Diagnosis of the Mentally Defective Child
News and Notes. In April, the Board of Education issued Circular 1359 to Local Education Authorities, prescribing” a new form (306 M.) for the use of Certifying Officers, in view of the importance of correct diagnosis.” This form allows greater detail and discrimination in setting out the characteristics and attainments of the child. In the Board’s circular stress is laid on the contribution towards correct diagnosis that parents, teachers, and social workers can make. It is interesting to note that the Board point out that, in their opinion, only Jn ” rare and quite exceptional circumstances ” can a child of school age be properly certified as a moral imbecile, within the meaning of the Mental Deficiency Act. They lay down that, in any but the clearest cases, the alternative method ?f considering the child as one who ” cannot be instructed in a Special School without detriment to the interests of the other children,” should be adopted. The general interpretation of the words ” moral imbecile,” has always presented difficulties. In the current number of the Journal of Mental Science, Mi*. John Maurice Ahern, M.B., B.Ch., Senior Medical Officer, H.M. Prison, Liverpool, has an interesting article on ” Certification as a moral imbecile.” He says: ” It seems clearly to have been the intention of the framers of the Act to bring within its scope those cases which exhibit vicious or criminal propensities undeterred by punishment, yet whose mental defect viewed apart from delin- quency is not of itself sufficient to justify certification as a ‘ feeble-minded person.’ “
Should a Special School Teacher have Opportunities for Special Training? No member of the Central Association for Mental Welfare would answer this question in the negative. By providing the Courses for Teachers which are being increasingly welcomed by all who are engaged in work among the mentally deficient, the Association gives its own answer.
It is with intense disappointment, therefore, that we search in vain for any reference to such special training in the Report of the Departmental Committee of the Board of Education on the Training of Teachers for public elementary schools, which has recently been published. The Committee’s reference limited the scope of their enquiry to the public elementary schools, though in principle they express agreement with the view that ” fundamentally the distinction between teachers for elementary and for secondary schools is grounded largely on historical and administrative rather than on ultimate educational considerations.” 1 hey do not deal with curriculum except in passing. But they find opportunity in Chapter X. of their report to discuss the training of Handicraft, Domestic subject and Physical training teachers.
We claim that in this chapter, special mention should have been made of the requirements of those teachers who must add to their general professional equip- ment, a real knowledge of psychology, of intelligence tests, and of the adaptation ?f ordinary methods of individual teaching to the children with whom they have to deal.
Unless and until public opinion is focussed on the need for such special trainingj we shall not attain the best results both in the school-life and the after- careers of the mentally deficient. Local authorities are being urged by the Board to fulfil their obligations under the Education Act of 1921, but so soon as they become active, the shortage of qualified teachers becomes more and more apparent.
Mental Welfare Clinic.
We are glad to read in the last Annual Report of the School Medical Officer, Stoke-on-Trent, that a Mental Welfare Clinic has been opened, and that a Special School for 100 children is to be launched. Dr Robert Hughes is devoting much time and research to the proper classification of sub-normal children, and, in connection with the work, has proposed to his Council the appointment of a woman welfare worker. He especially urges supervision, in co-operation with the Employment Exchanges, up to 18, for those who have been in special schools, but are not considered notifiable to the Local Authority.
Encephalitis Lethargica.
We are of opinion that one of our most urgent needs is proper institutional care for those suffering from the after-effects of encephalitis lethargica. Dr. Tredgold’s article in our January number set forth the distressing nature of those effects.
We think the general public should realise the prevalence of the disease, lest they should be lulled into apathy, based on the belief that only a few persons suffer.
The official returns, showing the weekly notifications, which we reproduce from the ” Lancet,” are as follows:? Week ending Week ending Week ending
April 4 … 56 May 2 … 55 June 6 … 06 ,, 11 … 48 ,, 9 … 80 ,, 13 … 59 ,, 18 … 52 ,, 16 … 70 ,, 20 … 61 ,, 25 … 54 ,, 23 … 91 ,, 27 … 49 ,, 30 … 71 210 367 225 Total 802
Courses Arranged by the G.A.Pd.W. The sixth course in Mental Deficiency for Medical Practitioners was held by the University Extension Board in co-operation with the C.A.M.W., at the University of London, South Kensington, from May 18th to 24th. This course was attended by 42 men and 11 women :? Certifying officers to Local Authorities under the M.D. Act … 11 School Medical Officers and Assistant School Medical
Officers … … … … … … … … 37 Medical Officers of Certified Institutions for Defectives … 2 Medical Officer of Industrial Home … … … … 1 Assistant Medical Officer of Prison … … … … 1 Candidate for post as School Medical Officer … … … 1
The Course consisted chiefly of clinical work and lectures, the lecturers being Dr Tredgold, Dr Shrubsall, Dr Cyril Burt, and Dr Norwood East. In April, a very successful Short Course for Teachers, attended by 33 selected teachers and one private student, was held for the Board of Education. The teachers were housed in the Co-operative Holidays Association’s Guest House at Hope, 15 miles from Sheffield. The schools visited were at Sheffield and Notting- ham, and all the lectures and classes were held in the Guest House. The choice of accommodation at so considerable a distance from the schools was a new experiment, but one that is likely to be repeated. The students thoroughly appreciated the beautiful surroundings, and the opportunity of seeing- something of the Derbyshire moors in no way detracted from serious study. The three months’ Course in London for Teachers is still in progress, and lias already proved its worth.
We hope that full attention will be paid to the particulars of the Course for Nurses and Attendants, on page 79.
Occupation Centre under a Statutory Committee.
The Mental Deficiency Act Committee of the Cardiff Council opened, on June 11th, an Occupation Centre (6 girls, 8 boys, ages from 8 to 19 years), and have appointed a Certificated Teacher, who is being trained in the management of low grade defective children by one of our organisers.
There are more children who ought to attend, but at present it is difficult to provide guides. The Session is from 2 to 4.30 p.m., five afternoons a week. There is a suitable room, but no playground.
There are now four Occupation Centres under the direct control of the Local Authority under the Act (Birmingham, Cardiff, Croydon, Norwich), and 87 under our Local Associations, most of whom have a grant for the centre from the Board of Control and the Local Authority. The centres deal with those excluded children, for whom institutional care is unnecessary or unavailable. Ample testimony comes from all sources, showing the improved behaviour and greater happiness of those attending. All that is needed is public opinion to press the demand for suitable training for all defectives.
A new edition of ” Occupation Centres for the training of mentally defective children ” has just been issued by the C.A.M.W., price 9d. It again sets forth clearly the aims and limitations of the Occupation Centre, brings information up to date, and contains a list of all the Occupation Centres at present opened, with particulars of the number attending, etc. And a Day Centre for children, both physically and mentally defective, not able to attend the Elementary Schools, was started by Miss Arnould, House of Helpj Fulham, in 1901, and Miss Woodhead, of the Guardianship Society, Brighton, had a Centre as long ago as 1899. In 1914, the Central Associa- tion for Mental Welfare, in one of its first pamphlets, advocated centres on the present lines, but, owing to the war, it was not until 1919 that the first Occupation Centre was opened in Islington through the enthusiastic endeavour of Miss Elfrida Rathbone. By 1923 the Board of Control had recognised the centres for purposes of grant towards the expenses of statutory supervision. An additional activity of the staff connected with the centres in certain areas is the Handicraft Class for higher-grade older boys and girls, who cannot obtain, or can only intermittently obtain, paid employment.
The pamphlet is a clear presentation of the aims, the achievements, and the potentialities of the training given in Occupation Centres and Handicraft classes. New Certified Institutions and Extensions.
Two new homes for mental defectives have recently been opened, both fulfilling a need. One is the new Roman Catholic Home, St. Teresa’s, The Cedars, 97, Belmont Hill, Lewisham. This home is for feeble-minded girls over 16 years of age. The maintenance fees are 22/6 per week, together with for outfit. The Home is certified under the Board of Control. The other Home is at Reigate, and is the Ellen Terry Home for defective blind babies, recently opened under the auspices of the Braille and Servers ?f the Blind League. It is certified by the Board of Control, and will shortly be certified by the Board of Education, and is intended for feeble-minded boys and girls up to the age of 10 years, preference being, at present, given to those between 2 and 8 years. The maintenance fees are ^,90 per annum, with an initial jQ5 in lieu of outfit.
The Besford Court Roman Catholic Mental Welfare Hospital for Children has recently opened a Junior Department at St. Josephs, Sambourne. There are some sixty boys there in charge of the same Sisters who so successfully managed Besford Court. The boys will pass later into the Senior Department, which is now staffed entirely by men. In a recent number of the ” Universe,” an interesting account of the pioneer work done at Besford Court, was given. A new hall and house, accommodating 25 men, has been opened at Sandle- bridge.
The Meanwood Mental Defective Colony, Leeds, is to be enlarged, and the patients housed in separate pavilions, accommodating from 40-55 patients. The new scheme will involve an annual charge of ?10,000 a year on the ratepayers, the enlargement costing ,?70,000.
Occupational Training in Mental Hospitals.
The need for varied occupation which can be carried on in wards by patients in Mental Hospitals, not only for their pleasure, but for their improve- ment, is becoming more and more evident to all who study the subject. A new development of the training activities of the Central Association for Mental Welfare is likely to prove only the beginning of a much wider scheme. At the invitation of some three or four of the Mental Hospital authorities up and down the country, our organisers have spent four weeks at each Hospital to help in the training of groups of patients admitted to these Hospitals under the Lunacy Acts, many of whom could more properly have been dealt with under the Mental Deficiency Acts had there been accommoda- tion for them.
The aim of the organisers is to give the attendants some idea of the advantages of definite instruction to defectives. It is not, however, possible, under the existing administrative conditions, to obtain results such as can be obtained in an Occupation Centre. The Wards are often so placed that instruction is subject to many interruptions, and the nurses-in-charge frequently have many and various duties to perform, so that they cannot give undivided attention. The variety in age and mental capacity is so great that it is very difficult to grade work, and the numbers are often not enough to justify separate groups. We may take as an example the selected patients of a hospital recently visited. :?
Females (19)? Idiot, aged 8 … … … … 1 Epileptic idiot, aged 13… … … 1 Dementia praecox … … … … 6 Epileptic and low-grade feeble-minded … 1 Other ages from 19 to 40 or 50 years Imbecile or low-grade feeble-minded … 6 Epileptics … … … … … 2 High-grade feeble-minded … … 1 Insane … … … … … 1 Males (7)? Imbecile, paralysed down right side (does Other ages from 19 not speak) … … … … 1 to 30 years Imbecile, paralysed, cannot walk, speaks indistinctly … … … … 1 Epileptics (one imbecile or low-grade feeble-minded, one higher grade, but deaf and dumb) … … … 2 Imbeciles (one 16 or 17 years) … … 2 Boy, aged 7, just admitted … … … 1
It has been found practicable to hold three separate classes, one for the males, and one for ^]le lower-grade females, and one for the higher-grade iemales.
In another hospital the ages of 17 boys and 8 girls vary from three to twenty-two years. Eight of these boys cannot speak (except a few odd words), two being of Mongolian type, while five of the boys can read and write and do simple arithmetic. All the boys and girls have been transferred to a detached block, with separate offices and entrances, and ample garden, so that the conditions in this case are far better than usual.
In many hospitals there are also encephalitis lethargica cases. They are usually of higher mental grade, and have, previously to the disease, attended ordinary schools, but together with this higher mental standard, they frequently show such lack of control, and, often, so violent a disposition, as to make them impossible, even in classes for defectives.
The staffs of the hospital are sympathetic to the new venture, and with the regular visits of our organisers for encouragement and help, or, better still, the attendance of the nurses at one of the short courses, such as our special course ln October, it is to be expected that, after a time, the improvement in the happiness and health of the patients and their increased capacity for useful occupation will justify this pioneer work.
Association of Mental Welfare Workers.
We regret to learn that Miss Nevile has felt obliged, owing to pressure of work, to resign the Hon. Secretaryship and Treasureship of the Association. Miss Nevile, who is, as our readers know, the Secretary of the Essex Voluntary Association, has done a great deal of spade work in placing the Association on a sound footing. She has always striven towards the attainment of the first object of the Association?to further the interests and increase the efficiency of salaried and other mental welfare workers. The Association is fortunate in having secured ,n her place Miss M. Laxton, who has had so much experience with the London Association.
Royal Commission on Lunacy and Mental Disorder.
The C.A.M.W. hopes to be able to present its Memorandum and evidence to the Royal Commission on Lunacy and Mental Disorder this month, but, unfortun- ately, the Commission cannot receive the Association before we go to press. A full account of the evidence will appear in our next number.
Mentally Weak Prisoners.
An interesting answer was given by the Home Secretary on May 8th in reply to a question in the House as to the arrangements for prisoners, mentally weak, but not certifiable as insane or mentally deficient. He stated that male prisoners unfit for the ordinary discipline of prison are collected in four prisons, and females in three. Since July, 1924, 91 males and 4 females were transferred to these centres. They are instructed in such industrial work as they can per- form, and Brabazon classes, outdoor work and extra exercise facilities are arranged.
School Intelligence Tests and Employment.
The Presidential Address of Dr J. W. Fraser, School Medical Officer, of Hull, to the School Medical Officers’ Group of the Society of Medical Officers ?f Health has been printed in pamphlet form. Its subject is the value of intelligence tests in estimating the future careers of mentally defective children. Out of 131 cases who have, since 1911 passed through the Special School, ?f> which Dr Fraser is the Medical Officer, 9 are earning more than 20/- a week, 34 less than 20/- a week, giving” a percentage of 32.8 employed. “Only 9. or practically 7 per cent., are earning enough to keep themselvesj and 35 are earning on an average 9/8 per week. Of this latter number, 15 have been discharged during the last three years, and may possibly do better later, and 13 of those unemployed have been discharged during the same period, and may obtain employment, but of these 28 a very liberal estimate would place the number of those capable of maintaining themselves at 14, which would raise the total percentage to about 17. A less optimistic view would limit the number of those capable of maintaining themselves to the nine above-mentioned.” Dr Fraser urges that it would be a policy of wise economy to increase the number of institutions, so that by careful organisation, every inmate could work according to capacity and make some contribution to maintenance.
By diagrams and tables the relationship is shown between intelligent quot- ients and average annual gain, and the probability of after-employment. Refer- ence is made to the reluctance of employers to employ a boy or girl who at 16 has to confess to having just left a Special School, and Dr Fraser states that the boy is more likely to succeed if he can leave at 14, and that ” as far as the experience of this school shows, there is no chance of a girl obtaining remunera- ted employment if school attendance is enforced until she attains 16 years.” It would be interesting to have similar figures for other areas regarding the after-employment of Special School children. By the courtesy of the London Association for the Care of the Mentally Defective, and the City of Birmingham Special Schools After-care Sub-Committee, we have been supplied with some extremely interesting data, but as the basis of calculation of the numbers in employment is not quite similar, and no intelligent quotients are given, real comparison is not possible. It is to be noted, however, that of the 1,919 persons born in or subsequent to 1906, who have left Special Schools and been on the books of the London Association during the year 1924, 1,136 (59.19 per cent.) are employed. In Birmingham, out of 3,513 cases that have passed through the schools since 1901, 1,301 (42 per cent.) are employed at an average wage of 20/11 (males earning from 3/- to ?4, and females from 6/- to 35/-). In the London figures, 271 doing useful work at home are included, and in the Birmingham figures 598 “living at home” and doing no paid work, and in the Hull figures 44 at home “unemployed” are excluded.
Dr Fraser’s results were based upon the Binet-Simon tests. We are greatly interested in the Northumberland Standardised Tests recently published by the University of London Press, Ltd., prepared by Dr Cyril Burt, Professor of Education in the University of London, whose work in connexion with standard- ised tests is so widely known.
These tests, as printed, are a model of clear arrangement, and should be eagerly welcomed. They were originally prepared at the request of the North- umberland Education Committee,t mainly with a view to examining school chil- dren aged 10-12, and selecting suitable pupils for Scholarships for Secondary Schools. The tests are in Arithmetic, English, and General Intelligence. The manual of instructions makes the principle of marking according to age extremely clear.
As Dr Burt says in his foreword : As contrasted with the ordinary exami- nation paper, the present test-sheets differ in several ways. First, instead of having long questions to answer or short essays to write, the child is confronted with a large number of brief problems; and all he has to do is to write down a few figures or underline particular words. In this procedure there are many advantages, some obvious to all, some clear only to those who are familiar with psychological research. It is a general principle, which recent investiga- tions have established, that, given a limited amount of time, a far better measure is obtained if the child is required to answer a large number of short questions instead of a small number of long questions. This is contrary to the traditional procedure adopted by most teachers and examiners, but seems well borne out by experimental work. The method of underlining- answers, instead of writing them, ?s a further feature that may be novel to many. It has two advantages : first, speed of writing (a very variable factor with young children) does not affect the final result; secondly, no uncertainty is possible about the correct replies, and all examiners are forced to allot exactly the same marks to equivalent answers? an utter impossibility with answers of the essay type.
New Zealand and the Mentally Defective.
A report by a Committee of Inquiry, appointed by the New Zealand Ministry ?f Health, was laid on the table of the House of Representatives at the end of June. The question of the treatment of mental defectives and of sexual offenders was the subject of the Inquiry, and the Committee, recognising that the two classes of persons are not identical, make separate suggestions. Three recom- mendations are of special interest. One is that a psychiatrist to advise the Prisons’ Department (and the Courts possibly likewise) on the grouping of sexual offenders, and a Prisons’ Department Eugenic Board should be appointed. A second recommendation would be far-reaching. It is suggested that a Agister of all mentally defective persons should be kept, and that such a register should contain the names given by school medical officers, hospital authorities and judicial authorities. There would be an appeal to the High Court by the person so registered, or by his parents or guardians. Marriage with a registered person would be made illegal.
Less novel is the recommendation which touches on the vexed question oT sterilisation. On this the opinion of the C.A.M.W. is quoted. The experience ?f America in its trial of a sterilisation policy in some of the States is not available in any statistical form, but it is true to say that fewer States now prac- t’se it than when first the policy was adopted. The New Zealand Committee ls of opinion that the Eugenic Board should have power in suitable cases to make sterilisation a condition of removal from the register, persons thus treated having their freedom of action, unless they are found later to be leading an immoral life.
We hope in our next issue to return to this Inquiry. At present the New Zealand Report is not widely available in this country, and we make acknow- ledgment to the “Lancet” for its summary.
The Registration of Nursing Homos.
The Second Reading of the Nursing Homes (Registration} Bill was move”*d ?n June 19th, but was withdrawn on the Government’s promising to refer the subject of Nursing Homes to a Select Committee for enquiry.
The main object of the Bill was the registration of all Nursing Homes carried ?n for private profit (hospitals and municipal institutions being expressly ex- cluded). One of the clauses of the Bill required that after January, 1930, the matron or other person having the management and control of the nursing of the patients should be a State-registered nurse on the general part of the register, ?r a person eligible to be registered on the general part of the register, ?r, in the case of a home used solely for maternity cases, a registered midwife. In view of the promised Select Committee, it is interesting to note that the National Council for Mental Hygiene gave in their evidence before the Royal Commission on Lunacy and Mental Disorders strong support to the registration of Nursing Homes. They urged that medical practitioners should be allowed to treat willing and non-volitional patients without certificates in registered Nurs- lng Homes, and they urged the registration of all Nursing Homes under the Ministry of Health. Later in his evidence, Dr E. Farquhar Buzzard said that the idea underlying the suggestion for registration was the same as that concern- lng the treatment of mental cases in general hospitals, i.e., that where one kind ?f disease was dealt with, another kind could also be treated.
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