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Gog Hey Ril LLL TE ese etBtaal ca Tigh PMB U rn @ Seo LUC SLL eaee Pe ees ve as ue a a. wily VV, BS ait Ve Wwe bd tt td 4 ane M+ wee Aol > mao, : Awe pits: give! bay be | Vy a : Nh hte hao SS these .y Cocveltes: ess : —_— Saat tot ey \ : “BLD ol + a ET ald tee seMenee [ee weed ay 4 why eB yee ‘ ' hs he ta ari T ae Vet ee HAA a oT ee mes | Yh ahaa } eevagteyretettn : é ona me Ef - mnennnti | att I ver vey 5 ew we TWUUTEDIgyrere ane tutnall 4 y) \. Tb r mrfobhy JUL pba da CUTE ETE ETT ET PEPE TET eee P. = on a a iy sie Tee } : > : , we": — : if s\ i es ~ = : r 2 : a ae te ase a i of INDIANA UNIVERSITY _ STUDIES Contributions to Knowledge made by Instruc- tors and Advanced Students of the University VOLUME VI Nos. 40-43. January, 1919, to December, 1919 - et ¥ r . 2 > aw e . t . “ oe CAM EF a ~s"\ Lae tiAS > BLOOMINGTON, INDIANA Published by the University The UNIVERSITY STUDIES constitute a series of University pub- lications, in which are published some of the contributions to knowledge made by instructors and advanced students of the University. At present four numbers are issued a year. For sale by the University Bookstore, Bloomington, Ind. 4(). 41. 43. Table of Contents VOLUME VI THE “AMERICAN BOTTOMS” REGION OF EASTERN GREENE CoUNTY, INDIANA—A TYPE UNIT IN SOUTHERN INDIANA PHYSIOGRAPHY. By Clyde A. Malott, Ph.D., Assista:t Professor of Geology, Indiana University. A StTupy oF HANDICAPPED CHILDREN: BASED ON ONE HUNDRED AND FIFTY CRIPPLED CHILDREN REFERRED TO THE SOCIAL SERVICE DEPARTMENT OF INDIANA UNIVERSITY. By Helen Hare, A.M., Hospital Worker in Robert W. Long Hospital, Indianapolis. THE SOCIAL ASPECT OF THE CARDIAC CASE: A STUDY BASED UPON ONE HUNDRED FIFTY-FOUR CARDIAC CASES REFERRED TO THE SOCIAL SERVICE DEPARTMENT OF INDIANA UNIVER- sity. By Lela Frances Thompson, A.M. THE SOCIAL SIGNIFICANCE OF MENTAL DISEASE AND DEFECT: A StTuDY BASED ON THREE HUNDRED FORTY-FIVE MENTAL AND NERVOUS CASES REFERRED TO THE SOCIAL SERVICE DE- PARTMENT OF INDIANA UNIVERSITY. By Helen Hunt An- drews, A.M., Head of the Social Service Department in City Hospital, Louisville, Ky. Yat Parmer is ee ; Marcu, 1919 pL I i een — : ea : INDIANA UNIVERSITY STUDIES MAR 18 1920 | ‘ *», Ya ; E ona: wuss Study No. 40. THE “AMERICAN BOTTOMS” REGION OF EASTERN GREENE COUNTY, INDIANA—A TYPE UNIT IN SOUTHERN INDIANA PHYSIOGRAPHY. By Ctryps A. Matort, Ph.D., Assistant Professor of Geology, Indiana Uni- versity, % For Sale by the University Bookstore, Bloomington, Ind. Price, 25 cents. The INDIANA UNIVERSITY STUDIES are intended to furnish a means for publishing some of the contributions to knowledge made by instructors and advanced students of the University. The STUDIES are continuously numbered;- each number is paged inde pendently. Entered as second-class matter March 27, 1916, at the post-office at Bloomington, Ind., under the act of August 24, 1912. The INDIANA UNIVERSITY STUDIES are published four times a year, March, June, September, and December, by Indiana University, from - the University Office, Bloomington, Ind. — oe i INDIANA UNIVERSITY STUDIES Marcu, 1919 VoL. VI STUDY No. 40 THE “AMERICAN BOTTOMS” REGION OF. EASTERN GREENE COUNTY, INDIANA—A TYPE UNIT IN SOUTHERN INDIANA PHYSIOGRAPHY. By Ctrype A. Matort, Ph.D., Assistant Professor of Geology, Indiana Uni- versity. oy. 3& fo QE, eS ~22a] Muse Submitted in partial fulfilment of the requirements for the degree Doctor of Philosophy at Indiana University. Contents PAGE INTRODUCTION, 2: 0) oe. Db be ie ie ee ee eee 3 LocaTION, EXTENT. AND NAME OF THE ‘‘AMERICAN BorroMs’”’.............. 5 DRAINAGE AND TOPOGRAPHY...) 2) 6050 2 ee 6 THE GEOLOGY OF THE ‘‘AMERICAN Bottoms’’ REGION AND THE TOPOGRAPHIC AND PHYSIOGRAPHIC INFLUENCES OF THE LiTHOLOGIC UNITS............ 7 The Mississippian Strata. 0.3. 2. +0 25 eee 8 The Mitchell Limestone... 5...) eee 8 The Sample Sandstone and Horizon: 2-33... 9 The Beaver Bend Limestone. =). ) The Brandy Run Sandstone Horizon, 3... 10 The Reelsville Limestone <:..+23.4 25... e ee 10 The Elwren Sandstone and Shale..:.-.. 2) dia The Beech Creek Limeston€. — 0.2 2h ee 11 The Cypress Sandstone. 34) 22. $40.2 2 eee 16 The Golconda Limestone and Shale... 2) i eee 18 The Pennsylvanian Strata: 2 00.000 ee ee 19 Ehe Mansfield*Sandstone.-s:. .. 2.4. 20-2 ee ee "i Se eee 19 THE PRE-GLACIAL PHYSIOGRAPHIC HISTORY OF THE REGION................ 21 The Significance of Land Forms... 2.22) =e eee 21 The Kirksville Peneplain...... 0.000 7.2 >. Se eee 22 The Partial Erosion Cycle Succeeding the Kirksville Peneplain..... 23 Eurther Uplift and Stream Trenching. .._...322) ee 26 Valley Filling): . 0.20030. nee A eee 26 Valley Filling Interpreted as a Result of Regional Depression. ... © 27 Valley Filling Interpreted as a Result of the Seaward Extension of the Master Stream. 62. 0000) 2515.0 29 General View of the Topography and Relief Before the Advent of the Illinois Glacial Lobe... 3... 2.5.30... See 34 Summary of the Pre-Glacial Physiographic Development.......... 35 THE PHysioGRAPHIc [INFLUENCE OF THE ILLINOIS GLAcTAL LoBE............ 36 General Obstruction in Front of the Illinois Glacial Lobe.......... 36 Stream Damming in the ‘‘American Bottoms’’ Region............. 37 Post-GLAcIAL PHYSIOGRAPHIC WORK AND READJUSTMENT...............--- 40 Remowval of the Pleistocene Deposits. ”....._.. 3. eee 40 Development of the Post-Glacial Clifty Creek........>..........3. 43 Development of the “‘American Bottoms”? Dramage.....5= 73... 45 The ‘‘American Bottoms’”’ Basin Specially Preserved... .. ON SY/ SUMMARY co: oP eisde ose s vp ce in Stee a nee Re ae ae Ae 58 3 The ‘‘American Bottoms’’ Region of Eastern Greene County, Indiana—A Type Unit in Southern Indiana Physiography CLYDE A. MALOoTT, Ph.D., Assistant Prefessor of Geology, Indiana University INTRODUCTION THERE are few regions with more diversified physiographic conditions and resulting wealth of topographic detail than southern Indiana. The fairly uniform monoclinal dip of the rock strata to the west-southwest brings to the surface a highly variable succession of strata, each lithologic type having its characteristic topographic forms. Since several erosion cycles have been initiated, only the oldest of which ever neared completion, the physiographic and topographic features have been multiplied and rendered complex. An- other highly important influence has been that of partial glaciation. The Illinois glacial lobes came in from the north on the two sides of the state, reaching as far south as the Ohio River, but coming together or overlapping in the middle of the state only as far south as northern Monroe County, thus leaving a triangular area, with apex to the north, some 5,000 square miles in extent. The effects of the glacial ice over the area covered by it largely determine the topographic features. In the region adjacent to the glacial margin are found some rather peculiar and striking drainage modifica- tions and resulting topographic features. Since the drainage of southern Indiana, especially its middle and western part, is almost exclusively toward the west and south, these drain- age modifications are to be found chiefly on the western side of the unglaciated area. While there is, therefore, a great variety of topographic forms resulting from the physiographic conditions mentioned above, the complexity is not so extreme as may appear to the (3) 4 Indiana University Studies casual observer. The types of rock exposed to the physio- graphic processes give rather distinct regional physiographic strips in succession from east to west. In a region like south- ern Indiana, which has been subjected to minor uplifts from time to time with short periods of stability between, the kind of rock is the controlling conditioning factor. It is easy to see in crossing the urglaciated area of southern Indiana from east to west that both the major and minor features are largely due to the kind orf rock present. It follows, therefore, that any discussion of the physiography must take fully into consideration the areal geology, in so far as the latter is re- lated to the lithologic type. While the type of rock of the various physiographic belts has been a controlling condition, there are also a number of forms, such as high, level-topped dividing ridges, local peneplains, and similarly developed stream trenches, common to all parts of the unglaciated area. With proper care these may be traced thru the various physio- graphic belts, and correlated. Since the major lines of drain- age either rise in the glaciated area to the east, or in the unglaciated area, and pass thru it into the glaciated area to the west or into a stream itself affected by glaciation, there are as a consequence certain other sets of conditions and results tending to give continuity to the physiographic types. Thus, it will be seen that the physiography of southern Indiana may have had its features determined by any one or any combination of four sets of conditions: first, the type of rock exposed; second, the several uplifts with intervening short periods of stability; third, glaciation on two sides of a triangular unglaciated area; and fourth, the fact that the main elements of the drainage flow toward the west or south from the glaciated region on the east, across the unglaciated area and into the glaciated area to the west, or into a stream that has been affected by glaciation. The physiography of southern Indiana may be expressed in terms of one or more of these four sets of conditioning factors. 3 The locality known as “American Bottoms” in eastern Greene County, Indiana, illustrates all four of the above con- ditioning factors, and may, therefore, be considered as a unit or type of southern Indiana physiography. With these intro- ductory remarks we are now ready to pass to a consideration | of the details of the region in question. On Malott: The “American Bottoms” Region LOCATION, EXTENT, AND NAME OF THE “AMERICAN BOTTOMS” The area included in the present discussion is represented on two maps, one of which shows the topography and drain- age and the other the geology. The geologic map carries a small insert of Greene County, showing the location of the mapped area within the county. The “American Bottoms” proper are situated in T. 7 N., 3-4 W., and consist of a filled valley about five miles in length and as much as a mile in width. The mapped area includes parts of these townships amma csmall part of IT. 6 N., R. 4-W. The entire mapped area comprises about 40 square miles. It will be scen by reference to the geologic map that most of the area lies within the driftless portion of the state, but that the eastern margin of the Illinois Glacial Lobe affected the western edge. A greater area is mapped than is directly concerned with the phenomena of the “American Bottoms’. Beech Creek valley is In no way connected with the ““American Bottoms’’, but its inclusion on the map gives clearness to the position and succession of the rock formations, and brings out the con- trasted elevations of these two valleys. It will be seen that the presence and position of certain kinds of rock are of the very first importance in preserving the broad, flat surface of the “American Bottoms’, which have resulted from the filling of a pre-glacial valley in front of the Illinois Glacial Lobe. Just why certain elevated, broad, alluvial terraces adja- cent to streams, or certain broad, filled valleys should so frequently be called ‘“‘American Bottoms” has never been made clear to the writer. The first description and attempted explanation of the “American Bottoms” cf eastern Greene County is by G: H. Ashley in the Twenty-Third Annual Re- port of the Indiana Department of Geology and Natural Resources for 1898, from notes made by C. E. Siebenthal. Ashley does not propose the name “‘American Bottoms” for the broad, flat, filled valley, but says that this name has been given to it. The only other mention of the region in geologic literatures is in Monograph XXXVIII, of the United States Geological Survey, where Leverett, using Siebenthal’s notes, calls attention to the filled valley as having been the site of a glacial lake “now known as the ‘American Bottom’’’. It is not clear whether Siebenthal gave the area the name which it now bears, or whether the name had been previously in use. 6 Indiana University Studies DRAINAGE AND TOPOGRAPHY Oniy an outiine of the drainage and topography need be included under this heading, since the topographic map has been prepared expressly to exhibit them. In general, the main streams flow to the west or southwest. Beech Creek flows along the northern edge of the area, and enters Rich- land Creek at the northwest corner. Clifty Creek, heading near the village of Cincinnati, flows west, and after travers- ing a number of remarkable meanders and stretches of sub- terranean drainage, turns southwest into Plummers Creek. The latter, with a course slightly north of west, enters the area toward the southwest, and leaves near the southwestern corner. The headwaters of Ore Creek occupy the middle western edge of the area. Bridge Creek is the principal stream in the “American Bottoms”. This stream is alto- gether peculiar, as it empties abruptly into a cavern in the sandstone bluff on the south side of the valley. Several smaller streams in the western and southwestern portions of the “American Bottoms” are smaller replicas of Bridge Creek. The waters from Bridge Creek and these smaller streams of the ““American Bottoms’, after an underground journey, de- bouch from two or three openings in the sandstone bluff in the northeast quarter of section 34, T. 7 N., R. 4 W., where they form springs in the valley of a stream which flows into Clifty Creek. The relief of the region varies from 525 feet above sea level in the broad valley of Plummers Creek to over 800 feet above sea level on the crests of a number of gentle promi- nences along the ridges between the main drainage lires. In the region of Cincinnati, where the main streams of the region head, an elevation of 900 feet is reached. Thus, the maximum relief of the area is about 375 feet. A representa- tive difference in elevation between the ridge and valley may be seen in the vicinity of Ridgeport, where the crest of the ridge is approximately 800 feet, and the valley of Beech Creek is about 550 feet above sea level. This gives an im- mediate relief of approximately 250 feet. The ridge between Bridge and Clifty creeks is also approximately 800 feet in elevation, and Clifty Creek valley is 575 feet above sea level, giving a relief difference of about 225 feet. Bridge Creek valley, or the “American Bottoms”, lies approximately 650 Malott: The “American Bottoms” Region i feet above sea level; so that its elevation is about 100 feet greater than the adjacent valleys. A brief inspection of the topographic map reveals at once the presence of two west- wardly extending, gently undulating ridges, formed by the bifurcation of a single broad ridge near Cincinnati. From these two ridges numerous spurs extend out to the north and south. The deep valleys of Beech and Clifty creeks he on the north and south respectively, while the broad elevated valley of the ‘‘American Bottoms”, with its peculiar drain- age, lies between the two ridges. To the southwest, north of Koleen, is a broad ridge between Plummers and Clifty creeks. This ridge is terminated rather abruptly by the narrow valley of Clifty Creek, which cuts it in two, leaving a subdued rem- nant on the west side. It is in this region that the most prominent cliffs appear. Sheer descents of 50 to 75 feet are found, and these are responsible for the name Clifty Creek. Further discussion of the drainage and topography will be given in the section on the detailed description and inter- pretation of the physiographic features of the region. THE GEOLOGY OF THE “AMERICAN BOTTOMS” REGION AND THE TOPOGRAPHIC AND PHYSIOGRAPHIC INFLUENCES OF THE LITHOLOGIC UNITS Under this head it is the intention to emphasize the stratig- raphy of the region with special reference to the lithologic succession. Formation names will be used mainly for the identification of the horizons under discussion, and for the purpose of calling attention to such strata as are clearly re- sponsible for topographic and physiographic forms. Since the position of certain strata at critical levels is important, the general structural conditions are also discussed. In this respect it may be said that the general dip to the west- southwest at the rate of approximately 30 feet per mile car- ries the higher strata of the eastern part of the area to lower and lower positions to the west and south. As in the dis- cussion of drainage and topography, attention was directed to the topographic map, so here attention is called to the geologic map, and especially to the areal distribution of the strata and to the stratigraphic column at the right of the geologic map. This column shows by the usual conventional 8 Indiana University Studies signs the lithologic succession of the solidified strata, as well as the corresponding symbols used to indicate the areal dis- tribution of formations on the map. It was not found con- venient or practical, especially in the case of the thinner members, to show each lithologic unit on the map. It is seen that the bedrock strata which occur in the region are of upper Mississippian and lower Pennsylvanian age, ard that these two periods are separated by a disconformity. The Mississippian Strata. The Mississippian strata found in the region are confined entirely to the Chester Series, and consist of limestones, shales, and sandstones. Recent work, yet unpublished, on the Chester Series of Indiana has led to a definite naming of the series of formations. This work was done by the writer and J. D. Thompson, of the Empire Gas and Fuel Company, during the summer of 1918. The various formations as they occur in the region here under discussion will be given the names as determined by this latest work on the Chester of Indiana. This work consists mainly in the correlation of the formations with those of Kentucky, following the nomenclature of Butts, of the United States Geological Survey, whose work was published by the Kentucky Survey in 1917. Several new formational names are introduced for the Indiana region, some of which have no representatives in Kentucky. No change has been made in the divisions and nomenclature below the top of that great thickness of limestone known in Indiana as the Mitchell lime- stone, the upper part of which belongs to the Chester and one lower part to the St. Louis. The Mitchell Limestone. The Mitchell limestone is really a group of formations, but makes one great lithologic unit very difficult to divide in a mapable way. The upper part in Indiana is equivalent to the Gasper Odlite and the Fredonia Odlite of Kentucky and is Chester in age, while the thicker lower part is the St. Louis limestone. Only the uppermost part outcrops in the “American Bottoms” region. The upper part of the Mitchell limestone is found near the head of Beech Creek valley. It consists of thin layers of compact sub-odlitic limestone, and rises approximately 25 feet above the floor of Beech Creek valley, in section 9. To the west the dip carries it beneath the alluvium of the stream. To the east along Beech Creek, in section 10, the Mitchell Maiott: The “American Bottoms’ Region 9 limestone does not appear above the valley alluvium, on ac- count of the presence of a disconformity and the consequent deposition of the succeeding sandstone in its place. The Mitchell limestone to the east of the region under discussion forms a surface rock of high importance from a physiographic standpoint, being responsible for a structural peneplain characterized by magnificent subterranean drain- age systems and an attendant highly developed karst topog- raphy. Since its outcrop is limited to a very small part of the area under discussion, and its position is for the most part at or below drainage level, it is of little physiographic influence here. The Sample Sandstone and its Horizon. Overlying the Mitchell limestone are gray and blue shales containing lenses of sandstone, sometimes quite massive and attaining a thick- ness of from 10 to 30 feet. This shale and sandstone horizon fills the interval between the Mitchell and another limestone from 5 to 20 feet thick, and occupies the position of the Sample sandstone. The Sample sandstone receive its name from its excellent exposures near Sample, Breckin- ridge County, Ky., where it occurs as a division in the Gasper Oohte.' The limited thickness of 20 feet, and the small areal outcrop of the shales and the associated lenses of sandstone render it of little importance physiographically in the region under discussion. The Beaver Bend Limestone. The limestones mentioned in the preceding paragraph as succeeding the Sample sand- stone horizon is a bedded limestone, often having massive beds, and is highly odlitic. It is conspicuously jointed, and, on this account, gathers waters into concentrated streams from the porous sandstone usually found above it. These waters come out as springs at the base of the limestone on the underlying impervious shale. Field work has demon- strated that this limestone is found consistently practically from the Ohio River northward as far as the Chester Series extend, into Putnam County. Locally, however, it appears to be separated by only a shght interval from the top of the Mitchell limestone; and in a number of places it has been removed by the erosion which in certain places extended down 1 Charles Butts, Mississippi Series in Western Kentucky. Kentucly Geological Survey. Wale, 2—16903 10 Indiana University Studies into the Mitchell limestone. The name proposed for this lithologic unit is the Beaver Bend limestone from a con- spicuous bend in Beaver Creek just east of Huron, Lawrence County, Ind., where the Baltimore and Ohio Railroad cuts thru a spur on the inside of the bend. Its entire thickness of 14 feet may be seen there near the bottom of the cut. It is the Upper Gasper of Kentucky, as seen in the region of Sample, where the Sample sandstone divides the Upper Oolite into an upper and lower member. The Beaver Bend lme- stone appears locally thruout the length of Beech Creek, ex- cept to the east, where the Elwren sandstone in an unusually thick mass comes down and occupies the position of the eroded portions of several members, including the upper part of the Mitchell limestone, as mentioned above. The Brandy Run Sandstone Horizon. Above the Beaver Bend limestone occur some 10 to 20 feet of gray-blue shales and sandy shales, overlaid in turn by another thin limestonc. This interval represents the stratigraphic position of a sand- stone which farther south in Indiana becomes quite promi- nent, and reaches a thickness of 30 to 50 feet. The latter is excellently developed in the region of Marengo, on Brandy Run Creek, and the name Brandy Run sandstone is proposed for the formation. It thins out south of the Ohio River, and is absent beyond Breckinridge and Meade counties, Ky. The horizon has little physiographic interest in the region under discussion. The Reelsville Limestone. The thin limestone mentioned above, ‘which overlies the horizon of the Brandy Run sand- stone, is typically only 2 feet thick. It is a compact to semi- crystalline limestone, frequently quite odlitic in texture, and almost always sub-odlitic. It contains considerable pyrite which causes it to weather to a-characteristic red color. The remarkable feature of this limestone is its persistence over a wide area. It is found at Reelsville, Putnam County, Ind., from which locality it is proposed that it be named. From there southward it forms a single consistent ledge, until middle Crawtord County is reached, where several other thin ledges come in on top of the main one. It can be traced over a wide area in Meade and Breckenridge counties, Ky., and is there rarely over 10 feet in thickness. Its fauna is closely allied to that of the Gasper Odlite. - It is of little or no im- Malott: The “American Bottoms” Region i portance physiographically in Indiana. Its outcrop is con- fined to Beech Creek valley in the region here considered, and it is only infrequently seen in position. The Elwren Sandstone and Shale. The lthologic unit succeeding the Reelsville limestone consists of one or more members of sandstone and frequently considerable thicknesses of shale, the whole having a total thickness of 40 to 50 feet. The name proposed for this formation is the Elwren sand- stone, from the vicinity of Elwren in western Monroe County, Ind., where excellent exposures are to be seen in the cuts of the Illinois Central Railway. It fills the interval between the thin Reelsville limestone and the next limestone above. The Elwren sandstone and shale unit is represented on the geologic map by a single convention. In the region of the “American Bottoms” it consists of a sandstone from a few feet up to 30 feet in thickness, and a gray-blue shale, with a maroon streak extending up to the overlying Beech Creek limestone, or to another sandstone member near the top. The latter in places attains a thickness as great as the lower sandstone member. The upper sandstone is thick where the lower sandstone is thin. This latter condition is shown in the typical stratigraphic column taken from Ray’s Cave sec- tion along Beech Creek near Ridgeport. The sandstone is usually bedded, but is occasionally massive. The Elwren sandstone and shale unit outcrops on both sides of Beech Creek valley thruout its course, and along the upper part of Clifty Creek valley. North and east of the extreme north- east corner of the mapped area the Elwren sandstone has unusual thickness, occupying the position of several of the lower units which had been eroded away previous to the deposition of the Elwren sandstone. Topographically the Elwren sandstone gives rise to local benches where it takes on the massive phase, as may be seen in the northwest quar- ter of section 7, on the north side of Beech Creek. Since the sandstones are medium to fine grained and usually con- tain considerable clay, they form slopes rather than bluffs and cliffs. The Beech Creek Limestone. The next stratigraphic unit in the Chester Series is the Beech Creek limestone. This name is proposed for the limestone unit which has heretofore been called the “Middle” or “Second” limestone of the Ches- WZ, Indiana University Studies ter Series of Indiana, according to Kindle, Hopkins, Ashley, and others. It receives its name from its excellent exposures along Beech Creek in the region under consideration. This Vic. 1. Mouth of Rayv’s Cave, near Ridgeport. Shows entire thickness of Beech Creek limestone (below) and Cypress sandstone (above). Photo- graph by P. B. Stockdale. limestone has a narrow areal outcrop, but it is given on the geological map a separate convention. It consists of two or more massive to thin bedded ledges with a total thickness of Malott: The “American Bottoms’ Region 13 8 to 24 feet, and a typical thickness of 12 feet. In the region considered in this discussion it attains its maximum thick- ness of 24 feet, as seen in the Ray’s Cave section (Fig. 1). Thruout the region of the “American Bottoms” it must have a thickness of 20 feet or more, and in places may possibly exceed its thickness in the Ray’s Cave section. Everywhere thruout the state from Owen County south to the Ohio River, where the Beech Creek limestone is exposed in weathered outcrops, it presents a ragged face made up of cubical chunks of limestone. It is a gray, compact to sub-oolitic, and often semi-crystalline limestone, frequently locally quite completely odlitic, and contains large numbers of brachiopods, especially of the genus Productus. Of the succession of Chester lime- stones, none contains such a number of large, well-preserved crinoid stems standing out prominently on the weathered faces as the Beech Creek. This feature along with the hackly, cubical weathering gives it such distinguishing characteristics that it can be easily told from any of the other Chester lhme- stones in the state. In the “American Bottoms” region, there is an added thickness at the top. This added thickness con- sists of coarse, crinoidal ledges with a considerable admixture of sand and clay. These upper ledges weather a distinct yellow. It would appear that the area may have been a local basin, or have led into one of considerable dimensions to the west. These upper yellow ledges contain a number of species of Archimedes. The Beech Creek limestone is quite persistent thruout the outcrop of the Chester in Indiana. Only locally is it absent where the strata are sufficiently high for its occurrence. Across the Ohio River it thins out and farther south is absent. At Sample, Ky., in the shale some ten feet above the Reels- ville limestone is a thin ledge of limestone about 4 inches thick that probably represents the Beech Creek. Likewise, in a railroad cut some two miles east of Garfield in Breckin- ‘ridge County there is a ledge 6 inches thick which is its probable representative. A short distance away from this latter place the overlying massive Cypress sandstone comes down considerably below the horizon of the Beech Creek. It may be added that toward the eastern outcrop of the Chester in southern Indiana there is conclusive evidence that the upper Chester formations overlap the lower ones, and this 14 Indiana University Studies overlap is quite notable in the Cypress sandstone, so that this latter formation may be expected to lie on lower and lower strata to the east. The Beech Creek limestone outcrops along Beech Creek and its tributaries high above the valley floor, and along Clifty Creek to its junction with Plummers Creek valley. In the latter case it comes down to the valley level, and in places is hidden by the valley alluvium. It outcrops only in the easternmost ravines of Bridge Creek, and is below the level of the flat “American Bottoms” valley. In the northeast corner of the area it does not seem to have been deposited at all. It is a rather curious fact that the area where the Beech Creek limestone has not been deposited should be coterminous with the area characterized by the development of the massive phases of the Elwren sandstone and the notable disconformity at its base. This raises a question the discussion of which cannot be undertaken in the present paper. The Beech Creek limestone is of great importance from both the topographic and physiographic standpoints. Along its outcrop it frequently stands out as a wall-like bench, partly on account of the shale which characteristically underlies it, and partly because of its recession en masse on weathering. Its highly jointed condition allows it to collect waters from the overlying sandstone into concentrated streams, the out- flow of which in steep-headed ravines and gorges makes it perhaps the most extensive and persistent spring-bearing horizon in the Mississippi valley. It possesses this character because of its relation to the massive overlying sandstone which has a high porosity. These springs often yield a con- siderable volume of water, and the characteristic steep-headed gorges with their high walls of solid rock are common thruout the region of the outcrop of this formation, especially where the limestone is rather. high above the drainage level. The Ray’s Cave gorge is typical (Fig. 1). Another example, weil outside the region in question, is “The Gorge’ southeast of French Lick, whose scenic beauty has been commercialized, so that any visitor who cares for an out-of-town dinner may partake of one of the excellent chicken dinners for which the place is noted. As may be inferred from the presence of these gorges with such large volumes of water coming from their steep-walled heads, the solution of the limestone along Malott: The “American Bottoms” Region 1S) the joints has frequently enlarged them to caves of consider- able size and length, considering the limited thickness of the formation. Ray’s Cave, near Ridgeport, is a cave of very uniform width and height, following the joints strictly, and turning frequently at sharp angles. This cave may be easily followed for a distance of about 1,000 feet, to a point where further progress is arrested by a mass of great sandstone blocks fallen from above. This distance, however, must rep- resent only a small part of the total length of the cave, since a large volume of water comes from under the fallen debris. Just how important this limestone is physiographically will be clear when it is realized that the peculiar drainage conditions in the “American Bottoms” are due to its presence at critical levels. Bridge Creek and its smaller associates do not empty their waters into the sandstone bluff for any other reason than that the Beech Creek limestone is immediately below it. This limestone is, in fact, only 10 feet below the point where the waters of Bridge Creek enter the sandstone, tho the limestone itself is nowhere visible about the margin of the “American Bottoms” flat. Had it not been for the presence of this 20 odd feet of limestone at this particular level, there could have been no subterranean drainage, such as occurs, nor could there have been preserved the unusually broad, filled valley, which, for the most part, is wholly intact. The physiographic effect of this limestone at a critical level is seen again in the southwest quarter of section 35, along Clifty Creek, where the limestone has been carried by the dip to slightly below the level of the stream, permitting the local development of subterranean drainage by the waters of Chlifty Creek. Only the flood waters pass around the great double meander at this point. The water passing thru this subterranean passage, or rather passages, along the enlarged joints in the limestone is lost to view for a distance of about one-fourth of a mile, and nearly 150 feet beneath the crest of the ridge above. This underground passage-way of Clifty Creek is in its initial stage, but we can see that it must finally cause the complete abandonment of the surface chan- nel, leaving the great double meander of a dry valley sunk deeply into the strata, the product of a stream which has entrenched itself since the invasion of the Illinois Glacial Lobe into the region (see Fig. 2). 16 Indiana University Studies The Cypress Sandstone. Cypress sandstone is the name applied to the massive, usually non-bedded, sandstone, over- lying the Beech Creek limestone. This sandstone is the most 1 | Je LOCATION 4 OF PICTURE "| ONLY THE FLOOD WATERS | PASS OVER THE BED OF >= CLIFTY CREEK AT THIS PLACE. THE BEECH CREEK LIMESTONE ALLOWSTHE PASSAGE OF THE NORMAL WATERS BY A SUBTERRAN- EAN CUT-OFF ONE- FOURTH MILE SOUTH. Fic. 2. Bluff on Clifty Creek, showing contact of the Beech Creek limestone and the Cypress sandstone. This part of the post-glacial stream is now being abandoned in favor of subterranean drainage. Photograph by P. B. Stockdale. persistent sandstone of the Chester Series, and is only locally absent, shale being sometimes substituted for it where its Malott: The “American Bottoms’ Region Le horizon appears. It is normally 30 feet thick along its whole outcrop in Indiana, but is occasionally thinner or thicker. The Cypress sandstone receives its name from its excellent exposures along Cypress Creek, southwestern Johnson and Union counties, Ill., where it attains a somewhat greater thickness than in Indiana.’ It has been traced by Butts around the crescentric outcrop of the Chester Series thru Kentucky to the Ohio River.’ Field work in 1918 by J. D. Thompson and the writer has proved its wide extension in Indiana. It appears everywhere its horizon is due. Evidence is at hand to show that it is an overlapping formation, and that it is perhaps the most continuous and widespread of all the formations in the Chester Series within the limits of its horizon. The Cypress sandstone is usually a medium-grained sand- stone, tho often quite coarse; it is yellowish to whitish in color, except along its well-developed joints, where it assumes a reddish brown color due to the concentration of iron oxide. It is usually massive and non-bedded, but laminated, and except along the joint planes and exposed surfaces, quite friable. Since the rock is so well cemented along the joint planes, its outcrop often exhibits great broad faces and rec- tangular blocks along the wall-like outcrop (Fig. 2). In the “American Bottoms” region it is from 30 to 40 feet thick, and rests everywhere directly upon the Beech Creek limestone. It is usually cross-bedded near the contact (Figs. 1 and 2). Toward the top it frequently becomes thin bedded, and rapidly grades into the blue-gray to olive shale that underlies the Golconda limestone. The Cypress sandstone is well developed high above Beech Creek valley along its middle and lower course. It is found everywhere along Clifty Creek, reaching the valley level along the lower course of the creek, and in conjunction with the Beech Creek limestone causing characteristic bluffs and cliffs (Figs. 2 and 3). It everywhere marks the rim of the “American Bottoms’, usually causing an abrupt rise from the monotonous valley flat. The Cypress sandstone, as indicated above, is everywhere an important topographic and physiographic factor, ranking -H. Englemann, Geological Survey of Illinois. Vol. I, 1866. 3 Charles Butts, Mississippian Series in Western Kentucky. Kentucky Geological Survey. 1917. 3—16908 18 Indiana University Studies next to the Beech Creek limestone in this respect in the “American Bottoms” region. It has a wall-like appearance along the streams, whether it be next to the valleys or high up the valley slopes. Since it is overlaid by shale it gives rise to rather sharp local benches, often of considerable breadth where erosion has removed the overlying material down to its resistant top. These benches have been mistakenly interpreted as local peneplains developed in the region where the sandstone is to be found. They are seen prominently above the abrupt slope produced by the sandstone where it rises above the “American Bottoms’. To the west the benches become considerably lower on account of the dip of the strata. Such benches are conspicuously developed on the north side of the “American Bottoms” in section 23. The streams of the ‘“‘American Bottoms’? pass into cavern-like openings de- veloped in this sandstone, owing to the undermining of the sandstone by the weathering and solution of the underlying limestone, and the corrasion by the inflowing waters. The cave-like openings of these stream inlets are among the most striking phenomena of the entire region (Figs. 5, 6, and 7). On the ridges in the eastern part of the area, a number of broad, fairly extensive sags are developed on the Cypress sandstone between the gentle summits of the ridges. Ex- amples of these are to be seen at Cincinnati and Tanner. Golconda Limestone and Shale. Overlying the Cypress sandstone are about 20 feet of olive shales. This shale forma- tion 1s seldom seen except beneath the overlying limestone, where it is protected from erosion. It may be considered as part of the Golconda limestone and shale unit. The Golconda limestone is poorly developed in the “‘American Bottoms” region. It usually consists of several ledges with intercalated thin shale bands, especially at the top; but occasionally the shale between the layers makes up as much of the thickness as the limestone. The Golconda limestone has been called the Upper Huron limestone, or the “Third” limestone of In- diana. The latter name refers to its position in the succes- sion of limestones above the Mitchell limestone. Farther south it has a characteristic thickness of 30 feet, with thin shale members in the upper portion. It is a coarse, semi- crystalline limestone, often beautifully oolitic, and contains large numbers of crinoid stems, blastoids, and several species Malott: The “American Bottoms” Region 19 of Archimedes, the latter usually in larger numbers than occur in any other Chester limestone of Indiana. In the ‘““American Bottoms” region it is usually overlaid by a few feet of green shales where it is not cut out by the discon- formity between the Mississippian and the Pennsylvanian. Toward the extreme southern end of the state, it is succeeded by a persistent sandstone of the Chester Series. This sand- stone is not found rorth of the French Lick region. The Golconda limestone takes its name from Golconda, on the Ohio River in southern Illinois, where the limestone and shale are upwards of 80 feet in thickness.‘ In the “American Bottoms” region there are nowhere more than 10 feet of limc- stone, and frequently much less. It is of little importance physiographically in this region. Where it appears in the accompanying shales above the Cypress sandstone, it has been included on the map under the convention used for the Cypress and other contiguous strata beneath the Pennsylvanian con- tact. The single symbol has been used because the discon- formity is so marked that the Pennsylvanian strata are found in several places resting on beds well down in the Cypress, the Golconda formation having been entirely removed by the erosion preceding the deposition of the later strata. The stratigraphic column shown on the right of the geologic map indicates at what levels the disconformity may occur in the region. The Pennsylvanian Straia. The Pennsylvanian strata ex- posed in the “American Bottoms” region belong exclusively to the lower part of the Pottsville, and are composed for the most part of coarse, gritty sandstone with some associated sandy shales and intercalated thin coal seams. The Mansfield Sandstone. The Mansfield sandstone is the name given to the massive, cross-bedded sandstone at the base of the Pennsylvanian rocks of Indiana. Frequently the lower portion is represented by sandy shales which may con- tain a thin seam of coal. The disconformity referred to in the preceding paragraph allows the Mansfield sandstone or its corresponding shale to begin at various horizons from the middle of the Cypress sandstone up to a level perhaps 60 feet higher. In the latter case the Golconda limestone and 4 Charles Butts, Mississippian Series in Western Kentucky. Kentuclhy Geological Survey. 1917. 20 Indiana Untwersity Studies associated shales appear in the section. Farther east in the vicinity of Cincinnati, only the highest parts of the ridges are capped by the shales containing a thin coal, and the sand- stones of the basal Pottsville. These strata reach lower levels to the west, the dip of the Pennsylvanian-Mississippian con- tact being considerably greater than the general westerly slope of the land surface. Consequently most of the western portion of the region is capped by the Mansfield formation. The lower portion of the Mansfield consists locally of sandy shale, which usually contains a thin seam of coal; but typically the Mansfield is a coarse, often gritty, massive, decidedly cross-bedded sandstone with occasional streaks of sandy shale. The occurrence of the shaley phase containing the thin coal seam is not haphazard, but takes place where the erosion of the Mississippian has been greater, previous to the deposi- tion of the Mansfield, than in the adjacent regions. That is, the shales and thin coal seams appear to have been de- posited in local basins. Above the shales, the sandstone phase usually comes in and becomes quite characteristic of the Mansfield formation. Many cases are known where the sand- stone rests disconformably on the green shale of the upper Chester. The Coal Measures in Indiana contain little or no olive shale. The massive sandstone on the ridge near Ridge- port is typical of the Mansfield formation as it occurs in the ‘““American Bottoms” region. It is about 50 feet thick east of the village, and considerably thicker west. Its. resistance to weathering and erosion is well illustrated by the higher elevation of the ridge west of Ridgeport where the Mans- field is excellently developed. It is well known that massive sandstones where well cemented must give rise to bluffs along streams, and that sandstones when they occupy the inter- stream areas, whether they are well cemented or not, cause sharp ridges of rather uneven crests. These features are characteristic of Mansfield sandstone topography. The above discussion includes all of the Paleozoic rocks found in the region of the “American Bottoms”. The remain- ing deposits belong to the Pleistocene and Recent periods. Since these latter deposits occur at various levels, and are concerned directly in the development of the physiography of the region, rather than indirectly as conditioning factors, they will be discussed under other headings below. Malott: The “American Bottoms” Region 2 THE PRE-GLACIAL PHYSIOGRAPHIC HISTORY OF THE REGION The Significance of Land Forms. Having shown that the series of rocks exposed to the various agencies has given rise to a number of primary regional forms dependent upon the characteristics of the strata themselves, and the particu- lar agencies at work, we may turn to the second set of con- ditioning factors mentioned in the Introduction. This second set of conditioning factors has been determined for the most part empirically by a study of the relations of the “American Bottoms” region to the wider territory of which it forms an integral part, a territory embracing the larger part of the Mississippi valley. The broad diastrophic impulses which have affected the Mississippi valley should be registered in the land forms of any unit area situated in such a central position as southern Indiana. It is maintained that any broad crustal change affecting a great interior continental basin, like the Mississippi valley region, will be recorded in land forms, and that this record will reach in measurable form the remoter parts of the area affected. The physio- graphic development of southern Indiana when finally read will not be essentially different from the history of the Mis- sissippi valley as a whole, and, turning the statement around, the physiographic development of the Mississippi valley must harmonize with that of southern Indiana. Further, it may be generally stated that any adjustment which has been made by the master stream of a region must be recorded in the streams which are tributary to it. Yet no particular small area has squeezed into it the full physiographic data of the larger territory to which it belongs. Direct data from some one particular area may be applied to another by inference. The particular region here in question by no means has within itself its full readable physiographic development, yet it is being presented here as a representative unit in southern Indiana physiography, which, in turn, must harmonize with that of the Mississippi basin. In so far as any of the con- ditioning factors belong to the second group, viz., those deal- ing with crustal movements separated by periods of crustal stability, have failed to stamp the region with the characters which neighboring regions lead one to expect, by so far it 22 Indiana University Studies fails to maintain the qualities which a type unit in southern Indiana physiography should possess. Whenever the physiographer searches over a _ region, whether in the field or by means of its representative, the detailed topographic map, he fixes upon certain salient forms which represent results that may be expressed in terms of denudational units. For example, monadnocks standing on bases which may now be no broader than the broader parts of inter-stream tracts bespeak the former existence of a pene- plain. Trenched valleys below such a peneplain show that uplift of the region initiated another cycle of erosion; and local benches and sags in the older ridge may indicate a halt or series of halts in the general uplift of the region. Features of this sort may conceivably exist in a region, regardless of the nature of the rocks upon which the features are de- veloped. Nevertheless it must be agreed that the nature of the material upon which these characters are impressed is a controlling factor, and that some rocks are favorable for preserving and revealing such historical monuments while others are not. We shall see how the region of the ““Ameri- can Bottoms” reveals periods of peneplanation, followed by uphft and other complicating associated processes. The Kirksville Peneplain. The broad ridge beginning in the region of Cincinnati and trending northwest and then west between Beech Creek valley and the “American Bot- toms’, and the branch of this ridge running between the “American Bottoms” and Clifty Creek valley, are fairly broad with gentle undulations, and are never flat over any con- siderable area. The general elevation of this Cincinnati- Ridgeport ridge and its branch south of the “American Bot- toms” is consistently 800 feet above sea level, but neverthe- less it slopes gently toward the west. By consulting the geologic map one may see that the generally accordant level of the ridges is not due to denudation down to a certain re- sistant stratum, but that to the east the top of the ridge is in rocks of Chester Age, while to the west it is in rocks of Pennsylvanian age. It is proper to mention here the fact that this level persists over a series of high ridges to the east of this region, and that it is developed on various strata, and furthermore that it gradually rises to the east, but at a moderate rate, probably not more than 5 feet to the mile, Malott: The “American Bottoms’ Region 2p One must conclude that the Cincinnati-Ridgeport ridge and its branch between the “American Bottoms” and Clifty Creek, and also the end of the ridge between Clifty and Plummers creeks, as seen north of Koleen, represent the level of a former peneplain, which may be seen on the upland divides over the whole unglaciated portion of the state, reaching up occasionally to maximum elevation of 1,000 feet or more. There are places in the state where it is broad and plateau- like as compared with local peneplains or structural levels below, or the entrenched drainage channels. Some of these characteristics may be seen on the topographic map of the “American Bottoms” region. To this high former peneplain of southern Indiana, Beede has given the name Kirksville plain from its excellent development near the little village of Kirksville in Monroe County.® It has been regarded as a correlative of the Lexington peneplain of Kentucky and the Highland Rim of Tennessee, and was probably developed in middle Tertiary times. The Kirksville peneplain is the oldest peneplain repre- sented in southern Indiana, and, so far as the physiography can be read from the topographic forms, must be used as a beginning of represented physiographic history; yet there is no doubt but that other peneplanations succeeded the with- drawal of the Pennsylvanian seas and preceded the develop- ment of the Kirksville. There is no physiographic record of the great lapse of time represented by the remainder of the Paleozoic, the entire Mesozoic, and the earlier part of the Cenozoic. The Partial Eresion Cycie Succeeding the Kirksville Pene- planation. Succeeding the Kirksville peneplanation, the re- sidual forms of which are found in the gently undulating, often broad, inter-stream spaces of the ‘““American Bottoms” region, was an uplift which initiated an ensuing cycle of erosion. Whether the amount of this uplift is to be measured by ‘the difference between the Kirksville level and the grade level of the present streams, or by more or less than this amount, we should be able to read from the resulting as- semblage of topographic features. Close study of the region Proceedings of the Indiana Academy of Science. 1910, 24 Indiana University Studies positively called local peneplains, such as should have resulted had the amount of uplift been less than the difference between the Kirksville level and the present grade level. Certain broad benches do occur, but in every case they may be cor- related with the particular strata upon which they are developed, since they are consistently present upon certain strata, and have their elevations corresponding exactly to the dip of the strata. Another criterion of local peneplanation which may be looked for is the presence of sags in the inner- stream ridges, developed at a fairly consistent level. One such is found at Ridgeport at an elevation of 735 feet, near the base of the Mansfield sandstone; another northeast of Koleen at an elevation of 705 feet, near the base of the Mans- field and in shale; a third at Tanner at an elevation of 735 feet; and a fourth, one-half mile southwest of Tanner at an elevation of 740 feet. These two latter are developed on the Cypress sandstone, and really mark the beginning of the more or less continuous line of benches above the “American Bot- toms” valley developed on the same strata. Briefly, it may be said that these sags constitute the sum total of the evidence that local peneplanation above the present stream level and below the Kirksville level has taken place in the region, and that there is insufficient evidence upon which to base a claim of local peneplanation below the Kirksville level. In other portions of the driftless area, conspicuous local peneplains are found below the level of the more ancient Kirksville plain. Beede® has identified a wide-spread pene- plain developed on the Mitchell limestone to the east of the “American Bottoms” region. This peneplain he named the Mitchell plain from its excellent development at Mitchell, Ind., on the Mitchell limestone of southern Lawrence County. It has an elevation varying from 100 to 175 feet below the Kirksville plain where both are present in the same region. Judged from its development exclusively on the Mitchell lime- stone it does not satisfy all the tests of a genuine peneplain. It has a fairly uniform inclination accordant with the dip of the limestone upon which it is developed. The writer has proved this by making several sections across it. In Harrison and Washington counties it seems to have been developed about the horizon of the top of the St. Louis limestone near SE OCuICIb De 20. Malott: The “American Bottoms” Region Zo the cherty layer within the Mitchell limestone group. The writer 1s not in a position to discuss this point at present as fully as could be desired. Further study will either prove the Mitchell plain to be due to denudation down to a particu- lar group of strata, or to be a true peneplain as described by Beede. Locally the Mitchell plain has all the characters of a true base-level plain, but it can be urged against this interpretation that the plain is well developed to the east- ward at elevations consistent with the level of the Kirksville plain, while to the westward where the same Mitchell strata have dipped down, the plain also is much lower than the typical Mitchell level is supposed to be. Judging from the development in Brown County, Ind., of a local gradation plain or peneplain below the level of the Kirksville plain, in rocks of uniform composition and struc- . ture and several hundred feet in thickness, it must be in- ferred that succeeding the Kirksville peneplanation there was a period of crustal stability after an uplift of about 150 feet. The Knobstone strata of Brown County are of such a char- acter as to allow no benches to be formed as a result of local differences in the operation of physiographic processes upon different materials. The material is uniform over a wide area and thru great thicknesses of rocks, and therefore favors a uniform result. Moreover, the strata are of a shaly, silici- ous nature such as favors steep slopes, but does not permit the development of bluffs or cliffs. Weathering and erosion are strictly mechanical. For these reasons the conditions for the making and preservation of local peneplains are very favorable. The writer expects to make the details relating to this matter the subject of a later paper. The conclusion, however, which may be stated now is: first, that there was a short period of crustal stability after an uplift of about 150 feet, and that a gradation plane was then developed below the Kirksville level in Brown County; and, second, that since a wide area must have been subject to similar uplift followed by a period of quiet, the “American Bottoms” region probably had approximately the same history. The absence of any topographic record of this short period in the “American Bottoms” region is tied up with the pres- ence of a complex series of rocks upon which the physio- graphic agencies had to work. The period was so short that 4—16903 26 Indiana University Studies its impress upon the variable strata must have been feeble, and a farther uplift and continued denudation have largely erased any such evidence as would clearly and conclusively show that there was in this region a stage of crustal stability below the Kirksville and above the present grade level of the streams. That there was such a period, the well-developed gradation plane in the Knobstone rocks of Brown County con- clusively testifies. The Mitchell plain of the limestone area gives a similar but more equivocal testimony, as above noted. In failing to record such a condition, the region of the ‘““Ameri- can Bottoms” fails by so much of being a representative unit of southern Indiana physiography. Further Uplift and Stream Trenching. So far as all ap- pearances are concerned in the “American Bottoms” region, the uplift following the development of the Kirksville pene- plain might have been commensurate with the difference between the Kirksville level and the grade level of the present streams. This difference is something like 225 to 250 feet, making proper allowance for the relief of the Kirksville pene- plain itself. It is assumed that the present divides, which are the sole representatives of the Kirksville, were also the divides of the peneplain before uplift, and that the valleys of the latter were lower than the divides by an average of perhaps some 25 to 30 feet to the mile, a reasonably low estimation of regional slope where the drainage lines are small and their distance from the divides short, as is the case in the region under consideration. By way of comparison, it may be noted that the difference of level between the Kirks- ville plain and the present graded stream level in the Knob- stone region of Brown County is about 275 feet, measured at places where the present streams are comparable in size to those of the region under discussion. This shows no dis- parity in the figures. It may be concluded, therefore, that the stream trenching which is characteristic of the unglaci- ated portion of southern Indiana is excellently repr esented in the “American Bottoms” region. Valley Filling. The question may well arise whether stream trenching below any local peneplain level, or below the Kirksville, as it is represented in the “American Bottoms” region, may not have gone deeper than the present base level. If so, the total uplift has been greater than is evidenced by Malott: The “American Bottoms” Region PA the present grade level of the streams. The broad valley flat in the lower course of Beech Creek and the much broader valley of Plummers Creek suggest this. No records of the depth of the alluvium were obtained in either of these val- leys, but it is noticeable that these stream valleys are filled valleys, and that nowhere in their middle and lower reaches do they flow over bed-rock. Their gradients are also low and well adjusted. Clifty Creek cannot be used as an example since it runs over bed-rock on account of having been deflected from the course it formerly followed. This point will be discussed later. When it is realized that all the major valleys of the south- ern part of the state have the characteristics of filled valleys, it will be seen that this question is an important one. Numer- ous records show that the major streams are now flowing from 50 to 150 feet above their bed-rock floors. The fact that the largest of these streams are incapable of bed-rock scour beyond a depth of 40 to 50 feet eliminates any suggestion that these great depths of alluvium are the normal flood-plain material which may be entirely shifted and reworked by the waters of the streams even in the passage of their highest flood waters. There are two explanations that may be offered to account for valley filling. These will now be discussed. Valley Filling Interpreted as a Result of Regional Depres- sion. Valley filling in southwestern Indiana has long been recognized as one of the chief characteristics of its physiog- raphy. Ashley, in his description of the topographic types in southwestern Indiana, reaches some very interesting con- clusions in this regard.’ In comparing the characters of the the stream valleys of the middle section with those of the western area, he uses Twin Creek, Washington County, and Big Blue River as types of stream valleys of the former area, and Pigeon Creek as a type of the latter. He says in part: _ Irwin Creek has along its course steep, precipitous banks. Pigeon Creek has well-rounded banks, nearly everywhere suitable for cultiva- tion. Twin Creek has broad bottoms, but evidently carved out of the rock by erosion, the creek bed being everywhere in rock. Pigeon ‘Creek’s broad bottoms are evidently due to the filling of sunken val- leys. .-. . In brief, the area in which Pigeon Creek lies has evi- dently sunk below drainage level so that all the valleys have been filled 7G. H. Ashley, The Geology of the Lower Carboniferous Area of Southern Indiana. 27th Annual Report of the Indiana Department of Geology and Natural Resources. 1902. 28 Indiana University Studies up so the streams have been raised so that they will run off again. At that point (just east of Ash Iron Springs) the sinking has been esti- mated as not less than 100 feet. Turning again to the region of Blue River it is at once evident that the region has not suffered the same depression as had occurred to the west. On the contrary, the evidence is quite strong that the Blue River region has recently been uplifted. Thus, it appears that Ashley explains the valley filling to the west as due to depression, and at the same time gives facts to show that farther east uplift has occurred. He further states that the great width of the Ohio River valley below Cannelton as compared to its gorge-like appearance above is due to recent uplift to the eastward. Newsom,* speaking especially in regards to the topography of the Knobstone rocks in Washington County, has the follow- Ine tO say: It will be noticed that these streams, after having cut through the overlying limestones, have in a!l cases quickly cut down to their present base levels of erosion, and that the main streams, especially Rush and Delaney creeks, flow through flat-bottomed valleys. As their topog- raphy indicates, these are silted up valleys in which the alluvial filling is from 20 to 40 feet thick. This silting has been brought about by a depression of the land from a former higher elevation, when the valleys were eroded more deeply than at present. With the depression of the surface the streams gradu- ally became checked and the valleys filled. All of the main tributaries of East White River in southern Indiana flow through valleys that have been filled in this manner from 20 to 60 to 75 feet. Beede® in summarizing the physiographic history of the Bloomington Quadrangle, which lies immediately east of-the “American Bottoms” region, states that the present streams flow at a level somewhat above the rock floors of their valleys on account of depression following a period of erosion when the stream valleys were trenched below their present floors. Numerous citations from the publications of such students of the Mississippi valley physiography as Glenn, Salisbury, Hershey, and others might be made, in which valleys filled with gravels, sands, and silts to depths of 100 to 150 feet or more have been described, and this peculiarity explained as due to the depression of the land. SJ. F. Newsom, Geologie Seetion Across Southern Indiana. 27th Annual Report of the Department of Geology and Natural Resources. 1902. °J. W. Beede, Features of Subterranean Drainage in the Bloomington Quadrangle. Proceedings of the Indiana Academy of Science. 1910. Malott: The “American Bottoms’ Region 29 It is conceded that valley filling would be the result of regional depression, and such an interpretation of valley fill- ing in southwestern Indiana and associated regions is a most natural and simple one, especially when looked at from the standpoint of any limited region. But when the question is considered from the standpoint of the entire area affected, other causes than regional depression are suggested. These causes call into account processes, which, if not now in opera- tion, have undisputably been in operation in the past, and were in themselves alone capable of accounting for the filled valleys in southwestern Indiana. This alternative explana- tion will now be discussed. Valley Filing Interpreted as a Result of the Seaward Exa- tension of the Master Stream. Large streams, like the Mis- sissippl River, which carry enormous quantities of sediment and empty directly into a great embayment of the sea, must in the course of time change their regimens markedly. Such streams must always maintain a grade that will permit them to carry their burden to the sea. The Mississippi river is contributing enormous quantities of material to the Gulf, but at present there is little extension of the delta seaward on account of the intensity of wave action on the now altogether peculiar, slender, protruding delta of the main distributaries. This peculiar, protruding, crow-foot delta, perhaps now some- what artificially encouraged in its idiosyncracies, 1s added to the generally protruding deltaic land. If there should be ever so little extension of this delta seaward, there would neces- sarily be an adjustment of the entire graded portion of the stream to fit the extended stream, since the present load capacity of the stream is delicately adjusted to the grade. In other words, the grade must be maintained, and any ex- tension of the stream must result in the synchronous build- ing up of the stream bed as far back up stream as the graded condition prevails. The fact that the master stream of the great interior plains of the United States has always emptied into an em- bayment is of considerable importance in relation to the physiography of the area. It is possible that the Gulf Em- bayment area may have been a deep arm of the Gulf basin extending northward, and that it has gradually been filled by the debris which the Mississippi River system has contributed 30 Indiana University Studies to it. It more likely has been for the most part an epiconti- nental: sea, which has from time to time subsided perhaps in response to the load of land waste from the interior plains. The embayment has been gradually crowded more and more toward the gulf basin until the ultimate result has been to extend the land out into the gulf. This has been the work of the master stream of the great interior of the United States. It would appear that this delta building, which has resulted in extending the land seaward, has been slowed down from time to time by depression of the lower part of the area. Data at hand show that the Mississippi valley is filled with Pleistocene and post-Pleistocene material to a depth of about 250 feet below the present valley surface at the junction of the Ohio with the Mississippi, and that farther south the filling is to be measurcd in hundreds of feet, probably not less than 900 or 1,000 feet in the region of New Orleans. It would appear that for the most part, if not altogether, the depression has been confined to the immediate axis of the embayment and that it has there been fairly sharp. Streams paralleling the Mississippi River on cither side do not seem to have filled valleys. Pearl River in Mississippi is an in- stance. This stream does not appear to have any more valley alluvium above its bed-rock floor than it is itself capable of moving. The present delta of the Mississippi River begins near the mouth of Red River. Here occurs the branching off of the first distributary. This position is 315 miles by channel from the mouth of the river, and has an elevation of approxi- mately 50 feet A.T. The channel could be shortened by 100 miles by eliminating all the crooks and oxbows. The stream - channel, however, is no more winding than it normally should be. The head of the present delta is some 125 miles north of the gulf, in a straight line. It is conceivable that this posi- tion was in no very remote past the sea-level mouth of the Mississippi River. Lyell’® in discussing the convergence of the deltas of the Red River and the Mississippi, says in part: “The date of the junction of the Red River and the Missis- sippi would, in all likelihood, have been known, if America had not been so recently discovered.” It is quite certain that the present delta is the work of continual deposition of ma- 1° Charles Lyell, Principles of Geology, 1873. BP. 482. Malott: The “American Bottoms” Region 51 terial which had been brought from the land mainly by the master stream. The present delta head is some distance in the interior, but, assuming that at one stage in the history of the embayment area the mouth of the Mississippi River was near this position, the Gulf waters once extended north- ward in a broad shallow embayment to this position. With the southward extension of the delta into this embayment, the graded portion of the stream had to adjust itself to the new condition. This was done by building up the stream bed, which in the course of time resulted in filling up the entire valley. Since the delta continually extended the river southward, the valley at the delta head was continually being built up. Today it stands 50 feet above sea level. Like- wise the valley was filled up to a corresponding depth as far back up stream as its grade had previously been perfected. The graded condition of the streams extended wel! into south- western Indiana. Thus the extension of the present delta of the Mississippi River in itself will account for a filling amounting to something like 50 feet. The vital question here is: Just where is the real head of the Mississippi River delta: that is, just where was it originally in the Gulf Embayment area? An important feature to be considered is the date of the valley filling. This refers to the time when the chief delta extension took place. Mississippi valley physiography is in- timately associated with the Pleistocene glaciation. The re- peated extensive glaciation of the upper portion of the valley where the major tributaries have their origin has determined almost wholly the present features. Bordering regions give a time check on the Pleistocene epochs. The lower Missis- sippi valley was greatly affected by glaciation. One of these effects is the associated loessial deposits. A chief effect must have been the bringing down of great quantities of debris by the glacial waters. The coming of the glacial ice from the north with its successive loads of debris and its attendant fluviatile waters obliterated to a large extent the pre-glacial drainage systems, and gave rise to new ones, or greatly modi- fied or enlarged the old ones, with waters centered in the master stream toward the head of the Gulf Embayment. The result was the extension of the Mississippi delta into the Gulf Embayment by enormously rapid delta building, By Indiana University Studies lengthening this master stream during the Pleistocene by several hundred miles. Streams that previously emptied into the trunk stream, and which had been graded in conformity with a sea-level base toward the head of the Gulf Embay- ment, now had to readjust themselves to a trunk stream that had built or was building its bed high above its original level at the place of its former entrance into the sea. It is quite likely that the delta building of the master stream caused the entering streams to build up their beds and valleys 100 feet or more in their middle and lower well-graded courses. This process of delta extension and attendant valley ag- gradation lasted thruout the Pleistocene, and into Recent times. The delta has extended itself at present so far beyond the original embayment that wave erosion is probably too se- vere for the process to continue. It is contended, however, that the chief delta building was during the early ice advances. It is thought that the Wisconsin glacial epoch contributed little to actual delta extension. Notable deposits, however, must have been made. The Wisconsin valley train is a rather feeble one at the junction of the Ohio with the Mississippi, probably less than 30 feet thick. This latest ice advance nevertheless did contribute to valley filling in that it gave rise to a peculiar system of lakes in the tributary streams, due to the valley train and glacial flooding in the master stream. Shaw'' has described this laked condition of the tributary streams and assigned it to the Wisconsin glacial epoch where it undoubtedly belongs. Shaw, however, states that valley filling amounts to about 150 feet, but shows that the condition which gave rise to the lakes could not account for more than 40 feet. He dismisses the effect of delta exten- sion as inconsequential, and makes no attempt to apply it beyond the Wisconsin glacial epoch. The following direct evidence indicates the time of valley filling. In collecting data with respect to the occurrence of coal seams in the region of Eel River valley in southwestern Clay County, Ind., J. G. Liston, of Lewis, Ind., has obtained a large number of drill hole records. A large number of these show that Eel River is a valley filled 100 feet or more above its bed-rock floor. A few of these records show that 11. W. Shaw, Newly Discovered Beds of Extinet Lakes in Southern and Western Illinois and Adjacent States. Bulletin 20, Illinois State Geological Survey. 1915. Malott: The “American Bottoms” Region 30 in places over the old valley the Illinois glacial till was de- posited on top of the valley-fill material. Thus, along Eel River the material which fills the valley is at least middle Pleistocene in age. This harmonizes with the idea that most of the delta building of the Mississippi River in the Gulf Embayment occurred in the earlier part of the Pleistocene. Should the entire Mississippi valley be depressed 100 feet, the Gulf waters would extend as an embayment up the lower Mississippi valley as far as the north line of Louisiana, about mid-way between Greenville and Vicksburg. The lower 575 miles of the present Mississippi River would be submerged. This submergence would allow the Mississippi River to en- trench itself not less than 30 or 35 feet at Cairo and the entrenchment near the mouth of the Wabash would be some- what like 40 feet. This cutting down would take place be- cause of the greater proximity of the interior regions to the sea In comparison to the present distances. It simply means that the low grade of the lower Mississippi would be trans- ferred into the interior regions whereas the present grade is fairly high in comparison. The grade of the lower Missis- sippi would be transferred some 500 miles farther into the interior. Thus, a moderate depression of the Mississippi val- ley would not result in valley filling as is ordinarily postu- lated, but would result in valley cutting, just the reverse of the ordinary interpretation. In order to account for valley filling by regional depression care must be exercised in choos- ing the sort of depression to be postulated, and limits must be set to its application. It is only logical to infer that should the mouth of the Mississippi have been at a position near the north line of Louisiana, the well-graded streams of the middle interior Mississippi valley, like those of southwestern Indiana, must have flowed some 100 or 150 feet lower than at present, and the extension of the Mississippi River by delta building, or by some other method, must have caused the filling up of the valleys as we see them today. The two interpretations of valley filing in southwestern Indiana outlined above have been presented rather as if either one alone could account for the phenomenon. The intention, however, has been to emphasize the latter one, but not to such an extent as to preclude any other interpretation. There is considerable evidence of differentia! crustal movements of a 54 Indiana University Studies minor nature thruout the Mississippi valley. The chief move- ments that have occurred since the middle Pleistocene have as a whole been slightly upward, tho there are some indica- tions of tilting. Everywhere beyond the influence of the con- ditions which gave rise to valley filling, the present streams are cutting their valley floors. It appears that instead of the valley-fill material gradually thinning out up stream, it thins rather abruptly, and streams are cutting their bed-rock floors where they might be expected to have filled valleys. The Cumberland River illustrates the general condition, Near its junction with the Ohio River, this stream valley is filled not less than 175 feet deep, but in the vicinity of Nashville, Tenn., barely more than the beginning of its middle course, the stream is eroding its bed-rock floor. Numerous other similar instances might be given. This condition indicates that uplift has been differential or that tilting has occurred. This condition is not out of harmony with the principle of valley filling due to the extension of the Mississippi River by delta building. General View of the Topography and Relief before the Advent of the Illinois Glacial Lobe. Near the close of the pre-glacial physiographic development of the “American Bot- toms” region, the ridges between the deep stream valleys probably appeared somewhat as they do now, tho perhaps slightly broader. The area was sharply trenched by the main streams, and their ravine-like tributaries began with rather abrupt, steep gradients, as they do today on the south side of Beech Creek valley. Ray’s Cave spring and all the other springs coming from the greatly enlarged joints of Beech Creek limestone along Beech Creek valley were well developed. A stream valley similar to the upper course of Clifty Creek valley traversed to “American Bottoms’’, and passed to the southwest thru the southeast quarter of section 27, and entered pre-glacial Clifty Creek near the center of section 34. Chifty Creek valley, instead of following the tremendous meanders seen in section 35, passed directly west thru sec- tions 35 and 34, and turned southwest into Plummers Creek valley in the northwest quarter of section 4, about one-half mile east of Mineral City. Some 75 feet above the valley of the stream which traversed the site of the present ‘“Ameri- can Bottoms”, the Beech Creek lmestone outcropped, and Malott: The “American Bottoms” Region aD had developed in it small caves in the greatly enlarged joints. Springs flowed from these small caves thru steep gorges with rock-walled heads, similar to the one at Ray’s Cave today. Thus, it will be seen that the “American Bottoms” region has a mature topography with a relief very much like that of the Beech Creek portion of the “Bottoms” and the vicinity of the upper part of Clifty Creek. The youthful condition now characterizing the “American Bottoms” had not yet come into existence, and the drainage of that portion was very different from the present. Summary of Pre-glacial Physiographic Development. The pre-glacial physiography of southern Indiana may be sum- marized as follows: 1. A long-continued period of erosion gave rise to a wide- spread peneplain. This peneplanation was probably completed in middle Tertiary times. The peneplain developed in southern Indiana is called the Kirksville plain. The broad undulating ridges rising near the 800-foot contour represent the Kirks- ville peneplain in the “American Bottoms” region. 2. An uplift followed amounting to 150 feet or more in the Indiana region adjacent to the ““American Bottoms” and widely affected the Mississippi valley. 3. The Kirksville peneplain was trenched by streams, and gradation planes and local peneplains developed in regions of unresistant strata. This stream trenching is well developed in the “American Bottoms” region; but gradation planes or local peneplains do not seem to have been produced. 4. The erosion cycle when well begun was interrupted by further uplift, amounting to some 250 feet or more in south- ern Indiana adjacent to the “American Bottoms” region. 5. The streams were then incised in response to the re- juvenation of the land, and the main streams were cut from 0 to 150 feet below the level of the present valleys. The mouth of Plummers Creek, some 3 miles west of the “Ameri- can Bottoms” region, must have been cut at least 100 feet below the present valley level. 6. A period of valley filling ensued, and the valleys were filled from 0 to 150 feet or more in the middle Mississippi valley region. This valley filling has ordinarily been inter- preted as the result of regional depression, but an alternative view is suggested here to the effect that the valley filling has 36 Indiana University Studies taken place on account of the extension of the mouth of the Mississippi River several hundred miles southward from its position in early Pleistocene time. This extension was brought about by the glacial floods, mainly, which in the Pleistocene period descended from the north. THE PHYSIOGRAPHIC INFLUENCE OF THE ILLINOIS GLACIAL LOBE General Obstruction cf the Streams in Front of the Illinois Glacial Lobe. The third and fourth conditioning factors in southern Indiana physiography, as stated in the introductory part of this paper, are glaciation on two sides of a triangular unglaciated area, and the fact that the main elements of drain- age are almost exclusively to the west and south and that this drainage bears a peculiar relation to the glaciated parts _ on the two sides of the unglaciated part. These two factors which give form and expression to the area here involved are treated together, tho only the first mentioned one is an active factor or involves active factors. The ice of the Illinois Glacial Epoch pushed in from the west and northwest upon the drainage systems leading toward it on the one hand, and on the other it pushed in from the east and north down the drainage systems leading away from it. Thus, there are only areas of inconsiderable size entirely immune from the influences of the Illinois Glacial Lobe in southern Indiana. Any particular area must be considered with respect te its relation to the particular glacial flank con- trolling its modification. The “‘American Bottoms” region is located on the west, and consequently the great ice and debris barrier invaded from the west and north into the drainage systems leading toward it. The streams of the region are not thru streams; that is, they are small and head in the unglaciated region only a few miles from where they flow against the position of the ice front. It may be noticed that the glacial ice advancing from the west and northwest vigorously over-rode the pre-glacial val- ley of the west fork of White River, having crossed it every- where almost at right angles, and that it advanced several miles beyond, going somewhat farther to the south than to the north. In transgressing somewhat beyond the pre-glacial White River valley, it advanced up the drainage lines coming Malott: The “American Bottoms” Region aif in from the east, blocking them very effectively at the time with ice and ice-borne material. This condition of blocked drainage, which in a number of instances persisted after the ablation of the ice, is everywhere in evidence along the former position of the ice front. Streams in a number of cases follow their pre-glacial course to near the position of the ice front and then change their course to some position that gave a favorable outlet to their waters previous to the melting of the ice. Others persist to the White River valley, showing only the effects of the temporary blocking of their courses. The smaller pre-glacial streams and ravines back of the posi- tion of the ice-front were for the most part obliterated by the over-riding ice with its burden of till and the glacio-fluviatile deposits that characterized the ablational period. Leverett'” describes briefly the temporary ponding and the permanent obstructions of the stream valleys heading beyond the former position of the ice front. Among the most striking derange- ments of drainage and ponding of pre-glacial valleys are those south of the east fork of White River, namely the Patoka River, Pigeon Creek, and others. North of the east fork of White River, Leverett discusses the following in order from south to north: Furse Creek, Richland Creek, the “American Bottoms”’, Raccoon Creek, and “‘Flat Woods’’. Stream Dammineg in the “American Bottoms” Region. The geologic map of the “American Bottoms” shows the approxi- mate area covered by the glacial invasion. It is impossible to show accurately the farthest actual advance of the ice itself. The criterion indicating the actual presence of the glacial ice itself en masse is boulder clay. The line on the map marking the approximate position of the front of the Illinois Glacial Lobe is drawn where the easternmost patches of boulder clay are found. The line runs nearly due south from the mouth of Beech Creek across the area, passing some- what west of Park, and passing Plummers Creek about mid- way between Koleen and Mineral City. In connection with the blocking of the drainage lines lead- ing from the unglaciated area to the ice front, great quanti- ties of material were carried locally by water coming from the ice margin itself, sweeping the ice-contributed debris 12 F, Leverett, The Illinois Glacial Lobe. Monograph XXX VIII, U.S. Geological Sur- vey, 1898-99. Pp. 97-195. 38 Indiana University Studies farther inland than it could ever have been brought by the ice alone. The morainic material has everywhere been car- ried by the glacio-fluviatile streams beyond the actual position of the ice-front. Occasionally debris has been carried in this manner several miles beyond the position of the ice front. Locally great outwash aprons occur, covering several square miles. In the re-entrants between these expansions of out- wash material there may be for a number of miles along the ice margin comparatively little material of this sort. These local expansions of outwash material have frequently nearly obliterated all the pre-glacial surface irregularities, and their fairly even, eastwardly sloping surfaces may still be seen descending from near the former position of the ice front. These fans are now deeply trenched by post-glacial erosion. Such an outwash fan occurs near the viaduct of the Illinois Central railroad across Richland Creek, north of the mouth of Beech Creek, and just outside the mapped area. Another one is beautifully developed south and east of Park. It would seem that broad sheets of water must have made this outwash deposit of ice-contributed material, carrying it eastward two or more miles. The sharp ravines and cuts next to the glacial margin frequently expose layers of coarse gravel inter-bedded with coarse sand. Farther east the gravel disappears, and only the sand, very much cross-bedded and rudely stratified, is seen in the sharp ravines and cuts. Much of the original surface of this outwash fan is excellently preserved in sec- tions 26, 27, 34, and 35. Its gently sloping surface shows very clearly on the topographic map, tho deeply trenched by post-glacial erosion. This outwash material in places almost completely obliter- ated the pre-glacial topography. A small monadnock-like hill one-half mile southeast is completely surrounded by stratified sand. It would appear that this hill of Mansfield sandstone stood island-like in the floods which swept the sands about and beyond it. The pre-glacial valley of Clifty Creek in the eastern part of section. 33, and thru the middle of section 34 was completely filled; and farther east in section 35 it was filled from bluff to bluff to a depth of 100 feet.or more. It is easily seen that Clifty Creek never recovered this drain- age, but sought an outlet to the southwest across the ridge thru section 3. The line of the former discharge can be de- -Malott: The “American Bottoms” Region oO” termined by noting the position of the outwash deposits shown on the geological map. The stream that came in from the pre-glacial “American Bottoms” valley was likewise filled, and, while its lower course has been partially resurrected, much of the old valley is still a sandy flat into which the rain waters readily sink instead of flowing over the surface. The southwest edge of the “American Bottoms” in section 26 is a flat surface of a portion of this outwash plain. The sand of which it is largely made up is exposed in the south- flowing stream and ravine-like tributaries near the line be- tween sections 26 and 27. Just north of Park there is a broad glacial col. It seems that the water from the ice came from the west over this col and was discharged to the southeast thru section 27, prob- ably finding its way out toward Plummers Creek along the route of the present Clifty Creek. Proof of the eastward discharge of water thru this col is found not only in the direction of flow indicated by the cross-bedding of the water- laid material, but also in the presence of silt terraces duc to the ponded condition of the northeast tributary of Ore Creek, in the north half of section 22. These silt terraces are at exactly the same elevation as the broad glacial col. This small pre-glacial valley leading southwest was ponded by the ice and glacial debris to the depth of the water flow- ing out at the col. The glacial sediment which eddied into this flooded pre-glacial valley combined with the indigenous material carried into it by the regional wash to fill the valley with silt, the remains of which still reveal its glacial history. It is quite probable that the strong discharge over this col resulted in lowering the head of the outwash apron in the vicinity of Park. The outwash material so effectually filled the lower part of the valley now occupied by the “American Bottoms” that the waters which gathered into it have never transgressed the barrier. The middle and upper part of the valley became a lake with the lowest margin at an elevation of 675 feet above sea level. The southwest rim was the broad outwash plain gently rising to the west. This outwash plain abutted against the abrupt ridge to the south. There are no indi- cations that the water of the lake ever overflowed the barrier at any point. AO Indiana University Studies The lower course of Clifty Creek, as has already been explained in some detail, was also evicted from its pre-glacial channel. The lake produced in its middle and upper reaches extended to within a short distance of the village of Cincin- nati, and the waters rose to an elevation of about 650 feet. At this elevation the water evidently found an outlet across a sag in the ridge to the south, and the draining stream de- bouched, as it does today, nearly one and one-half miles farther up Plummers Creek than in Pré-Illinoian time. Both Plummers and Beech creeks were also dammed by the ice. These streams still discharge thru their pre-glacial valleys. The presence of silt terraces in the valley of the former, some 40 feet above the present valley flat, indicates that it must have been effectively dammed for a time, but that the barrier was not sufficiently massive to derange the drainage permanently. In the lower part of Beech Creek valley the terraces rise about 50 feet above the present valley floor, and their presence far up the valley at a consistent elevation of 600 feet shows that the valley was effectively dammed to that height; but this again was not enough to derange the drainage permanently. The close of the Illinois glacial invasion in the region of the ‘“‘American Bottoms” found Plummers and Beech creeks ponded some 40 to 50 feet deep, with their waters rising to a level of a barrier that remained long enough to permit the lakes to be filled up by the incoming debris from the drainage basins above. Clifty Creek valley was so effectu- ally obstructed that the water in the glacial lake found an outlet approximately 100 feet above the valley of Plummers Creek. The pre-glacial valley of the ‘American Bottoms” was also blocked to such a height that the waters confined in its middle and upper portions never overtopped the barrier. The surface of this lake must have had an elevation of not less than 650 feet and not more than 670 feet above sea level. POST-GLACIAL PHYSIOGRAPHIC WORK AND READJUSTMENT Removal of the Pleistocene Deposits. The post-glacial his- tory of the “American Bottoms” region is concerned chiefly with the removal of the material contributed by the glacier to the pre-glacial valleys, and with the adjustment of the Malott: The “American Bottoms” Region 1] drainage to changes for which the presence of the ice on the west was responsible. The removal of this glacial material proceeds in two ways. One of these is the removal of the silt deposits from the floors of persistent pre-glacial stream valleys, and the other is the removal of deposits by. the trenching work of post-glacial streams. In the cases where the drainage lines were not changed, but were temporarily laked, the process has not been so simple as has often been supposed. The streams have not simply sunk down into the lake-like silts and removed the deposits by broadening their valleys, leaving the local unremoved por- tions as terraces. Plummers and Beech creeks have been at grade level for a long time, but it has been a progressively changing grade level. Their present valleys are wide and the stream channels meander in them. These features are indicative of base level. The presence of the lacustrine de- posits as local terraces of fairly uniform height here and there above the present valleys indicates the Pleistocene level of the streams. The Beech Creek terraces are about the same height above the base level as those of Plummers Creek. The similarity of the Pleistocene terraces along the minor streams near where they enter White River valley suggests a common cause. The large number of terraces 40 to 50 feet high, such as those of Beech and Plummers creeks, are not due to mere local laking of the particular valleys, but rather to a more general laking. The purely local filling of these streams has been insignificant. There are a number of cases, however, of local filling, and the results have been far from uniform. The ponding of the stream valleys in such a manner as to produce a uniform effect in so many cases can be ascribed only to the superior height of the main stream above its former base level. The occurrence of terrace remnants along both forks of White River accordant in height with those in the tributaries is quite common, but such terraces are not so common as those in the tributaries. Thus the terraces in Beech and Plummers creeks are due to the cutting out of the Pleistocene filling, except at locally protected places. These terraces had their cause in the great valley train of White River, which has since been largely removed. The removal of the Pleistocene silts, then, was not due simply to the cutting down of individual streams into their deposits, followed later 42 Indiana University Studies by broadening of the valleys by lateral corrosion; but it was caused by the slow reduction of the valley train of the main stream, and it took place almost entirely as the streams cut down their valleys, always retaining a broad graded surface. The terraces according to this explanation have always stood out higher and higher above the local base level, as the down- cutting of the main stream allowed the base level of the minor streams to be let down. These in the future will stand higher than they are at present above the wide valleys, as there is no doubt but that the steep gradient of the west fork of White River must be considerably reduced, tho the great load the stream has to transport will allow its middle and lower portions to be reduced only very slowly. The removal of the glacio-fluviatile deposits by the de- velopment in them of ravines and streams since their deposi- tion 1s mainly occurring in places where the pre-glacial val- lays were obliterated or permanently obstructed. To a minor extent, however, removal in this manner takes place in the silted-up pre-glacial valleys the streams of which still main- tain their original courses, as the many small tributaries in the terrace deposits along some of these valleys testify. The deposits which are undergoing the action of post-glacial streams are mainly in valleys where the pre-glacial drainage lines have been more or less completely destroyed. The lower part of the pre-glacial Clifty Creek valley and the pre-glacial valley of the “American Bottoms” are illustrations of this type of removal. Here the filling has been due to special rather than general considerations. No two such filled val- leys need be very similar, especially as regards depth of filling and the readjustment of drainage necessary to meet the derangement that took place. In the two valleys that serve as types, it will be noted that the filling was due to a local barrier in the form of an outwash plain. There are many other similar cases. The sandy outwash deposits in the completely or partially filled pre-glacial valleys are easily trenched by the streams. The stream heading about one-half mile south of Park has broadly removed the outwash sand and gravel in a pre-glacia! tributary of Clifty Creek, and then turned down the pre- elacial Chfty Creek valley itself. Many sharp precipitous ravines occur as its tributaries. Most of those which have Malott: The “American Bottoms” Region 43 their origin in sand have broad seeps at the foot of their steep slopes because of the permeability of the sand plain above. Development of Pest-Glacial Clifty Creek. Clifty Creek valley has been deeply excavated since Pleistocene time and has developed some unusual characteristics inherited from the period of adjustment subsequent to the ablational period of the ice. Its line of discharge after passing out at the middle of section 36 was up the pre-glacial valley of Little Clifty Creek for a short distance, high above its present level. It then curved westward and then to the north where it de- scribed an unusual ox-bow, returning to within 125 yards of itself, but continuing on southward and touching the north edge of section 2 before bending back into another ox-bow with a southwardly directed loop. In the first large loop about the center of section 35, it passed over the position of its filled pre-glacial valley, but on turning back from this loop it never again encountered the oid valley. After having made an unusually striking double loop in the southwest quar- ter of section 35, it at first took a course in a generally south- west direction thru a sag in the ridge that formerly separated its valley from that of Plummers Creek. This consequent stream must have flowed at an elevation of approximately 650 feet above sea level, or 90 feet above its present level in the southwest part of section 35. After entrenching itself some 10 feet below this level 1t remained stationary for a long time, allowing the pre-glacial portion of the stream, the part above the mouth of Little Clifty Creek, to become silted up with the incoming material from the surrounding area. Since then the stream has slowly cut downward, and the silt of the middle and upper parts of the valley has been largely removed. The great meanders in section 35 were entrenched im situ. The northwardly intended meander in section 35 has become greatly enlarged on account of having been formed in the pre-glacia! filled valley. The outside of this meander has always been a bank composed of unconsolidated sand. The stream today still swings against this sand bank on the western and southern sides, and the numerous sand slides carrying in the vegetation testify to the continued growth of the meander... The next meander looping broadly toward the south was also probably smaller originally, and has been 44 Indiana University Studies cut considerably on the outside where the stream is being entrenched. The present stream fits snugly against a rock wall of Cypress sandstone. It is likely that the other meanders have been somewhat enlarged also. Clifty Creek in its initial post-glacial course was perhaps everywhere working in the unconsolidated material of sec- tion 35, but on cutting down it came to the underlying bed- rock, except here and there. Wherever it has become en- trenched in bed-rock, it is now gorge-like. The wide pre- glacial valley flanked with terraces comes to an abrupt end at a gorge just below the mouth of Littie Clifty Creek. The present stream has no valley flat here at all, but flows be- tween rock walls composed of Beech Creek limestone below and Cypress sandstone above. This gorge, which is not a pronounced one, ends rather abruptly, and for a short dis- tance the valley widens out to considerable dimensions. The constriction between the rock walls is repeated where the stream turns north at the beginning of the great meander loop about the middle of section 35. The temporary increase in width just mentioned is due to a small pre-glacial valley which emptied northward into the pre-glacial valley of Clifty Creek. The northward loop, as already described, has a wide valley because here the stream worked in unconsoli- dated outwash material which has filied the pre-glacial val- ley. The stream in this very striking meander loop enters into a rock-walled gorge again just south of the center of section 35. The water here is flowing with considerable velocity over a bed-rock floor. After swinging around this northward loop the stream returns to within 125 yards of itself; but the short distance between the two limbs of the meander is separated by a high sandstone ridge. In making the broad southward loop the stream encounters a small, fairly broad pre-glacial valley trending northward, and fol- lows the latter to the northward. On rounding this meander the stream hugs a steep cliff of Cypress sandstone. This turn to the northward is due not only to the presence of the pre-glacial valley, but also to the height of the ridge to the west. The initial stream flowed northward until the height of the ridge lessened sufficiently to permit it to cross. It did not come quite far enough at this place to reach the pre-glacial valley of Clifty Creek. Initial flow to the northward was Malott: The “American Bottoms’ Region 15 unfavorable because the outwash surface had a southward slope. Clifty Creek follows a double meander thru a rock- walled gorge in the southwest corner of section 35. The lower part of this gorge is in the Beech Creek limestone, and the upper part in Cypress sandstone (see Fig. 2). The gorge here has walls about 50 feet high and a much higher steep ascent on the south. The bed of the stream is in highly jointed limestone, and the stream continues to run over or very close to bed-rock thru the remainder of its course to Plummers Creek valley, as shown on the geologic map. The topographic map shows excellently the post-glacial gorge which Clifty Creek has made. Its restricted width here in comparison to its pre-glacial valley is one of the striking features of the region. One of the remarkable conditions to which this adjust- ment of drainage has given rise is the present tendency of the stream to seek a subterranean channel. This is an ad- justment that belongs to the present (see Fig. 3). Only the flood waters of Clifty Creek go around the broad double loop to the north. The regular flow all passes beneath the ridge along the enlarged joints of the Beech Creek limestone, com- ing out on the other side in a small cave-like opening. This underground passageway is one-fourth of a mile in length, and the ridge reaches a height of nearly 150 feet above it. When the flood waters give sufficient pressure, water comes out on the lower side thru numerous openings, and thru some of the smaller ones, spurts out fountain-like from the limestone wall. Development of the “American Bottoms” Drainage. The filled valley leading from the ‘““American Bottoms” has a con- sequent drainage developed since the fill was made. One of the ravines heads at the col near Park. It descends very steeply into the outwash sand, and to the southeast joins a larger stream which comes from the north. The east side of this larger stream is formed by the exposed wall of Cypress sandstone which was also the east side of the pre-glacial valley leading out of the “American Bottoms”. The west side of this valley is composed of sand and gravel from which water continually seeps, locally making boggy places at the foot of the steep slope. This stream crosses the pre-glacial Clifty Creek valley at right angles and joins the present AG? Te. Indiana University Studies Clifty Creek just beyond the south side of the old valley. The stream turns southeast upon striking the rock wall of Cypress sandstone just before it enters the present Clifty Creek. The Fie. 3. Where Clifty Creek is now becoming subterranean, near the southwest corner of section 35. The Cypress sandstone here comes down slightly below the creek level. Photograph by P. B. Stockdale. valley has considerable width where it crosses the old filled valley. The topographic map shows this widening of the valley quite distinctly. In the extreme southeast corner of section 27 the main re-excavating stream from the north in Malott: The “American Bottoms” Region AT its downward descent came upon a “nose” of the bed-rock ridge, but kept its position, and cut a gorge at that point in the Cypress sandstone (see Fig. 4). ' Wie. 4. Post-Ulinoian stream-gorge in the southeast corner of section 27, where the stream from the north passed over a portion of the buried part of the ridge at the side of the pre-glacial valley. Photograph by P. B. Stockdale. We have already seen that the “American Bottoms’”’ is a filled valley, due to the spreading of an outwash apron which obstructed the lower part of the valley completely. 48 Indiana University Studies The middle and upper part of this valley became the site of a lake into which the waters came from all sides, bringing in silt and filling the valley back of the outwash dam to a height of approximately 650 feet above sea level. The con- clusion has already been stated that the valley has never been overflowed by the confined lake waters. It would seem that the waters may easily have filtered thru the sand deposits into the ravines to the west, in the lower part of the old valley. These ravines now contain streams of considerable volume due to the constant seepage of water from the sand at the foot of these steep slopes. Ashley in his discussion of the stratigraphy of Greene County has the following to say in reference to the Pleistocene: In the lowlands and prairies the deposits are found to be of con- siderable depth, often over 100 feet, these places evidently being old valleys filled up. Some interesting deposits occur along the glacial border in eastern Greene County. As the ice pushed its way southeast across the country it overran the lower course of many of the streams flowing west into White River, thus effectively damming them up. Small lakes were thus formed. In time these filled up. Then the ice retreated and the streams resumed their old channels. In most cases they immediately began clearing this lake-deposited material out. As this was in the upper part of their courses where the current had some power, most of the streams have about rid their channels of all vestiges of these deposits. Along Richland Creek in Beech Creek Township, however, much material yet remains in the form of gravel terraces mantling the bluffs of the banks of the streams. In places these ter- races are over one-quarter of a mile broad. In the case of a branch of Clifty Creek in the southeastern part of Center Township, instead of clearing out the deposit layed down in the ice-bound lake, the water finds its way down through the mass at several places and flows away underground to appear in the old channel farther down. In this case it would appear quite possible that the water found a passage under the ice before the glacier retreated. The result is a flat filling in a valley to which the name of ‘American Bottoms” has been given.” Leverett, following Siebenthal’s notes, has the following to say about the “American Bottoms’’: About four miles south from the point where Richland Creek turned westward into the glaciated district, the glacial boundary comes to the west end of another glacial lake whose site is now known as the “Ameri- can Bottom”. It extends eastward about five miles from the glacial boundary and has an average width of nearly one mile. This old lake bottom now has subterranean drainage through sand deposits to a tribu- 8 23rd Annual Report of the Department of Geology and Natural Resources of Indi- ana, 1898. Pp. 768-69. Malott: The “American Bottoms” Region 49 tary of Clifty Creek, where it appears in the form of springs. Because of subterranean drainage the plain is preserved in nearly the condition left by the lake.” From the above it seems quite evident that both Siebentha] and Ashley thought the water capable of filtering thru the coarse outwash sands and entering the headward-cutting streams below. Such is not the case at present. Bridge Creek and its smaller replicas, as already explained, enter into openings in the massive sandstone bluffs at the south side of the valley. These openings in the sandstone bluffs are very picturesque, and are in themselves remarkable phenomena (see Figs. 5, 6, and 7). It would appear that the water in the former lake of the ‘American Bottoms’”’ filtered thru the sand, or else entered the already considerably enlarged joints in the Beech Creek limestone, which was well up the side of the pre-glacial valley, and under pressure found its way along the magnificent system of joints. It would not appear that there was much opportunity for the discharge of water thru the present subterranean passages for a con- siderable time following the withdrawal of the ice from the region. The water at present enters the openings at an elevation of 620 feet, or slightly lower, and emerges as two or three springs in the sandstone wall at the present valley level at the northeast quarter of section 34, at an elevation of 560 feet above sea level, and at a point slightly less than 2 miles southwest measured from the Bridge Creek inlet. While this is an easy line of discharge at present, it is diffi- cult to believe that it was a line of discharge immediately following the ice withdrawal. The waters could have filtered thru the sands after having passed thru the limestone pas- sages; but it is more probable that they filtered thru the sands all along the western barrier, with sufficient volume to pre- vent the overtopping of the sand barrier. Certainly, if the waters traversed the limestone passages at all immediately following the ice withdrawal, they went thru very slowly, as these passages must have undergone most of their enlarge- ment subsequent to the ice period. Moreover, the valley into which the present outlets debouched was a filled valley, and has only in recent times been excavated to the level where the present springs emerge. 14 fF, Leverett, The Illinois Glacial Lobe. Monograph XXXVIII, United States Geo- logical Survey, 1898-99. BP. 103. OLUPYPOIS “A ‘dq AQ YARASOJOY "EZ UOT! JO LOULLOD JSOMTJLOU OT} UL JQP OUOJSPURS ssotdA olf} OJUL WUROUS Yooly ospLIq ‘G “DILT 2 a dies ity Stu WeTS? Un Indiana Malott: The “American Bottoms” Region al The present “American Bottoms” area consists of a flat, silty soil, everywhere wet and well leached of its lime con- tent. For the most part it is still the bottom of the former Fie. 6. Near view of cave-inlet of Bridge Creek. The Beech Creek limestone is 10 feet below the entrance level of the water. Note the massive Cypress sandstone. Photograph by P. B. Stockdale. shallow lake, the lake having been filled by the material car- ried in from the surrounding hills. The lake flat slopes west- 52 Indiana University Studies ward at a very slight angle from the east to the two main openings. The slope toward these openings from the west is somewhat greater, but is still at a low angle. The latter slope is the surface of the outwash plain which consists mostly of sand. The most fertile land of the region is in this sandy eastward slope. The present stream of Bridge Creek has a poorly marked valley some 12 feet below the general level of the lake flat where the stream flows into the opening in the sandstone bluff. The second largest opening, a quarter of a mile to the west, is entered by a stream flowing in a slightly depressed swail (see Fig. 7). The two small open- Fig. 7. Cave-inlet of the stream one-fourth mile west of where the Bridge Creek waters become subterranean. ings in the southern half of the southeast quarter of sec- tion 26 have independent streams both of which are de- pressed more sharply below the general level of the lake flat (see the topographic map). In the northeast quarter of sec- tion 26 are several small sinks which have their surface ex- pression in the joints of the massive Cypress sandstone. There are several similar sinks in section 24. Some of these are of more than passing interest on account of being on the “nose” of Cypress sandstone in the southeast quarter of the section. Several small ones here reach down some 40 feet, thru the whole thickness of the Cypress sandstone before coming to the Beech Creek limestone. These sinks show the Malott: The “American Bottoms” Region SPs results of the passage of water thru the joints in the sand- stone to the limestone below, which has been partially re- moved by solution. These sinks are, of course, due to the Beech Creek limestone below, but superficially they give the appearance of being sinks in the sandstone itself, a thing scarcely possible. It will be noted by reference to the maps that the entrance to all the inlets into the subterranean passageways lie against the sandstone bluffs at the south side of the valley in a belt running in a general southwesterly direction. A broad, shal- Tic. 8. Main outlet of Bridge Creek waters from beneath the Cypress sandstone, nearly 2 miles southwest of where the waters enter the subter- ranean passage ways. The Beech Creek limestone is here some 10 feet below the surface. Photograph by P. B. Stockdale. low sink-hole is the last of the series. In line with this belt and two miles to the southwest are the outlets to these pas- sageways in the Cypress sandstone bluff on the east side of the re-excavating valley from the north. The chief one of these outlets is the middle one, where most of the norma! flow comes out in a broad, ill-defined opening from under the sandstone at the very level of the valley floor (see Fig. 8). A much smaller amount of water comes from the outlet at the south, near the road. The opening to the north, nearly one-quarter of a mile north of the road, is the most interest- ing (Fig. 9). It is an opening some 214 feet high and about 54 Indiana University S tudies 10 feet in width, and reaches back under the sandstone to the east. This opening is slightly higher than the openings to the south, but perhaps less than 5 feet higher. The flood water comes out of this opening with great velocity. The opening has a perimeter composed entirely of sandstone, a rather interesting occurrence, showing that it must have been developed along a combined joint and bedding plane, and under pressure from the water within. It is not known how far back one would be able to crawl into the opening, but it is likely that one would come to the passageway, or a series of passageways, along the joints of the Beech Creek lime- Iie. 9. The flood-water outlet of the water from the “American Bot- toms” basin. This opening has its perimeter entirely in the Cypress sand- stone. stone within a few yards or a few hundred feet of the opening, after a descent of not more than 10 or 12 feet. As indicated by the topographic map, the “American Bot- toms” for the most part is a basin, and furthermore a basin with holes in it thru which the water escapes. The 675-foot contour line is the highest depression contour, and ercloses approximately 1,475 acres, or 2 5/16 square miles. The area enclosed by this contour line has a total perimeter of approxi- mately 18 miles. The lake waters were probably much nearer the 650-foot contour line. It may be noted here that some beautiful beach lines are preserved at an elevation of about Ut Malott: The “American Bottoms” Region bE 645 feet above the road leading east from the church, in the northwest portion of section 34. These gravel beach lines have no relation to the water level of the “American Bot- toms” lake. No beaches are preserved in the “American Bottoms” basin. The 625-foot contour line is the third de- pression contour in the basin, but it is restricted to small areas near where the streams enter the openings. The total depth of the basin from the lowest point in the rims to the hole where the water escapes from the basin is about 65 feet. Some further figures reveal interesting features. Bridge Fie. 10. Small recent valley leading up the pre-glacial “American Bottoms” valley north of the road at the west side of section 26. The glacial outwash sand is being rapidly removed here. Photograph by P. B. Stockdale. Creek drains approximately 3,900 acres or about 6 square miles. The water enters the largest inlet cave near the north- west corner of section 25. Sink-inlet number 2, about one- fourth a mile to the west, receives the drainage waters from approximately 1,100 acres. Sink-inlet number 3 or the east one in the southeast portion of the southeast quarter of sec- tion 26, receives the drainage waters from about 170 acres. The smallest sink-inlet, number 4, just to the west of num- ber 8, receives the drainage waters from about 60 acres. The sink south of the road in the southern half of section 26 re- celves the drainage waters from approximately 60 acres. 56 Indiana University Studies Thus, a total of approximately 5,200 acres or 8 square miles drains into the holes in the “American Bottoms”’. It may be noted that the ravines which are re-excavating the pre-glacial valley to the west and southwest of the old lake basin are taking away the material at a very rapid rate. The ravine in the southwest portion of the northwest quarter of section 26 is a great gully or series of gullies, near its abrupt head, eating directly back up the line of the pre-glacial valley. It would appear that this ravine, which at present is so rapidly reaching into the outwash sand by headward erosion, may in time tap the streams leading into the sub- terranean openings, and thus divert the drainage approxi- rately thru the old channel to the present Clifty Creek (Fig. 10). While this is a suggestive possibility, it will prob- ably never happen. The present streams of the basin at their subterranean inlets are approximately at an elevation of 620 feet, while the elevation of the ravine where it crosses the road considerably more than a mile to the southwest is only 20 feet lower. This difference is not enough to give the advantage necessary for piracy, since the small stream would probably require much more than 20 feet fall in the distance it would have to go. It would appear that the subterranean passages must persist, unless they should become thoroly | choked, which is unlikely. When the inlet-sinks of the “American Bottoms” basin were first examined it was thought that the Beech Creek lime- stone would certainly be visible, and the fact that nowhere is there the least vestige of it exposed at the surface at any of the openings gave cause for considerable surprise. These openings can be entered for only a short distance. It was found, however, that the water has to pass over logs, sticks, and other trash that has been lodged in the openings near the entrances, and it was found further that the water de- scends thru the trash very sharply, and probably within a short distance from the entrances reaches the Beech Creek limestone. Just why the water that enters the openings has not cut down to the level of the limestone passageways is not alto- gether clear. Only two suggestions adequate to explain this eondition occur to the writer from observations made in the field. At the opening much foreign material is carried in ~ Ries Wechnst secu cicget aeai Sigel 1 SPST Dk 7 ad, a A = i de + = bagpesreegs eB eae ae Sa Malott: The “American Bottoms’ Region 57 which continually keeps the throat of the sink in a clogged condition. Thus the water in passing over the logs, trash, and other material densely packed with silt at the entrance has no opportunity to cut down the opening to the level of the limestone passageways below. The second suggestion arises from the nature of the top of the limestone as com- pared with its deeper portions. The upper few feet of the Beech Creek limestone in the ‘“‘“American Bottoms” region, it will be recalled, consist of coarse yellow limestone, containing considerable sand and clay. This upper portion seems to dis- solve much more readily because of these properties (Fig. 2). It may be noted that the subterranean drainage which is developed along Clifty Creek does not begin until the top ot the limestone is entirely below the level of the stream. The water on the lower side comes out about the middle of the formation. Everywhere that the yellow upper edges are pres- ent, the solution joints are much larger than in the purer limestone below. So far as Clifty Creek is concerned, the yellow upper portion is much more favorable for development of subterranean drainage than the lower portion. Certainly if the middle and lower portions were as favorable, there should be considerable subterranean drainage beneath the high narrow ridge in the constriction southeast of the center of section 35, where the water at present strikes directly against the limestone. The yellow upper portion is apparently not present at this place. The “American Bottoms” Basin Specially Preserved. The “American Bottoms” basin is one of the very unusual physio- graphic phenomena of southern Indiana, and perhaps has no parallel anywhere in the Mississippi valley. It presents a series of special conditions all of which are specially adjusted. The position of the “American Bottoms” as a filled valley in front of the Illinois Glacial Lobe is not uncommon, but the case becomes special when one recalls that the valley was filled by a particular outwash apron from the ice sheet to the west. Valleys with the same combination of strata are common enough in the Chester Series of southern Indiana, and several of them are filled valleys; but no other has the filling at just the critical height with respect to the Beech Creek limestone, to favor the development of subterranean drainage. The fact that the impounded water which was C775 “| Ww S TOPOGRAPHIC MAP OF THE AMERICAN BOTTOMS REGION, GREENE COUNTY, INDIANA. BY CLYDE A.MALOTT CONTOUR INTERVAL 25 FEET COUNTOURS IN THE VICINITY OF CINCINNATI INTERPOLATED FROM THE BLOOMINGTON QUADRANGLE SCALE IN MILES 1918 58 Indiana University Studies raised to this critical level had a porous barrier which did not permit it to overflow, but rather encouraged it to filter thru in sufficient quantity to take care of the inflow, thus allowing time for the development of subterranean passage- ways with favorable outlets, is another very special factor entering into the problem. For, had this basin been able to overflow at the lower side, it is quite probable that the surface drainage would have persisted, and the “American Bottoms” basin would not have been preserved. Thus, the “American Bottoms” basin is an unusual physiographic feature, because of the exceptional set of conditions critically adjusted to one another. Only by understanding these conditions can we appreciate how and why the “‘American Bottoms” has been preserved as a youthful area topographically, which must remain for a long time almost exactly as it is today, standing scores of feet above the neighboring valleys. The “American Bottoms” basin, while probably without parallel, is not such a specific feature that it fails of being a representative of a certain general class. It is a very strik- ing and peculiar feature, but there are others of its type, tho none have gone so far or are so specifically adjusted. To a considerable degree it is a representative of all specially filled valleys in front of the Illinois Glacial Lobe, and perhaps has its closest relative in the “Flatwoods” region of south- eastern Owen and western Monroe counties. It has been shown that “Flatwoods” is also a filled valley, and that the filling was not without certain adjustments, and further that MeCormicks Creek Canyon, now set aside as one of the state parks because of its exceptional scenic beauty, was probably begun by subterranean drainage, not altogether unlike that of the present “American Bottoms.”’”’ SUMMARY This paper postulates that the physiography of southern Indiana has resulted from four conditions or sets of condi- tions which control the physiographic reactions and topo- eraphic forms. Probably the most important of these is the ceology. Because of the monoclinical dip to the west, a series of litho!ogical units is presented to the surface, upon which DC, A. Malott, The Flatwoods Region of Owen and Monroe Counties, Indiana. Pro- ecedings of the Indiana Academy of Science for 1914. Malott: The “American Bottoms’ Region 59 the physiographic agencies have imprinted their forms. The material on which the processes react is of prime importance in giving rise to topographic forms. A knowledge of the geology of a region goes far in explaining the type of topog- raphy present. The second set of conditioning factors con- sists of the broad crustal movements which have decidedly changed the stream regimen, and consequently have caused certain physiographic forms of more or less wide distribu- tion. The third conditioning factor is glaciation, of such a sort that a triangular area in the middle western portion of southern Indiana has been left unglaciated. The fourth factor is the drainage to the west and south. This factor is related to all the others, but bears a specific and peculiar relation to the glaciation. The latter combination has given rise to very peculiar physiographic relationships and topographic forms. The particulars of these conditioning factors need not be re- peated in this summary. The “American Bottoms” region of eastern Greene County is used as a type unit in southern Indiana physiography. This region is mainly located within the unglaciated area, but laps over into the glaciated portion to the west. Its drainage arises in the unglaciated part and flows toward and into the region formerly covered by the ice. The topography of the region is representative of the rougher and more dissected part of the state, having an immediate relief of some 250 feet. The drainage is peculiar, in that a broad, flat basin known as the “American Bottoms” has a subterranean drain- age of a very unusual character. The rocks of the “American Bottoms” region consist chiefly of several stratigraphic units of the Chester Series of the upper Mississippian. The ridges of the region are capped by the Mansfield sandstone of the Lower Pennsylvanian. The stratigraphic series contain several lithologic types which give rise to certain regional forms inherent in the particular litho- logic type. The Beech Creek limestone, the Cypress sand- stone, and the Mansfield sandstone are of high importance in controlling topographic forms. The Beech Creek limestone is especially important, not only for the topographic forms it gives rise to, but because it becomes a controlling physio- graphic factor. The peculiar underground drainage of the “American Bottoms” basin is thru the limestone. 60 Indiana University Studies The pre-glacial physiographic history of southern Indiana is concerned mainly with the development of the old Kirks- ville peneplain and the partial erosion cycles that follow it, one of which was of sufficient duration to develop local pene- plains below the older one. The “American Bottoms” region does not have developed in it any recognizable gradation planes or local peneplains below the Kirksville plain, and in so far fails of being a type unit. Stream trenching proceeded below the present valley level of the main streams. This is shown in the “American Bottoms” region. Succeeding the stream trenching there was a period of valley filling. The ordinary interpretation of this valley filling is that it is due to regional depression. An alternative view is given in this paper, in which the valley filling is ascribed to delta building of the master stream, the Mississippi, extending the stream south- ward into the Gulf Embayment. This delta building took place during the Pleistocene, and preceded the Illinois glaciai invasion into the Indiana region. The coming of the Illinois Glacial Lobe into the southern Indiana region, overriding the west fork of White River and going beyond up the minor drainage basins, thus blocking them either temporarily or permanently, was another impor- vant factor in southern Indiana physiography. Streams all along the western margin of the ice sheet were frequently deranged to such an extent that they never recovered, and sought new courses. Practically all streams show the effect of blocking. The “American Bottoms” region illustrates streams that were blocked by the glacial ice, but recovered from it almost entirely, showing now only the effects of hav- ing been filled some 30 to 50 feet in their lower courses, on account of the valley train in the west fork of White River. Beech and Plummers creeks are of this type. The lower part of Clifty Creek valley was completely filled by an outwash apron, as was likewise the case in the lower part of the pre- glacial ‘American Bottoms” valley. These valleys were laked, but Clifty Creek soon sought a new outlet to the southwest. The “American Bottoms” lake never overtopped the outwash barrier at the lower end of its valley. Following the Illinois glacial epoch, Beech and Plummers creeks gradually removed most of the silt which had accu- mulated in their valleys. They were able to do this because “ we ; ; . : i . ; ‘ / e . ‘ in Nt icin RCAATLeniReT dean Nbr Ny MiaAEO i nmy oping Umer mia “ et jhe san al {fh ? ‘ nie di | 4 ¥ f, ‘ y 7] wee i fk ‘ ae ' ¢ \, Y ~ wf f y 5 ie 5 | “ — OS Fs % oS v - 9 ~ Hi * me , y , hy } ’ fi ( ~ S * u 5 i ‘ : Varn 7 “y ‘ Ripa t i * n t wi pe =/ he : v ve 7 t4 1 ; : F ‘fe ty erga 8 i f 8 Park . ‘ y e rm ° 4 ave e: ¥ i ay : ‘ \ 7. ee) wit L ' a } Li & ti 1 “ 4 SHR th 7 t 4 \ My ¥ “ aay 1 ’ ‘i . ieee ~¥ My ? : . < bk ) . A | Wi f FY ; Sit thet : iy ee ay By ar ; = id = ni A. £ we ae ahi y i We Gh ¥ mtn « Bow a” - Malott: The “American Bottoms” Region 61 the west fork of White River lowered its valley train. While doing it they were always at temporary base level, as they are today. The outwash sands in the lower parts of pre- glacial Clifty Creek and the pre-glacial ‘““American Bottoms’”’ valleys is being deeply trenched by post-glacial streams. Clifty Creek in its initial flow over its adjusted course possessed some rather extraordinary meanders. It has preserved these meanders, entrenching them in both sand and bed rock, de- pending upon whether it flowed over a pre-glacial valley or over the pre-glacial upland. In its new course it is every- where gorge-like. At one place it is now making a rather remarkable adjustment to the Beech Creek limestone, where it strikes it at a critical level, and is seeking a subterranean course. The rim of the ““American Bottoms” basin was never over- flowed by the impounded waters, for the reason that the sandy barrier to the west permitted the waters to filter thru suffi- ciently to keep them much below the lowest part of the bar- rier. Later, subterranean drainage developed in the Beech Creek limestone. This is a remarkable feature. The streams of the basin flow into openings in the Cypress sandstone biutis at the south side of the valley. Their waters come out from beneath the same sandstone nearly 2 miles to the southwest. This drainage is thru the Beech Creek limestone which is but little more than 20 feet thick. The “American Bottoms” basin persists in its flat con- dition of topographic youth, because of the unusual condi- tions which gave rise to it, and because of the critical ad- justments of the drainage. As a physiographical phenomenon it is one of the most. peculiar in the Mississippi valley region. FEET ee a = qty Be 5 fa niegH S|5 eee ¢ a ee SK nN az. ee, al Fla SS = Nu jit zls S. S z\|o - Hi 3 aa 2 Iai L Wn Tay tl f "i << Hi et ti alee nn fl e Unceerotury S ats ee ED nui ae ATi wi | "LAN GOLCONDA $ = SSS nln | til itl J LHMESTENE an SME Ss Z if dil te SS STH TAT T7N | th i Mon RT f Adi onli or vt aS ‘ Ie CAS Se un SS S =a 7 il ee Ss SS TT alr ais Ss oy i TT Moy eet ely Na . BUILTH tt l tri TACHA CYPRESS rel TPE au Te ee Ey SANDSTONE Se Un nee Fel TE pt ee A) w wii # i) ial ae o BEECH CREEK dy a) LIMESTONE BECOND LIMESTOND YS Zz = fe TA) w o 2 ELWREN = SANDSTONE any SHALE z | be a a paneer poe fa C HORIZON OF BRANDY RUN SANDSTOKE HER ee cecg : GEOLOGIC MAP OF THE AMERICAN BOTTOMS AND Mise obi hee CE yy < ia At VICINITY, EASTERN GREENE COUNTY, INDIANA. SAMPLE SANOSTONE ai ULM | iit Mtl SHOWING APPROXIMATE POSITION OF ILLINOIS GLACIAL LOBE IN yop oF Will THE REGION, AND UNREMOVED OUTWASH AND LAKE-SILT DEPOSITS MITCHELL LIMESTONE c: IN FRONT OF THE ICE-LOBE POSITION GASPER OOLITE NE BY = Cs CLYDE A MALOTT se CONVENTIONAL AND TYPE COLUMNAR fs 1 SECTION OF OUTCROPPING S ne es i Mis 3 “MAINLY AFTER RAY'S CAVE SECTION as SC SCALE IN MILES NEAR RIDGEPORT 7 -1918— = POSITION OF QUTWASH DEPOSITS EXAG) LAKE-SILT DEPOSITS! ALLUVIUM. OF ~ = ILLINOIS ICE- FROM |CE&-FRONT IN GLACIAL DAMMED PRESENT STREAMS LOBE FRONT ae PRE-GLACIAL VALLEYS CREEME COUNTY OUTLINE SHOWNS LOCATION OF MArPEO AREA winepone= : Lae rae INDIANA UNIVERSITY STUDIES oe i The INDIANA UNIVERSITY STUDIES are intended to furnish a means for publishing some of the contributions to knowledge made by instructors and advanced students of the University. The STUDIES are continuously numbered; each number is paged inde- pendently. Entered as second-class matter, June 14, 1918, at the postoffice at Bloomington, Ind., under the act of August 24, 1912. The INDIANA UNIveRSITY STUDIES are published four times a year, in March, June, September, and December, by te University, from the University Office, Bloomington, Ind. INDIANA UNIVERSITY STUDIES JUNE, 1919 Vou. VI STUDY No. 41 A STUDY OF HANDICAPPED CHILDREN: BASED ON ONE HUNDRED AND FIFTY CRIPPLED CHILDREN REFERRED TO THE SOCIAL SERVICE DEPART- MENT OF INDIANA UNIVERSITY. By HELEN HARE, A.M. aut asoTban INS ty ry * ‘ 9. {Ji ; < tari } Submitted in partial fulfilment of the requirements for the degree of Master of Arts in Indiana University. Foreword THIS thesis has been prepared under the direction of Dr. Edna G. Henry in partial fulfilment for the degree of Master of Arts in the Social Service Department of Indiana Uni- versity. This opportunity is taken to express appreciation to Dr. John H. Oliver, Dr. Edna G. Henry, Miss M. Catherine Murray, the medica! and surgical staff of the Robert W. Long Hospital for their generous and valuable assistance. HELEN HARE. Indiana University, June, 1919. (3) Table of Contents PAGE INTRODUCTION. os 2. ooou ise bee ees oo ed eee 5 I. Source _or MaAtTPRIAL. . 052.2034. 22h Se eee ee 7 Il. -Causes or: Crietep Conprmion..-....). 2) 16 Ill. Soctan.Conprrions...>. 3. <. 22. 22155. eee 27 EV... Hosprrau ‘CAR® ..~ 05 2. soe eee ee eee 35 V.. EDUCATION. 2.0.0.5 So. oie ee bo os oe eee 43 VI. EMPLOYMENT. 2... 00.560 soos oe ee eee 49 Vil. Surveys anp LEGISLATION...:>..2:.> 4.53 55 CONCLUSION. 2.20.20. 5. s ce a belt nels ee eee 50 (4) A Study of Handicapped Children By HELEN HARE, A.M., Hospital Worker in Robert W. Long Hospital, Indianapolis INTRODUCTION Most of the modern social problems studied and puzzled over by the present-day sociologist have an historical back- ground, and it is interesting to observe the evolution of pub- he attitude toward them with the development of civilization. Cripples—both children and adults—have been a social problem, or at least a social recognition, from the beginning of history. ‘The superstition of mediaeval times lent a tinge of awe and fear to any human being varying from the normal type. The cripples, like the insane, were regarded as freaks of witchcraft, and were shunned accordingly. The poor creatures were discriminated against as if they had been to blame for their own tragic disability. The earliest record of any definite recognition of the problem of cripples dates back to 590 A.D. when Pope Gregory reformed the Church and charity administration in Rome, and included the cripples with all the other infirm and destitute, who as a class were to be supported by public funds.' Thus pauperism was consid- ered a special privileged state for cripples, and their salvation was farther from their reach than ever! The church was the original institutional basis for ‘‘poor”’ and “sick relief”, and tho the mistake of pauperizing was practiced, yet the church deserves credit for making the first effort to alleviate the situation. At this same time the cripple was being ex- ploited for the amusement of the idle pleasure-seekers, and we have historical tales of the dwarfed and hunchbacked court jesters and fools. The more grotesquely misshapen the cripple, the more popular ‘and valuable he was for catering to the cruel enjoyment of the courtiers. Verdi’s opera “Rigo- letto” illustrates the tragic appeal of the court jester, as does also a little play called The Birthday of the Infanta, in which 1The Modern Hospital, March, 1919, pp. 164-168. (5) 6 Indiana University Studies the poor crippled “grotesque” dies of grief when he beholds his misshapen figure in a mirror. This exploitation of crip- ples for entertainment did not equal in horror the Roman and Italian custom of commercializing the crippled children beggars. Powerful Roman ‘masters’ made slaves of these poor waifs and forced them to exhibit their deformities in conspicuous public places in order to arouse the sympathetic emotions of passers-by and thus obtain money. In many cases children were purposely maimed so that they could be used as a source of income either by their masters or fam- ilies. Such cruelty seems inconceivable and surely it was a hideous way for people to make money. In the early part of the sixteenth century, an organization of poor relief was formed outside the Church, in connection with the hospitals, and in 1601 came the really pioneer Poor Relief Act of Queen Elizabeth. Tho the cripples were in- cluded with the “infirm” and “sick” in this system of care of the poor, asylum care was the only provision made. With the beginning of the science of orthopedics in the nineteenth century, the care of cripples was put on a different and more optimistic basis, and since then rapid strides have been made in improving and often curing the deformity of the crippled individual. There are ‘many fundamental reasons why the care of cripples should be a field of social interest and investigation and improvement. The enormous economic saving to com- munities where all the cripples could be given surgical care is in itself argument enough for public support. The value of increased morale which would be secured thru the transforma- tion of many beggars into self-respecting wage-earners is another argument. But perhans the greatest argument for the care of cripples is the obvious social justice of giving every child an equal chance in life. The percentage of crippled children who can be cured or improved is so far higher than the percentage of the incurable that it is criminal for any deformed young- ster to be deprived of the opportunity of medical examination and subsequent treatment. It is obviously a social duty and public obligation to provide proper and adequate care for the crippled children who are unable to pay for private medical attention. I. SOURCE OF MATERIAL A Study of Handicapped Children is a title needing spe- cific definition, as the word “handicapped” embraces a wide field of deficiency, whereas this study is limited to the one group of “crippled” children. This term “crippled” excludes the blind and the deaf, and includes only orthopedic deformi- ties. The 150 cases of crippled children which are surveyed in this study were obtained from the records of the Social Service Department of Indiana University. These cases were with few exceptions given medical or surgical treatment in the free clinics of the Indianapolis City Dispensary and the Robert W. Long Hospital, and were referred to the Social Service Department for investigation of the social factors in- volved. The cripples included here are limited to those under eighteen years of age, the average age proving to be eight years. There are 76 girls and 74 boys among the total 150; and of these there are 7 cases of negroes. As the Social Serv- ice Department has two fields for its work—the State Hos- pital and the City Dispensary—these cases include representa- tives from both sources. The hospital cases here cited include all the cases referred to the Social Service Department of crippled children under eighteen years of age admitted to the Robert W. Long Hospi- tal from the opening of the hospital in 1914 till March 1, 1919,—a total! sum of 128 cases. There is constantly an enormous waiting list of applicants for admission to the hos- pital, but since the crippled cases are seldom emergency cases, they are frequently kept waiting for cases demanding immedi- ate attention. As the hospital is a state institution, only a limited number of city cases are admitted unless offering an unusual or instructive clinic for the medical students. More frequently in Indianapolis they are sent to the City Hospital. State cases are admitted more easily and in greater num- bers, and the Long Hospital has attained a popular reputa- tion thru the state of Indiana from the number of cripples who have been cured or helped there, and who have returned home to spread the tale of their marvelous care among their respective localities! There is one drawback to the efficiency of the care given these state cases: in a general hospital it is impossible to keep the patients (except in rare cases) for (7) 8 Indiana University Studies the full length of time necessary to complete an orthopedic correction. The convalescent cases are crowded out by emer- gency cases needing the beds, and a child once released from the hospital is difficult to bring in again for the frequent examinations and careful observation of developments that are necessary. To secure the return of one of these out-of- town cases requires correspondence with either parents or local social agency or both; and in many cases necessitates a visit by the state worker of the department. The state worker is a valuable asset for this particular work, and also for “follow up” work—ascertaining the subsequent condition of patients after leaving the hospitals and lining up the home situation. The greater per cent of the children in the Long Hospital come from out of town; of these 150 cases 98 or 65 per cent are state cases. As the after-care of these orthopedic cases is of such vast importance, the state cases are obviously the biggest problem the department has to deal with among its crippled children. The dispensary cases here included are those referred to the Social Service Department for following from one of the various clinics: pediatrics, general medicine, or orthopedic. The orthopedic clinic is held once a week, and here the cases previously diagnosed as orthopedic in one of the general clin- ics are examined by the attending surgeon. A diagnosis of the kind of crippled condition presented is made and orders for subsequent surgical care are prescribed. At this point the Social Service Department dips its finger in the pie and lends its invaluable assistance, for there is “many a slip ‘twixt” the examination in the dispensary clinic and the ad- vised surgical correction in the hospital! The word “hos- pital’ inspires fear in the minds of most normal children, and no less in the minds of ignorant parents. The first usual reflex to the doctor’s advice of surgical care is a positive re- fusal to comply on the part of patient and family. A doc- tor’s time is too valuable for him to argue and plead with each individual, so that it becomes the job of the social service worker to talk to the patient’s family and point out the ad- vantages and advisability of hospital care. CASE H. G. 6,900. In the case of a small nine-year-old boy, H. G., who was brought into the dispensary for examina- Hare: A Study of Handicapped Children 9 tion in the orthopedic clinic, there resulted a good deal of ex- citement. The doctor pronounced the boy’s case a congenital double clubfoot, and ordered immediate transference of the patient to the hospital for surgical correction. A storm of tears and sobs from both the child and his mother followed the doctor’s verdict. The mother vehemently announced her refusal and said she would rather have a deformed child than run the risk of losing him by an operation. The doctor pointed out to the mother that it was selfish of her to stand in the way oi the child’s chance to become a normal happy boy; and when the mother still refused to be convinced, the doctor grew impatient—as what man would not?—and dis- missed the patient as out of his power of jurisdiction, tho he said he would report it to the court as a case of criminal neg- lect. By dint of long argument and reasoning the social serv- ice worker was finally able to persuade the family that it was an actua! cruelty to the child not to give him the surgical care he needed. Usually in a family situation like this, one of the parents can be approached even if the other one is obdurate. In this case of H.G. the father proved sensible, arrangements were made quickly so that there might not be too much time for hesitation, and before nightfall on the same day the boy was installed in the hospital. Not every case coffers as many complications as the above- mentioned one. Occasionally a sensible patient comes in who is above the average, and is eager to obtain the right care for himself as soon as possible. In these cases the social service worker forms the link between the dispensary and the hospi- tal_—advising the patient how to make the application for hospital admission, making investigations of home conditions, and in general sizing up the social aspect of the case. When the patient is a cripple, the social background of the case is of great importance—to discover the possible cause of the physical condition of the patient, and the kind of social treat- ment he has encountered often lends a hint to the solution of the existing problem. 2—17726 II. CAUSES OF CRIPPLED CONDITIONS: ENUMERATION AND DEFINITIONS’ DEFORMITIES occurring in children can be traced to four general causes: disease, congenital condition, accident, and incorrect posture. A brief enumeration of the diagnoses aris- ing from these fundamental causes and a definition of each will perhaps be illuminating as a background for the discus- sion of the social aspect of crippled children. 1. Tuberculosis of Bones and Joints. This disease is re- sponsible for a large percentage of crippled children. It oc- curs most frequently in children from three to ten years of age—during the time when accidents are most apt to occur, and when rapid growth decreases constitutional resistance against possible infection. ‘The prognosis depends on the in- herited constitution of the patient, and the environmental treatment—including rest and nutrition—which he receives. Cases receiving proper treatment and general care soon after the diagnosis is made stand a good chance of recovery. This disease attacks the lower extremities and the spine most fre- quently. Tuberculosis of the Spine, or Pott’s Disease, is subdivided into dorsal, lumbar, and cervical Pott’s Disease. “The etiol- ogy or causation in at least one-half the cases is traceable to some slight injury to one or more of the vertebrae.’”’? During the course of the disease abscesses may or may not appear and eventually the typical “hunchback” condition develops “unless the destructive process 1s promptly checked’’.2 Early treatment by recumbency in a frame, plaster jackets, steel braces, and occasionally surgery gives a fairly favorable prog- nosis in young subjects. Tuberculosis of the Hip is located in the head of the femur, and the first sign of its presence is shown by stiffness and lameness, formation of abscesses, and a gradual shortening of the leg. Treatment by fixation, plaster casts, braces, and surgery will result in a probable cure of the tuberculous con- dition, but will leave the hip more or less stiff for life. Double hip joint disease is included under the diagnosis of tubercu- losis of the hip, and is treated in the same way, the chances for recovery being somewhat less. 1 Bradford and Lovett, Orthopedic Surgery. ° Quotation from Dr. John H. Oliver. (10) Hare: A Study of Handicapped Children It Tuberculosis of the Knee is indicated by localized pain, swelling, and abscess. Early treatment by operation, fixa- tion, and braces lead to favorable recovery in the majority of cases, tho there is a tendency to stiffness resulting, and in some virulent cases amputation of the lez becomes necessary. Tuberculosis of the Ankle, Shoulder, Elbow, and Wrist all show the same general symptoms of swelling, pain, suppura- tion, and atrophy. The treatment for all four conditions is practically the same, consisting of fixation and protection, plaster casts, and in most cases surgery. Among children the prognosis for all these conditions is favorable if given early treatment after the symptoms of the disease are dis- covered. 2. Osteomyelitis. This disease usually occurs at or after puberty, often as a result of any infectious and exhausting ill- ness or exposure. It is a bacterial infection of the bone marrow, with the formation of abscesses and a general sep- tic condition resulting. The localized seat of the infection is in the shafts of the long bones. Treatment consists of drain- age by incision, and in some cases the removal of the diseased portion of the bone. In severe cases there is danger of sep- ticaemia, but in ordinary cases proper treatment will result in a healing of the diseased parts. 3. Arthritis. This disease commonly known as “rheuma- tism” is an inflammation of the joints which may be chronic or acute. Symptoms are pain and swelling and often stiff- ness of the joint results. Acute articular rheumatism of one joint never occurs, and if such symptoms arise, the origin of the inflammation will usually prove to be “tuberculous or some other specific infection’’.® Arthritis Deformans is a chronic non-suppurative affection of the joints, commonly called “rheumatic gout’’, tho more virulent developments than gout sometimes occur. This dis- ease seldom occurs in children, as it generally appears with senile changes such as arterio-sclerosis. 4. Rickets. Rickets is a disease occurring in very young children as a result of faulty nutrition during first dentition. Softening of the bones is the characteristic feature, and muscular action of the child while the bones are in a pliable 3 Quotation from Dr. John H. Oliver. 2 Indiana University Studies condition resuits in deformities of various parts of the body— enlarged ankles and wrists, “rosary” of ribs, pigeon breast, bow legs, knock knees, flat feet, etc. Proper feeding and hygienic care bring favorable results if the patient is treated early in the course of the disease. 5. Scoliosis. Scoliosis is a lateral curvature of the spine, occurring more frequently in girls than boys between the ages of ten and sixteen years. This spinal deformity is caused sometimes by paralysis, by rickets, by faulty “positions of the body increased by the superincumbent weight of the head and body’? in industry and school, or by inequality of the limbs. Treatments for scoliosis are gymnastic exercises in mild cases and corrective plaster or leather jackets for the more ad- vanced cases. Scoliosis in the majority of cases is a prevent- able condition. If children are watched closely, with the first sign of a spinal curvature corrective exercises can be given to prevent faulty positions in standing and sitting and the de- velopment of deformity. 6. Kyphosis. Kyphosis is the typical “hunchback” con- dition—a backward curvature or knuckling of the spine, usually following Pott’s Disease. Round shoulders are com- mon and are best treated by gymnastics and the avoidance of heavy clothing hanging fom the shoulders. Shoulder braces are to be avoided. 7. Poliomyelitis. Anterior poliomyelitis, poliomyelo ence- phalitis, both are synonymous with the more commonly known term—ainfantile paralysis, which is responsible for such a large per cent of deformity among children. This is an acute con- tagious infection, most prevalent in summer, which attacks children almost exclusively. There are three stages to the dis- ease: (1) febrile symptoms and development of paralysis; (2) full development of paralysis and a stationary period; (8) atro- phy of muscles and wasting of limbs followed by about a six months’ period of gradual slight improvement. During the acute stage cf the disease the patient’s general condition should be stimulated to further resistance, and the weak muscles should be protected from sustaining weight, in order to prevent development of deformities as far as possible. De- formities result from bone shortening in some cases, but more * Quotation from Dr. John H. Oliver. Hare: A Study of Handicapped Children 1134 frequently from muscular paralysis which causes: (1) com- plete paralysis of the leg with wasted bones and distorted joints; (2) partial paralysis of the leg with the inability to support the weight of the body; and (3) dislocations with muscular contraction. The treatment of these cases should be absolute rest in bed until all acute symptoms have subsided. Later treatment for infantile paralysis consists in stimula- tion of the motor tract by massage, electricity, application of heat, etc.. so that the muscle may be able to respond when the nerve impulse is restored. In some cases surgery is used in the transference of muscles and tendons, or the stiffening of the joint. Plaster bandages and braces are also employed for corrective and strengthening purposes. Remarkable cor- rective results have been attained in cases where the par- alyzed condition was not too extensive to permit of improve- ment. Infantile paralysis is both an endemic and epidemic disease. ‘‘Endemic cases we have with us always, but epi- demics occur only occasionally, a notable one having occurred in the summer of 1916 in the United States.’ The eastern states suffered much more severely than the West and Middle West. The Indiana State Board of Health statistics for the summer of 1916 show that the ravages of the disease were not as devastating in Indiana as in the East: MONTHS CASES DEATHS JING © Ales eee tere erie eet rea iL 0 UU ged sey cog ce) sete 8) bs wie andeeee e's me ranens DAS) 5 PAO Steer cca wie ere ek id whisregie tigen OO 6 SEMLEMIDeH es ou cieb cce vos Sk eee seeks 64 14 OClOWe Cio ie cdots hares oles 57 9 8. Spastic Paralysis. Spastic paralysis is either congeni- tal or acquired. Congenital cases are due to intra-uterine hemorrhage which causes retardation of the growth of the brain plus secondary changes in the spine. Such cases are rare. Acquired spastic paralysis is due to a cerebral lesion or “affects children whose birth was assisted by forceps”. Spasm of the muscles, mental deficiency, and convulsions are characteristic. ‘‘When both legs and both arms, or both arms are paralyzed, the disease is called ‘diplegia’; when both legs alone, ‘paraplegia’; when the arm and the leg on the same side, ‘hemiplegia’; and when one member of the 5 Quotation from Dr. John H. Oliver. AS Indiana University Studies body only, ‘monoplegia’.’”’® The treatment for spastic paraly- sis 18 similar to that for spinal paralysis, only the prognosis is in most cases unfavorable, particularly where epilepsy and mental derangement accompany the paralysis. This is the one crippled condition where mental deficiency is a relative factor. “There are other conditions in which we may have both the mind impaired or destroyed together with paralysis, such as Hydrocephalus and Microcephalus; but these are not classified as paralyses per se.’ CASE E. W. 2,117. This is a case of an illegitimate child, paralyzed in both legs, and feeble-minded—a typical spastic paraplegia. He is unable physically and mentally to go to school. His mother has married and her husband is unwilling to support another man’s child, so the boy has been entered on the waiting list of the State School for Feeble-Minded, where he will probably remain indefinitely. 9. Congenital Dislocation of the Hip. This condition is found more often in girls than in boys. It is a marked de- formity and hinders walking. Treatment by manipulative re- duction followed by plaster casts results in gratifying correc- tion in many cases. 10. Clubfoot. The commonest form of clubfoot is talipes equino-varus, where there is an elevation of the heel and inversion of the sole inward, with pressure on the outer edge of the foot. In these cases the varus condition is con- genital; and the equinus is usually acquired when the pa- tient first begins to walk. The cause of the congenital condi- tion is a perversion of intra-uterine development 07 abnormal intra-uterine pressure. Treatment of the deformity consists in surgical correcticn first of the varus condition, and then of the equinus. Forced manipulation, sub-cutaneous division of ligaments (tenotomy), plaster splints, and braces all form the various steps in this treatment, and provided that the patient follows the treatment prescribed during the long convalescent period, favorable results are attained. There are several other forms of clubfoot besides talipes equino-varus. Talipes equinus or “horse heel’ is a form acquired after infantile paralysis, or from the shortening of a leg after a joint dis- ease such as tuberculosis of the hip. Talipes calcaneus is 6 Emerson, Essentials of Medicine, p. 200. * Quotation from Dr. John H. Oliver. Hare: A Study of Handicapped Children 15 characterized by the patient’s walking on the heel. Talipes valgus is a deformity where the patient walks on the inward edge of the sole, and it is contrasted with talipes varus where the patient walks on the outer edge of the sole. Talipes cavus or “hollow foct” is a condition where the arch is overdevel- oped. And lastly the non-deforming clubfoot is a condition where there is loss of the dorsal flexion of the foot. CASE H. E. 2,161. This case is an illustration of congeni- tal clubfoot—a little boy, five years old, who was brought into the hospital and received surgical correction, and afterwards braces. Two other cases of clubfoot in the family—the pa- tient’s brother and the father’s cousin—seem to indicate that such a congenital condition is apt to occur in the same fam- ily, tho there is no plausible explanation for it. In this par- ticular case there is a tragedy connected with the story. Eventually the patient’s little brother was brought into the hospital and had his feet corrected, and both children were sent home in splendid convalescent condition. A year or so later, a ietter was received from the father of the children saying the older boy while playing with a gun had accidentally shot and killed the younger brother. The parents were heart- broken, as they had been so delighted with the improvement in the children’s feet. 11. Flat foot. Flat foot is a condition where the arch of the foot is broken down and the sole becomes fiattened. Exercises and braces are used in corrective treatment. 12. Harelip.. Harelip is due to prenatal arrested devel- opment, and may be single or double. Surgical correction when the patient is about two months old results favorably in most cases, leaving only a slight scar. 13. Cleft Palate.’ Cleft palate is closely related to hare- lip condition and both often occur simultaneously. Cleft palate is also due to arrested embryonic development—“‘a defi- ciency in the median line of the roof of the mouth’. Here again surgical correction is recommended during the second or third month after birth, tho cases are treated in older children. A neglected cleft palate affects speech very notice- ably and is a marked handicap. Both cleft palates and hare- lips are often found occurring in different members of the 8’ MeMurrich, The Development of the Human Body, p. 100. 2Tbid., p. 284 16 Indiana University Studies same family; and tho there has not as yet been discovered a definite cause for this malformation, yet it has been noticed that cases are apt to occur in families where physical de- generacy is an outstanding characteristic. 14. Lordosis. Lordosis is a condition of round hollow back. 15. Torticollis. Torticollis, more popularly known as “wry neck’, is either a congenital condition or acquired from contraction of the sterno-mastoid muscle. Surgical treat- ment and braces are both used for correction. In summing up the causes of deformity in children, dis- ease 1s responsible for more than half. Taking statistics from two different jocalities, this statement is proved true. At the Massachusetts Hospital School for the care of Crippled Chil- dren, during the year 1917, “77 per cent of the cases received were suffering from the effects of surgical tuberculosis and in- fantile paralysis’.'° “In Cleveland, the survey of cripples in 1915-1916 showed that out of 936 cases of crippled children under fifteen years of age, 72 per cent were cases suffering from the effects of diseases.’’'' Likewise the statistics de- ‘duced from this survey of 150 crippled children prove the same results, as 54 per cent of the cases have definite diag- noses attributing the cause of deformity to disease, while many others in addition were doubtless due to disease in the original form of the disability. The following table gives the classification of the 150 cases here studied into the 14 differ- ent diagnoses of various conditions: | PER CENT i: Tuberculous: diseases (2% 22.4026 eae 43 28.66 Ac’ Tuberculosis, of hip ccc eee 23 . 15.33 B. Tuberculosis) of \spine.22 5%. eae 10 6.66 Cy ‘Tuberculosis ot knee. ave ae Die S130 D> Double hip*joint disease... 1-6 = 3 2.00 E> Luberculosis tof elbow... +5. 4 oe oe 1 .66 Fo Tubereulosis cot: 100t.) 23.259.) ee 1 .66 Here OA abil oGE ets] acne NCE ee ine aI: MRR MN COE RE ES (Gc 26 igo 3. intantile:( paralysis:

See p. 16, Note 10. Hare: A Study of Handicapped Children 37 States,®? it was found that there were 10 orthopedic hospitals and 14 convalescent hospitals in the United States at that time, and there is no available record of new institutions erected since that time, probably due to the World War. From this publication a quotation from page 8 is worthy of the reader’s attention. ‘We have no hesitation in advocating the creation of a state hospital for crippled children in every state in the Union.’ This wholesome recommendation will ‘take many years before its realization is attained, but grad- ually the different states are awakening to a consciousness of the situation. Minnesota was the first state to establish a hospital exclusively for crippled children in 1897, under the control of the State University Medical College. Statistics from the records of the Minneapolis Hospital show that three- fourths of the cases of deformity admitted were caused by disease, nearly 75 per cent by tuberculous infection. New York was the second state to erect a state hospital for crippled children in 1898, but this hospital has been less appreciated and known than the many private institutions previously established. The one field in which the Haver- straw State Hospital does excel pre-eminently is in the care of the rural cases which are not for the most part included in the other hospitals. Of the private orthopedic hospitals in New York, some of the most prominent are the New York Hospital for Ruptured and Crippled, the New York Hospital for Deformities and Joint Diseases, and the Children’s Ortho- pedic Ward in the Post-Graduate Hospital. The Hospital for Ruptured and Crippled averages between 4,000 and 5,000 new patients annually. The crowded and insanitary living condi- tions in the poorer districts of New York City are the obvious cause for such an enormous percentage of deformed children with tuberculous infection of the bones. The complete list of all the children’s orthopedic hospitals in the United States in 1914 is given as follows:* 3 Reeves, Care and Education of Crippled Children, p. 2. £Ibid., pp. 141-157, 38 Indiana University Studies ¥ AVERAGE YEAR STATE NUMBER OF HospitTaLs OPENED CHILDREN Maine (Portland) os 1908 57 Children’s Hospital. Minnesota (St.Paul)... 1897 63 State Hospital for In- digent Crippled and Deformed Children. Nebraska (hincoln)))... 1905 7¢ Nebraska Orthopedic Hospital. New Jersey (Newark)........ 1891 45 Home for Crippled Children. New Jersey (Orange)......... 1903 10 New Jersey Orthope- | dic Hospital and | Dispensary. New York (New York City). . 1906 AQ ' Hospital for Deform1- | ties and Joint Dis- ease. New York (New York City).. 1863 192 Hospital for the Rup- tured and Crippled. New York (New York City). . 1866 62 New York Orthopedic Dispensary and | Hospital. Washington (Seattle)......... | 1907 27 Children’s Orthopedic | | Hospital. Ilmois: (Chicago): 25.3. 3.5) Le 1892 87 Home for Destitute | Crippled Children. After the infantile paralysis epidemic in 1916, there were approximately 15,000 crippled children left with the stamp of paralysis. It was natural that at this time greater interest should be taken in providing adequate measures to relieve these handicapped youngsters, and in securing every possible treatment that human care could supply. But during war time building of every kind was suspended, and the expense of establishing hospitals was prohibitively high. In 1914, in the above-mentioned Russell Sage Foundation Survey, an estimate was determined of the cost of orthopedic hospitals.’ The average cost of hospital per child was found to be $2,747, and of a convalescent hospital $1,294. The current average expense annually per child was estimated for hospitals at $570, and for convalescent hospitals $348. In this connection © Reeves, Care and Education of Crippled Children, p. 99. Hare: A Study of Handicapped Children 39 it is interesting to observe a table of the cost of certain insti- tutions, the sources and amounts of the funds obtained. TABLE SHOWING SOURCES AND AMOUNTS OF PUBLIC FUNDS FOR FIFTEEN INSTITUTIONS: Pusiic FuNnps HosPpiras Source | Amount for 1 Year 2 , | Maine (Portland), Children’s Hospital..........] State.... $10,000 Minnesota (St. Paul), State Hospital........... State. ..- $13,043 Nebraska (Lincoln), Orthopedic Hospital.......| State... . $45,060 New Jersey (Newark), Home for Crippled Cini CHR@IN: = et Sine ne TARE etait eae Citye $2,500 New York (New York City), Hospital for De- fonmiges and Jomt-Diseases..................| City....:; $7,730 New York (New York City), Hospital for Rup- cummed and Crippled Children -................. City ==... $22,801 CONVALESCENT HospPiTraLs Maryland (Baltimore), Children’s Hospital SCNOG, 3s Ake ees ee ee SEATON eT ane anna, nn eae Maryland (Baltimore), Kernan Hospital School Kormeriopled'@hildren....... 0.5... 6 6c. ce eee State.... $3,750 Massachusetts (Canton), Massachusetts Hos- PAM SOMOO Mer es sl ae ke od ca eee Clive we $5,000 Minnesota (St. Paul), State Hospital School fomeniwopled @hildren-............. 0. eee State.... $11,398 New York (Garden City), House of St. Giles hae: Crryapalless a 0 eee Citivas $6,495 New York (Port Jefferson), St. Charles Hos- PHEalgror Crippled Children................... Citivas $19,294 New York (West Haverstraw), State Hospital LORenippled Children. .............. 00020508 State. ... $24,437 Pennsylvania (Pittsburgh), Industrial Home romOnipoled Children... ....0...00.55 008k Staten. 2: $5,000 Pennsylvania (Sewickley), Fresh Air Home.....| State.... $552 6 Reeves, Care and Education of Crippled Children, p. 104. The importance of convalescent hospitals cannot be over- emphasized. The best of surgical treatment is inadequate unless followed up by after-care in which every detail of prog- ress and development is watched and treated accordingly. If a patient is discharged to return to a neglected home, all the attention and care expended on him in the hospital are wasted, A() Indiana University Studies for relapses quickly occur if the technicalities of after-care are neglected. Since a hospital proper is not prepared to keep these orthopedic cases for the long convalescent period, there is an urgent need for regular convalescent hospitals or homes. The demand for this intermediary care is particularly urgent for rural cases such as constitute the majority of the Robert W. Long Hospital cases. As an example, recently a little girl (Case L. F. 6,528) with double hip joint disease was ready for discharge from the hospital, as she had received her braces and crutches and no longer needed hourly attention. This child lived in a remote corner of the state, and the chances of returning for regular examinations every few weeks if sent home were slight. In this instance, the Social Service Depart- ment bridged the difficulty, by securing permission thru the child’s native county to place her in a Children’s Aid Associa- tion boarding-home in Indianapolis till the convalescent pe- riod had passed. Just exactly at this point is obvious the need for a convalescent institution where such cases can be transferred directly from the hospital. Tho Indiana is lack- ing in such a necessary and valuable institution, there are 14 in other parts of the country, named as follows: Vin AVERAGE STATE NUMBER OF | CONVALESCENT HosPiTaLs OPENED CHILDREN eer | mee sae Hhnoss(Chicago)2: 1911 40) Convalescent Home for Destitute Crippled Children. Maryland (Baltimore)..... 1912 30 1. Children’s Hospital School. rE aes (Baltimore)..... 1895 ays} 2. Kernan Hospital and Industrial School for Crippled Chil- dren. Massachusetts (Canton). .. 1907 229 Massachusetts Hospital School. Michigan (Detroit)........ 1907 20 Van Leuven Brown Hos- . pital School. Minnesota (Phalen Park). . 1910 38 Minnesota State Hospital and School for Indigent Crippled and Deformed Children. Hare: A Study of Handicapped Children 41 e AVERAGE x YEAR : : STATE NUMBER OF | CONVALESCENT HOSPITALS OPENED ; | CHILDREN New York (Coney Island). 1904 42 1. Sea Breeze Hospital. 9 ee (Garden City).. 1891 45 2. House of St. Giles the Cripple. . one (Port Jefferson). 1907 110 3. St. Charles Hospital for Crippled Chil- dren. (West Haverstraw) 1900 61 4. State Hospital for the Care of Crip- pled and Deformed Children. Me (White Plains). . 1904 4 5. Country Branch and Industrial School of the New York Orthopedic Dispen- sary and Hospital. Pennsylvania (Philadelphia) 1906 96 1. Widener Memorial School for Crippled Children. oa (Pittsburgh). 1902 45 2. Industrial Home for Crippled Children. 5 5 ols. oe (Sewickley).. 1897 PH 3. Sewickley Fresh Air Home. Institutional cases of crippled children are registered and statistical information in regard to them is more readily ob- tained than concerning non-residential cases. However, it is known that the number of “out patients” far exceeds the num- ber of institutional cases receiving surgical care. ‘‘The most important provisions for medical supervision of crippled chil- dren not living in institutions are the dispensary services.’ Statistics comparing the number of admissions of 9 dispensa- ries and the 37 crippled children institutions shows ‘‘a total of 34,392 different out-patients—as against 4,901 patients resident in the entire 37 institutions”.* A statement made by many surgeons is “that while dispensary care may be ade- quate for some cases, it can be safely substituted for institu- "Reeves, Care and Education of Crippled Children, p. 33. Sibid., p. 34, 42 Indiana University Studies tional care only when the child is actually brought to the dis- pensary as frequently as the doctor orders, and when his di- rections for care at home are carefully followed’.® It might be suggested that dispensary care for cases not having active disease might be more satisfactory if accompanied by a care- ful system of social service “follow-up” care, whereby the responsibility of the patient’s regular return to the dispensary would be undertaken by the social service department work- ers, and the expense of salaries for social service workers would be far less than the expense of institutional upkeep. Social service workers are also valuable in keeping in touch with patients after discharge from hospitals or convalescent homes. Incidentally “it is a most encouraging feature that 15 out of the 37 institutions (for crippled children) maintain some helpful supervision of their patients after discharge.’’'° This field of “follow-up” care is one of the most important points to be emphasized in this study, because it is funda- mentally the purpose of medical social service to help in ad- justing the social situation where illness interferes with the normal routine; and at the same time to leave a permanent stamp of improvement and general gain in the family or com- munity approached. ®» Reeves, Care and Education of Crippled Children, p. 34. a ilies, Tos IU. V > EDUCA ELON THE meniality of crippled children is in the greatest per- centage of cases normal, and yet they are deprived of their rightful heritage of a public school education because of their physical. disability to attend school. Before giving the re- sult of this survey, it seems worth while to mention the re- sults of a mental examination given to 80 crippled children at the Phalen Park Hospital for Crippled Children in St. Paul! The intelligence of the children “‘was expressed as Dr. Kuhl- mann suggested, by his rate of mental development as com- pared with the average normal rate’’.2. The following classi- fication was made: WMIPRCAS OSHIP Gist. 6 suc sas ek a eles es above normal RS CASES 6 bts poe eee normal HDECASCSH ares ess... +... Slightly below average R CPSOSs 6 bce Oe eee ee eee borderline T CASCSs so BSS BRS eee feeble-minded This rating resulted in 8714 per cent of the children proving to have satisfactory mental development. ‘It is significant that in 40 out of 62 cases the Binet scale classified the child according to his mental age in the regular grade prescribed for an average child of that age.’’® Considering the handicap that a crippled child has to struggle against, this rating would seem extraordinarily high. It was impossible to obtain scientific mental tests of the 150 children in this study, so that the mental proficiency has been estimated only relatively. Out of the 150 cases, 7 cases, or 4 2/3 per cent, have a diagnosis of mental deficiency at- tached to them; and of these 7 cases, 4 are cases of spastic paralysis, which again illustrates the brain affection in these cases. The total 150 cases include 101 cases of school age, that:is, over six years of age. Of these 101 cases, 78, or 77 per cent, have records of school attendance, with the number of children in each grade as follows: 1 American Journal of Care for Cripples, Vol. III, No. 4. p. 190. 2 Ibid. Sbtd. pe 194. (43) A4 Indiana University Studies GRADE NUMBER OF CHILDREN rn rn TEMPE N EAM DW also cb coos 08 12 ne rere re hh Ook xs 'o0 ab ooGOU 12 3 ee cen rrOn SG Fe MUNCIE Mo 5s coo 0 ¢ 12 A cais Eas wie wie Ow tel s tas 8 oe) ee oe BUH OLE SOURS Re 10 a ee ane NIN SI aA GS 6 Go 00d 00 0 9 Gog ocak, sceitele ais, er 'ecleyos ov los bce eh ats 05 (gro) Sieg el ae ee rr ff re Sheers 5 en er Perri DS ss .5 So gd ooo 06 6 First year high ‘school. ...0s).% 35.2 oe ee eee 4 Kindergarten =o. oo6s ee i ee if Totals ov cele te Ab doce acs eee ee 78 The cases of school age and yet not attending school includes children who live in the country too far away from the school- house to be able to reach it; children who are not even able to walk the short distances to the schools in the city; and chil- dren who could reach school, but are unable to climb the stairs. CASE M.F. 3,107. This case is a bright lithe eirl with both legs paralyzed as the result of infantile paralysis, who lives directly across the street from a schoolhouse, and always enjoyed going to school enthusiastically. When she reached a certain grade, however, she was obliged with her class to go up and down stairs several times during the day, and in order to do this, the child needed someone to help her each time. At first a little friend or two helped her, but children are thoughtless and unkind, and most of the time they forgot her, and the teachers were all too busy to pay any attention to her pitiful struggles in climbing the stairs. Frequently the child’s mother came across the street and helped her; but she did this most unwillingly, and constantly urged the child to stop schoot. With discouragement from her mother, the child wili doubtless soon stop school, whereas if there were a school arrangement whereby she could attend her classes on the ground floor, she could go thru school and be fitted eventually to earn her living more efficiently and more lucra- tively. A survey of the number of crippled children in the Indi- ana public schools in April, 1919, brought the estimate of 222 cases out of the total 30,508* children attending school, .7 per cent. This percentage indicates not that there are few crippled children, but that only a few of these are able to * Report of Indianapolis Public Grade Schools, March 31, 1919. Hare: A Study of Handicapped Children A5 attend the regular schools because of physical disability. The questionnaire distributed among the schools demanded only the barest layman’s description of the crippled conditions of the children. The reports of the physical deformities are given as follows: CRIPPLED CHILDREN NUMBER OF CASES ID GHEE aa eye Wl eRe 016 aa er ee 16 WSO GELATIN ieee hia cle aia eye cclaue ila alee be Lome evale’ wigile 19 Wetonmmed hee eis. 8 sls My oe 6 al bs seks, sles ee 3 IDGRRO TETAS EC ey ae eR Sarg 5 Detommedback ae tse le lS le as wie a eles es 3 ID orkonaiane emlnapOe, senile ivicss ies Sal dee fale al es Saimccblared wee. 8 5 IDYETE@TETATIG LCL Sa SY he ee RU a ne ie ea 4 ANTODIOUENEZIUCIS NER oe See ee ange eS A aC 4 PAMANPO UNC ENUE Clements itn iicte soa is ae’ 8s anatase oe Wade wie due 3 IES CLEEUS 0°56 Saleh GONE Ene Ue a eg il MbrastictMNE TO AGANVISIS! 9 so. oie )e eect e siete ee elite goes oi eres 25 Heatecn ye HOCPIMNAINGE 3c 8, hla ois hates Cee Sidlos ae b Weve eble lp eels o.a%e 1 JP ECE NV MACCL CIGD ee eae Ree ae eee 14 eer sZEClEOOLI ees sl ik cry ccsuiw so saeiielvuntaeO4 widlele «as 5 Hea cANtG NVI Z2 MMO er ee et Pet ea ets aa th Gc aly 4 at nis GRIN a Yelal iw “6 3 JP BiTPB INT ASC! 1] OBO he arel ie a re oS eG ae 3 ANCES C UMNO US She Fela iokc soos Css! sab le Suc Sole lb ale woe sioete 1 ecicUlnyiZe CACO oi: oo alee els Sl deed eis lw cetevtioreler s.6 il Comneemibalenpavaly Sis) 2). 200% cielo & csale eS diag eG en ais 2 Seeclhee dene tiams Miss Soe. slo ws Weal eee 2 Tuberculous bone condition named................ 4 The mental development of these 222 school cases was esti- mated merely in an approximate manner from the reports of ages and grades as follows: AGES IN YEARS NUMBER OF CASES OM see occ ole ope Cos Ray es lu ro ceiatons {el etele di MPR eo cero Ceicremoe olla 4 1actnys oslonsy ehaiye e's ocariote ates! sae 24 OM Pea ale 0s ee aid dish Gaal sh wid ietielove as alela/S alaleté 3 eee a Neier PA Sis ose he asa yere ahaielayiaie) ale sises 21 ILO). 9 S593. 6° OE Oise eee So 0 CaO ee a Remecreee iratarierre nite 38 NUE es reap sck ee ore sueriak i cteve tierce s ctisce Sie een-e 1s b/s i ahee ces 18 WME ce ieee circa ese sire, slays tiatlays 6) Guepaiels. oid arene aie 23 ASMP ent a) cis a fos inyclist ss) Sle Se pyoie se ele oe erst are ere 16 14 18 MOM Ren Reise ae tenis sone ccc aieteice 6 6 680M erase are «8.8, 19 Gay. 2 Meet Meteor renee oh sis ees sr.0)'6) ay Sher ceeitetanis #16.) diate a etrasiiel soles = if ARON ess. Sn Geely icles PROB oe ee Aan A Eo Soa Pa 7-7 The average age of these 222 crippled children is estimated from these figures to be ten years. A6 Indiana University Studies GRADES NUMBER OF CASES Defective school. ..0... 2.24 Ss). se tee ee 1 Special school. ..:0..0. 2s 6.02 4e ne ee eee 1 EL PTAME is 4 wie wise « soecvd s Lao eeeee e 34 2 grade 2.660% 228 oes See ee eee 37 8 STAM. 6 oe oe ss bc oe ocho eee 35 ea 2X6 (ee een RS Es So 33 D PTAMES o oscew ee os ob wee oto Pe eee 22 6 grade. ..2 china Hike eos oe eee 20 T grade: voces vies so new wisive cycle ae eee si 8 grade: i006 ois, wanes 5 ee aes See ao Total 2.8. bo ace Cb eee eee 222 The average grade for these 222 cases is estimated from these figures to be the third grade. Considering that the age average is ten years, this grade average indicates only a slight degree of retardation. The responsibility of watching the physical condition of the school children is thrown chiefly on the school nurses, tho attending physicians visit the schools at specified intervals. The school nurse is overworked with eye and ear, nose and throat cases needing prompt attention, so that only rarely does she have time to look after the wel- fare of non-acute crippled cases. These cases should be segregated and receive special care. Special Schools. The solution of the problem of the cripple and his education lies in the establishment of special schools. Abroad special schools for cripples were organized long before they were considered in the United States.° By the middle of the nineteenth century Germany had established a system of educational and industrial training schools. In 1872 Denmark established the model European School in Copenhagen, with a curriculum of academic schooling, in- dustrial training, physical treatment, recreational outing, and resident home for out-of-town cases. In Sweden, a system was evolved whereby the school teachers visited the homes of the crippled children after schoo! hours and gave them instruction at that time. In 1886 Great Britain began to de- velop a special school system for her crippled, and made rapid strides, till in 1900 special schools under the National Board of Education became a part of the regular school system. In the United States, the first special school for cripples was established in Boston in 1893—an industrial school for ®> Munroe’s Encyclopedia, Vol. II, pp. 230-234. Hare: A Study of Handicapped Children 47 crippled and deformed children. Later in 1907, the Massa- chusetts Hospital School at Canton (already mentioned) was established for the physical care and education of deformed children. In New York City, the Children’s Aid Association established the Henrietta Industrial School for Cripples in 1898. This first attempt to help these disabled children was looked upon with suspicion by the ignorant and especially for- eign-born mothers, until their confidence was won and they realized that only kindness and help was intended by the visiting nurses and teachers. Really valuable social work was accomplished by the Henrietta and other Children’s Aid Day Schools, in the education of mothers as well as of children. “Mothers’ meetings” were held regularly and the hygiene and general information taught the ignorant mothers was a perma- nent benefit. In 1904 the Unitarian Lenox Avenue Church established a day home and school for crippled children where academic and manual training were taught and summer out- ings, transportation, and lunches were offered. In 1912 the City Board of Education took over all the expenses of this school except the lunches and medical supervision, which ex- penses were still met by private subscription. The other fore- most special schools in New York are the East Side School where about 200 children are cared for; the William H. Davis Free Industrial School; the Rhinelander Free Industrial School; and a Boat Class, taught on board a river boat where the children can be kept constantly in the open air. Recently, the City Board of Education has incorporated many of the private schools and established new special schools or classes for crippled children as a part of the public school system in New York. In Chicago, Graham H. Harris introduced the Special School for Cripples, and recently the City Board of Education has assumed the control of this department, appro- priating $12,000 annually for the upkeep of equipment and the necessary medical care for the children. All of these above-named special schools for cripples in- clude about the same general plan and equipment. First, and foremost, medical supervision with provision for dispensary or hospital treatment is provided, including visiting doctors, and nurses always present to carry out the doctor’s instruc- tions. Transportation is furnished, so that all the disabled children can be collected by bus and carried to and from school. Hot noon lunches are provided for the double purpose of avoid- AS Indiana University Studies ing the extra trips home, and of assuring each child of at least one nourishing meal during the day. As a part of the school equipment, ground floors only are used or elevators pro- vided, and adjustable desks and seats are arranged so that every possible comfort can be secured for the variously de- formed children. Shorter hours to meet the subnormal physi- cal strength of the children are prescribed; and individual at- tention is given in order to give each different child an evi- dence of personal interest in his development and progress. Every city and town should offer the facilities of a special school or at least special ground floor rooms with the necessary equipment for crippled children. It has been estimated ap- proximately that such schools incur an expense of $50 annually per child. For rural cases, institutions such as the Massachu- setts Hospital School where both physical and mental care can be provided are recommended. Of the 37 institutions men- tioned in the Russell Sage Foundation Survey, 29 maintained a school department; and of these 29, only 7 departments were - supplied with teachers by the local public school board. For city cases, wherever a child can be given the necessary atten- tion at home and receive adequate medical care at a dis- pensary, the special day school system is preferable to the in- stitutional. The importance of vocational training is a part of educa- tion, tho it is also closely associated with the employment question which will be discussed in the next chapter. Early vocational training can be given in the schools as part of the curriculum. For girls, sewing, weaving, pottery, etc., are the commonest occupations taught in the schools; whereas the boys are taught various kinds of manual training, bookkeep- ing, etc., according to their respective capacities. Since crip- pled children have to struggle against a disadvantage all the way thru life, they are never too young to begin to learn some specialized werk in which practice will enable them to become experts. Tho it is not right or fair that the academic education of these handicapped children should be abbreviated or neglected, yet part-time vocational training can be given them and after a public school education has been completed an intensive course in industrial training should be required before graduation, in order that each child may start out ade- quately equipped to be self-supporting. VI. EMPLOYMENT EMPLOYMENT is the key to economic independence and in- cidentally to happiness. The traditional idea that sick or dis- abled people must be kept in idleness is nowadays exploded; for it has been agreed that the psychic mental attitude of the sick has a decided effect on their physical condition. Idle- ness leads to introspection and boredom, whereas a certain amount of occupation proportionate to the individual condi- tion has proved a real blessing to the convalescent and in- valid. The very recent experiment of occupational therapy introduced in the United States base hospitals has carried out this theory and has proved gratifyingly successful. It has been only of late years that the cripple played any part in the field of industry. His disability automatically excluded him, and his natural sensitiveness instinctively for- bade his boldly pushing forward and claiming just recogni- tion. Enforced idleness naturally augmented the cripple’s sensitive retirement and morbidity, and he was obliged to real- ize that in many cases he was a burden in a wage-earning family. The only occupation sometimes practiced by the cripple was begging or peddling, and this source of livelihood is a Menace to any community. There is no reason whatever why a cripple not too extensively handicapped should not learn a trade and get a job. The range of choice of occupation is naturally more limited, depending on the nature of the indi- vidual disability. ‘A cripple is only debarred by his disabil- ity from performing certain operations. In the operations which he can perform, the disabled man will be just as effi- cient as his non-handicapped colleague, or more so.”' Voca- tional training is an essential prerequisite for the cripple en- tering the industrial field, inasmuch as his limited physical versatility narrows the number of occupations in which he can seek work, and therefore he must needs become an adept in specialization in order to hold his own in the competition field. It is a vital social work to encourage cripples while still children to become interested in some line of work which will lead to a future incentive toward employment. The greatest tact is necessary to persuade a growing crippled child that he or she can become an asset in the community 1American Journal of Care of Cripples, Vol. VI, No. 1, p. 146. (49) 50 Indiana University Studies and really amount to something. Once ambition is conceived, the rest of the task of encouraging the individual to work is an easy one. Even the most limited variety of occupa- tion offers some choice so that the individual’s taste and interest can be consulted. The crippled child should be taught that he is a normal human being and not altogether an alien on account of his physical difference. Potentially he is a normal child, full of creative ability, energy, and affection. Neglected he becomes mentally and abnormally deficient. ; Give the crippled boy a chance and two results follow: free- ing a child’s soul from a false sense of inefficiency, and society from a burden.” Efficiency can and is attained by the crippled worker as well as the normal, provided the former has had training and has chosen work suitable to his capacity. It has been sug- gested that skilled occupations where quality of production is of more importance than quantity are best adapted to crip- ples; but this limitation would not necessarily hold good, as in some occupations a cripple, if adapted to his work, can work just as rapidly as his average competitor. The education of employers to a true realization of the cripple’s situation and capabilities is an important part of the great work of transforming the cripple from a beggar and misanthrope into a self-respecting, self-supporting citizen. Most of the employers have always been too busy and unsym- pathetic even to give a crippled worker a chance to prove his ability; and a few have given jobs purely out of a sense of philanthrophy, in the days when the cripple did not have a chance to receive vocational training. Now, however, the purpose of broad-minded, socially-wise people is first to secure vocational training for the disabled, and then to prove to the employers that the work offered by these people is just as competent as that of any average man or woman. With the readjustment of soldiers from military to civilian and indus- trial life, every effort has been made to prevent the wholesale placement of the crippled man in jobs offered to them thru a spirit of patriotism and sympathy, and which they could never hold in equal competency against trained and experi- enced men. Such jobs could not be permanent, and it is to prevent the future chaotic readjustment which would natur- 2A, L. Lewis, ‘“‘The Toy Industry’’, in American Journal of Care for Cripples, Vol. WADE INOS Py 104. IBY Hare: A Study of Handicapped Children 51 ally result from such placements that the reconstruction de- partment of the army has not only offered but compelled dis- abled men to accept a vocational training course before dis- charging them from the army. The message which everyone who is interested in the welfare of the cripples should at- tempt to impress on the employer is that “the positive duty of the employer is to find for the disabled man a constructive job which he can hold on the basis of competence alone’’.® The special trades adapted tc cripples include a longer list than would on first thought be imagined. A cripple dis- abled in the feet or legs has of course a larger choice of occu- pations than the one who has lost the use of his hands or arms. Among the children’s industrial schools, the commonest occu- pations taught are sewing, basketry, pottery, etc., for the girls; wood carving, carpentry, cobbling, etc., for the boys. Toy manufacture has recently been suggested as an excellent trade to teach these crippled children, both on account of the enthusiastic interest it would arouse among the children and on account of the demand for toys in the market since the usual large supply from Germany has been cut off. Other trades can be learned by cripples, the most important of which have been included in the training school shop of the Red Cross Institute for Cripples, where their efficacy and success have been tested. These include type-setting and printing, manufacture of artificial limbs, mechanical drawing and drafting, acetyline welding, jewelry making, and cyne- matograph operation. In connection with the vocational training school, the Red Cross Institute Supports a special employment bureau for cripples, which keeps in touch with all the other employment bureaus in New York City, and also is doing a bit of unostentatious pioneer work in educating the employers to a realization of the cripples’ value in certain lines. The Red Cross Institute has discovered that in con- nection with the industrial cripple, the workmen’s compensa- tion law as it is now interpreted is more of a detriment than a benefit to the victim it is intended to help; for it makes no provision for a man’s rehabilitation training in a new field of labor other than the one shut off from him by his acquired disability; and the tendency is for a man to loaf while the compensation is being paid out to him. When the term of 3 American Journal of Care for Cripples, Vol. VI, No. 1, p. 146. 52 Indiana University Studies its payment expires, the man is left stranded, and it is at this time that the Red Cross Institute receives such men as appli- cants for the trade school. There is eminent need of a revi- sion of the compensation laws. This field of industrial crip- ples includes not only adult men and women, but also children over fourteen years of age very often. The reports of the Industrial Board of Indiana of industrial injuries have since January, 1919, included a separate statement of conditions among juveniles of sixteen years and under. The reports for January and February gave 75 and 62 cases respectively of injuries to children under sixteen years of age reported. The list of industries engaged in, causes of accidents, and kinds of injuries is too long to quote in detail, but in relation to a study of crippled children it is interesting to note here the number of orthopedic injuries. In January the following list occurred: CASES Loss or amputation. 2... .-. 1. of 1: finger. ..3.2 3 ee eerie ee 3 Loss: or amputation.=....--.-1. of all fingers;onevhanda—=---. 5 -.-~ 1 Fracture.or, brokenness... ie arm 2.5 e's ee eee eee ee 2 itracture or broken’ 2. e ee 1 finger. .6. 32052 Oe eee ee iL Eractureior broken... -o ee 1 foot: 2. eee eee 1 Crushed 4.153 ca eee ee hand °...... os .hosskees eee eee ee if Crushedie i yesie oe hee eee ee 1 finger i. sc Rage eee 2 Crushed. 2 £.cis.¢.0 ewe ode ood B06. te = eee eee ee ee 1 Crushed cso he cee eee ee eet 3 t06S ooh ee ee EE ee eee 1 Total ic 600. sais bo lets Sere os Sie Bie ole ee eee eee g i 13 For February, the following list occurred: Loss or amputatione.—...-2- 21 1. finger 6.2.6 ee eee eee eee 2 Eracture or prokens 2 ee leg. cos odse eee eee noces i ivacture: on broken: 3. se 1 ankle... 2.5 Se eee 1 Crushed .2..s..c5. 2.24 i..2..-0 finger ..2 7333S ee 3 Crushed . 0.0: 2. 0 fin eee 1 toe 2. eee i Total i. 2. 6e6. cel wan Sa de eats 6 oe. eS See ore 8 The ages of the children injured were as follows: JANUARY FEBRUARY Years Number of Cases Years Number of Cases VAY ct eee ee eee 4 14.00 2 5S 4 1: EE oe eres 7 15. eee 8 Hare: A Study of Handicapped Children 5d Tho the numbers of this orthopedic selection are small, yet the mere existence of any figures at all accounts for a few of the multitude of cripples and otherwise disabled children. The country-wide agitation against child labor and for child welfare is helping everywhere to ameliorate conditions for children and to raise the age standard of employment. The employment question has scarcely been touched upon in this study of 150 crippled children, because low average age has excluded al! but 5 cases from consideration from this point of view. The following cases have records of employ- ment: SEx AGE Pens OccUPATION WaGE DIAGNOSIS Girl (colored).} 18 | Amputation of leg............| Running elevator. . .| $20 per month. Gil (colored).| 17 | Amputation of Oe Seta ce Running elevator...| $32 per month. Op as. 16 | Osteomyelitis of TOE ws eek [Denson ORY on oe eae $32 per month. IDO ea ae HOM tClubtoot. = 45-2 Grocery delivery Oye eee es ee $6 per week. OW Fee: GE SCOMOSIS. . 2.2... Peddling and begginceen eee $5 to $25 per week. CASE R. W. 6,109. This case is the last one mentioned above, a crippled boy known all over Indianapolis because of his begging and peddling propensities. He should not legiti- mately be classed among the wage-earning but his case is cited to point out the mistake in neglecting both to offer and en- force some form of vocational training for such crippled chil- dren. This boy belongs to a neglected, ignorant family of the most destitute type. His father recently deserted the fam- ily but the court forces him to pay a certain regular amount for its support. The boy himself is badly hunchbacked from curvature of the spine. He has been brought up in Juvenile Court for truancy and for stealing, and he is known to almost every social agency in town. Every effort has been made to get him a job and urge him to stick to it; but since he has 54 Indiana University Studies never had any industrial training, his beginning wages are naturally low, and he always refuses to remain at a job stead- ily because he knows he can make more money by begging or peddling, his boast being that he occasionally makes as high as $25 per week! This child is so confirmed a vagrant that it is doubtfui whether ordinary measures will solve his prob- lem now. It will take an extraordinary person or circum- stances to lead him into the paths of righteousness and a sane economic life! The development of free and semi-enforced vocational training and a recognition of the cripple on an equal basis as his normal competitor in the field of industry will help to prevent the development of such cases as R. W. to lessen the drain on community charity; and to substitute self-respecting, economically independent citizens for one of the groups of useless dependents. Vil. SURVEY AND LEGISLATION IN order to obtain public support and interest in a bill before the legislature, it is necessary first to secure authentic data and figures on the subject at issue. Therefore before making an effort to pass reform laws to alleviate and improve conditions for crippled children in any locality, a survey of existing conditions and its publication is an excellent way of making known the need for legislation. The survey of all the cripples of Cleveland, Ohio, in 1916! serves as a fine illu- stration of the value of such pre-legislative agitation for a social reform. The Cleveland Survey included adults as well as juveniles, but only the results of the investigation of juvenile conditions will be mentioned here, in keeping with the limitations of this study. Crippled children under fifteen years of age to the number of 936 were discovered. Their physical deformities were diagnosed as follows: 16 per cent congenital, 9 per cent results of accidents, 15 per cent tuberculous bone and joint disease, 41 per cent infantile paralysis, and 16 per cent re- sults of other diseases. A survey of the educational situa- tion of the children between five and fifteen years of age gives the following estimate: SCHOOL ATTENDANCE® NUMBER PER CENT DISTRIBUTION Ota ic boi oe ee eee raat 100 per cent PMceUiliC: SCHOOl.:. 1. ..5. 0. ee ee 525 68 per cent veoular iclasseS -......5....- 415 79 per cent Specialclasses ....5...5.-.-: 110 21 per cent INGimateSChOO! oo 5. ee ee ws 246 32 per cent The survey stated that there were 4 institutions for crip- pled children in Cleveland: 1. Rainbow Hospital ..... capacity 50-85 cases..School instruction. 2. Holy Cross House...... capacity 50 cases..School instruction. 3. Willson School Classes. .capacity 110 cases. . Special school. AP OUnDeamM ASSOCIATION: «oss 26.5. cee ae ce eee eee Promotion of Aid for Cripples. These few facts from the Cleveland Survey serve the pur- pose of indicating the general plan of its investigation. At 1 Publication of the Red Cross Institute for Crippled and Disabled Men, Series II, No. 8. 2A Survey of Cripples in Cleveland, Ohio, in 1916, p. 48, Red Cross Institute Pub- lication. (55) 56 Indiana University Studies the time it was made, Ohio had the following laws which touched on the situation: (1) maintenance of a special school for crippled children; (2) appointment of teachers to this school just as tc other regular public schools; (3) compul- sory attendance of crippled children at special school; and (4) medical inspection of these children. The fruits of this survey are seen in an editorial from a Cleveland newspaper on March 20, 1919, which is quoted as follows: The present Legislature can hardly refuse to help along the move- ment for a state institution for crippled children. The Legislature two years ago without a dissenting vote took the initial step by appro- priating $90,000 with which to start the work. But before a begin- ning could be made America entered the war, and practically all pub- lic construction was stopped. The appropriation of $90,000 has since lain untouched in the State treasury. All the present Legislature has to do is to reappropriate this $90,000. No project with more real merit behind it has come before the Legislature for years. The State provides liberally for its blind and deaf children. Yet there are today more than 2,000 crippled children in Ohio, practically all of whom should become wards of the State so that they can have expert treatment, be educated properly, and be trained to become self-supporting citizens. This plea brought the desired results, as the Ohio state legislature did pass the bill reappropriating the $90,000 for the establishment and organization of an institution for de- formea and crippled children, and the commission appointed to carry out the plan of this bill remained on the same status, with the prospect of commencing constructive operations at once assured. Legislation in Various States. Laws directly in reference to the care of crippled children have been passed in 11 states, and the gist of their respective appropriations and enactments is as follows: Florida. 1. Erection of a hospital for indigent crippled children by the State Board of Health. 2. Annual appro- priation of $10,000 for maintenance. Illinois. 1. Authorization of Surgical Institution for Children under fourteen unable to pay for private surgical care. Iowa. 1. Power vested in Juvenile Court to compel medical and surgical treatment for children under sixteen. A. Free treatment at State University Hospital for patients unable to pay. Hare: A Study of Handicapped Children 57 Massachusetts. 1. Appropriation for Massachusetts Hospital School for Crippled and Deformed children, under supervision of State Board of Charities. Michigan. 1. Appropriation for two cottages for treat- ment and education of crippled children at State Public School at Coldwater. 2. Power of commitment to school vested in Probate Court. Minnesota. 1. Appropriation for State Hospital for crippled children. Nebraska. 1. Appropriation for equipment of a hospital for crippled children. | New York. 1. Appropriation for State Hospital for eare of crippled children. A. No admission for incurables. B. Admission only for patients unable to pay. Ohio. 1. Appointment of commission to buy land for hospital for treatment and education ef crippled children. Oregon. 1. Compulsory medical examination of crippled children under sixteen, at discretion of judge of county court. 2. Free treatment and transportation at hospital of Univer- sity of Oregon Medical School. Wisconsin. 1. Provision for admittance of crippled chil- dren to State School for neglected and dependent children. 2. Provision for medical supervision of such cases. The state of Indiana has no law governing the care of crip- pled children specifically. The only law which can be inter- preted to include such provision in a general way is an “Act (1907, Chapter 41) defining a dependent child and a neglected child, and providing for their custody and the punishment of any person responsible for, or in any way contributing to, such dependency or neglect’’.® The definition of ‘neglected child” in this law includes girls under seventeen, and boys under sixteen, ‘“who have not proper parental care or guar- dianship’’,* but it dees not specifically include mention of the uncared-for sick children; so that its terms are not by any means adequate. There is an appalling need for laws con- trolling the care of dependent crippled children, and if a sur- vey were made in Indiana such as was made in Cleveland, the statistical figures for Indiana would prove to be proportion- 3 Laws Concerning Children, compiled by State Board of Charities, March 1, 1914, D-. 6. * Ibid, 58 Indiana University Studies ately high. A recommendation for legislative provision for the care of crippled children in Indiana would include the following clauses: 1. Compulsory medical and surgical attention for all children physically abnormal. (A) Including report and examination of cases thru public schools and district system of public health nurses. 2. Adequate hospital provision for children. 3. Convalescent hospital institution for crippled children, with educational department coordinating. 4. Establishment of special schools with special equip- ment for crippled children thruout the state. 5. Provision for free vocational training for crippled children with departments adapted to various forms of handi- caps. CONCLUSION THE adjustment of handicapped individuals to a life as nearly similar to that of the normal as possible is a social problem worthy of investigation and realization. It is amazing to consider that the majority of normal average peo- ple never give a thought to the large number of handicapped individuals with whom they come in contact. People are not intentionally selfish and unkind; they are busy and ignorant! A social problem such as the one of crippled children dealt with in this study needs public education in regard to it first and foremost, and then the steps of reform will usually follow within due course of time. The World War with its results of thousands of maimed and crippled soldiers has recently brought the problem of the relationship of the cripple to his community before the public eye. The wave of sympathy which these war conditions have aroused has already done much—and will do more—to awaken the public to a realiza- tion of the problem and its social significance. The Division of Reconstruction of the Surgeon-General’s Office has devoted untiring energy to the most scientific solving of the crippled soldier's problem; and thru its rapid strides in discovering new methods of aid, the civilian cripple as well as the soldier should benefit eventually. The reconstruction work includes invention of new types of artificial limbs and the testing out of trades and indusiries best adapted to the ability of disabled individuals. Mention has already been made of the Red Cross Institute for Cripples which was organized just before Amer- ica entered the war, and which offers all its opportunities to civilians as well as soldiers. With the movement of reconstruction and readjustment of cripples in general in the foreground of the public vision at present, the importance of the crippled children’s situation should be emphasized and supported. There is a more opti- mistic side to the children’s problem, because so many of their cases if given medical attention promptly can be avoided, or cured, or improved, whereas the adults have less natural chance of physical improvement. The Child Welfare Move- ment which is being introduced into every community in the country is a great asset in the movement to help crippled children. From an economic point of view, the arguments for (59) 60 Indiana University Studies legislative provision for care of. crippled children are over- whelming. The independence derived from education, voca- tional training, and adjustment to industrial life would lessen the burden of expense of the charity and relief agencies; would eliminate a large per cent of begging, and would im- prove the economic self-respect of communities. “A physical burden bravely borne makes a strong man whose moral force in a community is worth a score of mere men machines.’ Crippled children have the same curious spiritual atmosphere of morale about them, which makes them appeal to the sympa- thies always; and the incentive to do constructive work to help their lot in life is the most worth-while product of sym- pathy. The old cry of “give the crippled children a fair chance” is the strongest appeal that can be voiced. In this study of 150 crippled children, no startling dis- coveries of the problem have been brought to light. This study is rather an illustration and proof of the veracity of theories and assertions claimed by pioneers in this field. It has been said by many excellent theorists that the problem of crippled children includes the following fundamental facts: the greatest cause of deformities is disease; the mental ca- pacity of a crippled child is normal and often above the aver- age; the need for special schools and institutions 1s enormous; the medical examination and proper treatment of these cases results in communistic economy; the need for legislation to obtain social reform and adequate facilities for the care of cripples is overwhelming. These, and other underlying facts, have been claimed as the fundamental principles back of the problem; and this study has been an attempt to show from the social point of view that these facts are true. Statistics of actual estimates and specific illustrations bearing out state- ments are the most practical proof of scientific assertions, and such has been the purpose of this study. Its endeavor has been to contribute information which might be of some little value in helping to secure a normal adjustment to social and industrial environment for the crippled children of Indiana. 1 American Journal of Care for Cripples, Vol. V, No. 2, p. 248. Bibliography Reeves, Care and Education of Crippled Children. Russell Sage Founda- tion. Cripples and Their Place in the Community. Annals of American Acad- emy of Political and Social Science, p. 36. American Journal of Care for Cripples, Vol. III, No. 4; Vol. IV, No. iol Ve Nos, 1,2; Vol. VI, Nos. 1, 2; Vol. VII, Nos. 1, 2; Vol. VIII, No. 1. Emerson, Essentials of Medicine. J. P. Lippincott and Company. Education and Occupation of Cripples—Juvenile and Adult. Cleveland Survey. Annual Report of the Massachusetts Hospital School for Crippled Chil- dren at Canton, 1917. Public Document No. 82. Lovett and Fish, Outdoor Treatment of Surgical Tuberculosis. In Bos- ton Medical and Surgical Journal, Vol. CLXIX, No. 5, 19138. The Modern Hospital, March, 1919. McMurtrie, Future Policy in Dealing with Cripples. In Medical Rec- ond, January 25, 1919. The Place of the Crippled Child in the Public School System. In Hy- giene and Physical Education, May, 1909. Epidermiological Studies of Poliomyelitis in New York City in 1916. In American Journal of Medical Science, Vol. CLVII, No. 3, March, LNG The Care of 15,000 Cripples. In World’s Work, Vol. XXXIII, p. 2389, January, 1907. Polio Points All Over the Country. In Survey, Vol. XXXVII, p. 312, December 16, 1916. Strong and Straight and Fine. In Survey, Vol. XXXVIII, pp. 312-18, Vly 1917, Caring for Our Little Cripples. In Literary Digest, Vol. LIII, p. 1713, December 30, 1916. Evelyn Goldsmith, A Plea for Crippled Children. In Kindergarten Magazine, Vol. XIX, p. 591, May, 1907. Bradford and Lovett, Orthopedic Surgery. William Wood and Com- pany, New York, 1915. Reconstruction and Re-education of the Disabled Soldier and Sailor. War Department Abstracts, Translations and Reviews, Bulletins II and IV. Cabot, The Layman’s Handbook of Medicine. Houghton Mifflin Com- pany. Cabot, Social Service and the Art of Healing. Moffat Yard and Com- pany, New York, 1912. Report of the Social Service Department of Indiana University, 1911, OZ 19135 1915, (61) 62 Indiana University Studies Annual Reports of the Massachusetts General Hospital, 1906-1916. Streightoff, The Standard of Living. Houghton Mifflin Company. Devine, Misery and Its Causes. Macmillan Company. Goddard, The Kallikak Family. Macmillan Company. Henderson, Modern Methods of Charity. (Chapters 4 and 6.) Mac- millan Company. Hart, The Psychology of Insanity. Howes, Early Pulmonary Tuberculosis. Warbasse, Medical Sociology. Pusey, Syphilis as a Modern Social Problem. Mary E. Richmond, Social Diagnosis. D. Appleton Company. West, Prenatal Care. In American Medical Association, 1915. Killicott, The Social Direction of Human Evolution. Russell Sage Foundation. Ida M. Cannon, Social Work in Hospitals. Reports of United States Department of Labor, Children’s Bureau, 1914. Nescher, The Institutional Care of the Aged. D. Appleton Company. De Schweinetz, This Side of the Trenches. Survey Associates Incor- porated, 1913. BIBLIOGRAPHY OF THE EDUCATION AND CARE OF CRIPPLED CHILDREN Compiled by Douglas C. McMurtrie Frederic Almy, Disability, Handicaps. Relief, a Primer, p. 19. The Child on the Crutch. In Ladies Home Journal, 1909, Vol. XXVI, p. 56. Day Schools for Crippled Children. In Charities Review, 1900, Vol. X, pp. 79-83. Crippled Children in the New York City Public Schools. In Kinder- garten Magazine, 1907, Vol. XIX, pp. 588-591. Conservative Treatment of Tuberculosis Cripples. In British Medical Journal, 1910, Vol. II, pp. 1124-1126. State Care of Indigent Crippled and Deformed Children. In St. Paul Medical Journal, 1900. ‘ Crippled Children. In Munroe’s Encyclopedia of Education, 1911, Vol. II, pp. 280-234. C. R. Henderson, Care of Crippled Children. In Introduction to the Study of the Dependent Classes, pp. 116-126. Education of Crippled Children. In Charities, 1905, Vol. XIII, pp. 429- 431. The Widener Memorial Industrial School for Crippled Children. In National Conference of Charities and Correction, 1908, pp. 389-391. Special Employment Bureau for the Handicapped. In Charities, 1906, Vol. XV, pp. 582-585. Hare: A Study of Handicapped Children 63 The Need of Special Schools for Crippled Children. In New York State Journal of Medicine, 1910, Vol. X, p. 188. Care of Convalescent Crippled Children. In Charities, 1901, Vol. VII, pp. 569-570. Crippled Children in the English Public Schools. In New York Medi- eal Journal, 1913, Vol. XCVII, pp. 188-1990. Educating the Crippled Child. In Education, 1912, Vol. XXXII, pp. 636-648. Meeting the Needs of the Cripple in the Community. In Pennsylvania Medical Journal, 1912, Vol. XV, pp. 444-445. Providing for the Crippled Child. In Lancet, 1912, Vol. CVI, pp. 607- 608. Social and Moral Considerations Related to Care of Crippled Children. In New York Medical Journal, 1911, Vol. XCIV, pp. 1330-1332. The Care of Crippled Children. In Survey, 1911, Vol. XXVII, pp. 1208-1211. The Care of the Crippled in Italy. In Medical Record, 1911, Vol. LXXX, pp. 1218-1222. The Copenhagen Institution for Cripples. In Boston Medical and Sur- gical Journal, 1911, Vol. CLXV, pp. 794-798. Duty of the State in the Care of Crippled Children. In Detroit Medical Journal, 1905, Vol. V, pp. 195-198. Crippled and Deformed Children. In National Conference of Charities and Correction, 1898, pp. 402-403. On the Care of Crippled Children. In New York Medical Journal, 1898, Vol. LXVIII, pp. 37-40. On the Care of Crippled and Deformed Children. In New York Medi- cal Journal, 1909, Vol. LXXXIX, pp. 264-265. The Care of Crippled and Deformed Children. In National Conference of Charities and Correction, 1898, pp. 394-401. What New York State is doing at the West Haverstraw State Hospital. In New York State Medical Journal, 1908, Vol. VIII, pp. 126-129. The Care and Treatment of Crippled and Deformed Children. In Cleveland Medical Journal, 1903, Vol. II, pp. 564-570. Education of the Crippled Child. In Archives of Pediatrics, Vol. XX VII, pp. 345-352. Widener Memorial School. In American Medicine, 1903, Vol. V, p. 148. Birmingham and District Crippled Children’s Union. In Lancet, 1906, Wolksihp. 1858. Care of Convalescent Crippled Children. In Charities, 1901, Vol. V, pp. 569-570. Care of Crippled Children in Germany. In British Medical Journal, nOO9 Viol; 1,. p: 1092. Care of Cripples. In Journal of the American Medical Association, 1908, Vol. LI, p. 1024. Crippled Children. In British Medical Journal, 1908, Vol. I, p. 165. Crippled Children in Minnesota. In Charities Review, 1900, Vol. X, pp. 106-107. Crippled Children of Liverpool. In Lancet, 1910, Vol. I, pp. 466-467. 64 Indiana University Studies Crippled Children’s League. In Lancet, 1905, Vol. II, p. 1582. Crippled Children’s Union. In Lancet, 1906, Vol. I, pp. 1139-1140; Lan- cet, 1907, Vol. 1, p. 1675; Lancet, 1908; Volk ipeetGa7e James Lawrence Kernan Hospital. In Journal of American Medical Association, 1911, Vol. LVI, p. 1828. Needs of School for Deformed Children. In Boston Medical and Surgi- cal Journal,.1911, Vol. CLXV, p. 849. New East Side for Cripples. In Medical Record, Vol. LXX, pp. 421-422. New York Hospital for Care of the Crippled and Defective Children. In Medical Record, Vol. LXV, p. 382. Schools for Crippled Children. In Journal of the American Medical Association, 1911, Vol. LVI, p. 1493. What Shall We Do With Our Cripples? In Journal of American Medi- cal Association, 1909, Vol. LII, pp. 1134-1136. The Crippled Child. In New York Medical Journal, 1911, Vol. XCIV, p. 1339. Vou. VI SEPTEMBER, 1919 INDIANA UNIVERSITY STUDIES Study No. 42 THE SOCIAL ASPECT OF THE CARDIAC CASE: A STUDY BASED UPON ONE HUNDRED FIFTY-FOUR CARDIAC CASES REFERRED TO THE SOCIAL SERVICE DE- PARTMENT OF INDIANA UNIVERSITY. By Lgta ‘Frances THompson, A.M. For Sale by the University Bookstore, Bloomington, Ind. Price, 35 cents. The INDIANA UNIvERSITY SrupiEs are intended to furnish a means — for publishing some of the contributions to knowledge made by instructors and advanced students of the University. The Studies are continuously numbered; each number is paged independently. e ington, Ind., under the act of August 24, 1912. The INDIANA UNIVERS STUDIES are published four times a year, March, June, September, and Decem by Indiana University, from the University Office, Bloomington, Ind. — ngs INDIANA UNIVERSITY STUDIES Vout. VI SEPTEMBER, 1919 STUDY' No. 42 THE SOCIAL ASPECT OF THE CARDIAC CASE: A STUDY BASED UPON ONE HUNDRED FIFTY-FOUR CARDIAC CASES REFERRED TO THE SOCIAL SERVICE DE- PARTMENT OF INDIANA UNIVERSITY. By Leta Frances T'Hompson, A.M. conan insite MAR 18 1920 NX is oe S575) Submitted in partial fulfilment of the requirements for the degree Master of Arts at Indiana University. Foreword THis thesis has been prepared under the direction of Miss Edna G. Henry, in partial fulfilment of the requirements for the degree of Master of Arts in the Social Service Department of Indiana University. This opportunity is taken to express thanks to Miss Edna G. Henry, Director of the Social Service Department; to Dr. George S. Bond; and to the members of the Social Service Department for their interest and assistance in the preparation and comple- tion of this thesis. Leta FraANcES THOMPSON. Indiana University, June, 1917. Table of Contents CUBE ODIUIC RONG SIs ee bebe Pb ee cca eee cuea ies: WHCEINSRUAT SITUATION 0.5050. 0.0. cede coe vlc ve cect eeeeuias PO Sr ee ee ae cs. MIE OIJQUGE Sree ie oe eee Pe ate WI. MErpican aND SocIAL TREATMENT?....... 5000-00000 ce eee eee Wee STATISTICS ON PATIENTS. ........... 0. oSa00.8e0- ele Bg hs MEENICINWISTONMIN Se ok ee (3) The Social Aspect of the Cardiac Case By Leta FRANCES THOMPSON, A.M. INTRODUCTION THE Social Service Department of Indiana University began its work September 20, 1911. The Department has three objects’: education, prevention, and research. It aims to further the cure of those patients referred to it by physicians in connection with the City Dispensary and the Robert W. Long Hospital who recog- nize that their patients need more than medicine. The patients are thus educated in personal hygiene and new ways of living. The education, however, does not stop here, for the community is taught thru the publications put out by the Department and the speeches made by the workers. Students, also, come in for their share of education, those studying medicine and nursing, as well as the ones enrolled in the Social Service Department. Codperation with the doctors was considered the best possible way to accomplish the results sought. Because of their medical connection, the worker was designated as the Medical Social Service Worker. In the beginning there was only one worker, so the question naturally arose as to which type of case should receive the most attention. The patients dealt with were those who presented themselves at the City Dispensary and the Robert W. Long Hos- pital. All patients were unable to pay for care of any kind, so the one demanding the most in time and money would be taken as the one in greatest need of outside help. Some needed nothing but medicine, while others needed constant care and supervision as to work, recreation, diet, and general hygiene. On October 4, 1911, the first cardiac case was referred to the Social Service Department by one of the doctors at the City Dis- pensary. The case was baffling. All kinds of social adjustments 1Report of Social Service Department of Indiana University, 1911-1912 and 1912-1913. (5) 6 Indiana University Studies were necessary. I*rom that day the Department decided that the cardiac case was one of its greatest concerns. Most doctors had realized this because of the failures with which they had met in trying to treat a case of this kind without aid in making social adjustments. Within the life of the Department thirty-three doctors have referred cardiac patients to the social service worker for aid in carrying out the treatment prescribed. Due to the lack of time, all these cases were not followed ag they would have been could more workers have been obtained. Because of this many of the patients have died. All of these patients could not have been saved, but most of them would have lived longer had adjustments to life been made. ease Again, on the records are dates when the patient was admitted to the hospital for care, sent home improved, and then readmitted. When he came in the second or third time the same complaint was usually given. Had the hospital made a mistake by dismiss- ing the patient too soon? Had the doctor failed in diagnosis? Had follow-up treatment been advised? Had it been understood ? Was the community obliged to give so much free treatment to these few? Could they ever be made anything but patients? These questions all presented themselves and it was in an endeavor to find suitable answers and perhaps aid in the formula- tion of future plans that this study has been made. An effort has been made to collect all the available material from statistics, studies made by other institutions, and records in this Department in order to ferret out all possible truths. Further study should be suggested by this material. The State Board of Health probably in the future will collect more detailed statistics (than now exist) in connection with the deaths reported from cardiac disease in Indiana. In this regard it would be of value to know facts concerning: (1) homes touched by these deaths; (2) widows, widowers, and orphans; (3) average length of illness ; (4) cost to the community of each case; (5) average length of time out of work: (6) occupations. L Those interested in the health of school children could con- tribute much to the argument for better care by examining and reporting the number of children of school age suffering from organic heart trouble. If this study succeeds in arousing an interest along the line of better care for those suffering from or liable to cardiac trouble, it will have performed its duty. I. GENERAL SITUATION Tue two words “physically handicapped” bring before the mind a long procession of people coming under the classification of “the lame, the halt, and the blind’. In some communities, where there has been recent agitation, the tuberculous present them- selves also. These are the spectacular, and it is that quality which catches the eye and stirs the sympathy. Within the last few years attention has been called to another group of as truly “physically handicapped”. Their physical condition also renders them unable to compete with normal persons. This is that ever- increasing group of people who suffer from one or more of the so-called heart diseases. Organic heart trouble, alone, has ranked first as a cause of death in Indiana for the past six years, with tuberculosis as a second cause. The third cause is chronic nephritis or Bright’s disease. This often occurs as a complication with heart trouble. So taking Indiana alone, heart trouble, both organic and with its complications, ranks first and third as causes of death. THREE GREATEST CAUSES OF DEATH IN INDIANA Organic Pulmonary Chronic Nephritis Year Heart Trouble Tuberculosis or Bright’s Disease INT Gb =: Hee 3,956 BTLPAL 2,021 iC). . Se Sea eee 3,972 3,588 2,210 1 ee OO eee 4,419 3,419 2 448 IN 1S. ¢ ce eee ae 3,998 3,446 2,533 Ig igioe Se er 3,915 3.471 2,694 ISTE. 24 oe ae 4,214 3.444 2,787 LUTE La eee 24,474 21,289 14,688 For the last four years heart trouble has been the greatest cause of death in New York City. For the last five years it has ranked first as a cause of death in the vital statistics of the United States. There has been a steady increase in the per cent of deaths from heart trouble from 1911 to 1915. In 1911 the per cent was 140.9 per 100,000, while in 1915 the per cent was 156.2 per 100.000. (7) 8 Indiana Umversity Studies TWO GREATEST CAUSES OF DEATH IN UNITED STATES Organic Pulmonary Year Heart Trouble Tuberculosis DO i Was ce, ipa, ia a SS NE 83,525 81,796 TOW he Saeco pra eae awe erate cies 86,179 75,429 a LS sR Sea ear Races tne Se ee oes os ee 93,142 80,812 TODA as SEIS syeeeore re elect en ences eee 93,588 84,366 PODS Ree eee ieee ee eA eae cece 105,200 85,993 Statistics show numbers but not the human suffering which must be a resultant factor of sickness and death. In order to show the general situation in complete form, statistics should have been given to denote the number of homes affected by these deaths, the number of widowers and widows left, and the number of children remaining to face the world with one parent or per- haps both parents gone. Such studies have not as yet been published in connection with organic heart trouble. Tuberculosis, upon the other hand, has been under discussion for so long now that very complete statistics can be found con- cerning it. As a result, such successful campaigns have been waged against this dread disease that its death toll was 25 per cent less in 1915 than it was in 1904. Summary From the facts shown here it can be seen that the cardiac patient is one of the greatest medico-social problems of the present day. More deaths are caused by this disease than by any one other, according to the statistics for the United States, Indiana, and New York City. re Cost Up to date there has been no widespread agitation nur infor- mation concerning heart disease. For that reason little has been thought of the expense incurred by the community for patients suffering from this disease. When the first break comes and the patient reports to the doctor for treatment he must remain idle for weeks. During this time some provision must be made for his family. CASE MR. B. This last winter when prices of groceries were so high, one family was given two dollars’ worth of groceries by the Charity Organization Society every other day for nine weeks. The man was out of work on account of his heart condition and the family had to be fed until he could return to some kind of a gainful occupation. After the long time of unemployment an attempt was made to obtain a light job for him. This was an almost impossible task for, as in many such cases, the man was uneducated and untrained. He had gone to school only three or four years and had had no occupational training. Finally a place was secured for him in a wood-working factory. Here he had to pile lumber, which was much too heavy for anyone in his condition. The constant lifting caused the heart so much extra work that another break was feared. Besides being a great expense to the community, which supports all relief agencies, the employer of such a man must face the possibility of a collapse at work, which may cost him much. Even if accidents can be averted, it would not be very satisfactory to try to operate an establishment with “half men”’. The family, too, often suffers from such an example in early life. The children learn to expect their employers to give them the easy job and the community to furnish support at any or all times. They thus become mere parasites on the next generation. Another less tangible result of heart trouble, yet one that is an outgrowth of all idleness, is delinquency. This adds greatly to'the general cost. As Chaucer has said, “Idleness is the gate of all harms. An idle man is like a house that hath no walls; the devils may enter on every side.” The boy or girl, man or woman, who is told by the doctor to cease work, but is given no legitimate substitute, is sure to meet with many temptations that might help (9) 10 Indiana University Studies to pass the time. This Department has been fortunate so far in not having to deal with many such cases, but this is a possibility that must be faced. CASE MRS. P. If every patient had the adaptability of one foreign woman known to the Department, no alarm would ever be necessary because of idleness. She had been a hard working woman before her break when she was sent to the hospital. The four years on this side of the ocean had been spent in lifting heavy buckets in a meat packing establishment. She lay at the point of death for six weeks in the hospital, but finally started to grow better. Then she was taken to her home before the doc- tors thought it safe for her to go. She was told not to work. She did not spend her time thinking of how strong she once was, but took up crocheting. When the visitor asked her if she was careful and did not work, she cheerfully answered as she took a few more stitches, “This my work now, me do nothing else.” So far no account has been taken of the cost of visits made by patients to the dispensary or of stays in the hospital. According to the Report of Committees on Out-Patient Work for the Boston Dispensary, 30 dispensaries estimated the cost per visit from 19 cents to 75 cents. Taking the average, it may be said that each visit costs about 40 cents. This must be paid in some way. If the patient cannot pay, and the majority of patients are unable to pay even 10 cents, the community must pay. This it does either by appropriation or private donations. Considering the fact that some heart patients attend the dispensary at least twice a month for several years, what seemed to be little to start with soon amounts to a large sum. In case a home investigation is made, and it always should be made on a dispensary patient, the expense of the visit is added. The nurse who goes to give practical lessons in hygiene and the district doctor, who may be called at any time should the patient become critically ill, must be paid for their services. : : Treatment in the hospital is more expensive yet for the time, but does not last so long. From the records of the 61 hospital patients dealt with by this Department, the shortest time spent in the hospital by any of them was 1 day and the longest 420 days. Talk of conservation of energy and money! Consider the fact that more than half of these patients would never have entered the hospital had there been more definite means of follow- ing them from the dispensary or even in their places of work Thompson: The Cardiac Case 11 before they were forced to “lay off” and seek a doctor for the first time. Worse yet, some of these patients returned to the hospital two or three times. This was certainly due to one of two or three facts. First, the patient may have been discharged before he was really strong enough to leave. This does not often hap- pen. Second, some have gone away from the hospital without a thoro understanding of how they should care for themselves. Third, the patient may have left the hospital facing a long period of convalescence. He had no convalescent home to which to go, so returned to unsympathetic or ignorant friends and relatives or to some necessary employment. CASE M.S. A very good example of the second is the history of a young woman who has been in the hospital three times. She is well-meaning and ambitious. She lives with her brother and sister-in-law, who seem very good to her. She, however, does not wish to depend on them, so leaves home to work. . ee eee 6 8 months.32 see ee 1 206>MONtNS.:.. eee ee 5 9. > months) eee iL MONTHS 3s 52 e Pee e 9 20:> months.=3eeeee eee if SED MONTHS: 3 eee oe a ete 2 — 4 MOnths. 3: Ss Se oe eee 4 Total’)? eee 49 AVG “MONS osta0 & sess ee ee 3 While these patients were here an attempt was made to teach them some trade that would not hinder their progress in get- ting well. When the patient returns to his home, if he does not know some remunerative trade, he must go thru the same process of adjustment as those who return from the hospital or have been cared for in the home. CASE Y. One patient, who had been a stone-cutter before his break, left the hospital without any idea of what he could do for a livelihood that would not be injurious. He was told that heavy work of any kind would not be at all suitable. For a time he tried driving a laundry wagon. This necessitated a period of low income, for he had to work up his own route. The wife was very impatient. She could not see that he was doing what would be for the future good of the family. At last he was forced to give up the idea of caring for himself and went back to heavy work. The home life was so very unpleasant that the man deserted a few months ago. When an attempt is made to aid a patient to change his occu- pation, the limited training usually stands in the way. He has usually done one thing all his life and knows nothing else. What does this mean? Certainly something is wrong with the great educational system that compels the student to remain in school until he is fourteen and then turns him out to “make a human derrick” of himself, as one patient said. This, to be sure, is drawing a conclusion from the older class of men, who were not influenced by the compulsory school system. It is to be hoped that this problem will be met less in twenty years from now. For those deprived of this early training some other means should be employed to supplement the meager education. One of these means is found in the Sharon School experiment men- tioned above. Other states and cities should establish similar schools. Thompson: The Cardiac Case 43 Something very important, however, might be done by a law- making body of the community. This would make up for the former neglect and make the lives of the physically haudicapped less a burden to themselves and friends. All such work with individuals, if it is to bear full fruit, must result in time in some form of legislation. Just what this should be no one positively knows. Some general attention of the employers, too, should be given to the physical well-being of the employees. Some laboring men object to physical examination for fear they will be thrown out of their chosen line of work, but they should be made to see that a little care now may save years of suffering and unemployment later. While a man is earning the most money is the time to begin to save for the time when his earning capacity is less and needs are greater. Few will save unless compelled to do so. They should be forced to this, however, by the community, for it must bear the burden when poverty comes. By making some provision for this class to care for themselves, the great number that now become helpless and poverty-stricken in later life because of cardiac disease would be greatly reduced. For, as Henry Ward Beecher has said, ‘“‘Poverty is very good in poems, but very bad in the house; very good in maxims and sermons, but very bad in practical life.” Bibliography Cabot, Social Service and the Art of Healing. Warbasse, Medical Sociology. Cannon, Social Work in Hospitals. Reports of Social Service Departments of Boston Dispensary, Massachu- setts General Hospital (Boston), Lakeside Hospital (Cleveland), Belle- vue and Allied Hospitals (New York), Babies’ Dispensary (Cleveland), Barnes and Children’s Hospitals (St. Louis), Municipal Hospital (Cin- cinnati), University of Pennsylvania (Philadelphia), Jefferson Hos- pital (Philadelphia), Howard Hospital (Philadelphia), Psychopathic Hospital (Boston), Memorial Hospital (Chicago), Central Dispensary (Chicago), Indiana University (Indianapolis). Reports of National Conference of Charities and Correction, 1911, 1912, 1913, 1914, 1916. Report of First National Conference of Medical Social Service, May, 1916. Reports of New York conference on Medical Social Service. Cabot, A Layman’s Handbook of Medicine. Emerson, Essentials of Medicine. Smith, What to Hat and Why. Hirshfelder, Diseases of the Heart and Aorta, Part II, Chapters 1 and 2. Symposium on Endocarditis in Childhood, reprinted from Boston Medical and Surgical Journal, September 2, 1915. Pusey, Syphilis as a Modern Problem. Hawes, Early Pulmonary Tuberculosis. Elwood, Modern Social Problems. Ward, Outlines of Sociology. Ward, Pure Sociology. Devine, Misery and Its Causes. Davenport, Heredity in Relation to Eugenics. Hart, The Psychology of Insanity. (44) Vou. VI | Decumsee, 1919 INDIANA UNIVERSITY STUDIES Wd a a < S Jona] Must THE SOCIAL SIGNIFICANCE OF MENTAL DISEASE AND DEFECT: A STUDY BASED ON THREE HUNDRED FORTY-FIVE MENTAL AND NERVOUS CASES RE- FERRED TO THE SOCIAL SERVICE DEPARTMENT OF INDIANA UNIVERSITY. By Herten Hunt AnpREWs, A.M. Study No. 43 For Sale by the University Bookstore, Bloomington, Ind. Price, 35 cents. « am / The INDIANA UNIVERSITY STUDIES are intended to furnish a means for publishing some of the contributions to knowledge made by instructors and advanced students of the University. The Studies are continuously numbered; each number is paged independently. Entered as second-class matter, June 14, 1918, at the postoffice at Bloomington, Ind., under the act of August 24, 1912. The INDIANA UNIVmRSITY STUDIES are pub- ~~ lished four times a year, in March, June, September, and December, by Indiana = University, from the University office, Bloomington, Ind. i December, 1919 INDIANA UNIVERSITY STUDIES Vou. VI STUDY No. 43 THE SOCIAL SIGNIFICANCE OF MENTAL DISEASE AND DEFECT: A STUDY BASED ON THREE HUNDRED FORTY-FIVE MENTAL AND NERVOUS CASES RE- FERRED TO THE SOCIAL SERVICE DEPARTMENT OF INDIANA UNIVERSITY. By Heten Hunt ANnpbreEws, A.M. itnsonian Insti a, MAK 13 1920 ) 4 o/ @ng] Muse i = Submitted in partial fulfilment of the requirements for the Masters degree in Indiana University. Table of Contents Pacr INTRODUCTION. 0665 Sw oe Se 5 I) Dany Gener at PROBLEMO 5. \s5 ao. ee ee ee oe ae S: i Pan hnenon-Manpepe ee ee Pee Recreate. Cee 16 ITT. Vas EPILEPTIC) 2) ook ose ee oe oe ee eee a EV io CEN SAINI Scere aaa ie Sot Freon ieee lace Neh hrs Ge ne De aie) Obes oa a CONCLUSION OSs Bagh sS eA b eaeaa sc Se een 52 (2) Foreword Tuis thesis has been prepared under the direction of Dr. Edna G. Henry, as a partial fulfilment of the requirements of the Social Service Department of Indiana University for the degree of Master of Arts. I wish to take this opportunity to express my gratitude to Dr. Edna G. Henry, to Miss Catherine Murray, Miss Elizabeth Tandy, and other members of the Social Service Department for their assistance, and to the Charity Organization Society, the Children’s Aid Association, the Department of School Attend- ance, and the Juvenile Court for the use of their records. HELEN Hunt ANDREWS. Indiana University, June, 1919. (3) The Social Significance of ;}Mental Disease and Defect By HELEN Hunt ANDREWS, A.M., Head of the Social Service Department in the City Hospital, Louisville, Ky. INTRODUCTION THE Social Service Department of Indiana University began its work in September, 1911, with one worker and an office in the School of Medicine building, where the Indianapolis City Dis- pensary is located. It was thought that here was a field for research work as a basis for future sociological study. Further- more, the Department could at the same time carry on a work of education and prevention. The work of aiding in the care and cure of the patients was its first business, as it is the business of all medical social service. Along with this, from the very first, records of the patients were carefully and fully kept to be used as teaching material. With the opening of the Robert W. Long Hospital in 1914 the main office of the Department was moved to that building, a branch office being retained in the School of Medicine building. The Department employs a hospital worker who takes care of the patients referred to her there, and a state worker who follows these patients into their homes out in the state to see that they are carrying out the doctor’s orders, to get family histories or facts of the environment, to report to the doctor and put upon the record. All records of these cases are kept and used as mate- rial for sociological study. A committee of interested individuals in the city of Indian- apolis maintains the office at the City Dispensary and employs the worker there. As both offices are under the direction of Dr. Edna G. Henry, they work together and the records of each are accessible to the other. 1From July 1, 1918, to July 1, 1919, funds were supplied by the War Chest. (5) 6 Indiana University Studies In the dispensary the patients are referred to the Social Service Department from the various clinics by the doctors. A doctor wishes home conditions investigated, a change of employ- ment secured, a prescribed diet supervised to see that it is fol- lowed, an obdurate parent persuaded to consent to an operation for his child, or many other things done for which the doctor him- self has no time, and yet which may be all-important for the cure of the patient. The task of the social worker on a certain case may be merely to refer it to the proper social agency. She can and does tell the patient where he can receive the necessary aid and also reports to the agency concerned what she knows of his character and his needs. Other agencies, in turn, refer to the Social Service Department persons needing medical care who perhaps come to the dispensary for the first time. They may thus be assisted and steered to the proper clinic, and taken as cases by the worker. Later a report of the doctor’s findings or his diagnosis and the method of treatment advised by him is made to the organization which referred the patient. In the State Hospital the method of the Social Service Depart- ment is somewhat different from that in the City Dispensary. Since October 1, 1915, all new free and part-pay patients have been the subjects of routine inquiry, and certain types of cases are always followed. More than seven thousand cases have been handled by the Department, thru both offices, between September 20, 1911, and April, 1919. The patients considered in this paper have been referred from the Mental-Nervous Clinic of the dispensary, or have been in the hospital, and each has a definite diagnosis of some mental or nervous disorder. The first patient referred to the Social Service Department in its beginning was from the Mental-Nervous Clinic.* There may be a significance in this fact, for the mental-nervous patient has proved, more than any other, to be a subject for social service. The doctor usually wants to know about the patient’s environment, family and industrial life, and facts of his heredity. These can best be discovered by the social worker who visits the home and perhaps the factory and homes of relatives, who becomes a friend of patient and family and listens to the telling of their troubles, often thereby discovering the source of the difficulty. As it is in this group that many of the “undesirable citizens” are found, it has been a field for study along biological as well as 2Dr. Charles E. Cottingham referred the case. Mental Disease and Defect 7 sociological lines. The inheritance of feeble-mindedness has been established as a scientific fact, but the amount of feeble-minded- ness which may be expected in the family where only one parent is defective, the relationship between epilepsy and feeble-minded- ness, alcoholism and epilepsy, and other similar questions are as yet unsettled. In this study there has been no attempt to settle any of these questions, but some facts have been gathered together, some defi- nite observations have been made which, it is hoped, may throw a little more light upon them and lead to continued social] think- ing about them. I. THE GENERAL PROBLEM THE mentally diseased or defective are those persons in society who, in their associations with their fellows and in the conduct of their everyday lives, are unable to meet the normal standards of reaction. The former are those whose brain tissues have followed the normal course of development but have been attacked by disease. In this group are included those who have a temporary disorder due to some exhaustive disease attacking other parts of the body as well as those suffering from true insan- ity. The latter are those whose brain-cells have never developed normally and there is no more hope of their becoming normal- minded persons, no matter what therapeutics or methods of edu- cation may be adopted, than for the dwarf to become a normal- sized man. The patients to be used for this study have been divided according to diagnosis into the following groups: (1) the feeble- minded; (2) the epileptic; (3) the insane; (a) true insanity; (b) the epileptic; (¢) miscellaneous mental and nervous dis- turbances. No hard and fast lines can be drawn between these groups as they often overlap. A feeble-minded individual may also be epileptic; an alcoholic may be feeble-minded; an epileptic may develop paresis, etc. Where there is more than one diagnosis, the individual has been classed according to his most outstanding characteristic from the social point of view. 1. The Feeble-minded. The feebleeminded person has a defective brain so that his mind can never develop beyond that of a child. There are three grades: the lowest, the idiot whose mental age never exceeds two years, no matter what his physical age may be, and who requires the care of an infant thru life; the imbecile, whe has a mental age of seven or eight years and is capable of attending to his own bodily needs and perhaps of learning some simple manual tasks; the moron, who attains a inental age of twelve years, and to the casual observer and often to the scientifically trained is not distinguishable from the nor- mal. fe igs incapable of abstract thought, lacks judgment, and has no Moral sense with which to meet emergencies, however, hence is easily misled and tempted to wrongdoing. In the group of defectives to be dealt with in Chapter II of this paper have (8) Mental Disease and Defect 9 been included a few cases of hydrocephalus and cretinism, because these individuals, while presenting a different pathological con- dition, involve the same social difficulties. | The social problems connected with the presence of the mental defective “in our midst” are generally known and discussed by the public today. Articles have appeared in late years in most of the leading magazines and newspapers on the subject and various methods of care advocated. Better care for the feeble-minded is a live issue—a burning, paramount issue, if we judge by importance rather than by the prospect of any early satisfactory outcome, in every American state and in every nation of both hemispheres. It is more important than illiteracy or Americanization. Since it has been demonstrated that feeble-mindedness is hereditary, that feeble-minded parents can have only feeble- minded children, people have begun to realize the necessity for prevention of procreation among them. They have come to believe in ‘a conscious improvement of the human race by the application of the laws of heredity to the human being’’.? Sterili- zation and segregation are the methods most generally indorsed, segregation perhaps meeting with more general favor. In 1916, thirty-four states maintained public institutions for the care of the feeble-minded, the oldest being that of Massachusetts, estab- lished and opened in 1848, and eight states had passed steriliza- tion laws, Indiana being first in 1908. As a social menace, mental defect has come to be recognized by relief agencies as one of the underlying causes of poverty. The practical definition of a feeble-minded person is one who, though capable of providing a living with his hands, is unable, by reason of mental defect, to make his living in competition with his more intelligent fellows. When we realize that the feeble-minded citizen is by definition a pauper, and when we further consider that the condition breeds as true as the spots on a dog, we can vaguely picture to ourselves the tremendous social saving in preventing their propagation and the incalculable social waste attending our neglect to catch this social opportunity at its flood tide.* School authorities are studying retardation and seeing the effect of the presence of subnormal children with normal ones and the consequent lowering of standards. 1“Arousing Interest in the Feeble-minded’’, Survey, April 26, 1919, p. 158. 2 Professor Scott Nearing. 3 Robert W. Kelso, Secretary State Board of Charity of Massachusetts, “Feeble- mindedness as an Element in Poverty’, Boston Medical and Surgical Journal, Vol. CLXXVII, p. 487, October 4, 1917. 10 Indiana University Studies Without doubt 10 per cent of the school children need special instruc- tion, and probably 2 to 3 per cent are feeble-minded. In this study (of the children in the schools of one county in Indiana) 2.5 per cent were found to be three years or more retarded.* Morally, the mental defective is perhaps the greatest menace. The moral sense is said to exist in the higher brain centers and if these are lacking or defective, the person is irresponsible and is unmoral if not immoral. Moreover, statistics show that 80 per cent of the prostitutes are feeble-minded. Because of this fact, however, responsible persons of normal mentality are often excused of immorality on the ground that they must be defectives. The social worker who sees these defectives and knows the problems they present realizes very strongly the need for insti- tutional care. However, she also sees the beneficial results obtained by careful supervision of them in the community. While this is difficult and not altogether safe, the fact that there will be large numbers which will not be cared for institutionally for some time to come, no matter what legislation may be passed, justifies her efforts. 2. The Epileptic. The epileptic has a pathological condition whose cause is unknown. He is subject to seizures during which he loses consciousness and may fall wherever he is, often inflicting serious injury. There are certain mental manifestations which accompany these attacks which make the social aspects of the dis- ease very important. | There have been many theories as to the cause of epilepsy: alcoholism of parents at the time of the conception of the child; infectious disease of either or both parents, as tuberculosis or syphilis; injury during labor or delivery; infectious disease in infancy of patient, as spinal meningitis; head injury of patient. However, none of these has been authoritatively accepted as the general cause, tho each may be demonstrated in individual cases. As no successful medical social case work can be done without diagnosis and a knowledge of the cause of disease, the social worker is handicapped by the lack of medical knowledge on this subject. The presence of the epileptic in the household presents a serious problem. In the first place the economic situation is handicapped if the person is an adult, for he cannot be a success- ful wage-earner. He cannot be trusted to work with machinery “Second Report of the Committee on Mental Defectives in Indiana, March 6, 1919, Pp. 32. Mental Disease and Defect 11 in a factory or to drive an automobile, or any such employment where he would endanger the lives of others as well as his own. Almost no employer will hire him if he knows of his disease. What he can and should do is farm work, but this is not always possible due to other circumstances in the family. It is also unsafe to leave one of these individuals alone, espe- cially when the disease has reached a rather advanced stage, as he may sustain serious injury during a seizure, or may become violent and destroy property. It is unsafe to leave him with small children because of the ill temper, often accompanied by loss of memory, which usually precedes or follows a seizure and may lead to acts of violence. The epileptic does not make for happiness and cheer but is characterized by irritability. He is usually also given to lying, his imagination being so strong that he cannot distinguish between truth and falsehood. Another outstanding characteris- tic is his excessive appetite. He usually craves meat, which the doctor says he should not have. If he gormandizes, especially in the evening, he is more likely to have a seizure. As the disease progresses and the seizures become more frequent, mental deterio- ration becomes evident. Maniacal insanity may result at the time of seizures and the patient become so violent that he must be placed in a padded cell. Simple dementia may result so that he resembles a feeble-minded child. Because of the progression of this disease and its social aspects, its victims should be segregated in institutions or colo- nies. It has been found that farm life is most beneficial and the number of seizures can be greatly reduced by this life in the open and medication. In 1916, thirteen states were maintaining sepa- rate colonies for the care of epileptics. Many others have insti- tutions admitting both feeble-minded and epileptic persons. 3. The Insane. (a) True insanity. In Heredity in Relation to Hugenics Charles B. Davenport says :° The marvelous complex of neurones (nerve cells and fibres) susten- tative tissue, and blood-vessels that constitute the central nervous system, forms, perhaps, the most wonderful mechanism in nature. Little wonder that it should beccme easily deranged. Such variations in structure and such derangement though ordinarily hidden from view can be inferred from the behavior of the person. For the general principle holds that every psychosis (or peculiar mental manifestation) has its neurosis (or aberrant Chap: iii; p. 92: 12 Indiana University Studies nervous basis). Peculiar or abnormal behavior, then, is an index of peculiar or abnormal brain condition. True insanity always has a physical basis, that is, there is an actual breaking down of the nerve cells. Certain forms of insan- ity, as paresis, have been found to be due to some infectious disease which finally affects the nerve centers. In other forms the cause is not so clearly demonstrated, as dementia praecox. From the social point of view it is necessary to call the lay- man’s attention to the simple facts of mental disease. Employers, especially, should be able to recognize when an individual is mentally sick and needs a doctor’s care. It used to be the pre- vailing notion that all insane people were raving maniacs requir- ing the straight-jacket and the padded cell. However, some enlight- enment has come thru popular articles in periodicals in more recent years and thru the founding of the National and State Hygiene Societies whose meetings are open to the public and whose literature is widely distributed. It must be realized above all that mental sickness is just as real, but far worse than physical sickness. It should be dealt with in a common-sense way until professional services can be secured. It is remarkable how closely mental abnormality approximates the normal, especially the normal under stress. All acute mental disorders are better taken care of in a hospital for their especial care, and all incurables should have permanent institutional care. It is the social worker’s duty often to persuade families to file inquests on some of their members and send them to institu- tions. The plea of safety for the rest, especially the children, usually overcomes regard for the patient and unwillingness to have him leave the family circle. Early recognition of mental dis- order and immediate expert medical attention may mean the prevention of an incurable condition. In visiting the homes of patients the observing social worker will be able to recognize many deviations from normal mentality and may advise exami- nation. She will doubtless be impressed by the number of instances where different manifestations of mental disease occur in the same family. (b) Psychoses not true insanity. The psychoses which are not true insanity include such diseases as hysteria, neurosis, and neurasthenia. General interest has been awakened in this group thru its war manifestations. Those who were greatly impressed Mental Disease and Defect 13 by the stories of “shell shock” are somewhat surprised to know that it is only the neurosis of civil life placed in a new environ- ment. It is only “nervousness” and not a new insanity. Those persons are subject to it who have had a case of “nerves” under other great stress. Since this has been discovered, the method of treatment for patients has been entirely changed. Men who were formerly sent back to the hospitals from the trenches with slight shock are now encouraged by their regimental officers to “earry on”. They are not allowed to get the mental impression of Invalidism, but are given confident assurance of complete recovery. Many neurasthenics are taught to be so self-centered and obsessed by self-pity and introspection that they unconsciously lay themselves open to suspicion, by those who have no special medical knowledge, of being men- tally afflicted. Nevertheless, neurasthenia and insanity are two totally distinct diseases. The one does not merge into the other, and if a man’s case is diagnosed as neurasthenia and he subsequently becomes insane, an error in diagnosis has been made and the early symptoms of insanity have been mistaken for neurasthenia. I think it a matter of considerable importance in the interests of neurasthenics, especially of the severer types, and that this should be clearly recognized.° The medical profession as well as the layman has learned much from the war manifestations of disease which will aid in the treatment of patients in civil life. Colonel Collie says: “It is not cowardice, nor fraud, nor malingering, nor self-deception, but a real disease.” As many of the milder forms may be found in almost any group of people, a knowledge of the best methods of dealing with it would be most helpful to everyone. Most normal individuals have mocds, and these in exaggerated forms become psychoses. A healthy, normal environment is the first essential factor for cure. “Infinite patience, common sense at every turn, and real but thoroughly disguised sympathy are essential in those who undertake the care of such cases.’’7 (c) Miscellaneous mental or nervous disturbances. In the group designated as miscellaneous mental or nervous disorders are included the drug habitués, choreics, and thyroid cases. They are related to the insane, tho not necessarily actually belonging to them. They may present as great problems to the social worker and illustrate the need for restraint outside of institutions. Since the passing of the Harrison law and its recent more strict ®@Colone)] Sir John Collie, M.D., A.M.S., “The Management of War Neuroses and Allied Disorders in the Army”, Mental Hygiene, Vol. Il, 1918, p. 3. Thid,, p, 9. 14 Indiana Unversity Studies enforcement there are fewer drug addicts. There has been a forced cure in many places, by the gradual reduction method, drugs being obtained only thru dispensaries, hospitals, or certain physicians appointed by law. The after-care of these cases is very important if they are to return to normal, useful living. They have had an abnormal mental outlook, and must be furnished now with wholesome environment and such associations as will stimulate healthy thinking and living. Suitable and pleasant occupations will go far in accomplishing this. Cases of Sydenham’s chorea (a disease of the cerebral hemi- spheres) occur usually in children and are caused by infection frequently traced to the tonsils. Its symptoms are the lack of muscular control giving rise to involuntary, irregular, and unpur- poseful movements of the arms and hands, the legs, and often the face. There is usually sleeplessness also and excessive irritability. Children in such a condition must be excluded from school, per- haps required to take rest in bed and given a simple but nourish- ing diet. If the disease is properly treated in its early stages and the source of infection removed whenever possible, gradual recovery is begun at once. However, too often, parents do not recognize the disease at its onset or do not attach sufficient importance to it to seek medical advice. It continues and grows worse; the infection reaches the heart and does serious and last- ing damage or affects the joints and causes rheumatism. The social worker can help here first by calling parents’ attention to the disease and persuading them to secure medical care for their children. She can then insist upon the carrying out of the doctor’s orders. This 1s not an easy thing to do, as the parents, tho well-meaning, often allow sentiment to overcome common sense and do not foree the child to submit to the prescribed treatment. It is true that the child is often difficult to control. He is petulant, cross, given to fits of temper and to crying spells. However, overcome the disease and the child will regain his good. disposition. Huntington’s chorea is perhaps more closely related to the insanities. It is hereditary thru the female line, is incurable, and leads to mental deterioration. It typically appears first in middle life. All of it which exists in the United States today is believed to have been transmitted from one family which settled in the New Haven colony. Institutional care should be provided for all cases of this disease and prevention of marriage of indi- viduals afflicted with it, that it may be stamped out. Mental Disease and Defect 15 Thyroid cases fall into this group of the mental and nervous disorders. Among them are found the cretins who lack sufficient thyroid substance which in some way is connected with the devel- opment of the brain. Children who are dull mentally and found to be cretins improve greatly under feeding of thyroid extracts. There are also the cases of hyperthyroidism, and of several differ- ent kinds of goitre. These cases often have a mental reaction which very nearly resembles insanity. Their extreme nervous- ness, irritability, and markedly self-centered attitude makes them unwelcome companions and a disturbing element in the home life. In the beginning it is often difficult for the family or even the patient to realize that he, or usually she, is actually sick. Here again, prompt expert medical attention is necessary to a rapid recovery. Under medical or surgical care complete recovery usually ensues. These patients, like the choreic children, are not normally-minded during their illness, and are most difficult to handle. This is especially true of the adults, who often cannot be persuaded nor coerced into following the measures prescribed for their cure. It will be noted that the social aspects in each form of mental disease or defect are most significant. The following cbapters will attempt to point out by examples some social problems pre- sented by each group. Il. THE FEEBLE-MINDED CERTAIN great degenerate families in America have been made the subject of study and their histories recorded. Notably among these are the Jukes, whose history was first written by Robert L. Dugdale more than forty years ago, and the Kallikaks, more recently studied by Henry Herbert Goddard. It is interesting to read and compare these two volumes, as the older one was con- cerned with the influence of environment rather than heredity, while the latter one presents a study in heredity. The problems connected with the presence of the feeble-minded in society have of recent years become familiar to all who read the magazines and newspapers. The general public has in a measure come to understand the necessity of institutional care and the preventing of procreation among defectives. We know now that we have to deal with a growing group in our com- munity who demand permanent care and control as well for their own sakes as for the welfare of the community. All are now agreed on the general principle of segregation, but it is true that something more than this should be forthcoming. The difficulties of theory are clearing up as our wider view obtains a firmer grasp of our material, but the difficulties of practice are still before us.* It was formerly believed that feeble-mindedness was mainly due to depravity, drink, general disease, or malnutrition of the parents, and to environmental conditions, but these factors, tho recognized as serious and frequent, are no longer believed to be fundamental. | Feeble-mindedness is essentially a variation, belonging to the same large class as all other biological variations, occurring, for the most part, in the first place spontaneously, but strongly tending to be inherited. It thus resembles congenital cataract, deaf-mutism, the susceptibility to tuberculous infection, etc.” The problem of care of the low grade feeble-minded is com- paratively easily solved, because he is so obviously a helpless and irresponsible member of society and can best be cared for in an institution. The higher type, the moron, is less obviously men- tally defective, can often be an earning power in the family and thus an asset. This may be a more potent factor as an argument for keeping him within the family circle than family ties and 1Dr. R. J. Ryle at Conference on Feeble-mindedness (British Medical Journal), October 3, 1911. 4 Havelock Ellis, Introduction to The Task of Social Hygiene, p. 33. (16) “Mental Disease and Defect 17 affectionate regard. Because this moron may be able to pass for normal to the casual observer, he is all the more dangerous as a member of society. He is defective and hence lacks judgment, moral stamina, and decision. He is a prey to the unprincipled exploiter who misuses him. He may become a criminal and be punished as such, only to become a “repeater” when released to life in society once more. The study of the relation of mental defectiveness to juvenile and adult delinquency has been carefully studied only in the last few years, and various statistics have been published showing that a considerable number of the delinquents now in institutions are mentally defective. There is such a variation in these statistics, however, that no conservative figure ean be guoted at the present time. Individual cases here and there, how- ever, Show that there is a close correlation between mental defectiveness and delinquency.’ When a child's defect is hereditary from one or both parents, this defect is usually increased and exaggerated by his lack of early training and the unwholesome environmental conditions which are apt to exist in the home. Such parents are unqualified to rear their offspring by reason of their own mental subnormality.* The defective should be committed thru court to institutional eare for life. He can then be cared for and, whenever possible, trained in such a way as to make him a useful member of the community of which he is a part. He will not be able to pass his defect down to succeeding generations, nor will he be as likely to commit crime or indulge in vice. Some one lately and aptly has said that the mental defectives include the 2 per cent of the general population lowest in the scale of intelligence. This is near the truth, and being so, the burden of their care should not stagger the 98 per cent, or normal population, nor would it, if systematically or thoroughly done.° However, if institutional care is prescribed, adequate institu- tions for the purpose must be provided and all defectives removed from other state and county institutions. The accompanying table (I) of mental defectives in institutions in Indiana on Sep- tember 30, 1916, shows the deplorable situation regarding the feeble-minded. 2 Report of Committee on Mental Defectives in Indiana, November 10, 1916, “Mental Defectives in Indiana’, p. 24. 4Dr. Charles F. Neu, Indianapolis. ® Report of Committee on Mental Defectives in Indiana, November 10, 1916, “Mental Defectiyes in Indiana’’, p. 3. 18 Indiana University Studies TABLE I. FEEBLE-MINDED IN COUNTY AND STATE INSTITUTIONS MALE FEMALE State, Prison: <0. cde oo ieee ee eee 42 Woman’s Prison— Correctional Department ............... Ree il! Penal: Department: 55... 36th eee ay Tf Indiana “Reformatory. 3.2.2 eee 106 Indiana Boys School... 2.2. -.-. eee 323 sie Indiana, Girls? Schoola...o.-cee. ee oe - 80 Indiana State’ Warm:2). 2.06. esis Cane eee of aes School for Feeble-minded Youth............. 506 619 Marion County Asylum for Insane........... 8 2 County. poor sasylums. .2.. 2%)... 0 oe eee 436 345 County: jails occ. o etos Se vos Se eee ae 4 Orphans’ NomeS® |... os. os vce eee 67 47 Totals -for- each: Se. 6.00. ae eee 1,495 1,105 Grand total 03.0 6.2 soca eee eee 2,600 Of the 100 defectives used for this study only 22 are or have been in the School for Feeble-minded Youth, altho in almost every case, excepting the males over sixteen who are not eligible, all effort has been made to secure application. Two of the reasons for failure are: first, the unwillingness of the parents to send their children to the institution; and, second, the amount of time and work necessary for a social worker to put upon such a case to complete the details. When there is an insufficiency of workers, such tasks are apt to be neglected. If less than 25 per cent of these cases diagnosed in the State Hospital and City Dispensary reach the proper institution, is it not indicative of an error in the system? It is hoped that the law passed by the 1919 legislature making admission by court commitment instead of application by parent or guardian as formerly, together with the provision for a new and larger insti- tution, will aid Indiana to care for more than 7.1 per cent of her mental defectives. Table II shows that of the 100 individuals in this group there are 57 males and 48 females. The table shows ages also. Mental Disease and Defect 19 TABLE II. CLASSIFICATION BY AGE AND SEX OVER UNDER AGE SIXTEEN SIXTEEN UNKNOWN TOTAL EN ESEe te See cee cieeee eee bs 19* 31 7 57 RE TINAIES ae oo sis oo 5 orsislece ee ee 237 20 ar 43 PRO GAN Sila cteserces cienacereevonerecebe 42 51 of 100 *This includes 4 married who have 5 children. 7This includes 11 married who have 12 children. Seven illegitimate children are also recorded. What is the social significance of these data? First, it is rather a surprise, perhaps, to find a predominance of males in the first 100 feeble-minded patients referred to the Social Service Department. When it is further discovered that the large nuin- ber of females and more than one-half of the males are over six- teen years of age, the situation becomes more complicated. As the School for Feeble-minded Youth—the only institution in Indiana for the care of the feeble-minded—does not admit males over sixteen, and its department for adult females is very limited in capacity, it becomes evident that a large number of these must remain in the community. Clarence B. is a moron, age twenty-six, the son of a drunkard and a hard-working, commonplace but virtuous mother. He boasts of having married seven women. He was in Juvenile Court on a charge of incorrigibility when sixteen years old and care in the School for Feeble-minded Youth was then advised. He was instead sent to the Boys’ School at Plainfield, and released on parole after two years. He roamed about and became known to the police in several cities, told many stories of his parentage and his experiences which were later found to be untrue. He told of his marriage in Kentucky, describing his wife’s appear- ance, her work in the cotton mills, etc., and later told of pro- ceedings for a divorce because of her infidelity. It was after- wards learned that the patient had never been to Kentucky, was not married, and that these tales were but products of his imagination. ‘The 11 married women are reported to have 12 children, while the 4 married men have 5 children. Adding to this 7 known illegitimates, there is a total of 24 children. According to the laws of heredity of feeble-mindedness, all evidence would indicate that a large number of these are defectives. It might be added that there were perhaps other children unrecorded and also that, 20 Indiana University Studies as most of these parents are yet young, there is ample opportunity for additional offspring. It is said that the average number of children of feeble-minded parents is 7 as compared with 3 of normal-minded parentage. Retta J. is of the Mongolian type, admitted to the School for Feeble-minded Youth at the age of twenty-three. Her father was a wanderer, syphilitic and alcoholic; of her mother little is known except that she died in childbirth. Retta was one of 18 children, 4 of whom are living. She had spasms as a baby, was cross-eyed and never able to talk plainly or intelligibly, and is color-blind. Her first illegitimate child, a boy, was born in 1912, and her second, a girl, was born in 1916 in the Robert W. Long Hospital. Thru the assistance of the Juvenile Court, the children were placed in orphans’ homes and the mother sent to the Custodial Department of the School for Feeble-minded Youth in the early part of 1917. Newton T., formerly an inmate of Julietta Hospital for Incur- able Insane, married Maggie C., a feeble-minded woman. They had 10 children, of whom 8 died in infancy, 3 are now in the School for Feeble-minded Youth, 1 is reported married to a men- tal defective, 1 has an illegitimate child, and of the other 2 nothing is known. | aie Charles S8., age twelve, is a defective physically and mentally. He did not walk until five years old, has a speech defect, and is anemic. He was unable to go beyond the first grade of school. His father died of tuberculosis and his mother was “too defective to give accurate history”. It will be noticed in Table III that, while the majority in this group are white Americans, there are 9 colored, 1 foreign-born, and 5 of foreign-born parentage. It is interesting to note that of the 9 colored, 5 are in the institution, while application papers have been filed for the sixth. Of the other 3, 1 is in a special school in the city, 1 is married after having given birth to an illegitimate child, and 1 has shown such marked musical ability (altho unable to go beyond the fourth grade in school) that funds have been raised by interested individuals to secure additional musical education for her. The one foreign-born is a Russian Jewish boy graded as a moron, whose application to the School for Feeble-minded Youth was rejected on the ground that it did not show sufficient evi- dence of mental defect. Mental Discase and Defect 21 Abe G. was brought to the United States at the age of four years by his parents. His mother tells the following story to account for his mental defect: As the steamship was entering New York harbor little Abe fell over- board. After several hours he was rescued and revived. The doctor and hurses worked with him a long time to get the water off his brain. He was sick for a week and then apparently recovered. However, there must still be some of that water on his brain or he would be more like the other children. Abe does not do well with abstract work in school and has failed to make his grades. What concerns his parents more, he shows no desire to work and earn money. The other children in the family have clothed themselves by their earnings at his age and he cannot even keep a paper route. Of foreign-born parentage there are 2 Germans, 1 Russian Jew, 1 Austrian, and 1 Mexican. Of these, 3 are being cared for in the institution. One is Retta J., mentioned before as the mother of 2 illegitimate children, 1 is a cretin, 1 a low grade moron with chorea and a history of alcoholism of his parents. Of the 2 who are at home, 1 is a case of congenital syphilis and the other of spastic paraplegia. TABLE III. CLASSIFICATION BY RACE AND NATIONALITY MALE FEMALE TOTAL WMG DO ATHOTICAN. . 06s ee. beeclee lees 49 36 85 BOlORCEAMEEICAN: | 2 50.5 36 So ee ee ew 4 D 9 PREP IDOI vars c2c.a 0 ok a a wt eee ee 1 0 1 Of foreion-born parents. .....c:......- 3 2 D LT TG! oe RG gs oe ge 57 43 100 In the classification of defect as given in Table IV there is found to be the largest number of imbeciles and morons. As the unclassified would probably all fall into one or the other of these grades, perhaps the majority being morons, there is a pre- dominance of the group which is the greatest social menace. The idiot is easily diagnosed, but the higher grades require skilful testing for correct classification. Of the idiots, 1 only, an epileptic, is in an institution. One other is a female with epilepsy whose parents desire institutional care but cannot secure it until the completion of the buildings for women at the Indiana Village for Epileptics. Of the imbeciles, 10 are in the School for Feeble-minded Youth, 1 was discharged from there, and application is filed for another. There are 3 who have a complication of epilepsy and of these 1 is in the Village 22 Indiana University Studies for Epileptics; 1 female was so violent that she was placed in Julietta Hospital pending the completion of the buildings for women at the Village; 1 is cared for at home. Of the morons, only 1 male and 1 female are in the School for Feeble-minded Youth, and 1 male is in the Epileptic Village. There are 6 males and 2 females who have formerly been in institutions. Of the unclassified, 4 males and 3 females are in the School for Feeble- minded Youth, 1 male is serving a sentence in Jeffersonville, while 2 males and 2 females were formerly in institutions; of the 6 cretins, 2 are in the School for Feeble-Minded Youth. TABLE IV. CLASSIFICATION BY DIAGNOSIS SHOWING THOSE IN THE SCHOOL FOR FEEBLE-MINDED YOUTH NUMBER IN INSTITUTION WUnelassified -5cok con ete stots eee eee 48 8 MOONS ieee b esos cohers te horse se Sees a eee 19 2 TIM DE CHES cess lere 5 oie os aoe Sos ee OI 20 10 TAL Otero xe eccane nie ors eee eae Tous et ae 6 0 CretinsS ices ve sisiscrind oie ae te nO ee 6 2 Hydrocephalies 225i. ceo ee tek ee eee 1 0 Total cose wateronrnwe sore ee ee 100 22 Olive D. was brought to the hospital when four years old for diagnosis ; her mother was epileptic and her father’s brother was described by the family as “not just right”. Instruments were used at the patient’s birth. Later she was found to be an idiot, but thyroid extract was recommended as an experiment and she was discharged to her home. Louise T., an imbecile of nine years, died at the School for Feeble-minded Youth in 1917. Her father and mother were first cousins. Her father is dull mentally; her mother died of measles and tuberculosis. Her mother’s mother’s father was insane and an inmate of Central Hospital. His son’s daughter is now in the School for Feeble-minded Youth. Louise’s mother’s brother, who is also her father’s mother’s brother, is an inmate of the Central Hospital for Insane. Her father’s mother died of paralysis, her mind being affected for three years previous to her death. Her mother’s sister is of doubtful mentality. Alice R. is a colored woman now twenty-eight years old ho has been for three years in the Custodial Department of the School for Feeble-minded Youth. She is an imbecile, syphilitic, and partially paralyzed. Her father died of pneumonia; he used alcohol to excess. Her mother is feeble-minded and is now mak- Mental Disease and Defect 23 ing every effort to withdraw Alice from the institution. While she has a real affection for her daughter, she says, “If Alice ean do laundry work up there, she can do it here and help me keep house too.” (She has a fairly large boarding-house.) No amount of persuasion will induce her to believe that Alice is better off where she is and that she would prove more of an economic bur- den than an aid. Pansy C. is a moron, now eighteen years of age, described as “having the ways of a child”. She was reared in an orphans’ home and at sixteen allowed to work out as a domestic. Her employer says she was very erratic and subject to moods, often morbid and given to crying spells. She was returned to the Home, from which she later ran away, in company with another girl, and was traced to a town not far distant where she was working in a factory. She was again returned to the Home, but later sent to her mother, who will now assume all responsibility, in a large city. What the results of this arrangement will be can only be imagined. The relatively small number out of this group in the School for Feeble-minded Youth has been mentioned elsewhere. It will be noted in Table V that here again the majority are males. Those in other institutions at present include the feeble-minded epi- leptics who have been sent to the Village for Epileptics and the female epileptics who are temporarily housed in hospitals for the insane. Of those who were formerly in other institutions, some came from orphans’ homes, several had been sentenced to the Girls’ School at Clermont or the Boys’ School at Plainfield, 1 came from the Woman’s Prison, and 1 from the Detention Home. The number convicted of crime is rather small and the crimes in most instances were petty. Of the boys 3 were convicted for stealing; the offenses of the other 2 are unknown. One girl was said to have slain her illegitimate baby; the other was a Woman’s Prison ward, but her offense is unrecorded. TABLE V. 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YM Mang vate mem aS a j , SHARAN ageen sper ramnac fms ate g0f esa Ome TTR PETE. AAA AAS of aan : oa a r re A : oo ) iene eT Petry Tue ao ss ar) 2a 7, ER < b. . lel s AS Hey Nats SMITHSONIAN INSTITUTION LIBRARIES 3 9088 00876 4227