In 1901, due to considerable effort by the citizens of Taylor County, the 26th and 27th Legislature, which met respectively in 1899 and 1901, established a colony for the "care, treatment, and support of the epileptic insane" of Texas on a 640-acre tract donated by the city of Abilene. The first one hundred patients arrived in 1904, transferred from the asylums in Austin, San Antonio, and Terrell. With no reliable treatment for epilepsy available, the best options were believed to be a proper diet and hygiene, regular habits, and exercise. The 1913 annual report mentions "the only thing new in the treatment of epilepsy is the crotalin, or rattlesnake venom. We are giving it a thorough test but as yet are not prepared to say what the ultimate result will be.'' A year later, hopes had waned: only a limited number were taking the crotalin and "the benefit they receive is psychological, mostly at least."
However, the early promise of care continued, and "a spirit of kindness seems to pervade the entire institution, inspiring the employees (sic) and patients to render one another help and assistance in the alleviation of the common affliction." Epidemics of flu and measles took their toll, along with several cases of pneumonia, epileptic convulsions, and exhaustion which led to the death of sixty-six people in a single year. Pneumonia was regularly the leading cause of death, tuberculosis was prevalent, and by 1918 the annual report said "we have nothing new to offer in the way of treatment of epilepsy." The Colony became the Abilene State Hospital in 1925. During the 1920s, the Colony became the test site for a new drug, Dilantin.
In 1917, the State Colony for the Feeble Minded, later named the Austin State School, opened with an enrollment of 65 female students. Until this time, many people with retardation were housed in the Asylum. With no thought of enlisting volunteers, employees were responsible not only for caring and supervising during work hours, but also for organizing recreational pursuits and church attendance. Later, in 1934, men from the Austin State School were removed to the Austin State School Farm Colony, in part because there was a prevailing belief that retardation was linked with criminal disposition and promiscuity. Here they farmed to supply food to area psychiatric institutions. Several of the residents working on the farm were, in fact, not retarded but delinquent, as the courts favored the school over remand homes for young offenders.
A statewide survey of state hospitals was carried out in 1916. The survey recommended that eleemosynary (charitable) institutions throughout Texas be placed under a central Board of Control. The Board was created by the 36th Legislature in 1919, and formally organized in 1920. Made up of three members appointed by the Governor, the Board took charge of overseeing purchasing for state departments, institutions, and agencies. It controlled and supervised the State's eleemosynary institutions including the state schools, hospitals, and sanitariums. One important purpose was to ensure that overcrowding was reduced, and that people who were mentally ill or had retardation were not languishing in jails or almshouses. The Board also contracted for all construction, repairs, and improvements made to the institutions. Thirty years later, in 1949, the Legislature transferred control of the eleemosynary institutions to the Board for State Hospitals and Special Schools and the Youth Development Council.
In 1919, the Rusk Penitentiary in East Texas became a hospital for the "Negro insane." African-Americans were transferred here from other asylums, jails, and places of restraint. At first, it was a general hospital for the acutely sick, aged, and frail accommodating both Anglo and African-American tubercular patients.
The Northwest Texas Insane Asylum, which later became the Wichita Falls State Hospital, received the first mental patients from the 62 surrounding counties in 1922. Built on a cottage plan, with the chapel as center of both religious and recreational activities, the function and building complex of the School expanded over the years to include a branch at the Vernon State Home, and added programs for the geriatric and persons with retardation.
The School for the Deaf published a brief handbook of information in 1935. In it, the authors noted that despite its official name, and despite no offense being intended, to refer to the children as "Dummies" was thoughtless. The school catered to the deaf and hard of hearing between 7 and 21 years of age, and the students were "capable of receiving a common school education and knowledge of a useful trade." In a turnaround from the first years when only manual instruction was given, a notice now announced, "sign not taught." The school expanded extracurricular activities which allowed the children a chance to integrate with other young people. The campus athletic association offered several team sports. Students could also join the Scouts and the Christian Endeavor Society. To help boys in both discipline and exercise, uniforms were provided and military instruction given. The School for the Blind, also now encouraged to broaden student horizons, took advantage of the services which had first been provided by the Texas State Library as early as 1918 when the Legislature appropriated $1,000 to purchase raised-letter books. The new state librarian and former archivist, Elizabeth Howard West, saw to it that despite no provision being made by the law, a good selection of juvenile books was made available.
By 1931, the Library of Congress selected Texas to participate in a regional system established to provide service nationwide to adults who were blind. The service introduced juvenile books in 1952.
A spurt in the opening of new institutions matched the increase in population and the trend toward urbanization. In 1910, Texas had a population of 3,897,000. Of this figure, 938,000 people lived in cities in towns. A decade later the total population had reached 4,663,000. More than a million and a half people now had urban homes, while the rural increase was barely 200,000. This trend continued, and the 1930 U.S. Census showed that for the first time Texas was more urban than rural, with the population divided into a 60% to 40% ratio. The urbanization of Texas between the two world wars allowed for a vastly improved infrastructure, and an increased job pool able to supply enough staff and peripheral labor for the hospitals and schools designed for people with disabilities.