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Feeblemindedness



IN



Children of School-Age



BY



C. PAGET LAPAGE, M.D., M.R.C.P.

Lecturer in School Hygiene to the Manchester University, and
Physician to the Manchester Children's Hospital



WITH AN APPENDIX ON

TREATMENT AND TRAINING

BY

MARY DENDY, M.A.



MANCHESTER

AT THE UNIVERSITY PRESS

1911

1^






University of Manchester Puplications
No. LVIT.



'^\ZZ'L






TO THE MEMORY

OF

HENRY ASHBY



PREFACE.

Up to the present time the immense importance
to our national welfare of effective methods in
dealing with the Feebleminded has not been
generally realised. The report of the Royal
Commission on the Care and Control of the
Feebleminded, published in 1908, has, however,
served as a stimuluSj so that, latterly, there has
been a large amount of interest taken in the
subject. This has rendered necessary the pro-
vision of a book suitable for school medical
officers and also for teachers or social workers
who have to deal with feebleminded children.

The further objects of this book are (i) To
emphasise the importance of the subject of
mental deficiency and of the prominent place
that efficient care of feebleminded persons should
take in the measures for the welfare of the
community.

(2) To point out that feeblemindedness is
an inherited taint handed on from generation
to generation, and that every feebleminded
person, who is a free and unrestrained agent,
may, by becoming a parent, transmit that taint
and so affect tens or hundreds in future genera-
tions.



viii PREFACE

(3) To demonstrate that the only way to
deal effectively with the problem is to provide
suitable supervision and care, which will last
during the whole lifetime of the feebleminded
individual, and to show how such care may best
be administered.

I wish to express my great indebtedness to
Miss Dendy for her help and advice, and for
the material which she has placed at my disposal.
Her appendix on the Treatment and Training
of Feebleminded Children adds immensely to
the practical value of the book.

I also wish to thank Professor Lorrain Smith
for his help, and Dr. J. Mcllraith (Medical
Officer to the Sandlebridge Colony), Mr. Wyatt
(Director of Elementary Education in Man-
chester), and Miss Dickens (Superintendent of
the Manchester Special Schools) for so kindly
placing material at my disposal. Most of the
photographs were taken by Mr. Quinn. Mr.
G. Lapage has also given me much assistance
wnth the proofs.

C. P. L.

Manchester,

November, 1910.



CONTENTS.

CHAPTER PAGE

1. Introductory and Statistical - - - I

2. Physical Characteristics - - - - 46

3. Mental Characteristics - - - 64

4. Defects of Speech - - - - 87

5. Special Types - - - - - loi

6. Diagnosis - - - - - -123

7. Prognosis - - - - - - 141

8. Treatment and Care - - - - I55

9. The Cell, Reproduction, and Heredity - 179

10. The Condition of the Brain in Feeble-

mindedness - - - - - 186

11. The Causation of Feeblemindedness —

Inherited Factors - - - - 201

12. The Causation of Feeblemindedness —

Acquired Factors - - - - 218

13. Preventative Measures and General

Considerations - _ - _ 228

APPENDIX

1. On the Training and Treatment of

Feebleminded Children. Written

by Mary Dendy, M.A. - - - 243

2. The Detailed Examination of the Head 296

3. The Detailed Examination of the Speech 303

4. School Form and Certificate suitable

for use when examining a child sent
up for admission to an institution for

feebleminded children - - - 307

5. List of Homes, Schools and Institutions 312

Glossary - - - - - - - 321

Bibliography - - ' - - - - 333

Index - - - - 344



LIST OF ILLUSTRATIONS.

PLATE

I. Group of Feebleminded Boys Working

at Sandlebridge - - Frontispiece,

TO FACE
PAGE

II. Feebleminded Children of the Ordinary

Type - - - - - - 48

III. Tracings to Show Abnormalities in the

Shape of the Head as found in the

Feebleminded - - - - 51

IV. Abnormalities of the External Ear - 53
V. Defective Expressions - - - 60

VI. Diagram to Show Paths and Centres

that have to do with Speaking,

Reading and Writing - - - 66

VII. Cretinism - - - - - - 102

VIII. Slighter Mongolian Types - - - 107

IX. Microcephalic, Hydrocephalic and

Morally Defective Types - -113

X. Paralytic (Hemiplegic) Types. Athe-

toid Movements - - - - 117

XI. Three Brothers and a Brother and

Sister, all Feebleminded - - 234

XII. Models Used in Training the Senses of

Sight, Colour, Form and Balance - 272



LIST OF TABLES

TABLE PAGE

I. The Comparative Frequency of the

Types of Feeblemindedness - - 48
II. Comparison of the Heights, Weights
and Head Measurements of Feeble-
minded and Ordinary School Child-
ren - - - - - - 58

HI. Comparison of the Age of Learning to
Walk and Talk and the Degree of
Mental Defect _ - . - 80
IV. The Physiological Alphabet (Wyllie) - 94
V. Results of the Detailed Examination
of the Heads of Ordinary Children
and Feebleminded Children of
School- Age Compared - - - 301

VI. Table of Words Suitable for Making

the Child Pronounce the Various
Consonants - - - - - 305

VII. Table Illustrating Frequency of Sub-

stitution - . _ _ - 306

DIAGRAMS.

Diagram I. Showing the Periods of Lile after

Conception - - - - 187

Diagram II. Showing Inheritance of Feeble-
mindedness - - - - 214



Feeblemindedness in Children
of School-Age



CHAPTER I.

Introductory and Statistical.

History.

In 1904 it was thought necessary to appoint
a Royal Commission on the Care and Control of
the Feebleminded. This fact may be regarded as
the culmination of the efforts that had been going
on in various quarters to promote the welfare of
these unfortunate individuals. The pioneer
work of Seguin, Itard, Howe, Wilbur and others
with regard to the treatment and care of "idiots"
as distinguished from " lunatics " has been
described in other text-books, and we shall deal
here chiefly with the history of the movement in
England.

In the past the words "funatic" and "idiot"
have stood for two divisions of mentally deficient
persons, the one implying "disorder of the mind
iji a person who has been in possession of his
faculties," and the other "a state of mental
incapacity, which has been present from birth or
from an early age." The Lunacy Acts still
include under their jurisdiction both lunatics and
idiots, but the Idiots Act of 1886 deals with idiots
apart from lunatics, and by the use of the word
imbeciles, as referring to mental defect of a lesser
degree than idiocy, recognises a sub-class of the



2 FEEBLEMINDED CHILDREN

mentally defective. Later a further sub-class of
still lesser degree, the feebleminded, was recog-
nised.

Most people are familiar with the type known
as the 'Village idiot" and anyone who has to
deal with such persons will know how^ helpless
they are, how often they form the butt of gibes
and jests, how they can be goaded to fits of
passionate and uncontrollable rage during which
they may commit acts of violence, and finally
how subservient they are to the will and sugges-
tion of others. Such persons are obviously in
need of care and help ; but until quite recently,
in spite of the fact that much attention has been
devoted to lunatics, of the idiots, only those with
the lowest grade of intellect have been generally
recognised as being in want of care. The
existence of a very large number of persons who,
though certainly of too low a mental level to look
after themselves without assistance, are still of
a higher level than idiots, has only been partially
recognised, and though various more or less
isolated attempts have been made to care for
special classes of the w^eak-minded no compre-
hensive scheme has been adopted. The great
majority of such persons have, up to the present
time, been dealt with by various authorities such
as the poor-law, the prisons, the inebriate homes,
and the education authorities, according as to
whether they are destitute, habitual criminals,
drunkards or too deficient to benefit from instruc-



ACCOMMODATION 3

tion in the ordinary schools, as the case may be.
Obviously it is wrong to make it impossible for
them to come under care until they have com-
mitted an" offence of some sort rather than to take
them under care and prevent such offences.

In the attempts that have been made to deal
with this class of mental deficiency we can trace
several distinct movements. First, there was
the establishment of the institutions known as
the idiot asylums, which were founded at a time
when idiocy was thought to be more or less
curable, and the importance of permanent care
had not been realised.

To quote the Commissioners : —

In gt^neral we may say that the object of the
asylums is primarily educational, and that, origin-
ally at least, they were the outcome of a belief that
in many cases special education would prepare "for
the duties and enjoyments of life" the children or
young persons, who gained admission to them.

Since the regulations included the discharge
of pupils after a period varying from four to
seven years, it is evident that permanent care
formed no part of the original idea of their
founders.

The first idiot asylum, Earlswood, was founded
in 1847, but a small school had been established
at Bath in 1846 and this became the Magdalen
Hospital School. Other idiot asylums were
established later, the Eastern Counties at Col-
chester in 1859, the Western Counties at Star-



4 FEEBLEMINDED CHILDREN

cross in 1864, the Royal Albert at Lancaster in
1864, and the Midland Counties at Knowle in
1868. In all, these institutions provide accom-
modation for about 1,900 cases. But it should
be pointed out that until a few years ago when
they changed their names to "Training Schools
for the Feebleminded," these asylums were
largely devoted to the care of the lower grade
cases.

Secondly, taking the Poor Law Authorities,
the Commissioners show that, though they have
had permissive powers of making provision for
the mentally defective class, the Guardians have
not evolved any suitable scheme of dealing with
such persons on the ground of their mental
condition, but have treated them rather on the
ground of their pauperism and need of relief, the
mentally defective being kindly looked after but
maintained rather than treated, and no attempt
being made to separate the various grades. The
evidence on this point is, as the Commissioners
say, "quite conclusive" : —

It comes almost entirely from persons who as
Inspectors ... or as Guardians are thoroughly
familiar with the facts, and it relates practically to
the whole country. There are special arrangements
here and there . . . but it is admitted that, as a
whole, the accommodation now provided for these
persons is insufficient, unsuitable and unsatisfac-
tory. It is not asserted that they are treated with
unkindness . . . nor are the Poor Law Guardians
throughout the country to blame. The system of



ACCOMMODATION 5

indoor relief is merely a housing system and . . .
there has sprung up a demand for a more dis-
criminating and individual treatment of mentally
defective persons. . . .

The practice of giving outdoor relief or of board-
ing-out such cases has also had very bad results
in England and is entirely undesirable for many
reasons.

The Guardians have power to make use of
other institutions and pay for the maintenance of
the mentally defective there, and latterly there
has been a marked tendency for the Guardians
in various parts of the country to make use of
available accommodation, but such accommoda-
tion is wholly insufficient. In London there is
much better provision since there is the Industrial
Colony at Darenth for the accommodation and
training of improvable cases of all ages ; also the
Birmingham and King's Norton Unions have
an institution at MonyhuU for epileptic and
feebleminded persons. Their third Annual
Report shows that the inmates lead useful and
contented lives and are much better in health.
Up to the present time children have not been
received because it w^as thought that the Educa-
tion Committee would provide for such cases,
but it has been found necessary to make provi-
sion for admitting children. The average inclu-
sive cost per week per head is 12s. 2|d.

Thirdly, taking the Education Authorities, the
Education Act of 1870 gave the school boards



6 FEEBLEMINDED CHILDREN

the duty of dealing with all educable children,
and the establishment of schools for the physi-
cally defective soon followed (1872). The Royal
Commission on the Blind, Deaf and Dumb (1889)
recommended that every parent should cause his
or her child "to receive instruction suitable to
it," and that "with regard to feebleminded
children, they should be separated from ordinary
public scholars in public elementary schools in
order that they may receive special instruction
and that the attention of school authorities be
particularly directed towards that object." The
latter recommendation arose from the evidence
of several witnesses, especially Drs. Shuttle-
worth and Warner, with regard to those children
defective in sight, hearing and speech because
they were mentally deficient. London and seven
provincial towns^ established such schools,, but
the cost was a very heavy charge on local
expenditure, when unsupported by a Govern-
ment grant, and representations were made for
special legislation in favour of feebleminded
children. General F. J. Moberly, who was then
Chairman of the Sub-Committee of the London
County Council Schools for the physically defec-
tive, gave evidence before this Commission and
later became the Chairman of the Sub-Committee

1. Towns that first established special schools for
feebleminded children are Birmingham, Bradford,
Bristol, Leicester, Liverpool, London, Manchester,
Oldham and Salford, Leicester being the first of all.



EDUCATION 7

in charge of the Special Schools for the Mentally
Defective.

In 1876-77 a Special Committee of the Charity
Organisation Society of London reported on the
education and care of idiots, imbeciles and
harmless lunatics estimating their number at
49,041, and recommencing the establishment of
schools and asylums Hn every large centre or
group of counties.

Again in 1890 the s^me society appointed a
special committee to consider and report on "the
public and charitable provision made for the care
and training ' of the feebleminded, epileptic,
deformed and crippled." This Committee issued
in 1891 an interim, and in 1892 a final report,
which embodied the results of an examination of
a very large number of school children by Dr.
Francis Warner and others, who found that
approximately i per cent, of the children
examined required special care and training.

In 1893 the Elementary Education (Blind and
Deaf Children) Act was passed, and by it the
teaching of blind and deaf children became com-
pulsory. In 1895 a Committee under the
auspices of the British Medical Association, the
Charity Organisation Society of London, the
British Association for the Advancement of
Science, the International Congress of Hygiene
and Demiographv, and other public bodies
issued "A Report on the Scientific Study of the
Mental and Phvsical Conditions of Childhood



8 FEEBLEMINDED CHILDREN

with particular reference to Defective Children"
from the Parke's Museum, Margaret Street, W.^
The interest in defective children created by
these various reports was great and led up to the
appointment of a Departmental Committee on
Defective and Epileptic Children in 1896. The
Committee consisted of the Rev. F. W. Sharpe,
C.B., then Her Majesty's Chief Inspector of
Schools; Messrs. Pooley and Newton of the
Education Department; Mrs. Burgwin and Miss
Douglas Townsend; and of Professor Wm.
Smith and Dr. Shuttleworth ; Mr. H. W. Orange
acting as Secretary. Their report was issued in
1898, and one of the main conclusions they
formed was "that children exist, who, on the
one hand, are too feebleminded to be properly
taught in ordinary elementary schools by
ordinary methods, and, on the other hand, are
not so feebleminded as to be imbecile or idiotic.
These feebleminded children exist as a distinct
class from imbeciles, they are not certified as
imbeciles, not provided for as imbeciles, they
differ both from ordinary children and from
imbeciles in the treatment they require during
their school-life." The Committee also found
that approximately one per cent, of the children
in the public elementary school classes appeared
to be feebleminded, and they recommended that

1. See Shuttleworth and Potts, "Mentally Deficient
Children."



EDUCATION 9

such children should attend school when possible
rather than remain idle at home.

These suggestions were embodied in the
Elementary Education (Defective and Epileptic
Children) Act of 1899, defective children being
there defined as "children, who, not being
imbecile and not merely dull and backward, are
by reason of. mental and physical defect incapable
of receiving proper benefit from the instruction
in the ordinary public elementary schools, but
are not incapable, by reason of such defect, of
receiving benefit from instruction in such special
classes or schools as are in this Act mentioned,"
and the period of compulsory education for these
children was extended to 16 years instead of 14,
as in ordinary children.

By this Act the authorities were empowered
but not compelled (i) to establish special classes
for defective children in some of their schools;
(2) to board them out in houses near to special
classes or schools; (3) to establish either day or
boarding special schools for them. For epileptic
children boarding schools only were allowed.

For some 30 years, however, much attention
had been paid to means for helping feebleminded
women, especially those who had been led into
disgrace by reason of their mental defect, and
Lady Frederick Cavendish established the first
home for this purpose. Her efforts were followed
by Miss Stacey in Birmingham, Miss Grayson
in Liverpool and Miss Scott at Hitchen. Largely



10 FEEBLEMINDED CHILDREN

owing to the establishment of Special Day
Schools which revealed the very large numbers
of the weakminded children for whom no special
provision was made, the subject of feebleminded-
ness assumed increasingly more importance, and
in 1896 was founded the National Association
for Promoting the Welfare of the Feebleminded.

At this time a new development in the care of
the feebleminded began with the foundation in
1898 of the Lancashire and Cheshire Society for
the Permanent Care of the Feebleminded, since
hitherto no large society or institution had
grasped and emphasised the essential point in
dealing with the problem, that of permanent
care.

The foundation of this last societv followed
directly as a result of the efforts of Miss Mary
Dendy and the late Dr. Henry Ashby. Miss
Dendy's attention had been attracted to the large
numbers of obviously weak-minded children in
the elementary schools under the Manchester
School Board, and Dr. Ashby examined and
reported on 500 mentally defective children
selected by her from 39,600 scholars.

This examination, entailing as it did a ques-
tioning of the parents, only served to emphasise
the point that, valuable as special day schools
may be, the work done in them must be largely
wasted and nullified if the children are dis-
charged at the age of sixteen, the most critical
period of their lives, to become in many instances



ROYAL COMMISSION. 11

the parents of children similar to themselves.
Miss Dendy's efforts led to the foundation of
the above society, to which she is Honorary
Secretary and which has now attained important
dimensions. Mr. C. H. Wyatt, late Clerk to the
School-Board and now Director of Elementary
Education in Manchester, has also done a great
deal to aid. the work of the Society, which is
based on the fact that only lifelong care of the
feebleminded is satisfactory. The success of
the colony at Sandlebridge demonstrates the
feasibility and value of this method of caring for
the persons of weak mind.

In April 1903, a petition signed by some 140
influential persons, especially interested in the
subject, was sent to the Home Secretary pleading
for the appointment of a Royal Commission "to
consider and report upon the existing provision
for Idiots, Imbeciles, and the Defective or
Feebleminded, and to make recommendations."
This led up to the appointment in 1904 of the
Royal Commission on the Care and Control of
the Feebleminded.

The Marquis of Bath was first appointed
Chairman of the Commission but he resigned
and the Earl of Radnor was appointed in his
place. The other members were (2) W. P.
Bvrne, Esq., Principal Clerk to the Home Office.

(3) C. E. H. Chadwick-Healey, Esq., K.C.

(4) C. E. H. Hobhouse, Esq.', M.P. (5) F.
Needham, Esq., M.D., Commissioner in Lunacy.



12 FEEBLEMINDED CHILDREN

(6) H. B. Donkin, Esq., M.D. (7) J. C.
Dunlop, Esq., M.D. (8) H. D. Greene, Esq.,
M.D. (9) The Rev. H. N. Burden, Manager of
Brentry and other Inebriate Reformatories. (10)
W. H. Dickenson, Esq., M.P., Chairman of the
National Association for promoting the welfare
of the Feebleminded. (11) C. S. Loch, Esq.,
Secretary to the Charity Organization Society.
(12) Mrs. Hume Pinsent, Chairman of the
Special Schools Sub-Committee of the Birming-
ham Education Committee.

Their report consisted of eight volumes ;
volumes one to four being minutes of evidence,
volume five appendix papers, volume six the
reports of the medical investigators, volume
seven the report on the visit of certain of the
Commissioners to America, and volume eight
the Report Volume. The report was issued in
August 1908, and served to correlate and focus
the knowledge on the subject, to bring forward
much fresh evidence and to bring out promin-
ently the urgent need of a comprehensive scheme
for dealing with the feebleminded.

The Commissioners were at first directed to
consider the methods of dealing with idiots,
epileptics, imbecile, feebleminded or defective
persons not certified under the Lunacy Laws,
but later the scope of the enquiry widened and
they were also directed to enquire into the
Lunacy Laws with a view to the suggestion of
some scheme that would provide care for all



ROYAL COMMISSION. 13

persons of deficient intellect whether they be
lunatics, dements, idiots, imbeciles, epileptics or
feebleminded. The Commissioners examined
248 witnesses, obtained information from foreign
countries and visited American institutions. At
the outset it was found that there were no
available statistics ; medical investigators were,
therefore, appointed in various districts, their
duties being to examine the following groups
of persons : —

(1) Children in Public Elementary Schools.

(2) Children and Adults in Poor Law Institu-

tions.

(3) Children and Adults in receipt of Outdoor

Relief.

(4) Persons known to Sanitary Authorities.

(5) Persons relieved by Medical Charities.

(6) Persons known to General Practitioners.

(7) Children and Adults in various Charitable
Institutions and Common Lodging Houses,
Training Homes, and Reformatories and
Industrial Schools.

(8) Persons to be heard of from other sources.

(9) Known to the Police.

(10) Idiots of the District in Idiot Asylums.

(11) Inmates of Prisons.

(12) Inmates of Inebriate Homes.

Classification and Definitions.

Strictly speaking the term Mental Deficiency



14 FEEBLEMINDED CHILDEEN

includes all persons of unsound mind, and such
persons can be divided into two classes : —

(i) Lunatics, dements or insane persons, who
from disorder of the mind or from a decay of
their mental faculties, have lost the powder of
managing themselves or their affairs.

(2) Aments, or persons who, because their
brain is incapable of normal development, have
never had and never will have the power of
managing themselves or their affairs.

There has been and still is a tendency to limit
the term Mental Defect to Aments as distin-
guished from Dements. In this book we shall
use the term mentally defective in reference to
class (2), the aments, the terms idiot, imbecile
and feebleminded and moral imbecile being used
to designate various grades. We shall dismiss
class (i), or lunatics, with the two remarks that
the Commissioners recommend that the words
''lunatic" and "asylums" should be superseded
and those of "persons of unsound mind" and
"hospital" substituted, and that it is entirely


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