Idiots, Imbeciles, and Harmless Lunatics

263 Art. V.? :Author: Robert Boyd, M.D. EDIN., F.R.C.P. LONB. President Medico-Psychological Association, 1870 ; late Physican and Superintendent County Somerset Lunatic Asylum ; formerly resident Physician St. Marylebone Infirmary, and Lecturer on Medicine.

In the previous number of the Journal (page 96) it is stated that ten years ago it was suggested that the five south- western counties of England should unite and form a separate establishment for the care, training, and education of the im- beciles and younger idiots, such as that at Earlswood, in Surrey. The practical reasons adduced for the division and separation is that the association with epileptics and others in asylums, especially of young idiots, who are imitative and capable of instruction chiefly by that faculty, must be injurious.

There appears now to be a prospect of something being done to remedy’this evil by legislation, through the energy and influence of Sir Chas. Trevelyan, Bart., who is desirous that the proceedings of, I may call it, his Committee should be cir- culated. The subject is one of great importance and interest to all, but more especially to those connected with the manage- ment of public asylums, as it holds out a prospect of their being relieved of the care of harmless lunatics, and so far enabled to make room for acute and curable cases, thereby returning, as it were, to the original intention of asylums, built as hospitals for the treatment of insanity, not as they have become in many in- stances, workhouse infirmaries for the aged and infirm. To amend this, fresh legislation is required, for the Lunacy Acts, it is admitted, promote the manufacture of pauper lunatics. ” The Council of the Charity Organisation Society, re- cognising the expediency of placing institutions for idiots and imbeciles on the most comprehensive and satisfactory footing, resolved that a Committee should be formed to consider and report upon the whole subject.”

A most important addition to the scope of the Committee was made at the suggestion of Mr. Dickinson, Chairman of the Visitors of the Somerset County Asylum, who proposed that its enquiry should extend to persons demented after the age of infancy, under the name of ” harmless lunatics.”

This suggestion having been accepted, the enquiries of the Committee extend to idiots, imbeciles, and harmless lunatics. In addition to Sir Charles Trevelyan, Bart., the members of the Committee were?Earls of Devon and Lichfield, Lord Wrot- tesley, Hon. C. H. Strutt; Sir Alexander Acland Hood, Sir John Ogilvy, Barts.; Sir Rutherford Acland, K.C.B., Lieut.-Gren. Cavenagh; Eevs. Canon Hopkins, R. J. Simpson, and H. I. Cummins ; Messrs. Dickinson, Pole Carew, Mocatta, Wilkinson, D. P. Fry, Cropper, Purdy, Buxton, Sperling, Courtenay Boyle ; the secretary, Mr. Loch, and assistant-secretary, Howgrave Graham. In addition to these, the Committee is assisted by the medical experience of a number of professional members; amongst these are Dr Langdon Down, who, formerly at Earlswood and latterly at Normansfield, has had vast experience amongst idiots and imbeciles of the middle and upper classes. The experience of his successor at Earlswood, Dr Grrabham, is also vast; Drs. Bell Fletcher, F. Beach, Ireland, and Mr. Millard have also had special experience in the training and education of these classes.

In addition to these, the Committee has the assistance of Dr Brewer, whose great administrative capacity and experience cannot fail to be of the greatest service; and lastly, Drs. Hack Tuke, and Wise (who has had long experience in India), Cortis, and Boyd, are members well known for their practical experience and writings on the subject.

The attention of the Committee having in the first instance been directed solely to the legislation in England bearing on the provision for idiots and imbeciles, that bearing on lunatics not in asylums and chronic lunatics have not been noticed. By sec. 66 of the Act of 1853, copies of the quarterly lists of pauper lunatics not in asylums are sent to the clerks of the visitors, and by sec. 69 justices can order any such cases in the asylum. Sec. 8 of the Act of 1862, 25 and 26 Vic. c. Ill, provides for the care of chronic lunatics in workhouses ; the clause is permissive, but if made compulsory, under the regulations of the Commissioners in Lunacy, as specified in the Lunacy Acts, by D. P. Fry, pp. 535-6, 1864, the difficulty might be met by utilising the existing accommodation in work- houses as provided under these Acts.

The following extract will show that the public begin to dread the expense of further additions to lunatic asylums:?

PAUPER LUNATICS.

In a petition to Parliament the guardians of the Guildford Union draw attention to the desirability of an enquiry into the state of the law affecting the admission of patients into asylums, and to the cause tend- ing to create an increase of the number of the insane paupers, and thereby to impose heavier burdens upon ratepayers. ” That pauper lunacy advances at a rate more rapid than the population,” remark the petitioners, ” appears from the fact that in 18G1 the pauper lunatics were 1 in 583 to the population, and in 1861, 1 in 451. In Surrey the ratio is still more striking, being in 1862, 1 in 500; in 1871, 1 in 427 ; and in 1875, 1 in 369 of the population, notwithstanding the fact that the population during the last decennial period has increased more in Surrey than in any English county, save Durham. In the opinion of the petitioners, a portion of the increase is rather apparent than real, as many who formerly would have been left at large or classed as persons of weak intellect are now sent to swell the numbers in asylums. There can be little doubt that recent legislation has greatly induced persons to throw upon the rates the charge of maintaining their insane rela- tives. Among other statutes which had this tendency are the Union Chargeability Amendment Act (28 and 29 Vic. c. 79), and the Act of 1867, establishing the Metropolitan Common Poor Fund. Moreover, persons who are well able to maintain their insane relatives should pay a higher amount for such patients in county asylums than that required from paupers?a sum which covers only their weekly expenditure, ex- clusive of either rent or interest on capital. The petitioners call atten- tion to the Government capitation grant of 4s. per week per head to the pauper insane in asylums, as tending greatly to send thither persons wno might well be cared for elsewhere. The form of admission to asylums by a certificate, signed by any medical practitioner, however unskilled, and countersigned by a magistrate or clergyman, and cause of disease certified by the relieving officer, who knows still less of the matter, is also a circumstance requiring legal amendment.” ” The amount of madness caused by intemperance,” the petitioners consider, ” merits searching enquiry. The experience of asylum authorities, the confes- sion of patients and the statement of friends, show that a very large and increasing proportion of patients are the victims of intemperance ; eight out of ten of the males discharged as cured being often patients whose admission is due to excessive drinking.”

SUMMARY OF THE EXISTING PROVISIONS FOR THE CARE AND EDUCATION OF IMBECILES AND IDIOTS, WITH SUGGESTED FURTHER ARRANGEMENTS. (For the use of the Committee to be appointed in accordance with the Resolution of the Council of the Charity Organisation Society of the 21 st June, 1875.)

According to the Census returns of 1871 there were about 30,000 imbeciles and idiots in England and Wales, or one in every 771 of the population.* Although the most afflicted and helpless of the human * The following extract from the ” General Report upon the Census of 1871 ” (Vol. iv. p. 63) is deserving of attention in reference to this and other points:? ” According to the return, the total number of persons described as idiots or imbeciles, in England and Wales, is 29,452, the equality of the sexes beiDg remarkable?namely, 14,728 males, and 14,724 females. Compared with the entire population, the ratio is 1 idiot or imbecile in 771 persons, or 13 per 10,000 persons living. Whether the returns are defective, owing to the natural sensitive- ness of persons who could desire to conceal the fact of idiocy in their families, wa have no means of knowing; but such a feeling is no doubt likely to exist among race, they are nearly all capable of being in some degree improved, so as to make their lives more tolerable to themselves and less burdensome to others, while a proportion of them may be made wholly or partially self-supporting. The young are especially susceptible of improvement, and the most favourable period is the earliest age at which the child can dispense with a mother’s care. On the other hand, confirmed fatuity is likely to be the result of neglect in childhood and youth. But the provision as yet made for this unhappy class of our population is totally inadequate. More than 10,000 are scattered in union houses, where they cannot receive the training and supervision they specially require, and often seriously interfere with the comfort of the other inmates, meeting in return with ridicule and unkindness. A large number are in lunatic asylums, where they are bewildered by the delusions of the insane, or alarmed at their ravings; and, owing to their imitative propensities, they are made worse than they were before. Others remain at their own homes, where they can only in rare instances obtain the education and treatment suited to their condition, while too often they are grossly neglected.

Private charity has proved unequal to the task. Only about 1,100 idiots are in training in asylums on the voluntary principle, and attempts which have recently been made in the central and western counties to found new institutions have not been attended with much success. Afflictions of this class can only be effectively dealt with as a common burden by public administrative arrangements. As they prevail in a certain fixed ratio to the whole population, the means of mitigation or remedy should be provided, not merely at favoured points like the metropolis and a few large towns, but generally through- out the country. They, also affect all classes of society in nearly an equal degree; so that, while the removal of an imbecile member of a struggling working-class family is a necessity, there is no family so wealthy to whom it is not an object to secure for such a member the best scientific treatment, with a public guarantee of proper supervision. The machinery required to provide for this class of cases in every part of England is also so expensive, and so dependent for its efficiency upon proper organisation and inspection, that, although much incidental aid may be obtained from private benevolence, the necessary buildings and establishments cannot be set up and maintained in working order by any power short of that of the entire community, every member of which has a personal interest in the absence of the painful and those who look upon mental infirmity as humiliating, rather than as one of the many physical evils which afflict humanity.

” Idiots and imbeciles seem to be the last class which has obtained the attention of philanthropists and men of science. Less has been done for them than the lunatics?partly because they are a less dangerous and troublesome class, but partly also from the doubt which existed as to the possibility of effecting a cure, or even any material alleviation of their condition. But attention has now been directed to them, and in consequence of the observation and experience of the last twerty- five years, it has been ascertained that in a large proportion of cases of congenital mental infirmity, a patient may, by care and training, bo made able to contribute, at least in part, to his own support. This and other important results have been accomplished by means of the special institutions established for these unfortunate persons.”

demoralising spectacle of the neglected idiot, and in the knowledge that he is properly cared for, and improved to the extent of his capacity.

Even now, in the contemplation of the law, every idiot and imbecile who cannot be provided for by his own family is entitled to a suitable provision at the public charge.

The State has acknowledged this obligation in reference to the large number of idiots who have been received into public establish- ments as paupers or lunatics, although no arrangement has been made for their separate treatment and instruction there.

By the Poor Law Act of 1844 (7 and 8 Yic. c. 101) the Local Government Board may combine any number of country unions and parishes into school districts for the management of any class or classes of infant poor not above sixteen years of age; and children may be sent from parishes not combined if within twenty miles. The largest powers are given to build schools, provide necessaries, and pay out of a common fund.

By the 19th clause of a Bill recently submitted to Parliament by the President of the Local Government Board, the provision in the 14th section of the Poor Law Amendment Act, 1819, which enables guardians to contract to receive in their workhouse certain paupers chargeable to some other union or parish, is proposed to be extended to the managers of a district or other asylum for the reception of paupers, and to every case in which the Local Government Board shall give their consent.

By the Acts 25 and 26 Vic. c. 43, and 31 and 32 Vic. c. 122, Poor Law guardians may, with the consent of the Local Government Board, send pauper idiots to any institution for the reception and relief of idiots maintained at the charge of the county rate or by private subscription, ?r to any other union house where special arrangements have been made for the same purpose, paying their full cost therein. By the Elementary Education Act of 1870 (33 and 34 Vic. c. 75) School Boards are bound to provide for the education of all children, not excluding idiots, with all necessary teachers and appliances; and children of the idiot and other afflicted classes have at least as strong a claim as other children to capitation grants out of the annual vote for education, according to suitable standards of proficiency to be fixed in each case.

• The necessity of a ” distinctive system ” of treatment for idiots has been re-

peatedly urged by the Lunacy Commissioners, as, for instance, in the following passage from their Report for 1865 :?

” It has long been our opinion, as the result of extended experience and observation, that the association of idiot children with lunatics is very objection- able and injurious to them, and upon our visits to county asylums we have frequently suggested arrangements for their separate treatment and instruction. It is always to us a painful thing to see idiot children, whose mental faculties and physical powers and habits are capable of much development and improvement, wandering, without object or special care, about the wards of a lunatic asylum. The benefits to be derived, even in idiot cases apparently hopeless, from a distinctive system, and from persevering endeavours to develope the dormant powers, physical and intellectual, are now so fully established, that any argument upon the subject would be superfluous.- The soundness and importance of such views are generally recognised and appreciated, and benevolent efforts are being made in several quarters to carry them into practical operation.”

But by far the most effective legislation which has taken place on this subject is the Act ‘60 Vie. c. 6, under which the managers of the Metropolitan Asylums District have the power, under the direction of the Local Government Board, to establish asylums for the sick, insane, and infirm at the cost of the Metropolitan Common Poor Fund. These powers have been acted upon, greatly to the public advantage, by the transfer of the imbeciles and idiots from the metropolitan workhouses and lunatics asylums to the Caterham, Leavesden, and Hampstead idiot asylums, and by arrangement subsequently made for separating the children, and educating them in a training-school at Clapton, pending the completion of a mere perfect building at Darenth, near Dartford, for 500 children, at an estimated cost of ?75,000. In short, this branch of social administration has been satisfactorily provided for, not only by law but also in fact, as regards the great metropolitan population; and the question for consideration appears to be whether this arrangement may not be extended to the rest of England, with such modifications as local circumstances may require, so that the idiots and imbeciies in each county or union of counties may be sepa- rately cared for in asylums or training-schools maintained out of the rates?a portion of the expense being recovered from the relatives when they are able to pay, and capitation grants being made from public iunds for every pauper idiot so maintained.

There is still another class of cases. Persons of the ” lower trades- man ” or ” upper artisan ” class, who are so unfortunate as to have an imbecile child, have real difficulty in obtaining proper care and training for him. They cannot appear as paupers before their Boards of Guardians to claim the benefit of the legal arrangements for destitute imbecile children, while the conditions of admission to the great insti- tution at Earlswood are a tedious and expensive canvass, or a minimum payment of fifty guineas a year, both of which are impossible to them. According to the rules of the Earlswood Asylum, ” paupers who are provided for by the law of the land ” are ineligible ; and the Founder explained that the object was to ” supply relief chiefly to the middle and poorer classes, and at the same time become a model and a motive for improvement in our pauper institutions.” But it appears from an analysis of the list of the candidates, that, having regard to the position in life and the occupations of the respective families, less than one-fourth answer to the description primarily intended to be relieved, while the remainder are simply pauper cases from all parts of the country, which ought to be fully paid for in charitable institutions by the Guardians, or to be supported by them in their own institutions. It appears, there- fore, as an indirect consequence of the undeveloped state of our pro- vincial Poor Law arrangements for imbeciles and idiots, that the provision made by voluntary charity for the relief of the lower-middle and artisan class has been diverted from its original object, and these classes have been left without assistance to bear the burden of providing for the care and education of an idiot child, or to break down under it. Everything, however, will fall into its place when the provincial ad- ministration shall be placed upon the same footing of efficiency as the metropolitan. Persons of the lower-middle class with small means, and the well-to-do of the artisan class earning good wages, would be glad to contribute according to their means towards the education of their idiot children. They cannot pay fifty guineas, but they might pay some thirty, some twenty, and some ten; and the charitable would gladly make good the deficiency.

Agenda of the Committee on Arrangements for the Education and Care of Idiots and Imbeciles. 1.?General Statistics. 1. Nature of infirmity: Congenital. Arising from subsequent ailments. 2. Number of idiots and imbeciles: Census return of 1871. Whether really more or less ? Proportion in different classes of society. 3. Where placed: Idiot asylums. Lunatic asylums. a. Special wards. b. Ordinary wards. Metropolitan District asylums. Workhouses. Boarded out, or at their own homes. 4. Idiocy and imbecility, how far preventable or capable of diminu- tion :

Marriage of blood relations, and of persons with a predisposi- tion to insanity. Moral and physical condition of the wealthier classes. Condition and habits of the poorer classes. Study in asylums of the causes of idiocy and imbecility. 5. How far capable of improvement: What proportion can be rendered self-supporting. How far the habits of the remainder can be improved so as to make their lives happier to themselves and less burden- some to others.

Are there any cases not capable of amelioration; and, if so, of what nature are they, and what can be done for them ? 2.?General Principles of Treatment. 1. Whether idiots and imbeciles should be treated distinctively from other classes. 2. Whether they ought to be placed in lunatic asylums. 3. Whether they ought to be mixed up with paupers in union houses:? Absence of all means of special education. Interference with the comfort of the other inmates. Liability to meet with ridicule and unkindness, and to acquiro bad habits. 4. Whether this distinctive treatment ought to be applied, especially in the earlier stages of education, individually or collectively. 270 IDIOTS, IMBECILES, AN I) HARMLESS LUNATICS. 5. Under what circumstances idiots and imbeciles may with advan- tage be placed in ordinary schools with other children. 6. Whether their improvement would be promoted by boarding them out in families according to the Belgian practice, and, if so, under what circumstances ? 7. Whether the education of idiots and imbeciles should be based on physical considerations. 8. Whether it should commence at the earliest age at which they can dispense with a mother’s care, and the subsequent stages should depend upon the capacity developed by them. 9. Whether idiots and imbeciles belonging to working-class families should have a thorough industrial training, so as: 1st. To enable them to support themselves, or, at least, to contribute towards their support; 2nd. To promote their self-respect, by making them feel that they are of some use in the world; and 3rd. To occupy them pleasantly. 10. Whether idiots and imbeciles belonging to the upper and middle classes should be encouraged to cultivate any literary, scientific, or mechanical tastes they may happen to possess; or, if incapable of this, they should at least be provided with the means of harmless amusement.

3.?Treatment of Adults. 1. Whether the treatment of adults must depend upon the degree in which the character and faculties have been developed by previous training. 2. In what cases, after having completed their educational course, they may be sent back to their own homes, or be boarded out, or be employed in industrial establishments; and under what safeguards ? 3. Whether adult asylums can with advantage be managed as industrial establishments for manufacturing or agricultural industry. 4. The best mode of treating those who are only susceptible of supervision, shelter, and kind care. 4.?Administrative Arrangements. 1. Private charity has awakened the national conscience to the claims of this neglected class, worked out the experimental process, and established a model for general adoption; 2. But has it proved equal to providing a remedial machinery coextensive with the evil ? 3. Of the 11,000 cases under twenty years of age for whom train- ing is needed, according to the Census of 1871, what proportion have been provided with suitable means of instruction by private charity ? 4. How far private charity has suitably provided for the 19,000 adult cases, according to the Census of 1871. 5. Can suitable provision be made for all the idiots and imbeciles in England and Wales, whether juvenile or adult, otherwise than through public administration, by the collective force of the entire community ? 6. Arrangements for this object in Scotland, Ireland, and the Colonies, and in the principal foreign States. IDIOTS, IMBECILES, AND HAKMLESS LUNATICS. 271 7. In England the legislation bearing on the provision for idiots and imbeciles may be briefly stated as follows: ?

Under the Lunatic Asylums Act (16 and 17 Vic. c. 97, sec. 2) the justices of every county, and (with certain exceptions) of every borough, are bound to provide an asylum ” for the pauper lunatics thereof; ” and by section 132 of the same Act, it is expressly enacted that the word ” lunatic ” shall mean and include ” every person of un- sound mind, and every person being an idiot.” In any case of default, the Home Secretary, on the report of the Commissioners in Lunacy, is empowered, by section 29, to require the justices ” to provide a fit and sufficient asylum for so many pauper lunatics as, upon the report of the Commissioners, he may think fit and direct.’’ These provisions refer to one asylum; but under section 30 the justices are empowered to provide additional asylums where necessary, and the Home Secretary, on the report of the Commissioners in Lunacy, is likewise empowered to require the justices to do so, in the event of default on their part. The Poor Law Amendment Act of 1834 (4 and 5 Wm, IV. c. 76, sec. 45) prohibits the detention in any workhouse of any dangerous lunatic, insane person, or idiot, for any longer period than fourteen days ; and the Lunacy Act of 1862 (25 and 26 Yic. c. Ill, sec. 20) pro- vides that no person shall be detained in any workhouse, being a lunatic or alleged lunatic (and the term ” lunatic ” here includes an ” idiot “), beyond the period of fourteen days, unless the medical officer of the workhouse shall certify that such person is a proper person to be kept in a workhouse, nor unless the accommodation in the workhouse is sufficient for his reception.

By the Poor Law Act of 1844 (7 and 8 Vic. c. 101), the Local Government Board may combine any number of country unions and parishes into school districts for the management of any class or classes of infant poor not above sixteen years of age; and children may be sent from parishes not combined, if within twenty miles. The largest powers are given to build schools, provide necessaries, and pay out of a common fund.

By the 1 9th clause of a Bill recently submitted to Parliament by the President of the Local Government Board, the provision in the 14th section of” The Poor LaAV Amendment Act, 1849,” which enables Guardians to contract to receive in their workhouse certain paupers chargeable to some other union or parish, is proposed to be extended to the managers of a district or other asylum for the reception of pau- pers, and to every case in which the Local Government Board shall give their consent.

By the Acts 25 and 26 Vic. c. 43 and 31 and 32 Vic. c 122, Poor Law Guardians may, with the consent of the Local Government Board, send pauper idiots to any institution for the reception and relief of idiots maintained at the charge of the county rate or by private sub- scription, or to any other union house where special arrangements have been made for the same purpose, paying their full cost therein. By the Elementary Education Act of 1870 (33 and 34 Vic.

c. 75) School Boards are bound to provide for the education of all children, not excluding idiots, with all necessary teachers and appli- ances ; and children of the idiot and other afflicted classes have at least as strong a claim as other children to capitation grants out of the annual vote for education, according to suitable standards of proficiency to be fixed in each case.

But by far the most effective legislation which has taken place on this subject is the Act 30 Vic. c. 6, under which the managers of the Metropolitan Asylums District have the power, under the direction of the Local Government Board, to establish asylums for the sick, insane, and infirm at the cost of the Metropolitan Common Poor Fund. 8. The practical action taken under the last-mentioned Act will be seen from the following extracts from the Eeport of the Chairman of the Metropolitan Asylums Board, dated on the 11th of February 1876:?

Summary of the Principal Events of the Four Years which preceded 1875.

In June 1872 the pressure on the Leavesden and Caterham Asylums became excessive, and forced on the managers the considera- tion of the best method of meeting the increased demand for accom- modation for imbeciles, the extent of which was approximately ascertained by returns obtained from workhouses and county asylums. Some relief was afforded by the appropriation of the Hampstead Hospital as a temporary asylum for imbeciles; but neither this nor the additions which were being made to the Leavesden and Caterham asylums proved adequate; and in October 1874 this question again presented itself to the managers. It then appeared that the Leavesden, Cater- ham, and Hampstead asylums were full ; that the parishes were urgently pressing for accommodation, which could not be supplied by the existing asylums, and that patients were therefore being sent, at great expense, to licensed houses and asylums in distant parts of the country. The managers were further informed that there was a con- siderable accumulation of lunatics who could not be received into the county asylums, as those were already full, and that there were in those asylums a number of metropolitan cases, which might be transferred to the care of the managers, if they had the adequate accommodation. With such facts before them, the managers decided to enlarge the Leavesden and Caterham asylums to the fullest extent which the ad- ministrative department in each would allow.

The experience gained in these large institutions had brought the managers in face of a special difficulty, viz. the presence of a large number of children of imbecile mind who were being brought up with the adult and aged imbeciles. To remedy this obvious defect of man- agement, measures were taken in each institution to separate the children, and to make special arrangements for their education and training. The success which attended this system stimulated the managers to further efforts, which led eventually to the removal of all the children, temporarily, to Hampstead.

Accordingly, the managers further resolved to purchase a site for erecting a school for these children sufficiently large to accommodate and train as many as might reasonably be expected to come under their charge.

This site was to be of sufficient extent to admit of the erection of a third asylum for adults if absolutely required. Pending the erection of the school, the asylum at Clapton was hired by the managers for a term of three years for the temporary reception of the children.

Report for 1875.

The subject of the provision of additional accommodation for imbecile patients has continued to engage the serious attention of the managers at the Board and in committees.

By the extensive additions in progress at the Leavesden and Caterham asylums, the accommodation of those establishments will be enlarged to about 2,000 beds each.

At the commencement of the year a site was purchased at Darenth, Kent, of 109 acres, a portion of which will be adapted to the erection of schools l’or the imbecile children, the remainder being of sufficient dimensions for the purposes of the third asylum for adults, should its erection be ultimately found necessary. Much careful consideration was given to the preparation of plans for the new school, and the managers ultimately selected those of Messrs. A. and C. Harston. The estimated cost of the erection and fitting up of the school, ex- clusive of gas works and farm buildings, is ?75,000.

The Clapton Asylum, which was taken by the managers for the reception of the imbecile children pending the erection of their new school, was ready for occupation in May last, when 271 children were at once transferred there from the Hampstead Asylum; and the number under treatment at Clapton at the end of the year was nearly 300. For a long time past the managers have been impressed with the desirability of treating the children apart from the adults, and attempting to educate them and develope, as far as possible, any latent capacities they might possess for mental and physical training. During the short time that this plan was tried at Hampstead Asylum it was attended by satisfactory results, which have been considerably increased since its continuation under more favourable circumstances at Clapton. It is hoped that this effort to improve the condition of the children will be attended with still greater success when they possess the advantages of the special school which is to be erected for them at Darenth, and that many of the children may, by perseverance in a proper course of training, be at least improved so far as to be able to return to their homes, whilst a percentage may even be taught some Useful trade, so as to lift them out of perpetual dependence. At the commencement of the year 1875 there were 4,183 imbecile patients under the care of the managers. During the year 870 fresh cases were admitted into the asylums from the several parishes and unions, making a total of 5,053 patients under treatment. There have been 540 deaths, and there were remaining at the end of the year 4,294 patients, viz. at Leavesden, 1,786; Caterham, 1837; Clapton, 300 ; and Hampstead, 371. For the first time there are now vacancies in these asylums, so that the accommodation provided appears, for the present, to have overtaken the demand.

Detailed returns of the admissions, discharges, and deaths at the several establishments are appended.

9. How far this branch of social legislation has been satisfactorily provided for, not only by law, but also in fact, as regards the great metropolitan population; and whether this arrangement may with advantage be extended to the rest of England, with such modifications as local circumstances may require.

10. Whether Asylum Boards for idiots and imbeciles should be established throughout England and Wales. 11. Whether such boards might also be charged with the education and care of other afflicted classes.

12. How such boards should be constituted.

13. Whether asylum districts should be formed according to popu- lation and local connection, and, if so, into how many districts England and Wales might with advantage be divided. 14. Whether Government inspectors should be specially employed under the Local Government Board for the supervision of all insti- tutions for the education and care of idiots and imbeciles, whether public or private.

5.? Ways and Means. 1. Whether the necessary buildings should be erected, and the in- mates should be primarily maintained, out of a common fund formed by contributions from the poor-rates of the district. 2. Whether any union houses which are no longer wanted, owing to the diminution of pauperism, and the consequent possibility of making the same house serve for more than one union, may be utilised as train- ing-schools and asylums for idiots, blind, and deaf and dumb. 3. Whether families which, although able to pay their way under ordinary circumstances, would be reduced to poverty if required to defray the entire cost, should be charged at lower rates for an idiot or imbecile member.

4. Whether a capitation-grant should be paid from the Parliamentary grant for every idiot and imbecile maintained out of the rates in a training-school or permanent asylum. 6.?Provision for Idiots and Imbeciles of the Lower-Middle and Upper- Working Classes.

Whether, when all pauper cases have been provided for by public administrative arrangement, the existing asylums supported by volun- tary contributions may be relied upon to provide for cases from the lower-middle and upper-working classes at rates payable by the re- spective families, supplemented, when necessary, by charitable sub- scriptions.

7.?New Legislation. Whether any, and, if any, what, new legislation is required. Idiots and Imbeciles, and Harmless Lunatics Needing public administration, being two-thirds of the total number, this proportion being chargeable to poor rates, and one-fifth of the remaining third being added. Harmless lunatics are calculated at one- fourth of the total number of lunatics included in the Census of April 3, 1871. Districts Population Idiots and Imbeciles under 20 years of age Adult Idiots and Imbcciles Harmless Lunatics Total of Adult Idiots and Harmless Lunatics London South-Eastern South Midland Eastern South-Western West Midland North Midland North-Western York . Northern Monmouthshire Wales Increase of popu- lation, 5 per cent. 3,254,260 2,167,726 1,442,654 1,218,728 1,880,777 2.720.669 1,406,935 3,389,044 2,395,569 1,414,234 1.421.670 942 1,866 924 863 1,192 1,786 856 1,737 1,171 553 722 806 1,973 1,138 893 1,385 2,100 1,080 1,993 1,267 708 1,040 665 1,028 1,332 425 685 873 302 780 518 326 319 1,471 3,001 2,470 1,318 2,070 2,973 1,382 2,773 1,785 1,034 1,359 22,712,266 1,135,613 12,612 630 14,383 719 7,253 362 21,636 1,081 23,847,879 13,242 15,102 7,615 22,717 Idiots and Imbeciles under 20 years of age Adult idiots and harm- less luna- tics … Total . 13,242 22,717 35,959*

• This total does not agre* with the total of 36,046 given upon the former

paper, because the exact number of harmless lunatics has now been calculated ; whereas in the former paper the number was merely estimated at “about 10,000.” One-fourth of the whole number of lunatics returned in the Census is 9,892. Two-thirds of this number, with one-fifth of the remaining third, make up 7,253, as above returned.

The above numbers include 25 per cent, for idiots and imbeciles not returned in the Census. Twenty per cent, of the whole number is apportioned to cases under 20 years of age, and the remaining five per cent, is apportioned to adult idiots and imbeciles. Probably 100 idiots and imbeciles belonging to London are at Earlewood, by which the proportion of cases is somewhat diminished for London and increased for Surrey.

List of Counties into which the districts are Divided in the Census. I.?London. 1. Middlesex (part of). 2. Surrey (part of). 3. Kent (part of). II.?South-Eastern. 2. Surrey (Extra Metropolitan). 3. Kent (Extra Metropolitan). 4. Sussex. 5. Hampshire. 6. Berkshire. III.?South Midland. 1. Middlesex (Extra Metropo- litan). 7. Hertfordshire. 8. Buckinghamshire. 9. Oxfordshire. 10. Northamptonshire. 11. Huntingdonshire. 12. Bedfordshire. 13. Cambridgeshire. IV.?Eastern. 14. Essex. 15. Suffolk. 16. Norfolk. Y.?SoUTH-W ESTERN. 17. “Wiltshire. 18. Dorsetshire. 19. Devonshire. 20. Cornwall. 21. Somersetshire. VI.?West Midland. 22. Gloucestershire. 23. Herefordshire. 24. Shropshire. 25. Staffordshire. 26. Worcestershire. 27. Warwickshire. VII.?North Midland. 28. Leicestershire. 29. Rutlandshire. 30. Lincolnshire. 31. Nottinghamshire: 32. Derbyshire. VIII.?North Western. 33. Cheshire. 34. Lancashire. IX.?York. 35. West Riding. 36. East Riding (with York). 37. North Riding. X.?Northern. 38. Durham. 39. Northumberland. 40. Cumberland. 41. Westmoreland. XL?Welsh. 42. Monmouthshire. 43. South Wales. 44. North Wales. IDIOTS, IMBECILES, AND HARMLESS LUNATICS. 277 Number of Idiots and Imbeciles. Census, April 3, 1871. Page 79, Vol. 3. Under 20 years of age . . 11,330 20 years of age and upwards . 18,122 29,452 25 per cent, added . 7,363 Under 20 years … 14,162 20 years old and upwards . 22,653 36,815 This is a proportion of about 16 in every 10,000 of the population, or 1 in every 621 persons. Of the 39,567 lunatics returned in the Census, pro- bably one-fourth were harmless lunatics, being about …….. 10,000 (About 3,000 were in union houses.) Total of idiots, imbeciles, and harmless lunatics …… 46,815

(The population of England and Wales has increased about 5 per cent, since April 1871, and if idiots and lunatics have similarly in- creased 2,347 must be added, making up a total of 49,162.) ” More than two-thirds’’’’ of idiots and lunatics were chargeable to the poor rates, according to the Census. If the total of 46,815 be taken, two-thirds will be 31,210. Of the remaining 15,605, probably 0ne~fijth will belong to the classes just above paupers, but needing to be benefited by public administration, viz. 3,121 cases, which, when added to 31,210, will make a total to be provided for of 34,331 cases. If 5 per cent, be added for increase of population, the number will reach 36,047.

About 14 adult asylums will be needed, holding 2,000 cases, providing for 28,000 16 training schools holding 500 cases ….. 8,000 Total . 36,000 278 IDIOTS, IMBECILES, AND HARMLESS LUNATICS. Condensed Statement of Numbers of Idiots and Imbeciles, calcu- lating 20 per Cent, for Cases under 20 Years of Age, and 5 per Cent, for Cases of 20 Years and upwards, not Returned in Census List. Needing Public Administration. Two-thirds of cases under 20 years chargeable to Poor Eates … …. 11,480 One-fifth of the remaining third …. 1,148 12,628 Proportionate increase of population . . C31 Total of idiots and imbeciles under 20 years of age ……. 13,259 Twenty years old and upwards, two-thirds chargeable to Poor Rates. …… 13,063 One-fifth of the remaining third …. 1,306 14,369 Proportionate increase of population . . 718 15,087 Total of idiots ….. 28,346 Harmless Lunatics. Two-thirds of 10,000 harmless lunatics chargeable to Poor Rates. …… 6,667 One-fifth of the remaining third …. 667 7,334 Proportionate increase of population. . 366 7,700 Total 36,046 26 training schools needed of 500 cases … 13,000 11 adult asylums of 2,000 cases …. 22,000 Providing for 35,000 Letter on the Arrangements for the Care and Education of Idiots and Imbeciles in North Germany, by Dr Kind, Medical Superintendent of the Idioten-Anstalt at Langenhagen, in Hanover ; translated from the German. Langenhagen: June 25, 1876. Honoured Doctor,?I thank you heartily for the papers which you have sent me, both before and now, and would be well pleased to receive more of such interesting communications in the future. IDIOTS, IMBECILES, AND HARMLESS LUNATICS, 279 The following data are principally taken from the ” Journal of the Royal Prussian Statistical Office,” compiled from the Census of the year 1871. The last Census in 1876 is not yet ready to be used in our inquiry. Probably there will soon be a special census for the insane. I cannot give the number of idiots in the whole of North Germany, but only the results of the Census in Saxony, Mecklenburg, and Hamburg are wanting.

There were found in Prussia 51,808 males 49,807 females In all 101,615 persons with physical and mental deficiencies. This comprised blind persons, deaf mutes, idiots not deaf and dumb, idiotic deaf mutes, and insane persons. Of these last there were 10,187 males 11,132 females In all 21,319 insane. Of the idiotic there were 17,437 males 15,566 females In all 33,003 idiots not deaf and dumb. Besides these there were 382 males 354 females In all 736 deaf and dumb idiots. This makes a total of 33,739 idiots and imbeciles. Of this last class there were found living in families and private households, 16,133 males 14,395 females In all 30,528. In institutions for idiots and similar establishments there were 1,686 males 1,525 females In all 3,211.

From the agenda kindly sent to me it appears that in England, at the end of 1875, 4,294 out of 30,000 idiots, nearly 1 in 7, are in institutions; while in Prussia there are only 3,211 out of 33,739, that is, 1 in 10. Thus, though we have made some progress during the last four years, we are not yet abreast of England in our provision for the care of idiots.

According to Kollman, in the Grand Duchy of Oldenburg the number of those who are mentally afflicted in early youth is 996 ; a third of these have reached the age of twenty, but there is no institu- tion for idiots in the whole State. I know o? no more complete account of German institutions for idiots than that of Laehr, which you have got.*

Both the old criminal and civil code of Prussia distinguish between insanity and idiocy. The new criminal code for the German Empire lays down in general terms: ? 51. A punishable offence cannot be committed if the delinquent, at the time of the offence, be in a state of unconsciousness or diseased mental activity, through which the free use of his will was impeded. The provincial order for the old provinces of Prussia, of the 29th June 1875, distinguishes (? 120) between lunatic asylums and institutions for idiots, and gives the provincial diets the power of making regulations about the admissions, treatment, course of instruction, and discharges, subject to the approval of the Minister of the Interior, or of Instruction.

By ? 128, the management of the Councils of the Commune,f as far as they have to do with the care of the poor, the insane, the deaf and dumb, the blind, and the idiotic, is given over, with all rights, to the provincial councils.

By the law of 8th July 1875, concerning the carrying out of some paragraphs about the grants of the Councils of the provinces and circles, the assigned sums are ordered to be spent upon the care, security, and help of the insane, deaf and dumb, and blind, and for the support of foundations for the relief of idiots, and other charitable institutions. By no law is the care of idiots made obligatory. Nowhere in the whole of Prussia is there an institution for idiots erected by the pro- vincial administration. The sums granted from the provincial funds for their assistance are relatively very small. Our province, Hanover, which does more than the other provinces for idiots, gives an annual fixed subsidy of ?600 out of a budget to institutions of ?4,500. The four deaf and dumb institutions of the province, which together contain no more pupils than our single establishment. J but are provincial institu- tions, and not private ones, get a subsidy of ?3,750. The only institu- tion supported by the State is in Mecklenburg ; but it is small and only for educable children.

In the kingdom of Saxony there is for idiots, Plubertusburg, con- nected with a hospital for the insane, a State institution, but much too small. The number of idiots in Saxony, from a census taken at the same time as in our province of Hanover, in the year 1871, was found to be 3,436?that is, one idiot to 571 inhabitants, while there were only * “Die Idioten Anstalten von Deutschland,” von Dr Heinrich Laehr (Berlin, 1876). A copy of this pamphlet was presented to the Committee. In compiling the short account of German Institutions for Idiots, Dr Fletcher Beach and I used ” Die Heil und Pflege-Anstalten fur Psychisch Kranke in Deutschland, der Schweitz, &c.,” by the same author (Berlin, 187G), besides some other documents.?[Translator.]

f In Prussia, the Council of the Commune, or Gemeindo, elected by the tax- paying inhabitants, fixes the local taxes. Their Chairman is the Burgermeister, ?who is nominated by the Government from a list given by the Council of the Gemeinde. The Provincial Councils or Diets are a higher assembly, representing many Gemeinde. which send delegates to them, and also the landed nobility. Apparently there is another Council, the ” Kreis-Verband,” which perhaps answers to the ” Kreis-Korporation ” of Rhenish Prussia.?[Translator.] J At the beginning of the year 1875 there were at Langenhagen 130 male and 98 female patients, = 228, and during the whole year there had been 155 males and 109 females, = 2G4.?[Translator.] 2,391 insane?one lunatic to every 820 inhabitants. But what will an institution for 200 idiots do to meet this ?

The kingdom of Saxony was the first State in Germany to erect an institution for idiots, and Saxony, in the new Education Bill of 1873, has been the first to make the instruction of the weak-minded obligatory. ? 4 provides that neglected children?those wanting in intellect, weak- minded, and fatuous (imbeciles and idiots)?are to be brought up in the public or private institutions provided for that purpose, if sufficient pro- vision be not otherwise made by those whose duty it is to attend to it. No report has yet been published of the working of this law. No special provision has yet been made for grown-up idiots. Those who are dangerous and epileptic have been for a long time back sent to the hospitals for the insane ; but the protests against this are becoming every year more energetic. Single cases may be met with in ordinary hospitals for the sick and in poorhouses. Institutions for idiots have begun in their hospital compartments to take older idiots. Other in- stitutions do not discharge their inmates on account of age. Our insti- tution at Langenhagen does not dismiss any idiot as long as the minimum board is paid, no matter whether the idiot can be employed in the farm, workshops, kitchen, or house, or whether he is helpless and requires nursing.

Let me add that in the year 1874 a petition was sent by the Asso- ciation of German Physicians for the Insane to the Prussian Minister of Instruction, which asked for revisal of some points in the educational code. The petition will be found in the ” Allgemeine Zeitschrift fur Psychiatrie von Laehr,” Band xxxiii. Seite 34 (Jahrgang 1876).* The special part which was committed to me by the Association at P- 37 A takes in at B the necessary provisions for idiots. The answer of the Minister will be found at p. 40.

In our country, too, men have not yet come to grant to idiots the same rights as to those who are sound, nor have those who enjoy the use of their faculties come to discharge their full duties to those less happily gifted.

I hope that this information may meet what you desire. With the assurance of my highest esteem Believe me to be yours truly, (Signed) Kind. To Dr W. W Ireland, Scottish National Institution for the Education of Imbeciles, Larbert, Stirlingshire, Scotland.

• This petition points out the consequences of the disregard of hygienic laws

in the education of children, and the necessary precautions to take in the case of children affected with diseases of the nervous system. Under the special head mentioned by Dr Kind, it is recommended that children suffering from temporary attacks of insanity, if sent to asylums for the insane, should be kept apart from grown-up lunatics; that all idiots who are dangerous to the community, who are neglected, or who give hopes of learning a useful trade, should be sent to special training schools, and that the provinces and larger communes should give a subsidy to help this object. In reply, the Minister of Instruction, Dr Falk, thanks the petitioners for the interest they show in the welfare of the people and ^tate. Similar representations have been already made to him from the Educational Department, but some of the representations go beyond the school into the house, and lie out of the scope of his ministry.?[Translator.] Letter on the Asylums for Idiots in the United States of America. N.Y. Asylum fob Idiots, Syracuse, N.Y. May 8, 1876. W. Millard, Esq. My Dear Sir,?Yours of the 14th ult. was duly received about a week since, but I could not well reply till now, for I had a pamphlet in the printer’s hands begun, and he was close at my heels demanding copy. This, with the proof-correcting and a large official correspondence, kept me very busy.

I proceed at once to the topics suggested by your letter. There are at present the same number of institutions as at the date of my re- port in 1875. Since then, however, there has been a moderate increase in the number of pupils in several of them, so that there are probably 1,500 pupils at this time.

The State of Iowa has established a new institution, which will go into operation some time in the present year. In Illinois, where my brother has the charge of an asylum now occupying leased building that will accommodate 100 pupils, a new structure is now going up to accommodate 275 pupils. At this asylum we have just received from the State 35,000 dollars for building pur- poses.

To understand the difference in the status of the institutions that you indicate with tolerable accuracy, a word or two may be said of their history. Years ago, when asylums for the insane, for the blind, and for deaf-mutes were established, it was done by private endowment, and they were supported by private donations and legacies. After awhile the different States began to subsidise them, receiving in return the privilege of sending a certain number cf patients or pupils, depending upon the sums appropriated. After a time these were followed in the newer States by the establishment of State institutions for these several purposes, the buildings for which, and the money for the annual support of which, came directly from the State treasuries. In fact, in some of the Western States provision for the insane, blind, and deaf-mutes is a part of the organic law. The State constitutions require the legislative bodies to make the necessary appropriations. In these cases the trustees are nominated or appointed by the governors of the States. As a result of this example, in the older States the sums appropriated by the legis- lative bodies have dried up the private benefactions, so that almost no one thinks of giving to such charities.

Of these older institutions, they are now to all intents and purposes State institutions?except a few insane asylums that are supported by the sums received from private patients, They are still managed by corporate bodies, though in some instances a limited number of State trustees or managers have been added to these bodies. The control over these by the State is, in the main, indirect. They find the money to pay for the support of a certain number of pupils and make the appropriations for building purposes, and can withhold this, if the man- agement is not satisfactory.

Judging by the statistics of the State of New York, I should estimate that 20 per cent, of the number were in City Alms-houses and in County Poor-houses ; not one per cent, in jails ; and the remainder, except the 1,500 in asylums for idiots, are in the custody of friends. We have so little downright poverty away from the large cities that an idiot member of a family can be tolerably well cared for at home. The statistics of idiocy are very imperfect. I still think that, leaving out the cases of dementia following insanity, the number will not much exceed one in a thousand. Others estimate it considerably higher.

Our definition of idiocy in America is a generic one, and includes imbeciles. Tnis is the practical one in the admission of pupils to our asylums.

Originally all our institutions were designed as educational establish- ments ; so they excluded epileptics, the greatly deformed, and tne insane?as vou will see in the appendix to my reports. In Pennsyl- vania and Ohio they have departed from this principle, and have added a custodial department. I still adhere to the old plan, to be supple- mented bv separate custodial asylums for the adult and unteachable idiots.

Any case of idiocy or imbecility would be admitted into an American asylum that has been found incapable of being educated else- where.

The general exclusion of epileptics deprives our establishments of a class of pupils or cases that make quite good show-pupils in ordinary school exercises. So, too, the exclusion of greatly deformed cases, cripples, &c., cuts off some of those who would make the most progress in strictly school matters.

Being State institutions, or State charities, rather than mere charities, the question is one of political economy as well as charity. Thus, of two cases applying, the management here will select, not the one that appeals most strongly to their sympathies, from family circum- stances, or otherwise, but the one whose training and education will render him or her less burdensome to the State, if not absolutely pro- ductive. So our scheme of education is subordinated to giving the pupil a capacity for some useful occupation, that he may produce as much as he consumes. Where, from the low mental condition of the pupil, the expectation is much less, even then the aim is to develop such habits of order, cleanliness, and self-care as to diminish the cost and burden of their future support.

Another point may be mentioned. In State institutions we make no difference in treatment between rich and poor, pay cases and paupers. In those controlled by corporations, distinctions are sometimes made and certain special attendance and care is allowed.

In looking over the ‘ Agenda’ sent me, I am pleased to see that it covers almost every point relating to idiocy and the management and training of idiots. Suitable answers to the questions propounded will cover the whole ground. I may venture an opinion on a single point. It has seemed to me that your lunacy laws need some amendment; that is, to the extent of drawing the line between the insane and idiots. Their condition is so different, the requirements so unlike for the two classes. Practically we make this distinction, and without objection from anyone. Thus, in the case of idiots, at the age we admit them, there is no occasion for a medical certificate, except as furnishing the medical history of the case. Even the judicial certificate, upon which some pupils come, is not in the nature of a commitment, but simply a certificate that the applicant is a proper subject for our institution; that is, an idiot and indigent. I cannot legally retain a pupil if the friends wish to remove him. The friends can come and see the pupil when they choose. There is no confinement. There are no more pro- visions for confinement than in an ordinary boarding-school. There is no restraining apparatus used, except a long-sleeved apron, sometimes, but rarely, applied to prevent a child from picking a sore hand, or some- thing of the kind.

When insanity is added to the idiocy, or insanity supervenes with increasing age, the case is dismissed to go to an asylum for the insane. We have no arrangements to meet the needs of an insane case. The few that I have seen, when young, are very troublesome; for where insanity is manifested before much intelligence is developed, there is no basis lor moral treatment, and the pathological condition, upon which the insanity depends, being organic and chronic, remedies are of little avail.

It seems to me that before many years your local governments will provide for the education of idiots as well as for proper care of the insane. The experience of the Commissioners of Charity for the City of New York is an instructive one. They had separated their idiots from the other paupers as a matter of convenience, into a mere receptacle or place of custody. This separation brought out quite clearly the prac- ticability and the need of training them to some care of themselves. In a few years a little school was added, and this is now a marked and satisfactory feature in their management. So the establishment of institutions in this country for the training and education of idiots, with the industrial results that have been attained, has had a favourable effect upon the management of idiots elsewhere. In County Poor-houses they have been set to work, &c.

I have written hastily, only touching upon a few points that your letter suggests. The ‘ Agenda ‘ sent me shows that the whole subject is in thoughtful hands, and the topics suggested in that cover the whole ground. I have no doubt that you will reach wise conclusions. Wishing you all success in your deliberations, I remain, my dear Sir, Yours very truly, II. B. Wilbur. IDIOTS, IMBECILES, AND HARMLESS LUNATICS. 285 Special Committee on Idiots and Imbeciles and Harmless Lunatics.

Reference. ” That the Council, recognising the Expediency of placing Institutions for Idiots and Imbeciles on the most Comprehensive and Satisfactory Footing, resolves that a Committee be formed to consider and report on the whole subject.

Third Meeting. Wednesday, May 3rd, 1876.

Sir Charles Trevelyan drew attention to Professional Treatises by Drs. Bucknill, Grabham, and Bell Fletcher, and to the First Annual Report of the Committee for the Clapton Asylum for Imbecile Children, and undertook to procure copies for the use of the Special Committee. The first section of the Agenda, as settled at the two previous meetings, headed ” General Statistics,” was considered.

It was resolved, after discussion, that the inquiry of the Committee should extend, under the name of ” Harmless Lunatics,” to persons demented after the age of infancy, and the title of the Committee was amended accordingly.

Heads 1 and 2, viz., ” Nature of Infirmity,” and ” Number of Idiots and Imbeciles,” were discussed in detail. As regards the third head, ” Where placed,” the Committee, after considering the statistics contained in the Reports of the Commis- sioners in Lunacy and of the Local Government Board, in which ^ idiots and imbeciles” are included, without distinction, in the same returns with ” lunatics,” found it impossible to arrive at any certain conclusion.

The fourth head, ” Idiocy and Imbecility, how far preventable or capable of diminution,” was discussed, and the remarks made by Lord Derby on this subject in 1873, at the annual meeting of the Royal Albert Asylum at Lancaster, were read.

The Committee considered the fifth head, ” How far capable of Improvement,” and the following resolution was agreed to :? ” That a small proportion may be made self-supporting; that a further larger proportion may be trained to do some useful work; and that, as a general rule, the habits of the remainder can be improved so as to make their lives happier to themselves and less burdensome to others.”

Fourth Meeting. Wednesday, May 10th.

Letters were read from the Colonial and Foreign Offices stating that the Earls of Carnarvon and Derby had complied with the request of the Council to procure information as to the arrangements in force for the education and care of idiots and imbeciles in the principal British colonies and European Continental countries, and it was resolved to apply to the Earl of Derby for similar information in regard to the United States of America.

A letter was also read from Mr. Murray Browne, Poor Law In- spector, expressing his opinion that a considerable improvement might be effected in the condition of idiots and imbeciles at small expense. The Committee then proceeded to consider the several heads of the second section, entitled ” General Principles of Treatment,” and the following resolutions were come to, after discussion, in reference to the five first heads :?

1st. ” That idiots and imbeciles should be treated distinctively from other classes.” 2nd. ” That they ought not to be associated with lunatics in asylums.”

3rd. ” That they ought not, unless in exceptional cases, to be asso- ciated with paupers in union houses.” 4th. ” That the distinctive treatment suited to idiots and imbeciles ought to be applied collectively, especially in the earlier stages of education;” and 5th. ” That idiots and imbeciles cannot with advantage be placed in ordinary schools with other children.”

A motion made by Sir Charles Trevelyan, that ” Feeble-minded children ought not to be associated with adult idiots,” was discussed in detail, and on its being shown that, under certain circumstances, mutual aid might with advantage be interchanged among those diversely afflicted, and the elder might act as nurses and helpers to the younger, and having regard also to the improvement likely to be effected by early training in the habits of this class, the motion was withdrawn.

Fifth Meeting. Wednesday, May Y7t.li. A letter was read from Dr Ireland, Superintendent of the Scottish National Institution for the Education of Imbecile Children, at Larbert, Stirlingshire, transmitting a pamphlet containing a complete list of the Institutions for Idiots in Germany, and the Twenty-fourth Annual Report of the New York Asylum for Idiots, and expressing his great regret that the urgent duties of his office had as yet prevented him from taking part in the discussions of the Committee.

Dr Boyd presented copies of his recently published Treatise on the Diseases of the Nervous System.

The Committee then proceeded to consider the remaining heads of the second section of the Agenda, entitled “General Principles of Treatment,” and passed, after discussion, the following resolutions:? 6th. ” That the improvement of idiots and imbeciles would not be promoted by boarding them out, but in certain cases, boarding out, under proper supervision, is not unsuitable to harmless lunatics.” 7th. “That the education of idiots and imbeciles should be based on physical considerations.”

8th. ” That the education of idiots and imbeciles should commence at the earliest age at which they can dispense with a mother’s care, and the subsequent stages should depend upon the capacity developed by them.”

9th. ” That idiots and imbeciles should have a thorough industrial training, so as to enable them, as far as practicable, to support them- selves, or at least to contribute towards their support, when circum- stances render it necessary; ” and?

10th. ” That idiots and imbeciles of all classes should, as far as may be pruriently done, be also encouraged to cultivate any literary, scientific, artistic, or mechanical faculty they may happen to possess, or be otherwise furnished with employment, so as to promote their self- respect, and to make them feel that they are of some use in the world, or, at any rate, to occupy them pleasantly.”

Sixth Meeting. Wednesday, May 2?th. The Committee commenced the consideration of the third section of the Agenda, entitled ” Treatment of Adults,” and, after discussion, passed the following resolutions:? 1st. ” That the treatment of adult idiots and imbeciles must depend upon the degree in which the character and faculties have been developed by previous education and training.” 2nd. ” That a small proportion may be permanently improved, so as to take care of themselves, either at their own homes or elsewhere, and to earn their own living.” 3rd. ” That a larger proportion may be improved so as to support themselves under proper safeguards.” 4th. ” But that there is also a large proportion of cases which, having achieved a certain improvement, are unable to get beyond this, and are, indeed, liable to retrograde, and for these suitable institutions are in- dispensable.”

5th. ” Not only can idiots and imbeciles in asylums be employed with advantage to themselves, and the asylums be managed as indus- trial establishments for manufacturing or agricultural industry, but it is essential to the moral and mental well-being of the class that such a system should be adopted; and, under good management, it may be made advantageous to the institutions in a financial sense by diminish- ing the cost of maintenance.”

Seventh Meeting. Wednesday, May 31 st. Dr Langdon Down presented copies of a paper on the ” Education and Training of the Feeble in Mind,” read by him at the Social Science Congress of 1867, and reprinted for the use of the Committee. Mr. Millard communicated a condensed statement of the arrange- ments for the education and care of idiots and imbeciles in the United States, and a letter to him on the same subject from Dr Wilbur, Super- intendent of the New York Asylum.

The Committee then discussed, at considerable length, the fourth head of the third section of the Agenda, viz. ” The best mode of treat- ing adults who are only susceptible of supervision, shelter, and kind care,” and, instead of recording a separate opinion on this point, it was determined to amend the fourth resolution passed at the preceding meeting, which will now stand as follows:? ” 4th. But that there is also a large proportion of cases which, having achieved a certain improvement, are unable to get beyond this, and are, indeed, liable to retrograde, and for these cases, institutions, or departments of institutions, where suitable classification may be carried out, .are indispensable.” 288 IDIOTS, IMBECILES, AND HARMLESS LUNATICS. Eighth Meeting. Wednesday, June 7 th. It having been resolved at a previous meeting to reserve the con- sideration of the third section of the Agenda (” Treatment of Adults “), so far as it bore upon the case of harmless lunatics, the Committee discussed this part of the subject at considerable length, and Sir Charles Trevelyan moved the following resolution :? ” That, as a general rule, improved, but uncured, adult idiot, harmless lunatic, and epileptic and other hospital cases, should be provided for, in accordance with the preceding resolution (see the Pro- ceedings of the 31st May), in separate institutions, or departments of institutions, where suitable classification may be carried out.” To which the Honourable C. H. Strutt, moved the following amend- ment ?

” That those idiots, imbeciles, and harmless lunatics who, after training and education, are neither capable of further improvement, nor of useful employment, and whose presence may be injurious to those under training, should be maintained in separate institutions, or de- partments of institutions.”

This amendment having been put, and lost by nine votes to eight, the original resolution was carried. Ninth Meeting. Wednesday, June 14th. A report was made of a visit paid on the previous day by ten members of the Committee to the Earlswood Asylum. A letter, dated the 27th ult., from Dr Wilbur, Superintendent of the New York Asylum for Idiots, to Sir Charles Trevelyan, approving of the Agenda, and commenting upon the proceedings at the third and fourth meetings, were submitted to the Committee. The Committee then considered the five first heads of the fourth section of the Agenda, viz. ” Administrative Arrangements,” and passed the following resolutions :?

1. “Voluntary charity has directed attention to the claims of this neglected class, and made great progress towards the establishment of a model for general adoption; but it has not proved equal to providing a remedial machinery co-extensive with the evil.”

2. ” Assuming that the returns of the Census of 1871 are within the mark, only about three per cent, of the idiots and imbeciles in England and Wales have been suitably provided for by voluntary charity.” 3. ” Adequate provision for all the idiots and imbeciles in England and Wales of the poorer classes, whether juvenile or adult, cannot be made without the intervention of the State.”

Under the sixth head, letters were read from Mr. Jonathan Pim and Professor Hancock, stating that the provision made in Ireland for idiots and imbeciles was simply that they might be confined in luneAic asy- lums as being insane, or in prisons as criminals, or in workhouses as paupers, excepting only the Stewart Asylum, established about eight years ago, in which there are at present 43 inmates ; but that a report is being prepared by the Charity Organisation Committee of the Dublin Statistical and Social Inquiry Society, under the several heads of the Agenda, so that the Committee may have uniform information for all parts of the United Kingdom, as a basis for an uniform law for the helpless classes.

Tenth Meeting. Wednesday, June 21 st. A report was made of a visit paid on the previous day by nine members to Dr Langdon Down’s establishment at Normansfield, Hampton Wick.

Answers were read from the Foreign Office, transmitting informa- tion relating to idiot institutions in Switzerland and Belgium. And printed copies of the following papers were distributed :? 1st. A Short Account of the Idiot Asylums in Switzerland and North and South Germany, by Drs. Ireland and Beach.

2nd. On the Arrangements for the Education and Care of Idiots and Imbeciles in Scotland, by Dr Ireland, Superintendent of the Scottish National Institution for the Education of Imbecile Children ; and 3rd. Letter to Sir Charles Trevelyan from Dr Seguin, formerly of Paris and now of New York.

The existing arrangements for the education and care of idiots, im- beciles, and harmless lunatics in Scotland were then considered, under the sixth head of the fourth section of the Agenda, and letters were read from Dr Mitchell, member of the General Board of Commissioners in Lunacy for Scotland; Mr. Skelton, Secretary to the Board of Super- vision for the Kelief of the Poor in Scotland ; and Dr Ireland. Under the seventh head of the fourth section it was determined to postpone the consideration of new legislation until it shall be seen what arrangements may be recommended to be made.

Under the eighth and ninth heads it was resolved ” That the arrange- ment 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 idiots, imbeciles, and harmless lunatics should be removed from workhouses and county lunatic asylums, and that young persons of those classes should be suitably educated and trained.”

Under the tenth head it was resolved ” That the education and care of idiots, imbeciles, and harmless lunatics should be conducted by governing bodies specially appointed and responsible for that purpose and Under the eleventh head, ” That such governing bodies should also be charged with the education and care of blind and deaf and dumb children of the poorer classes.”

Eleventh Meeting. Wednesday, June 28th. Dr Hack Tuke and Mr. Mocatta reported visits paid by them to the School of the Metropolitan Asylums Board for Imbecile Children at Clapton. Dr Hack Tuke presented a paper, reprinted for the use of the Committee, on the Kichmond District Lunatic Asylum, Dublin, showing how much may be done, even for adults, by regular school teaching.

Copies of the report of the Charity Organisation Committee, of the Dublin Statistical and Social Inquiry Society, alluded to at the close of the proceedings at the ninth meeting, were received and dis- tributed.

The Committee then considered the twelfth head of the fourth section of the Agenda, ” Administrative Arrangements,” and Dr Boyd moved the following resolution :?

” That the visitors of the County Lunatic Asylums, which contain a considerable proportion of the idiots, imbeciles, and harmless lunatics in the kingdom, are the very best guardians that could be selected to form a board for the supervision of schools, separate institutions, or parts of institutions, for the improvement and care of these helpless classes.” To which the following amendment was moved by Sir Charles Trevelyan:? ” That such governing bodies (see the Proceedings of the previous meetings under the tenth head) should be composed:? 1. Of representatives of the local magistrates; 2. Of representatives of the local guardians; and 3. Of persons appointed by the Crown.” Eight having voted for the amendment and five against it, the amendment was put as a substantive resolution and carried. Twelfth Meeting. Wednesday, July 5th. A report was made of a visit paid by a deputation of the Committee on the previous Friday to the Leavesden Asylum. Answers were read from the Foreign and Colonial Offices, trans- mitting information relating to arrangements in Holland and the West Indies.

And copies were distributed of a translation (made by Dr Ireland) of a letter from Dr Kind, Medical Superintendent of the Idioten- Anstalt at Langenhagen, in Hanover, on the arrangements for the education and care of idiots and imbeciles in North Germany. The Committee then had before them the thirteenth head of the fourth section of the Agenda, ” Administrative Arrangements,” and after ‘ considering a paper prepared by Mr. Millard on the number of idiots, imbeciles, and harmless lunatics, under and above 20 years of age, who had to be provided for, unanimously passed the following reso- lution :?

” That the country should be divided into districts, each sufficiently large to fill an asylum containing not more than 2,000 adults, and schools containing, at the utmost, 500 young people.” And under the fourteenth head the Committee resolved, by 10 to 5? ” That, besides the supervision of the Commissioners of Lunacy, the schools and asylums should be inspected and reported upon to the Local Government Board.”

It was then determined to consider together the first and fourth heads of the fifth section (” Ways and Means “) and, after a prolonged discus- sion, the subject was adjourned. Thirteenth Meeting. Wednesday, July 12th.

Papers relating to the Blind Asylum at Amsterdam, received through the Foreign Office, were submitted to the Committee. Returns of idiots, imbeciles, and harmless lunatics needing public administration, according to districts, prepared by Mr. Millard, super- intendent of the Eastern Counties Asylum, were distributed. The Committee then resumed the discussion of the first and fifth heads of the fifth section (” Ways and Means “), and resolved? ” That the education and care of idiots, imbeciles, and harmless lunatics must, as at present, be mainly provided for by local adminis- tration and local rates; but, as every member of the community is interested in the object, and this national obligation has already been acknowledged in several ways, assistance should be given out of the public revenue; and ” That the best mode in which such assistance can be given is by advances for the necessary buildings on easy terms, liberal capitation grants for young people under training, and grants of less amount for adults.”

Under the second head of the same section it was moved : ? ” That union houses and gaols which are no longer wanted, owing to the diminution of pauperism and crime, might, when the circum- stances are suitable, be adapted as training schools and asylums for idiots, imbeciles, and harmless lunatics.” To which the following amendment was moved, and unanimously carried:?

” That, although many workhouses and gaols are likely soon to be available for other purposes, yet, having regard to adaptability, sanita- tion, and economy, it is desirable to erect new buildings for the institutions contemplated by the Committee.”

Under the third head it was resolved? ” That families which, although able to pay their way under ordinary circumstances, would be reduced to destitution if required to defray the entire cost, should be charged at such rates as their means will allow for an idiot, imbecile, or harmless lunatic member admitted into a training school or a’sylum ; and that the privilege accorded by Act of Parliament to the blind and deaf and dumb?viz. that relief given to children should not be deemed to be parochial relief given to their parents?should be extended to idiots, imbeciles, and harmless lunatics.”

Fourteenth Meeting. Wednesday, Jidy 19. A statement by Dr Ireland on the bearing of the Scottish Lunacy Acts upon the condition of Idiots and Imbeciles in Scotland was dis- tributed.

The 6th section of the Agenda, entitled ” Provision for Idiots and Imbeciles of the Lower-Middle and Upper-Working Class,” was then considered, and the following resolutions were passed :?

1st. ” That persons belonging to the lower-middle .and upper- artisan class, who are so unfortunate as to have an imbecile child, are in a less favourable position than any other for obtaining proper edu- cation and care for it, because, while they can rarely afford to pay the full cost of maintenance and education, they cannot well appear before their respective Boards of Guardians to claim the benefit of the legal provisions for destitute imbecile children.

2nd. ” That institutions mainly supported on the voluntary prin- ciple are best adapted to the needs of the class specified in the fore- going resolution, provided all suitable cases are admitted at the proper age, at rates suited to the circumstances of the respective families.” 3rd. ” That the Government may assist in the formation and maintenance of such institutions by removing unnecessary legal re- strictions.”

Fifteenth Meeting. Wednesday, July 2G. Letters were read from the Foreign Office, transmitting documents relating to the education and care of idiots and imbeciles in Germany, Sweden and Norway; and from the Colonial Office, relating to the same subject in Jamaica.

The following resolution having been moved by Mr. Wilkinson, in reference to the resolution which was passed, under the 3rd head of the 5th section, to the effect that families which cannot defray the entire cost in institutions mainly supported out of the rates, should be required to pay to such extent as their means may allow :? ” That, considering the great want which now exists of efficient training schools for the young, and of custodial institutions for adults, it would be desirable that persons able to pay the entire expense of their maintenance and training should be received into these institu- tions, on such payment by parents or friends as the managers may approve;”

upon which the ” previous question” was moved, and carried by seven votes to two.

The 7th section of the Agenda, entitled “New Legislation,” was then considered, and it was resolved?

” That the legislative provisions required for idiots, imbeciles, and harmless lunatics should be consolidated in a single act distinct from those applicable to dangerous lunatics, but the details of such legisla- tion must depend upon the measures which may be actually adopted.” It was then resolved that a sub-committee should be appointed to prepare a draft of the report, consisting of the following member : ? The Hon. C. H. Strutt. Sir Charles Trevelyan, Bart., Iv.C.B. Dr Brewer. Dr Langdon Down. Dr Grabham. Mr. W. M. Wilkinson. Mr. Millard.

In some observations on the administration of medical relief to the poor, in a letter of mine in the Lancet in March 1854, it is stated that, besides paupers, there is a another class of persons in humble circumstances, and that is the industriouss mechanics and labourers dependent on their daily earnings, who too frequently, for want of timely assistance, not having the means to employ a doctor, and being too proud to seek medical aid as paupers, fall into fever or long-con- tinued illness, and from consequent inability to maintain their families, and the expenses attending their affliction, become at length dependent on the parish. Their children are placed in the workhouse, their home being entirely broken up; and all this train of calamity might have been arrested had timely medical aid been provided for them without degradation. Cases of this nature are of such common occur- rence that it is the cry of parochial officials, ” Medical relief is the first stepping-stone to other relief.”

Apart from the question of humanity, in a mere economic point of view, it is to be hoped that some beneficial measure, not only for idiots and imbeciles, but also for granting gratuitous medical assistance in rime of sickness, to this important class of persons, will be shortly enacted. The principle of affording gratuitous assistance to persons not paupers is recognised in the Vaccination Act; why should not the same principle be extended in cases of sickness, so as to afford medical relief in time to prevent the spread of pauperism as well as of fevers or such other serious diseases?

From my statistical report of the diseases of the out-door patients of the Marylebone Infirmary, in 1841, it appears that in three years there were 127 cases of small-pox and 32 deaths, and of fever 918 cases and 47 deaths.

My own experience induces me to give a decided preference to medical attendance at the patients’ homes, or house-to-house visitation, to that of receiving them into hospitals, as in the former mode the mortality is much less than in the latter; in proof of which I can refer to my tables published in the Lancet, 18th June, 1842, including up- wards of 13,000 cases, about 7.000 of which were attended at their own homes, being for the most part confined to bed, unable to attend as out-patients at the infirmary. The mortality amongst them was upwards of 7 per cent., while among the 6,000 attended in the in- firmary, during the same years, the mortality was upwards of 15 per cent.

In many instances the removal of a patient from his home?sepa- rating him from his family?placing him in an hospital among strangers, some near him dying perhaps, must have a very depressing effect, and add materially to the mortality of such institutions. If the homes of the poorer classes were improved, and the means of cleanliness and general sanitary measures, to which the charitable and benevolent mind of the public is now happily directed, were further extended, hospitals, unless for accidents, infectious diseases, fevers, and for the insane, would be much less required than they now are.

With respect to chronic and harmless lunatics, it would be very desirable if facilities were afforded for the interchange of such cases between the asylum and workhouse. Relapses occur in about 16 per cent, of cases in asylums after recovery.

In the wards of the Marylebone Infirmary there were usually under treatment about twenty recent cases of insanity, for which admission could not be obtained at Hanwell Asylum, which was crowded with chronic cases. An application was made by the Guardians to the Visitors to allow an exchange of the old incurable for recent curable cases, but the Visitors refused.

In my report on the lunatics chargeable to the parish in 1844 I referred to the frequent occurrence of relapses, the result of defective means of separating the convalescent from the more acute and noisy cases. Also that this want of separation was not confined to the infirmary; for in the workhouse the want of proper separation of the epileptics, idiots, and imbeciles, from other paupers, was equally manifest. An instance was given of an imbecile, G. F., who assigned as a cause for attempting self-destruction?which he nearly effected? the constant jeering of others in the workhouse-yard.

The Metropolitan Commissioners in Lunacy, in their Report, state? ” In reference to the populous parish of St. Marylebone, the magistrates refused to exchange old incurable for recent and curable cases. But the professed, and indeed the main object of a county asylum is, or ought to be, the care of insanity. The patient who has had the benefit of a trial in the asylum where he has become incurable should, we submit, give way to the afflicted pauper who is in the workhouse or at home, and is probably curable, and equally entitled to be received at the asylum, where by prompt and proper treatment he may be restored to health and to his family, instead of being permitted to become an incurable lunatic, a source of expense to others and of suffering to himself. A county asylum is erected for the benefit of the whole county, and is to be considered not merely a place of seclusion or safe custody, but a public hospital for cure. The result of the system adopted by the justices in Middlesex is, that the county asylum is nearly filled with incurable lunatics, and almost all recent cases are practically excluded from it.” The result was that a licence was obtained for ninety-five patients in wards, and exercising-yards set apart, with attendants and a dietary, approved by the Commissioners in Lunacy, where the acute cases were treated, and the admissions averaged about two a week.

Since that time enormous sums have been expended in Middlesex for lunatics of all classes. Colney Hatch, Leavesden, Caterham, Hampstead, have been erected for thousands of patients ; a school for idiots is to be built, and another asylum. Those mentioned, with the exception of Colney Hatch, are considered as workhouses under the Local Government Board, formerly the Poor Law Board?always regarded incompetent for the care of the sick. According to my experience, special legislation for pauper lunatics is a grievous error. Is not a pauper afflicted with fever, pneumonia, or with- a broken leg, as much an object requiring care as a lunatic ? Do not all come under the category of ” medical relief” ?

The overcrowding of asylums by chronic cases, and an adequate provision for such, has occupied the attention of the Commissioners in Lunacy frequently for many years. In their last annual report for 1875 it is stated “that they have visited 361 workhouses, containing a total of 12,566 patients. In many of them the arrangements are of a liberal character: the accommodation being good, the diet sufficient, the employment and recreation of the inmates fairly attended to, and responsible paid attendants being placed in charge; in fact, good and sufficient provision is made for the care of many harmless chronic patients (and these alone can be legally detained in workhouses) who would otherwise require to be placed in asylums. The good, however, effected in one direction is too often more than counterbalanced by evil in another, and, 011 the whole, it is found that lunatic wards in work- houses lead to direct violation of the Lunacy Laws, which aim at causing insane persons to be placed, at the earliest possible period, under care and treatment, in properly-constituted asylums.” Numerous accidents and suicides in workhouses are related in this full and sug- gestive report.

Fresh legislation is required, including a better organisation and stricter supervision of workhouses generally. The Metropolitan Poor Act of 1867 provides only for the Metropolitan district, which includes about one-seventh of the population of the United Kingdom. By the Lunacy Acts the visitors of County Lunatic Asylums have submitted to them, through their clerks, copies of the quarterly lists of pauper lunatics and idiots not in asylums, and have power to remove suitable cases to the asylum, and thence, if need be, to an hospital for chronic cases.

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