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74 19,814
-

HOLLAND, Howard Owen, 1918HISTORICAL SURVEY OF ATTENDANT-NURSES TRAINING
IN MICHIGAN.
Michigan State University, Ph.D., 1974
Education, special

U niversity Microfilm s, A XEROX Company , A n n Arbor, M ichigan

HISTORICAL SURVEY OF
ATTENDANT-NURSES TRAINING
IN MICHIGAN

By
Howard Owen Holland

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Elementary and
Special Education

1973

i

ABSTRACT
HISTORICAL SURVEY OF
ATTENDANT-NURSES TRAINING
IN MICHIGAN
By
Howard Owen Holland

Attendant-Nurses have been responsible for the direct care of
the institutionalized mentally retarded since the establishment of the
Michigan Home for the Feebleminded and Epileptic.

They have been

responsible for training assigned groups of the retardates in funda­
mental habit behaviors such as bathing, eating, dressing and toileting
Also, they have been expected to participate in the development of
speech, language, play, obedience, moral standards and other
behaviors essential to the social acceptance of the individual.

The

Attendant-Nurse has been identified as the parent surrogate of the
institutionalized retardate.

Time and again, the literature has

identified the Attendant-Nurse as the most significant adult in the
life of the institutionalized retardate.
Despite numerous acknowledgements of the important role played
by the Attendant-Nurse in the care and training of the mentally
retarded in institutions they are hired without experience or training
At the present time, the Michigan Civil Service Commission requires
that they be eighteen years old, have an eighth grade education and

Howard Owen Holland
an average intellectual level.

They hold low statue positions and

receive the lowest pay.
From the beginning of institutions for the retarded in Michigan
to the present the need for training for the Attendant-Nurse has been
constantly expressed by those in authority but never more than
partially accomplished.
Because of the foregoing paradox, this historical survey has
been undertaken with the expectation that documentation of the futile
attempts at training, if brought to the attention of concerned
officials, could result in more meaningful Attendant-Nurse training
programs.
Information about institutions for the retarded and the training
of Attendant-Nurses was obtained from institutional files, the State
Library, Lapeer and Lansing newspapers, the Michigan Historical
Commission’s Archives as well as from publications such as the
Journal of Insanity.
The survey is divided into four distinct eras as follows:
1.

period prior to establishment of the Michigan Home for
the Feebleminded and Epileptic.

2.

Period of management of institutions by independent
governing board (1895-1922;.

5.

Period of Michigan Hospital Commission (1923-19*+*+) •
Period of Department of Mental Health (19^5 to date).

There is contained in the individual chapters a brief description
of the prevailing thoughts and attitudes in regards to the mentally
retarded; comments about conditions within institutions during the era

Howard Owen Holland
and a discussion pertaining to the methods and attitudes about the
training of the Attendant-Nurse.
The survey indicates that there has been a continually decreasing
interest in the training of the Attendant-Nurse as the control of the
institutions has become more remote; that is, the independent board
of trustees and the superintendent of the early era had a far greater
concern and devoted more attention and effort to this training need
than is evident at the present time.
Another finding is that the training of Attendant-Nurses in
institutions for the mentally retarded failed to keep pace with the
continually improving training of nurses in general nor was there any
great effort made to meet training standards set by legislation
concerned with nursing practice.

At the time the original Michigan

Nurse Practice Act was passed the Attendant-Nurse training being
conducted at Lapeer was adequate for gaining licensure.

At this time

the training received by Attendant-Nurses in the Michigan institutions
for the mentally retarded is not sufficient for gaining any type of
nursing license.
The last chapter is concerned with implications which indicate
that the attempts at inservice training of Attendant-Nurses in insti­
tutions have been quite unsuccessful.

However, newly established

community college programs for the technical training of mental health
workers will enable institutions for the mentally retarded to hire
people with adequate training to fill Attendant-Nurse positions.

ACKNOWLEDGEMENTS

Without the guidance and support of Dr. Donald A. Burke this
dissertation would not have been forthcoming.

The other committee

members, William V. Hicks and Isabel Payne have made significant
contributions that are greatly appreciated.

My wife, Jean M. Holland

is to be complimented for her patience and support.

Last, but by no

means least, thanks to Mrs. Thelma VandenBossche who assisted by typing,
editing and organizing the dissertation.

ii

TABLE OF CONTENTS

Chapter
I.
II.

Page

INTRODUCTION .........................................
PERIOD PRIOR TO INSTITUTIONS FOR THEMENTALLY
RETARDED IN MICHIGAN.........................

1
6

Establishment of the Michigan Home for the
Feebleminded and Epileptic......................
III.

PERIOD OF INDEPENDENT MANAGEMENT OFINSTITUTIONS
IN M I C H I G A N .................................

23

31

Institutional Description ................ . . . .
Training of Attendant-Nurses........... .....
IV.

PERIOD OF STATE HOSPITAL COMMISSION.............

53

Institutional Description ........................
Training of Attendant-Nurses.................
V.

PERIOD OF MICHIGAN DEPARTMENT OFMENTAL

56
58

HEALTH. . . .

Institutional Description ....................
Training of Attendant-Nurses.................
VI.

37
*+3

68

..

SUMMARY AND IMPLICATIONS.......................

SELECTED BIBLIOGRAPHY > .....................................

?8
82
93
99

APPENDICES
APPENDIX A ...............................................

101

APPENDIX B ...............................................

113

APPENDIX C ...............................................

118

APPENDIX D ...............................................

125

APPENDIX E ...............................................

131

APPENDIX F ...............................................

139

APPENDIX G ...............................................

1^5

iii

CHAPTER I

INTRODUCTION

CHAPTER I
INTRODUCTION
Since the first institution for the mentally retarded was
established in Michigan Attendant-Nurses have been responsible for the
direct, twenty-four hour daily care of the impaired residents.

They

have been responsible, with minimal guidance, for training an assigned
group of the handicapped in the fundamental habit behaviors such as
bathing, eating, dressing, toileting, and so forth.

Additionally,

they have been expected to participate in the retardates' development
of speech, language, play, obedience, moral standards and other
behaviors essential for social acceptance.

Many times the Attendant-

Nurse has been identified as the parent surrogate of the institution­
alized and with ample justification.

Time and again, in the literature

concerned with institutions, it has been stated that the AttendantNurse is the most significant adult in the life of the retarded, the
person who has the most detailed and intimate knowledge of the
impaired individual’s behavior.
Despite the numerous acknowledgements of the important role
played by Attendant-Nurses in the care and training of the mentally
retarded they are, and have been for seventy-eight years, hired
without training or experience.

At the present time the Michigan

Civil Service Commission requires that persons aspiring to the position
be at least eighteen years old, have an eighth grade education and

1

2
an average intellectual level.

Within institutions the Attendant-Nurse

occupies a low status position among the professionals and paraprofessionals engaged in caring for the retarded populations and they
also receive the lowest salaries.
From the era of independent management of the Michigan Home for
the Feebleminded and Epileptic by a Board of Trustees to the present
day centralized control of institutions by the Michigan Department of
Mental Health the need for extensive training of Attendant-Nurses has
been constantly expressed by those in authority but never more than
partially accomplished.
With an awareness of the foregoing paradox, this survey has
been undertaken with the expectation that a concise historical
documentation of the continual futile attempts at training, if brought
to the attention of concerned officials, could result in more
meaningful Attendant-Nurse training programs.

Such an attainment

would not only benefit the institutionalized retardates but would
provide the parents of these unfortunates with great solace and the
community at large with more effective habilitative and rehabilitative
services for the mentally retarded.
Throughout the survey that follows terminology has been used in
regards to nursing and mental retardation that may be confusing to
some readers unless explained because effort was made to use terms
that were consistent with the era being considered.

Thus a brief

explanation of terminology is presented.
NURSTNG TERMS— For years prior to the enactment of the Nurse
practice Act, hospitals had training schools for nurses and those who
successfully completed the course were called Graduate Nurses to

differentiate them from Student Nurses who were still attending
classes.

In general hospitals persons, usually male, who assisted with

the care of the sick, and received little or no formalized training
were known as Orderlies.

In mental hospitals and institutions for the

mentally retarded the term Attendant was used to identify personnel
who had not been trained at a level equal to the Graduate and/or
Registered Nurse.
This hierarchy of nurses continued until recently when first the
Licensed practical Nurse and then the Licensed psychiatric AttendantNurse gained status by recognition in revisions of the Nurse Practice
Act.

Both practice nursing with a lesser degree of specialized skill,

knowledge, education and training than the Registered Nurse and must
perform such acts under the direction of a Licensed Physician, a
Licensed Dentist or a Registered Nurse.

The Licensed practical NurBe

provides care for, treats and observes the ill, injured and infirmed
while the Licensed psychiatric Attendant-Nurse cares for the mentally
ill and the mentally retarded.
With the advent of the Michigan Civil Service the Attendant
became known as the Attendant-Nurse.

in other parts of the country

they are called Psychiatric Aides, Psychiatric Technicians and Mental
Health Technicians.
MENTAL RETARDATION TERMS— At the time of the establishment of
the first institutions for the intellectually impaired those admitted
were considered to be of one functional level and were called idiots.
However, it was soon evident that among the idiots were those who
could learn and others who failed to respond to instruction.

The

learners were initially called high grades or imbeciles and the

4
non-learners were referred to as low grades or idiots.

With the

realization that the intellectually impaired were of two levels the
group as a whole were called feebleminded.
Wide spread use of intelligence tests in the early days of the
present century revealed additional individuals, previously unrecog­
nized, with sub-average intelligence.

These persons, named morons

functioned at a behavioral level higher than the idiot and imbecile,
in fact, their major area of maladjustment was their inability to
function adequately in the academic environment.
With the realization that some students in community schools
were unable to learn because of intellectual deficits, educators
became involved with the problem.

Teachers introduced more functionally

related terminology naming the moron, educable; the imbecile,
trainable; and the idiot, custodial.
Although feebleminded remained the legal term for the intel­
lectually impaired until replaced by mentally handicapped at
mid-century, the name mentally deficient gradually became the preferred
designation as it was accepted that pathological conditions contributed
to intellectual inadequacy.

As prevailing thought regarding etiology

accepted again the contribution of environment to mental impairment
the presently used mentally retarded became the name of choice.
Since mid-century the three level functional classification of
the mentally retarded, namely, educable, trainable and custodial has
expanded to four levels to conform to standard deviations below the
mean in the normal distribution of intelligence.

A mildly retarded

individual has an intelligence quotient that is two to three standard
deviations below the mean and has the potential for independent

socio-economic adjustment as an adult.
those who were formerly called educable.

This is approximately equal to
Second is the moderately

retarded who has an intelligence level minus three to four standard
deviations below the mean, was formerly considered trainable and as an
adult will probably be socio-economically Bemi-independent.

Severe

retardation is consistent with an intelligence that is four to five
standard deviations below mean, will at beBt reach a semi-dependent
level of adult socio-economic adjustment and was previously called
custodial.

An intelligence quotient five or more standard deviations

below the mean is termed profound mental retardation and will be a
totally dependent individual throughout life.

CHAPTER II

PERIOD PRIOR TO INSTITUTIONS
FOR THE RETARDED IN MICHIGAN

CHAPTER II
PERIOD PRIOR TO INSTITUTIONS
FOR THE RETARDED IN MICHIGAN
There is no date in history which can be used to indicate the end
of the Renaissance and the beginning of the era in which mans interest
in the freedom and well being of his fellow man waB awakened.
United States became a democracy in 1776.

The

Pinel removed the shackles

from the unfortunate at the Bicetre in Paris in 1792 and inaugurated
psychiatric reform.

The establishment of the first successful school

for idiots by Sequin in 1837 is a significant date in the history of
mental retardation.
Prior to the time of Pinel's action, "criminals, chronic invalids,
paupers and mental suffers (the insane and idiots), were all herded
together at the Bicetre and Saltpetriere and treated alike.

The

buildings were untenable, the cells were narrow, cold and dripping,
unlit and unventilated; and furnished with a litter of straw, which
was rarely changed and often infested with vermin.

Men crouched

there covered with filth; in hideous lairs in which one would have
hesitated to confine a beast."'*'

The physically and mentally handi­

capped dwelling there were at the mercy of brutal keepers who were for
^Nowrey, Joseph E., "A Brief Synopsis of Mental Deficiency,"
American Journal of Mental Deficiency, Volume XLIX, Number 3. January,
19^51 pp. 3^2-343.

6

the most part prisoners confined to the two institutions.

Patients

were chained and tied with ropes and as a result of such unjust
treatment reacted with rage, indignation, shrieks and howls.

Added to

the above degradation was the practice of charging an admission fee to
the general public who considered viewing their less fortunate peers as
a form of amusement.
Early care of the mental retardates in the United States was
similar to that found in Europe.

Wolfensberger*s description Indicates

the plight of these unfortunates in colonial daysi

"In early America,

the Puritans looked with suspicion on any deviation from behavioral
norms, and irregular conduct was often explained in terms of the super­
natural, such as witchcraft.

There is reason to believe that retardates

were hanged and burned on this suspicion.

Later in New England, records

showed that lunatics, distracted persons, people who were non compos
mentis, and those who had fits were all classed together, perhaps with
vagabonds and paupers thrown in.

Connecticut's first house of cor­

rection in 1722 was for rogues, vagabonds, the idle, beggars, fortune
tellers, diviners, musicians, runaways, drunkards, prostitutes,
pilferers, brawlers— and the mentally afflicted."

2

Although philosophers and others had explanations of mental
retardation from the middle ages onward, medicine was unconcerned about
it.

In fact, until the end of the eighteenth century, there were only

rare references in medical literature.

"It is easy to agree with

Weygant, who wrote in the introduction of his classical monograph on
2
Wolfensberger, Wolf, Changing Patterns in Residential Services
for the Mentally Retarded, part IV, History and Development, Chapter 5.
The origin and Nature of our Institutional Models, p. 70.
Robert B* Kugel and Wolf Wolfensberger, rEditors), U.S. Government
Printing Office, Washington, D. C., 1969.

8
idiocy and imbecility:

'While the writers of antiquity gave vivid and

correct descriptions to specific psychotic conditions (e.g., Hippocrates
of epilepsy and Aretaeus of mania and melancholea) idiocy has rarely
been mentioned until recently.'

Any bibliographic quest for publi­

cations in the area of psychiatry, neurology, and psychology leads one
invariably to Heinrich Laehr's complilation of the pertinent writings
from 1^59 to 1799.

In this magnificent collection, which comprises two

hugh volumnes and a separate index of authors and subjects, there is
among the many thousands of recorded and sometimes annotated items, not
one, however faint, allusion to mental deficiency, except for the evi­
dence of sporadic interest in cretinism toward the end of the Middle
3
Ages."
The study of mental deficiency as a specialized branch of
medicine could not develop until investigators realized that mental
defect required treatment dissimilar to that of mental illness.
"Scholars knew quite early that madness and idiocy presented different
clinical pictures, but both being classed as manifestations of an
abnormal mind, were therefore subject to similar and often ineffectual
if
forms of the empirical treatment of the day."
Early educators were acutely aware that there were children who
did not respond to the orthodox methods of teaching.
frequently mentioned were the idiotic children.

The most

Another, less con­

spicuous class was the simpleton, (to be later called imbecile).

For a

long time no effort was made to teach these groups, until in 1798* Itard,
a French Otologist, attempted to train Victor, the "Wild Boy of Aveyron."
^Kanner, Leo, A History of the Care and study of the Mentally
Retarded. Springfield, Illinois: Charles C. Thomas, Publisher, 196^,
pp. 7-8.
if

Nowrey, op. cit., p.

9
,rHe was entirely untrained in any way when captured, being not only
idiot

by deprivation, but also, according to Pinel, an idiot at birth.

He attempted to train this boy by methods then in use in the training
of deaf mutes, and while he was disappointed with the results of his
experiment, he noted much that he considered significant."

5

The insane were divided into two groups:
(1) violent and dangerous, and (2) the harmless and
mild. The former were treated as criminals and the
latter as paupers. Mental defectives were usually
grouped with the latter class. The paupers, includ­
ing the mildly insane and the mental defectives, were
cared for by public funds in the following ways:
(1) in their own homes, (2) in almshouses, and (3) by
auction to the lowest bidder, (i.e., to a person who
agreed to support the pauper at the lowest cost to the
community in return for which the pauper worked for
the successful bidder in order to earn his keep).
Sometimes a single contractor would bid for the care
of all the paupers, exploiting them for the work he
could get out of them. This system of auctioning off
the poor originated in the northeastern section of the
country and was known popularly as *the New England
System.* The paupers were brought to the auction
block. The bidders stood in front, calculating the
potential working ability of the goods offered for
sale. The insane and foeble-minded were the most
eagerly sought after, as they were usually capable of
a maximum of work with a minimum of remonstrance.
The bidding proceeded downward and not upward, and to
stimulate the bidding further a free drink of liquor
was given to any person who lowered the bid of a
previous bidder. Although some communities required
a bond to be posted to insure 'decent* treatment of
these public charges, this was often a mere formality.
Fortunately, public opinion became strong enough
by 1835 to demand the discontinuance of this practice,
and it gradually began to disappear from most parts of
the country. As this practice became less prevalent,
the custom of sending the aged and infirmed, the
lunatic and the idiot to the poorhouse became the
common one. With the establishment of these places the
percentage of insane, idiots, and helpless persons
gradually became larger until it required all the time
of those inmates who could work to take care of those
who could not. Conditions in the almshouses grew worse

5 Ibid., pp.

34*4-3^5.

10
and worseT due to crowding and lack of appropriations,
until Dorothea L. Dix began her crusade for state
hospitals in l8*tl. The activity of this fearless
pioneer for humane treatment of the insane did more
to establish state hospitals for the psychotic, and
indirectly, state schools for the mentally deficient,
than the combined efforts of both the medical and
legal professions. Nevertheless, the construction of
state schools were spread over a long period of years,
and the capacities of these institutions could never
equal the number of applicants, and on this account
for many years the jails and poorhouses continued to
be used as places for the confinement of mental
defectives and the mentally ill,6
Edouard 0> Sequin was born January 20, 1812 and studied medicine
and surgery under Itard, who encouraged him to devote himself to the
investigation and treatment of Idiocy.
educate an idiotic boy.

In 1837. Sequin attempted to

He worked with him steadily for eighteen

months, at which time, hi6 pupil was able to make better use of his
senses, could remember and compare, speak, write and count,

sequin

began to teach more children at the Hospice des Incurables and at the
Bicetre.

In 18^3* a commission gave a detailed report of their exami­

nation of his work and stated:
of beneficence.

"Sequin has thus opened up a new career

He has given to hygiene, to medicine, to ethics an

example worthy of being followed.

We, therefore, have the honor of

suggesting that a note of thanks be written to Monsieur Sequin for the
communication which he has addressed to this Council, and that he be
encouraged in his charitable enterprise."

In l8Mt, a commission

examined ten of his pupils, and declared that he had solved the problem
of idiot education.

Sequin, later referred to the commission reports

as the cornerstones of all mentally retarded institutions.
6Ibid., p. 3^7 n
Xanner, op. cit., pp. 35“36.

11
In l8*+6 , Sequin published his classical textbook.

In this widely

read manuscript, he described his method of instructing idiots.
"According to this method, education is the ensemble of the means of
developing harmoniously and effectively the moral, intellectual and
physical capacities, as functions, in man and mankind.

To be physiolog­

ical, education must at first follow the great natural law of action and
repose, which is life itself.

To adopt this law to the whole training,

each function in its turn is called to activity and to rest; the
activity of one favoring the repose of the other; the improvement of one
reacting upon the improvement of all others; contrast being not only an
instrument of relaxation, but of comprehension also.

The general

training embraces the muscular, imitative, nervous, and reflective
g
functions, susceptible of being called into play at any moment."
Sequin became famous and men of many nations flocked to Paris to
view his work.

Then came the 1848 revolution and being distrustful of

the new government Sequin emigrated to the United States.
INSTITUTIONS IN THE UNITED STATES.— The American Asylum for the
Deaf and Dumb, at Hartford, Connecticut, experimented with the idea of
training idiots as early as 1818, but this attempt was soon abandoned
and America's first successful schools date from 18*18.
A probable stimulus to establishment of institutions for the
mentally retarded in the United States were appeals such as that of
Dr. Samuel B. Woodward, first president of the Association of Medical
Superintendents of American Institutions for the Insane and the
Superintendent of the Massachusetts State Lunatic Hospital who in his
annual report of l8*+5 to his Board of Trustees exorted them to remove
g
Ibid., p. 37.

the undesired and troublesome idiotB from the asylum.

The plea of

Dr. William S. Chipley of the Eastern Lunatic Asylum, at Lexington.
Kentucky demonstrates the intensity with which the removal of idiots
was sought:

"There is one class of persons frequently committed to the

Asylum, as provided by law, in whose behalf I esteem it a duty to appeal
to the humanity and generosity of the Commonwealth.

I allude to idiots.

The attention of your board has been heretofore directed to the manifest
evils resulting from the promiscuous mingling of those persons with the
insane.

As early as 1848 you said:

'We are sure that every one having

any experience on this subject will testify, most strongly, against the
evil effects of such unions, and the injurious consequences of such
association to the lunatic.'

And you state very correctly and circum­

stances under which these persons are generally sent to the Asylum:
Whenever an idiot becomes so utterly diseased and helpless that no one
will support him for the fifty dollars allowed by lnw, he is sent to the
Asylum."

9

Similar appeals for the removal of idiots and also the

epileptic from the Michigan Asylum for the insane were frequently
recorded in the Annual Reports of the Board of Trustees from 1860-1890.
On April 11, 1846, the General Court of the Commonwealth of
Massachusetts passed an Act requiring the appointment by the Governor
of a Commission "to inquire into the condition of the Idiots of the
Commonwealth, to ascertain their number, and whether anything can be
done in their behalf."
Commission.

Dr. Samuel G. Howe was named Chairman of the

Dr. Howe had Bpent his first six years after graduation

from medical school as a surgeon in the war of the Greek Revolution.
9

__________ , "Education of Idiots at the West," American Journal
of Insanity, Volume XI, April, 1856, p. 317•

13
Upon return to the United States he collected $60,000.00 which he
personally disbursed in a relief station he established in Aegina.
Later he established a refugee colony for war exiles.

In l831» inter­

ested in establishing an asylum for the blind he returned to Europe to
investigate its facilities in this field.

Temporarily diverted from

this task by a commission from Lafayette to carry funds across the
Prussian frontier to the polish revolutionists beyond, he was caught
and imprisoned for awhile in Berlin.

In July, 1832, he took a few

blind children into his father's home.
the future Perkins School for the Blind.

There was born the beginning of
He was the first to attempt

the education of a blind deaf-mute and he began the first printing
press for the blind in America.

Howe was a supporter of Dorothea Dix

and was responsible along with Horace Mann for the reformation of the
Massachusetts educational system.^
On February 28, 1848 Howe's Commission presented the "Report to
inquire into the condition of the idiots of the Commonwealth" to the
Senate of the General Court of the Commonwealth of Massachusetts.

In

part it said:
Massachusetts admits the right of all her citizens
to a share in the blessings of education; she provides
it liberally for all her more favoured children; if some
be blind or deaf, she still continues to furnish them
with special instruction at great cost; and will she
longer neglect the poor idiot— the most wretched of all
who are born to her— those who are usually abandoned by
their fellows— who can never, of themselves, step up
upon the platform of humanity, will she leave them to
their dreadful fate, to a life of brutishness, without
an effort on their behalf?
It is true, that the plea of ignorance can be
made in excuse for the neglect and ill treatment which
^Haskell, Robert H., M.D., "Mental Deficiency Over a Hundred
Years," American journal of Psychiatry, Volume CII, pp. 10?-ll8.

Ik
they have hitherto received; but this plea can avail
us no longer. Other countries have shown us that
idiots may be trained to habits of industry, cleanli­
ness and self-respect; that the highest of them may
be measurably restored to self-control, and that the
very lowest of them may be raised up from the slough
of animal polution in which they wallow; and can the
men of other countries do more than we? Shall we, who
can transmute granite and ice into gold and silver,
and think it pleasant work— shall we shrink from the
higher task of transforming brutish men back into
human shape? Other countries are beginning to rescue
their idiots from further deterioration, and even to
elevate them; and shall our commonwealth continue to
bury the humble talent of lowly children committed
to her motherly care, and let it rot in the earth, or
shall she do all that can be done, to render it back
with usury to Him who lent it? There should be no
doubt about the answer to these questions. The
humanity and justice of the legislature will prompt
them to take immediate measures for the formulation
of a school or schools for the instruction and
training of idiots.
The benefits to be derived from the establish­
ment of a school for this class of persons, upon
humane and scientific principles, would be very great.
Not only would all the idiots, who should be received
into it, be improved in their bodily and mental con­
dition, but all the others in the state and the
country would be indirectly benefited. The school,
if conducted by persons of skill and ability, would
be a model for others. Valuable information would be
disseminated through the country; it would be demon­
strated that no idiot need be confined or restrained
by force; that the young can be trained to industry,
order and self-respect; that they can be redeemed
from odious and filthy habits, and that there is not
one of any age, who may not be made more of a man,
and less of a brute, by patience and kindness,
directed by energy.H
The first permanent institutions of the mentally retarded in the
United States were started in 181+8.

At Rarre, Massachusetts, in the

early summer, Dr. Hervey E. Wilbur, a young practicing physician
received the first pupil, a seven year old son of a distinguished
lawyer, into his home, stating:

"This institution is designed for the

"^Haskell, op. cit., pp. 108-109.

15
management and education of all children who by reason of mental
infirmity are not fit subjects for ordinary school instruction.

It

aims to nourish and encourage the growth of what may be mere germs of
functions and faculties, to direct these functions and aptitudes in
the natural channels of physical and mental labor, and to give to the
subjects of it the greatest possible resemblance to children well
endowed and properly educated.
Mrs. Catherine W. Brown, wife of Dr. George Brown, who in
September succeeded Dr. Wilbur, when he accepted appointment as super­
intendent of the soon to be opened New York State Asylum at Albany,
New York briefly describes life in the newly established school as
follows:

"We were teachers, supervisors, and attendants by turn, with

a single domestic in the kitchen.

The children sat with us at table

that we might seek to cultivate good habits of eating, or in the sit­
ting room that we might direct their ways and continually prune their
uncouth habits of body.

Such intimate association gave us practical

insight of the characteristics, needs and ways of reaching such
darkened minds.

When our helpless ones were safe in bed we sat down to

read M. Sequin's Traitment Moral, Hygiene et Education Des Idiots.
In October of 18^8, Dr. Howe brought ten idiotic children together
at the Perkins Institute and Massachusetts Asylum for the Blind.

It was

his expectation that these youths, "below the grade of simpleton, be
trained up to cleanliness and decency; to prevent or root our vicious
^^Brown, George A., M.D., "President's Annual Address," Journal
of Psycho-Asthenics, Volume III, Number 1, September, 1898, pp. 1-2.
13
Brown, Catherine W . , "Reminescences," Journal of PsychoAsthenics, Volume III, Number 1, September, 1898, pp. T5^“1^0.

16
habits, to moderate gluttonous appetites; and to lessen the strength of
the animal nature, generally by calling into some activity and higher
feelings and desires, and by substituting constant occupation for idleness."

li+

The above mentioned improvements in behavior, according to

Dr. Howe were to be obtained in training "all the senses and perceptive
faculties by constant and varied exercises, to strengthen the power of
attention; to teach, as much as possible, the rudiments of knowledge;
to develop the muscular system; and to give some degree of dexterity in
simple handicraft.

Efforts will be made to call out their social af­

fections, by awakening some feeling of regard for others, in return for
kindness and love manifested towards them."1^
In his second report to the Legislature, Dr. Howe was of the
opinion that the hopes and expectations he had for his experimental
school had been fulfilled.
he related:
body.

In describing the improvement of the pupils

"They have improved in health, strength, and activity of

They are cleanly and decent in their habits.

They dress them­

selves, and for the most part sit at table and feed themselves.
are gentle, docile, and obedient.
or unkind word.

They

They can be governed without a blow

They begin to use speech, and take great delight in

repeating the words of simple sentences, which they have mastered."

16

The early success of the enterprise was attributed to
Mr. J. B- Richards, who was the teacher, and his assistants who were
1*+
Howe, Samuel G., M.D., "On Training and Educating Idiots,"
Journal of Insanity, Volume VIII, Number 2, October, 1851, p. 100.
15
Howe, op. cit., p. 100.
l6Ibid., p. 103.

17
not further described.

The general routine which was followed in ob­

taining the above mentioned success is vividly detailed;
A plain but plentiful diet; abundance of sleep;
cold bathing, followed by friction; walking and running
in the open air; gymnastic exercises, for giving muscular
activity and strength; amusements of various kinds:—
such are the means relied upon for promoting and main­
taining the bodily health of the pupils. An improvement
of the physical condition and a nearer approach to a
normal state of health, naturally begets greater freedom
and precision in the action of the mental powers; just
as repairing and cleansing the works of a watch causes
greater precision in the motion of the hands.
Special care and attention has been given, how­
ever to bring out and to train the feeble mental facul­
ties of the pupils, by simple exercises, adapted to
the purpose.17
In the latter part of his report, Dr. Howe expressed his opinion
of the more than two years experience of teaching mental retardates in
the following manner:
I consider this experiment, therefore, to have
been entirely successful. It has demonstrated beyond
question that, among those unfortunate human beings who
are left to grovel in brutal idiocy, there are many who
can be redeemed and elevated, and made to be compara­
tively intelligent, and happy and useful. Here stand
the rescued ones, living proofs of the power of
education. Let even the most sceptical examine them
closely; their doubts will be removed. Let those who
have disapproved the project as a vain and hopeless one,
and those, also who have ridiculed it as a presumptuous
one, (for there have been both, and in high places, too),
let them come, and see whether they have not unwittingly
been encouraging an abandonment of their fellow-beings,
who might have been saved from a condition at which
humanity shudders.18
It is worthy to note that Howe did not accept all intellectually
impaired children because he excluded five of the initial entrants for
the following reasons:
17

Ibid., p. 105*

1^Ibid., p. 117.

'Three were found to be more deranged than

18
idiotic.

One proved to be hydrocephalic, and was discharged on that

account and one was so feeble and unhealthy, and required such constant
nursing as to be unfit for an experimental school. 19

In 1851,

Dr. Wilbur wrote into the by-laws of the New York State Experimental
Asylum more explicit limitations for admission eligibility.

In his

words, "Only idiotic children who were not of custodial character,
epileptic, insane or greatly deformed and between the ages of seven and
fourteen years would be admitted."

20

Thus, with expectations of great success the initial institutions
for the mentally retarded were launched.

Allocated funds were small,

pupil enrollment few but the missionary ardor of the founders great.
By laboring long hours in the behalf of their charges there was little
need for the assistance of ancillary personnel.

Despite the small

number of retardates enrolled in the early institutions, information
of their success was widely disseminated into other states, to the
extent that fifteen institutions existed forty years later.
The original optimism did not prevail for long.

The expected out­

ward flow of graduates from the original schools to permit the entrance
of new pupils did not result.

A build up of static population prompted

Dr. Wilbur, in 1869$ to comment:

"There is necessary a separation of

the two classes of idiots; viz., those who can be benefited by instruction and those who are unteachable,"21

He goes on to state:

^ I b i d . , p. 104.
20
21

Haskell, op. cit., p. 109-

Wilbur, H. B., "Annual Report of New York State Asylum,"
Journal of Insanity, Volume XXVIII, Number 4, 1870, p. 368.

"The

19

degree and extent for the education of the idiot may not have been as
great as first predicted."

22

On June 6 , 1876 the first meeting of the Association of Medical
Officers of American Institutions for Idiots and Feebleminded Persons
was held at the Pennsylvania Training School.

The Philadelphia Medical

Times commented on the newly formed organization as follows:
An interesting meeting of the Superintendents of
American Institutions and Asylums for the Feebleminded
and Idiotic was held last week (June 6, 7 and 8) at the
Pennsylvania Institution, near Media, resulting in a
full discussion of the objects and conditions of this
comparatively new work, and the organization of a
National Association to advance its interests. Seven
gentlemen, from the eight institutions already founded
in successful operation, were present, from States
as follows: Massachusetts, New York, Connecticut,
Pennsylvania, Ohio, and Illinois. The position assumed
from the experience of those present is, that legis­
lation in behalf of this afflicted class should be no
longer experimental, and that public money whenever
expended should be directed at once to suitable build­
ings and premises expressly for the purpose intended,
it having been proven in Germany, England, and America,
That a fair percentage of admissions (from 10 to 20
per cent) can be rendered self-supporting, that few
cases are not capable of some amelioration, and that
the habits of all can be improved so as to render the
patients happier themselves, less afflictive to others,
and more cheaply and humanely cared for in asylums
than scattered in the community.
Many questions of importance lie over for con­
sideration at the next meeting, to be held in
Columbus, Ohio, June
1877; such as Idiocy and
Imbecility, how far preventable or capable of dimi­
nution? To what extent should the education and
training be directed toward industrial development?
Whether adult asylums can be wisely managed as
establishments for manufacturing or agricultural
industry? The best modes of treating and providing
for those who only need supervision, shelter, and
kind care?
It is perhaps too early to expect reliable sta­
tistics of a social and psychologic character from

22w ilbur, op. cit., p. 368.

20
gentlemen who have been of necessity immersed in the
details of building for and training this hither to
hopeless class. Excepting annual reports, and the
interesting and valuable work on Idiocy by
Dr. E. Sequin, no contributions have been made to the
literature of the subject in this country. It is to
be hoped that, with organization and increasing oppor­
tunities for observations something will yet come
from this new and broad field of scientific research. ^
It is in this period of the formation of the first organization of
persons associated with retarded institutions that important changes
began to take place.

Kuhlman states:

"That there is plenty of evidence

that radical departures from the ideas of 1850 about mental deficiency
are not far distant."

2k

In 1875, the number of state schools was eight.

Enrollments that

began with twenty or less pupils had increased to several hundred in
the case of a few schools.

The public had accepted the idea of having

schools for mental defectives.

Waiting lists of children who could not

enter for lack of space grew each year.

It could no longer be said

that mental defectives could be cured by special training.

The entrance

of untrainable cases happened against the objections of superintendents
and state laws that prohibited such admissions.

State schools became

asylums for incurables.
Various reports showed that from one half to two
thirds of the admissions were regarded as untrainable.
Moreover, many of those who had been under training
for the number of years that were allowed by the laws
remained indefinitely and in opposition to retention
laws, because it was recognized that the purpose for
which they had been admitted had not been realized.
23
2k

Nowrey, op. cit., p. 3^9-

Kuhlman, F . , "One Hundred Years of Special Care and Training,"
American Journal of Mental Deficiency, Volume XLV, Number 1, September,
191+0 , p. 9.

21
They had not improved to a point where it was felt
that they could be returned to the community, capable
of meeting the requirements of normal children.
Undoubtedly there had been considerable difficulty in
classifying children as definitely trainable or
untrainable, because of the lack of an adequate method.
But even if there had been such a method, any effort
to apply it would probably have been ineffective. A
public that had been told that mental defectives could
be restored to normal by this training would not likely
have tolerated a distinction between individual cases
that held out this hope for some and denied it to
others. . . .

In recognition of these facts, the State Schools
had begun to make important re-adjustments. One of
these was the training of pupils for permanent
retention in the School. This applied to a middle
group between the untrainable and those who might be
returned to the community. It was a natural step.
There were many tasks in which the school needed help,
in the kitchen, dining rooms, dormitory, and on the
farm. If pupils could be taught to give satisfactory
service in these tasks it would give valuable practical
training to the pupils and save money for the School at
the same time. In addition to this, it provided a life­
time home and useful employment for the pupil. . . .
Along with this adjustment came another. The
'physiological' training of Sequin to develop intelli­
gence was being superceded largely by industrial
training to supply skills in various occupations. This
applied to the brightest pupils in qualifying them for
return to the community. Skill became a substitute for
intelligence although this fact was not discussed and
apparently not recognized at the time. Shops for
industrial training were added to the School. In some
instances they supplemented to quite an extent the
school occupations themselves, such as found in the
bakery, laundry, dormitory and farm. . . .
Summing up this period, we may say that it marks
the turning point for changes in several directions.
We are leaving behind the school of yesterday that
knew only school pupils, and are coming to the insti­
tution of tomorrow that will know also custodial
inmates. The big school house of the past is enlarging
into groups of buildings that include custodial wards,
and shops, and enlarged acreage with farms and dairy
herds. We are still thinking only of helping the
mentally defective and not yet of protecting society.

22
We are not yet aware of their number, of the economic
losses for which they are responsible, of the de­
linquencies and crimes they commit, and of the general
havoc they create in our social order. By degrees
we shall hear of all these things. Talk of permanent
retention in the State Institutions for most is
already in the air, and compulsory commitment will be
heard about soon. An important change in the public
attitude is to take place during the next twenty-five
years. . . .^5
Something else was happening that would have great impact on the
future status of the mental retardate.

An inspector of jails in

New York, R. L. Dugdale, reported to the American Prison Association in
1875 of his study of crime, pauperism and disease in five generations
of the Juke family, and related the conditions to feeblemindedness and
other adverse conditions.

"Dugdale did not develop the theme of

heredity as the factor producing the continuity of such social inade­
quacy through this family,

indeed his stress was on the etiologic

importance of the environment.

Under the influence, however, of this

study were initiated the first planned custodial provisions in this
field, the creation of the New York Asylum for feebleminded women of
child bearing age."

26

According to Wolfensberger by l8?5:
The Institution is no longer to be a school,
but a shelter, an asylum of happiness, a garden of
Eden for the innocent. What doubt there may have
remained was largely dispelled by the close of the
century: Slowly but surely the conviction has
become general, especially among the trustees and
officers of institutions, that admission as a pupil
of the training school should be but the first step
to permanent care; that, with a few exceptions, so
few that they may be disregarded in establishing a
policy, all the pupils of the school, from the lowest

^ I b i d . , pp. 9~11

26

Haskins, op. cit., p. 112.

23
to the highest grade, ought to be permanently re­
tained in the safe, kindly, maternal care of the
state. The above conviction is held by all who have
expressed themselves publicly within the last few
years in this country, excepting a few persons whose
pecuniary interests seem in conflict with such a
theory. It has been acted upon by the legislature
of many states, whose laws have been changed by
removing from the institution code the age limit of
retention, and in some cases of acceptance. A belief
in the necessity of permanent care for all this de­
fective clans is professed by the superintendent of
every state school for the feebleminded in the United
States today.27
The residential institution for the retarded of that day empha­
sized benevolent shelter.

The retardate was to be placed in an insti­

tution in order to protect him from the persecution and ridicule of
society.

Special protective care required that provisions be made for

growth in population and meeting the many needs of the adult resident.
ESTABLISHMENT OF THE MICHIGAN HOME FOR THE FEEBLEMINDED AND
EPILEPTIC.— Minutes of the Board of Trustees of the Michigan Asylum for
the Insane at Kalamazoo during the l660's

and the minutes of the Joint

Meetings of the Michigan Boards of Asylum Trustees from 1877 onward
repeatedly expressed the need for the establishment of an institution
to care for the idiots and epileptics.

Finally in 1893 Representative

W. B. Baum of Saginaw introduced and the Michigan State legislature
passed Public Act No. 209, "An Act to establish a home and training
school for the feebleminded and epileptic, and making an appropriation
for the same."^
This Public Act stated:

"There shall be established in this

State an institution for the custody, care, education, proper treatment
27

Wolfensberger, op. cit., p. 96.

28
.
Michigan Public Acts, 1903, P» ^12.

2k

and discipline of the feebleminded and epileptic persons, under the
name and style of the Michigan Home for the Feebleminded and
29

Epileptic."

At the time of the signing of this Act on June 2, l893i Governor
John T. Rich appointed three commissioners to select a suitable site
and erect and furnish buildings for the Home.

Ex-Governor Cyrus G. Luce,

former State Senator John C. Sharp, and newspaper editor Loren A. Sherman
were Governor Rich's appointees.

From the State treasury 850,000.00

was appropriated for the purpose of putting into effect the provisions
of the Act which further stated that the general supervision and govern­
ment of the institution should be vested in

a board of control of three

members to be appointed by the Governor.
Section Seventeen of said Act stated;"The said
shall have the sole and exclusive control and
institution and its affairs.

board of control

management of the said

It shall establish a system of government

and make all necessary rules and regulations for enforcing discipline,
for imparting instruction, for preserving health, and for the proper
physical, intellectual, and moral training of the inmates of said
home.
As to who might be admitted to the home Section Twenty of the Act
stated;
All feebleminded and epileptic persons between
the ages of six and twenty-one years who are legal
residents of the state of Michigan may be admitted to
said home without charge for tuition, boarding, lodging,
washing, medicine or medical attendance. In the
selection of inmates preference shall be given to
29Tbad., p. *+12.
^°Ibid., p. *+15.

25
indigent or pauper orphans, and when this class is
provided for such others may be admitted for whom
applications may be made, and as accommodations may
be provided for by sufficient buildings. And when
these classes are provided for other feebleminded
and epileptic persons who are entitled to admission
may be received at such institutions.31
Section Twenty-one of the Act 209 gives expression to the object
of the institution:
The object of said institution shall be to
provide by all proper and feasible means, the intel­
lectual, moral and physical training of that un­
fortunate portion of the community who have been
born or by disease have become imbecile or feeble­
minded or epileptic, and by a judicious and welladapted course of training and management to
ameliorate their condition and to develop as much as
possible their intellectual facilities, to reclaim
them from their unhappy condition and fit them as
far as possible for future usefulness in society.32
The appointment of duties of personnel are contained in Sections
Twenty-three and Twenty-four:
Sec. 25* The board of trustees shall appoint
a medical superintendent, who shall be a well educated
physician, experienced in the treatment of the feeble­
minded and epileptic. They shall also appoint upon the
nomination of the medical superintendent a steward.
Sec. 2*+. The superintendent shall daily
ascertain the condition of all the patients and pre­
scribe their treatment, subject to the rules of the
board; he shall appoint, with the approval of the
board of control, such and as many assistants and
attendants as the board may think necessary and proper
for the economical and efficient performance of the
business of the home, and to prescribe their several
duties and places, and with the approval of the board
their compensation, and may discharge any of them at
his sole descretion, but in every case of discharge
he shall forthwith record the same with the reasons
^Ibid., p. ^16.
^Ibid., p. *+16.

26
under an appropriate head of one of the books of the
home.33
Sections Twenty-six, Twenty-seven, and Twenty-eight set down the
manner in which admissions were to be made to the Home:
Sec. 26. The superintendents of the poor in
each of the counties of the State in which they are
or shall be persons of this class eligible to
admission to this home by the provisions of this act,
who have no contagious disease, and who are, or shall
become chargeable to said county, or to any township
therein, Bhall cause all, or any such persons to be
taken to the home for the feebleminded and epileptic
and to be taken into the custody and care of said
home, in accordance with the rules and regulations of
said home. No person, however, shall be admitted to
said home, until a certificate of admission has been
issued for the admission of said person by some
officer of said home duly authorized by the board of
trustees to issue such certificate.
Sec. 27. The superintendents of the poor shall
cause any and all such persons to be taken to the
Home for the Feebleminded and Epileptic at the
expense of the county, and to be taken into (the)
custody and care of the school in accordance with the
rules and regulations of said home.
Sec. 28. The superintendent of the poor in
every case before taking or sending any person to
said home as provided in Sections Twenty-five and
Twenty-six of this act, shall see that such person
is in a state of perfect bodily cleanliness, and
comfortably and decently clothed.34
Indications are that the commission appointed by Governor Rich set
to work at once to learn about institutions in other states and to give
consideration to the area in which the Michigan Home for the Feeble­
minded and Epileptic should be erected.
Information pertaining to the selection of Lapeer as the site of
the new institution follows;
53Ibid., p. 417.
xii.
Ibid., p. 417.

". . . The Governor at this time was the

27
Honorable John T. Rich of Lapeer who used his influence to make Lapeer
the location of the institution. . . .

The City of Lapeer donated the

one hundred sixty acres upon which the buildings are located." 35
January 19, 189*+ Lapeer newspaper item told of the ire of the citizens
of Greenville who were seeking to have the new institution erected there.
It was stated:

"Lapeer is nothing but a swamp hole and no foundation

can be found for the buildings."

36

The newspaper indicated that

numberous areas of the State sought to have the institution erected in
their geographic area.
A newspaper interview with Representative W. B. Baum of Saginaw,
the sponsor of Public Act 209 of 1893, on June 8, 189*+, the day of the
corn'

stone laying for the new Home told of legislative reactions

while Act 209 was being considered:

Typical questions were:

you do with them after you*ve got your school?
fool anyhow?

Representative Baum answered:

"What can

What can you do with a

"We can do as well with

them in Michigan as they do in Columbus, Ohio.

Then I showed them the

report of that institution proving that 50 per cent could be so
developed that they could learn geography and that 60 per cent could
thus learn some light handicraft." 37
On March 23, 189*+ Loren A. Sherman, secretary of the Board of
Building Commissioners visited the site selected at Lapeer along with
Civil Engineer Paldi to lay out plans of operation.
interview, Mr. Sherman said:

In a newspaper

"It is estimated that there are now 3,000

people who are subjects for the school, but it will scarcely be possible
^Bently, Roy. ,rHow We Grew," Employees1 Reporter, Lapeer State
Home and Training School, Volume 5, Number 6, June 14, 19*+5» P- 1*
36
37

Lapeer Clarion, Volume 39, Number 3, p. 1.
Lapeer Clarion, Volume 39, Number 23, p. 1*

28
for the Commission; with the sura at their disposal, to provide for more
than a hundred or two at present.

The design is to put in the sewers,

erect the boiler house and somewhat lay out the grounds, besides build­
ing two, so-called cottages.

These 'cottages* are to be three story

bricks, accommodate seventy-five people each; one of these is for males,
the other for females.

The 'cottages' are to cost $1^,OCX).00 each, and

the whole amount expended in building this year will be about $^+2 ,000.00
vQ
leaving 83»000»00 for sewers and S5,000*00 for running expenses."
The June 29, 189*+ headline of a Lapeer paper read:

"CORNER STONE

OF MICHIGAN'S NEW INSTITUTION LAID AMID POMP AND SPLENDOR."

Ex-Governor

Cyrus G. Luce of Coldwater delivered the principal address of the day.
The corner stone was laid with Masonic ceremonies and an estimated
crowd of 25,000 was present,

portions of Governor Luce's address

follows:
The leading characteristic of the 19th century
is the onward march of humanity. . . . This quality
of humanity, thus developing year by year through
Christian education, demands more and more care for
the unfortunate. Thirty-five years ago there was no
place in Michigan where the insane could be provided
for or taken care of. These afflicted creatures
were found in the country and hamlet where they
frightened children and were a scare and a horror to
the women who encountered them. During the year 1859,
however, an asylum for the unfortunate insane was
established at Kalamazoo. . . . Michigan has pro­
vided for her deaf and dumb at Flint. Dependent
children are cared for at Coldwater. It has been
asserted that after the insane should follow the
feebleminded in the claim for care from the State.
My opinion is that the State should take care of its
insane first always, second its blind, third its
feebleminded. . . . The law under which this Home
is to be erected wisely provides not only for the
care and custody of the epileptic and feebleminded
but does not make the mistake of perpetual custody
of those who under its training, become improved,
vQ
Lapeer Clarion, Volume 39, Number 12, p. 1

29
neither does it force into the world again those who
having entered are not developed to such a condition
that they can care for themselves. . . . And now the
good thing is here, and all of this unfortunate class
between the ages of six and twenty-one are eligible.
It is our duty to educate and cultivate, in so far as
possible, and Michigan has done that duty well for
every class except her feebleminded, which alone has
stood out in the cold.
When we considered the place for establishing,
we visited institutions of the same kind in other
states, we went to Columbus, we went out into Indiana
and everywhere they said. The president of one of
these Homes down in Pennsylvania, speaking of what can
be accomplished, stated that in forty years of operation
thirty-five per cent have been so improved as to go out
and become self supporting.
All, to be good citizens must work. These weak
minded must work and they take to the soil more natu­
rally than anything else. In all you ever have here
I'll guarantee there won't be more than one or two
inventors. There won't be any lawyers. There won't
be any preachers nor aspirants in other educated lines.
But they make good tillers of the soil and transform
it into an Eden, with no Eve in it. It is no use to
put these unfortunates in schools but this Home will
give them kindergarten work in which they are capable
of Bhowing some interest when they will not in any­
thing else. . . . This is the twentieth institution
of the kind in our country. The inmates of these
schools are ignorant of the laws of their own being
and incapable of self control. They must be kept
from and cured of diseases. They need special care
and custody for reasons of which I cannot here speak.
The girls, perhaps more particularly but the boys as
well in many cases, have not the power to resist
impulses that pertains to the sexes. Mr. Baum in his
bill has provided that they should be improved, cared
for and not turned out while in this condition. . . .
Let me assure you that this Home will be of great
benefit to your city; in fact, it is already.39
Construction continued throughout the winter and early in 1895 it
was announced that Dr. W. A. Polglase was appointed superintendent
starting on March 1st.

A short item in the local newspaper stated that

he was a graduate of the Chicago School of Medicine, had practiced in
39

Lapeer Clarion, Volume 39» Number 3i P- 1*

50
Detroit for seventeen years, was a specialist in nervouB diseases and
IfQ
was on the staff of Grace Hospital.
In early April of 1895 the Board of Building Commissioners for the
Michigan Home for the Feebleminded and Epileptic met in Detroit.

In a

letter to Governor Rich, inviting him to attend, the stated purpose of
the meeting was "to decide upon the employees and the salaries to be
paid them and the rules and regulations for the government of the insti­
tution.

As you are much better posted as to the management of other

institutions than any other member of the commission, it would seem to
me that it would be very desirable that you should be with us at that
time.

Our subsequent business will be to decide upon furniture, and

other like details, which would not require your attention."

*fl

Other than another newspaper article stating that there were
almost a 1000 applicants for positions at the Michigan Home for the
Feebleminded and Epileptic nothing further is recorded about the new
institution.^
"The first patients were admitted in August, 1895-

The first boy

was Lawrence Ward (died May, 1912) and the first girl, Ethel Annie
Carter (now living in Cottage 50)-

By the spring of 1896 more than 200

patients were enrolled with about 16 employees."
llO

0

Lapeer County Democrat, Volume 55 , Number 2*t, February 27, 1895,

p. 1.
i+l
Letter from L. A. Sherman, president, Board of Building
Commissioners, Michigan Home for the Feebleminded and Epileptic,
April 1, 18951+2
Lapeer County Democrat, Volume 55, Number 38, June 5, 1895, p- 1«
Bentley, Roy, op. cit., p. 1.

CHAPTER III

PERIOD OF INDEPENDENT MANAGEMENT
OF INSTITUTIONS IN MICHIGAN

CHAPTER TTI
PERIOD OF INDEPENDENT MANAGEMENT OF INSTITUTIONS
IN MICHIGAN (1895-1923)
The Michigan Home for the Feebleminded and Epileptic began and
greatly expanded during the period of time when there was "an ever
increasing interest in the problems presented by the feebleminded class.
There has been a growing appreciation of the fact that feeblemindedness
entered in and complicated a great many problems, especially those
connected with dependency, crime and sexual immorality."^

In order to

determine the extent of the relationship of the problem to juvenile
deliquency and dependency in the State of Michigan, a commission under­
took a study of the populations of the Lansing Industrial School for
Roys, the Adrian Industrial Home for Girls and all of the County
Infirmaries in the state.
prior to reporting result of the study the Commission felt it
necessary to first define and discuss the general nature of feeble­
mindedness and the problems it presented.

The report stated:

"Feeble­

mindedness is defined by Tredgold as 'a state of mental defect, from
birth, or from an early age, due to incomplete cerebral development, in
consequence of which the person affected is unable to perform his
1

_________ , Report of the Commission to Investigate the Extent
of Feeblemindedness, Epilepsy and Insanity and Other Conditions of
Mental Defectiveness in Michigan, Lansing, Michigan:' Wynkook
Hollenbeck Crawford Co., State Printers, 1915* P» **2.
31

52
duties as a member of society in the position of life to which he is
born.*

There are in common acceptation in this country, three terms

used to express differing degrees of feeblemindedness;
cility and the moron group."

2

idiocy, imbe-

The report continues, stating that the

idiots and lower grades of imbeciles were so defective that permanent
care was necessary.

Attention was focused on "the high grade imbeciles

and the morons, who, though capable of contributing either partly or in
whole to their own support, yet are the types which menace society with
the increase of their kind."^
In regards to the etiology of feeblemindedness the Commission
recognized that environmental conditions existing during the pre-natal
period and in the early years of life as well as accidents were con­
tributing factors but the major emphasis was that "Feeblemindedness
more often is the results of a morbid heredity than of environmental
causes.

The degree to which inheritance dominates environmental

influences as a cause of feeblemindedness is variously stated.

Homer,

Goddard, Davenport, and Tredgold agree that in at least 80 per cent
of the cases of feeblemindedness heredity is the dominant cause."

4

Mention is made that the Mendelian law is in the main applicable to
the inheritance of feeblemindedness and "since feeblemindedness is so
largely the result of hereditary factors, procreation by feebleminded
5
individuals should be prevented."
^Ibid., p. 42.
^Ibid., p. *+2.
Ibid. , p. *+3.
^Ibid.,

p. 4^.

33
In order to learn of the problem feeblemindedness presented in
Michigan the Commission decided to learn of its extent, the means being
used to control it and the adequacy of such means.

A June 191*+ report

found 1,1^1 individuals of defective mentality in the Michigan Home and
Training School of which three hundred and twenty-four were also
epileptic.

The waiting list at the Lapeer institution had one hundred

and sixty-five names, thirty-four of whom were epileptic.

Twenty-four

other epileptics were at the recently built Michigan Farm Colony for
Kpileptics at Caro.
In the State Hospitals for the Insane there were three hundred
and fifty-three feebleminded and four hundred and eight epileptics.
The Commissions' investigations fcund seven hundred and ten feeble­
minded and one hundred and fourteen epileptics in the County
Infirmaries.

At the Adrian Industrial Home for Girls there were one

hundred and thirty-one feebleminded girls and the Lansing Industrial
School had one hundred and seventy-one feebleminded boys.

It was

concluded that the extent of feeblemindedness was indeterminable in
the communities at large.
The Commissions' report then focused on means being used to
control feeblemindedness:
Michigan has realized the fact that feeble­
mindedness is transmissible from generation to gener­
ation and consequently has adopted measures to prevent
procreation. Tt has laws prohibiting the marriage of
a feebleminded or an epileptic individual and inflicts
heavy penalties upon anyone party to, or aiding in such
a marriage
However, even were there the
strictest enforcement of these laws, yet the illicit
propagation of the feebleminded could not be
prevented............. Thirty per cent of the
unmarried feebleminded women in the County Infirmaries

have children. Tf restrictions against marriage were
enforced, it would merely mean that these illegal
unions would be increased. . . .

Michigan also recently enacted a law authorizing
the sterilization of its insane and mentally defective.
The law, however is inadequate from two standpoints.
It limits the application of this means of preventing
the propagation of the feebleminded class to those
who are in institutions and therefore least likely to
reproduce. Moreover, very little advantage has been
taken of the right given by this act to prevent pro­
creation. . . . There are alBo a considerable number
of people who feel that the act of sterilization while
preventing procreation, is a menace to society in that,
by removing the restriction of sexual intercourse
caused by fear of the possibility of consequent off­
spring it would tend to increase promiscuity and
spread disease. . . .
Michigan has also attempted to segregate the
feebleminded members of the state. At the present
time, however, its institution for the special care
of this class is crowded to the limit and has a long
waiting list. There are about a fourth of the boys
and about a third of the girls in the juvenile reforma­
tories who are feebleminded and in a very few years
will be turned out into the community at large. There
are about one fourth of the inmates of the County
Infirmaries of the state who are either feebleminded
or epileptic and who are neither adequately nor
permanently segregated.
:>ince our marriage laws are not enforced, and
since, if they were enforced, the propagation of the
unfit would not be prevented, and since prevention by
the means of sterilization has not been taken advantage
of, the one method that stands out clearly as the most
effective means of preventing the increase of our
feebleminded class is increasing the extent of the
segregation of its members and an especial effort
should be made to permanently segregate the feeble­
minded women of child-bearing a g e . 6
During a meeting of the American Association for the Study of the
Feebleminded held at Lapeer, Michigan in June, 1913 Governor Ferris of
^Ibid., pp. *+^-^6.

55
Michigan addressed the group in regards to solving the problems
suggested by the feebleminded.

He stated that progress would be handi­

capped until the time we cared more about human beings than we did for
livestock.

He expressed hope for the enactment of more stringent

marriage laws, better control of immigration and the need to provide
for the better rearing of healthy, promising boys and girls.

He favored

drastic measures being taken to segregrate defectives and bringing about
the sterilization of sexual perverts.

7

In 1920, Dr. H. A. Hayes, Superintendent of the Michigan Home and
Training School added further to the knowledge of prevailing thoughts
and attitudes of the era regarding the feebleminded.

Regarding the

first mass psychological testing of draftees with the Army Alpha and
Beta he stated that "the results obtained by examining the draft
furnished the lesson that would have taken fifty years to teach, and
then we would not have had it in concrete form.

Segregation is good as
g
far as it goes but can we segregate this large per cent of society?"
Next consideration was given to the recently enacted Dry Law with
expression of the hope that although it could not be expected that the
birth rate of unfortunates would be lowered it would bring about better
home conditions, "a greater co-operation on the part of parents, a
greater interest because of the fact that the financial leakage caused
by the opening saloon having been stopped"
better care for itself.
7

9

and enable the family to

The effort to wipe out veneral disease was

Ferris, Hon Woodbridge N., "Governor's Address," Journal of
Psycho-Asthenics, Volume XVIIT, Number 3, December, 3913, pp. £>7-72.
g
Hayes, H. A., "Address of the Vice-President," The Journal
of Psycho-Aathenics, Volume XXV, Number 1, September, 1920, pp. 1^-20.
9

Ibid., p. 15.

36
cited as another positive step toward lowering the incidence of feeble­
mindedness in the next generation.
part of Dr. Hayes' address focused on the Colony System that had
its beginning during this period.

In his discussion of the subject he

first opined that in the past the Home and Training School staff were
content

tohouse the feebleminded,

educate them to the limit of their

ability

andtrain them to be helpful about

the institution.

When this

was accomplished it was believed the inmates were happy because they
were living in an environment fitted to their needs.

He stated that the

ColonySystem of

New York State had shown that the above was not

necessarily true

and as a result Michigan institutions were trying out

the Colony System and finding that it worked.
The fiystem being tried was described as follows:
After a period of institutional training certain
girls are well fitted to go out from the institution
into homes as domestics and find great enjoyment in so
doing. It is a more normal life for them; they feel that
they are in a large measure free, and the love of freedom
is as strong in the higher grade girls as in ourselves.
She is doing the thingB other people are doing and she
is earning money. This is no small goal in most of our
lives. Moreover she is making good morally in this
experiment. She is proving her right to this larger
degree of living. All of this is done under supervision.
The same is true
holding down a job, be
institution.

for the boys. They are happy
it even so small, outside the

These children may have their own colony building
to which they return as to their home, or a rooming
house; or they may live with families who will be
responsible for their care.
There is also another sort of Colonization which
J believe to be a good thing in many ways, though, of
course, it is not without some drawbacks.
Under this plan, the huge and centralized insti­
tution of the past would be at an end. There would
rather be a central or parent institution, where

37
patients would be received and given a course of train­
ing, but a goodly proportion of the children would be
living in small colonies scattered here and there about
the state. Colonies of boys in a good agriculture
district would operate separate farms for the good of
the institution as a whole, and scattered units of girls
would also live under the supervision of reliable
matrons, and functions for the good of the whole.10
INSTITUTIONAL DESCRIPTION— The first biennial report of the
Michigan Home for the Feebleminded and Epileptic began by stating:
,rWe have endeavored in the management of the institution, thus far, to
restrict current expenses to the lowest possible limit.

We believe

there has been no waste and that the exceedingly onerous duties of
officers, teachers, attendants and other employees are performed at the
lowest possible rate of compensation that can reasonably be offered."^
Further stated objectives included making the Home self-supporting, or
nearly so, so far as the care of adult custodials were concerned
although it was conceded that children and low-grade feebleminded
persons of adult age would have to be a burden to the state.
operation was a primary concern of institutions of the era.

Economy of
Much con­

sideration was given to the least expensive way to purchase coal, basic
foods and other necessities for operation.
By June of 1899 the census was two hundred sixty-seven inmates
who ranged in age from six to fifty-nine years.
mindedness were represented.

All grades of feeble­

It had been found necessary to place

low-grade, uninstructable children who were also very destructive in
^ T b i d . , pp. Id-19
^ __________ , Report of the Board of Control of the Michigan
Home for the Feebleminded and Epileptic at Lapeer, 1596-1918, Lansing,
Michigan: Robert Smith Printing Co., State Printers and Binders,
1 9 0 6 , p. 3 .

38
a separate building because they were a detriment to the progress of
the others.
Dr. polglase indicated that "the life in the institution was
made to resemble, as nearly as possible, home life with its duties,
responsibilities and privileges and its little joyB and pleasures."

12

Living areas constituting day room, sleeping dormitories and bathingtoilet facilities, as well as a sleeping room for the attendant, held
twenty-five inmates.

The attendant "watched every habit of life,

regulated, directed and helped them to conform to the best type of
physical, mental and moral perfection possible with a defect; the
purpose being to promote usefulness and contentment."^
had their own toys and were encouraged to use them.
went on to say:

Every child

The Superintendent

"every boy and girl of suitable age has some regular

daily work assigned to them.

This duty is very simple and could

possibly be done by someone else, but it is a lesson in independence
lh
and happiness, for the busy child is generally a good child."
Discipline was enforced without corporal punishment, by cutting
off some pleasure or other similar means adapted to the misconduct.
Love of praise was a factor used to encourage good conduct.
The initial report of the Lapeer institution went on to state
that:

".School children are drilled daily in marching, singing and

calisthenics which alternates purely mental processes.

Sewing,

crocheting, knitting and fancy work are also taught in school and
^Jbid., p. 5*
"^Ibid., p. 7.
" ^ I b i d . , p. 8.

59
Sloyd work has recently been added (a system of manual training origi­
nating in Sweden, using wood carving as a means of training in use of
tools).

Music is used as much as possible, as it is a factor producing

harmony of action and correlating discordant mental and physical
irregularities, besides, we have already discovered enough musical
talent, when cultivated to form the nucleus of a band."

15

In addition

to the above, the five teachers who were hired in the first two months
after opening placed great stress upon sense training and academics.
Initially it was thought that the inmates would not be able to do
any work.

It was believed they needed the same care as mental patients.

Employees were hired to totally care for resident population and do all
the work such as cooking, cleaning and making beds.

Gradually, however,

a few bright inmates were allowed to assist with the w o r k . ^
From the onset epileptics presented a problem as indicated in the
institution's early reports which described them as the most troublesome
and annoying cases who were always liable to injury or disturbing spells
and even under the most watchful care were prone to damage either them­
selves or others.

During the year 1916 the Michigan Home for the

Feebleminded and Epileptic had one hundred and forty deaths.

Twenty-

eight were due to uncontrolled Epileptic Seizures and sixty-four to
Tuberculosis.

That year Typhoid Fever accounted for three others.

Another medical problem of the early institution was Small Pox, an
outbreak of which required strict quarantine in 1910.
■^Tbid., p. 11.
■^Bishop, E. Beryl, "Worker Placement", Lapeer State Home and
Training School Employees Reporter, Volume 5, Number 6 , June I4*, 19^5,
p. d.

40
A summer school for public school teachers was started in 1912
under the guidance of Charles S. Berry, Ph.D., Assistant professor of
Education at the University of Michigan.

In 1915* Dr. McCord of Parke

Davis Company was permitted to do research which later developed into
the production of Dilantin, an anti-convulsive medication. 17 Attendants
salaries were $18.00 per month.

The Michigan Home and Training School

(name changed by legislative action in 1917) grew rapidly and in 1919
its census was 15^+3 with three hundred and five individuals on the
waiting list.

At that time it had added to the original staff a

Psychologist, Registered Nurses, an Eugenics Worker and a Bandmaster.
The school had eleven teachers and one hundred pupils.

The average

mental age of its population was four and nine-tenth years.
The second general rule of the Home's Rules and Regulations
(APPENDIX A) best reflects the conditions under which employees worked
during early institutional days.

It stated that the entire time of the

employees were contracted by the Home and they were not to leave the
premises, or their assigned duties without permission of proper
authority.

Other rules of interest and indicative of the ear were the

requirements that all personnel be in at 10:30 P-M. and the restriction
of employee's visitors, as much as possible to Wednesdays from two to
four P.M.

Attire was also prescribed as indicated by the following:

"I was rather pleased with the costume of the attendants.

Being

summer time, all male attendants were dressed in white and the women
17
Michigan Home for Feebleminded and Epileptic Dianes,
1908-1918.

bl
in striped seersucker nurse-costume; supervisors and department-heads,
on the girls' side, being in white."

l8

In order to better understand the scope of the worked performed
the following is utilized;

"While nurses and attendants are required

as a rule to spend only eight hours per day in the care of patients
yet their time still belongs to the state and they are to be accounted
for every hour of the day or night by the general supervisor or supex—
intendent of nurses.

They are required to hold themselves in readiness

for extra assignments, for emergencies such as the pursuit of escapes
or for relief in cases of sudden illness, for practicing.;the fire
drills, etc.

There are other customary duties for them to attend to

when not engaged upon the wards such as ushering visitors, caring for
their own rooms, attending upon lectures, demonstrations, recitations,
etc. m

connection with the training school."

19

The early institutional days were not without difficulties and
one great concern was the "hospital tramps."^

These were men and

women, many times of questionable character who moved from one insti­
tution to another, staying a short time at each.

They were readily

hired because it was difficult to get employees for the attendant
Jl3
Johnson, Alexander, "Notes on Institutions Visited— The
Michigan School for Feebleminded," The Training School Bulletin,
Volume 11, February 19151 p* 191.
19
Noble, A. I., "Report of Michigan Asylum," Proceedings of the
Meeting of the Joint Board of Trustees of the State Hospitals of
Michigan, Lansing, Michigan! Wynkoop Hollenbeck Crawford Co.,""state
Printers, 1915, p» 20.
20

Christian, E. A., "Concerning Programmes for Joint Board
Meetings," Proceedings of the First Semi-Annual Meeting of the Year
1903 of the Joint Board of Trustees of the Michigan Asylums, Lansing,
Michigan: Robert Smith printing Co., State printers, 1903* p- 21.

b2

positions.

For example, it is recorded that during the year May 1908

to April 1909 thirty-nine women and twelve men left the employment at
the Lapeer institution.

The total number of attendant positions at

the time was sixty-six.

Some resigned but others were discharged

because of drinking, striking an inmate with hair clippers, cruelty
to an inmate and insubordination.

21

The October 15, 1906 issue of the State Republican contained an
item headlined:
minded."

"Supt. polglase to Leave Michigan Home for Feeble­

The sub headline went on to state:

Charges of Laxness in Management."

"Action the Outcome of

The brief story said "No reason was

given but it is understood the Board of Control took the initiative
toward a change in the management.

Recently the lax administration of

the home was aired, and it was claimed the closest attention was not
given its affairs."

22

Correspondence to Governor Fred M. Warner shed further light on
Dr. polglase's resignation:

"At a meeting yesterday, Dr. polglase

informed us of his decision to resign...............After the develop­
ments in connection with the management, which were brought out, the
board was a unit as to the desirability of a change, so this decision
of the doctor's was most welcome............... It was agreed that the
matter of announcing the resignation would be left with the doctor, as
it is desired to do anything within reason to make his future as easy
as possible."

23

^Michigan Home for Feebleminded and Epileptic Diaries, 1909-1919.
22
The Lansing State Republican, Volume 39, Number 88,
October 15, 1906, p. 3.
23
Letter from J. R. Johnson, Treasurer, Board of Control,
Michigan Home for the Feebleminded and Epileptic, October 12, 1906.

43
Institutional notes indicated that an inquisition was held on
September 20, 1906 in regards to the death of William Hoten, an inmate
of the Michigan Home for the Feebleminded and Epileptic before a local
court in the City of Lapeer.

Findings of the inquisition were:

"We

find William Hoten came to his death from scalds received during a
bath given by inmate Frank Vernon under the supervision of an attendant
contrary to the rules of the institution."

24

Testimony revealed that

William Hoten, an apparent paretic who was incontinent and noncommunicative was bathed following soiling on Thursday evening
September 6, 1906 during which he was scalded by hot water that
resulted in a large area of second degree burns of the lower part of
body.

Despite fact the incident was reported to the Superintendent

on Friday morning he did not see the inmate until Monday noon.

Testi­

mony further revealed that despite Rules and Regulations (APPENDIX A)
to the contrary it had apparently been a common practice to allow
inmates to bathe other inmates.
TRAINING OF ATTENDANTS— The first document regarding training
schools for attendants in Michigan was from the Michigan Asylum for the
Insane at Kalamazoo in the year 1894.

It announced that on the evening

of November 20th the training school for attendants graduated its first
class of eleven.

Instructions consisted of lectures by the medical

officers, quizzes and practical instruction on the wards.

25

Several years later, the Michigan Home for the Feebleminded and
Epileptic reported that:

"Our weekly lectures and training school

24

Inquisition on body of William Hoten before Benjamin F. Perkins,
Justice of the peace, September 20, 1906.
25
__________ , "Half Year Summary-Michigan," Journal of Insanity,
Volume 51, January 18951 P» 244.

44
work has done much to improve the qualifications of those having the
care of inmates, and infuse into them earnestness and faithfulness in
their work.

For the measure of the success of an institution of this

character is very largely determined by the character and usefulness
of the persons occupying subordinate positions."

26

In 1904, the Board of Control reported that the training school
was starting again and the attendance was large.

Although not aiming to

graduate a highly accomplished individual such as the best hospitals,
"we do desire to raise the standards of competency of those in charge
of our wards, and develop abilities in those desirable for advanced
positions in the institution."

27

The 1906 report related that attempts to maintain the training
school for attendants and nurses had been most difficult due to the
limited medical staff whose other duties often caused them to neglect
the school.

"Besides there is always some indifference unless the

course is made compulsory; or encouragement given to those who meet the
requirements of its two year course and get their diplomas by receiving
some advance pay.

Those who have been trained and are still in the

employee of the institution are as a rule more capable of advancement
than others, and have always proved valuable assistants, either in the
routine of cottage work or in the work of the medical department."

28

__________ , Reports of Board of Control of the Michigan Home
for the Feebleminded and Epileptic at Lapeer, 1895-1918, Lansing,
Michigan: Robert Smith Printing Co., State printers and Binders,
1900, p. 8 .
27Ibid., 1904, p. 16.
28Ibid., p. 14.

k5
The 1900 reference to weekly lectures and training school work,
although not documented, was apparently like that announced for the
Vineland Training School which is reproduced:
The winter course of talks for the employees'
class began last month. For several years at stated
times we have held employees' meetings, at which
matters of interest and importance of all employees
were talked over. Aa the tenure of office of our
employees has grown larger there haB been expressed
a desire to know more of the work than appears in the
daily routine and this course of talks is in response
to this demand. The season's course comprises twentyeight lectures, as follows:
Feebleminded Children
The Psychological Problem
The physical Care of Children
Discipline
The Use and Abuse of Schedules
What to Observe and How
The Care of the Children
Responsibility
Food
Business Relations
Entertainments
Economy and property Rights
Repairs and Industrial Work
Experiments
Institutional Efficiency
Clothing and Linen
Water and Food
Suggestions
Training
The Unseen Work
Bathing, etc.
The Farm and Dairy
The Significance of Little Things
Punctuality
Care and Tidiness of the Institution
Organization of the Institution
Housekeeping and Homemaking
Ventilation and Sanitation

The Superintendent
Dr. Goddard
Dr. Patterson
The Superintendent
Miss Morrison
Dr. Goddard
Miss Vernon
The Superintendent
Mies Hutchinson
Miss Fallon
Miss Morrison
The Superintendent
prof. Nash
Dr. Goddard
The Superintendent
Miss Vernon
Dr. Patterson
Dr. Goddard
Miss Morrison
The Superintendent
Dr. Patterson
Mr. Veale
Dr. Goddard
The Superintendent
Prof. Nash
The Superintendent
Miss Hutchinson
Dr. patterson29

It is of interest to note that professor Nash was the Band Master,
Miss Vernon the Matron and Miss Morrison the School Principal.

In

, "Winter Lectures," The Training School Bulletin,
Volume 3i Number 33, June 1906, p. 88.

46
order to demonstrate the contents of the lectures, Dr. Patterson's
talk, "The physical Care of Children," is reproduced in APPENDIX BFocus on the training of attendants and nurses was a frequently
mentioned subject in the literature of the era as is indicated by a
publication of Delia E. Howe, M.D. in the initial issue of the Journal
of psycho-Asthenice.

It concerned training schools for attendants.

Dr. Howe stated that newly hired attendants were not capable of caring
for the institutionalized feebleminded without training.

They did not

have a thorough knowledge of the laws of hygiene nor the principles of
nutrition.

Many could not properly bathe an inmate and not two per cent

knew what massage meant.
symptoms with accuracy.

Not one in ten were able to observe and report
Very few knew "the importance of the elimi­

nation from the body of its waste matter and recognized morbid
appearances of the excreta."

30

Numerous other areas of deficiency were

noted by the physician from the Fort Wayne, Indiana institution for the
feebleminded.
Secondly, Dr. Howe advocated the need for the establishment of
training schools in the institutions because adequate training "cannot
be done with an occasional talk or by a book of rules."3^- The training
school she recommended would be for a period of one to two years,
similar to the training schools in the better hospitals with a princi­
pal, text books, didactic presentations of theory, clinical demon­
strations, and supervised practice periods.
30
Howe, Delia E . , "Training Schools for Attendants," Journal of
Psycho-Asthenics, Volume 1, September, 1896, pp. 75-84.
31Ibid., p. 79.

^7
During his tenure as President of the Association of Medical
Officers of Institutions for the Feebleminded, Dr. W. A. Polglase made
reference to attendant training.

He pointed out that "advances in the

methods of training and care of the defectives called for more
skillful attendants and nurses, and a number of institutions had
established training schools with commendable results.

32

Evidence that training schools were highly developed is contained
in publications of the day.

"The Rome, New York, State Custodial

Asylum Training School for Attendants for Men and Women"
scribed in detail in the Journal of Psycho-Asthenics.
training covered two years of fifty-two weeks each.

33

was de­

The course of
The first year was

devoted to the preparation of attendants to provide physical care to
the infirmed and enfeebled.

The second year was concerned with pre­

paring the attendants in the physical, mental, moral and industrial
training of the feebleminded.

To enter the school an applicant had to

be twenty-one years of age and take a preliminary entrance examination
in writing from dictation, punctuation and the fundamental operations
of arithmetic.

The curriculum content, number of hours of classroom

lectures and practical training would have been sufficient to make a
graduate eligible for certification by waiver as a Registered Nurse in
Michigan (APPENDIX C).
In 190**, the Michigan State Nurses Association was formed and
the constitution stated;

"Object of this association shall be the

32
Polglase, W. A., "Presidents Address— Twenty-fifth Annual
Convention of Association of Medical Officers of Institutions for the
Feebleminded," Journal of Psycho-Asthenics, Volume 5, June 1901, p. 96.
33
Bernstein, Charles, "Training School for Attendants for the
Feebleminded," Journal of Psycho-Asthenics, Volume 11, 1906, pp. 31“^3.

*♦8
organization and registration of the graduate nurses of Michigan, the
futherance of all means aiming to elevate the standard of the nursing
profession, the establishment of professional reciprocity between
nurses of Michigan and those of other states and countries, and
acquiring statutes regulating the profession of nursing,"

After

several unsuccessful attempts the Association was instrumental in
having Act 319, Public Acts of 1909, Laws Governing Examination and
Registration of NurseB passed.
by stating:

The law described a Registered Nurse

"Within the meaning of this act, a State registered nurse

is defined as one who, for hire or reward, nurses, attends and ministers
to the sick and afflicted under the supervision and direction of a
legally registered practitioner, and who has qualified for such calling
or profession through a regular course of instruction and practice in a
recognized training school for nurses connected with a hospital,
sanatorium or State institution for the consumptive, insane or feeble­
minded and compliance with the further provisions of this act."
usual with licensure laws a waiver clause

wsb

As is

contained in the law which

allowed for a certificate of registration without examination to anyone
who had diploma from a training school giving a two year course of
training provided application be made before December 1, 1911.
The Michigan Board of Registration of Nurses issued in November
1910, a curriculum as a standard for the guidance of training schools
for nurses which were the minimum of instruction required in order to
comply with the law.

(APPENDIX C.)

In summary it provided for a

full two years devoted to hospital training.
3^

Letter from Mabel E. Smith, R.N., Executive Secretary, Michigan
Board of Nursing, May 7, 19^8.

*♦9
The first two months was to be a probationary period which
included instruction during the first two weeks in care of rooms, bed
making, vital signs, bathing, feeding helpless patientB and use of
disinfectants.

At the end of two weeks of instruction the probationer

was placed on the wards to gain practical experience.
During the remainder of the first year forty-eight hours of
lecture which included hygiene, bacteriology, anatomy, physiology and
dietetics was required,

practical work included the learning and

practicing of medical nursing procedures.
Thirty-nine hours of theoretical lectures on Surgery, Gynecology,
Obatetrics, Pediatrics, Infectious Diseases, Nervous Disorders and
Anesthetics were required of the senior class.

Practical work focused

on surgical, obstetrical and pediatric nursing as well as bandaging
and methods of instruction.
All training was to be under supervision of the superintendent of
nurses, her assistant or a senior nurse.

It was suggested by the Board

of Registration of Nurses that special hospitals affiliate with general
hospitals; that lectures and classes be held during the day and that
all training schools employ a graduate nurse to teach and supervise
practical instruction.
The newly organized Board of Registration of Nurses soon dis­
covered that many applicants for registration lacked theoretical
knowledge of required subject matter and the appropriate skills in
nursing procedures that the Board considered to be the minimum standards
for a qualified nurse.

They attributed these deficiencies to

(1) meager equipment for successful teaching, (2) insufficient staff
to afford the necessary drill in fundamental precepts, and (3) too

50
hasty selection of student nurses.

35

The Board felt it necessary for

a representative to visit the training schools and help correct defects.
As a result of this need the Nurse Practice Act was amended by Act 87
of the Public Laws of 1913 to include the following:

"The Michigan

Board of Registration of Nurses is hereby authorized to appoint and
employ a registered nurse who has not less than five years* experience
in nursing since graduation, three years of which have been spent as
superintendent of a training school approved by said board, to act as
a visitor and inspector of training schools for nurses, to the end
that the rules and regulations adopted by said board may be promoted
and upheld throughout the State."^
First indication that the amended Nurse practice Act had an
effect on the institutions for the insane and feebleminded is in the
remarks of Dr. Noble, Medical Superintendent of the Kalamazoo State
Hospital who reported that the State Board of Registration of Nurses
had required that pupil nurses at his institution have six or nine
months work in a general hospital in addition to the training they then
received.

As a result of the new requirements the Board of Trustees

voted to extend the course of the school to three years and to add to
the usual requirements for graduation a certificate of nine months work
in an affiliated hospital. 37
35McCabe, Miss, "The Development of Nursing Legislation in
Michigan," (Unpublished and undated excerpts from the History of
Nursing in Michigan obtained from Michigan State Board of Nursing), p. 1.
■^Michigan public Law 319 of 1909 as amended by Section 8 of
Public Law 87 of 191337Noble, A. I.,
of the Meeting of the
of Michigan, Lansing,
State printers, 1915,

"Report of Kalamazoo State Hospital," proceedings
Joint Board of Trustees of the State Hospitals
Michigan: Wynkook Hallenbeck Crawford Co.,
P» 7.

51
Early records of the Board of Registration of Nurses revealed
that they exercised control over the training schools of the state.

In

November of 1915 the Board "moved and voted that the Secretary be
instructed to write to Dr. Christian, Medical Superintendent at Pontiac
State Hospital in regards to changing the wording of 'Training School
lg
for Attendants' on the diploma for graduate nurses."
At another Board meeting it was "moved by Dr. Peterson that
in as much as there had been no reply to the communication with the
Pontiac State Hospital it be understood that there is no longer a
training school connected with the hospital.

Carried."

39

Kalamazoo State Hospital was also sanctioned by the Board because
a graduate of their training, who had made application for examination
was noted to have no practical experience in Operating Room and
Obstetrical Nursing.

"The secretary was requested to write to Miss Muff,

the Superintendent of Kalamazoo Asylum Training School advising her
that the Board felt it necessary for their nurses to have practical
experience m

these services."

Due to a "relative large number of failures in the last exami­
nation" the Board, in 1919, instructed the Secretary to again communi­
cate with the Kalamazoo State Hospital and urge them to make a special
4l
effort to improve the class work in their training school.
38
__________ , "Record of Proceedings of the Michigan Board of
Registration of Nurses (Unpublished document obtained from Michigan
State Board of Nursing), November 5, 1915.
59Ibid., May 13, 1917.
ilQ

Ibid., May 16, 1916.
*+1
Ibid., November 3, 1919*

52

Records of the Board of Registration of Nursing showed that in
March of 1920 training schools for nurses were functioning in only
three of the State Hospitals, namely, Kalamazoo, Newberry and
Traverse City.

Total enrollment in the three schools was seventy-three

! ,td the data indicated that Btudents must be high school graduates to
enter and that a cash allowance as well as uniforms were provided to
the pupils.
In 1921, the NurBe Practice Act was again revised.

The war, the

influenza epidemic and the shortage of nurses resulted in provisions
being made for the training of attendants.

The Board provided for the

examination of trained attendants who must be at least twenty years of
age, have an eighth grade grammer school education and possess a
certificate showing graduation of at least nine months of training in
a hospital or sanitarium approved by the Michigan Board of Registration
of Nurses and Trained Attendants.

**2

‘The enactment of this amendment

was to have impact on the future status of attendant training in the
State Hospitals of Michigan.
if.p

Act 318, Michigan Public Acts, 1909, as amended by Act 87,
Laws 1913, and Act 255, Laws 1921, Section 4,

CHAPTER IV

PERIOD OF MICHIGAN STATE
HOSPITAL COMMISSION

CHAPTER IV
PERIOD OF MICHIGAN STATE HOSPITAL
COMMISSION (1923-19*+5)
The belief that the feebleminded had strong criminal and anti­
social tendencies began to abate.

In 192*+, Fernald pointed out that

the development of such concepts had been based on past studies of the
only known large groups of defectives of the period, namely, Mthose
who had got into trouble and were in institutions, who were largely
of the hereditary class and had behaved badly and were shiftless and
lazy."^

Ignored were the feebleminded from good homes without trouble­

some traits.

Studies of those in special school classes, the alleged

feebleminded identified by the World War I tests and other community
based individuals demonstrated that the earlier generalizations
concerning the feebleminded were not warranted.

It was discovered

that many came from average homes of all socio-economic levels with
industrious, well behaved parents.

"The clinical history of many

suggested that infective, inflammatory or other destructive brain
disease in infancy was the cause of the mental defect.

Other types

of defect are probably non-hereditary— the Mongolian, the Cretin,
the Syphilitic, and Traumatic, etc."

2

^Fernald, Walter E., "Thirty Years Progress in the Care of the
Feebleminded," The Journal of Psycho-Asthenics, Volume 29, June, 192*+,
p. 212.
2
Ibid., p. 213.

53

5^
The early 1920's was a period of changing attitudes.

There was

beginning awareness that the need to protect the general public from
the deviant had been over-stressed and the obligations society had for
the well being of the feebleminded had been overlooked.

Realization

that all of the intellectually impaired could not be segregated in
institutions gradually gained acceptance with the resulting development
of some local school classes.

However, the residual effect of the

previous beliefs that the feebleminded were evil, dangerous and the
like would continue for a long time.

When an attempt to declare

Virginia's sterilization law unconstitutional reached the United States
Supreme Court in 1927, Justice Oliver W. Holmes upheld the law stating:
"We have seen more than once public welfare call upon the best citizens
for their lives.

It would seem strange if it could not call upon those

who already sap the strength of the State for these lesser sacrifices
in order to prevent being swamped with incompetents."^
Despite the realization that institutionalization was no longer
necessary for the bulk of the feebleminded, institutions continued to
grow although the rationale for same no longer existed.

Wolfensberger

noted that institutional growth evolved dynamically from l8;!7 to about
1925 as ideas and innovations continuously followed one another.
Logically, community based special services should have developed after
the first quarter of the twentieth century but many factors inhibited
■^Nowrey, Joseph C., "A Brief Synopsis of Mental Deficiency,"
American Journal of Mental Deficiency, Volume 55, January, 19^51 P» 35^*
it
Wolfensberger, Wolf., Changing patterns in Residential Services
for the Mentally Retarded, part IV, History and Development, Chapter 5,
The Origin and Nature of~our Institutional Models, pp. 128-131.
Robert B. Kugel and WoIT Wolfensberger (Editors), U.S. Government
Printing Office, Washington, D. C., 1969.

55

such movement:

(1) The general public had been well indoctrinated into

the menace of leaving the feebleminded in the community, (2) The
depression required the efforts of social agencies for factors essential
to the economic survival of the nation, (3) World War II diverted
attention and concern from social problems to those necessary for
gaining victory for the country, (k) The prevalence, in professional
groups, of the belief that the individual intellectual level was
unalterable, and (5) The discoveries of new treatment methods in mental
health diverted attention of workers from the field of mental retar­
dation.
Late in the period it became evident that competent researchers
began to breakdown the concept of the homogeneity of the feebleminded
by discovering group differences among them.

The work of Werner and

Strauss at Wayne County Training School, of Jervis at Letchworth
Village and of Doll at Vineland began to command respect and again
5
awaken interest in the field.
Michigan reflected trends found in the country in general.
Act 285 of the 1929 Public Laws of Michigan, now amended, an act to
prevent procreation of feebleminded and insane persons, moral degener­
ates and sexual perverts; and to authorize and provide for the sterili­
zation of such persons and payment of the expenses thereof, was passed
by the Legislature.

By 19^5, the population of the Lapeer State Home

and Training School was more than *+000 and sixteen dormitory buildings
had been built since 1923*

In addition to the above, Wayne County

Training School was opened in 1926; the Federal Government Indian School
5

Kanner, Leo, "The Exoneration of the Feebleminded," American
Journal of Psychiatry, Volume 98, 191*!, p. 27.

56
became the Mt. pleasant State Home and Training School in 1931*; The
Michigan Children’s Village (state orphanage) became the Coldwater State
Home and Training School in 1937 and a unit for the feebleminded was
established at the Newberry State Hospital.
INSTITUTIONAL DESCRIPTION— Act 151 of the Michigan Public Laws of
1923 entitled "The Hospital Act for Mentally Diseased Persons" created
a State Hospital Commission, and provided for the transfer of the
powers and duties then vested in the BoardB of Control of the indivi­
dual institutions.

The Commission was directed to revise and

consolidate the laws organizing the hospitals for the mentally ill and
homes and schools for the mentally handicapped and epileptics and to
regulate and provide for the care and management of the institutions.
Rules and Regulations of the Commission provided for the
appointment of one or more commissioners as a visiting and advisory
committee for each institution.

Each visiting commissioner was required

to make a thorough inspection of the assigned institution at least
monthly.

Responsibility for the day to day operation of the institution

was assigned to the Medical Superintendent.^
One of the first changes brought about by the newly organized
State Hospital Commission was the division of the work of Attendants
and Nurses into two shifts a day.

In 193^1 the unpublished minutes of

the Commission indicated that henceforth the minimum wage for employees
was to be $50.00 per month and that no employee was to be required to
work more than fifty-four hours per week.

September, 1936 action of

the Commission resulted in the awarding of two weeks vacation with pay

6

, Rules and Regulations of the Michigan Hospital
Commission, Lansing, Michigan: Boys Vocational School Press, 1931-

57
per year to the institutional staffs and in June, 1939 & cash commu­
tation allowance in lieu of maintenance was granted.
to be considered worth H35»00 per month.
as used in Act 151 was defined as follows:

Maintenance was

The term mentally handicapped
"The term mentally handi­

capped shall include morons, idiots, imbeciles and those as to whom
7
congenital defects have produced the same deficiency."
In 1938* the Michigan Legislature changed the State Constitution
to provide for the establishment of the Michigan Civil Service.
Through a Commission, appointed by the Governor with the consent of
the Senate the Civil Service Department was charged with the responsi­
bility of developing a merit system that would provide equal employment
to all and bring about the demise of the spoils system so common to
governmental politics.

Although the immediate impact of the Civil

Service Department was minimal, with the passing of time, it entered
in all phases of conditions of employment within the institutions.
The first Social Worker was appointed at the Michigan Home and
Training School in October, 1923*

In the beginning, the lone worker

supervised fifty parolees and the fifty-five patients, male and female,
who did day work in downtown T,ap©pr. as well as compile the family
histories of patients for use by the Medical Staff.

In 19^5i an

enlarged staff, supervised five hundred patients on parole, over 2000
monthly day work assignments in Lapeer and the surrounding area;
besides coping with the problems of Selective Service, Income Tax,
g
Social security, and Ration point Stamps.
7

__________ , State of Michigan Mental Health Statutes, Lansing,
Michigan! Legislative Service Bureau, 1969* p*" ^1*
g
Owsley, Ada and Beryl Bishop, "Social Service," Lapeer Employees'
Reporter, Volume 5, 19^51 P-

58

An Employees' Club was established in 1925*

The nearest stores

and entertainment were three miles away in Lapeer and transportation
was just about non-available.

The vast majority of employees lived on

the grounds, were prohibited from visiting in one anothers rooms and
had extremely limited facilities for social activities available to
them.

Dr. H. A. Hayes, Medical Superintendent, saw the need and

fostered the founding of the "Club Store."

The basement under the

Chapel was excavated and an employee area established.

Two bowling

alleys were installed, the club room furnished with comfortable
furniture, pool tables, piano and other items that provided many hours
of recreation for the employees,

profit from the store which sold to

both patients and employees was pro-rated to aid the Patients' Benefit
Fund and maintain the Employees' Club.

9

By 193^, the School Department reached a peak enrollment of seven
hundred and eighty-three students and a staff that included a principal,
nineteen teachers, an accompanist as well as recreational specialists.
Classes met in five different buildings and training was offered in
academic work from sense training through eighth grade; manual training
including simple hand work, fine arts, sewing, cooking, weaving,
woodwork and printing was another part of the total curriculum.
Recreational activities included school parties, mixed dances, programs,
band concerts, ball games and other play ground activities.10
TRAINING CF ATTENDANTS— By 1923, the Michigan Board of
Registration of Nurses and Trained Attendants had defined the practice
9
Prather, V. A., "Employees Club," Lapeer Employees' Reporter,
Volume
P* 11*
^Niblack, A., "The School Department," Lapeer Employees'
Reporter, Volume 5, 19^5t P* 6.

59

of nursing by a trained attendant as caring for the ill, injured and
infirmed in accordance with education and training which gave the
practitioner a lesser degree of specialized skill, knowledge, education
and training than that required to practice as a registered nurse.

The

Board required that a trained attendant practice nursing only under the
direction of a registered nurse, licensed physician or dentist.
In 1928 the requirements for "Schools for Trained Attendants"
was issued by the Michigan Board of Registration of Nurses and Trained
Attendants (APPENDIX D).

The first requirement stated that training

schools for attendants could not be established in hospitals or
sanitoria that had training schools for nurses.

Secondly, the course

of training could not be less than nine months nor longer than one year.
The school had to be conducted by a registered nurse qualified to teach
elementary practical nursing procedures and preparation of diets for
the sick.

Uniforms were required to be plain and not duplicate those

of students in accredited training schools for nursing and were not to
include nurse's cap.
The minimum course of instruction for the "Schools for Trained
Attendants" required at least six months spent in the actual care of
patients and one hundred thirty-five hours of instruction which was
to consist of practical nursing demonstrations, housekeeping, anatomy
and physiology, dietetics and ethics.

Textbooks recommended would

today be classified as home nursing, practical nursing and first aid.
Regulations of the Michigan Board of Registration of Nurses and
Trained Attendants prohibited Kalamazoo and Traverse City State
Hospitals from having accredited Schools for Trained Attendants
because they had Training Schools for Nurses.

Newberry State Hospital

60
was notified, in a letter to Mrs. Sheldon, the Superintendent of
Nurses, "that at a meeting of the Board of Registration of Nurses and
Trained Attendants on October 26, 192? the trained attendant course was
formally approved."^1

The letter went on to state that the approval

was back dated to October 1, 1926 and cautioned the hospital not to
exceed the recommendation that students work more than fifty-four hours
per week.
A letter from the Newberry State Hospital t^o the Board of
Registration of Nurses and Trained Attendants in early 1950 stated:
"Our course for Trained Attendants did not turn out very well last fall,
and we discontinued it.

We had only two girls finally decide to take

the course, and the doctors here did not think it worth while to spend
so much time on so small a class."

12

Contained in the August 13, 1932 minutes of the Michigan Board of
Registration of Nurses and Trained Attendants was the decision that
the course given at Pontiac State Hospital was not considered equiva­
lent of the standards required for trained attendants.

It recommended

that the Hospital secure an adequate teaching staff, improve its
housing facilities and give post-graduate and affiliate courses in
psychiatric nursing in place of the attendant training.
There is no further evidence to indicate that the other insti
tutions under the jurisdiction of the State Hospital Commission ever
attempted to gain approval of the Board of Registration of Nurses and
"^Letter from Helen de Spelder Moore, R.N., Secretary, Michigan
Board of Registration of Nurses and Trained Attendants, November 1, 1927*
12
Letter from Mrs. M. H. Barringer, Superintendent of Nurses
and Attendants, January 2*f, 1930.

61
Trained Attendants for the training they were conducting.

Files of the

Board of Nursing revealed that the attempts to establish training
courses for attendants were unsuccessful.

Closure of the last approved

school, Mercy Hospital at Manistee occurred in 1952.
The Michigan Hospital Commission, as directed by the newly
enacted 1923 law, established the responsibilities of the Medical
Superintendent.

In regards to the training of personnel the Medical

Superintendents were directed to "establish and supervise a training
school for attendants or nurses, or both, at each of the several
institutions under rules and regulations of the institution as approved
by the Hospital Commission.

13

P. C. Robertson, Medical Superintendent of the Ionia State
Home surveyed the training of attendants being conducted in the insti­
tutions responsible to the Michigan State Hospital Commission in early
1936.

Training at the nine institutions was very much alike in that

classes were held in the evening off-duty hours and it was expected
that all would attend the course and pass the examination if they had
any expectation of either promotion or salary increase.

The majority

of classes were lectures given by physicians on medical subjects such
as Bacteriology, Asepsis, Social Diseases, and Obstretics.

1*+

Other

professional personnel lectured in the areas of their specialization.
There was very little or no time devoted to demonstrations or the
direct care procedures of the institutions population.

The appropriate

manner of caring for patients was learned by observation, trial and
1^State of Michigan Mental Health Statutes, op. cit., p. 131^
P. C. Robertson, M.D., "Attendant Lecture Series," a
personal file.

62
error or incidental training by ward and cottage personnel.

A sample

lecture and the training program outline of the Pontiac State Hospital
appears in APPENDICES E and F.
The Michigan State Hospital Commission, in late 1936, appointed a
committee of Medical Superintendents, Dr. R. R, Sheets of Traverse City
Chairman, Dr. R. A. Morter of Kalamazoo and Dr. 0. R. Yoder of
Ypsilanti to investigate the needs for the training of nurses and
attendants.

Their findings were gathered from data obtained by solici­

tation from a number of State Hospital Departments and individual
institutions.

15

At that time forty-eight state hospitals in the United

States had undergraduate schools of nursing, a smaller nur.;ber had
either affiliate or postgraduate nursing courses.

They also found that

training for attendants was quite prevalent, although not universal.
The Committee recommended that State Hospitals should not have
training schools for nurses unless there were insufficient schools in
the community in which the hospital was located.

It further recommended

that all State Hospitals should be required to conduct a training
school for either affiliate or postgraduate students in the area of
psychiatric nursing.

Apparently this recommendation was acted upon

because in 1939 Kalamazoo State Hospital closed its training school and
the training school at Traverse City became more closely associated
with the Munsen Memorial Hospital.

Also stated was that the Committee

deemed it essential that all institutions in the group participate in
a program of nurse training and that permission to not participate be
15__________ , "Report of Committee on Nurse's and Attendant's
Training in Michigan State Hospital Group," December 1, 1938, an
unpublished report obtained from files of Ionia State Hospital.

63
granted by the Hospital Commission only.

Despite this recommendation

there is no evidence that any of the State Homes and Training Schools,
(Lapeer, Mt. pleasant and Coldwater) all members of the hospital group,
ever had affiliate nurse programs.

An insight into prevailing atti­

tudes of the time may be gained from the curriculum for the affiliate
nurse programs.

One study unit was titled Psychiatric Disorders,

Functional Reaction Type6 which were described as conditions in which
insufficient organic pathology was demonstrable.

Types of cases

considered essential for the adequate experience of the student
included manic-depressive and schizophrenic psychoses, involutional
meloncholia and the psychoneuroses.

Types of cases desireable but

not essential for the adequate experience of the student included
psychoses with psychopathic personality and mental deficiency.
In regards to the training of nurses the Committee concluded by
stating they were of the opinion that the training of nurses was a
serious undertaking and the utmost care should be exercised in working
out plans and organization that would approach as nearly as possible
the ideal.
Concerning the training of attendants the Committee recommended
that all newly employed attendants be given a comprehensive course of
instruction to better prepare them for the responsibility of caring
for mental patients.

The recommended curriculum consisting of thirty

hours of lecture and twelve hours of demonstrations is reproduced:
SUGGESTED SUBJECT MATTER FOR LECTURES
History of the Treatment of Mental Disease . . . . 1 hour
The Modern Mental Hospital .................... . 1 hour
Hospital Ethics & Attitudes Toward the Public. . . 1 hour
Anatomy.........................................
2 hours
2 hours
Physiology .....................................

6k
First Aid.................... * ................... 3
Causes of Mental D i s e a s e
2
Classification of Mental Diseases. . . .
2
Treatment of Mental Diseases .................... 3
Nursing Care of the Mentally Sick.................. 3
Dietetics and Nutritional Care of Mental patients. 1
Contagious Diseases
1
Habit Training and Socialization Programs
2
Occupational Therapy ............................ 2
Recreational Therapy
2
Hospital Economics . . . . . . . . . . . . . . . . 1
Correlation of Hospital Activities
__1
Total:
30

hours
hours
hours
hours
hours
hour
hour
hours
hours

hours
hour
hour
hours

The outline for the twelve practical demonstrations is
given below:
1.

Demonstration and instruction - Hospital
Housekeeping — 1 hour
1.
2.
3.
k.
5.
6.
7.
8.
9.

2.

Ventilation, temperature and lighting of wards
in general.
Special attention in regard to these at meal
hours and at other times when wards are empty.
General and special cleaning of wards and rooms.
Care and cleaning of scrubbed and of polished
floors.
Care of brooms, brushes, mops, pails and other
ward utensils.
Care and cleaning of tile, enamel, marble and
metal work.
Care and cleaning of windows.
Care and cleaning of stairways, halls, clothes,
and dust chutes.
Cleaning, ventilating and general care of
toilet rooms, laboratories and baths.

Demonstration and Instruction —

1 hour

1.

Care, airing and cleaning of bedsteads,
mattresses, pillows and bed linen.
2. Opening bed for ventilation and at night.
3*. Care and cleaning of furniture, rugs and
carpet.
k . Care of wardrobes, bureaus, etc., and their
contents, in patients* rooms.
3.

Demonstration and Instruction —
and linen rooms — 1 hour
1.
2.
3-

care of clothes

Marking hospital and private clothing.
Marking ward linen.
Arranging clothing and ward linen.

65
4.
56.
7.
4.

Mending clothing and ward linen.
Care of footwear.
Sending to and receiving from the laundry.
Making requisitions and receipting for
ward supplies.

Demonstration and Instruction —
clothing — 1 hour

Toilet, hath and

1. Attention to patients' toilet.
2. Special attention to hair, teeth and nails.
3. Shaving.
4. Keeping patients neat and tidy.
5. Spray and tub baths*
6. Changing soiled and wet clothing.
7. Dress and undressing of apathetic, resistive
and irritable patients.
8. Preparation for bed.
9. Care of patients' clothing at night.
5.

Demonstration and Instruction —

Bed patients —

1 hour.

1.
2.

Changing bedding with patient in bed.
Changing patient's clothing with patient
in bed.
3. Protection of patient from exposure and
draughts.
4. Setting patient up in bed.
5- Setting patient out of bed on commode and
chair.
6. Care of back and other parts exposed to
pressure.
7 . care of cupboards and medicine cabinets.
8. Care and use of disinfectants and other
poisonous ward solutions.
6.

Demonstration and Instruction —
1 hour.
1.

Food Service —

Getting patients ready for meals and attention
to patient during and after eating.
2. Proper food for the aged, paralyzed and very
demented.
3- Precautions against scalding and choking.
*t. Feeding the feeble and demented.
5. Training the untidy to better habits of
eating.
6. Tray service.
7- Feeding patients in bed.

66
7.

Demonstration and Instruction —
1.
2.
3.
k,

8.

5.
6.
7.
8.
9.
10.
11.
12.
13.
9.

2.
3.
4.
3*
6.
7.
10.

2.
3.
*+.
3.

Management of

Tactful, patient, gentle, firm, reasonable
methods.
Management of emotional outbursts.
Management of depressed conditions and
agitations.
Management of delusions.
Precautions against suicide.
Management of violence, destructiveness,
mischievous tendencies.
Physical control, hospital regulations —
methods under various conditions,

Demonstration and Instruction —
Patients — 1 hour.
1.

Occupation and

Indoor occupations.
Management of the idle and eccentric.
Management of working party.
precautions against accidents and escapes
while employed.
Proper treatment of a patient at work.
Clothing, shoes, hats and mittens.
Toilet facilities.
pest.
Exposure to heat, cold and wet.
Indoor and outdoor games.
Reading.
Conversation.
Music.

Demonstration and Instruction —
Patients — 1 hour.
1.

1 hour.

Getting patients ready for outdoor exercises;
guarding and caring for patients doing exercise.
Indoor and outdoor games.
Guarding against accidents and escapes while
exercising.
Guarding against suicide while exercising.

Demonstration and Instruction —
Amusements — 2 hours.
1.
2.
3.
k.

Exercise —

Management of

Care of the aged, feeble and demented
walking cases.
Attention to suitable clothing, underwear,
night clothes and footwear.
Changing of soiled and wet clothing.
Management of incontinence.
Exercise in and out of doors; guarding against
exposure, over-exertion.

67

6.
78.
11.

Pest during the day.
Suitable and properly served food.
Guarding against fractures and other
injuries.

Demonstration and instruction —
1.
2.
3.
4.
56.
78.
910.

Night Duty —

1 hour.

Attention to quiet moving and speaking.
Ventilation, heating, and lighting of
wards and rooms.
Method of systematically observing patients.
Proper distribution of day clothing.
Night clothing of patients.
Guarding against exposure and draughts.
Getting patients out of bed. Management
of incontinence.
Precautions against accidents, escapes
and suicides.
Action in case of fire and other emergencies.
Keeping night charts, records and reports.
Total:

12 hours'1'^

■^"Report of Committee on Nurses and Attendant's Training in
Michigan Hospital Group,” op. cit., pp. 2-4.

CHAPTER V

PERIOD OF MICHIGAN DEPARTMENT
OF MENTAL HEALTH

CHAPTER V

PERIOD OF MICHIGAN DEPARTMENT
OF MENTAL HEALTH (19J*5-1973)
In the United States, the conclusion of World War II again
brought into focus problems that had been cast into the background
during the depression and the war years.

In 19^5 the provisions for

the care of the mentally retarded were just about the same as they had
been in the late 1920's.
The first significant action was brought about by the newly
organized National Association for Retarded Children made up primarily
of parents of mentally retarded.

They were very much disenchanted with

the efforts being made to meet the needs of their handicapped
off-springs in institutions and in the community.
In Michigan, the State Association for Retarded Children was
initially concerned with the difficulty and the time delay faced in
having their handicapped youngsters admitted to the retarded insti­
tutions.

Acting as a lobby group and enlisting the aid of newspapers

and other media, they embarked upon a campaign to eliminate the large
waiting list which resulted in the construction of the Plymouth State
Home and Training School, the acquisition of the station hospital at
Fort Custer and the utilization of the tuberculosis sanitoria at
Gaylord and Howell for the institutional care of the mentally retarded.
These additional installations made another 1+300 beds available

68

69

for institutional care but in actuality it failed to eliminate the
waiting list.
During the period 1950-1965 the Michigan Association for Retarded
Children as well as the National Association grew in size and influence.
Along with a number of professional personel who were engaged in the
care of the mentally retarded they managed to begin a movement that
would provide the retarded with more equal opportunities for education
and training at the local level.

The State Department of public

Instruction attempted to increase the number of classes for the educable and trainable by providing for varied types and amounts of added
reimbursement to school districts that conducted special education
classes; made provisions for the certification of special education
teachers and stimulated the State's institutions of higher learning to
increase their course offerings and to develop curricula for special
educators.

In 1957% the State Legislature enacted public Law l*f8, the

"County Trainable Bill" which allowed intermediate school districts to
organize trainable classes when local districts were unable to do it.
Public Acts 265 of 1955 and 191 of the 1963 Michigan Legislature made
it possible for local and intermediate school districts to vote millage
for special education purposes*
Toward the end of this period, the parents of the retarded and
others began to take a critical look at the institutions wherein their
children resided and began to voice dissatisfaction with what they saw.
One such expression of discontent was a television documentary "A Wind
Is Blowing" produced and shown by Channel 12, WJRT-TV Flint, which was
an expose of the overcrowding, poor equipment and personnel shortages
at the Lapeer State Home and Training School.

However the impact of

70
the many efforts of the decade had minimal influence in resolving the
problems of correcting the existing deficiencies in the services
provided for the mentally retarded.
On October 17, 1961, John F. Kennedy, the President of the United
States appointed a panel, headed by Leonard

w.

Mayo, which was mandated

to prepare a national plan to combat mental retardation.

Three hundred

and sixty-four days later the panel sent to the president "A proposed
Program for National Action to Combat Mental R e t a r d a t i o n . A n accompa­
nying letter from Dr. Mayo stated that the Panel has "devoted the inter­
vening months to carrying out the assignment and have prepared for your
consideration recommendations concerning research and manpower, treatment
and care, education and preparation for employment, legal protection and
development of federal, state and local programs."

2

The Panel*s recom­

mendations were transformed into a message the President delivered
to the Congress on February 5» 196? in which he stated:

"It is my

intention to send shortly to the Congress a message pertaining to
this Nation's most urgent needs in the area of health improvement.
But two health problems— because they are of such critical size and
tragic impact, and because their susceptibility to public action is so
much greater than the attention they have received— are deserving of a
wholly new national approach and a separate message to the Congress.
3
These twin problems are mental illness and mental retardation."
The
^__________ , A proposed program for National Action to Combat
Mental Retardation, Washington, D. C . : United States Government
Printing Office, 1962.
2
Letter from Leonard W. Mayo, Chairman of the President's Panel
on Mental Retardation, October 16, 1962.
3
Message from the President of the United States Relative to
Mental illness and Mental Retardation, 15*+ Session, 88th Congress,
Document No. 58, 1965*

71
message continued, pointing out that since the earliest days of the
Nation the Federal Government had assumed a major role in alleviating
health problems beginning with the Public Health Service and more

recently with the research work of the National Institutes of Health.
The success of these undertakings had overcome many contagious and
physical diseases but progress in the area of mental disabilities had
not made any significant advancement.

The tremendous expenditure of

tax dollars was mentioned as well as the waste in human resources and
the anguish suffered by both the afflicted and their families.

The

Presidential message continued as follows:
This situation has been tolerated for too long.
It has troubled our national conscience but only as
a problem unpleasant to mention, easy to postpone,
and despairing of solution.
The Federal Government,
despite the nationwide impact of the problem, has
largely left the solutions up to the States.
The
States have depended on custodial hospitals and homes.
Many such hospitals and homes have been shamefully
understaffed, overcrowded, unpleasant institutions
from which death too often provided the only firm
hope of release.
The time has come for a bold new approach.
New medical, scientific, and social tools and in­
sights are now available.
A series of comprehensive
studies initiated by the Congress, the executive
•branch, and interested private groups have been
completed and all point in the same direction.
Governments at every level— Federal, State and
local-private foundations and individual citizens
must all face up to their responsibilities in this
area.
Our attack must be focused on three major
objectives.^
The first objective was prevention.

The president stated that

quickly activiated programs in general health, education, welfare and
urban renewal could make a major contribution in overcoming adverse

h

Ibid., pp. 2-jS.

72
social and economic conditions that would result in reduction of mental
retardation,

providing better medical care, nutrition, housing and

health education could also aid in prevention,

programs of compre­

hensive maternal and infant care were also needed.

Cultural and edu­

cational deprivation that resulted in mental retardation would be
decreased by requiring that ten per cent of proposed Federal Aid for
elementary and secondary education be committed by each State to
special project grants designated to stimulate and make possible
improved educational opportunities in slum and distressed areas, rural
and urban.
The development of desperately needed community services was
cited as the second objective.

The message to Congress continued:

"We must move from the outmoded use of distant custodial institutions
to the concept of community-centered agencies that will provide a
coordinated range of timely diagnostic, health, educational, training,
rehabilitation, employment, welfare, and legal protection services.
For those retarded children who cannot be maintained at home by their
own families, a new pattern of institutional services is needed.

The

key to the development of this comprehensive n e w approach toward
services for the mentally retarded is twofold.

First, there must be

public understanding and community planning to meet all problems.
Second, there must be made available a continuum of services covering
5
the entire range of needs."
To stimulate public interest and to develop comprehensive plans
the President recommended that Congress enact legislation to establish
5Ibid., pp. 10-11.

73
a program of special project grants to the States for financing reviews
of needs and programs in the field of mental retardation.

To assist

States and local communities to construct and activate facilities the
surveys justify and plan it was further recommended that Congress
authorize matching funds for the construction of public and other
non-profit facilities, including centers for comprehensive treatment,
training and care of the mentally retarded.
It was further recommended that there be developed facilities
that would increase the role of qualified universities in providing
services to the retarded and the training of specialized personnel
needed to effectively implement the multitude of programs being
proposed.

Also, vocational training, youth employment and vocational

rehabilitation programs that would help release the untapped potenti­
alities of mental retardates needed to be developed.
The third major objective on which the president placed emphasis
was research.

He said the greatest challenge of mental retardation

was to discover the causes and the methods of successful treatment.
This would require the expansion of our scientific knowledge which
could only be accomplished by the training of medical, behavioral and
other professional specialists.

In order to provide for additional

research into the "complex mysteries of mental retardation"^ the
President recommended that legislation be passed to authorize the
establishment of centers for research in human development where
clinical, laboratory, behavioral and social science research could be
carried out on an interdisciplinary basis.
6

Ibid., p. 13.

7U
Congress reacted favorably to president Kennedy's message and
on October 31, 19&3 passed the "Mental Retardation Facilities and
Community Mental Health Centers Construction Act of 1963"

7

which

provided "assistance to the States in combating mental retardation
through grants for construction of research centers and grants for
facilities for the mentally retarded and assistance in improving mental
health through grants for the construction of community mental health
g
centers and for other purposes."
This Act also made available funding
for State planning, for training of teachers of the mentally retarded
and for research and demonstration projects in education of handicapped
children.
The interest of president Kennedy in the mentally retarded and
the commitment of president Johnson to continue the course of action
just getting underway at the untimely death of President Kennedy
created a level of interest among parents, professionals and the
general public that was more intense than the action Samuel Q. Howe
generated more than a century ago.
Jn 1968 the President's Committee on Mental Retardation in its
second annual report, stated that meaningful change had come into lives
Q
of the nations' mentally retarded in the decade of the 1960's.
How­
ever, the report continued, there is a long way to go and much to do
before services for the retarded are complete and equal to the
7
U.S. Congress, Senate, Mental Retardation Facilities and
Community Mental Health Centers Construction Act-, S. 1576, 88th
Congress, 1963.
g

Ibid., p. 1.
9

, MR 60, The Edge of Change, Washington, D. C.:
U.S. Government printing office, 19^5.

75

opportunities available to his peer with average intelligence.

To

demonstrate the progress being made in this country three developments
were cited as being of high significance.

They were:

Popular and professional acceptance of the
mentally retarded as human beings who can grow and
learn to make the most of their abilities.
Agencies reappraisal of their missions and
methods in light of new and different human needs
to be served. This reevaluation often painful, is
bringing new patterns of social action and citizen
participation in community affairs.
Recognition of mental retardation program
development as an inescapable part of the response
to critical national issues such as poverty and
deprivation, city planning and renewal, manpower
training and use, education policy, population
study and human resources planning. -*-0
In regards to continued difficulties the President's Committee
reported that there is still a need for additional interest and
expertise in mental retardation on the part of professionals in the
fields of health, education, social work, psychology and others.

Also,

for the most part, the institutionalized retarded continue to be cared
for in custodial care environments.

And most significantly, "the

conditions of life in poverty— whether in an urban ghetto, the hollows
of Appalachia, a prairie shacktown or an Indian reservation— cause and
nuture mental retardation."^
The momentum started by the Kennedy Administration and the con­
tinued support of federal programs for the mentally retarded during
President Johnson's tenure was enhanced by public Act 91“517 of 1970,
the Developmental Disabilities Act.
10T, . .
,
Ibid., p. 1.
^Ibid., p. 19.

This legislation, enacted during

76
the Nixon Administration, provided program support for the cerebral
palsied, epileptic and neurologically damaged as well as the mentally
retarded.
Events in Michigan have closely followed national trends.

Public

Act 51* of the 1963 Legislature, known as the Community Mental Health
Act, made it possible for local governmental units to develop services
for the mentally ill and the mentally retarded with seventy-five
per cent of the cost being paid by the State.

This furthered the

development of Child Guidance Clinics and Adult Mental Health Clinics
but did little or nothing for the mentally retarded until the 1970*s.
The Governor appointed the Directors of the Departments of Public
Health, Mental Health, Education, Social Welfare and Vocational Reha«

bilitation as the Governor's State interagency Coordination Committee
to develop a plan for State action to provide services for the mentally
retarded and to bring about coordination of the efforts of the several
departments.

The Department of Mental Health made provisions for any

local governmental or non-profit citizens group to open Day Care
Centers and/or Adult Activity Centers for the community based mentally
retarded who were not eligible for school programs, independent
employment or sheltered workshop placement on a one hundred per cent
funding basis as an alternate to institutionalization.

The Institute

for the Study of Mental Retardation was established at the University
of Michigan under the direction of William M. Cruickshank.
Clustered together from 1969 onward are several other events
that demonstrate a continuance of the momentum originated by
President Kennedy in 1963.

E. Gordon Yudashkin, M.D. was appointed

by the Governor to be the Director of the Department of Mental Health

after achieving great success in returning the mentally ill to the
community after brief periods of hospitalization at the Northville,
Michigan, State Hospital.

As Department Director, Dr. Yudashkin

caused the more capable institutionalized retardates to be moved into
community placements more consistent with their needs and more
compatable with their human rights.

He also brought pressure on the

Community Mental Health Programs (Act 5k Boards) to devert some of
their resources and efforts to the successful community placement of
the retardates by aiding in the development of suitable living
facilities, activity centers and sheltered workshops.
Effective September 1, 1973 Michigan school law makes it manda­
tory for local and intermediate school districts to provide for the
education and training of all handicapped persons up to the age of
twenty-five years.

Prior to the passage of this legislation which

came about as a result of a state-wide referendum providing educational
services to the handicapped had been permissive and many school
districts had little or no provisions for the education of the retarded
and other handicapped persons.
Executive Order 11 of 1973, signed by Governor William G. Killiken
on October 2k states that the "statutory authority, powers, duties,
functions and responsibilities of the Michigan Department of Social
Services, the Michigan Department of Public Health, the Michigan
Department of Mental Health, the Indian Affairs Commission, the
Division of Vocational Rehabilitation, the Office of services to the
Aging and Commission on Services to the Aging, the Michigan Economic
Opportunity Office, the Manpower Planning Council and Emergency
Employment Act Program, the Office of Health and Medical Affairs and

78
the Coordinated Child Care Council are transferred to the Department
of Human Services effective January 1, 197^•"

12

The reorganization is

expected to make the delivery of human services more efficient.

In

his announcement of the change the Governor "made special mention of
the need to improve community placement programs.

An attempt is under­

way to solve the problems which have emerged as we move selected
patients from large institutions for the mentally ill and mentally
retarded to smaller community facilities."^

The major objective

in providing human services is to eliminate the underlying causes of
dependency, whether economic, social, educational or medical and the
reorganization is intended to stop the duplication of effort or the
waste of resources which can contribute to dependency.
INSTITUTIONAL DESCRIPTION— Act 271 of the 19^+5 Michigan
Legislature established a Department of Mental Health and provided for
the transfer to said Department the powers and duties of the State
Hospital Commission.

The Act required that the Director, appointed by

the Governor, be a psychiatrist certified by either of the boards of
psychiatry or neurology.

A State Advisory Council on Mental Health

Services also appointed by the Governor was another provision in the
legislative action that was intended to centralize and make more
efficient the relatively independent functioning institutions for the
mentally ill and the mentally retarded.
The reorganization that resulted from the establishment of the
Department of Mental Health provided for a group of specialized

12
__________ , "Governor Issues Reorganization Order," Michigan
Department of Mental Health 'Liuk', Volume 5» Number 4,
November 15, 1973, p. 3*
"^Ibid., p. 3.

79

consultants in the areas of Nursing, Psychology, Social Work and
personnel as well as a sub-dividing of the Department into sections
concerned with the institutions, the community clinics, mental health
education and research.

Eliminated was the assignment of a specific

individual from the Advisory Council to be a periodic visitor to each
of the institutions.
Although established in 1938, the full impact of the Civil
Service Commission was not felt until after the war years.

The State

Legislature authorized the Commission to classify all positions in
State service, fix the rates of compensation, make rules and regu­
lations covering all personnel transactions and regulate all conditions
of employment in the classified service.
The Mental Retardation Hospital Improvement project grant program
was begun in 196*+.

It was designed to assist state institutions for

the mentally retarded to improve their care, treatment and rehabili­
tative service.

The maximum amount of support, including direct and

indirect costs, that an institution could receive for any one budget
year was $100,000.00.

An analyses of the projects showed a major

focus was placed on deraonst-ra.tion projects for the more severely
retarded and dependent residents in the area of self-care training
using operant conditioning methods.

1*+

For the first time, insti­

tutional personnel were challenged to develop innovative methods of
better caring for their resident populations with a realistic possi­
bility of having them funded.

14

, Mental Retardation Activities of the U.S. Department
of Health, Education and Welfare, Washington, D. C.: U.S. Government
PrintingOffice, 1969, pp. 49-50.

15
A journal article by Ellis,
served as a stimulus for many
projects in Michigan.

He proposed a toilet training program for the

severely retarded using operant conditioning techniques,

jn addition

to outlining a theoretical behavioral modification format to be used he
asserted that:

“It is apparent only in very unusual instances does

biological accident reduce the human organism to a point below potenti­
ality for learning.

The writer has definitive evidence that some

patients at the idiocy level who show little adaptive behavior are
capable of learning."^

It was necessary to make analyses of behavior

such as eating, dressing and other self-help habits and to develop
methods of teaching them to the severely retarded.

"These problems

should be of central concern to behavioral science and should be termed
•hopeless* only after devoted attempts to alleviate them have failed.
The present Zeitgeist provides a 'mental tester* role for the psycholo­
gist.

Only when the psychologist puts aside his Binet kit and attacks

problems such as this, as a behavioral engineer, will he come to grips
with the central issue in mental deficiency."

17

Initial Hospital Improvement Programs demonstrated that Ellis was
correct, that severe mental retardates could be habit-traineu.

The

President’s Committee on Mental Retardation, in 1968, recommended that
the Hospital Improvement program having "elicited imaginative new
15

Ellis, Norman R., "Toilet Training the Severely Defective
Patient: An S-R Reinforcement Analysis," American Journal of Mental
Deficiency, Volume 68, Number 1, July 1963, pp* 98-103.
l6Ibid., p. 103.
17Ibid., p. 103.

81
approaches to delivering residential care in state institutions'*

18

be

expanded to effect major change by greatly increasing funds with
particular effort being made to meet the needs of the severely and
profoundly retarded.
Behavioral modification projects brought psychologists and others
into the mainstream of the resident care program in Michigan insti­
tutions for the retarded and began to bring about a change from almost
total medical-nursing care orientation to a multidisciplinary approach
in meeting the needs of the institutions' populations.

The most

tangible evidence of the evolution in resident care concepts is demon­
strated by the action of the Michigan Legislature in passing public
Act 321 of 1969*

This statute states that the Director of the

Department of Mental Health "shall appoint a superintendent for each
state home and training school who shall have such professional qualifications and experience as established by the director." 19

Prior to

this legislative action only physicians, licensed to practice medicine
in the State of Michigan were eligible for appointment as medical
superintendents.
A national planning committee on accreditation of residential
centers for mentally retarded persons was organized in 1966 by the
National Association of Retarded Children, the American Association on
Mental Deficiency, the American psychiatric Association, the Council
for Exceptional Children, the United Cerebral palsy Association and
the American Medical Association.

In 1969 the five sponsoring agencies

18
__________ , M. R. 68, The Edge of Change, op. cit., p. 13.
19
__________ , State of Michigan Mental Health Statutes, Lansing,
Michigan^ Legislative Service Bureau, 1969, p. 8.

82
formed the Accreditation Council for Facilities for the Mentally
Retarded in order to establish a national, voluntary program of
accreditation to improve the level of service for all mentally
retarded persons.

20

The standards are intended to be applicable to

all twenty-four hour programming institutions establishing needed
levels of care necessary to provide each resident with the services
which will enable him to attain maximum physical, intellectual,
emotional and social development.

Here in Michigan the State

Association for Retarded Children has gone on record as being in favor
of the state institutions being required to meet this standard and
gain accreditation.
During this period the institutional populations have undergone
a radical change.

At the present time there is an almost total absence

of the educable and trainable.

A recent survey indicated that there

were only a few raongoloid children under ten years of age at any of
the state facilities.

Fifteen years ago this diagnostic group made up

twenty-five per cent of the population in that age grouping.

Indi­

cations are that the institutional populations of the next era will be
made up of severe and profound levels of retardation and severely
multi-handicapped individuals.
TRAINING OF ATTENDANTS— In 19^5, at the end of World War II,
inservice training for attendant-nurses in the institutions under the
newly organized Michigan Department of Mental Health was at an all
time low.

This depressed level of training was due primarily to the

critical shortage of personnel that prevailed in all institutions
20
__________ , A Development Model for Residential Services,
Arlington, Texas: National Association for Retarded children,
1972, p. 9 .

83

during the war years due to national mobilization for duty with the
armed services and maximum production in industry.

As a result of

insufficient numbers of personnel the attendant-nurse could not be
freed from resident care duties to attend training and professional
persons did not have time available to conduct training sessions,
Charles A. Zeller, M.D. was the first Director of the Department
of Mental Health and Irene C. Walsh, R.N. was the first Nurse
Consultant.

Miss Walsh's duties were to organize and develop the

psychiatric nursing affiliations in the mental hospitals for the
collegiate and general hospital schools of nursing and develop the
inservice training programs for attendant-nurses in the mental
hospitals, the state home and training schools and the state hospital
for epileptics.
First priority was given to the affiliate nurse programs and by
1953 all student nurses in Michigan were receiving a twelve week
affiliation in psychiatric nursing.

The only expansion of the program

needed was to establish a site in the upper peninsula because student
nurses from that area had to travel to the lower peninsula or out of
state for training.

The total student nurse enrollment during that

year in the mental hospitals of Michigan was eight hundred and fifty.

21

In 1953t there was no requirement for employment in the stace
for the attendant-nurse beyond passing a civil service examination.
Each hospital and state home conducted a training program for attendantnurses.

The programs ranged in length from eighty to one hundred and

thirty hours and were usually given over a three to four month period.
21
__________ , Mental Health Research and Training in Michigan,
— Survey of Facilities and Programs, Lansing, Michigan: Michigan
Department of Mental Health, 195**, pp. 23-25.

8*t
"In some instances, the training programs began at the time of
employment or after a brief orientation period.

In the large per­

centage of cases, the program of training was given to the employees
as soon as feasible and this might be from six months to two years
after employment.

In any event, all newly employed attendant-nurses

received a basic orientation which ranged from sixteen to forty hours
in length."

22

At that time, approximately five to six hundred

attendant-nurses completed the training program annually.

The

Department of Mental Health report stated that the institutions could
increase their inservice training activities "if instructor staff
could be added and if time for training was allowed in the staffing
for service."

23

It was estimated that at the time of the report a

minimum of sixty per cent of the 5*728 attendant-nurses had completed
the required attendant-nurse training program.
In conclusion the Department of Mental Health Survey of Training
recommended that:

"(1) Attendant-Nurse training should be reviewed

with two factors in mind.

The first factor was an evaluation of the

method of training, and the second factor was the evaluation of course
content to more factually determine whether or not the progress best
prepared the attendant-nurse for the service required.

(2) Additional

instructor staff be added to the attendant-nurse training program in
order to provide a more intensive inservice training program."
22Ibid., p. 28
25Ibid., p. 28.
2U
Ibid., p.

85
During the first decade of the Michigan Department of Mental
Health, although having "the prime responsibility for agency inservice
training,"

25

did not demonstrate any significant advancement in the

level of training of the attendant-nurse.

Although the Department's

Survey of Training indicated a lack of sufficient instructors as one
of the factors that impeded progress, the second, namely the inability
to have attendant-nurses available for training was, no doubt, a
greater impedediment.

In prior periods, all personnel attended

training sessions as a part of their work day regardless of what time
classes were held or how many hours they had worked.

By 19^5 the eight

hour work day was in effect for all workers and that included time
spent in training.

Thus, with a limited number of personnel available

for resident care, a limitation was placed on the number of attendantnurses available for training.
Training curricula content and its applicability to the work at
hand was also mentioned in the survey conducted by the Department.
Analysis of the curricula being used at the time indicated that great
emphasis was being placed upon subjects such as bed making and other
basic nursing procedures and little or no time was devoted to the
care of the mentally retarded or the mentally ill.

Such a situation

is readily understandable when consideration is given to fact that
there were only thirty-five registered nurses employed in the entire
Department of Mental Health in 1953 and the best trained were assigned
to either the positions of Directors of Nursing or instructors for the
psychiatric nursing affiliation programs.

Registered nurses assigned

25
Michigan!

, Rules of the Civil Service Commission, Lansing,
Michigan Civil Service Commission, 1969, p. 39.

86
to attendant-nurse training, for the most part, had little or no
training or experience in the care of the mentally retarded or the
mentally ill.

Method of instruction was basically the lecture with

a minimal amount of demonstration.
Although the Department of Mental Health was apparently reasonably
well satisfied with the training of attendant-nurses such was not the
case with the recipients of the training.

On August 17, 195*+ a group

of attendant-nurses from thirteen of the state institutions met at the
Pontiac State Hospital to formally organize the Psychiatric AttendantNurse Association of Michigan.

Discontent with the training they were

receiving to assist them to better care for the mentally ill and
mentally retarded in their charge they set out to obtain better training
and official recognition.

By March of 1955, the organization had more

than nine hundred members.
A vigorous campaign was instituted by the Psychiatric AttendantNurse Association of Michigan to further increase its membership and
to gain licensure under the Nurse practice Act of Michigan.

The

groups' efforts were successful and on April 18, 1957 the Michigan
Legislature passed public Act 289 which established a fourth category
of nurses, namely, the Licensed Psychiatric Attendant-Nurse which is
defined by the Michigan Board of Nursing as meaning "the performance
for compensation of acts in the care of the mentally ill and mentally
handicapped, or for the maintenance of the health or the prevention
of illness of others, performed in accordance with education and
preparation which has provided the practitioner with a lesser degree
of specialized skill, knowledge, education or training than that
required to practice as a registered nurse.

A licensed psychiatric

87
attendant-nurse shall perform such acts only under the direction of a
registered nurse or licensed physician or dentist"

26 The new law

also provided for the appointment to the Michigan Board of Nursing
three Licensed psychiatric Attendant-Nurses who were to serve "as
members of the board only in relation to and for the purpose of
administering the provisions of the act which related to psychiatric
attendant nursing."

27

public Act 289 required the Board of Nursing

to make rules and regulations for the examination, regulation,
licensing and registration of licensed psychiatric attendant-nurses
and to define minimum curricula and provide for accreditation of
schools and programs leading to their licensure.
In 1957 change in the Michigan Nurse Practice Act made pro­
visions for waiving or "grand-fathering" in those who had previously
practiced lawfully and reputably as psychiatric attendant-nurses.
Individuals who had worked as attendant-nurses for five years or more
during the ten years prior to July 1, 1958 and persons who had an
inservice training course of one hundred and fifty hours and worked as
an attendant-nurse for two or more years during the five years prior
to July 1, 1958 were eligible to write the qualifying examination until
July 1, i960, provided they were of good moral character, had an eighth
grade education and could produce verification of such practice by
affidavits from one licensed physician or one registered nurse.
Many attendant-nurses availed themselves of the opportunity to
gain licensure by the waiver clause as is indicated by the fact that

26

, Michigan Statute and General Rules Relating to the
Practice of Nursing, Lansing, Michigan: Department of Licensing and
Regulations, 1967*, p. 2
27

Ibid., p. *+.

88
in 1963 the Mt. pleasant State Horae and Training School had two
hundred and thirty Licensed Psychiatric Attendant-Nurses and only two
of that number had become eligible for licensure by attendance at a
school accredited and approved by the Board of Nursing.

They had

attended the Northern Michigan College School of practical Nursing
which in I960, with the approval of the Board of Nursing, had added a
twelve week psychiatric affiliation at the Newberry State Hospital
to their regular curriculum and thereby made their graduates eligible
to take both the practical nurse and psychiatric attendant-nurse
examinations.
The program at Northern Michigan College lasted only the one
year and pine Rest Sanitorium, a psychiatric hospital with a unit for
the mentally retarded, located in Grand Rapids, and operated by the
Christian Reform Church, was the only institution in the state to gain
approval and accreditation from the Michigan Board of Nursing for a
Bchool of psychiatric attendant nursing.
Attempts within the institutions of the Michigan Department of
Mental Health to establish training for attendant-nurses which would
enable them to be eligible to take the licensure examination failed
despite the fact that a Curriculum Guide for Inservice Training of
Attendant-Nurses was developed by the Inservice Instructors and had the
support and approval of the Department's Director.

(SEE APPENDIX G . )

The Curriculum Guide consisted of an eighty hour Orientation
Section, the two sections titled Fundamentals of General Nursing and
Fundamentals of psychiatric Nursing, each of two hundred and forty
hours duration.

Specific recommendations for implementation included

establishing training wards and assigning the employees in training to

89

the education department during the training period.

Although it was

intended that all institutions in the Department of Mental Health
follow the guide there was ample opportunity to vary the emphasis of
the curriculum or alter the number of hours devoted to a particular
subject area depending upon the training needs of the specific insti­
tution or sub-section of it.

In the preparation of the guide the

Suggested Curriculum for Inservice Training of Psychiatric Aides,
prepared by the Michigan League for Nureing*s Sub-Committee for
practical Nurse and Psychiatric Aide Education was utilized because
the curriculum was used by the Michigan Board of Nursing as the
standard for accrediting nursing programs preparing students for
licensure.
The failure of either inservice or pre-service training programs
to develop was due in part to the fact that the Michigan Civil Service
Commission did not recognize the licensed psychiatric attendant-nurse
by establishing a position classification for the group that was at a
pay level above that of the untrained or partially trained attendantnurse.

Neither did any institution in the Department of Mental Health

ever implement the level of training recommended in the Curriculum
Guide for Inservice Training of Attendant-Nurses.

There were several

reasons for the failure, amongst them being a continually decreasing
interest on the part of the Department of Mental Health administrators
and many of the Medical Superintendents.
In 1967, a letter to the Superintendents of the Michigan insti­
tutions for the mentally retarded stated that:

"As our institutions

move toward specific defined program areas which reflect actual program
content and activities, there is a commonly recognized need to provide

90
inservice training for the clinical program staff personnel (program
aide) for development of those understandings, attitudes and behaviors
necessary to promote effective programming and care of the mentally
retarded.

Specific inservice training is needed for program staff

personnel within each clinical program.

Our present State Curriculum

Guide for Inservice Training of Attendant-Nurses which has been used
in the past as a base for training does not suffice to meet present
needs."

The letter further announced that the program consultants

of the Department of Mental Health in the areas of nursing, special
education, psychology, social work and activity therapies had started
to develop a curriculum guide for inservice training of one of the
program areas into which the retarded institutions had been divided.
The ultimate results of this endeavor was the completion of a cur­
riculum for one program when, due to the untimely death of Dr. Deiter,
the project was not completed.

The curriculum developed for the Growth

apd Development program staff placed much more emphasis upon the
retarded youngster as a living, growing, learning individual and
contained a specific unit on behavioral modification.
In 1968 the Michigan Civil Service Commission announced an
additional classification level with an increase in wages for attendantnurses.

It was described as a merit promotion for those who had

become skilled at their work.

The objective criterion used to make the

determination as to whom should be promoted was whether or not the
individual had completed one hundred and fifty hours or more of

28

Letter from John B. Deiter, Ph.D., Assistant Director of
Michigan Department of Mental Health for Research, Planning and
Development and Evelyn Provitt, R.N., Associate Nursing Consultant,
April 20, 1967.

91
approved inservice training.

At the Mt. pleasant State Home and

Training School, a survey of the hours of inservice training attained
by each attendant-nurse revealed that of three hundred and eighty-nine
employed, two hundred and fourteen had sufficient inservice training
hours to be eligible for a raise in classification level and a pay
increase.

Of this total, ninety-two were Licensed psychiatric

Attendant-Nurses.

As a result of the Civil Service ruling an

intensified inservice training was instituted.
A 1972 survey of the curricula presently being followed in the
inservice training programs for attendant-nurses in Michigan's
institutions for the mentally retarded reveals that very little change
has occurred during the past decade.

The most significant difference

is in the area of curriculum content with units of study such as
Individualized Resident Programming, Human Growth and Development,
Behavioral Management, Behavioral Modification, Nursing Supervision
and Management and Fundamentals of Supervision appearing for the first
time.

Also there is an over-all decrease in the number of training

hours being allocated to the Fundamentals of Nursing.
The amount of time being devoted to the training of the attendantnurse has increased with the latest report showing that the several
training programs range from one hundred and twenty hours to two
hundred and forty hours.

The average number of hours utilized for

training in the reporting institutions was one hundred and ninety
hours.
Although the method of instruction has remained the same, that
is, mostly lectures except for nursing demonstrations followed by
return demonstrations there is a great difference in the disciplinary

background of the instructors, with physicians, psychologists, special
educators, and many others participating along with nurses.

In line

with this multidisciplinary approach to instruction is a noted change
in the reference and resource material being used.

CHAPTER VI

SUMMARY AND IMPLICATIONS

CHAPTER VI
SUMMARY AND IMPLICATIONS
Attendant-Nurse training in Michigan institutions for the
mentally retarded has made little progress in the seventy-eight years
since the Home for the Feebleminded and Epileptic opened at Lapeer.
Present day training, both in content and methodology, are totally
inadequate to meet the needs of retarded institutions that have
evolved from the expected specialized training sites as envisioned
by Samuel Gridley Howe, through the dismal period of custodial care
to the threshold of the implementation of dynamic developmental
programs that have expectations of providing the residents with an
opportunity to grow and develop to the maximum of their potential.
Through the entire time span institutions for the retarded have
existed, administrators, parents, governmental officials and
innumerable others have extolled the work of the Attendant-Nurse,
given recognition to the important role they play in the life of the
institutionalized retardates and acknowledged that they should have
better training.

However, despite the many accolades bestowed upon

Attendant-Nurses very little effort has ever been made to elevate
their level of training.
Changes in curriculum content have been reflective mostly of the
changes in personnel who have been responsible for the training of the
Attendant-Nurse,

initially, physicians served as instructors and

93

94
their lectures were modeled on the medical courses in which they had
participated.

Far too many times, the lectures and clinical presen­

tations were complex and technically beyond the understanding level
of the Attendant-Nurse.

With the advent of the nursing instructor,

content and method of instruction became nursing oriented.

General

nursing subjects with demonstrations, return demonstrations and
supervised practice became the predominant feature of the inservice
training.

The level of instruction, although less complex than that

of the physician, continued to be at a high academic level.

In recent

years, other professional groups, particularly those oriented in the
behavioral sciences, have played an increasingly important role in the
training of Attendant-Nurses.

They, like the physician and nurse,

have presented their parts of the training sessions in complex
terminology.

Throughout the entire time Attendant-Nurses have parti­

cipated in training programs, the instructors have expected the
trainees to adapt to their level of academic attainment rather than
making an effort to transpose their information to a level of
instruction more easy for the average Attendant-Nurse to assimulate.
Conditions of employment have had an impact upon the success or
failure of the inservice training of Attendant-Nurses.

At the time

the Lapeer institution was opened the rules and regulations stated that
the institution contracted for the whole time of the employee which
enabled the administration to hold classes in the evening after the
residents had been put to bed.

Even when the State Hospital Commission

reduced the daily hours of duty to twelve and later to eight hours
daily training classes continued to be held in off duty time.

However,

the Civil Service Commission ruled that all inservice training was to

95

be considered a part of the eight hour work day.

This rule made it

necessary to limit the number of Attendant-Nurses available for
participation in training sessions because they had to be taken from
resident care activities that were already understaffed.

Unavaila­

bility of personnel to participate in training because they were
needed to care for the retardates was as important determent as was the
lack of capable instructors.
During the early days of Michigan's first institution for the
retarded, its level of Attendant-Nurse training was comparable to that
which was being conducted in both general and mental hospitals.

How­

ever, in 1909 with the passage of Michigan's Nurse Practice Act, the
Michigan Home for the Feebleminded and Epileptic failed to conform to
the established standards set up for nursing schools.

The probability

is that, had a training school for nurses been begun it would have
suffered the same fate as the nursing schools at Kalamazoo, Pontiac
and Traverse City.

However, in 1957, the failure of the Michigan

Department of Mental Health and the Michigan Civil Service Commission
to provide an appropriate classification for the Licensed Psychiatric
Attendant-Nurse at a pay level above that of the Attendant-Nurse
probably did more to provide for the doom of the efforts of the
psychiatric Nurse Association of Michigan to acquire recognition and
status than any other one factor.
After more than seventy-five years of attempts to institute and
maintain meaningful inservice training programs for Attendant-Nurses
in the Michigan institutions for the mentally retarded it seems
reasonable to assert that the foregoing survey indicates that the
attempts have to be considered failures.

However, recent events in

96

the area of the training of Attendant-Nurses gives indications that
a new era is within the realm of probability just as it now appears
that a new and more promising era has begun for the mentally retarded.
After several years of procrastination Michigan, in 1971* decided
to participate in the Federal Government Medicaid program wherein the
State could obtain specified amounts of Federal monies for the patients
in institutions for the mentally retarded that required a skilled level
of nursing care.

In order to participate in the Medicaid Program and

receive reimbursement the State was required to meet certain standards
amongst which was the requirement of having one Licensed Nurse for
every seven Attendant-Nurses.

Not having sufficient Registered Nurses

and Practical Nurses to meet this requirement it was necessary to
count the previously rejected Licensed psychiatric Attendant-Nurses to
meet the stipulated standards.

As a result of this situation the

Psychiatric Attendant-Nurse Association, which had been in a state of
limbo during the latter part of the 1960*6, again became active.
They again sought recognition for their licensed status and in June
of 1973 the Department of Mental Health in conjunction with the Civil
Service Commission came forth with specifications for a career ladder
for personnel in the mental health field which gave Licensed Psychiatric
Attendant-Nurses recognition at a classification level equal to the
Licensed practical Nurse.
Concurrent with the above and as a result of the impetus
provided by the availability of Vocational Education funds from the
Federal Government several Michigan community colleges, as early as
1968, became interested in the training of individuals, at a technical
level, for careers in the mental health field.

This interest has

97

developed into actual programs at Wayne County Community College,
Mid-Michigan Community College, Oakland Community College and
Schoolcraft College for the granting of an Associate of Art degree

in the field of mental health.

The Mid-Michigan Community College

describes its program as follows:

'The Mental Health Technician

program is designed to prepare graduates for beginning positions in
the semi-professional occupations for employment in mental health
clinics, general hospitals, mental institutions and training schools
for the retarded and emotionally disturbed."

1

Two recent studies have, for the first time, realistically

focused on the performance and function of the Attendant-Nurse.
McBride demonstrated that institutional administrators reinforced the

traditional custodial care role of the Attendant-Nurse rather than
rewarding them for their contributions to the training of the mental
retardates in their care.

2

Rowland demonstrated that Attendant-Nurses,

with appropriate assistance, could effectively supervise higher
functioning institutionalized retardates as they aided lower
3
functioning retardates in the acquisition of language.
Despite the fact that inservice training of Attendant—Nurses in

Michigan has proven to be less than successful there is a hopeful

^
Traverse^ City:

,Mid-MichiganCommunity
College Catalog, 1972-7**,
Village press, Inc., 1972, p. *+6.

SlcBride, Hugh J., "The Differential Effectiveness of Two
Methods of Training Institutional Attendants in the Techniques of
Behavior Modification," (unpublished Ph.D. thesis, Michigan State
University, 1972).
^Rowland, Martha E. S., "A Study of the Use of Higher Functioning
Retardates as Language Acquisition Trainers of Lower Functioning
Retardates in Attendant Supervised Training Sessions in Institutional
Wards," (unpublished Ph.D. dissertation, Michigan State University,
1973).

98

outlook for the future.

The past several years has seen the beginning

of community college programs for the training of Mental Health
Technicians who will have the basic preparation to function in the role
now assigned to the Attendant-Nurse and be eligible to the licensure
examination to become Licensed Psychiatric Attendant-Nurses.

However,

in order to attract the graduates of the community college programs
to basic level institutional positions they must be given recognition
for their training by establishing appropriate classifications and
salaries.

Additionally, institutional administrators need to make

greater efforts to avert actions that reinforce the custodial
orientation of the Attendant-Nurse and give support to their partici­
pation in training of the retarded residents.

Also, of great

importance is the need for meaningful research that will demonstrate
the ways in which the Attendant-Nurse can become maximumally effective
in the care, training and rehabilitation of the populations of retarded
institutions.

SELECTED BIBLIOGRAPHY

SELECTED BIBLIOGRAPHY
__________, Annotated Bibliography on Inservice Training in Mental
Health, Washington, D. C.: U.S. Government Printing Office, 1969*
__________, A Proposed Program for National Action to Combat Mental
Retardation, Washington, D. C.: U.S. Government Printing
Office, 1962.
Bernstein, Charles, "Colony Care for Isolation Defective and
Dependent Case," The Journal of Psycho-Asthenics, Volume 26,
1921, pp. 43-59.
Bernstein, Charles, 'Training School for Attendants for the Feeble­
minded," Journal of Psycho-Asthenics, Volume II, 1907,
pp. 31-43.
Bicknell, E* P - , "Custodial Care of the Adult Feebleminded," Journal
of Psycho-Asthenics, Volume 1, 1896, pp. 51-63*
Cowles, Edward, "Nursing Reform for the Insane," American Journal of
Insanity, Volume 44, 1887, pp. 176-191.
Deutach, Alfred, The Mentally 111 in America, Second Edition,
New York: Columbia University Press, 1949*
__________, "Education of Idiots at the West," American Journal of
Insanity, Volume XII, No. 4, April, 1856.
Fernald, Walter E., "State programs for the Care of the Mentally
Defective," Journal of Psycho-Asthenics, Volume 24, 1919,
pp. 114-125.
Fernald, Walter E. , 'Thirty Years progress in the Care of the
Feeble-minded," The Journal of Psycho-Asthenics, Volume 29,
1924, pp. 206-21^“
Hallahan, Daniel p., Editor, Guidelines for the Preparation of Support
personnel, Ann Arbor, Michigan; The University of MichTgan, 1970.
Haskell, Robert H., "Mental Deficiency over a Hundred Years," American
Journal of Psychiatry, Volume 102, 1945, pp. 107-118.
Jamieson, Elizabeth M. and Mary Sewall, Trends in Nursing History,
Philadelphia; w. B. Saunders Company, 1940.

99

100
Kanner, Leo, A History of the Care and Study of the Mentally
fletardecT, Springfield",~ Illinois: Charles t . Tfiomas,
Publisher, 196*f.
Kuhl* an, F . , "One Hundred Years of Special Care and Training,"
American Journal of Mental Deficiency, Volume ^5, No. 1,
19^0, pp. 8-2*+.
__________, "Michigan Asylum for the Insane," Journal of insanity,
Volume 23, No. 4, April, 1857, PP* 291-305.
Mogridge, George, 'president*s Annual Address," Journal of PsychoAsthenics, Volume 11, 1907, pp. 33-35.
M. R. 68, The Edge of Change, Washington, D. C.:
Office, 1958.

U.S. Printing

Nowrey, Joseph E., "A Brief Synopsis of Mental Deficiency," American
Journal of Mental Deficiency, Volume *+9, No. 3, 19*+5,
pp. 3^2-357«
Parnicky, Joseph J. and Richard C. Ziegler, Inservice Training for
Attendants in Institutions for the Mentally Retarded,
Bordentown, New Jersey: Vocational Workshop, Edward R. Johnstone
Training and Research Center, 1965.
__________, Policy Statements on Residential Care, New York:
National Association for Retarded Children, 1968.
, Residential Care for the Mentally Retarded: An
Action Policy proposal, Washington, D. C-: U.S. Government
Printing Office, 1970*
__________, Rules and Regulations for Employees of the Lapeer
State Home and Training School, Lapeer, Michigan: Lapeer State
Home and Training School printing Department, 1959.
Stribling, Francis T., "Qualifications and Duties of Attendants on
the Insane," American Journal of Insanity, Volume 9, 1852,
pp. 97-103.
Wolfensberger, Wolf, Changing Patterns in Residential Services for
the Mentally Retarded, part IV, History and Development,
Chapter 5, The origin and Nature of our Institutional Models,
Robert B. Kugel and Wolf Wolfensberger, Editors, Washington,
D.C.: U.S. Government printing Office, 1969.

APPENDICES

APPENDIX A

Rules and Regulations

MICHIGAN HOME

• • i I o n t h e •••

FEEBLE-MINDED AND EPILEPTIC

Lapeer, Mich.

..1897..

Lapeer press Print.

RULES AND REGULATIONS
The Superintendent
The Superintendent being by law the chief executive officer of
the Home, is the head of the establishment.

He shall have the general

superintendency of the entire institution, and the direction and
control of all persons employed therein.
He shall superintend the preparing of bills of fare of the meals
served to the children and household.
He shall from time to time confer with the Steward and Matron
regarding the affairs of the institution, and furnish them with lists
of children whom he considers capable of working in their respective
departments.
He shall inquire into the condition of the inmates daily, or as
much oftener as may be necessary, and shall direct such medical, moral
and physical treatment as may be best adapted to their condition.
He shall keep a record of the name, age, ccn, place of nativity,
and residence, of each inmate, also as far as can be ascertained, the
date and history, and probable cause of his or her mental condition;
the time when received and when removed, and from what cause; together
with any results or statistics likely to promote the interests of
science and humanity.
He shall keep a record of the names and residences of all persons
employed in the institution, with the time and terms of their re­
spective engagements, and if discharged, the date and cause.
101

I
102
He shall, if requested, at each visit of the Board of Control
exhibit the records of the institution, and inform them minutely of
its affairs, making Buch suggestions as he may think the interests of
the institution may require.

He shall prepare for the Board of Control

an annual report, in which he shall show the history, progress and
condition of the Home, and the success of the attempts to educate and
improve the Feeble-minded and Epileptic.

He shall receive and answer

all communications relating to the concerns of the institution and
keep a record of all correspondence.
The Steward
The Steward shall have the superintendence of the farms, stables,
barns, gardens and grounds, together with the furniture, horses and
stock, and all supplies of clothing and food for the institution, under
the direction of the Superintendent.

He shall have charge of the store­

rooms, under the general direction of the Superintendent, and be re­
sponsible for the safe-keeping and economical distribution of stores.
He shall issue no supplies except on requisitions approved in
writing by the Superintendent.

He shall keep accounts of the house

expenses, of the income derived from the inmates for their maintenance
and from all other sources separately, which accounts, with other
records of the institution, shall at all times be open for examination
by the Board of Control.
He shall see that all of the departments under his supervision
are kept clean and in good order, and that all employees perform their
duties faithfully, reporting to the Superintendent any instance of
neglect or misconduct.
During the temporary absence of the Superintendent, he shall, so

103
far as practicable, have control of the affairs at the Home, unless
the Board shall direct otherwise.
All leaves of absence of outside employees, granted by him should
be reported to the Superintendent.

He shall receive and answer all

communications relating to the business affairs of the institution
entrusted to him, and shall keep a record of such correspondence.
The Matron
It shall be the duty of the Matron to act with the Superintendent,
be subject to his authority, direction and advice, and maintain good
discipline and economy.

It shall be her duty to exercise a motherly

supervision of the children.

She shall, under the general direction of

the Superintendent, have charge of the entire domestic arrangements of
the institution, and shall see that all departments are kept clean and
in good order.
She shall have the supervision of the cooking for the inmates
and household, and of the regular distribution of food to the several
dining rooms, at such hours as the Superintendent shall direct; also of
the sewing and mending rooms and laundry, and all employed therein.
She shall, unless the Superintendent for sufficient reasons other­
wise orders, have the right of visitation of the hospital at all times.
She shall furnish employment for such children as the Superin­
tendent considers capable of working in the departments.

She shall

assign the duties of the Assistant Matrons, who shall always be under
her direction.
Assistant Matrons
The Assistant Matrons in charge of a particular building shall
have entire charge of the domestic economy thereof, subject to the

I
I

104
direction and control of the Superintendent and the Matron.
principal Teacher
The principal Teacher shall from time to time classify those
children whom the Superintendent considers capable of receiving in­
struction, and for that purpose she shall provide training, kinder­
garten and primary schools.
She shall assist in teaching, and perform such other appropriate
duties aB the Superintendent assigns to her.

She shall, subject to the

approval of the Superintendent, make such rules and regulations for the
government of the schools, as shall best serve the interests of the
same, and from time to time make such recommendations as may lead to
improvement in her department.

She shall present semi-annual reports

of the condition of the schools, at the 1st of June, and 1st of
December.
As to the mental condition of the children in the schools, she
shall confer with the Superintendent and be guided by his advice.

He

shall, at her request, make the necessary examinations of the children
as to their condition and ability to receive instruction.
Assistant Teachers
They shall be under the direction of the Principal Teacher, whose
instructions they shall receive and carry out in all things pertaining
to the teaching of the children, and shall discharge such other duties
as the Superintendent may assign them.
Attendants
The duties devolving upon Attendants are arduous and responsible,
requiring great self-denial, severe schooling of temper and dispo­
sition; and all accepting such positions are expected to perform their

duties cheerfully, zealously, and promptly, and in no case shall they
be allowed to punish inmates, but must report any misconduct to the
Superintendent.

Under all circumstances the law of kindness must be

the governing one; other qualifications will be of little value, if
the disposition to carry out this law is wanting.
The Attendants have charge of the children out of school hours,
and when not transferred to some special department, each Attendant
having the care of a group, over which he or she is to preside;
teaching, guiding and directing with patience.

They shall see that

the children rise at the designated hour, and are properly washed and
dressed.
The more advanced children may assist in this work, but the
Attendant must superintend all such help.
Attendants shall preside at meal hours, watch and direct their
play time, see that they are prompt in responding to school and work
hours, or such other duties as may be required.

In the dining room

they must maintain good order, instructing the children in proper modes
of eating, drinking and sitting, for at no other time of the day can
the children receive such important lessons in order and propriety.
Talking is not to be allowed, and the children must be kept in their
seats at the table for at least one half hour.
After meals, and on arising and going to bed, (sometimes oftener),
the Attendant of each group of children must take them to the water
closets to prevent accidents to bedding and clothing.

Untidy children

must be kept clean and dry at all times, and all soiled clothing be
sent at once to the laundry.
There are times when the charge of large groups of children is

106
thrown upon one or more detailed Attendants, and no ill-will or preju­
dice against each other must in such case affect any one in the care of
children belonging to another.

Attendants will be expected to be

always neatly dressed in uniform when on duty.
They shall instruct the children to kneel at their bedside every
night and morning to utter some simple prayer.

Dormitory rules will be

regulated by the Matron, and all needs of the children are to be re­
ferred to her.

Attendants shall have one-half day off duty during the

week, and part of Sunday.
The Engineer
The care and oversight of the engines, boilers, machinery, appli­
ances for fire protection, pumping apparatus, heating and ventilation,
tanks, sewers, steam cooking apparatus, laundry apparatus, water,
steam and electric supplies, are committed to the Engineer.
He shall not permit anyone to enter the boiler, engine or ma­
chinery rooms, without an order from an officer, or upon a necessary
errand.

He is made responsible for the proper conduct, punctuality

and fidelity of his assistants.

He is expected to devote his whole

time tc the institution, and to regulate his hours according to the
necessity of the case.
He shall keep an accurate account of the time and service of
those who work under hiB direction, and report monthly in detail the
object to which all labor has been applied.
Night Watchman
The Watchman shall call at the office every evening to receive
any particular orders for the night.

His hours of duty will begin at

seven o'clock p.m., continuing until seven o'clock a.m., the following

10?
day.

During the night he must be faithful and vigilant, making as

little noise as possible.

He must be especially careful to guard

against danger from fire, the least suspicion of which in any part of
the institution should excite his immediate attention.

He shall visit

the lower halls of all buildings as often as required during the night,
shall attend to the fires in the kitchen, etc., as directed by the
Superintendent or his representative.
It is the duty of the Watchman to guard during the night against
violations of rules of the institution, and report such violations to
the Superintendent in the morning.

He must see that no unnecessary

lights are burning, and report employees who leave their roomB without
turning out their lights.

In fact, attend to all duties at night for

the safe care of the inmates and employees.
The Farmer
The special care of the farm, garden, barns, farm teams etc.,
utensils, stock including hogs, cows and poultry, is assigned to the
Farmer, under the general supervision of the steward.
He

shall see that tools, harnesses, etc. are kept in good order

andrepair, and that nothing is lost.

He

shall also keep an accurate

account of the time and service of those who work under his directions,
and report monthly in detail the object to which all labor has been
applied.

He is required to devote his whole time to the service of

the institution.
Neither he nor his assistants may absent themselves from duty
without the knowledge of the Steward.
No
or to be

institution property of any kind is to be taken from the farm
used for private purposes except by special arrangement in

108
each case.

If additional farm labor is required, the Farmer shall

report to the Steward for authority to employ the same.
General Rules
1st.

Do not gossip.

The doings and mishaps of the Home must be

kept as private as in any well ordered home.

The affairs of the insti­

tution or its officers are not to be discussed by employees either in
the institution or outside.
This rule must not be violated under pain of dismissal.
2nd.

It must be distinctly understood that the Home contracts

for the whole time of all employees, and that they are not to leave the
premises, or their assigned duties, nor to engage in work of their own,
without express permission from the proper authority.

They must expect

an unceasing observation of the manner of performing their respective
duties, and kindly receive and promptly heed every suggestion in regard
to deficiencies or improvements.
3rd.

All employees are expected to perform with cheerfulness and

to the best of their ability, all duties which may be assigned them;
and at all times or in all places to do what they can to promote the
comfort and happiness of the children and the prosperity of the insti­
tution.
They are expected to feel a sufficient personal interest in the
welfare of the Home and its inmates, to be ready and willing to respond
to a call from the Superintendent or his representative, to any duty
which an emergency might necessitate.
kth.

They are expected to fulfill their engagements scrupulously

as to time of service; and no one shall discontinue service without
giving four weeks notice to Superintendent or steward.

When the

109
institution wishes to dispense with the services of any one, the same
notice will be given, except in the case of persons discharged for
violation of rules, or improper conduct.
5th.

It is distinctly and positively enjoined chat the rule of

government is that of kindness, and no severity towards the children
will be tolerated.

Corporal punishment is never to be inflicted,

except by the Superintendent, or in his absence, his representative.
All tantalizing, striking, etc., are strictly forbidden.
6th.

Employees must treat the children, each other, and any one

having business at the Home, with kindness and courtesy, as in order to
teach the children to be kind, obliging and respectful, they must be so
to each other.

Cheerfulness is always to be desired, but levity and

boisterous conduct are forbidden.

Especially avoid making any noise

that may disturb the children after they have retired.
7th.

Refrain from all recital of grievances, and conversation

of an objectionable nature, at the table, at work, or before the
children.

If you cannot, as a rule, be cheerfully prompt and

responsive to reasonable demands made upon you, forbearing with the
children and each other, you arc net fitted for a position in this
institution.

Guard well your language and temper; swearing will not

be permitted.

By each one attending strictly to his or her own

affairs, much trouble will be avoided.
8th.

While it is desired to give as much relaxation as possible

to those who perform their arduous duties well and faithfully, yet
when the absence of any one connected with the institution is likely
prejudicial to its interests, ALL will be expected to remain on duty.
9th.

Every employee is responsible for the children under his

110
or her care, and ia expected to be able at any moment, to say where
each child is, or into whose charge he or she has been given.

No child

is to be taken from the cottages for work or for any purpose or by any
one without mentioning the fact to the attendant in charge.

No child

is to do sewing or other work for the private benefit of employees,
unless by special permission from the proper authority; and the
children are not to go to the rooms of employees without permission.
10th.

Employees must not write to friends or relatives of the

children unless authorized to do so by the Superintendent, and all
letters to be submitted to him.

Neither must they accept any fee or

reward from friends of the children.
11th.

The children must be protected from the idle curiosity of

visitors, and do not report their names or pecularities in the presence
of strangers.
12th.

All employees will be held personally responsible for the

cleanliness, good order and general appearance of their respective
apartments, and must be prepared at all times for their inspection by
the Superintendent, Matron or detailed officer.
15th.

Male employees are forbidden to enter the buildings occu­

pied by females without permission from the Superintendent or Matron.
All company to be entertained in the public sitting room or other place
designated by the Matron.
l^th.

Do not loiter in places where you are not regularly

employed; if you have business to transact, attend to it promptly and
return then to your own department.
15th.

Employees when at leisure must not visit other employees

who are on duty.

16th.

Do

grounds, and do
17th.

not throw anything from the windows, or about the
not allow it to be done.

Take no furniture or any other institution property from

one room to another without permission from the proper
l8th.

Do

authority.

not invite your friends to take a meal with you, with­

out previous permission from the Superintendent, or his representative.
The Matron to be always notified of any guests in the institution.
19th.

All persons employed in any capacity upon the premises,

whose duties are not specially defined here, will nevertheless be
expected to conform to the general spirit of the rules in every par­
ticular.
20th.
the office.

When going off duty, employees must leave their keys in
The hour for closing the institution for the night is

10*30 o'clock, at which time the doors will be locked.
Visitors
The institution will be open to visitors on Wednesdays from two
to four p.m.

Friends of the employees are requested, as far as possi­

ble, to confine their visits to these hours.
as a day of rest and quiet.

Sunday shall be observed

Me visitors to be admitted, without

special permission.
Vacations
At the expiration of a full year, a vacation of two weeks is
allowed employees who work by the month, except those whose positions
cannot be filled by substitutes.
their duties will permit.

Such employees may have time off when

Teachers will be allowed one month vacation

(with salary) during the summer school closing.

112
Rules for Bathing
1.

Every innate is to be bathed as soon as possible, after

admission, and the hair combed with a fine comb.
2.

Inmates shall be bathed at least once a week, at such times

as designated by the proper officer, and as much oftener as may be
necessary to keep the body clean.
3*

In preparing a bath, the cold water is always to be turned on

first, and then the temperature of water raised to a point not above
98, and tested before the inmate enters the tub or shower.
4.

Before the child enters the bath, the temperature

is to be

ascertained and is not to be less than 88 degrees, nor above 98 degrees.
Older children may assist in bathing the younger and more helpless
ones,

but never except when an attendant is present.
3*

The bath tub is to be emptied and cleaned after each child.

Two children are never to occupy the bath at the same time.
6.

The body of each child is to be carefully cleansed and

thoroughly dried, after which the clothing is to be put on as soon as
possible.
7.

Any marks, bruisss, sores, pain or evidence of disease of any

kind, complained of by the child or noticed by the attendant, must be
reported as Boon as possible.

8.

At least one hour must follow a meal, before bathing.

After

the bath the finger and toe nails are to be trimmed.
9.

Shaving and hair cutting of older male inmates, to be done by

male attendant at stated times.

APPENDIX B

THE PHYSICAL CARE OF CHILDREN
(A talk to Attendants.)

LOUISE PATTERSON, M.D.

VINELAND TRAINING SCHOOL BULLETIN

VOLUME V

October, 1908
Pages 12-14

THE PHYSICAL CARE OF CHILDREN
(A talk to Attendants.)
Louise Patterson, M.D.
You have probably heard it said of the feeble minded, that on
their arrival in this world, they find an environment entirely unsuited
to them.

Allow me to carry that a step further, and say that the ma­

jority of children who are born find an environment and conditions not
only unsuited to them, but absolutely injurious and detrimental to
their existence.

I have only to tell you that 50# of all children born

die before they are 5 years old, and that 30# of those who die, die
from indigestion in some form, to give you the idea of the scope of the
lack of knowledge as to the physical care of the child.
It does seem to me as if those to whom some special glimmer of
light comes through the darknesB should "Cry aloud and spare not" that
these little ones may be cared for by the most improved and rational
methods.

If we have been in the line of this light belt, let us "Let

our light so shine" that the darkness may be dispelled.
This subject of physical care divides itself naturally into two
headings.
1.

The care during health.

2.

The care during disease.

The first will be the principal topic of this talk.
The physical care of children duringhealth
a.

The Choice and Care of the child's

b.

The Care of the child's body.
113

issubdivided into

home and diet.

Ill*
In an institution it will be necessary, of course, to take the
homes as you find them, and do the very best you can with respect to
cleanliness, fresh air, sunshine, heat, etc.

The subjects of sani­

tation and ventilation should be dealt with at some length, but just
here let me tell you that scrupulous cleanliness in every respect is
very necessary in the care of all.

I cannot at present think of a

much more dangerous thing than dust, just because it gets mixed up
with the excreta from the body and is blown about.

The careless child

flops its duster here and there, scattering and not gathering up the
little elements of danger.

A sink that emits an odor, or a toilet that

is stopped up is dangerous and needs reporting and rapid action.
air is very necessary.

Fresh

We can live *+0 to 60 days without food, l*t or

more days without water, but we die in a few minutes if the whole
supply of air is cut off.

Nearly all of our cottages are ventilated

when the fan is running and the register open.
Sunshine is God's disinfectant, and is necessary to the growth
and development of children.

A plant set back in the room will become

white and sickly, spindly if you please.

A child kept out of the fresh

air and sunshine will grow white, weak and spindly.

If you wish to

keep your children well, keep them out all possible.
Heat is much more dangerous than cold.

A temperature of 85 is

more to be feared than a temperature of 60 or even lower, but the
great danger lieB in sudden variations of temperature, such as having
a child in a day room with a temperature of 80 and taken to a dining­
room where the temperature is 56 or 60.

If the heat cannot be kept

from 65 to 72, every effort should be put forth not to let it get above
70, or even to keep it lower.

There should be a thermometer in every

115
day room, dormitory, dining-room, etc., and these should be consulted
and an effort made to keep them as near right as possible.

Heat is

more dangerous than cold.
Now as to the care of the bodies.

Allow me to remind you that

you take the place of the parent to the most unfortunate class of
children in the world.
some mother's boy.
to keep him."

As you look at the helpless one, think "he is

I will do my best for her sake.

She had no place

Little we know how many Gethsemenea have been gone

through by the parents of these children!

Little do we know of the

heart-rending cries of the fathers and mothers as they give us the
afflicted one, committing it to our tender care with a heartache that
I hope we may never feel!

Ah, my friends, when they come to us we muBt

take up the threads of responsibility concerning the care of their
bodies and weave a web of happiness, helpfulness, and love into their
little darkened lives!
How does the mother heart care for them?
properly clothed day and night.

She sees that they are

If it is too cold, she puts on an

extra blanket or heavier underwear; she sees that the shoes and stock­
ings are heavy enough and uholc; chc eccc that the clothing is buttoned
on properly, that the buttonholes are so they will hold the buttons,
she sees that they have the proper amount of food at each meal, and is
solicitous if they will not eat, taking them to the doctor; she sees
that the skin is kept clean and in a healthy condition, also that the
teeth are d e e m e d at least once a day, that each child has his own
tooth brush; she sees that nature's wants are attended to, and at the
first disturbance in that direction, she reports at once.

She is very

anxious that the child should have exercise in the fresh air.

If a

116
child is restless at night and wakeful, but is not sick, I know of no
better medicine easier to administer than a long walk in the air, a
rapid walk, till the child gets comfortably tired.

Sometimes a glass

of hot water at bedtime will induce sleep.
The mother is very careful on wet days about the feet.

Usually

the head can be wet and there will be no trouble, but if the feet are
wet, there will be danger.

I believe it would be wise to report wet

feet, and if found, to rub vigorously.

It would only take a minute

and might save a weeks work in case the child got pneumonia.
In case of a spasm, the child during the attack should be laid
down and the clothing at the throat unfastened.

Indeed, it is best not

to have tight clothing on a child addicted to spasms.
takes a couple of minutes before anyone can get there.

Sometimes it
It is also

best to allow them to sleep for a time after a spasm.
When the children are outside, it is wise to play with them.
makes them happy, and makes better blood, muscle and bone.
makes the whole body better.

It

In fact, it

The child that is sluggish should be

encouraged to move at least, but not be dragged around because some
serious injury might be done.
About the eyes, nose and ears, children need to be restrained
from putting foreign substances into these places.

And the ears, nose

and eyes should be kept clean, and the doctor called if there is some
foreign matter in them.

As often as practical, the bodies should be

looked at for boils or sores, and these reported.
Many of these children have a mania for eating trash.
strain such.

Try to re­

Leaves, limbs of trees, acorns, toad-stools, paste-board

boxes, and corn husks ore hard to be dealt with and will either kill or

117
cause seriouB danger to health.
Corns are the better for being filed down once a week at least,
and the nails kept trimmed.

Ingrowing nails are very obstinate, and

if they get sore should be noticed by the doctor.

Such nails are the

better for being scraped thin on the centre of top, or cut with a nick
in the centre.
is great danger.

Broken shoes should receive attention at once, as there
Keep the feet warm if you would avoid trouble.

Try to make the child happy.

Upon this depends so much.

The

food will digest better and more rapidly, the blood will circulate
more freely, if the unfortunate one feels that at last he has found a
home and a mother heart to whom he may go for guidance, or help in all
his troubles.

APPENDIX C

C U R R I C U L U M

Recommended by

THE MICHIGAN STATE BOARD OF
REGISTRATION OF NURSES

to the

TRAINING SCHOOLS

ia the

STATE OF MICHIGAN

THE MICHIGAN STATE BOARD OF
REGISTRATION OF NURSES
issues the following curriculum as a standard for the guidance
of training schools for nurses, and the same shall be considered
the minimum of instruction to be given to comply with the law.
November, 1910

118

CURRICULUM
The period of instruction in the training school shall be not
less than two full years, and said two years to be devoted entirely to
hospital training.
The Course will be divided as follows:
Probation:

Two months.

preliminary work.)

Junior term.

Preliminary Work:
First Week:

(The first two weeks of this time for
Senior term.

Two weeks.

Talks on care of rooms; carc of bathrooms; utensils

and their uses; practical work in caring for pupils* rooms and bath­
rooms.

Sweeping and dusting, one hour daily.

Talks on hospital

routine, rules and ethics of nursing, one hour daily.
making, demonstrations of same, one hour daily.
and serving of food, one hour daily.
on bathing, one hour daily.

Talks on bed-

Preparation of trays

Talks on bathing, demonstrations

Talks on pulse, respiration and temperature,

practice in taking same, one hour daily.

Study hour, one hour daily.

Recreation time, two hours daily.
Second Week:

Care of patients' rooms, one hour daily.

linen and linen room, one hour daily.
less patients, one hour daily.

Care of

Serving trays and feeding help­

Talks on simple disinfectants and their

use, practical demonstration of the same, one hour daily.
with patients in bed, one hour daily.
Recreation time, two hours daily.

119

Bed-making

Study hour, one hour daily.

I
120
At the end of this two weeks, the probationers go to the wards
and are required to continue this training by practical work.

At the

end of two months, if accepted they become pupil nurses and are given
their uniforms.

No probationer shall be allowed to catheterize patients,

care for patients recovering from an anaesthetic, administer drugs or
in any way care for critical cases.
Nursing:

Practical work and instruction begin with the day of

one’s entrance into the school and are continued throughout the course.
One rule that must always be adhered to iB that every duty shall be
made familar to the pupil and that the performance of it shall be under
the supervision of the Superintendent of Nurses, her assistant, or a
eenior nurse, until such time as the pupil may consistently undertake
the responsibility of it herself.

Thus, by classes, demonstrations

and bedside clinics, all the work and responsibilities are anticipated
that later will be assigned the nurses in their regular duties.
PRACTICAL WORK FOR THE JUNIOR YEAR.
The following are some of the subjects demonstrated during the
first year, many of them offering material for one or more lessons:
household sanitation; personal hygiene; bed-making; general order of
the ward; points in making patients comfortable; pulse, temperature
and respiration; hydrotherapy, sponging, packs, hot and cold, tubbing,
in bed and bedside; use and care of ice coil, ice cap, ice bag, hot
water bottle, air cushion, rubber gloves; charting; care of the dead;
gastric lavage; gavage; enemata; fomentations; stupes; handling of
sterile supplies; giving of medicines; making solutions; giving hypo­
dermics and care of instrument; counter irritants, poultices, plasters,
cupping, use of iodine; positions and draping of patients for

l
121
examination; surgical cleanliness, disinfectants; catheterization;
douches,.vaginal vesical; preparation of patient for operation; care
of patient after operation; care of dressing-room and its supplies;
surgical preparation of supplies; of patient; fractures; bandaging.
LECTURE COURSE:

JUNIOR YEAR.

Lectures in Hygiene and Sanitation, 6; Bacteriology, *+; Materia
Medica, 8; Anatomy, 6; physiology, 6; Urinalysis, 3, Dietetics, 4:
(1) Foodstuffs and their classification, (2) Principles of Cooking,
(3) Beverages:

Milk, etc., (*♦) Serving of Food, Combinations of Food,

and 12 lessons in practical demonstration in diet kitchen.
Written examinations to be held at the end of each course of
lectures.
SENIOR YEAR.
Surgical Nursing and Gynaecology:

Practical demonstration:

Use

of antiseptics; aseptic, disinfectants, germicides, deodorants;
sterilization by heat and chemical agents; nurse's technic in preparing
sterile dressings and utensils, in assisting at surgical dressings,
and in preparing for and during operations; the preparation of the
patient for the operation and after care; the preparation for gynae­
cological examinations and the positions for the same; the application
of splints and extension.
Qbsterical Nursing:

Nurses should be required to care for at

least 6 cases of confinement both during and following labor.
The practical lessons should include:

the preparation of room

and patient for normal labor; the preparation of patient for different
positions for examination or delivery; after care and treatment; the

122
massage and treatment of the breast; the application of the breast
binder.
Nursing of Infants:

The practical lessons should include:

Method

of bathing; the baby's first bath; the special care of the baby's eyes,
nose, mouth and genitals; the care of the skin; the preparation of the
baby's food; artificial feeding; the care and handling of bottles,
utensils, clothing, etc.
Bandaging:

The practical lessons should include:

bandages,

use, material, methods of making, spiral, figure of eight, reverse, arm,
elbow, Bhoulder spica, hand bandages, finger and thumb spica, foot and
leg, head and eye bandages, binders of various kinds, plaster of Paris
bandages, splints.
Methods of Instruction:

The demonstrations and clinical teaching

in the wards shall be given by the Superintendent of Nurses, her
assistant or senior nurses.

The classes should recite regularly and

written quizzes should be required frequently.

Occasional lectures on

special subjects (like the eye, ear, nose and throat) should be given
the entire class during the course.
LECTURE COURSE:

SENIOR YEAR

Lectures in Surgery, 6; Gynaecology, 5» Obstetrics, 6; Medical
Nursing, 6; Nursing Sick Children,
Diseases, 4; Anaesthetics, 2.

Infectious Diseases, 6; Nervous

Each lecture is to be preceded by a

quiz of fifteen minutes.
Final examinations at close of school year.

The following are a few suggestions regulating the work of the
Training Schools, which the Michigan Board of Registration of Nurses
believes should be carried out by the hospitals.

123
(1)

Special hospitals should affiliate with general hospitals,

for the work which they are unable to give their pupils, in order to
be recognized by this Board.
(2)

All training schools should keep an accurate record of each

pupil's qualification, class work, examinations and time spent in each
service.
(3)

Whenever practical, the lectures and classes should be held

during the day, instead of evenings.
(*0

In the two years' course, the class work should be not less

than eight months in each year.
(5)

Continued and special instruction should be given throughout

the course in Dietetics, Hygiene, Obstetrics and the Nursing of Sick
Children, as these subjects in the past have not been given sufficient
attention.
(6)

All hospitals maintaining training schools should employ a

graduate nurse, who holds a diploma from a reputable training school
(preferably a registered nurse) to teach and supervise all practical
instruction.

124
List of Text Books Recommended for Use in the
Training Schools for Nurses.

Anatomy and
Physiology:—

Anatomy and Physiology. . . . . ..........
Anatomy for Nurses. . . . . ..............
Anatomy and Physiology for Nurses ........

Bac teri ology:—

Bacteriology for Nurses ..................
Bacteriology in a Nutshell................

Care of Infants
and children;— Care of the Baby..........................

. Griffith.

Dietetics;—

Dietetics for Nurses.......... Friedenwald
Diet in Disease ..........................
How to Cook for the Sick..................
Hand Book of Invalid Cooking..............

and Ruhrah.

Ethics;—

Nursing Ethics............................

Gynaecology and Obstetrics for Nurses ....................
Obstetrics;—
Obstetrics and Gynaecologic Nursing . . . .
Hygiene;—

Hygiene for Nurses........................
Personal Hygiene..........................

Materia
Medica;—

Materia Medica for Nurses ........ . . . .
Materia Medica for Nurses ................
Quiz Compends on Materia Medica ..........

Mental and
Nervous
Disease:—

Nursing the Insane........................
psychology and Mental Diseases............

Nursing:—

primary Nursing Technique .................... Me Isaac.
Practical Nursing .................. Maxwell and Pope.
Nursing— Its Principles and Practice............ Robb.
Clinical Studies for Nurses . . . .Charlotte A. Aikens.

Surgery;—

A Nurse's Guide for the Operating Room. - .

Urinalysis;—

Guide to Examination of Urine ............

Dictionary;—

Medical Dictionary

Gould.

APPENDIX D

MICHIGAN BOARD OF REGISTRATION OF NURSES
AND TRAINED ATTENDANTS

SCHOOLS FOR TRAINED ATTENDANTS

REQUIREMENTS AND
COURSE OF INSTRUCTION

March 18, 1928

SCHOOLS FOR TRAINED ATTENDANTS
REQUIREMENTS
Schools for training of attendants may be established in a hospital
or sanitarium having no training school for nurses.
Schools for training of attendants must be inspected and approved
by the Michigan Board before students are admitted.
The course of training shall not be less than nine months or more
than one year; practical nursing experience to cover at least
six months as required by law.
The school must be conducted bya registerednurse,
who is
qualified to teach the students elementarypractical nursing
procedures, preparation of diets for the sick, and to hold
such class instruction as may be outlined by the Board.
Suitable room must be provided for claBBes and practical
demonstrations.

A record must be kept by the School of each student's class and
practical work as follows:
(a)
(b)
(c)

(d)
(e)
(f)
(g)
(h)
(i)
(j)

Name and address.
Date of entrance.
Age.

preliminary education.
physical condition.
Number
of
classes held weekly in each subject*
Number
of
hours given weekly to practicaldemonstrations
of nursing methods.
Grades
on
each written examination.
Number of weeks in caring for patients in different
services.
Grades on practical nursing performed in the demonstra­
tion room and in the sick room.

Time on regular duty should average about 5^ hours weekly.
Sanitary and hygienic living accommodations must be provided for
the students. This refers to sleeping hours, hot and cold
water supply for bathing purposes and proper food.
Uniforms should be plain and should not duplicate uniforms of
students in accredited training schools for nurses or include
a nurse's cap.

126
9«

It is the opinion of the Board that certificates of graduation
issued to attendants should be uniform from all schools; to be
worded similar to sample on last page of thiB leaflet. School
pins are not a necessity as a requirement of the Board of
. Registration of Nurses and Trained Attendants.
REQUIREMENTS FOR ADMISSION TO A SCHOOL
FOR TRAINED ATTENDANTS
(a)

(b)

(c)

Age:

19 years and 3 months for a course of 9 months.
19 years for a course of 12 months.
(Applicants will not be admitted to examination
until 20 years of age.)
Education: Eighth grade or equivalent. Applicants
having two years high school or equivalent
should be encouraged to enter a school
for nurses.
Moral and physical fitness.
MINIMUM COURSE OF INSTRUCTION FOR
THE TRAINING OF ATTENDANTS

1.

The course of instruction should cover the entire period of
training which, according to law, may not be less than nine
months; six months of which to be spent in the actual care
of patients.

2.

The following outline for classroom work in theory and practical
demonstration will be considered the minimum requirement of
the Board. It is the opinion of the Board that the course
should be elementary and practical with emphasis on the latter.
This outline may be altered by the Board at its discretion:
Practical nursing demonstrations.....................6?
Household and Personal Hygiene.......................13
Elementary Anatomy and Physiology with
emphasis on physiology
13
Diet for the sick and in health including class
and practice c o o k i n g
30
Ethical Standards .................................
8
Total

hrs.
hrs.
hrs.
hrs.
hrs.

135 hrs.

The accompanying outlines must be covered fully.
The school may give additional hours on any subject as it desires.
The record of extra work must be kept ou file.
BOOKS RECOMMENDED FOR CLASS AND REFERENCE WORK
Delano— American Red Cross Textbook on Home Hygiene and Care of
the Sick.
American Red Cross on First Aid.
Henderson— ’Practical Nursing.
Dakin--Simplified Nursing.

f

127
PRACTICAL NURSING DEMONSTRATIONS
1.
2.

protection against infection: Care of hands, abrasions,
disinfectants, preparation of solutions.
Care of patients' rooms: Dusting, care of furniture,
ventilation, temperature.

3.

Care of bathrooms and utensils; care of utility rooms and

*t.

utensils.
Care of linen closet; care of patient's clothes closet;
listing patient's clothes.

6-7*
8.
9.
10.
11-12.
13.
lU.
15“l6.
17.
18.
19.

Care of medicine cupboard; care of diet pantries,
refrigerators, sinks, etc.
Bed making, with and without patient; ether bed, etc.

Daily toilet of patient; bed bath; foot bath; sitz bath.
Care of hair: Shampoo, larkspur cap.
Bed soreB; cause, prevention, relief of pressure, cleanliness.
Preparation of surgical supplies.
Taking pulse, temperature and respiration; care of clinical
thermometer.
Charting.
Administration of medicines.
Enemata:
Douches:

temperature.
Hot water bags.
Poultices:

20.
21.
22.

Care of equipment, kind of soap, temperature.
Care of equipment, strength of solution and

Linseed, mustard, etc.

Fomentations, compresses, counterirritants, mustard plaster,
iodine, etc.
Cold applications:
Ice bags, cold sponge, tepid sponge;
especial attention to temperature of cold baths.
Use of bed pan; after care of patient.
Care of infected stools, sputum cups, rubber sheets and
tubing.

23*
24-25.

Care of mattresses, linen and blankets.
Making patient comfortable in bed:
Bed rest, foot sling,
rubber rings, cradles, etc.

26.
27.
28.
29.
30.

Getting patient up in a chair.

Surgical positions for examination, treatment and drainage.
Splints, extensions, sand bags, etc.
Preparation of patient for medical examination.
Feeding helpless patients.
Special nursing care of pneumonia patients;

Pneumonia jacket,

temperature of room, supply of fresh air, position,
crisis, etc.
31.
32.
33-39.

Special nursing care of typhoid patient:

Care of excreta,

baths, observation of symptoms, hemorrhage, perforation,
etc.
Special nursing care of patients suffering from respiratory
and heart conditions.
Medical first aid emergencies; surgical first aid
emergencies.

128
40-5**.

55*
56.
57*
58-61.
62-63*
6*t-66.
67.

Obstetrics: Preparation for delivery, preparation of bed,
procedure during normal labor, procedure immediately
following labor, daily care of mother, care of breasts,
vulva dressings, application of binders.
Daily care of infant: Care of cord, prophylactic treatment
of eyes.
Special instruction on care of pre-school child.
Special instruction on modern care of tuberculosis.
Simple occupations for convalescents and children.
Bandaging: Roller, triangle, sling, plaster of paris, etc.
Laboratory specimens; Sputum, vomituB, feces and urine.
Urinalysis.
Rules and regulations of State Department of Health.
Care of the dead.
HOUSEHOLD AND PERSONAL HYGIENE
FOR TRAINED ATTENDANTS

1.

2.
3*
4.
5*
6.
7-10.

11-13*

l*t.
15.

Talk on health standards; Reasons for proper food, pure
water and fresh air, sufficient sleep, normal exercise,
care of hair, teeth, skin, hands and nails, proper
clothes and shoes.
Ventilation of room; temperature of rooms in health and sick­
ness; proper method of sweeping and cleaning; care of
flowers.
Hygiene of food: Care of contamination of food, milk, water,
ice, etc.; results of improper eating.
Care of refrigerator, sinks, cupboards, etc.
Hygiene of special senses including throat; first aid care.
Hygiene of generative organs:
Menses and common disorders.
Talk on venereal diseases:
Secure leaflets from State
Department of Health, Lansing.
Communicable Diseases; Obtain printed material from State
Department of Health. Teach prevention of these diseases
from hygienic viewpoint.
Laws on registration of births and deaths.
Function of local Board of Health.
Function of State Department of Health.
Factors in health problems:
Heredity.
Environment.
Education: General dissemination of laws of health.
Legislation: Housing code, labor laws to regulate hours,
wages and sanitary conditions; welfare laws to obtain
safety devices, etc.
Disposal of sewage and garbage in homes, institutions,
cities, villages and rural districts.
Sterilization, disinfection and fumigation.
Household hygiene: Care of toilets (seats and bowl); heating,
ventilation, etc.
Insects, vermin, flies, mosquitoes.

129
ELEMENTARY ANATOMY AND PHYSIOLOGY
FOR TRAINED ATTENDANTS
1.
2.
3.

Brief talk on bony framework of the body.
Various tissues, joints and cavities.
Talk on anatomy of the organs and location in various
cavities.
External division of the body. Definition of important terras.
5* Function of organs of respiration.
6 . Function of the organs of skin; itsappendages.
7* Serous, synovial and mucous membranes.
8 . Function of kidneys and bladder.
9-10. Function of heart, blood and lymph.
11-12. Function of digestive organs including liver and pancreas.
13- Functions and excretions.
14. Function of special senses.
15* Generative organs.
DIETS
Class
Instruction
Essential composition of food. Its relation to
growth, repair of the tissues of the body.
How to cook the foods which are classified as
proteins. Use of protein in the body
tissues— Eggs, meat, poultry, fish, etc.
Use of milk.
How to cook foods with high proportion of starch.
Use of starchy foods in the body tissues.
How to cook vegetables.
Use of vegetables in the
body.
Cellulose, vitamin, minerals, etc.
How to prepare fruit for serving.
Use of various
fruits and sugars.
Fats, oils and salads.
Proper place in dietary
for the well and for the eick=
Beverages— Tea, coffee, etc.
Liquid diets,
soups, gelatines, ice cream, etc.
Diets for typhoid, diabetes, nephritis,
tuberculosis, etc.
Preparation of milk for infants.
Additional
foods up to two years of age.

Practice
Cooking

2 hours

1 hour

hours

1 hour

3 hours

1 hour

2 hours

1 hour

1 hour

l Vyryyir*

1 hour

1 hour

2 hours

1 hour

k hours

1 hour

3 hours

l
iW W4

ETHICAL STANDARDS FOR TRAINED ATTENDANTS
1.
2.
3>
U.
3*
6.
7~8.

Law regulating registration of nurses, trained attendants and
practical nurses.
The special field of the trained attendant.
Principles of conduct.
Relation of trained attendant to patient.
Relation of trained attendant to physician.
Relation of trained attendant to registered nurse.
Etiquette in hospital and home.

130

SAMPLE OF CERTIFICATE
NAME OF HOSPITAL
NAME OF CITY
NAME OF STATE
THIS IS TO CERTIFY THAT.................................
has completed a ........

. . . . • ........

months' course

of instruction and practice in nursing as a TRAINED ATTENDANT
and is entitled to this certificate.
Dated t h i s ........... day of..................... 1 9 . .

Pres. Board of Trustees.
Supt. of Hospital.
(Seal of Institution)
Pres. Medical Staff.

Supt. of Nurses.

APPENDIX E

CURRICULUM
OF THE
TRAINING SCHOOL

PONTIAC STATE HOSPITAL

1936

PONTIAC STATE HOSPITAL
Dr. Perry V. Wagley
Superintendent

P0NTIAC* M I C H '

Bartlet Wager
Steward
April 18th, 1936.

Dr. p. C. Robertson, Med. Supt.,
Ionia State Hospital,
Ionia, Mich.
Dear Doctor Robertson

In answer to your letter of the 16th
regarding our Training School, would advise you as
follows:
In 1927 we changed our school to meet
the standard of minimum requirements for accredited
nursing schools of mental hospitals established by the
American Psychiatric Association in June, 1923*
As you perhaps know this standard
is no longer in existence because the American
Psychiatric Association no longer follows any definite
curriculum but have returned to a regular R.N. nurses
course.
We cannot meet the requirements of a
course in registered nursing because of lack of nurses
home and other things, therefore we have continued to
follow the regular two-year course which is outlined on
the attached sheets.
At the beginning of each year I have
prepared a number of lectures which you will note on the
page marked No. 1. I require all the graduate nurses to
take this course once a year to keep up with the new things
in psychiatry which pertain to nurses. Pages 2 and 3 are
our regular nurses courses, one year for juniors and one
for seniors. We require every employee interested in
nursing who wish advancement, to take this course. Their
promotions depend upon their passing these courses, junior
and senior years in the training school, and upon their
length of time in the service also.

131

132
Page-2.

T h e requirement is a high school education.
personally I think this plan better than
the regular registered nursing course, so far as benefit
derived for patients is concerned.
Every employee in
this institution who holds a responsible position is a
graduate of our own Training School, including the Superin­
tendent of Nurses.
We have an adequate consultant staff so
that our nurses get a sufficient amount of training in the
specialities.
If there are any other questions you
would like to ask please feel free to do so and I will
be glad to tell you whatever you desire to know.

Very truly yours,
P. V. Wagley
Med. Supt.

P VW/Van.

PSYCHIATRY
JUNIORS & SENIORS -- 1935-36

SUBJECTS

LECTURER

HOURS

DATE

Dr. Wagley

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 19, 1935

General paralysis

Dr. Kelly

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 20, 1935

Schizophrenia

Dr. Butler

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 21, 1935

paranoia and paranoid conditions

Dr. Glenn

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 22, 1935

Manic Depressive psychosis

Dr. Rooks

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 23, 1935

Senile psychosis

Dr. MacKenzie

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 24, 1935

Organic and traumatic psychosis

Dr. Wagley

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 26, 1935

Alcoholic psychosis

Dr. Kelly

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 27, 1935

Schizophrenia

Dr. Butler

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 28, 1935

Psychosis with mental
deficiency and epilepsy

Dr. Glenn

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 29, 1935

Manic depressive psychosis

Dr. Rooks

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 30, 1935

psychosis with cerebral
arteriosclerosis

Dr. MacKenzie

Lectures 9:00 to 11:00 A. M.
Lecture and demonstration

August 31, 1935

133

psychoneurosis

S E N I 0 R S -- 1935 - 1936

SUBJECT

LECTUFER

SURGERY
Dr. Wagley
1. Preparation & sterilization in Surgery
2. Surgical technique & minor operations
3. The operating room
4. Nursing in accidents and emergencies
5. Major operations
GENERAL MEDICINE
Dr. Butler
1. Local applications
2. Enema, douche, nasal feeding, etc.
3. Temperature, charting, etc.
4. Medicines, poisons and antidotes

NO. HRS.
9 hrs.

Recitations 2:30 to 3:00
Lectures 3:00 to 4;00
8 recitations 8, demonstrations

12 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to 4:00

9 hrs.

DATES
Sept. 4-6-11-13-1820-25-27
Ouiz Oct. 2, 1935

Oct. 4-9-11-16-1823-25-30 Nov. 16-8
Quiz Nov. 13i 1935

Nov. 15-20-22-27-29

Recitations 2:30 to 3:00
Lectures 3:00 to 4:00
4 recitations (Kiss Bailey)
5 practical demonstrations

Dec. 4-6-11
Quiz Dec. 13» 1935

OCCUPATIONAL THERAPY

Miss Miller

Recitations 2:30
Lectures 3:00 to
Recitations & 10
demonstrations,

to 3:00 4 hrs.
4:00
practical
1 hr. each

Dec. 18-20-23
Quiz Dec. 27, 1935

GYNECOLOGY & OBSTETRICAL
NURSING

Dr. Furlong

Recitations 2;30 to 3:00 6 hrs.
Lectures 3:00 to 4;00
Recitations & demonstrations

Jan. 3-8-10-15-17
Quiz Jan. 22, 1936

134

PHYSICAL DIAGNOSIS &
Dr. MacKenzie
CHEMICAL ANALYSIS
1. Observation and examination
2. Examination of vomitus, sputum, excreta
3. Elementary bacteriology
4. Surgical bacteriology & asepsis
5. Laboratory tests

HOURS

S E N I O R S -- 1935 - 1936

SUBJECT

LECTURER

DIET THERAPY
Miss Clark
1. The Normal Diet
2. Modification of the normal diet
in regard to:
A) Energy Content
B) protein Content
C) Carbohydrate Content
D) Ash Constituents
3. vitamin Deficiency Diseases

HOURS

Recitations 2:30 to 3:00
Lectures 3:00 to 4;00

EYE, EAR, NOSE & THROAT

Drs. Baker & Larson

HYDROTHERAPY & MASSAGE
1. Baths and packs
2. Bandages and splints

Dr. Kelly

Dr. Cooper

Jan. 24-29-31
Feb. 5-7-12
Quiz Feb. I1*, 1936

10 hrs.

Feb. 19-21-26-28
Mar. 4-6-11-13-18
Quiz Mar. 20, 1936

5 hrs.

Mar. 25-27 Apr. 1-3
Quiz April 8 , 1936

Lectures 3:00 to 4:00
4 hrs.
Recitations 2:30 to 3:00
Recitations & demonstrations

April 10-15-17
Quiz April 22, 1936

Recitations 2:30 to 3:00

6 hrs.

Apr. 24-29 May 1-6-8
Quiz May 13, 1935

Lectures 3:00 to 4:00

6 hrs.

Hay 15-20-22-27-29
Quiz June 3, 1936

** ALL PUPILS ARE REQUIRED TO PASS A WRITTEN EXAMINATION IN EACH OF THE ABOVE SUBJECTS
WITH A MARK OF AT LEAST 7<# FOR PASSING.

135

Recitations 2:30 to 3:00
Lectures 3:00 to 4j00

Dr. Rooks

PEDIATRICS

7 hrs.

DATES

Four days of practical work
in the diet kitchen

NEUROLOGICAL DISEASES

PSYCHOLOGY & SOCIAL SERVICE Miss Davis

NO, HRS.

J U N I 0 P S -- 1935 - 1936

SUBJECT

LECTURER

HOURS

NO. HRS.

12 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to *+:00
Recitations by Supt. Nurses
Six demonstrations and
recitations, 12 hrs.

PHYSIOLOGY
Dr. Glenn
1. Organs of abdomen & pelvis
2. Respiration and temperature
3. Blood & circulatory system
*+. Urinary system
5. Digestion and absorption
6. Skin and glands
7. Post mortem

12 hrs.

MATERIA MEDICA
Dr. Butler
1. Remedial agents
2. Weights and measures
3* Medicines and their administration
*+. Emetics, diuretics & diaphoratics
5* Cardiac stimulants and sedatives
6. Remedies improving digestion & nutrition
?. Nerve sedatives and antiseptics
8. Miscellaneous

Recitations 2:30 to 3:00
Lectures 3:00 to *+:00
Recitations by Supt. Nurses
Six demonstrations and
recitations, 12 hrs.

12 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to *+:00
Recitations by Supt. Nurses
10 demonstrations, 1 hr. each

Sept.. 3-5-10-12-1719-2*+-26
Oct. 1-3-8
Quiz Oct. 10, 1935

Oct. 15-17*22-2*+29-31
Nov. 5-7-12-1^-19
Quiz Nov. 21, 1935
136

ANATOMY
Dr. Rooks
1. General structure of human system
2. The human skeleton
3. Muscles and joints
*+. Articulation
5. Surgical anatomy, Post Mortem

DATES

Nov. 26-28 Dec. 35-10-12-17-19-2*+26-31
Quiz Jan. 2, 1936

J U N I O R S

SUBJECT

LECTURER

—

HOURS

1935 - 1936

NO. HRS.

DATES

7 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to 4:00
Recitations by Supt. Nurses

Jan. 7-9-14-16-2123
Quiz Jan. 28, 1936

BACTERIOLOGY
Dr. Kelly
1. Infection and immunity
2. Surgical cleanliness & disinfection
3 * Practical demonstration

7 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to 4;00
Recitations by Supt. Nurses

Jan. 30
Feb. 4-6-11-13-18

HYGIENE 8r SANITATION
1. General hygiene
2. Water and food
3 * Personal hygiene

5 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to 4:00
Recitations by Supt. Nurses

Feb. 25-27 Mar. 3"5
Quiz March 10, 1936

Dr. Michal

CHEMISTRY
Dr. MacKenzie
1. Introduction
2. Fundamental laws & principles
3* Common elements & compounds
4. Solutions, acids, bases & salts
5* Physiological chemistry
6. Chemistry and cleansing

6 hrs.
Recitations 2:30 to 3:00
Lectures 3:00 to 4:00
Recitations by Supt. Nurses

Mar. 12-17-19-24-26
Quiz March 31> 1936

137

CARE OF MENTAL CASES
Dr. Wagley
1. Nervous system
2. Special senses
3* Sleep and sleeplessness
4. Classification of mental diseases

J U N I O R S

SUBJECT

LECTURER

-- 1935 “ 1936

HOURS

NO. HRS.

NORMAL NUTRITION
Miss Clark
10 hrs.
1. Food & Health
Recitations 2:30 to 3:00
2. Energy Requirements of Adults
Lectures 3:00 to 4;00
3. Ash Constituents & Vitamins
Recitations by Supt. Nurses
4. Nutrition at Beginning of Life
Practical demonstrations by
5. Requirements during growth
Miss Clark
6. Classification of Foods
7. Summary of Digestion; Cooking Processes
8. Serving the Tray: milk & milk products; meats
Dr. Rooks

SOCIAL PSYCHOLOGY & ETHICS
HISTORY OF NURSING

Miss Davis

PRACTICAL NURSING

Mrs. Coppersmith

Apr. 2-7-9-14-1621-23-28-30
Quiz May 5, 1936

Lectures 8- demonstrations 3 hrs.

May 7-12
Quiz May l4, 1936

4 hrs.

May 19-21-26
Quiz May 28, 1936

Lectures 3:00 to 4:00

*** ALL PUPILS ARE REQUIRED TO PASS A WRITTEN EXAMINATION IN EACH OF THE ABOVE SUBJECTS
WITH A MARK OF AT LEAST 70# FOR PASSING-

138

HYDROTHERAPY

DATES

APPENDIX F

PNEUMONIA AND TUBERCULOSIS

ONE, IN A SERIES OF LECTURES USED IN THE
ATTENDANT NURSE TRAINING PROGRAM

IONIA STATE HOSPITAL

PNEUMONIA AND TUBERCULOSIS
I.

The Pneumonias
A.

Lobar pneumonia--Is an acute infectious disease caused by the
pneumococcus, and characterized by a marked general toxemia,
consolidation (massive congestion) of the lungs, and a high
fever which usually ends by crises.
1.

Etiology— The penumococcus is a lance-shaped coccus
occurring in pairs (Diplococcus), gram positive and
possessing a capsule or membrane surrounding the organism
by means of which it can be identified by special capsule
staining methods.
Pneumonia accounts for from 5# to IO56 of all deaths. The
frequency of penumonia increases up to the 6th year, then
falls to the 15th year when it gradually riseB again
especially in the later decades. Males are more frequently
affected than females probably due to conditions of life.
Its distribution is universal and the colored races have
a higher incidence and mortality than whites.

2.

Factors Increasing Liability to Disease— As the pneumo­
coccus is frequently present in the throat of healthy
persons, the factors are supposed to act by reducing the
resistance of the body to its effects.
a.
b.
c.
d.
e.
f.

3-

Season— Incidence highest in winter and spring.
outdoor occupation shows a higher incidence.
Previous attack— frequently several attacks occur— one
probably predisposes to a second.
Cold— Pneumonia frequently follows exposure. Cold pre­
sumably lowers resistance to infection.
Debility (rundown condition) due to any cause, i.e.,
exhaustion, alcohol, prior diseases such as influenza,
Trauma— An attack often follows directly upon an injury,
particularly the chest.

Symptoms— The incubation period (time from invasion of
organisms to appearance of disease) varies from a few
hours to 3 or k days.
The onset of the disease is sudden and usually ushered in
by a severe chill lasting from 15 minutes to one hour.
During the chill the temperature rises rapidly up to 10^
and the patient feels acutely ill. Following this he
complains of a severe pain in the side of chest, develops
a short dry cough and respiration becomes rapid. Within
2k to *+8 hours condition is characterized by:

139

140
a.
b.
c.
d.
e.
f.

g.

Face flushed and eyes bright. Anxious expression to
face.
Respiration— short and rapid. Adults 40-50, children
55-60. Frequently expiratory grunts and dilatation of
nasal wings.
Cough— Short, frequent and repressed. Increases pain
in side.
Sputum— Very thick and blood stained, so-called "rusty
sputum" within 2 days.
Skin— Dry and cold sores are common.
Temperatures— Usually rises rapidly to about 104°,
then remains rather constant between 103° and 104°
until disease terminates either by crisis or lysis.
(1) Crisis— The most remarkable phenomenon in
pneumonia and probably represents the stage of
active immunization built up by body against the
organism. The temperature falls abruptly to
normal within 6 to 12 hours— usually occurs around
the 7th day of disease.
(2) Lysis— Temperature falls more gradually, slow
decline over several days— most common in children.
Cyanosis— May be marked due to insufficient oxygenation
of blood.

4.

Prognosis— The mortality of all cases at all ages is from
20# to 25#. It depends to a great extent upon; (a) age,
(b) previous habits and general health of patient, (c) type
of pneumococcus present. Under two years of age mortality
is high. From 2 to 5 years of age fatality is rare. From
20 to 30 years about 20#; at 60 years about 60#. Habitual
alcoholics, as well as those suffering from some other
intercurrent disease, i.e., nephritis, diabetes, cardiac
disease, and tuberculosis, succumb rapidly to the disease.
Undernourished as well as stout individuals are poor
subjects. Other unfavorable signs include:
(a) Coma and
marked delirium, (b) Extremes of temperature, i.e., above
106° or subnormal with severe toxemia (means poor body
reaction), (c) Severe dyspnoea— respiratory rate over 50
per minute, (d) Absence of leucocytosis— which should
normally be between 15*000 to 25*000 W.B.C.

5*

Complications— In addition to the mechanical impairment
resulting from consolidation to the lung as well as
throwing an increased burden on the heart, the potent
toxins elaborated by the pneumococcus attack particularly
the nervous systom, the vital centers and the muscles of
the heart and blood vessels. So that failure of the
circulatory system is the great danger in pneumonia.
Complications (other diseases which may follow pneumonia)
include:
a. pleurisy— Inflammation of the lining of the lung—
always present.

l*tl
b.
Cm
d.
e.
f.
6.

Empyema— Pus in the pleural cavity— a common sequela— *<#.
Perioarditis— inflammation of lining of heart--l#
serious.
Meningitis— Inflammation of the brain membranes— rare
but serious.
Abscess of Lung— Rare but mortality high.
Gangrene of Lung— Rare but'almost always fatal.

Treatment*— pneumonia is one of the diseases in which nursing
care is probably the most important factor in getting well,
and skilled nursing care can do much to give comfort and
prevent complications.
Treatment may be divided into three groups:
a. Specific*— Within the past decade much advance in the
treatment of pneumonia hae occurred with the use of
specific serum therapy. Four different strains of
pneumococcus have been discovered and called con­
veniently type I, II, III, IV- About 3396 of all cases
are due to type I pneumococcus; 3396 to type II; 10# to
type III; and about 20# to type IV, which has recently
been subdivided into many different strains. Felton's
serum has been prepared for each of these types so that
by typing the strain of organisms present in the sputum
of a case of pneumonia we can administer the corre­
sponding type of serum. The mortality rate in pneu­
monia has been markedly reduced by using serum therapy—
as low as 996 in type I. Obviously, to be of greatest
value it must be given early in the disease— by the
3rd day if possible. The cost of the serum is as yet
somewhat prohibitive.
b. General Treatment.
(1) Rest— is absolutely essential. The patient must be
spared every effort which means extra strain on
the heart so that he may muster all his forces to
combat the disease. If difficulty in breathing
is oSvsrs , ho m o j bo placed in a CwSx sitting
position, well supported by pillows. Mental rest
and quiet are equally essential as physical rest.
(2) Diet— In lobar pneumonia the patient is usually
very toxic. The appetite is poor, digestion
impaired and course of disease short, so soft or
liquid diet is sufficient. Give fluids, 3~^
quarts daily of water, lemonade, orange ade or
imperial drinks.
(3) Do not neglect the care of the mouth. Give daily
enema.
(*0 Quinine— 60 to 70 gr. daily for 2 or 3 days.
c. Symptomatic Treatment.
(1) pleurisy pain— Use external applications and
counter irritants— hot pad, mustard plaster, etc.
Use opiates such as codeine freely, morphine
sulphate if pain is severe.

1H2
(2)
(3)
(k)

(5)
B.

II.

Cough— Stimulating expectorants.
Fever— -Tepid sponge bath every 3 hours for
temperature above 103°• Avoid anti-pyretics.
Abdominal distension— Daily S.S. enema.
Turpentines stupes. Pituitrin, 1 cc. every
3 hours with rectal tube.
Cyanosis— Oxygen tent or nasal catheter.

Broncho-pneumonia— Similar in most respects clinically to
lobar pneumonia except as to pathology which reveals scattered
areas of congestion throughout the lung rather than localized
areas. Broncho-pneumonia is more apt to attack the weak—
infants and older people, in whom the power of heat production
is very lew. Usually secondary to pre-existing cold, bronchitis
or as a terminal event in other debilitating diseases.

Tuberculosis
A chronic infectious disease caused by the tubercle bacillus
characterized by its insidious onset, weakness, loss of weight and
strength, poor appetite and slight afternoon temperature variation.
The disease may affect almost any tissue in the body and hence is
named thereby, i.e.,:
Pulmonary tuberculosis— affecting the lunge.
Tuberculosis adenitis— affecting the lymph glands.
Tuberculosis meningitis— affecting the meninges.
Tuberculosis peritonitis— affecting peritoneum.
Tuberculosis enteritis— affecting the intestines.
Tuberculosis osteitis— affecting the bones.
Pott's Disease— affecting the vertebrae.
Acute miliary tuberculosis— affecting all organs.
Tuberculosis has been known through the ages and called "The White
Plague" by the early Greeks but more progress has been made towards
its irradication and treatment since the discovery of the tubercle
bacillus and its cause by Koch in 1882, than in all the hundreds
of years previous. Durxng the pust 3 dccudos, through cooperutxon
of the public health agencies, physicians throughout the world,
and in education of the laity as to the nature of tuberculosis,
much progress has been made in the right direction. Still,
tuberculosis at present stands well up near the top of the list as
causes of death. But even greater than this is the great economic
burden resulting from incapacitation of the individual as well as
cost of hospitalization. The annual cost of hospitalization from
tuberculosis exceeds 970,000,000 in the United States. There are
*+71 sanitariums in the United States which admitted some 121,800
patients during the past year.
The most frequent part of the body affected is the lungs, hence we
will limit our discussion to pulmonary tuberculosis.
The tubercle bacillis is rod-shaped and recognized by acid-fast
stain methods, as was demonstrated in a lecture on bacteriology.

1*3
The organism is extremely resistant to heat, cold and drying*
Virulent organisms capable of producing disease may be present in
dried sputum after 2 months.
Conditions which predispose to the development of active tuber­
culosis include under-nourishsnent, bad ventilation, insufficient
exercise, chronic debilitating diseases, subsequent to acute
respiratory disease and in general anything which tends to lower
one's vitality and resistance to infection.
The main path of infection in pulmonary tuberculosis is by "droplet
infection" (inhaling air containing fine droplets contaminated with
tubercle bacillis). It is estimated that in a single expectoration
from a case in which liquifying cavitation is taking place, as many
as one billion organisms may be coughed out. Ingestion of contami­
nated milk and food is the most frequent portal of entry for bone,
joint and abdominal tuberculosis.
A.

Symptoms— The onset of plumonary tuberculosis is insidious;
often the first symptom noticed is a weakness or tired feeling.
Patient realizes that he does not have his usual "pep" or vigor
and tires more easily than usual. A considerable number of
patients give a history of repeated attacks of "colds" which do
not seem to clear up. Every case of chest cold which does not
clear up within 2 weeks should be investigated. Probably the
most frequent early symptom is a cough, or possibly nothing more
than a persistent and annoying "clearing" of the throat.
Grouping characteristics symptoms of pulmonary tuberculosis
include:
1.

Cough— Mostly at night and early morning. Early stages:
Dry and hacking. Later stages: Loose and with sputum.

2.

Sputum— Early— mucoid.

Later— greenish purulent matter.

Haemoptysis— (blood spitting). Onset sudden— salty taste
in mouth. Sputum may be merely streaked with blood.
Severe hemorrhage may cause death.

4.

Pain-Usually associated with pleurisy or from coughing.

5.

Fever— Early and important sign and the most valuable
measure of severity and progress of disease. Fever is due
to absorption of toxins. Afternoon rise of 1/2 to 1
degree very suggestive.

6.

Night sweats— Often drenching cold sweat during night and
early morning.

7.

Loss of weight and strength— Often early symptoms— weight
is important index of disease.

8.

Loss of appetite and dyspepsia.

JM
9.
10.
B.

Increased, pulse rate— May persist when temperature is normal.
With active tuberculosis rarely below 8*t.
Anemia— Muddy pallor and musty odor to skin.

Treatment
1.

Rest is by far the most important single factor in the
treatment of tuberculosis, includes mental as well as
physical rest. The average early case of pulmonary
tuberculosis requires approximately 2 to 3 years of
intensive treatment for a complete healing— the most
important part of the treatment is rest. After healing
has occurred graduated exercise is begun to get the patient
back to normal activity again.

2.

Fresh air is very important.

3.

Diet— Avoid highly seasoned, spicy, irritating foods.
Otherwise regulate according to weight gain. Variety is
an important factor.

4.

Ultra violet light (sun baths)— are excellent when patient
is not running a temperature. Dosage must be regulated
carefully.

5.

Pneumothorax— Collapse therapy— inject air into pleural
cavity to put diseased lung at rest as well as rest of body.

6.

Drugs used for symptomatic relief as needed to control
cough, gastro-intestinal distress, pain, insomnia and
the like.

7.

Surgery has its place in treatment of certain selected
cases.

APPENDIX G

CURRICULUM GUIDE
FOR
INSERVICE TRAINING OF ATTENDANT NURSES

MICHIGAN DEPARTMENT
OF
MENTAL HEALTH

1961

PREFACE
A brief review of the history of the world shows through the
ages that one or another form of life rose to a position of dominance
and then faded into oblivion. In examining these recurring dominant
forms, one learns that each succeeding form had some characteristic
that was unique and which was responsible for its power and dominance.
Man is not an exception. His unique possession or characteristic
which gives him dominance over other forms of life lies in his intelli­
gence and his ability to transmit knowledge from one generation to
the next.
Leaving the vast world stage and looking at the man made systems
and subsystems therein, one can demonstrate the validity of the above
theory that effective transmission of knowledge is essential for
survival. Political, educational, and social systems thrive or fade
depending on the ability they have to assimilate and transmit
constantly derived new knowledge.
The Department of Mental Health is no exception to this rule. We
can only provide the best possible care and treatment, and insure early
return of our patients to their homes, by constantly seeking new
knowledge and transmitting this to one another. The profession of
nursing, which plays so vital a role in the treatment of our patients
has, in recent years, acquired significantly different forms of
knowledge concerning patient care. Specifically, the profession is
moving away from the older functional categorizations of classical
nursing practice characterized by structural compartmentization into
nursing administration, nursing education, bedside nursing, and the
like; and developing a concept of clinical nursing practice with major
emphasis on the acquisition and utilization of clinical skills.
Present knowledge suggests that patients improve with the help of
nurses practicing nursing in a clinical setting and a review of the
contents of this curriculum indicates that the committee has taken this
new knowledge and approach into consideration in developing this
curriculum guide,
We should make every effort to implement this curriculum as
rapidly as possible, since it is only through the use of new techniques
and methods that we can obtain new knowledge that will lead the way to
further progress.
Vernon Stehman, M.D.
Deputy Director
Michigan Department of
Mental Health

146
INTRODUCTION
The need for a curriculum guide has been recognized by those
charged with the responsibility for providing an effective inservice
education program for attendant nurses caring for patients in our
state hospitals and training schools. The responsibility of nursing
education has been clearly outlined in the nursing program guide of
the Department of Mental Health;
"Nursing education ha6 the responsi­
bility for improving patient care by providing on-going clinical edu­
cation for the various levels of nursing personnel and nursing
students.
In order to meet this responsibility, a committee was appointed
to develop a curriculum which would promote consistency in the training
of attendant nurseB throughout the various institutions of the
Department of Mental Health. Such a curriculum would be of inesti­
mable value in providing a guide for the instructor and in promoting
continuity in the programs.
Many recommendations and topical outlines for basic attendant
nurse training have been developed by variouB groups. Among the out­
lines utilized in the preparation of the curriculum guide are a
Suggested Curriculum for In-Service Training of Psychiatric Aides,
prepared by Sub-Committee psychiatric Aide Education and Practical
Nurse Education of the Michigan League for Nursing and, A Project in
Pre-Service psychiatric Aide Education, prepared under the direction
of the College of Nursing, Wayne State University, i960.
The curriculum guide consists of three sections; (1) Orientation,
(2) Fundamentals of General Nursing and (3) Fundamentals of Psychiatric
Nursing. Section One has been planned to meet the needs of the
attendant nurse who is new to the hospital. Upon completion of the
Orientation, the attendant nurse should be able to perform simple
nursing procedures and to assist the ward staff under the direction
of the ward supervisor. It should be noted that the administration of
medications is not a part of the Orientation.

Sections Two and Three have been planned with enough flexibility
in time and content to allow for meeting the specific needs of indi­
vidual institutions. Upon completion of sections Two and Three, the
attendant nurse should have a better understanding of and ability to
provide safe patient care.
The curriculum guide includes only that material necessary to
provide for a basic training program for attendant nurses. Those
demonstrating ability to advance beyond this level would then be
given additional courses in advanced nursing arts procedures, in
psychiatric nursing, and in principles of supervision and adminis­
tration.
^Program Guide NurBing, Department of Mental Health, State of
Michigan, Lansing, January, i960, p. 11.

14?
The curriculum guide outlines what we believe to be appropriate.
The institutions that need to will add content to meet their individual
needs. In implementation of the curriculum it is recommended that:
1.

Training wards be established to provide supervised
clinical practice.

2.

Employees be assigned to the educational department during
their educational program.

3.

Section One* Orientation, be initiated immediately upon
employment.

4.

Sections Two and Three, Fundamentals of General Nursing and
Fundamentals of Psychiatric Nursing, be initiated as soon
as possible, and preferably by the time the attendant nurse
has satisfactorily completed the six-month probationary
period.

3-

The Department of Mental Health establish a standing
committee with representation from Nursing Education and
Nursing Service to study, assist and make recommendations
for the implementation of the curriculum.

The committee wishes to express its appreciation to all who have
assisted in the preparation of the curriculum guide. We especially
wish to thank Miss Doris Haid, Associate Professor of Psychiatric
Nursing, Wayne state University, for the guidance she has given us.
Subcommittee on Curriculum
Attendant Nurse Inservice Education Group
Michigan Department of Mental Health

SECTION I
ORIENTATION

I. INTRODUCTION TO COURSE
II. INTRODUCTION TO HOSPITAL
III. INTRODUCTION TO NURSING DEPARTMENT
IV. INTRODUCTION TO ASSIGNED CLINICAL AREA
V. PERSONAL HYGIENE FOR EMPLOYEE
VI. SUGGESTED NURSING PROCEDURE CHECK LIST
VII. SUGGESTED TWO-WEEK CLASS SCHEDULE

SECTION I
ORIENTATION

*+0 hours theory
*40 hours clinical practice
Objectives:
To become acquainted with the philosophy and goals of nursing within the Department of Mental Health
To become acquainted with the hospital, its organization and functions
To develop understanding of the policies, rules and procedures essential to the operation of the hospital
To develop understanding of the functions of the psychiatric attendant nurse on the hospital nursing team
To develop an awareness of basic nursing techniques necessary for the care, comfort and safety of
the patient

Content
I.

INTRODUCTION TO COURSE
A.
B.
C.
D.

PURPOSES
COURSE DESCRIPTION
SCHEDULING
OTHER INSERVICE EDUCATION PRO­
GRAMS AVAILABLE TO ATTENDANT
NURSE

Learning Experiences and Methods
Lecture and discussion

Content
II.

INTRODUCTION TO HOSPITAL
A.

RELATIONSHIP TO DEPARTMENT OF MENTAL HEALTH

B.

BRIEF HISTORY

C.

PURPOSE AND PHILOSOPHY

D.

ORGANIZATION
1. Services (Departments)
a. relationships between departments
b. major responsibilities
c. administrative personnel
2 . physical structure

Lecture and discussion

Lecture by medical superintendent

Tour of the hospital

E.

POLICIES
1. Civil service personnel policies
2. Hospital policies

Lecture by personnel director

F.

SAFETY DEPARTMENT
1. Safety regulationo
2. Accident prevention
3* Fire prevention

Lecture by representative of the Safety
Department
Demonstration of the use of fire alarm box

INTRODUCTION TO NURSING DEPARTMENT
A.

ORGANIZATIONAL STRUCTURE
1. Philosophy, purposes, goals
a. nursing service
b. nursing education

Lecture by director of nursing
Assignment:

Robinson, The Psychiatric Aide.
A Textbook for Patient Care

150

III.

Learning Experiences and Methods

Content
2.

B.

PHYSICAL ORGANIZATION OF WARDS FOR
VARIOUS SERVICES

C.

PROCEDURES AND POLICIES
1. Manuals
2. General and specific policies
for patient care
3. General nursing personnel policies
a. staffing
b. assignments
c. schedules

D.

E.
IV.

Relationships (intra-and interdepartmental)
a. lines of communication
b* nursing team concept
c. role of attendant nurse

INTERPERSONAL RELATIONSHIPS
1. Factors which influence
2. Characteristics of good human
relationships
3. Results of faulty interpersonal
relationships

Review of job description

Demonstration of use of procedure and
policy manuals
Assignment:

Read and discuss Department of
Mental Health's Policy Letter
on Abuse of Patients

Lecture and discussion

Assignment:

M* 0. Weiss, Attitudes in
psychiatric Nursing

APPROACHES TO PATIENTS

INTRODUCTION TO ASSIGNED CLINICAL AREA
A.

Learning Experiences and Methods

PERSONNEL
1. Staffing
2. Assignments
3. Schedules

Introduction to patients and ward personnel
on assigned ward

Conference with ward supervisor

Content

Learning Experiences and Methods

B.

PHYSICAL FACILITIES

Tour of the ward

C.

THERAPEUTIC ENVIRONMENT
1. Definition
2. Characteristics
a. provides for meeting needs of
patients
b. provides safety
c. provides cleanliness and comfort
d. provides security
e. provides opportunity for satisfying
relationships

Lecture and discussion

NURSING PRINCIPLES BASIC TO PATIENT CARE

E.

BEHAVIOR PATTERNS OF PATIENTS

F.

RECORDS

G.

NURSING SKILLS AND PROCEDURES
1. Bed making
2 . Bathing
3. Personal hygiene
k. Vital signs
5. First aid
6. Feeding of patients
7. Specialing patients
8. Enemata
9. Application of heat and cold
10. Preparing and escorting patients
11. Care for patient with seizures
12. Care for suicidal patient

Stern and Corcoran,
Working in a Mental Hospital

Ward conference: Observations of nursing
team, participation as a member of the team,
relationships of nursing personnel

152

D.

Assignment:

Supervised ward practice
Demonstration and return demonstration of
selected nursing procedures

Content
13.
1*K
15*
16.
H.

Learning Experiences and Methods

Body mechanics
Emergency nursing procedures
Observation
Recording

PLANNING NURSING CARE

Participation in planning approaches to
patient care

PERSONAL HYGIENE FOR EMPLOYEE
A.

UNIFORM

B.

GOOD HEALTH HABITS

Self-evaluation of health habits

153

15**
SUGGESTED CLASS SCHEDULE
1st Week Orientation

TUESDAY

MONDAY
Class - 2 hrs
Introduction - Keys
Introduction to course

Class - 2 hrs
Introduction to
Nursing Dept.

Coffee Break

Coffee Break

Class - Zh hrs
Introduction to hospital
organization and
structure
Personnel Director
Civil Service policies
Hospital policies

Class - 1 hr
Safety Department
demonstration
Ward Practice
Introduction to
personnel
Tour of ward
facilities
Lunch

Lunch
Class - 1# hrs
Introduction to hospital's
physical plant (ct'd)
Tour of administrative
facilities and other
pertinent areas
(Class - 6 hrs)

Class - 3 hrs
Demonstration and
practice - bed
making
Interpersonal Rela­
tionships
Role of the attendant
nurse
(Class - 6 hrs)

2nd Week Orientation
Ward practice
r 1! nr>r*

n

O

I—

m

First aid
Lunch
Ward practice
Class - 2 hrs
Observation and
recording

(Class - U hrs)

Ward practice
— 2 hrs
Emergency nursing
procedures Seizure patients
Suicidal patients
Lunch
Class - 1 hr
Feeding of patients
Ward practice
(Class - 5 hrs)

155
SUGGESTED CLASS SCHEDULE
1st Week Orientation

WEDNESDAY
Class - 2 hrs
Interpersonal Rela
tionships (ct'd)
Behavior patterns
of patients
Coffee Break
Class - 2 hrs
UBe of procedure
manual
Demonstration bed bath
Lunch

Ward practice

THURSDAY

FRIDAY

Ward Practice

Ward Practice

Coffee Break

Coffee Break

Class - 2 hrs
Vital signs (ct'd)
Demonstration
and practice

Class - 2 hrs
Approaches to
patients
Lunch

Lunch
Class - 3 hrs
Therapeutic
environment
Personal hygiene
of patient and
employee

Class - 3 hrs
Body mechanics
principles,
demonstration
and practice

Class - 2 hrs
Vital signs
(Class - 6 hrs)

(Class - 5 hrs)

(Class - 5 hrs)

2nd Week Orientation
Ward practice
Class - 2 hrs
Planning nursing
care
Lunch
Class - 1 hr
Planning nursing
care (ct'd)
Ward practice

ClasB - 1 hr
Written exam
Class - 1 hr
Director of
nursing
Hospital
superintendent
Lunch
Ward Practice

(Class - 3 hrs)

(Class - 2 hrs)

Ward practice
Individual con­
ferences for
evaluation and
assignment

156
SAMPLE
NURSING PROCEDURE CHECK LIST
ORIENTATION
NAME:

DATE:
Observed

Supervised

Practiced

TRANSFER OF PATIENTS
BODY CARE
ORAL HYGIENE
TUB BATH
SHOWER
BED BATH
DRESSING
SHAVING
NAIL CARE
UNTIDINESS
FEEDING
ASSISTED
SPOON
ACTIVITY
ESCORTING TO CLINICS
MOVING IN BED
WALKING
BED MAKING
OCCUPIED
UNOCCUPIED
MAINTENANCE OF SUPPLIES & EQUIPMENT
WARD HOUSEKEEPING
CARE OF LAUNDRY AND SOILED LINEN
FIRE PREVENTION
SUPERVISION OF SMOKING
SECLUSION
MANUAL RESTRAINT
* TEMPERATURE, PULSE, RESPIRATION
AND BLOOD PRESSURE
* CHARTING
ENEMA
APPLICATION OF HEAT AND COLD
When new attendant performs the procedure satisfactorily, place a
small /, date and initials of supervisor should be placed in
supervised column.
* TO BE RECHECKED BY ATTENDANT INSTRUCTOR OR REGISTERED NURSE ON WARD.
This form is to be kept on ward. The proper columns are to be checked
when procedure is observed, supervised, or practiced.

TEACHING AIDS
A.

Books, Phamphlets, Mimeographed Materials
1.

Goulding, Fora and Torrop, Hilda.

The practical Nurse and Her Patient, Philadelphia:
J. B. Lippincott, 1955.

2. Hospital Map
3. Hospital Organization Chart

k.

Hospital Policy Manual

5. Hospital Procedure Manual

6. Leake, Mary.

Simple Nursing Procedures, 3rd ed., Philadelphia:

W. B. Saunders Company, 1961.

7. Nursing Department Organization Chart.
Robinson, Alice.

The psychiatric Aids, A Textbook for patient Care, 2nd ed., Philadelphia;
J. B. Lippincott, 1959.

9* Samples of Hospital Forms and Records.
10. State of Michigan, Department of Mental Health.Program and Activities, Lansing:
11. State of Michigan.

Rules of the Civil Service Commission, Lansing;

12. State of Michigan.

Grievance Procedure, Civil

13. Stern, Edith and Corcoran, Mary.

I960.

Service Commission.

Working in a Mental Hospital, New York:
AssociatTon for Mental Health, 1955*

l*f. Thompson, Ella and LeBaron, Margaret.

i960.

The National

Simplified Nursing, 7th ed., Philadelphia:
J. B. Lippincott, i960.

157

8.

TEACHING AIDS
15.
B.

Weiss, Madeline.

Attitudes in Psychiatric Nursing Care, New York:

G. p. Putnam's Sons, 195*f.

Films
Department of Mental Health, Education Section
1.

It's a Big Problem

2.

Man to Man

3*

Nurse-Patient Relationships in Psychiatric Nursing

158

SECTION II
FUNDAMENTALS OF GENERAL NURSING

I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.

PATIENT CENTERED CARE IN NURSING PROCEDURES
PATIENT'S ENVIRONMENT
BODY STRUCTURE AND FUNCTION
SIGNS AND SYMPTOMS OF MALFUNCTION
PHYSICAL AND PSYCHOLOGICAL CARE OF PATIENTS
PERSONAL HYGIENE PROCEDURES
NUTRITIONAL NEEDS OF PATIENTS
BASIC NURSING PROCEDURES
EMERGENCY CARE
OBSERVING, REPORTING AND RECORDING SYMPTOMS

REACTIONS AND CHANGES

SECTION II
FUNDAMENTALS OF GENERAL NURSING

80 hours theory
160 hours clinical practice
Objectives:
To develop ability to provide for the physical and psychological comfort and safety of patients
To develop beginning skills necessary to perform basic nursing procedures
To gain elementary knowledge of body structure and function
To develop the ability to recognize signs and symptoms of the more common ill-esses

To gain appreciation of the nutritional needs of the body
To develop an understanding of emergency care

Content
I.

Learning Experiences and Methods

PATIENT CENTERED CARE IN NURSING PROCEDURES
A.
B.
C.
D.

PHYSIOLOGICAL SIGNIFICANCE
PSYCHOLOGICAL SIGNIFICANCE
SOCIAL SIGNIFICANCE
BACTERIOLOGICAL SIGNIFICANCE

Lecture and discussion
Reference assignment

160

To develop the ability to observe, report and record symptoms, reactions and changes

Content
II.

III.

Learning Experiences and Methods

A.

EFFECT ON PHYSICAL AND MENTAL WELL BEING

Lecture and discussion

B.

CARE OF UNIT
1. Cleanliness
2. Safety
3. Orderliness
**•. Temperature
5. Ventilation

Orientation to ward

C.

CARE OF HOSPITAL EQUIPMENT

D.

CARE OF PATIENT'S CLOTHING AND POSSESSIONS

BODY STRUCTURE AND FUNCTION
A.

GENERAL PLAN OF THE BODY
1. Body wall
2. Body cavities and organs
3. Extremities
4. Systems of the body
a. names
b. functions

B.

ORGANIZATION OF THE STRUCTURE
1. Cell
2* Tissue
3. Organ
4. System

C.

GENERAL BODY FUNCTION
1. Characteristics of all living matter
a. metabolism
b. movement

Lecture and discussion

Z&mi

Content

2.

D.

c. irritability
d. conductivity
e. integration
f. reproduction
Compounds and their functions in living matter
a. water
b. proteins
c. carbohydrates
d. fats

INTERRELATEDNESS OF STRUCTURE AND FUNCTION
1. Interdependence of body systems
2. Function of human body as total organism

SIGNS AND SYMPTOMS OF MALFUNCTION

A.

INTERRUPTION OF USUAL HABITS
1. Sleeping
2. Eating
3. Exercise
Elimination
5. Socialization

B.

COLOR AND CONDITION OF SKIN, LIPS, NAILS

c.

LOCATION, CHARACTER, DURATION, AND FREQUENCY OF PAIN

D.

CHARACTER OF VITAL SIGNS
1. Blood pressure
2. Temperature
3. Pulse
h. Respiration

Lecture and discussion

162

IV.

Learning Experiences and Methods

Content
CHARACTER, FREQUENCY, AND AMOUNT OF EXCRETIONS
1. Perspiration
2. Expectoration
3. Eraesis
k. Defecation
5. Urination

F.

INFLAMMATION
1. Definition
2. Causes
3. Signs
a. heat
b. swelling
c. redness
d. pain

G.

STRUCTURAL CHANGES
1. Edema
2. Growths
3. Fractures and dislocations

163

E.

Learning Experience and Methods

PHYSICAL AND PSYCHOLOGICAL CARE OF PATIENTS

Lecture and discussion

A.

BODY MECHANICS

Review procedure book

B.

MECHANICAL DEVICES

Classroom demonstrations

C.

SAFETY PRECAUTIONS
1. Use of restraints and sideboards
2. Prevention of accidents
3. Prevention and control of fires
k. Checking sharps and keys

Reference assignment

Content
D.
VI.

VII.

Learning Experience and Methods

DIVERSIONAL AND SOCIAL ACTIVITIES

PERSONAL HYGIENE PROCEDURES
A.

BATHS

B.

ORAL HYGIENE

C.

SKIN CARS AND GROOMING

D.

PREVENTION OF DECUBITI
Lecture and discussion

A.

BASIC ADEQUATE DIET

Tour of food preparation area

B.

SPECIAL DIETS

Explanation of various diets and dietary
procedures by dietitian

C.

NUTRITIONAL DEFICIENCIES

Reference assignments
*

VIII.

BASIC NURSING PROCEDURES

Lecture and discussion

A.

PREPARATION OF PATIENT FOR PROCEDURES
1. Explanation of procedure
2. Need for privacy

Review procedure book

B.

ADMINISTRATION OF MEDICINES
1. Definitions and abbreviations
2. Types and methods of preparation
3. Methods of administration
Physician's orders
5- Action of drugs

Lecture and discussion
Classroom demonstrations
Reference assignment

164

NUTRITIONAL NEEDS OF PATIENTS

Content

Learning Experiences and Methods

6 . Computation of dosages
7. Recording and reporting
8. Care of medicine cabinet

Class practice on computation

CARRYING OUT AND ASSISTING WITH DIAGNOSTIC PROCEDURES
1. Blood pressure, temperature, pulse, respiration
a. definitions
b. mechanics of operation
c. reporting and recording
2. Weights and measurements
3. Collecting and testing specimens
Assisting physician, nurse, or technician
a. physical examination
b. x-ray examination
c. laboratory procedures

Lecture and discussion

ASEPTIC TECHNIQUE
1. Definition
2. Principles

Lecture and discussion

PRINCIPLES AND TECHNIQUES OF ISOLATION
1. Indication for use
2. Procedures
a. setting up isolation unit
b. use of gown and mask
c. handwashing
d. disinfection of equipment and utensils

Lecture and discussion

Classroom demonstration
Reference assignment

Review procedure book
Classroom demonstration

165

MEAL SERVICE
1. Serving food
2. Spoon feeding
3. Tube feeding

Review procedure book

Content
G.

H.

MOVEMENT OF PATIENTS

I.

CARE OF SURGICAL PATIENT

J.

RELIGIOUS RITES

EMERGENCY CARE
A.

DEFINITION

B.

ALTERCATIONS
1. Individual
2. Group
3. Anticipation and prevention

Lecture and discussion
Review procedure book
Demonstrations

166

ROUTINE NURSING PROCEDURES
1. Bed making
2. Enemata
3. Dressings
k. Catheter irrigation
5. Applications of heat and cold
6 . Feeding patients
7. Suction apparatus
8. Care of patients in casts
9. Sponges
10. Sitz baths
11. Moving patients
12. Care of decubiti
13. Tube feedings
Ik. Use of orthopedic devices
15. Post mortem care

Learning Experiences and Methods

Lecture and discussion

Content
C.

D.
X.

MEDICAL EMERGENCIES
1. Hemorrhage
2. Shock
3. Cuts and wounds
k, injuries to bones and joints
5- Burns
6. Cardiac failure
7. Asphyxiation
8. Foreign bodies in eye, ear, nose, throat

Learning Experiences and Methods
Lecture and discussion
Review procedure book
Demonstration
Reference assignment

PSYCHOLOGICAL REACTION TO EMERGENCIES

OBSERVING, REPORTING AND RECORDING SYMPTOMS, REACTIONS
AND CHANGES
IMPORTANCE OF OBSERVATION AND REPORTING

Practice in charting and reporting

B.

AREAS OF OBSERVATION
1. Appearance
2. Behavior
3. Conversation

Reference assignment

C.

CONDITIONS DEMANDING IMMEDIATE ACTION AND NOTIFICATION

D.

OBJECTIVITY IN OBSERVATION AND REPORTING
1. Use of correct terminology
2. Use of direct quotations
3* Avoidance of subjective interpretation

E.

RECORDS AS LEGAL DOCUMENTS

167

A.

Content
TECHNIQUES AND METHODS OF CCKMUNICATION
1. Charts
2. Kardex
3. Nursing care plan
Oral and written reports
5. Other lists and records

Learning Experiences and Methods
Lecture and discussion

TEACHING AIDS
A.

Books, Pamphlets, Mimeographed Materials

1.

American Red Cross.

First Aid Manual, New York:

2.

Charts of Equivalences

3.

Charts on Foods
Simplified Nursing, 6th ed., Philadelphia:
J. B* Lippincott, 1956.

*+. Dakin, Florence and Thompson, Ella.

5.

Goulding, Forn and Torrop, Hilda.

Doubleday and Co., 1957*

The Practiced Nurse and Her patient, Philadelphia:
J. B. Lippincott, 1955*

6 . Hospital's Procedure Book
Information on Commonly Used Drugs

8 . Ingram, Madelene E.

9.

169

7.

Leake, Mary.

Principles and Techniques of Psychiatric Nursing, 5th ed., Philadelphia:
V. B. Saunders Co., i960.

Simple Nursing Procedures, 3rd ed., Philadelphia:

10.

Memmler, Ruth L.

11.

Metropolitan Life Insurance, N. Y. Company pamphlets.

12.

Michigan League for Nursing.

13*

Montag, Mildred and Filson, Margaret.

W. B. Saunders Co., 1961.

The Human Body in Health and Disease, Philadelphia:

J. B. Lippincott, 1959*

Manual on Disaster Nursing, Lansing, Michigan.
Nursing Arts, Philadelphia:

l*t. Otto, James H., Julian, Cloyd J., and Tether, Edward J.

W. B. Saunders Co., 1959*

Modern Health, New York:
Henry Holt & Co., 1955*

TEACHING AIDS
Pretest

16.

Robinson, Alice.

17.

Shafer, Kathleen; Sawyer, Janet; McCluskey, Audrey; Lifgren, Edna. Medical-Surgical Nursing,
St. Louis; C. V. Mosby Co., 195#*

18.

Steele, Katherine and Manfreda, Marguerite,

19*

Symbols and Abbreviations.

20.

Thompson, Ella M. and LeBaron, Margaret.

The Psychiatric Aide, A Textbook for Patient Care, 2nd ed., Philadelphia;
J. E. Lippincott, 1959*

Films:
Balance in Action
Vital Signs and Their Interpretation

psychiatric Nursing, 6th ed., Philadelphia;
F. A. Davis Co., 1959.

Simplified Nursing, 7th ed., Philadelphia:
J. B. Lippincott, i960.
170

B.

15*

SECTION III
FUNDAMENTALS OF PSYCHIATRIC NURSING

I.
II.
III.
IV.
V.

VII.
VIII.

GROWTH AND DEVELOPMENT
SIGNS AND SYMPTOMS OF MENTAL ILLNESS
DEVIATE PATTERNS CF BEHAVIOR
EPILEPSY
MENTAL RETARDATION
CLASSIFICATION Of* MENTAL ILLNESS
THERAPIES

IX.

REHABILITATION

X.

LEGAL ASPECTS

171

VI.

INTRODUCTION

SECTION III
FUNDAMENTALS OF PSYCHIATRIC NURSING

80 hours theory
160 hours practice
Objectives:
To develop a better understanding of himself and others
To gain an understanding of basic psychiatric and mental health concepts and principles
To acquire beginning skills in interpersonal relationships
To develop ability to recognize the needs of the patient

To develop an appreciation of the roles of other disciplines
To develop awareness of community resources available for rehabilitation of the patient

Content
I.

Learning Experience and Methods

INTRODUCTION
A.

HISTORICAL ASPECTS OF PSYCHIATRIC NURSING
1. Primitive peoples
2. Ancient civilizations
3. Early Christians
k. Contemporary approach

Lecture and discussion

172

To develop a beginning understanding of the causes, classification and treatment of mental illness
and mental retardation

Content

Learning Experiences and Methods

a. from custodial to therapeutic care
b. from state hospital to community involvement
c. team concept
5 . Personalities in psychiatry
B.

173

CULTURAL INFLUENCES ON THINKING
Lecture and discussion
1. Behavior variations and individual differences
result of hereditary endowment plus
environmental influences
2. Cultural milieu
a. geographical influences
b. social heritage transmitted by learning
1. knowledge
2 , beliefs
3« mores
laws
5 - customs
6. modes of communication
c. major area of cultural development
1. ability to manipulate environment by use of
hands
2 * ability to speak and communicate ideas
3* Motivation of human behavior related to cultural
heritage and development
a. need for new experiences
b. need for security
c. need for response
d. need for recognition
The family as a cultural influence on thinking
5. Group influences on thinking
a. groups originate to satisfy man's needs
Ward conference: Ethnic groups
1. primary groups
in local community
2. secondary groups

Content

Learning Experiences and Methods

b.

6.

C.

groups exert social pressure and control on
individuals and uphold traditions
Social structure of the hospital

ATTUTW3S
1. Definition of attitude
2. Types of attitudes
3. Use cf attitudes in specific situations
*f. Use of specific therapeutic attitudes in
interpersonal relations

D.

Ward conference: Analysis of speci­
fic attitudes in patient care
Reference assignment
Lecture and discussion
Ward conference: Analysis of role of
attendant in activities

Reference assignment:
Gregg, "The Psychiatric Nurse's Role"
Assignment:
Diary of day's activities of
attendant nurse

174

ROLES OF THE ATTENDANT NURSE
1. protection of patient
a. prevent combative, destructive behavior
b. prevent suicide and injury
c. make decisions where necessary to protect
patient against judgmental defects
d. provide safe, simple, regulated daily
2. Supervision of personal hygiene
a. maintain dietary and fluid intake
b. encourage and supervise rest, exercise,
c. supervise toiletry
3* Activation of patient
a. establish positive rapport
b. give realistic praise and encouragement
c. adopt an accepting, non-judgmental attitude
d. provide assurance
e. redirect expression of emotional tension
into constructive channels
f. set limits for behavior
g. stimulate recreational and occupational
interest
h. help patient maintain contact with reality
i. encourage socialization

Lecture and discussion

Content

Learning Experiences and Methods

participation in routine and diagnostic measures
a. explain treatments and procedures
b. communicate observations
ETHICS
1. Definition
2. Ethical obligations in relationships
a. to patient
b . to personnel
c. to patient's family
3. Ethical obligation concerning
a. records
b. communication
c. promotion of total hospital program
Ethical responsibilities to self
a. in job performance
b. in handling personal problems
c. in controlling emotions

Lecture and discussion

THERAPEUTIC ENVIRONMENT
1. Definition
a. physical properties
b. dynamic qualities
2. Characteristics
a. provision for day by day living
b. provision for protection of patient
1. from injury or self mutilation
2. from harming others
3. from anxieties of former environment
from somatic disorders and infection
5. from decisions beyond his responsibility
6. from indiscriminate confession

Lecture and discussion

Reference assignment;
Robinson, The Psychiatric Aide

175

Ward conference: Analysis of observa­
tions of various relationships, e.g.,
patient-staff, patient in group
Ward conference: Analysis of a day's
program of activities and provision
for consideration of individual and
group needs
Reference assignment

Content
c.

Assignment: Diary of day‘s activity
of attendant nurse

176

provision of testing ground for establishment
of new patterns of behavior
d. provision of selected experiences and ac­
tivities to help him participate and
communicate
e. acceptance of the individual with rights,
needs, opinions
f. consideration of individual differences and
needs as well as group needs
g. democratic management with fewer restrictions
and increasing freedom of choice as patient
is able to assume responsibility
Responsibilities for maintaining the therapeutic
environment
a. hospital and nursing administration
1. policies, functions, responsibilities
defined
2. identification and focus of problems
3. promotion of consistency and stability
*t. promotion of dynamic program
b. individual employee responsibility

Learning Experiences and Methods

TEACHING AIDS
Books, Pamphlets and Mimeographed Materials
1. Attendant Nurse Job Descriptions.
2. Belknap, Ivan.

3.

Human Problems of a State Mental Hospital, New York:
Book Co., Inc.,~1956-

Brown, Martha M. and Fowler, Grace R.

Psychodynamic Nursing 2nd ed., Philadelphia:
W. B. Saunders Co., 1961.

Greenblatt, Milton, York, Richard H. and Brown, Esther Lucile.

5*

Gregg, Dorothy E.

From Custodial to Therapeutic
Patient Care in Mental
Hospitals, New York: Russell
Sage Foundation, 1955-

"The psychiatric Nurses' Role", American Journal of Nursing, 5^:8^8-851.

6. Hofling, Charles K. and Leininger, Madeleine M.

7. Hyde, Robert W.

McGraw-Hill

Basic psychiatric Concepts in Nursing,
Philadelphia: J. B. Lippincott Co., i960.

Experiencing the Patient's Day, New York:

G. P. Putnam's Sons, 1955*

8. Local Hospital Compendium of Ethical Responsibilities
9.

Peplau, Hildegard E.

'Therapeutic Concepts, Aspects of Psychiatric Nursing", League Exchange,
No. 26, Section B,
New York; National
League for Nursing.

10. Robinson, Alice M., The Psychiatric Aide: A Textbook for Patient Care, 2nd ed.,
Philadelphia; J. B. Lippincott Co., 1959*

Content

Learning Experiences and Methods

GROWTH AND DEVELOPMENT
A.

Lecture and discussion

THE CONCEPT OF ANXIETY
1. Definitions
a. anxiety
b. fear
2. Sources
a. internal
b. external
3* Symptoms
a. physiological
b. psychological

Lecture and discussion

Ward conference: Identification of ward
personnel as groups having specific
needs
Assignment:
1) Assess some of the needs of selected
patients on assigned wards
2) Identify opportunities for creativity
of personnel and patients within the
hospital

178

B.

NEEDS OF THE HUMAN ORGANISM
1. Definition of need
2. Physiological needs
a. food, shelter, clothing
b. exercise and rest
3. Safety nee-3
a. protection from physical injury
b. protection from emotional trauma
k. Belonging and love needs
a. group participation
b. trust in others
c. manifestations of belonging
5. Self esteem needs
a. maintenance of prestige and status
b. threats to prestige
c. recognition and approval
6 . Self realization needs
a. opportunity for creativity
b. integrity and dignity

Contents
4.

Learning Experiences and Methods

Reactions to anxiety
a. positive
b. negative
Relationship to need satisfaction

Lecture and discussion

Lecture and discussion

1.79

THE STAGES OF GROWTH
1. The prenatal period
a, value of prenatal care
b. emotional state of the mother
2. Infant - birth to one year
a. physical growth
b. emotional development
c. social behavior
d. specific needs of infancy
3. Early childhood - 1 to 5 years
a. physical growth
b. emotional development
c. social behavior
d. specific needs of early childhood
Later childhood - 6 to 12 years
a. physical growth
b. emotional development
c. social behavior
d. specific needs of later childhood
5. Adolescence - 13 to 20 years
a. physical growth
b. emotional development
c. social behavior
d. specific needs of adolescence
6. Adulthood - 21 to 65 years
a. maturity
1. physical aspects
2. emotional aspects
3. social aspects

Assignment:
Oral reports on assigned reading
material

Content
b.

7.

PERSONALITY
1. Definition
2. Types
3. Structure and/or functions of
a. basic energy drives
b. reasoning
c. conscience
Factors which influence personality
a. heredity
b. environment
c. social conditions
d. cultural forces
5. Methods of adjustment
a. mental mechanisms
1. purpose
2. definition
3. manifestation
b. symptom formation

Lecture and discussion
Tour: Geriatric area of state hospital
and discuss reactions
Ward conference: Identification of
various attitudes of society toward
the aging population

Lecture and discussion

Assignment:
your Child

A Healthy personality for

Ward conference: Identification of
factors which may have contributed
to the personality type and/or to
the illness of a selected patient

180

D.

cultural expectations of the mature adult
1. selection of marriage partner
2. marriage
3. family relationships
4. earning a living
5. recreation
6. retirement
c. cultural differences
The aging process - 65 years plus
a. physical changes
b. specific needs
c. population trends
d. specific problems
1. nursing homes
2. state hospital care
3* Social Security Act

Learning Experiences and Methods

TEACHING AIDS
A.

Books, Pamphlets, Mimeographed Materials
1.

Children's Bureau Publications, U.S. Dept, of Health, Education and Welfare
Infant Care No. 8., 1955
Your Child from Six to Twelve
The Adolescent in Your Family
A Healthy personality for Your Cnild

2.

Science Research Associates, Inc., 57 W. Grand Ave., Chicago, 111.
The SRA Better Living Booklets: Ross, Helen, Fears of Children
English, 0. Spurgeon and Finch, Stuart M., Emotional Problems of Growing Up.
Menninger, Wm. C., Self Understanding - A First Step to Understanding Children.

B.

Strecker, Edward A., and Appel, Kenneth E., Discovering Ourselves, 3rd ed., New York:
The MacMillan Co., 19&0.

Films:
(Michigan Department of Mental Health, Education Section
Film Series on Growth and Development)
Terrible Two's and Trusting Three1s
Frustrating Four's and Fascinating Five's
From Sociable Six to Noisy Nine
From Ten to Twelve
The Inner Man Steps Out
preface to a Life
The Steps of Age

181

3*

Content
III.

Learning Experience and Methods

SIGNS AND SYMPTOMS OF MENTAL ILLNESS

Lecture and discussion

A.

Assignment:

Noyes, Modern Clinical
Psychiatry

FORMATION OF SYMPTOMS
1. Failure of psychological defense mechanisms
in conflict
2. Conflict
a. concept
b. types of conflict

Ward conference: Identification of
examples of conflict as seen in
patients, personnel and society

B.

CAUSE AND MEANING OF SYMPTOMS
1. Psysiological
2. Psychological

Ward conference: identification of
mechanisms used in various stress
situations

C.

AREAS OF DISTURBED FUNCTIONING
1. Thinking
a. disorders of perception
b. disorders of orientation
c. disorders of memory
d. disorders of thought progression and content
2. Somatic
a. motor activity
b* psychophysiological disturbances
3. Affect

D.

SYMPTOMS COMMONLY OBSERVED
1. Anxiety
2. Depression
3. Obsession, compulEdons
k. Hallucinations, delusions
3* Withdrawal
6. Hostility

Assignment: Observe and analyze one
incident involving assigned patient
in terms of cause of behavior and
meaning for the patient, and impli­
cations for nursing care

Ward conference: Recognition of
symptoms observed in patients

TEACHING AIDS
A.

Books, Pamphlets, Mimeographed Materials
1. Mimeographed sheets of signs and symptoms of mental illness.
2. Brown, Amy and Fowler, Grace.
3. Kalkman, Marion E.

Psychodynamic Nursing, Philadelphia:

Introduction to Psychiatric Nursing, New York; McGraw-Hill Book Co., 1958.

U. Noyes, Arthur P. and Kolb, Lawrence C.

5* Noyes, Arthur

6. Matheney, Ruth V. and Topalis, Mary.

Textbook of Psychiatric Nursing,
5th ed., New York; McMillan, 1957.

Psychiatric Nursing, St. Louis:

The C.

V.Mosby Co.,

The Psychiatric Aide: A Textbook for Patient Care,
Philadelphia: J. B. Lippincott Co., 1959.

Weiss, Madeline 0., Attitudes in Psychiatric Nursing Care, New York:

G. P. Putnam's Sons, 195^.

Toward Therapeutic Care. Group for the Advancement of Psychiatry, Committee on Psychiatric
Nursing. No. 51* New York: 19&L.
B.

Films:
(Michigan Department of Mental Health, Education Section.)
Angry Boy
Breakdown

1961.
183

8.

Modern Clinical Psychiatry, 5th ed., Philadelphia:
W. B. Saunders Co., 1958.

P., Haydon, Edith M., and VanSickel, Mildred.

7. Robinson, Alice, M.

W. B. Saunders Co., 1?6C.

Content

Learning Experiences and Methods

DEVIATE PATTERNS OF BEHAVIOR
A.

B.

WITHDRAWAL PATTERN OF BEHAVIOR
1 Dynamics of withdrawal
2. Recognition of withdrawal
3. Nursing care
a. problems
b. approaches
c. nurse-patient relationship
d. group relationships

Lecture and discussion

AGGRESSIVE PATTERN OF BEHAVIOR
1. Dynamics of aggressive and assultive behavior
2. Recognition of aggressive behavior
3. Fear - major factor in assultive behavior
k. Nursing care
a. problems
b. approaches
c. nurse-patient relationship
d. group relationships

Lecture and discussion

DEPRESSIVE PATTERN OF BEHAVIOR
1. Dynamics of depression
2. Recognition of depression
3. Nursing care
a. problems
b. approaches
c. nurse-patient relationships
d. remotivation of patient
e. group relationships
f. recognition of suicidal intentions
g. precautions against suicide

Lecture and discussion

.

Reference assignment
Ward conference: Discussion of specific
patient showing pattern of withdrawal.

Ward conference: Discussion of
depressed patient

184

Ward conference: Discussion of
specific aggressive patient using
assultive behavior

Content
D.

E.

G.

ANXIETY PATTERN OF BEHAVIOR
1. Dynamics of anxiety
2. Recognition of behavior due to anxiety
3. Nursing care
a. problems
b . approaches
c. nurse-patient relationship
d. group relationships

Lecture and discussion

Ward conference: Discussion of specific
patient using projective pattern
Reference assignment
Lecture and discussion
Ward conference: Discussion of specific
patient using physical symptoms or
ritualistic behavior to handle anxiety
Reference assignment

SOCIALLY AGGRESSIVE PATTERNS OF BEHAVIOR
1. Dynamics of anti-social behavior
2. Recognition of anti-social behavior
3. Nursing care
a. problems
b. approaches
c. nurse-patient relationship
d. group relationships

Lecture and discussion

PATTERN OF BEHAVIORAL OR PATIENT DEPENDENT ON
ALCOHOL OR DRUGS
1. Dynamics of dependency
2. Recognition of dependency
3. Brain syndrome

Lecture and discussion

Ward conference: Discussion of specific
patient with socially aggressive
behavior
Reference assignment

Ward conference: Discussion of specific
alcoholic patient or patient addicted
to use of drugs

185

F.

PROJECTIVE PATTERN OF BEHAVIOR
1. Dynamics of projective pattern
2. Recognition of projection
3. Use of projection in the paranoid process
a. problems
b. approaches
c. nurse-patient relationship
d. gro\p relationships

Learning Experiences and Methods

Content

Learning Experiences and Methods

a. acute
b. chornic
Nursing care
a. problems
b. approaches
c. ' nurse-patient relationship
d. group relationships
H.

i

Lecture and discussion

Ward conferences: Discussion of
specific patient with illness due
to organic disease

186

ORGANIC BEHAVIOR DISORDERS
1. Brain syndromes
a. causes
b. characteristics
1. acute
2. chronic
2. Recognition of behavior changes
3. Nursing care
a. problems
b. approaches
c. nurse-patient relationship
d. group relationships

Content

Learning Experiences and Methods

EPILEPSY
DEFINITION

B.

TYPES OF EPILEPTIC SEIZURES
1. Grand Mai
2. petit Mai
3. psychomotor
Jacksonian

C.

DIAGNOSTIC AIDS
1. Medical and family history
2. Neurological and physical examination
3. Laboratory studies
Psychometric examination and interview
5. Nursing observations
6. Induced seizures

D.

TREATMENT
1. Medical
2. psychological
3. Surgical

E.

NURSING CARE
1. problems
2. Approaches
3. Nurse-patient relationships
k. Group relationships

Lectur

and discussion

Reference assignment
187

A.

188

Form
Used
At

STATE HOSPITAL FOR EPILEPTICS
#257

patientfs Name _______________________________________ No.___________
Date
Time
Did patient ever state that she had any aura or forewarning?
If so, what was the nature of it?
(IDescribe in patient's own
words on reverse side of paper) Time of aura before seizure

Characterization of seizure:
(Check)
Did patient cry out?
Fall? ______________
Right
Left _________
Pitch _______________
Collapse___________________________
Tonic (Stiffening)
phase present ______________________
What parts of body first affected? ______________________
What parts of body affected? _____________________________
Did all affected parts of body seem to shake with equal
intensity?
______ ________________________________________
Length of clonic phase _____ ______________________________
Eyes rolled? ____________ Right ____________ Left_________
Continuous ______________ Transient ______________________
Face turned? ____________ Right ____________ Left_________
Continuous
Transient
Head turned?
Right
Left
Did patient bite tongue? _________________________________
Did patient lose bladder control?
Did patient lose bowel control?
Did patient lose consciousness?
Did patient sleep following seizure? ____________________
Did patient become disturbed following seizure? ________
Length of entire seizure?
Reported by ________________________
For additional remarks use reverse side of paper.

TEACHING AIDS
A.

Books, pamphlets, Mimeographed Materials
1.

Crawford, Annie L., and Euchanan, Barbara 3., Psychiatric Nursing, Philadelphia:
F. A* Davis Co., 1961.

2.

Gibbs, Frederick A., and Stamps, Frederick W., Epilepsy Handbook, Springfield, Illinois:
Charles C. Thomas, 1958.

3.

Matheney, Ruth V., and Topalis, Mary, Psychiatric Nursing, St. Louis:

C. V. Mosby Co., 1961.

Noyes, Arthur P., and Kolb, Lawrence C., Modern Clinical Psychiatry, 5th ed., Philadelphia:
W. B. Saunders Co., 1958.
Steele, Katherine and Manfreda, Marguerite L., Psychiatric Nursing, 6th ed., Philadelphia:
F. A. Davis Co. , 1961.

6.

Von Mering, Otto and King, S. H., Remotivating the Mental patient, New York:
Foundation, 195?•

7.

Toward Therapeutic Care. Group for the Advancement of Psychiatry, Committee on Psychiatric
Nursing. No. 51* New York: 1961.

Films:
Michigan Department of Mental Health, Education Section.
Alcoholism; The Revolving Door
Feelings of Hostility
Qverdependency
Retire to Life
The proud Years

Russell Sage

189

B.

5.

TEACHING AIDS
Smith, Kline and French Laboratories:
Psychiatric Nursing:
United World Film, Inc.:

Philadelphia

The Nurse-patient Relationship
New York

Seizure
Ayerst Laboratories:

Chicago

Modern Concepts of Epilepsy

vo

Content

Learning Experiences and Methods

MENTAL RETARDATION
A.

INTRODUCTION
1. Historical concepts
2. Definition
3. Social Attitudes
a. problems related to family
b. community attitudes and their influence
CAUSES
1. Prenatal
a. genetic
1. chromosome defects
2. metabolic defects
3. Rh factor incompatibility
b. gestational
1. infections
2. nutritional deficiencies
3. prematurity
2. Peri-natal
a. trauma
b. cerebral anoxia
3. Post-natal
a. central nervous system infections
b . trauma
c. anoxia
d. lead ingestion

C.

CLASSIFICATIONS OF MENTAL RETARDATION
1. Mildly retarded (50-70 I.Q.)
a. where cared for
b. levels of corapeten—
c. goals of training program
d. special problems

Reference assignment

191

B.

Lecture and discussion

Lecture and discussion
Reference assignment

Content
2.

3.

D.

F.

Moderately retarded (30-50 1*0.)
a. where cared for
b. levels of competence
c. goals of training program
d. special problems
Severely retarded (0-30 I.Q.)
a. where cared for
b. levels of competence
c. goals of training program
d. special problems

COMMONLY SEEN ENTITIES
1. Cerebral malformations
a. microcephaly
b. macrocephaly
c. hydrocephaly
2. Mongolism
3. Brain damaged
km Metabolic disturbances
5. Familial disorder
CONDITIONS ASSOCIATED WITH RETARDATION
1. Sensory impairment
2. Motor defects
3. Structural abnormalities
k. Language disorders
5* Psychological disturbances
TREATMENT
1. Medical
2. Education and Training

Lecture and discussion
Reference assignment
Ward conference: Presentation of
commonly seen entities

Lecture and discussion
Reference assignment

192

E.

Learning Experiences and Methods

Content
NURSING CARE
1. Goals in care of patient
2. Training in activities of daily living
3. Needs of the patient
a. psychological
1, security, recognition, dependency,
support, redirection, affection
2. influence of attitudes on patient
b. physical
1. principles of good health and hygiene
2. care of physical illness or abnormality
c. social
1. group living
2. relationship with families, peers and
employees

H.

INTERDISCIPLINARY APPROACH
1. Diversity of needs of mentally retarded patient
2. Roles of disciplines
3. Community involvement

I.

PREVENTION OF MENTAL RETARDATION
1. Improved prenatal care
2. Early diagnosis and treatment
3. Research

193

G.

Learning Experiences and Methods

Lecture and discussion
Reference assignment

TEACHING AIDS
A.

Books, Pamphlets and Mimeographed Materials
1. American Journal of Mental Deficiency. A bi-monthly publication by the American Association
on Mental Deficiency.

2. Anatomical Charts.
3. Buck, Pearl.

k.

The Child Who Never Grew, New York:

Chamberlain, Naomi H. and Moss, Dorothy H.

5. Davies, Stanley p.
6. Dittman, Laura.

The John Day Co., 1950.

The Three R's for the Retarded, New York; The
National Association for Retarded Children.

The Mentally Retarded in Society, New York;

Columbia University Press, 1962.

7. Home Care of the Mentally Retarded Child, 3rd printing, Vineland, New Jersey:
the staff of the training school at Vineland, New Jersey, 1961.
8. Hutt, Max L. and Gibby, Robert G.

The Mentally Retarded Child, Boston:

9. Kirk, Samuel, Karnes, Merle B. and Kirk, Winifred D.

10. Levinson, Abraham.

12. Sarason, Seymour.

Allyn & Bacon, Inc., 1958.

You and Your Retarded Child, New York:
The MacMillan Co., 1958.

The Mentally Retarded Child, New York:

11. Michal-Smith, Harold.

prepared by

The John Day Co., 1952.

The Mentally Retarded patient, Philadelphia:

J. B. Lippincott Co., 1956.

Psychological problems in Mental Deficiency, New York:

Harper and Bros., 1959*

13. The Backward Child, Mental Health Division - Department of National Health and Welfare:
Ottawa, Canada, 1957*

194

The Mentally Retarded Child at Home, Washington, D. C.: Children's Bureau,
publication No. 37^, U.S. Dept, of Health, Education and Welfare, 1959.

TEACHING AIDS

B.

14.

The Child Who is Mentally Retarded, Children's Bureau Folder No. ^3, Washington, D. C.:
U.S. Department of Health, Education and Welfare, 1956.

15.

Tregold, Alfred Francis and Soddy, Kenneth.

16.

Wallin, John Edward.

A Textbook of Mental Deficiency, 9th ed., London;
” Bailliere, Tindall & Co., 1956.

Children with Mental and Physical Handicaps, New York:
prentice Hall, Inc., 19^9*

Films;
Michigan Department of Mental Health, Education Section
A Class for Tommy
Tuesday's Child
195

Content
VII.

Learning Experiences and Methods

CLASSIFICATION OF MENTAL ILLNESSES
DISORDERS CAUSED BY IMPAIRMENT OF
BRAIN TISSUE FUNCTION

Lecture and discussion

B.

PSYCHOTIC DISORDERS
1. Involutional psychotic reaction
2. Affective reactions
3. Schizophrenic reactions
Paranoid reactions

Reference assignment

C.

PSYCHOSOMATIC DISORDERS

D.

PSYCHONEUROTIC DISORDERS
1. Anxiety reaction
2. Dissociative reaction
3. Conversion reaction
k. phobic reaction
3. Obsessive compulsive reaction
6. Depressive reaction
7. Others

E.

CHARACTER DISORDERS

F.

BEHAVIOR DISORDERS OF CHILDREN

196

A.

Contents
VIII.

Learning Experiences and Methods

THERAPIES
A.

B.

SOMATIC THERAPIES
1. Electroconvulsive therapy
2. Insulin coma therapy
3» Other coma therapies
k. Psychosurgery
5* Hydrotherapy
6. Nursing Care
PSYCHOTHERAPY
1. Individual therapy
2. Group
3* Nurse’s supportive role

C.

CHEMOTHERAPY
1. Tranquilizing drugs
2. Psychic energizers
3* Nursing care in chemotherapy

D.

OTHER THERAPIES

Lecture and discussion
Ward conference: Observation and
participation in administration of
somatic therapies

Reference assignment

TEACHING AIDS
A.

Books, pamphlets, Mimeographed Materials
1. Kalkman, Marion E.

Introduction to Psychiatric Nursing, New York:

2. Matheney, Ruth V. and Topalis, Mary,

3. Mimeographed sheets:

McGraw-Hill Book Co., 1958.

psychiatric Nursing, 3rd ed., St. Louis:
C. V. Mosby Co., 1961.

Nursing Care of Somatic procedures
Recreational Activities for Ward Use
Suggestions for planning Ward Activities program
Tranquilizing Drugs

198

Content

Learning Experiences and Methods

REHABILITATION
A.

DEFINITION

B.

GOATS OF REHABILITATION

Lecture and discussion

C.

REHABILITATIVE HOSPITAL SOCIAL STRUCTURE

Ward conference: Observation of patient
participation in Patients' Council,

D.

UNIT OF REHABILITATION

RT, OT

E.

REHABILITATIVE ATTITUDES IN PERSONNEL

F.

PROCESS OF REHABILITATION
1. Determination of existing ability of patient
2. Development of experiences appropriate to
current level of functioning
3. Involvement of patient, family and
community in process of rehabilitation
ROLE OF THE NURSE

199

G.

Reference assignment

Field trips-nursing homes, family care
homes, half-way house, consultation
center or public health agency

TEACHING AIDS
A.

B.

Books, pamphlets and Mimeographed Materials
1.

Schwartz, Morrisand Schockley, Emery L.

2.

Ingram, Madeline Elliott, Principles and Techniques of Psychiatric Nursing, 5th ed.,
Philadelphia: W. B. Saunders Co., I960.

5.

Von Mering, Ctto

k.

Robinson, Alice M.

and King, S. H.

The Nurse and the Mental patient, New York;
Russell Sage Foundation, 195&.

Remotivating the Mental Patient, New York:
Russell Sage Foundation, 1957•

The Psychiatric Aide: A Textbook for Patient Care, 2nd ed., Philadelphia;
J. B. Lippincott Co., 1959.

Bitter Welcome
Man to Man
Psychiatry in Action
Retire to Life
RX Attitudes

200

Films:
Michigan Department of Mental Health, Education Section

Content
X.

Learning Experiences and Methods

LEGAL ASPECTS OF NURSING CARE
A.

TERMINOLOGY
1. Legal
2. Psychiatric

Lecture and discussion

B.

COMMITMENT LAWS
1. General
2. Michigan

Assignment:
court order

C.

ATTENDANT NURSE'S RESPONSIBILITIES
1. patient's legal rights
Field trip:
a, transaction of business with an outsider
b . communication
1. telephone calls
2. letters
3. wills
2. Criminal offenses
a. negligence
b. assult and battery
c. defamation
d. carnal knowledge of a patient
3. Nursing situations with potential legal involvement
a. admission procedure
b. transfer procedure
c. discharge
d. restraint
e. medication
1. narcotics
2. recording
k. Special situations with potential legal involvement

Review sample of a

Visit Probate Court

201

TEACHING AIDS
A.

Books, pamphlets and Mimeographed Materials

1.

Davidson, Henry A.

Forensic Psychiatry, New York;

2.

Lesnik, Milton J. and Anderson, Bernice.

5.

Mereness, Dorothy and Kornosh, Louis.

Department of Mental Health.

The Ronald Press Company, 1952.

Nursing Practice and the Law, Philadelphia;
J. B. Lippincott Company, 1962.

Essentials of psychiatric Nursing, 6th ed., St. Louis;
The C. V. Mosby Company, 1962.

Michigan Department of Mental Health Statutes (12-1-60),
Lansing: 1961.

Noyes, Arthur, Hayden, Edith and Van Sickel, Mildred.

Textbook of psychiatric Nursing, 5th ed.,
New York; The MacMillan Company, 1958.

6.

Recommendations for probate Court practice, prepared by A Group of Southeastern Michigan
probate Judges, Hon. John W. Conlin, Chairman. Lansing; Office of the Court Administrator.

202

5*