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THE CARE OF THE MENTALLY DEFECTIVE
672 For example, the transit of personnel and material between departments, which is one of the causes of extra expenditure in a very large hospital, is minimised if the hospital is built on a vertical rather than on a horizontal plan; and the relative cheapness of construction and maintenance of a very small hospital often implies less efficient medical service, especially in the lack of special diagnostic departments. The wide variation of standards is illustrated by the statement attributed by Sir JAMES to the staff of a Bush nursing hospital of 30 beds, that not more than 4 per cent. of the patients require a pathologist. The primary need, however, in isolated districts is adequate clinical supervision and nursing care, and that is clearly available in the hospitals under the contributory scheme of the Victoria Bush Nursing Association. Sir JAMES BARRETT’S main theme, that in all countries institutional rather than domiciliary treatment is being demanded by an increasing section of the public and will have to be supplied, is not likely to be disputed, and his exposition of a hospital insurance system so well adapted to the needs of the country it serves will command attention.
THE CARE OF THE MENTALLY DEFECTIVE PUBLIC interest is easier to
arouse
in curable
disease than in disorders which are apparently not amenable to treatment, and this no doubt has been one reason why mental defect has been largely left to
philanthropy. Another reason for its is neglect the stigma of its supposed relation to insanity. But more and more has mental deficiency been forced on public notice as a problem in sociology by the Brock report and by the suspicion that a considerable proportion of crime is committed by those suffering from mental defect. What has not kept pace with this realisation is the effort to solve the problem. It is only slowly being grasped that much less spectacular measures than eugenic sterilisation or the intelligence testing of offenders can be undertaken by authorities which have the encouragement of informed public opinion. An important section of the Board of Control’s report for 1934, a summary of which is given on p. 685, contains some record both of the activities of philanthropic bodies and of the tardy appreciation by public bodies of what can be done. Only half the estimated probable number of defectives are notified, and of these rather less than half are in institutions. Something of the discrepancy which exists may be gauged from the fact that of the small number of criminals during 1934 who were proved to be defective almost threequarters had not attended a special school at all, a figure closely resembling the Wood Committee’s estimate that 77 per cent. of feeble-minded children are educated in ordinary elementary schools. Such a result can only arise from the fact that the provision of special schools remains too small; numbers of children who swell the overcrowded elementary school classes are incapable of profiting by the teaching provided. These facts are
education committees. But local authorities have no legal responsibility for the defective child between the ages of 14 and 16, and although this is a state of affairs that cannot last much longer, the knowledge that such a gap exists has played into the hands of authorities which shirk the care of defectives. The medical practitioner meets many situations in which a knowledge of the social implications of mental defect is of value. He is not limited to the thankless task of seeing that the unfortunate child is properly notified. Many defectives can be placed under guardianship in suitable homes, where they have a chance of doing some kind of manual work for which they are fitted. In Scotland, where guardianship is more generally used, the removal of defectives from home-often, alas, the environment most unsuitable for them-has had a beneficial effect. There are many cottage homes in the country which would welcome a paying guest of this kind if the medical man were to suggest it. There is work to be done both for defective children and adults. Special schools offer an opportunity of teaching posts to those who are better suited for this specialised work than for more routine teaching. Medical practitioners are likely to know the kind of women who, making hard weather of ordinary teaching, might flourish teaching the educable defective. Day centres and clubs, now being opened in various places, afford scope for many who would fight shy of more obvious philanthropy. At these centres defectives who live at home, or are under guardianship, can attend and do simple but useful work. Women applying for such posts need not have had previous experience in schools, though interest in Froebel method or its equivalent is of value. The extent of all these opportunities is outlined in a pamphlet issued by the Central Association for Mental
appreciated by
Welfare, 24, Buckingham Palace-road, London, S.W.I. Medical influence in these matters need not be restricted to the private contact between doctor and patient. Medical officials of the public bodies can only work for reform if the elected representatives on these bodies are pressing for progress. Whether as a member of the public health committee or as a magistrate the medical man’s opportunities of stimulating interest in the care of the mentally deficient are considerable. There is no obvious reason why England should lag behind Scotland in the guardianship of mental defect, or why freer use should not be made of the services offered by the Central Association or the Guardianship Society. There are bodies whose title suggests more exciting efforts, but few which are working so quietly along progressive lines.
PERSONALITY AND AGE PERSONALITY is the product of a large number of dependent variables every one of which must be studied in relation to the independent variable, age. It is fortunate that, in this country at any rate, documentary evidence is available for determining age with scientific accuracy, fortunate
THE CARE OF THE MENTALLY DEFECTIVE PUBLIC interest is easier to
arouse
in curable
disease than in disorders which are apparently not amenable to treatment, and this no doubt has been one reason why mental defect has been largely left to
philanthropy. Another reason for its is neglect the stigma of its supposed relation to insanity. But more and more has mental deficiency been forced on public notice as a problem in sociology by the Brock report and by the suspicion that a considerable proportion of crime is committed by those suffering from mental defect. What has not kept pace with this realisation is the effort to solve the problem. It is only slowly being grasped that much less spectacular measures than eugenic sterilisation or the intelligence testing of offenders can be undertaken by authorities which have the encouragement of informed public opinion. An important section of the Board of Control’s report for 1934, a summary of which is given on p. 685, contains some record both of the activities of philanthropic bodies and of the tardy appreciation by public bodies of what can be done. Only half the estimated probable number of defectives are notified, and of these rather less than half are in institutions. Something of the discrepancy which exists may be gauged from the fact that of the small number of criminals during 1934 who were proved to be defective almost threequarters had not attended a special school at all, a figure closely resembling the Wood Committee’s estimate that 77 per cent. of feeble-minded children are educated in ordinary elementary schools. Such a result can only arise from the fact that the provision of special schools remains too small; numbers of children who swell the overcrowded elementary school classes are incapable of profiting by the teaching provided. These facts are
education committees. But local authorities have no legal responsibility for the defective child between the ages of 14 and 16, and although this is a state of affairs that cannot last much longer, the knowledge that such a gap exists has played into the hands of authorities which shirk the care of defectives. The medical practitioner meets many situations in which a knowledge of the social implications of mental defect is of value. He is not limited to the thankless task of seeing that the unfortunate child is properly notified. Many defectives can be placed under guardianship in suitable homes, where they have a chance of doing some kind of manual work for which they are fitted. In Scotland, where guardianship is more generally used, the removal of defectives from home-often, alas, the environment most unsuitable for them-has had a beneficial effect. There are many cottage homes in the country which would welcome a paying guest of this kind if the medical man were to suggest it. There is work to be done both for defective children and adults. Special schools offer an opportunity of teaching posts to those who are better suited for this specialised work than for more routine teaching. Medical practitioners are likely to know the kind of women who, making hard weather of ordinary teaching, might flourish teaching the educable defective. Day centres and clubs, now being opened in various places, afford scope for many who would fight shy of more obvious philanthropy. At these centres defectives who live at home, or are under guardianship, can attend and do simple but useful work. Women applying for such posts need not have had previous experience in schools, though interest in Froebel method or its equivalent is of value. The extent of all these opportunities is outlined in a pamphlet issued by the Central Association for Mental
appreciated by
Welfare, 24, Buckingham Palace-road, London, S.W.I. Medical influence in these matters need not be restricted to the private contact between doctor and patient. Medical officials of the public bodies can only work for reform if the elected representatives on these bodies are pressing for progress. Whether as a member of the public health committee or as a magistrate the medical man’s opportunities of stimulating interest in the care of the mentally deficient are considerable. There is no obvious reason why England should lag behind Scotland in the guardianship of mental defect, or why freer use should not be made of the services offered by the Central Association or the Guardianship Society. There are bodies whose title suggests more exciting efforts, but few which are working so quietly along progressive lines.
PERSONALITY AND AGE PERSONALITY is the product of a large number of dependent variables every one of which must be studied in relation to the independent variable, age. It is fortunate that, in this country at any rate, documentary evidence is available for determining age with scientific accuracy, fortunate