"The road to hell is paved with good intentions."
– Samuel Johnson
The Rise of the Institutions 1800 - 1950
Understanding and Progress
Living Conditions
Living conditions for persons with disabilities in the early 19th century were harsh, especially in industrial areas. Wealthier parents tended to keep their children with disabilities at home. Individuals who lived in poverty, whether it was due to being widowed, orphaned, alcoholic, or because of physical or mental disabilities, often were placed in poorhouses , or almshouses. These residential institutions were tax-supported and began as a less expensive alternative to what would later be referred to as "welfare."
Warning Out
A widespread practice in mid-17th century colonial times, "warning out" was used to pressure outsiders to settle elsewhere. The practice was based on the theory that a town had a common law duty to provide and care for those individuals who could not support themselves. A town, however, that didn't want the responsibility, could exclude them by serving a notice to move on. While forced removal was not carried out, "passing on" achieved the same result; individuals were loaded onto a cart and dropped off in the next town.
Extreme Wealth and Extreme Poverty
Around the 1820s, amid a climate of enormous wealth in the growing industrial cities, the result of rapid mechanical progresss and medical achievements, a large number of rural and urban people were enduring extreme povert. Seeing these extremes and determined to work for change, people began to speak out on the conditions of persons with disabilities and others who were oppressed or neglected.

In those days, we didn't clearly conceptualize mental retardation, or mental deficiency, or feeble mindedness. We dealt with inadequate people, who we put into poorhouses. Now poorhouses were not just for people who were poverty stricken, but rather people who were inadequate. And were outcasts. And inconvenient. And uncomfortable.
People would land up in those institutions because they were sick, you see. You have to remember this; we still have in our day people who've been in institutions – for retardation – who never were retarded, but were in the way of somebody. So we need to understand that, last century there was no clear concept of a retarded personality.
New Categories of Intellectual Deficiency
In the 19th century, Jean Etienne-Dominique Esquiol (1782-1840), a student of the French physician and psychiatrist, Philippe Pinel, proposed the first major change regarding the concept of what was termed "intellectual deficiency." Esquirol divided intellectual deficiency into two levels: idiocy and imbecility.
Esquirol defined "idiots" as persons with little or no intellectual functioning: "Incapable of attention, idiots cannot control their senses. They hear, but do not understand; they see, but do not regard. Having no ideas, and thinking not, they have nothing to desire; therefore have no need of signs, nor of speech." Esquirol's concept, though limiting, provided some consistency to the terminology used to describe persons with disabilities.
He defined "imbeciles" as "generally well formed, and their organization is nearly normal. They enjoy the use of the intellectual and affective faculties, but in less degree than the perfect man, and they can be developed only to a certain extent."
In the 18th century, Jean Jaques Rousseau's philosophical works were widely read but not widely accepted. The central claim of his works, that all human beings are good by nature and the worth of the individual should be celebrated, caused great controversy in France and were banned by Paris authorities. Regardless, many 19th century "Romantic poets, including Wordsworth, Byron, Shelly, and Coleridge, were influenced strongly by Rousseau's call to return to nature and celebrate the worth of the individual. The poets praised the restorative potential (clean air, fresh water, open spaces) of living a simple rural life. This rationale may have later justified locating institutions in the countryside.
By the middle of the 19th century, society was much more aware of persons with disabilities. In an era of scientific and economic progress, social reformers alerted society to the often horrible living conditions of its many outcasts.

Dominique Esquirol
"The founding of the institutions was accompanied by a pride, hope, and euphoria we can scarcely comprehend."
– Wolf Wolfensberger
Make the Deviant Undeviant
The early 19th century was marked by "an increased interest in individuals with disabilities" as well as a period of significant social, political, and economic change in the United States. Dorothea Dix (1802-1887), educator and social reformer, strongly criticized the cruel and neglectful practices, and living conditions of individuals with disabilities, primarily those with mental illness. She was instrumental in founding or expanding more than 30 hospitals that provided better services and treatment of individuals with mental illness.
Dix spent her early years teaching children. Later in life, while teaching Sunday school at a Massachusetts house of corrections, she was horrified by the living conditions of the women inmates and became determined to make improvements. She devoted the "next two years of her life visiting jails. visiting jails, almshouses, poorhouses, and asylums across the United States, drawing attention to the dreadful treatment of the individuals living there; and "shaming political leaders" to act on her behalf. She observed:
"More than nine-thousand idiots, epileptics, and insane in these United States, destitute of appropriate care and protection. Bound with galling chains, bowed beneath fetters and heavy iron balls, attached to drag-chains, lacerated with ropes, scourged with rods, and terrified beneath storms of profane execrations and cruel blows; now subject to jibes, and scorn, and torturing tricks, now abandoned to the most loathsome necessities or subject to the vilest and most outrageous violations."

Dorothea Dix
Since it was unthinkable in 1848 for a woman to address Congress, Dix had Samuel Gridley Howe, a well-known social reformer, present her speech. Her specific appeal – that the United States set aside 5 million acres of land throughout the nation to accommodate persons with disabilities – was passed by both houses of Congress but vetoed by President Pierce. Through her passionate appeals, and with only the best intentions for persons with disabilities, Dix helped to prepare the way for public institutions.
Early Training Schools and the Abendberg School
In 1842, a training school for children with disabilities was established in Berlin, and another in Leipzig in 1846. England followed, setting up schools for children with physical disabilities, and for children who were deaf or blind. In 1842, Johann Jakob Guggenbuhl (1816-1863), as a young doctor at the age of 20, was stirred "by the sight of a dwarfed, crippled cretin of stupid appearance mumbling the Lord's prayer at a wayside cross."
That prompted his desire to "devote his life to the cure of cretinism and he went on to found a training school in Switzerland, the Abendberg. The school was built 4,000 feet above sea level on a mountain summit, because Guggenbühl believed that the lower altitudes somehow contributed to cretinism. He also believed that his students could be cured through proper health programming and training.

Children Exercising
Guggenbühl was praised for his efforts. He traveled widely throughout Europe and spoke of the accomplishments at the Abendberg. Eventually, however, visitors to the Abendberg discovered neglect and abuse, due in part to Guggenbühl's frequent and prolonged absences from his pupils. Unfortunately, contemporaries viewed the failure of the Abendberg as the personal failing of Guggenbühl.
The most important lesson of the failure of Abendberg was that overcrowded, understaffed, segregated facilities inevitably tend toward abuse and neglect. Although the Abendberg was closed, and Guggenbühl was disgraced, his initial efforts influenced others to open training schools for children with disabilities.

Guggenbühl at Abendberg
Edouard Seguin
Another influential young doctor was Edouard Seguin (1812-1880), who studied medicine and surgery under Itard (author of "Victor, the Wild Boy of Aveyron"), and psychiatry under Esquirol. Sequin improved upon Itard's method of sensory training and is considered the first great teacher in the field of disabilities. He improved upon Itard's method of sensory training.
While he worked as a director at the school for "idiots" in the Salpetriere asylum, Seguin saw the potential benefits of a physiological method in treating "mental retardation. He believed that "mental deficiency" was caused by and could be cured through a process of motor and and sensory training. By developing their muscles and senses, Sequin believed that his pupils, regardless of their intellectual abilities, would obtain more control over their central nervous systems and in turn gain control over their wills.
In 1844, the Paris Academy of Science praised Seguin's methods, stating that he had solved the problem of "idiot education." His methods and positive results served as a foundation for similar efforts throughout Europe and America.
Among those later influenced by his teaching methods was Maria Montessori (1870-1952), a pioneer in teaching children with and without disabilities. In 1850, Seguin left France for the United States, and worked with Dr. Samuel Gridley Howe, Dr. Hervey Wilbur, and others in developing training schools.

Edouard Seguin