Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

Taking, however, the census of 1871, in which a return of idiots was made, as the basis, we find the number in England and Wales to be at that time 29,452. Inquiry of the parents of known idiots has so often resulted in the discovery that they had not been returned, that it has been considered fair to add one-fourth to the above figures, thus bringing them up to 36,815, of whom 14,162 would be under twenty years of age, and therefore suitable objects for training, and 22,653 twenty years old and upwards. To these should be added five per cent. for increase of population since 1871, making the numbers, respectively, 14,869 and 23,786, or a total of 38,655, or 1 to 616 of the population. Of these, then, 1147, or about three per cent., are in training schools provided by charity. The remainder are either at home, in lunatic asylums, workhouses, or boarded out. We have found it impossible to arrive at any satisfactory result in attempting to apportion them to these various allotments. We know, however, that the census of 1871 gives 3456 as the number in asylums, and 7976 as the number in workhouses, including in the term the metropolitan district asylums. This would leave, out of the number of idiots reported by the census, about 18,000 with their friends or boarded out, or 18,900 at the present time, in consequence of the increase of population. We have, however, but scant faith in the correctness of these relative amounts. All we really know is the number receiving definite teaching or training, and an approximation—nothing more—to the gross number of idiots and imbeciles in the land. The next point is to determine the number who belong to the class, already indicated, which we have to legislate and provide for—the poor and the class immediately above them. The wealthy can send their children to private institutions; those who belong to an intermediate class to voluntary establishments, which would, in the event of the proposed legislation being carried into effect, be sufficient. It appears that about two-thirds of the idiots and imbeciles were chargeable to the poor rates, according to the census. Two-thirds of 38,655 yield 25,776. It is estimated that one-fifth of the remainder, that is to say 2176, may be added to comprise the class just above paupers and needing public help in the way proposed. Adding these figures together, we get in round numbers 28,000, for whom it is desirable for the State more or less to provide, in the way of training schools and custodial establishments. Those who are now in workhouses and in lunatic asylums would be removed from them, and so far would relieve the latter from their present crowded condition. This object would be still further gained if harmless lunatics, as proposed by the Charity Organization Committee, should be legislated for in the same way as idiots and imbeciles, and removed from asylums to separate institutions, as has been done at Caterham and Leavesden. The number of this class needing public administration is calculated at 7615.

Confining still our attention to England and Wales, where, as we have seen, voluntary effort has only succeeded in providing training schools for about three per cent. of the idiot and imbecile class, we desire to draw attention to the action taken by the Charity Organization Society of London, arising out of a consciousness of the inadequacy of this provision. In the summer of 1877 a sub-committee of this Society entered very fully into the consideration of this subject in all its bearings, and continued week by week, for some months, to discuss the various questions which presented themselves. Sir Charles Trevelyan, who originated the inquiry, observed that "he had rarely, if ever, known a subject so completely threshed out."

The most important conclusions arrived at were—that a small proportion of idiots and imbeciles can be so far improved as to support themselves, that a larger proportion may be trained to do some useful work, and that the remainder can be rendered happier and not so burdensome to others. On inquiry, it was found that about two per cent. of the cases admitted at Earlswood were cured so as to be able to support themselves. At one period in the history of this institution, when certain very unfavourable classes were rejected, as many as ten per cent. were so trained and improved. That this should be the maximum proportion will surprise those who have been misled by the ad captandum statements sometimes put forward to the public, no doubt with laudable and benevolent motives. This amount of success, disheartening as it seems at first, is not to be despised; but the strength of an appeal, whether to the charitable public or to the State, to provide for the training of idiots, lies in elevating them to the highest level of which their organization admits, curing them of offensive habits, affording them some positive happiness, and shielding them from unkind and irritating treatment.

It is the judgment of the above-mentioned Committee that idiots ought to be treated distinctively from other classes, whether the blind, or lunatics in asylums and workhouses, or children in schools, and that they should not be boarded out.

For those idiots and imbeciles who have been trained up to a certain point, beyond which it is impossible to advance them, suitable institutions or departments of institutions—adult custodial asylums—are suggested. Those idiots who are young, and can be taught, should be kept, as a general rule, distinct from adult idiots, in training schools. These two classes of institutions should be united, if possible, under the same superintendence.

The action to which we have already referred as having been taken by the Metropolitan Asylum Board, arising out of the Act of 1870, forms a useful experiment for the consideration and possible guidance of those engaged in endeavouring to provide for the training and custody of idiots and imbeciles, not in the metropolis alone, but the country.

After full discussion, the Charity Organization Committee resolved "that the arrangement which has been made for idiots, imbeciles, and harmless lunatics in the Metropolitan Asylum District is applicable in its main principles to the rest of England, viz. that they should be removed from workhouses and county lunatic asylums, and that young persons of those classes should be suitably educated and trained." Seeing that experience clearly proves that the voluntary principle is a failure, or at least wholly inadequate, for it only touches the fringe of the difficulty, it becomes absolutely necessary that the State should step in and supplement charitable effort. The Acts at present in force are possibly sufficiently elastic to provide for the want, if there was a determination on the part of the authorities in the various counties to avail themselves of them; but it is quite certain that no steps will be taken to do so, unless a new Act makes a distinct and special provision for the education and training of the idiot classes.

It appeared just to the Committee that not only should the local rates provide, as they do at the present time, for the charge of this class, but that assistance should be granted out of the public revenue; the best mode for such assistance being in the form of advances for the buildings required on easy terms, liberal capitation grants for young people under training, and grants of less amount for adults.

It is obvious that an idiot, while under the process of education, is at least as much entitled to the capitation grant allowed by the Education Department as the school children of the non-idiotic class.

A certain sum would also be received from the families of some of the inmates of the training schools and custodial institutions. It is proposed that those families which, although able to pay their way under ordinary circumstances, could not possibly defray the entire cost, should pay according to their means. As in the case of the blind and the deaf and dumb, it is considered that the relief given to children should not be counted as parochial relief to their parents.