establishing the Colony as one of the fundamental purposes for which the Colony was organized.

In connection with the laboratory work at the Colony, investigations along the lines of neuro-pathology could profitably be carried on if sufficient money was available for a larger laboratory staff and for the erection of much needed addition to the existing structure. Under existing circumstances this very important phase of research has to remain practically untouched, whereas systematic study in careful detail along these lines might ultimately bring to light much of value to neurology. It is hoped that in the not distant future a reasonable amount may be made available for developing this very important branch of the Colony's work, leading perhaps ultimately to the discovery of new unknown methods of relief and prevention, permitting of a wide application in overcoming this distressing affection of the human race. Pathological states of various organs, other than gross changes in the brain, e. g., the kidneys, the gastro intestinal tract and the various glands connected or associated therewith; the internal secreting or endocrine glands, are sought for so far as present facilities permit.

Population and Expenditures for the Year Ending June 30, 1917

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