News and Notes
The C.A.M.W. and the Royal Commission on the Administration of the Lunacy Laws.
At the July meeting of the Council of the C.A.M.W. a member raised the question as to whether the C.A.M.W. should offer evidence before the Royal Commission on the Administration of the Lunacy Laws, just set up by Parliament. The subject was felt to be of such importance that it was referred for consideration to a Joint Committee of the Medical, Education and Parliamentary Committees, who were to report upon it to the October Council.
The Joint Committee met on September 29th and its decisions were embodied ,n a report which was approved by the Council on October 13th. The chief points of the report are set out below.
It will be remembered that the Royal Commission’s terms of reference are as follows :? (1) The existing Law and administrative machinery in England and Wales in connection with the certification, detention and care of persons who are, or are alleged to be, of unsound mind ; (2) The extent to which provision is, or should be, made in England and Wales for the treatment without certification of persons suffering from mental disorder.
With regard to (1) the Council has decided that no evidence shall be offered on the subject of mental deficiency, as this is not strictly within the terms of reference of the Commission. Some members of the Council, moreover, are strongly averse from running any risk of the administration of the Mental Deficiency Act being brought into closer touch with that of the Lunacy Laws. At the same time the Council decided that the C.A.M.W. should watch carefully the evidence given before the Royal Commission.
With regard to (2) the Council have authorised the Medical Committee to prepare a Memorandum on the subject of ” borderline ” cases, and cases of disordered conduct as a result of encephalitis lethargica. It was felt that the C.A.M.W. and its Local Associations might possess valuable information, not in the possession of any other body, on these types of cases, and that such information ought to be available for the information of the Royal Commission. This Memorandum is to be presented to the Council in January, 1925, and it will then be decided what further action, if any, should be taken. Should any necessity arise for immediate action before this date, the Officers of the Association and the Chairman of the Medical Committee are authorised to take such steps as they deem advisable.
National Special Schools Union Conference, —————————————-A very successful Conference was held in Glasgow by the National Special Schools Union on October 9th, 10th and 11th.
The papers included four on subjects of special interest to Mental Welfare Workers, viz., ” The Special Schools and the Importance of their Position in the Social Organisation,” by Dr Ivy Mackenzie, Consulting Physician, Glasgow District Board of Control ; ” The Problem of the Uneducable Child,” by Dr. Letitia Fairfield, Assistant Medical Officer, L.C.C. Public Health Department ; ” The Place of the Colony in the Permanent Care of the Feeble-minded,” by Lady Leslie Mackenzie, and ” Some Observations on After-Care of the Mental Defective,” by Mrs. Fern, Renfrewshire Education Authority.
During the Conference, facilities were given to delegates for visiting various Special Schools in Glasgow and the neighbourhood.
We are informed that the papers read at the Conference will shortly be published at the price of 1 /- a set, and orders for them should be sent to Miss Aitchison, Broomloan Road School, Govan, Glasgow.
The British Medical Associetion and the Prevention of Mental Deficiency. At the Annual Conference of the British Medical Association, held at Bradford in July, one of the Sessions was devoted to a discussion on the ” Prevention of Mental Deficiency,” when the opening paper was given by Dr A. F. Tredgold. A debate of great interest to Mental Welfare workers followed, but we regret that, owing to pressure on our space, we are obliged to hold over a report of it until our next number.
The First English ‘’ Hostel’’ for Defectives. ——————————————-Although, as Miss Winifred Gibson in sending us the following account points out, the Hostel recently opened by the Surrey Voluntary Association is as yet only in its difficult initial stages, we arc glad to have the opportunity of bringing the experiment to the notice of our readers, as it is the first of its kind yet actually launched in this country :?
” The Eagle House Hostel, Mitcham, was opened at the end of May this year, and there are already 14 girls in residence. The type of girl admitted is the high-grade certified defective who has already had experience of Institution life in an ordinary Certified Institution, and who has shown by her general behaviour that she is fitted for wider opportunities of increased liberty.
The girls at Eagle House are encouraged to look upon it as their own home. They not only do the housework, but provide small accessories themselves. So far their chief work has been to get the house and garden in order and to equip themselves with outfits, but one or two have already been tried in factory work with considerable success. The difficulty here is to obtain speed equal to that of the normal girl in a somewhat complicated operation, but great improvement has already been shown. The girls sent to the Hostel up to the present time are also rather above the age of those usually employed in the factory, but we hope to have some younger girls soon.
The additional liberty given to the girls has been fully justified. They shop, do errands, and go backwards and forwards to work without any escort, and have given no trouble whatever. One or two of them have been home to see their relatives. The chief difficulty is to find enough suitable work outside the Hostel but near enough to make daily work practicable. The second difficulty has been the very serious ill-health of long standing of many of the girls admitted. The general spirit in the Hostel is excellent. The cliques and animosities which were very evident at first are gradually being broken down and a spirit of comradeship is taking hold. At first the girls were ultra-sensitive about their mental condition, and when one or two slightly lower grade cases were admitted, there was resentment on the part of the first comers.
The experiment is as yet only in its initial stages but the results so far are hopeful and encouraging.
The Work of the Metropolitan Asylums Board for Mental Defectives. The Annual Report of the Metropolitan Asylums Board, recently issued, contains a section on Mental Diseases which should be of great interest to Mental v> elfare workers, who perhaps do not always fully realise the extent of the Board’s activities in connection with Mental Deficiency.
On December 81st, 1923, there were in the Board’s five Mental Hospitals? Cater ham, Leavesden, Tooting Bee, the Fountain and Darenth?4,956 mentally defective patients, 3,125 of whom were certified under the Lunacy Act, and 1,831 under the M.D. Act and there are now provided for :? (a) Chronic and harmless cases of all forms of insanity.
Idiots and imbeciles who come within the terms of the Lunacy Acts.
(c) Feeble-minded persons as approved by the Local Government Board in 1897 and 1911.* (d) Cases covered by the Mental Deficiency Act, with the exception of those who have been found guilty of any crime of violence and of moral imbeciles.
A careful system of classification is in force. Thus the Fountain Mental -^ospital is reserved for children under 7, unimprovable boys up to the age of 9, and unimprovable girls up to 16. Caterham takes healthy unimprovable adults and unimprovable low-grade and trainable children, including large numbers of b?ys passed on from The Fountain on reaching the age of 9. Leavesden is regarded as an infirmary institution accommodating unimprovable adults, most of whom are suffering from some form of chronic infirmity. Darenth caters for trainable children and for adults capable of industrial training.
The Report devotes considerable attention to the subject of training and occupation, and an account of Caterham Mental Hospital contains a section on the methods adopted for dealing with the low-grade children there, for whom classes have recently been instituted, with the help of one of the C.A.M.W. Occupational Organisers, under the direction of an experienced teacher. The school department is also a prominent feature of the work at The Fountain, despite the fact that the majority of the children sent there are received as ” unimprovDuring the year several scientific researches bearing on different aspects of * E.g., Patients who ” by reason of mental defect, are incapable of receiving proper benefit from ordinary instruction, or cannot be properly trained in association with other persons in ordinary schools or institutions, or are incapable of using ordinary means or precautions for protecting themselves from injury or improper usage or treatment, or are incapable of maintain,r,g themselves by work,” mental deficiency have been made by the Board’s medical staff and in the Report papers are included on the following subjects :?” The Diagnosis of Mental Deficiency,” by Dr E. B. Sherlock, Chief Medical Officer in the Mental Hospitals Service ; ” Syphilis as an Aetiological Factor in Mongolian Idiocy,” by Dr R. M. Stewart, Medical Superintendent of Leavesden, and Dr D. O. Riddell, late Assistant Medical Officer ; ” An Application of the Methods of Industrial Psychology to Mentally Defective Persons,” fry Dr P. D. McGowan and Dr John Rose, Assistant Medical Officers of Darenth Training Colony ; and ” Cases illustrating the After Effects of Encephalitis Lethargica,” by Dr Charles Glen, Assistant Medical Officer at Darenth.
The Mental Diseases Section of the Report is published separately and can be obtained from the Offices of the Metropolitan Asylums Board, Victoria Embankment, E.C.4, price 1/-.
Mental Defectives and Sexual Offences. ————————————-The liability of mentally defective persons to commit sexual offences is a question which is manifestly of great practical importance and must be taken into account in any discussion as to the necessity of the provision of institutional care. It is a question, however, upon which we lack data in the shape of definite facts and figures, and any contributions which can be made towards building up such a body of knowledge should be welcomed by mental welfare workers.
In our April number we recorded some investigations made by Dr Hamblin Smith, and we can now add to them those of another investigator, Dr Norwood East, late Senior Medical Officer of H.M. Prison, Brixton, and now Medical Inspector of Prisons in England and Wales.*
Dr East took as his material a series of 150 cases admitted to Brixton Prison on trial or on remand charged with the offence of exhibitionism or indecent exposure, and these he classified into two main groups : (i.) the psychopathic, and (ii.) the depraved. In the former group, consisting of 101 individuals, he found 24 who were definitely mentally defective and 9 who, though not certifiable, were sub-normal, this making a total of 22% of the whole number investigated.t The offence, as committed by this group, may have various causes. It may be due, Dr East writes, ” to a lack of appreciation of social convention, to be contributory to masturbation, to obtain sex gratification or stimulate phantasy, to attract, excite, or invite some female or child, and occasionally it appears to be due to an infantile pleasure in showing off.” In another case it appeared to be a ” retaliatory insult to some girls who, the defective said, were accustomed to laugh at him in the street, probably on account of his foolish appearance. The exposure in this case seemed fairly comparable to the less offensive putting out of the tongue at times indulged in by children.”
Whatever the exciting cause, however, Dr East considers from his personal experience that ” any sexual offence committed by a defective will be repeated unless institutional care is adopted.” It would be well if this significant pro* ” Observations on Exhibitionism,” reprinted by The Lancet, August 23rd, 1924. t It is interesting to compare these figures with those of Dr Hamblin Smith who, out of 50 cases of indecent exposure, found 18 mentally defective or sub-normal, a percentage closely agreeing with Dr East’s, nouncement could be borne in mind by all magistrates when faced with th? necessity of deciding how to dispose of cases of this sort brought before them. Mental Defect in a Rural Area. A Survey.
In a recent number of ” The Lancet “* there is published a paper containing the results of a systematic attempt by the Local Education Authority of Wiltshire to carry out its duty of ” ascertaining ” the number of mentally defective children in the area.
The statistics that resulted are based on the examination of 4,979 children, the majority of whom were tested personally by the Assistant County Medical Officer, Dr E. K. Bowes, by whom the experiment is recorded. There were discovered to be 169 cases of mental defect (feeble-minded, 140, or 88% ; Imbecile, 27, or 16% ; Moral Imbecile 1), making a proportion of 3% of the total school population of the area (Imbecile, 5% j feeble-minded, 2.5 /0). This proportion is higher than that found by other investigators taking the same standards of classification but working in urban areas (Dr Cyril Burt s corresponding figures for London, e.g., for feeble-minded children, being only 1.5%), but for various reasons Dr Bowes considers his estimate probably errs on the side of being too low, and that 4% is likely to approximate to the actual number.
The results of his investigation the writer interprets as pointing to the fact that the number of mentally defective children in Wiltshire is so high because it is a rural area, and that in a rural area the incidence of mental defect is higher because of the lower level of intelligence at which it is possible to maintain partial or complete self-support. He would, however, no doubt admit that until other Rural Education Authorities have conducted an ascertainment equally thorough, generalisation from the experience of one county alone can be only very tentatively made.t t th 4u,?ust> 1924- , .. , ?nval Commission on the Care and Control of the Feeble-SUe ^ ” MenW Deflciency.” 4th Edition, P* 179 et seq.
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