Notes about Institutions for Defectives
F. Douglas Turner M.B. (Lond.) etc. I am of opinion that the amount of Institution accommodation that will be required in the future is much larger than is generally recognised. My experience as a specialist in seeing patients in their own homes for the Essex Mental Deficiency Committee has shown me the very large number of defectives in one County alone that need and should have Institution care. I believe tha,t large Institutions taking all grades of mental defect from the STUDIES IN MENTAL INEFFICIENCY. 33 lowest idiot to the higest type of feeble-minded are the only way of dealing with defectives. The cases would necessarily be classified according to their mental capacity in different blocks of buildings. 1 he small homes have done admirable work at small expense, and have helped considerably in making some provision for defectives, but it is to be remembered that few of them took low grade cases. When, however, a public authority is dealing with defectives it has to take all classes of paor it is no use. It is just as much the duty of the local authority to provide for the paralysed idiot unable to feed or do anything for itself as to segregate the good-looking feeble-minded girl who may become a danger to society. When a County Authority, or two Counties combined, realise that they will eventually have to provide for say a thousand defectives, it is inconceivable that they will do this by means of homes scattered about the County with forty or fifty patients in each. The expense would be prohibitive, the duplication of staff for teaching and for cooking and supplies alone would make it impracticable, and the difficulty of supervision would make it unworkable. 1 he large numbers of defectives that will have to be dealt with in the future can only be dealt with in the large Institution. A valuable point in favour of the large Institution is that it enables the patients to be better classified, according to their respective mental and physical capacities. The larger the total number to be classified the easier it is to divide them up so as to secure about the same degree of defect in each class. I think the tendency will be to have Institutions containing a thousand or twelve hundred patients, but personally I should prefer one with not more than six or seven hundred, because I think this is the largest number a superintendent can keep in actual touch with, and it is important he should have a personal interest in all his patients. Of necessity also the large Institution must take all grades of defect. The County Authority with a thousand defectives to provide for cannot have one Institution for those called feeble-minded, another for inbeciles, and another for idiots. But there are better reasons than convenience. The all-grade Institution is more economical. The high grades do the skilled work for the low grades, the low grades do the unskilled work for the higher grades. An Institution composed of high grade cases alone would be very nice, but there would be a very great waste of labour. Much of their time would be taken up in doing work that might easily be done by lower grade patients. For instance, it is a waste of ,time for a boy who can make a brush to spend his time sandpapering the back to make it smooth, when another boy who cannot make a brush and can never learn to make one could do the sandpapering; or to keep a boy who can sole a boot merely cleaning boots when there are other boys, who cannot sole a boot and will never learn to, quite able to polish a boot. Many other instances of this kind could be given. The principle applies to each trade that is taught. Those who can do housework even though not very high grade, can do the housework of that part of the Institution where there will be helpless idiot cases who can do 34 STUDIES IN MENTAL INEFFICIENCY. nothing for themselves. The nursery can find useful employment for some ot the higher grade women helping under supervision to look after the children. It is work the women like and it is good for them. An Institution confined only to low grade cases would be very expensive if the whole of the labour had to be supplied by paid staff. If the Institution takes all grades, then the better patients will make all the clothing and boots, brushes, etc., do the laundry work and supply the labour necessary to provide the vegetables and milk, for the lower grade patients. There is another point in favour of the all-grade Institution, which in practice saves trouble. Patients improve, patients deteriorate; a word from the Superintendent sends them up or down one or more classes. The change will take place much less often and will take much longer in the doing if it means a transfer to another Institution. One of the most important points in organisation is the number of classes in which the patients shall be divided. Their classification must depend on mental and physical capacity alone. I am referring to their life in the Institution and not to the organisation for school work. That is a different matter, and as I have already indicated you snould get in your workshops a mixing of grades if you are to get the best results. There must, of course, be a male side and female side to the Institution. On each side you will want at least the following clesses. ‘ First class ‘ means the highest grade mentally : First Class Adults, Second Class Adults, Third Class Adults, Youths’ Class, First Class School Children, Second Class School Children, Nursery or Third Ciass Children, Adult Feeble and Paralysed Class, Hospital It is worked out for an Institution of six to seven hundred patients. A larger number will enable further improvements in classification to be made. The Nursery Class should take the babies and the helpless cases the size of children; as everyone with experience will know, size with this class of patient is no guide to age. They may be any age. If placed on the female side of the Institution it can be used as a combined class for male and female nursery cases. The Youths’ Class is for high and medium grade boys from about fourteen to eighteen. Many boys of fourteen are too big or know too much to live any longer with school boys, though they may still attend school for part of the day. They are not big enough to be with adults. A separate day room, lavatory, and bedroom is necessary. I am not sure the class corresponding to this is necessary on the female side though I think it desirable, but in place of it, most Institutions will want a special class for the higher grade cases too vicious to mix with the ordinary patients. I do not think a separate youths’ class is necessary for lower grade boys. It is not necessary to have separate classes for epileptic defectives. They may go to the class indicated by their mental capacity. The other defectives do not appear to mind the epileptics and the cases having the worst and most frequent fits tend to deteriorate mentally and to sink to the lower grade classes. In many places, the adult feeble and paralysed cases tend to drift to the hospital and block that building. It is better if possible to have separate STUDIES IN MENTAL INEFFICIENCY. 35 accommodation for them and keep the Hospital free for the acute cases. The hospital must provide separate accommodation for tubercular patients, but it is necessary to have in addition isolation accommodation for dysentery. Dysentery can be just as great a bugbear in an Institution for defectives as in one for insane people. Isolation accommodation is also necessary for the ordinary infectious diseases like scarlet fever. An Institution for defectives is as bad as an ordinary school for spreading infection. If it is possible to arrange with the local sanitary authority to receive these cases into their Infectious Hospital, it saves a good deal of anxiety and gets them right out of the Institution and it is in my opinion the best way of dealing with the matter. If this is not possible, a separate isolation hospital is necessary with facilities for doing the whole of its own laundry work and cooking. The Board of Control have published suggested plans for mental deficiency Institutions of three hundred and twenty beds, and six hundred and forty beds so that it is unnecessary to go into these. A suggestion I would make is that more day W.C. accommodation be allowed for the lower grade patients. In my opinion the lower grades want one W.C. to seven patients if they are not paralysed or nursery cases. The nursery cases are generally treated like babies and the paralysed cases mostly need special commodes. The next thing to consider is occupation and training for the patients. Those under fourteen will go to school, except some of the paralysed, nursery and very low grade children, but most of those commonly called low grade will benefit considerably by some kind of training. In the upper classes the school work approximates to that of second standard in an ordinary school with plenty of musical drill and dancing. Dancing even such a complicated thing as “The Lancers” or “La Triomphe” is well learned and of exceptional benefit physically and mentally. In all classes taking three R. work, every afternoon should be devoted to manual work including, even for boys, sewing, making button holes, etc. The ordinary manual occupations arc so well known I need not go into them. The classes below these upper ones will be doing the elements of three R. work. There should be plenty of simple object and conversational lessons; let the children not only see but touch and use the things on which the lesson is being given. Have special speech training lessons. The dancing can be nearly as advanced as for the upper classes. Then there should be a class into which doubtful cases can go, a kind of testing class. If after a probation here, it is thought the child will do any good at three R. work it is sent up to the lowest three R. class, but if it is decided that the child will never do any good at these subjects it is better not to waste time trying to teach him but send the child to the lower classes where the whole teaching is oral-manual, where in fact the object is to train chiefly the patients’ hands and legs. It does however frequently pay to put a child you think will do fairly well at the three Rs., first for a month or two into the oral manual class. It will wake him up, teach him to carry himself properly and to use his hands and feet and certainly benefits 36 STUD1KS IN MENTAL INEFFICIENCY. his after-training. The personahty of tile teacher in the lower grade classes counts tor much. She must have great energy and patience, but she must have initiative also and be frequently thinking out fresh exercises, the simpler the better. A lot of instruction for these children can be got out of a pair of steps, an old box or two, a couple oi 9 inch wide planks, a small wheelbarrow, a box ol skittles, a rug, a pillow, a skipping rope, and a good many wooden bricks of various sizes. J_et everything be made in the Institution. The best size bricks are four inches square so as to give the hands some work to do. Smaller bricks are not heavy enough and do not stretch the lingers enough. In addition for building and balancing have some 9” x 3” * 1” and some 4^” x 3” x 1”. Have an equal number of each painted with eacli oi the six brightest colours. Bright colours are essential lor lower grade work, a fact not recognised in the Montessori apparatus. As the children become fourteen each case should be considered separately. Some are still doing well at ordinary school subjects and may continue in the school classes ior another six months or a year but many or most will benefit by going half-time into a proper shop where they will be taught the hrst steps of a trade and if they get on at this work they should in my opinion go ail day to the shop oil or before, reaching fifteen. With girls, their manual work in school consists so much of needlework and laundry work which is the very work they will probably be doing when they leave school, that there is not the same need for them to leave the school classes for the industrial classes so early as the boys. In regard to manual occupations for adult defectives, an old established Institution is in a little different position to that of a new Institution. The new Institution will not, to begin with, have a large number of patients available for occupations and it will be necessary to concentrate those they have on the work that must be done. Their efforts will therefore be devoted to house work, that is making beds, sweeping up, setting tables, washing up and cleaning generally for males and females, and to boot repairing, garden and farm work for males, and laundry work and needle work including iepairs for females. As the numbers increase, the other ordinary occupations can gradually be added, such as making suits and dresses, brushes, baskets, mats, furniture, cutting up firewood. Later, printing and a tinsmith’s shop may be added, and if the Institution is ambitious and has sufficient labour, the weaving of cloth, blankets, and shirting, as at the Western Counties Institution. Far more, however, will be learned about industrial occupations by a day at Darenth Industrial Colony or at the Western Counties Institution than by any number of written articles. So far as my experience goes, the following are a few practical points. Basket and hamper making is one of the most difficult occupations. It is not easy to get the baskets a proper shape as there is no fiame or shape to make 011, it is all a matter of hand and eye. Brush making when confined to the wire-drawn brushes is one of the easiest occupations. For an ordinary scrub it does not matter much even if the amount of stuff in each hole varies a good deal. It does matter, though, for a clothes or hair brush. STUDIES IN MENTAL INEFFICIENCY. 37 Tiic pitch-work brushes are more difficult. Yarn, wool-bordered and wool mats made 011 a loom are 1101 an easy occupation, but it is a paying one, and picking the fibre is useful work for quite low grade patients. A loom makes better mats than a frame, but the frame is easier, though only yarn mats can be made 011 it. There is 110 difficulty in finding a ready sale for these mats whereas the wool rugs made on canvas in school, though they are a good occupation and one the patients enjoy, are not easy to dispose of in any quantity. The wool costs so much. The carpenter’s shop will find plenty to do in the way of repairs, but the aim of this shop should be the making of every bit of furniture the Institution requires except bedsteads. Ihey should not be satisfied with tables, cupboards, and chairs, but should make staff chests of drawers, wardrobes, washstands, sideboards, etc. Wood carving is not perhaps an occupation for every Institution, but where a good trainer is available it is interesting work for the patients and pays well. Begin with chip carving and go on to relief work later. In the girls’ needlework department aim at making the patients’ dresses and every bit of underclothing, male or female, that the Institution wants in the same way that the tailor’s shop makes all the suits and men’s uniform. Stockings and boys’ jerseys are also knitted in the girls’ department. Stocking knitting is easily picked up, though monotonous work. Jersey knitting is difficult. In the laundry, which will of course be a machine one, it is best to have the washing department cut off from the ironing part, then male labour can be used in the former, where the work is heavy, and female labour in the latter. In most cases it is better not to keep the girls at laundry work morning and afternoon, but to let them put in half the day at needlework. Garden work and farm work naturally fall to the men and absorb a lot of low as well as high grade labour. The girls can only be employed at garden work in a mixed Institution if their part of the garden is well shut off ?from the male side. The girls enjoy it the greater part of the year and are healthier lor it. Chickens are best looked after by girls. Amusement is as necessary as work for defectives but the desire for it has to be stimulated or many will sit round quite contented to do nothing. For exercise for the males, football, cricket, gymnasium and athletic sports are good. I have not had experience of boxing. The girls, however, are not nearly so keen on exercise. They will play cricket after a fashion, they will kick a football about to keep warm and they seem to like rounders. Lately we have tried hockey and they seem to like this best. Tennis and croquet they take little interest in. A a matter of fact, girls, especially those who are grown up, seem to prefer doing crotchet and knitting lace in their spare time. There should be a dance once a week or fortnight in the winter, combined with musical chairs, and songs and sketches for the lower grade who cannot dance, but barn dances, military two-steps, veletas, etc., are easily learned. A Brass Band is a necessity; it should consist almost entirely of patients. All the better patients can learn whist; an occasional whist drive with small prizes is appreciated; a few can play chess, many draughts, and a great many snap, ludo, etc. 38 STUDIES IN MENTAL INEFFICIENCY. We find that in an Institution taking all grades, the proportion of staff to patients works out at one to five. This includes the whole staff, teachers, industrial trainers, artizans, and domestic staff as well as attendants. Whereas the very low grade patients need a large number of attendants to look after them, the expense of looking after the high grade cases is increased by the necessity of having teachers and industrial trainers. Every trade taught needs one properly qualified tradesman, not an amateur to teach it. If the shop is so large as to require more than one staff, the second one can be an unskilled or partly skilled man or woman who has been taught in the shop itself. In the schools it is necessary to have certificated and uncertificated teachers for the higher classes, but for the lower grade classes where the work is oral-manual, school attendants can be successfully employed.
Bibliography
- Reference type:
Journal Article
- Record-number:
17208
Author: Turner, F. D. Year: 1920 Title: Notes about Institutions for Defectives Journal: Stud Ment Ineffic Volume: 1 Issue: 2 Pages: 32-38 Epub-Date: 1920/04/15 Date: Apr 15 Short-title: Notes about Institutions for Defectives Alternate Journal: Stud Ment Ineffic PMCID: PMC5109084 Accession-number: 28909962 Notes: Turner, F Douglas eng England Stud Ment Ineffic. 1920 Apr 15;1(2):32-38. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109084/ Name-of-database: PubMed Language: eng Copyright:Attachment: internal-pdf://0164392850/Notes about Institutions for Defectives.pdf
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