Chapters in the History of the Insane in the British Isles Part 22

OUR IDIOTS AND IMBECILES.

Attention has of late been freshly drawn to this unfortunate cla.s.s. We propose in this chapter to give some particulars respecting their past history, their numbers, their location, and the claims, not yet sufficiently recognized, which they have upon the public and the State, with a few suggestions in regard to the legislation required to meet these claims.

The terms "idiots" and "imbeciles" are popularly employed with great vagueness, and the latter by even medical men in more senses than one.

Among the Greeks an idiot was a private, as opposed to a public or a professional person. He was unskilled, unlearned; and early English writers use it in this sense. Thus Wiclif translates 1 Cor. xiv. 16, "For if thou blessist in speyrit; who filleth the place of an _idiot_, hou schal he sae amen on thi blessyng." Chaucer similarly employs the word. It is easy to understand its gradual transition to the exclusive sense in which it has for long been employed.

It is not necessary to distinguish between idiocy and imbecility (Lat., weakness, feebleness) further than this, that an idiot is at the very bottom of the scale of beings born with defective mental powers, while he who labours under imbecility or feeble mindedness is understood to be one much less completely deprived of power. Strictly speaking, these terms ought to be rigidly restricted to states of mind at birth, but this has been found to be practically inconvenient, if not impossible, because changes occurring in the brain in very early life impair the functions of that organ so completely as to induce the same helpless condition which is found in congenital cases. We dismiss now one distinction which has been drawn between idiocy and imbecility--that the former is, and that the latter is not, necessarily congenital; one arising from the supposition that infantile mental deficiency is less likely to be so grave an affection than that which has been present from the moment of existence. Besides, the term is constantly being applied in common parlance to those who, originally of sound mind, have in adult life lost their faculties.

It is most important that a clear distinction should be preserved between these adult cases and those which date from birth or childhood.

The former are labouring under _dementia_, not _amentia_. They are demented persons, or, as they are called in our asylums, dements. They are not always, but they are for the most part, harmless lunatics. It is confusing to call them imbeciles, now that this term has become restricted by medical writers to those who are, or once were, feeble-minded children. There are, of course, all degrees of mental defect possible at birth or in childhood, between that of the most degraded idiot and of a child who is said to be not very bright. With a large majority, however, something can be done to improve the mental condition, whereas with demented persons there is no ground for expecting improvement. The past history of the condition and treatment of idiots differs in some respects widely from that of the insane.

Happily in many countries, especially in the East, they have been regarded as objects of special affection and care--as sacred beings possessing a certain weird, if not divine, element in their nature.

Though helpless and involving much trouble, they do not exasperate or terrify their relations in the same way as the furious maniac. As a rule, they do not suggest the same exercise of force and use of fetters as the ordinary lunatic. Still, in many instances, no doubt, weak-minded and wayward children have been harshly treated and beaten.

But whether regarded as specially favoured by Heaven, or treated as stupid children, they were never subjected to any special training for education until recent times.

St. Vincent de Paul is regarded as the first who made any effort to train idiots. This was in the Priory of St. Lazarus. He failed, however, as was to be expected, to make much progress in the work. Itard followed, also a Frenchman. He strove to educate the celebrated idiot called the Savage of the Aveyron, and by doing so hoped to solve the problem of determining what might be the amount of intelligence and the nature of the ideas in a boy who from birth had lived entirely separate from human beings. Although he regarded his effort as a failure, he no doubt exerted considerable influence in inducing others to make the same attempt with a more practical aim, and with a better understanding of the material upon which it was proposed to work. M. Belhomme published a work in 1824 on the subject of educating idiots. Four years later some were taught at the Bicetre, and the school there became famous. Falret, in 1831, adopted the same course at the Salpetriere, but we believe the school was not sustained for a long period. Another physician of Paris, Voisin, taking up the subject as an enthusiastic phrenologist, also worked hard at idiot-teaching. None, however, devoted themselves so fully, and for so long to this work as the late Dr. Seguin, who so long ago as 1839 published, with Esquirol, a pamphlet on idiocy, and has only recently pa.s.sed away. For some years he taught idiots in Paris, and in 1846 published a work ent.i.tled "Traitement moral, Hygiene, et Education des Idiots." He resided for many years in New York, and made, while in America, valuable contributions to the literature of idiocy.

America has certainly not been behindhand in her efforts to raise the condition of idiots. In 1818 an attempt was made to instruct them at the Asylum for the Deaf and Dumb at Hartford. It is said they were taught to communicate by the sign language.

To George Sumner the credit is due of having called attention powerfully to the subject in 1845. He had recently visited Paris, and gave a description of the idiot schools there. Dr. Woodward and Dr. Backus shortly after took up the question; the latter became in that year a senator of New York, and in 1846 introduced a Bill providing an idiot asylum or school. It was five years, however, before one was opened.

This was at Albany, as an experiment; but it was eventually established at Syracuse, as the New York Asylum for Idiots. In 1855 a new building was erected in New York, the number provided for being 150. The first to superintend the inst.i.tution was Dr. Hervey B. Wilbur. Accommodation was subsequently made for 225. In 1875 the average attendance at this school was 210; of these 180 were supported by the State, the remainder paying altogether or in part. The expenditure was 45,407 dollars; the cost per head for board and instruction being 200 dollars.

At the same period that New York took the initiative (1846), a commission was appointed by the Ma.s.sachusetts Legislature to inquire into the condition of the idiot population of this state, and to report as to what was necessary to be done. The report being favourable to action, a wing in the Blind Inst.i.tution at South Boston was appropriated to an idiot training school. This was in October, 1848. In 1850 this school underwent a transformation, being incorporated as the "Ma.s.sachusetts School for Idiotic and Feeble-minded Youth," and placed under the charge of the well-known Dr. S. G. Howe, the instructor of Laura Bridgman. "We are happy to say," he observes in a report of this school, "that in its experience there have been hardly any so low as to be beyond the reach of some elevating influence, none, or next to none, so fixed in their degradation as to be unrecoverable."

Dr. H. B. Wilbur states that no provision is made for a large proportion of idiots in America; the present training inst.i.tutions being quite inadequate to the applications made. The consequence is that many are placed in jails or almshouses. Recommendations have been made that these custodian cases should have either special asylums provided for them, or separate departments connected with lunatic asylums or training idiot inst.i.tutions. It is calculated that there must be fully 38,000 idiots in the United States.

It would be wrong to pa.s.s over Germany without stating that much persevering and successful work has been accomplished by Herr Sagert and others. We were more struck with the results he obtained, when we visited his school in Berlin in 1853, than with anything we witnessed elsewhere on the Continent.

In Switzerland there are training schools at Basle, Berne, Zurich, Lausanne (two), and Etoy. They provide for about eighty cases.[224]

In our own country[225] we believe we must signalize Bath as the first town in which a school, or rather a home, for idiots was opened.

Established on a very small scale (only four cases in the first instance) by the Misses White in 1846, it has flourished to the present day. Two years later, an idiot asylum was established at Park House, Highgate, whose founders, however, did not know of the home at Bath. It had its branch at Colchester, and eventually developed into the great inst.i.tution at Earlswood, near Redhill, opened in 1855. The Earlswood report for the past year states that there are altogether 561 inmates, of whom 400 are supported gratuitously, and of the remainder upwards of 70 pay less than the actual cost of their maintenance. One of the inmates discharged in May had since held the situation of nurse in a family; another was becoming an expert shoemaker; and a former female inmate was employed as a teacher in an elementary school. Earlswood is under the efficient charge of Dr. Grabham. In connection with Earlswood, we ought to recognize the considerable influence which a continental inst.i.tution exerted in helping to excite that interest in the education of idiots which, among other influences, induced the Rev. Andrew Reed, D.D., to urge the erection of a large building for the training of idiots. We refer to Dr. Guggenbuhl's inst.i.tution for cretins, on the Abendberg, near Interlachen, which undoubtedly did more good in this indirect way than by curing the cretins placed there. At any rate, there was a certain mystery connected with the work done at this school, which left an unsatisfactory impression on ourselves when we visited it in 1862, and which struck many others in the same way. At his death, in 1863, the inst.i.tution was closed. Ess.e.x Hall, Colchester, in the first instance a branch of the Highgate Asylum, ultimately (1859) became the inst.i.tution for the eastern counties. Mr. Millard, who has devoted himself to the arduous work of training idiots for many years, is the superintendent, and had the original charge (with a matron) of the idiots when first placed at Park House, Highgate. The inmates number ninety-seven. In 1864 an inst.i.tution was opened at Starcross, near Exeter, through the efforts of the Earl of Devon, for the idiotic cla.s.s in the western counties. There are now eighty pupils there.

In the course of the same year the Northern Counties Asylum for Idiots and Imbeciles was established at Lancaster. Its origin is thus given by Dr. de Vitre, the chairman of the committee: "A member of the Society of Friends, with moderate pecuniary means, but possessing a large amount of Christian benevolence, offered to give the sum of 2000 for the purpose of erecting an asylum for idiots in Lancas.h.i.+re. The gift was a n.o.ble one and handsomely offered, but useless standing alone." Donations were consequently solicited, and they were obtained, the result being the establishment of the above inst.i.tution, which now has 445 inmates, and is under the care of Dr. Shuttleworth.

Dorridge Grove Asylum, at Knowle, was opened in 1866, and, although on an exceedingly small scale, may be regarded as the inst.i.tution for the central or midland counties. Its establishment in the first instance was due to Dr. Bell Fletcher and Mr. Kimbell.

We have now enumerated the inst.i.tutions for idiots and imbeciles which are supported in part or altogether by charity. They were, no doubt, mainly intended, not for the highest, nor yet for the very lowest cla.s.s of society, but rather for the upper lower cla.s.s and the lower middle cla.s.s. This idea has, however, by no means been carried out in practice, for, in consequence of the State having failed to make provision for the education and training of idiots and imbeciles, charitable inst.i.tutions have become disproportionately filled with persons of a different cla.s.s from that for which they are properly designed, and the difficulty attending admission has acted as a barrier to the latter availing themselves of the provision intended for them.

There are six of these charitable or voluntary inst.i.tutions in England and Wales, the number cared for being as follows:--

Under 20 Over 20 years of years of age. age.

Earlswood 295 266 Lancaster 370 75 Ess.e.x Hall 57 40 Star Cross 72 8 Bath 30 -- Knowle 45 -- ---- ---- 869 389

the total being 1258.

For the higher cla.s.s, an admirable private inst.i.tution has for some years been in operation at Normansfield, near Hampton Wick, under the care of Dr. and Mrs. Down, who were formerly at Earlswood. There are about one hundred inmates.

Lastly, for the pauper cla.s.s in the metropolis a school for imbeciles has for some time been carried on, first at Clapton, and now at Darenth (Kent), under the superintendence of Dr. Beach. The house will accommodate five hundred. It should be stated that this inst.i.tution, as well as those at Caterham and Leavesden for incurable lunatics, originated in the Act 30 Vict. c. 6, and that these establishments are under the Metropolitan Asylums Board, subject to the Local Government Board. There are sixty members, of whom fifteen are nominated by the last-mentioned Board, the remainder being elected by the metropolitan unions.

Taking the numbers under training in these three divisions, the charitable or voluntary inst.i.tutions, the private inst.i.tution, and that for paupers, we find the total to be somewhat about eighteen hundred.

Scotland and Ireland have various inst.i.tutions for idiots and imbeciles, which may be briefly enumerated. In the former an idiot school was established at Baldovan, near Dundee, in 1853. It was on the estate of Sir John Ogilvie. There are forty-seven inmates. In 1862 an inst.i.tution was opened at Larbert, Stirlings.h.i.+re, by a society formed for that object, called the "Scottish National Inst.i.tution for the Education of Imbecile Children." Dr. Brodie, who now, we believe, has a private inst.i.tution at Liberton, near Edinburgh, for ten pupils, was the first superintendent. It was superintended by Dr. Ireland from 1870 to 1881.

In January, 1881, there were one hundred and twenty-four inmates.[226]

Thus only about a hundred and eighty idiots and imbeciles are in training inst.i.tutions in Scotland.

In Ireland the only inst.i.tution for training idiots was founded in 1868, in consequence of Dr. Henry Stewart handing over his asylum at Lucan, together with a donation (payable under certain conditions) of 5000, to certain trustees. It is called the "Stewart Inst.i.tution for the Training, Education, and Maintenance of Idiotic and Imbecile Children."

A large mansion at Palmerston, in the neighbourhood of Dublin, was in 1875, when we visited it, being adapted to the requirements of an asylum, and to it the idiots have been removed from Lucan. It was recently stated that in Ireland seventy per cent. of the idiots and imbeciles are at large, twenty-one per cent. in workhouses, and only seven per cent. in asylums.

We are now in a position to estimate the opportunities afforded in England for the systematic training of a cla.s.s of unhappy beings, unable to help themselves and calling loudly for help from both men of science, philanthropists, and legislators. Let us see how far these opportunities meet the want, and what becomes of those idiots and imbeciles for whom no distinct provision is made. Unfortunately, the statistics of idiocy are very imperfect, partly owing to the reluctance of their relatives to acknowledge such a defect in the family, and partly from there being no distinction made in the annual Report of the Lunacy Commissioners between idiots and lunatics.

Taking, however, the census of 1871, in which a return of idiots was made, as the basis, we find the number in England and Wales to be at that time 29,452. Inquiry of the parents of known idiots has so often resulted in the discovery that they had not been returned, that it has been considered fair to add one-fourth to the above figures, thus bringing them up to 36,815, of whom 14,162 would be under twenty years of age, and therefore suitable objects for training, and 22,653 twenty years old and upwards. To these should be added five per cent. for increase of population since 1871, making the numbers, respectively, 14,869 and 23,786, or a total of 38,655, or 1 to 616 of the population.

Of these, then, 1147, or about three per cent., are in training schools provided by charity. The remainder are either at home, in lunatic asylums, workhouses, or boarded out. We have found it impossible to arrive at any satisfactory result in attempting to apportion them to these various allotments. We know, however, that the census of 1871 gives 3456 as the number in asylums, and 7976 as the number in workhouses, including in the term the metropolitan district asylums.

This would leave, out of the number of idiots reported by the census, about 18,000 with their friends or boarded out, or 18,900 at the present time, in consequence of the increase of population. We have, however, but scant faith in the correctness of these relative amounts. All we really know is the number receiving definite teaching or training, and an approximation--nothing more--to the gross number of idiots and imbeciles in the land. The next point is to determine the number who belong to the cla.s.s, already indicated, which we have to legislate and provide for--the poor and the cla.s.s immediately above them. The wealthy can send their children to private inst.i.tutions; those who belong to an intermediate cla.s.s to voluntary establishments, which would, in the event of the proposed legislation being carried into effect, be sufficient. It appears that about two-thirds of the idiots and imbeciles were chargeable to the poor rates, according to the census. Two-thirds of 38,655 yield 25,776. It is estimated that one-fifth of the remainder, that is to say 2176, may be added to comprise the cla.s.s just above paupers and needing public help in the way proposed. Adding these figures together, we get in round numbers 28,000, for whom it is desirable for the State more or less to provide, in the way of training schools and custodial establishments. Those who are now in workhouses and in lunatic asylums would be removed from them, and so far would relieve the latter from their present crowded condition. This object would be still further gained if harmless lunatics, as proposed by the Charity Organization Committee, should be legislated for in the same way as idiots and imbeciles, and removed from asylums to separate inst.i.tutions, as has been done at Caterham and Leavesden. The number of this cla.s.s needing public administration is calculated at 7615.

Confining still our attention to England and Wales, where, as we have seen, voluntary effort has only succeeded in providing training schools for about three per cent. of the idiot and imbecile cla.s.s, we desire to draw attention to the action taken by the Charity Organization Society of London, arising out of a consciousness of the inadequacy of this provision. In the summer of 1877 a sub-committee of this Society entered very fully into the consideration of this subject in all its bearings, and continued week by week, for some months, to discuss the various questions which presented themselves. Sir Charles Trevelyan, who originated the inquiry, observed that "he had rarely, if ever, known a subject so completely threshed out."

The most important conclusions arrived at were--that a small proportion of idiots and imbeciles can be so far improved as to support themselves, that a larger proportion may be trained to do some useful work, and that the remainder can be rendered happier and not so burdensome to others.

On inquiry, it was found that about two per cent. of the cases admitted at Earlswood were cured so as to be able to support themselves. At one period in the history of this inst.i.tution, when certain very unfavourable cla.s.ses were rejected, as many as ten per cent. were so trained and improved. That this should be the maximum proportion will surprise those who have been misled by the _ad captandum_ statements sometimes put forward to the public, no doubt with laudable and benevolent motives. This amount of success, disheartening as it seems at first, is not to be despised; but the strength of an appeal, whether to the charitable public or to the State, to provide for the training of idiots, lies in elevating them to the highest level of which their organization admits, curing them of offensive habits, affording them some positive happiness, and s.h.i.+elding them from unkind and irritating treatment.

It is the judgment of the above-mentioned Committee that idiots ought to be treated distinctively from other cla.s.ses, whether the blind, or lunatics in asylums and workhouses, or children in schools, and that they should not be boarded out.

For those idiots and imbeciles who have been trained up to a certain point, beyond which it is impossible to advance them, suitable inst.i.tutions or departments of inst.i.tutions--adult custodial asylums--are suggested. Those idiots who are young, and can be taught, should be kept, as a general rule, distinct from adult idiots, in training schools. These two cla.s.ses of inst.i.tutions should be united, if possible, under the same superintendence.

The action to which we have already referred as having been taken by the Metropolitan Asylum Board, arising out of the Act of 1870, forms a useful experiment for the consideration and possible guidance of those engaged in endeavouring to provide for the training and custody of idiots and imbeciles, not in the metropolis alone, but the country.

After full discussion, the Charity Organization Committee resolved "that the arrangement which has been made for idiots, imbeciles, and harmless lunatics in the Metropolitan Asylum District is applicable in its main principles to the rest of England, viz. that they should be removed from workhouses and county lunatic asylums, and that young persons of those cla.s.ses should be suitably educated and trained." Seeing that experience clearly proves that the voluntary principle is a failure, or at least wholly inadequate, for it only touches the fringe of the difficulty, it becomes absolutely necessary that the State should step in and supplement charitable effort. The Acts at present in force are possibly sufficiently elastic to provide for the want, if there was a determination on the part of the authorities in the various counties to avail themselves of them; but it is quite certain that no steps will be taken to do so, unless a new Act makes a distinct and special provision for the education and training of the idiot cla.s.ses.

It appeared just to the Committee that not only should the local rates provide, as they do at the present time, for the charge of this cla.s.s, but that a.s.sistance should be granted out of the public revenue; the best mode for such a.s.sistance being in the form of advances for the buildings required on easy terms, liberal capitation grants for young people under training, and grants of less amount for adults.

It is obvious that an idiot, while under the process of education, is at least as much ent.i.tled to the capitation grant allowed by the Education Department as the school children of the non-idiotic cla.s.s.

A certain sum would also be received from the families of some of the inmates of the training schools and custodial inst.i.tutions. It is proposed that those families which, although able to pay their way under ordinary circ.u.mstances, could not possibly defray the entire cost, should pay according to their means. As in the case of the blind and the deaf and dumb, it is considered that the relief given to children should not be counted as parochial relief to their parents.

The question arose in the Committee whether those who are able to pay for the whole of their maintenance should be admitted, but no definite opinion was arrived at; there being much to be said on both sides of the question. No doubt such a course might interfere with private inst.i.tutions, and might in some instances lead to filling up the room of an asylum which ought to be occupied by the needier cla.s.ses--a complaint frequently made (whether justly or unjustly) against the lunatic hospitals of America. At the same time, the principle of making the payments of the higher supplement those of the lower cla.s.ses is a sound one, and has been found to answer in such inst.i.tutions as the York Retreat. But those who have had most experience of the friends of idiots know that they are much less willing to pay handsomely for their training or care than they would be for an insane member of the family.

The occurrence of insanity in a family, especially if manifesting itself in the form of outrageous violence or of suicide, alarms the relatives, and forces them to place the patient in an asylum at almost any cost. In the case of idiotic or imbecile children, they are easily secluded, or placed with some one willing to take charge of them, without necessitating the restraint of an asylum.

Idiot establishments, supported by the weekly payments of the rich, are not therefore proposed; and although there may be cases in which the cost of training and maintenance may be properly paid, this course would not be allowed to wealthy persons, who are really able to pay higher terms in a private asylum.

With regard to a very important aspect of the subject--the governing bodies of these asylums for idiots--it is not proposed that they should be the same as in the case of county asylums, but that they should consist of representatives of the local magistrates, representatives of the local guardians, and, thirdly, of persons appointed by the Crown.

Following the example of the Metropolitan Asylums Board, it is proposed to erect large inst.i.tutions capable of accommodating not more than two thousand adults, and schools containing not more than five hundred children, that is to say, idiots and imbeciles up to twenty years of age.

In this large number of adults, however, is included the proposed provision for harmless lunatics, for whom it is desired to legislate at the same time. With these we are not concerned in the present chapter.

It may be remembered, however, that by adopting the "block" system of construction of asylums, harmless lunatics can be placed with facility in one department, and adult idiots in another.