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THE CASUAL POOR.
415
SPECIAL ARTICLES less
THE CASUAL POOR. A STUDY OF ECONOMIC AND SOCIAL FAILURE.
THE recent report of the Departmental Committee the Relief of the Casual Poorincludes the result of an investigation by Dr. E. 0. Lewis of the types of person who fall into this category. As about 12,000 casuals are relieved in England and Wales on any one night it was necessary to conduct the inquiry on some plan which would give representative results, and for this reason Dr. Lewis and his colleagues visited 15 casual wards in various Welsh and English towns, and interviewed 592 persons in all. It was - an investigation, in essence, of those men and women who have failed economically and socially and the reasons for such failure may be either physical infirmity, -on
mental infirmity, temperamental defects, psychoneurosis, criminal tendencies, or merely overwhelmingly adverse environment. To assess the important factor in any individual case and during a brief interview was a matter of difficulty, especially as the chief object was to ascertain the proportion of casuals who could be classified as persons of abnormal mentality. Dr. Lewis appears to have given borderline cases of both mental deficiency and insanity the benefit of the doubt ; so that his figure for the incidence of feeblemindedness is probably rather low. His difficulties were increased by the extremely limited field of interest, and the ignorance, sometimes illiteracy, of many of the casuals, which made the application of any large number of standardised tests out of the question. The interview was conducted as an informal talk from which it was possible to make some estimate of the mental capacity ; if this appeared to be normal a rapid physical examination was made of the chest and the man was dismissed. Dr. Lewis observes that the most cursory physical examination was appreciated as a sign of good faith, while if the subject had an inkling that a mental investigation was being made he regarded it as a personal affront. As the women in the casual wards were few in number it was decided to include Southwark Casual Ward, where special arrangements are made for the reception of women vagrants in the London
County
area.
MENTAL DEFECT.
Among
the group of 592 casuals
investigated, 93,
and from this it was estimated that there are about 1800 mental defectives nightly in casual wards in England and Wales. There was a complete absence of imbeciles and idiots, who would have been lacking in even the small degree of intelligence necessary for a vagrant life. The casual with the lowest intelligence examined had a mental age of 7, but most of those who were mentally defective had mental ages of 8 or 9. There was a tendency among them to attach themselves to other vagrants of better intelligence, sometimes to their advantage; occasionally, however, their disor
15-7 per cent.,
ability
was
were
exploited by
Most of them
were
mentally defective,
an
unscrupulous companion. physique, and showedI
subnormal in
H.M. Stationery Office. 1 Ministry of Health. Cmd. 3640. Pp. 99. 1s. 6d. The members of the Committee were Mr. J. A. Dale, Mr. Douglas Hacking, M.P., Sir Arthur Lowry, Dr. A. C. Parsons, Mr. A. Paterson, Rev. L. R. Phelps (chairman), Mr. Arthur Shepherd, M.P., and Mrs. Wintringham, with Mr. L. N. Ure of the Ministry of Health (secretary).
foresight
than their fellows in the
care
feet ; their clothing with few exceptions
of their
below the average of that of most casuals. Among the 50 women examined the incidence of feeblemindedness was slightly higher than among the men. The impression formed of the mental capacities of most of those who did not fall into the mentally defective group was one of subnormality ; men and women of normal or supernormal mentality among them formed a small minority. Such a conclusion, Dr. Lewis points out, should be borne in mind when formulating plans to prevent the social failure of such persons in the future ; their inefficiency even as unskilled labourers makes them incapable of retaining a situation long. The total number of insane casuals interviewed was only 32, of whom 20 were cases of senile dementia ; the remainder included 2 cases of dementia prsecox, 4 of manic-depressive insanity, 3 of toxic psychosis, and 3 of paranoia. In only two cases was the condition so severe as to demand treatment in a mental hospital. Symptoms of some form of psychoneurosis were found in 34, or 5-7 per cent. of casuals, in several of whom the condition appeared to have developed as a sequel of a war neurosis ; the commonest form was a state of anxiety, due in many cases to a failure to secure work. Often the adoption of a life of vagrancy appeared to be a reaction of flight from an unhappy environment. Neurotic cases of the psychasthenic type were not uncommon, but hysteria was rare and found for the most part among the women, usually in association with alcoholism. In view of these findings Dr. Lewis advises a periodic medical examination of all casuals by practitioners with an interest in psychiatry. was
PHYSICAL DEFECT.
It was impossible in the course of such an investigation to make an exhaustive search for physical defects, but attention was paid to any symptom of which a casual complained, with the result that 43 cases of circulatory disease, 75 of chronic alcoholism, and 27 of diseases of the respiratory system were found. Other common physical disabilities were hernia, varicose veins, failing vision, malnutrition, and minor deformities such as ankylosed joints and spinal curvature, or due to rickets and war injuries. Osteoarthritis and skin diseases were surprisingly rare. In the absence of suitable tests it was impossible to determine the incidence of venereal disease. A periodic medical examination would prevent the deterioration of slight disabilities into serious conditions, Dr. Lewis considers, and would extend the working life of casuals for several years. The age distribution of casuals gave 13-8per cent. under 30 years, 66-6 per cent. between 30 and 60, and 19-6 per cent. over 60. None of the women casuals was under 30, and only one child, a few weeks old, was present in the wards visited ; the total number of children belonging to the group, according to the information received, was 35, of whom 8 were in the charge of relatives and 10 were under the care of the poor-law authorities or charitable organisations ; no information could be obtained about the remainder. Marriage appears to be rare among casuals, no less than 80 per cent. declaring themselves to be unmarried. When questioned on their employment, 80 per cent. admitted to being unskilled labourers, 15 per cent. had performed some kind of skilled work, and less than 5 per cent. had held clerical positions. A casual was classified as habitual " when he had "
416 visited casual wards at
fairly frequent intervals
for year, and 81’9 per cent. of the total fell into this class ; it was estimated that approximately one-third of habituals were not seeking work. Yet whether judged by moral, intellectual, social, or economic standards, Dr. Lewis finds the vagrants of the casual wards better than large numbers of men and women seen from time to time in common lodging-houses, and advises that no innovation be considered which would have the effect of increasing the numbers in such houses, where owing to less adequate public control the vagrant proves a greater menace to the community. He suggests that there should be closer cooperation in the administration of the lodging-houses and the casual wards. a
period exceeding
LISTER INSTITUTE OF PREVENTIVE MEDICINE.
one
(Continued from p. 1370.)
I
The Committee’s Recommendations. These follow the opinion of Dr. Lewis in the matter of medical examinations; they suggest that these should be made once a month, but on no fixed day, and should include every inmate of the ward at the time. In addition, the officer in charge of the ward should make a practice of bringing to the notice of the doctor any casual who appears to be ill or mentally disordered. Facilities for bathing should be avail-
mittees, employment exchanges, and voluntary bodies willing and able to accept for treatment vagrants who wish to alter their mode of life; moreover,
they recommend that local authorities should be allowed, by subscribing to suitable voluntary bodies, to encourage the formation of training centres or to establish such centres themselves. could
Cooperation
Department of Biochemistry. Ossification.-Dr. R. Robison has continued
to,
collaborate with Dr. Honor B. Fell, Director of the Strangeways Research Laboratory, Cambridge, in the investigation of the development of cartilage and bones of the embryo chick, both in the egg and when isolated and cultivated in vitro. The work has now been extended to the study of membrane bone, for which purpose the jawbone has been found most suitable. Experiments on calcification in vitro have been continued by Dr. Robison, Miss M. Macleod, and Miss A. Rosenheim, and the formation of new deposits in slices of the bones of rachitic rats has been investigated under various conditions. Evidence has been obtained of the existence of two mechanisms. favouring calcification in hypertrophic cartilage, the enzyme mechanism producing supersaturation of the solution by increasing the inorganic phosphorus concentration, and a further mechanism favouring deposition of salts from the supersaturated solution thus formed. In order to gain information on the nature of this second mechanism Dr. Robison and Miss M. Maclean are studying the deposition of calcium salts in colloid gels, under conditions similar to those used in the experiments with bone slices. THE VITAMINS.
Dr. S. S. Zilva has continued his investigation of the spontaneous inactivation of the antiscorbutic factor, and more light has now been thrown on the cause of the modification of the stability in neutral solutions of the vitamin produced by autoclaving active solutions. The investigation instituted to ascertain whether a functional relationship exists between the antiscorbutic factor and any other factor or factors in the apple and in citrus fruits has been extended in several directions. The inquiry into the vitamin content of dairy products as influenced by environment, breed of cow, transit, storage, and other factors has been continued by Dr. Zilva, Miss Crawford, and Miss Perry, and a further number of controlled samples of butter has been assayed. Attempts are being made to improve methods for vitamin assay. Work on the isolation of vitamin B is being continued by Miss Harriette Chick, D.Sc., and Miss A. Copping. They are endeavouring to prepare concentrations of this vitamin from egg-white, in which it occurs unaccompanied by vitamin B 1, and from mammalian liver. Miss Chick, Miss M. H. Roscoe, and Miss Copping have made a quantitative study of the heat stability of vitamin B2in yeast and yeast extracts and of its sensitiveness to the presence of alkali. Their finding that vitamin B2is very sensitive to alkalies at high temperatures is opposed to the conclusions of other workers in this field (Drummond and co-workers ; Reader), who consider that vitamin B2 is stable to the action of alkalies at high temperatures but that yeast contains an additional dietary factor, vitamin B 3," which is heat and alkali-labile.
be effected by means of advisory committees representing the vagrancy committee, the standing joint committee or watch committee, the Ministry of Health, the employment exchange, and the interested voluntary bodies in the area.The cooperation of neighbouring councils by means of vagrancy committees is also recommended. It is hoped that, by giving individual attention to each casual, the man who enters the ward for the first time will be " given an early opportunity to reinstate himself, while Evidence that a third, hitherto unrecognised, dietary those suffering from some mental or physical disability will be referred to the appropriate institution for factor exists in yeast has been accumulated in the course of the above but the evidence points to its being treatment; both measures would have the desirable heat-stable.research, For example, the growth of young rats on effect of reducing the numbers in the casual wards. synthetic " diets in which the vitamin Bis provided by .,
SPECIAL ARTICLES less
THE CASUAL POOR. A STUDY OF ECONOMIC AND SOCIAL FAILURE.
THE recent report of the Departmental Committee the Relief of the Casual Poorincludes the result of an investigation by Dr. E. 0. Lewis of the types of person who fall into this category. As about 12,000 casuals are relieved in England and Wales on any one night it was necessary to conduct the inquiry on some plan which would give representative results, and for this reason Dr. Lewis and his colleagues visited 15 casual wards in various Welsh and English towns, and interviewed 592 persons in all. It was - an investigation, in essence, of those men and women who have failed economically and socially and the reasons for such failure may be either physical infirmity, -on
mental infirmity, temperamental defects, psychoneurosis, criminal tendencies, or merely overwhelmingly adverse environment. To assess the important factor in any individual case and during a brief interview was a matter of difficulty, especially as the chief object was to ascertain the proportion of casuals who could be classified as persons of abnormal mentality. Dr. Lewis appears to have given borderline cases of both mental deficiency and insanity the benefit of the doubt ; so that his figure for the incidence of feeblemindedness is probably rather low. His difficulties were increased by the extremely limited field of interest, and the ignorance, sometimes illiteracy, of many of the casuals, which made the application of any large number of standardised tests out of the question. The interview was conducted as an informal talk from which it was possible to make some estimate of the mental capacity ; if this appeared to be normal a rapid physical examination was made of the chest and the man was dismissed. Dr. Lewis observes that the most cursory physical examination was appreciated as a sign of good faith, while if the subject had an inkling that a mental investigation was being made he regarded it as a personal affront. As the women in the casual wards were few in number it was decided to include Southwark Casual Ward, where special arrangements are made for the reception of women vagrants in the London
County
area.
MENTAL DEFECT.
Among
the group of 592 casuals
investigated, 93,
and from this it was estimated that there are about 1800 mental defectives nightly in casual wards in England and Wales. There was a complete absence of imbeciles and idiots, who would have been lacking in even the small degree of intelligence necessary for a vagrant life. The casual with the lowest intelligence examined had a mental age of 7, but most of those who were mentally defective had mental ages of 8 or 9. There was a tendency among them to attach themselves to other vagrants of better intelligence, sometimes to their advantage; occasionally, however, their disor
15-7 per cent.,
ability
was
were
exploited by
Most of them
were
mentally defective,
an
unscrupulous companion. physique, and showedI
subnormal in
H.M. Stationery Office. 1 Ministry of Health. Cmd. 3640. Pp. 99. 1s. 6d. The members of the Committee were Mr. J. A. Dale, Mr. Douglas Hacking, M.P., Sir Arthur Lowry, Dr. A. C. Parsons, Mr. A. Paterson, Rev. L. R. Phelps (chairman), Mr. Arthur Shepherd, M.P., and Mrs. Wintringham, with Mr. L. N. Ure of the Ministry of Health (secretary).
foresight
than their fellows in the
care
feet ; their clothing with few exceptions
of their
below the average of that of most casuals. Among the 50 women examined the incidence of feeblemindedness was slightly higher than among the men. The impression formed of the mental capacities of most of those who did not fall into the mentally defective group was one of subnormality ; men and women of normal or supernormal mentality among them formed a small minority. Such a conclusion, Dr. Lewis points out, should be borne in mind when formulating plans to prevent the social failure of such persons in the future ; their inefficiency even as unskilled labourers makes them incapable of retaining a situation long. The total number of insane casuals interviewed was only 32, of whom 20 were cases of senile dementia ; the remainder included 2 cases of dementia prsecox, 4 of manic-depressive insanity, 3 of toxic psychosis, and 3 of paranoia. In only two cases was the condition so severe as to demand treatment in a mental hospital. Symptoms of some form of psychoneurosis were found in 34, or 5-7 per cent. of casuals, in several of whom the condition appeared to have developed as a sequel of a war neurosis ; the commonest form was a state of anxiety, due in many cases to a failure to secure work. Often the adoption of a life of vagrancy appeared to be a reaction of flight from an unhappy environment. Neurotic cases of the psychasthenic type were not uncommon, but hysteria was rare and found for the most part among the women, usually in association with alcoholism. In view of these findings Dr. Lewis advises a periodic medical examination of all casuals by practitioners with an interest in psychiatry. was
PHYSICAL DEFECT.
It was impossible in the course of such an investigation to make an exhaustive search for physical defects, but attention was paid to any symptom of which a casual complained, with the result that 43 cases of circulatory disease, 75 of chronic alcoholism, and 27 of diseases of the respiratory system were found. Other common physical disabilities were hernia, varicose veins, failing vision, malnutrition, and minor deformities such as ankylosed joints and spinal curvature, or due to rickets and war injuries. Osteoarthritis and skin diseases were surprisingly rare. In the absence of suitable tests it was impossible to determine the incidence of venereal disease. A periodic medical examination would prevent the deterioration of slight disabilities into serious conditions, Dr. Lewis considers, and would extend the working life of casuals for several years. The age distribution of casuals gave 13-8per cent. under 30 years, 66-6 per cent. between 30 and 60, and 19-6 per cent. over 60. None of the women casuals was under 30, and only one child, a few weeks old, was present in the wards visited ; the total number of children belonging to the group, according to the information received, was 35, of whom 8 were in the charge of relatives and 10 were under the care of the poor-law authorities or charitable organisations ; no information could be obtained about the remainder. Marriage appears to be rare among casuals, no less than 80 per cent. declaring themselves to be unmarried. When questioned on their employment, 80 per cent. admitted to being unskilled labourers, 15 per cent. had performed some kind of skilled work, and less than 5 per cent. had held clerical positions. A casual was classified as habitual " when he had "
416 visited casual wards at
fairly frequent intervals
for year, and 81’9 per cent. of the total fell into this class ; it was estimated that approximately one-third of habituals were not seeking work. Yet whether judged by moral, intellectual, social, or economic standards, Dr. Lewis finds the vagrants of the casual wards better than large numbers of men and women seen from time to time in common lodging-houses, and advises that no innovation be considered which would have the effect of increasing the numbers in such houses, where owing to less adequate public control the vagrant proves a greater menace to the community. He suggests that there should be closer cooperation in the administration of the lodging-houses and the casual wards. a
period exceeding
LISTER INSTITUTE OF PREVENTIVE MEDICINE.
one
(Continued from p. 1370.)
I
The Committee’s Recommendations. These follow the opinion of Dr. Lewis in the matter of medical examinations; they suggest that these should be made once a month, but on no fixed day, and should include every inmate of the ward at the time. In addition, the officer in charge of the ward should make a practice of bringing to the notice of the doctor any casual who appears to be ill or mentally disordered. Facilities for bathing should be avail-
mittees, employment exchanges, and voluntary bodies willing and able to accept for treatment vagrants who wish to alter their mode of life; moreover,
they recommend that local authorities should be allowed, by subscribing to suitable voluntary bodies, to encourage the formation of training centres or to establish such centres themselves. could
Cooperation
Department of Biochemistry. Ossification.-Dr. R. Robison has continued
to,
collaborate with Dr. Honor B. Fell, Director of the Strangeways Research Laboratory, Cambridge, in the investigation of the development of cartilage and bones of the embryo chick, both in the egg and when isolated and cultivated in vitro. The work has now been extended to the study of membrane bone, for which purpose the jawbone has been found most suitable. Experiments on calcification in vitro have been continued by Dr. Robison, Miss M. Macleod, and Miss A. Rosenheim, and the formation of new deposits in slices of the bones of rachitic rats has been investigated under various conditions. Evidence has been obtained of the existence of two mechanisms. favouring calcification in hypertrophic cartilage, the enzyme mechanism producing supersaturation of the solution by increasing the inorganic phosphorus concentration, and a further mechanism favouring deposition of salts from the supersaturated solution thus formed. In order to gain information on the nature of this second mechanism Dr. Robison and Miss M. Maclean are studying the deposition of calcium salts in colloid gels, under conditions similar to those used in the experiments with bone slices. THE VITAMINS.
Dr. S. S. Zilva has continued his investigation of the spontaneous inactivation of the antiscorbutic factor, and more light has now been thrown on the cause of the modification of the stability in neutral solutions of the vitamin produced by autoclaving active solutions. The investigation instituted to ascertain whether a functional relationship exists between the antiscorbutic factor and any other factor or factors in the apple and in citrus fruits has been extended in several directions. The inquiry into the vitamin content of dairy products as influenced by environment, breed of cow, transit, storage, and other factors has been continued by Dr. Zilva, Miss Crawford, and Miss Perry, and a further number of controlled samples of butter has been assayed. Attempts are being made to improve methods for vitamin assay. Work on the isolation of vitamin B is being continued by Miss Harriette Chick, D.Sc., and Miss A. Copping. They are endeavouring to prepare concentrations of this vitamin from egg-white, in which it occurs unaccompanied by vitamin B 1, and from mammalian liver. Miss Chick, Miss M. H. Roscoe, and Miss Copping have made a quantitative study of the heat stability of vitamin B2in yeast and yeast extracts and of its sensitiveness to the presence of alkali. Their finding that vitamin B2is very sensitive to alkalies at high temperatures is opposed to the conclusions of other workers in this field (Drummond and co-workers ; Reader), who consider that vitamin B2 is stable to the action of alkalies at high temperatures but that yeast contains an additional dietary factor, vitamin B 3," which is heat and alkali-labile.
be effected by means of advisory committees representing the vagrancy committee, the standing joint committee or watch committee, the Ministry of Health, the employment exchange, and the interested voluntary bodies in the area.The cooperation of neighbouring councils by means of vagrancy committees is also recommended. It is hoped that, by giving individual attention to each casual, the man who enters the ward for the first time will be " given an early opportunity to reinstate himself, while Evidence that a third, hitherto unrecognised, dietary those suffering from some mental or physical disability will be referred to the appropriate institution for factor exists in yeast has been accumulated in the course of the above but the evidence points to its being treatment; both measures would have the desirable heat-stable.research, For example, the growth of young rats on effect of reducing the numbers in the casual wards. synthetic " diets in which the vitamin Bis provided by .,