OPENING OF THE LONDON MEDICAL SCHOOLS.

892

OPENING OF THE LONDON MEDICAL SCHOOLS.

class of children, receives the children into its classes between the ages of five and 16, but at the latter age no provision for them is forthcoming, however defective they may be. Even such accommodation as was designed for imbeciles has been diverted to other purposes and boards of guardians have to a large extent adopted the practice of sending to institutions primarily intended for imbeciles their old men and women suffering from senile decay. Indeed, as Sir John McDougall said in his evidence, ’’ there is no line between a lunatic and an imbecile of later age except that a very tiresome imbecile is a lunatic, while a very quiet lunatic is an imbecile-that is the practical result." The general conclusion of the Commission on the subject is that there are in London a division of authority and a want of administrative accord which are fatal to any successful treatment of the problem. It is unfortunately only too frequently the case that the public regard conditions of mental defect as irrecoverable. In this, yet more unfortunately, they are abetted by medical men. The methods of Seguin, Bourneville, and others have received but scant attention, and of what can be done for mentally defective children we are for the most part in lamentable ignorance. It is therefore well to lay stress upon the evidence on this point collected by the Royal Commission. Miss Turner, a medical witness, gave evidence to the effect that there might be total recoveries if proper treatment and education could be commenced at a sufficiently early age. ’’ five is really too old to start special training ; three would be better." Miss Hargreaves, matron at Rochester House, showed how imbeciles could be educated into supervised forms of occupation, and the method by which this result was obtained is now adopted on a larger scale at Darenth Industrial Colony. Dr. A. Rotherham said: " The children could be very greatly improved ; they could do any" thing mechanical so long as they were looked after." Parallel to this evidence that the condition of mentally defective children is capable of great improvement is evidence of the deterioration of such children as are withdrawn from supervision and instruction. In the forefront of the Royal Commission’s recommendations a problem is set out which appears to us to be of so great importance that we quote the paragraph in extenso :Before coming to a conclusion on the alternative, whether the Poorlaw system should be expanded so that it may make entire provision for mentally defective persons, or whether this task should be assigned to some other control and local authorities, the ultimate question, which both parties raise, and which we have to decide, is whether the mentally defective should be considered and dealt with as suffering primarily from mental disease, or primarily from poverty or In the former case they would destitution, however caused? be relieved-whether paupers, or prisoners, or inebriates, or " feebleminded," or persons of "unsound mind," as having a claim on the community on the common ground that they are mentally afflicted; and assistance for them would be organised with a view to their treatment as patients. In the latter case they would be relieved as poor or destitute persons who happen to be mentally defective, and who on that account are paupers as being in need of relief, but incidentally patients, as being in special need of treatment. But the evidence shows that the division between pauper and non-pauper is quite unreal in the case of the mentally defective. The son of respectable parents, who is permanently supported wholly or in part by relatives or friends, requires, as mentally defective, the same treatment as another person whose relatives and friends cannot help him at all; and the greater or lesser possibility of obtaining payment for the treatment-the more or less poverty or destitutionis not the dividing line in these cases, but the existence or nonexistence of mental disease. Further, the distinction, on which we insist, is especially applicable to a class of case for which it would be difficult for the great mass of people to make any provision. These cases, wherever they may be, or whatever public department or organisation may deal with them, involve continuous expenditure greater than can ordinarily be met by the people themselves, even when they are capable and industrious members of the middle and working classes....... All possible obligations which can reasonably be imposed should, indeed, in our opinion, be enforced on relatives, and the help of friends and voluntary agencies also should be used to the utmost. But in the development of any organisation for the care of the mentally defective the precedent of the Lunacy Acts should, we think, be followed, rather than the precedent of the Poor-law. Under the Lunacy Acts intervention is due to the existence of mental incapacity; under the Poor-law to the existence of poverty and destitution. It must also be remembered that the certification, detention, and segregation, in regard to which all our witnesses are agreed, are advocated in the interest of the community at large and not merely or chiefly, as relief is given under the Poor-law, in order to meet the personal needs of particular cases,

officer of the London County Council, states of the kind of children handled in special classes :’’ Many who can con. tribute materially to their own livelihood would be better if under custodial treatment....... Compulsory powers for detention will be required for many cases....... The matter as a State provision for the improvement of social conditions will be almost futile, if provision is not also made for con" tinuing the custodial treatment after school ages." To improve the condition and meet the needs of the mentally defective, whether in elementary schools, prisons, inebriate homes, or asylums, the Commission considers that it will be necessary that there should be established one central authority for the general supervision of such persons and to made for their maintenance, care, The local authority which is to carry out such regulations, it is suggested, should be the council of each county or county borough. The Commission finds nothing peculiar in the conditions which obtain in London which would suggest a scheme different from that recommended for England generally, and since it is of opinion that a Poor-law authority cannot suitably under. take the care of the mentally defective it is unable to recommend that the Metropolitan Asylums Board should be the local authority in London, but it is suggested that the duty should devolve upon the County Council acting through a statutory committee. As regards the education of mentally defective children it is recommended that where there are special classes they should be used for teaching those who would be able to look after themselves later in life and that such classes should pass under the Board of Control and should not remain under the Board of Education. To ascertain the number of mentally defective children and to provide for their education, supervision, and segregation it is recommended that the system of registration now in force with regard to school children should be turned to account and made the foundation of records which would be of use in caring for them throughout life. It is recommended that notification from public authorities and private homes should be required by statute, but that otherwise there should be no notification except in regard to patients received for profit. Where there are no special classes or schools it is recommended that the local authority may intervene and either make provision in connexion with the education authority or independent of it. The Commission is of opinion that the ordinary education authority should not be the authority in charge of mentally defective children. To the Commission it seems that a single and continuous control over the mentally defective person, both in childhood and subsequently in adult life, is indispensable and that the education authority as the educator of children and not as the supervisor of adults could not exercise this control, and just as the Poor-law, established for the care of the poor and destitute, is unsuitable for the care of the mentally defective, so the educational system of the country, established for the teaching of the normal child, is unsuitable for the child who can never reach the mental level of the normal.

regulate

the

provisions

treatment, and training.

OPENING

OF

LONDON SCHOOLS.

THE

MEDICAL

Winter Sessiorz 1908-09. St. Bartholome7v’s Hospital.-The session will begin on Oct. lst. The old students’ dinner will be held on the same evening in the great hall of the hospital at 7 P.M., when Mr. H. Gilbert Barling will preside. Charing Cross Hospital.-The session will commence on Oct. lst by the delivery of the seventh biennial Huxley lecture on Recent Advances in Science and their Bearing on Medicine and Surgery, in the out-patients’ hall at the hospital, at 4 P.M., by Sir Patrick Manson, K.C.M.G., F.R.S. The dinner of the past and present students will take place on the evening of the same day, at 7.30 P.M., at the Criterion Restaurant, when Mr. Edgar A. Browne of Liverpool will

as segregation is concerned there is a general conpreside. that it is not good for the individual or for the comSt. George’s Hospital.-The session will open on Oct. lst munity that a person who is mentally defective and has been with an inaugural lecture which will be given by Dr. Charles The annual dinner will be held on the convicted of crime should be set free, like an ordinary Slater at 4 P.M. prisoner, to go where he may on discharge. Equally is this same evening. so in the case of inebriates, or paupers, or children of school Guy’s Hospital.-The annual dinner and first meeting of Ii Guy’s Hospital Physical Society will be held on Oct. 8th. age, who are mentally deficient. Dr. James Kerr, the medical

So far

sensus

I the

THE MEDICAL INSPECTION OF SCHOOL CHILDREN.

893

The dinner will be held in the dining hall of the Students’ E school or the exclusion of certain children from it Club at7 P.M., with Mr. Cosmo Bonsor, treasurer of the c n’’reasonable grounds."" In this last duty the importance hospital, in the chair. At the meeting following the dinner ( f cooperation with the sanitary authority is urged and the Sir Richard Douglas Powell, Bart., K.C.V.O., will deliver an7 ioard expects that "the school medical officer will address on the "Just Procedure of Medicine." Dr. J. F.I aturally consider the matter from the point of view of I ducation as well as from that of sanitation, and, while Goodhart will preside at the meeting. King’s College Hospital.-The winter session will be opened l :eeping in close touch with the medical officer of health will 1 Ie in a position to advise the local education authority on on Oct. lst, when Professor A. Macalister, LL.D., F.R.S., will distribute the prizes and deliver an address. The annuali uch difficult matters." The section goes on to say that the old students’ dinner will be held on the same day, at 7 P.M., 3oard does not expect that all the work detailed above can )e carried out by a single officer in a large area, but that in at the Waldorf Hotel, Aldwych, Professor M. M. McHardy presiding. Tickets, one guinea each, may be obtained from nost cases he will be assisted by subordinates. (b) As regards ,he provision by local education authorities of an adequate Dr. StClair Thomson, 28, Queen Anne-street, London, W. London Hospital.-The session will be opened on Oct. lst. ;taff for the medical inspection of their school children, a The old students’ dinner will be held on Oct. lst at the Savoy )lank schedule is appended to be filled up and returned to Restaurant, at 7.30 P.M. Dr. A. J. Rice Oxley will occupy ;he Board by each authority stating the estimated number )f children for whose inspection provision is to be made; the chair. St. Mary’s Hospital.-The session will commence on jhe arrangements made for such inspection; the working Oct. 1st, when Sir John F. H. Broadbent, Bart., will deliver instructions given to the staff engaged thereon, and the scope the introductory address at 3.30 P.M. The annual dinner of )f the work contemplated. The schedule further requires past and present students will be held in the Whitehall Lhe following information concerning the medical officers Rooms of the Hotel Metropole on Oct. 2nd, at 7 P.M., with Mid nurses thus engaged :-Name ; professional qualification ; Dr. A. P. Luff in the chair. salary ; date of commencement of duties ; extent to which Middlesex Hospital.-The session will open on Oct. lst at these occupy the officer’s time (e.g., whole time, one-half, 3 P.M., when Dr. A. M. Kellas, Ph.D., will give an intro- one-third) ; the nature of duties, distinguishing inspecductory address, after which the prizes gained during the tion from treatment ; and general remarks. The Board previous year will be distributed by Mr. Rudyard Kipling. will consider the information returned on these schedules The annual dinner of the past and present students and their for each area on its own merits with due regard to local friends will take place at the Trocadero on the same evening circumstances and does not expect uniformity of procedure at 7 o’clock precisely, Dr. A. F. Voelcker being in the chair. so long as it is satisfied that the inspection is adequate. St. Thomas’s Hospital.-The session will open on Oct. 2nd Uniformity is not expected (Section (c)) regarding the with the old students’ dinner, which will take place at the annual reports to the Board to be returned by local These are to deal with the Savoy Hotel, Strand, W.C., at 7.30 P.M. Mr. Thomas education authorities. whole subject of school hygiene, including the sanitary, Wakley will preside. University College Hospital.-The session will open on lighting, ventilating, and warming arrangements in each Oct. 2nd, when the medals and prizes will be distributed in school building as well as with the detailed results of the library of the hospital at 3 P.M., and Sir Edward Fry the inspection of the children. A page of the circular will deliver an introductory address. The annual old is devoted to a long syllabus of matters to be dealt with students’ dinner will be held on the same day in the library in the report, and under section (d), where their applicaof the school, at 7.30 P.M. Dr. A. H. Carter of Birmingham tions are rehearsed under the headingArrangements for will preside. attending to the health and physical condition of school Westminster Hospital.-The session will begin on Oct. lst children,"the manifold duties of the school medical officers and the annual dinner will take place on Oct. 2nd at the are described as forming a 11 formidable catalogue." The Great Central Hotel. circular proceeds to express this opinion : " The mere fact Royal Free Hospital (London School of Medicine for that the services of a specially skilled officer and staff are IFcmcm).—The session will open on Oct. lst, when an devoted by the local education authority to the oversight introductory address will be delivered by Dr. Harrington of all matters affecting the health of the children in their Sainsbury, physician to the Royal Free Hospital. public elementary schools gives to the whole question of school hygiene a dignity and importance which cannot but produce a considerable effect on the minds of teachers, parents, and children alike. From this point of view the THE MEDICAL INSPECTION OF SCHOOL school medical officer should be not merely a functionary CHILDREN. charged with specific duties, but a pervading influence making, in the long run, for better hygienic conditions in the school and at home." The remaining sections THE recent circular of the Board of Educationto local under heading (d) deal with the exercise of powers under authorities has already been dealt with in a leading article, Acts relating to school children, the methods of but its provisions require further notice. It was issued under special with the sanitary authority, advice or direction cooperation Part III. of the Education Act, 1902, on certain questions to parents, the school nurse and her functions, the proarising under recent legislation concerning (a) the Functions vision of spectacles in cases where the parents or some of the School Medical Officer";; (b) Provision for Medical association are quite unable to procure them; and voluntary the Code of 1908 ; contributions to hospitals, Inspection of School Children under infirmaries, dispensaries, and (c) the Local Education Authority’s Annual Report to the "Children’s Care Associations " for the treatment of children Board of Education on Medical Inspection ; and (d) Arrangeon terms of adequate advantage, a section which permits the ments for Attending to the Health and Physical Condition of inclusion among conditions of contribution of a reasonable School Children. As stated in former circulars, the policy remuneration to the medical men working for such instiof the Board is to countenance a certain amount of latitude in the administration of the Act providing for the medical tutions. The last section deals with school ,clinics and authorises inspection of school children until such time as its difficulties their establishment at some place more convenient than and necessary limitations shall have been made clear. Under the first heading (a) the functions of a " school the school premises for the more thorough examination of medical officer " are defined. This title has been substituted cases such as ophthalmic cases, where special appliances for the vague expression medical authority " which was used are required. The Board forbids the use of such clinics for in the Code of 1907, and implies an official who shall be the regular inspection of all the children of any school. The relating to the treatment of children by this responsible to the local education authority from which he:: paragraph which means, brings the circular to a close, is sufficiently holds office for supervising and controlling the general work of medical inspection of school children, who shall reporl: important to be quoted in full:The establishment of of treatment of defects revealed 5School Clinics for on the working and effect of any arrangements made by inspection givespurposes rise on the other hand to questions of for educating children at an open-air school or schoo: considerable difficulty, and, before sanctioning the establishcamp, and shall have power to advise the closure o: ment of a School Clinic as anarrangement’ under of the Act, the Board will require to be Section 13 (1) 1 No. 596, dated August 17th, 1908, supplementary to Circulars 576B furnished with(b)detailed information as to the methods and ,

and 582.