Notes and News
Board of Control.
Sir Marriott Cooke, K.B.E., M.B., and Dr Sidney Coup land, F.R.C.P. (Consulting Physician to the Middlesex Hospital) have retired from their position as Commissioners of the Board of Control. Both of them were appointed Commissioners in Lunacy in 1898 and the former, who was previously Medical Superintendent of the Worcester County and City and the Wiltshire Asylums, acted during 1916-18 as Chairman of the Board.
The London Gazette of the 18th November announced that the King has appointed Sir Edward Marriott Cooke, K.B.E., M.B., who had recently retired from the Board of Control, to be an unpaid Commissioner of the Board of Control for Lunacy and Mental Deficiency.
Annual Report of the C.A.M.D., 1920-21. ————————————–For the benefit of those readers who have not seen a copy of the recently issued report of the C .A .M .D. we append a short summary of its chief contents. Six new Local Associations for the Care of the Mentally Defective were formed during the year 1920, viz., South East Lancashire, North Lancashire and Central Lancashire (all at the request of the Lancashire Asylums Board), Portsmouth, Staffordshire, and Suffolk, a trained organiser being sent in each case to start the work. Arrangements were also made to start an Association in Worcester City, the prospective local Secretary coming up to the Central Office for a period of training. The Exeter Association unfortunately found itself unable to continue its work, and has now ceased to exist.
The training of workers has been actively carried on, and during the year eleven social workers came to the office for the purpose, ten of whom are now employed as Secretaries or Assistant Secretaries of Local Associations. In addition the Superintendent Health Visitor for the Durham County Council came up for a short time to gain an insight into the work, as did also an American student from the London School of Economics.
Four other students took Part I. of the C.A.M.D.’s Training Course which consists of three weeks in a Certified Institution.
Two Short Courses for Teachers of Mentally Defective Children were held on behalf of the Board of Education during the year, one at Colchester attended by forty students, and one at Manchester attended by forty-four students. The holding of two Post-Graduate Courses for Medical Practitioners in conjunction with the University of London constituted a new development of the work. These were attended altogether by 142 students and proved a great success. At the time of the Joint Conference of the C .A .M .D. and the National Special Schools Union held at the Church House, Westminster, in November, a series of three meetings were arranged for the Secretaries of Local Voluntary Associations, forty-one of whom were able to be present.
A course of nine public lectures was also given during the year. A new Standing Medical Committee has been appointed to act as an advisory body to the Council on matters needing expert medical opinion. A Special Statistics Committee was also appointed during the year to revise the form of Annual Return in use by Local Associations.
From 1st January 1920, to 31st December, 603 cases of defectives were referred direct to the C.A.M.D., and those coming from areas where there is no Local Association were dealt with in various ways. The total number of cases recorded on the central register amounted at the end of the year under review to 22,856, this being an increase of 4,408 on the previous year.
The circulation of ‘’Studies in Mental Inefficiency” rose during the year to 890, in addition to the sale of single copies.
The reports of 32 Local Associations are appended to the Report: these received notice in our last issue.
Change of Name of G .A .M. ,D. As reported in our last issue the Council of the C.A.M.D. held, on July 18th 1921, had before it a Resolution to change the name of the Association to the “Central Association for Mental Welfare,” based on a Memorandum on the subject drawn up by the Chairman, Mr. Leslie Scott, which had previously been circulated. Considerations of space precludes its reproduction in full, but it may be summarised as follows:?
It is in the direction of the care of the defective in the community?one of the three main functions of the C.A.M.D.,?that its work needs development , for experience has shown:?
(a) that advice and assistance for high grade and for borderland cases cannot be sought too early, and (b) that the number of such cases where parents and relations do not know where to apply for help and advice is infinitely larger than was ever thought possible.
It has been found that the present name of the Association tends to limit its usefulness in dealing with these cases, for the popular belief is that “mental deficiency” necessarily implies a condition of imbecility or idiocy and parents of high grade cases or of those who may be on the borderline shrink from seeking the help of the Association except as a last resource, when irreparable harm may have been done. For the same reason the following important branches of work may be instanced as being handicapped by the present name:?
(a) Training Homes, Schools and Institutions for children and young persons. Many children and youn gpersons pass through Homes and Schools and are known to the authorities as rather sub-normal, possibly high grade feebleminded, unbalanced, and likely to fail in competition with others. Such children on leaving the Homes would benefit by the advice of those trained and experienced in dealing with such cases, and yet the authorities of the Homes hesitate naturally to refer for help to an Association for “defectives.” (b) Special Schools, After Care and Employment.
Many children leave the Special Schools without being notified to the Local Authority and the larger proportion of these are for a time at least, capable of employment, and often of good work. But help is needed to enlist the interest of employers and secure the right work under proper conditions. Employers often hesitate to take children coming from an Association with a name they completely misunderstand.
(c) Criminals and Persons brought before the Courts. Criminals and persons tried before the Courts, or in prison, who are, if not actually defective, often subnormal, are in need of special advice and treatment. Magistrates, prison doctors and others connected with the administration of the law, often hesitate to refer cases to the Association for help and advice, as unless the persons charged are absolutely certified as defectives it may hinder rather than help. In view of the general ignorance regarding mental deficiency it is clear that many persons who specially need caring for are thus lost sight of.
Amongst other considerations too which bear on the subject is the possibility that the Association may later be able to assist workers who are claiming exemption from the Minimum Wage clause of the Trade Boards Act on the grounds of “mental infirmity.” It can be easily understood that its present name might be looked upon as likely to prejudice the Board and both employer and employee.
A further weighty factor in the question is the future position of the Association with regard to the home visiting of cases attending Psychiatric Clinics for the early treatment of mental disease, which are now being started in connection with an increasing number of general hospitals. Experience has already shown that a not inconsiderable proportion of pat ients brought to such Clinics are mentally defective or on the borderline of mental defect. If separate workers are to be employed to visit these cases a certain amount of overlapping will be inevitable. It would therefore seem desirable that visitors of the mentally defective should be so trained as to be qualified to undertake this special visiting if asked to do so. Here again the name stands in the way.
The development of the work as set out above does not mean a new departure for the Central Association. It means a constructive and organised carrying out of the work for which the Association was originally formed, in a manner which will be recognised by the public and which will make it more efficient and more complete. No alteration will be needed in the Memorandum and Articles of Association owing to the wide lines on which they were originally drawn up.
In conclusion it is pointed out that it is not suggested that the Local Voluntary Associations affiliated to the C.A.M.D. should feel compelled to follow its lead by changing their names also: the matter will be left entirely to their own discretion.*
During the course of his remarks upon this Memorandum Mr. Scott referred to the possibility that those members of the Council who represented Institutions formerly registered under the Idiots Act might?after their long and splendid fight in support of their contention that Mental Deficiency and insanity were two different conditions which needed different legislation and treatment?look upon the proposed change as a retrograde step. He felt, however, that such would not be the case as the Association would always continue to recognise that vital distinction. As regards the new name he did not pretend that it was perfect, but after long and earnest thought it was the best they could arrive at.
An Amendment proposing that the words “and nervous” should be added after “mental” having been lost, the original Resolution was carried with one dissentient. The Resolution was accordingly submitted to the Annual Meeting on October 20th, and the decision of the Council was endorsed by a large majority. An application to the Board of Trade for permission to carry out the change of name has now been forwarded and as soon as it is received the necessary steps will be taken.
Conference of Educational Associations. ————————————–As we go to press, the C.A.M.D. is taking part in the Tenth Annual Conference of Educational Associations held at University College during the first week in January.
Lectures are being given by G. A. Auden, Esq., M.A., M.D., D.P.H., F.R.C.P., School Medical Officer, Birmingham, on “The possibility of co-operation between the School Medical Officer and the Teacher in the Training of Subnormal and Mentally Defective Children”; Miss Lucy G. Fildes, B.A., Holder of Board of Control Research Studentship, Psychological Laboratory, Cambridge, on “The Training of Teachers for Mentally Defective and Backward Children and Special Methods of Teaching”; and Miss K. L. Marsden, Inspectress of Infant Schools, City of Nottingham Education Committee, on “The Organisation and Scope of Backward Classes.”
An Exhibition of didactic apparatus, etc., used in teaching mentally defec?Three Local Associations have already made the change, viz.: Cambridge, Suffolk and Ipswich.
tive children, specimen schemes of work, time-tables and photographs is also on view.
It is thus hoped to bring before the public the educational needs of the mentally defective and the backward child and thereby to stimulate interest in his welfare.
By the time this journal is issued the Conference will be over, but a report of it must be deferred to our next issue.
New Occupation Centres. ———————-Four more Occupation Centres have been opened by Local Associations during the last few months?at Willesden, York, Worcester and Barrow.
The Worcester Centre which was opened at the end of June, first on two days a week, then on four, has an average attendance of seven: a room was lent temporarily by the Education Committee, but upon its being required a few weeks ago, other quarters had to be found. The centre is now installed in a room at the Congregational Chapel for which it only has to pay firing and caretaker.
The expenses are met by voluntary subscriptions and the Centre is run by voluntary helpers with the assistance of the Secretary of the Association.
The Willesden Centre, opened at the beginning of October, is attended by seven children. It is held three half days a week in a room in the School Clinic lent by the Education Committee, and is in charge of an experienced worker with the assistance of volunteers. The Board of Control have allowed part of the grant which they give to the Association to be used to meet the expenses of the Centre, but this has to be supplemented by subscriptions and donations.
The York Centre opened at the end of October, and has at present an attendance of only three children; it is hoped, however, shortly to find occupations for some of the older boys and girls who are at home unoccupied and deteriorating. A loom has been purchased with that end in view and mat and rug making will also be taught if possible. A part-time teacher, trained in Nursery School work has been appointed. The expenses of the Centre are at present paid from the interest of a capital sum originally subscribed for starting a Home, but not used for that purpose. Later it is hoped to obtain voluntary subscriptions to supplement this income.
The North Lancashire Association have made a beginning in Occupation Centre work by holding a small class for ineducable children at Barrow one afternoon a week, a room for the purpose having been placed at their disposal by the local Board of Guardians. A similar weekly class is also being held in Lancaster in one of the rooms of the School Clinic lent by the Education Committee. Intelligence Tests.
In the current Annual Report of the School Medical Officer to the Manchester Education Committee an interesting section?contributed by Dr Herd, Chief Assistant School Medical Officer?is devoted to a criticism of the use of Intelligence Tests.
Dr Herd has given special attention to tests allotted to different ages in different scales and publishes a table of his results in Manchester as compared with those of the Stanford Revision and of Mr. Cyril Burt’s revised Binet Scale. He considers, however, that there is a tendency to attach undue importance to the scoring system and to the calculation of “mental ages” and “intelligence quotients,” his criticism being specially directed to the following points:? (a) The fallacy of evaluating each test as of equal importance. (b) The need of more differentiation in the scoring of different types of answers.
The doubtful value of the principle of a time limit to certain tests.
(d) The impossibility of expressing adequately in terms of scoring, the method of response to tests?a factor of considerable significance. But even assuming that an approximately correct mental age can be arrived at by means of tests, of what practical value, Dr Herd pertinently asks, is it? It is of necessity a pure abstraction, particularly in the case of retarded children, owing to the lack of homogeneity amongst them, and their irregularity of development, and the expression, he prophecies, will probably be discarded altogether by psychologists before many years have passed: at any rate, at the present time with tests that are admittedly imperfect, its use is both premature and fallacious.
Dr Herd, however, does not deny that, meantime, certifying officers and teachers may find the Stanford Tests of considerable service, as if they are supplemented by other lines of enquiry they do provide some sort of indication as to whether or not a child is “educable.” Amongst the “crucial” ones he would place first and foremost, the “vocabulary” test, and after that the “differences and similarities,” the repetition of numbers backwards, the “pictures,” the “detection of absurdities,” the “dissected sentences” and the “comprehensive questions,” all of which involve certain of the higher mental processes and are therefore useful for diagnostic purposes.
In the recently issued Annual Report of the Chief Medical Officer of the Board of Education, to which we again refer below, the subject of mental tests is also dealt with at some length and a table (furnished by Dr Shrubsall,of the L.C.C.) is given showing how intelligence quotients can be used by Certifying Officers as a guide in deciding the type of education for which a child is suited.
The use of three types of tests is advocated:?”Education Tests,” “Intelligence Tests” and “Environmental Tests,” these latter being defined as “general questions intended to elucidate the mental relationship of child to home, out of school occupations, teachers, friends, and the world in which it moves, with a view of correlating these findings with the results of education and intelligence tests, and of determining to what extent the child is likely to be able to manage for itself after the expiry of school age.”
Sir George Newman, however,?while not sharing to the full the scepticism of Dr Herd?is careful to point out that the discovery of “mental age” can in no sense be considered to be all that is needed, and he lays particular stress on the necessity of obtaining also a “clinical picture of the mental condition,” a factor which, at the present time, tends to get too much thrust into the background. Report of Chief Medical Officer to Board of Education.
In Sir George Newman’s recently issued report (to be obtained from H.M. Stationery Office, 6s. net.) two sections are devoted to the subject of “Abnormal Children” and Special Schools, and much that is of value to Mental Deficiency workers is contained therein.
To take first, the statistical information:?we learn that it is estimated that there are in England and Wales 37,000 mentally defective children of whom 31,000 are feebleminded, 5,000 imbeciles, and 1,000 idiots;* in addition probably half a million children at least are ‘ ‘dull and backward.’’ The number of Special M.D. Schools is now 201 (compared with 199 last year) with accommodation for 16,123 (last year 15,825), an increase upon which we can hardly pride ourselves. A numerical return of all “ascertained exceptional children in 1920” gives * It is interesting to compare this estimate with that given ia 1914, viz.: feebleminded 24,000; imbeciles and idiots, 12,000. some interesting results. Of 28,344 feeble-minded children reported, 9,389 were attending public elementary schools, 14.656 were attending certified schools for mentally defective children, 1,196 were notified to the local control authority during the year, and 3,103 were not at school. Of 4,500 imbeciles, 467 were attending public elementary schools, 652 were notified to the local control authority during the year and 3,381 were not at school. Of 870 idiots, 107 were notified to the local control authority during the year, 763 not being notified. In this report for the first time official recognition is given to the existence of the “Neuropathic Child” for whom, as such, no special treatment is, as yet, available, although he may be regarded as suffering from a definite defect. His leading characteristics are summed up as follows:?”His behaviour may be marked by certain psychological characteristics, a tendency to quarrel, to make violent friendships, to engender bitter dislikes, to attend unduly to his bodily functions, to night terrors, to unreasonable fears, grief, abnormal introspection and self examination, and to separation from family and friends. The physical accompaniment of these psychical symptoms may include loss of sleep, constipation, diarrhoea, sickness, stammering, fainting, resentment of change of diet and scene, for no assignable reason.” The proper treatment of this type of child is emphasised as being of first-class importance, as permanent mental injury may result from the use of repressive or unsympathetic disciplinary methods. On the other hand by skilful management mental stability may be restored. Special attention has been given to the incidence of this condition at a school in a slum area in Notting Hill, and the figures show a percentage of 12 in 1912-13, rising to 31.6 in 1917-18, and falling to 18.1 in 1919-20. With regard to age incidence it might be supposed that with the approach of adolescence the numbers would rise, but on the contrary there is a material fall in the ages groups of 11,12 and 13, the incidence being greatest at those of 9 and 10. This is attributed by Sir George Newman to the cumulative steadying effect of school-life.
Another subsection of the Report is devoted to the Dull and Backward Child who is described as a “serious factor in national life.” Sir George Newman considers that the problem should be dealt with on the following lines:? (i) Ascertainment of the nature and extent of the problem by special methods of inspection which shall include medico-psychological examination.
Treatment of physical defects associated with backwardness.
(iii) Assisting in framing educational proposals for the suitable training of backward children. (iv) Co-operation with the health authorities in advancing domestic ideals in regard to a proper and hygienic mode of life, and he gives a lucid account of the nature of backwardness and the factors associated with it.
We allude above to the references to Mental Tests which are also to be found in the report.
Mentally Defective Prisoners. —————————-The recently issued report of the Prison Commissioners for the year ended 31st March, 1921, contains some interesting information bearing on the problem of Mentally Defective delinquents.
83 male prisoners and 21 female prisoners were certified under ?fin this connection, see also article on “The Elementary School and the Individual Child” in the October number of the American journal ‘’Mental Hygiene.”
Section 1 of the Mental Deficiency Act, 1913. Orders were made by the Secretary of State under Section 9 of the Act for the removal of 54 males and 8 females to Certified or State Institutions; and 66 males and 29 females were handed over to the care of Local Authorities on discharge or from the Courts. During the year, 67 reports were received of the reception of feeble-minded prisoners not coming within the scope of the Lunacy or Mental Deficiency Acts. In addition to the above, 1,348 males and 390 females were remanded to prison for mental observation and report.
During the year 22 males and 6 females were certified under Section 1 of the Mental Deficiency Act, 1913, and orders were made by the Secretary of State, under Section 9 of the Act, in the case of 6 males and 3 females for removal to Institutions for mental defectives.
The Report refers to the difficulty of securing the transference of Mentally Defective inmates of Borstal Institutions, with the result that some have to be retained for many months after they have been certified. To mitigate the inconvenience occasioned by this state of things it has been decided to collect such certified cases in one Borstal Institution where they can be segregated from the normal inmates and given a special regime. This however is recognised as being an expedient only and its enforced adoption is regarded as indicating “a grave departure from the spirit actuating the advocates of legislative control of defectives and indeed from that of the Mental Deficiency Act itself.”
The Commissioners moreover, it is interesting to note, take the view that ‘ ‘even the provision of adequate accommodation would not remove the problem, for as long as the important operative sections of the Act remain permissive, and not obligatory, so long will these cases remain for considerable periods in prison.” Copies of the Report (C.M. 1523) may be obtained from H.M. Stationery Office, Imperial House, Kingsway, W.C.,Price 9d. net .
A Mental Deficiency Act for Tasmania. ———————————–The Tasmanian Legislature has recently passed a Mental Deficiency Act in connection with the administration of which a Psychological Clinic is being set up in Hobart.
The Act is based upon our own Act, though its procedure is, of course, greatly simplified. It is interesting to note too that it accords legal recognition to the Psychologist who may give one of the two certificates necessary for certification provided that the other is given by a medical man.
Another point of divergence from the English Act is the provision by which defective children leaving ordinary schools at fourteen may be notified to the “Mental Deficiency Board” as well as those leaving Special Schools at sixteen; head teachers of private schools, too, are empowered to report direct to the Board defective children who appear to be “ineducable.”
A Tasmanian correspondent, writing to us about the Act, states that the first task to be undertaken in connection with it is the making of a “survey of the schools for the purpose of combing out the defectives and setting up Special Schools and Classes.” It is intended too, he says “to make a special feature of ‘supervision,’ and the Board is charged with the responsibility of providing supervision for all defectives who leave the schools at sixteen years, and who are not committed to an institution for the feeble-minded.
It will be interesting to hear at a later date how the administration of the Act is progressing.
London Special Schools Sports Association.
We have pleasure in drawing attention to the following report of an interesting development of London Special School work, kindly sent to us by the Hon. Secretary of the Association:?
The possibility of holding sports meetings and swimming galas for Special School boys has often been discussed. Everybody has felt that the boys would benefit by taking part in such competitions and in May last a meeting was held at which all the London Elder Boys (M .D .)Schools were represented, and an Association with Sir Harry Stephen (L.C.C.) as President, Mr. A. H. Hill (L.C.C. Inspector of Special Schools) as Chairman, and Mr. L. C. Beber (of Edward Street E.B. School, Deptford) as Hon. Secretary, was formed forthwith.
The intention was to hold only a swimming gala during 1921, but, owing to the kindness of Miss K. Gallwey, the ground of the Barnsbury Girls’ Club was placed at the disposal of the Committee for a sports meeting.
This was held on Friday, July 8th, the ground arrangements being in the able care of Mr. W. H. Fletcher (Cloudesley E.B. School) and his enthusiastic staff. The weather left nothing to be desired and over four hundred and fifty entrants keenly contested the events, some fine performances being given. Our visitors were impressed by the splendid sportsmanship displayed; this was also shown admirably when at the conclusion of the events the President presented the challenge cup to St. Hubert’s School and the prizes to the winners, for the recipients were most heartily cheered by their less fortunate fellows, and the officials are to be congratulated upon a most successful meeting.
The swimming gala was held at St. Bride’s Swimming Baths on Wednesday, September 28th, and again a good programme was presented and carried out most successfully. The swimming was of a very high order, all the events being closely contested, the same sportsmanlike spirit that animated the previous contests again being shown. The challenge cup (presented by Mr. A. H. Hill) was won by Harmood Street School, whose captain received it from the Hon. Neville S. Lytton, who had kindly attended to present the medals to the winners. Miss Stone, a visitor and friend of Special Schools, was so impressed by the good feeling of the boys that she immediately offered a further trophy for competition in future years.
The Association, thus well started, is now seeking to enlarge its sphere of usefulness and a sub-committee is at work drawing up a scheme to enable the Junior (M.D.) Schools to participate in the sports in 1922. It will be of general interest to learn that Henry Stockton, a pupil at Edward Street E.B. School, has been awarded the Vellum Certificate of the Royal Humane Society for gallantly saving the life of a boy from drowning in the River Thames in June last.
Society of the Crown of our Lord. ——————————-We have been asked to state that the Society of the Crown of our Lord? which has tried to help mental invalids of all classes since 1895?has recently decided to sever its connection with the little religious community (previously a part of it) whose scheme for a sanatorium for mentally defective girls we reported in our last issue. The community in question is changing its name in order to avoid confusion with the parent society.
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