Before drawing from this first inquiry any practical conclusions, we should like to reach a comprehensive view of the question. We shall give our conclusions after we have synthetised all our results.
After the Salpêtrière, Bicêtre.
Bicêtre.—The reader would be wrong to imagine that in these visits to the hospitals we are forgetting the school cases of mental deficiency; we are at the heart of the question. Whether we are dealing with hospital cases or school cases, there are details of organisation which are the same for all, and there are similar mistakes which we must try to avoid.
The asylum-school of Bicêtre, which owes its origin, in 1892, to the General Council of the Seine, and its organisation to Dr. Bourneville, has a world-wide reputation. Dr. Bourneville has set himself to demonstrate, by every possible means, that idiots can be improved if they are treated methodically and progressively. It is thanks to his initiative that the medico-pedagogical treatment of idiocy, a treatment which has been much vaunted by the doctors, is now known everywhere. His clinique has constantly been cited as a model. This model has been imitated in France and more especially abroad. The asylums of Saint-Yon, of La Roche-sur-Yon, of Clermont, of Sainte-Gemme, and of Auxerre, have been inspired by the example of Bicêtre, and have followed its methods. The State supports 440 boys in the asylum-school of Bicêtre, and 230 girls at the Fondation Vallée.
We have no intention of describing here at length the organisation of these establishments. All who are interested may join in the Saturday morning visits, when Dr. Bourneville goes round the whole of his clinique. We shall content ourselves by saying that the children in the asylum-school of Bicêtre are divided into three groups:
1. The group of invalids—children who are idiotic, dirty, epileptic, demented. In this group are those who are regarded as incurable, and some who, although completely idiotic, are capable of some slight improvement. By means of a swing or see-saw their limbs are strengthened, by means of a go-cart they are taught to walk, and by means of the parallel bars they are taught to keep themselves upright.
2. The healthy children of the little school, all of whom are able to walk alone. These undergo treatment for uncleanly habits. Special chairs are kept for the dirty, who are placed at stated times upon conveniences in order to regularise their functions. Then come strengthening exercises, which are gymnastics of a very simple kind; toilet lessons to teach them to wash themselves; table lessons, to teach them to feed themselves, with spoon, fork, and even knife; the training of the senses; and, lastly, training in speech.
3. The third group includes children in the big school. These are less defective than the preceding. They are fit and healthy. But, on the other hand, there are found here a great many abnormal children (perverse and ill-balanced) who are not wanting in intelligence. The big school includes four classes, each under the charge of a professor. The education, especially in the last class, is carried pretty far, and many of the pupils possess their certificate of study.
For reasons upon which we will not insist, we were not so delighted with the hospital of Bicêtre as we had been with the Salpêtrière. We might have dispensed with this visit. The medical superintendent of the school for defectives at Bicêtre has taken the trouble for a long time to publish regularly every year a volume of several hundred pages, which contains the most diverse statistical information about everything that goes on. We have studied the volumes bearing upon four years only—the years 1899, 1901, 1902, and 1903. Moreover, we profess that we have some knowledge of the school at Bicêtre, having not only joined several times in the Saturday visits, but having on several occasions carried on there researches in cephalometry; and, in the last place, we have had the pleasure of following in their inspection two members of the ministerial commission, who had had the idea of finding out how the teachers in the big school were fulfilling their functions.
It will be remembered that we made a distinction between the educational and the social return. This distinction is not recognised by everyone, and many good people take into account only the social return. There are those who would judge the school of Bicêtre by one thing only—the number of patients who are made useful to society. This is a question of great interest, but it is wrong to think that it is the only one to be considered. It would be unjust to confine oneself to it. The injustice can be understood by supposing that one is considering an institution which receives idiots only. Would one judge such an institution by asking how many of its patients become capable of winning their livelihood? Certainly not. It is possible to be of real service to the patients without raising them to such a level. The cure of dirty habits, for example, is not a thing to be disdained. Not only does it result in an economy of linen and washing, but it makes the patient less disgusting, less difficult to take care of. Here we have material and moral improvement which, even for those who consider expense only, cannot be considered negligible, for in the end the result is pecuniary economy. But, having stated this principle, it would be necessary to find out what is the value, what is the duration, what is the frequency of such improvements. It would be necessary to know what is their cost, and to compare the cost with the results in order to find out where one was. This kind of stock-taking, both financial and medical, has no place in the publications of the Bicêtre, and cannot be replaced by isolated observations on the treatment and improvement of idiot children. There is here, therefore, a first lacuna. We note also with regret the absence of any inspection of the teachers in the schools, who are left to themselves without any supervision but that of the doctor. Now, the doctor is not usually an educationist, and it is to be regretted that he does not himself recognise his incompetency in pedagogy, but that, on the contrary, his nature, often prone to take offence, will not submit to any collaboration in his work. Having said this, we are going to confine ourselves to the social return of the school of Bicêtre, since it is affirmed that such a return exists.