Another census of the institutional type of feeble-minded made by the Director of Public Health Charities in Philadelphia and reported in 1910 enumerated 0.2% of the population as in this group. It included cases in the institutions for feeble-minded, the insane hospitals, almshouses, hospital, reformatories, orphanages and known to charity workers (168, p. 13).
One of the most careful surveys of individuals who, because of mental abnormalities, show such social maladjustment as to become the concern of public authorities was made under the auspices of the National Committee for Mental Hygiene in 1916.[[5]] It selected Nassau County as representative of New York state. Part of the survey consists of an intensive house to house canvass of four districts of about a thousand population each. The result disclosed that 0.54% of the population of this county were socially maladjusted because of “arrests in development” and 0.06% more, because of epilepsy. This was in a population of 115,827.
The Children's Bureau in the U. S. Department of Labor in 1915 made a census of the number of “mental defectives” in the District of Columbia. The census included only those whom we have termed feeble-minded. The report states that 798 individuals, 0.24% of the population, were found to be “in need of institutional treatment; and the number reported, allowing for the margin of error in omission and inclusion, is probably a fair representation of the number in the District who should have custodial care” (88, p. 13). Over a quarter of the population of the District is colored. The census was taken in connection with plans for immediate care. The same Bureau also made in 1915 and 1916 a Social Study of Mental Defectives in New Castle County, Delaware.[[6]] This county had a population of 131,670 and the survey disclosed 212 “positive cases of mental defect” and 361 “questionable cases,” a total of 0.44% of the general population in this county. Among the positive cases, 82.5% were in need of public supervision or institutional care. Among the questionable cases, information was obtained about only 175, and 165 of these were either in institutions, delinquent or uncontrollable, or living in homes where proper care and safeguarding were impossible.
Two other important attempts to enumerate carefully all the feeble-minded in definite areas in the United States have been made in recent years. Lapeer County, Mich., was chosen for such a study, as it was of average size and contained no large city. The census as reported in 1914, showed 36 feeble-minded from that county in the state institution and 116 others living in the county, a total of 1 from every 171 inhabitants ([145]). A special children's commission was appointed by the state of New Hampshire to investigate the welfare of dependent, defective and delinquent children. Its report in 1914 contained a section by its chairman, Mrs. Lilian C. Streeter, on feeble-mindedness ([40]). This comes the nearest to a complete enumeration for an entire state which has ever been attempted. The commission tested with the Binet scale the inmates of the State Hospital for the Insane, the County Farms, the State Industrial School and the Orphanages within the state. The borderline which it used for the scale was high. It counted all those testing three or more years retarded and under XII as feeble-minded. Taking its figures as they stand we find that they listed 947 as feeble-minded in institutions and 2,019 outside, a total of 0.69% of the inhabitants of the state. Outside the institutions the commission sent a questionnaire to all school superintendents and to chairmen of school boards, physicians, overseers of the poor, county commissioners, probation and truant officers, district nurses and charity workers throughout the state, by which means they listed 792 additional cases. This questionnaire gave the following description of the type of case it was trying to list as feeble-minded.
“The high grade imbecile, frequently known as the moron, is one who can do fairly complicated work without supervision, but who cannot plan, who lacks ordinary prudence, who cannot resist the temptations that are common to humanity. The high grade imbecile is most dangerous because, except to the expert, he is apparently not feeble-minded and is, therefore, usually treated as normal, and permitted to multiply his kind, and to corrupt the community.”
This description would tend to include cases above our isolation group. Besides the questionnaire the commission made an intensive study of 52 towns in which it says practically complete census returns were obtained by consulting doctors, school and town officials. With these supplementary cases it secured a list of 2,019 cases outside of institutions, making a total of 2,966 recorded cases within the state or 0.69% of the population. When it estimated the proportion for the entire state on the basis of the rate of canvass returns to questionnaire returns, this proportion rose to 0.95%. The commission does not advocate compulsory isolation for all of these people although it recommends custodial care for the feeble-minded women and girls of child-bearing age, apparently of the degree of deficiency represented by its criteria. This enumeration of 0.69% of the people of a state as feeble-minded is the most liberal general census of the feeble-minded in any large area. It clearly shows the trend of diagnosis since the British Census.
The Extension Department of the Training School at Vineland, N. J., states regarding estimates of the number of feeble-minded in the general population: “Conservative estimates give one in three hundred as the probable present number.” Under the discussion of estimates of the general population I have already cited Goddard's estimate which was approximately 0.3 to 0.4% and the enumeration of 0.4% by the British Royal Commission in 16 districts with over two million population. While all of these estimators are speaking broadly of the feeble-minded, in the general population, we shall not be far wrong in supposing that they are considering mainly those deficients for whom the state might well expect to provide care for life, isolating all those who cannot be eugenically guarded at home. We shall later quote the estimate of Van Sickle, Witmer and Ayres of 0.5% of the school population as “institution cases.”
Our estimate of 0.5% in the group justifying isolation on the ground of intellectual deficiency seems to be conservative and to harmonize fairly this type of estimate.
The Social Assistance Group. Passing now to the next higher group of deficients, those needing special training in order to get along with social assistance, the estimates have been based almost entirely upon the study of school children. Francis Warner was the moving spirit in the early investigations in Great Britain, which were made without tests from 1888 to 1894. The census which he directed included about 100,000 school children who passed in review before medical examiners. As cited by Tredgold ([204]) the estimate growing out of this work was that 1.26% of the school population should have instruction in special classes. Of these 0.28% required special instruction because of physical defects only ([204]).
About the same time Will S. Monroe ([155]) on the basis of a questionnaire sent to California teachers, who reported on 10,842 school children, found that they estimated 1,054 of these as mentally dull in school, 268 feebly gifted mentally, and 6 imbeciles and idiots. He summarized his conclusion as follows: “A long experience teaches that every school of fifty pupils has at least one child that can be better and more economically trained in the special institutions than in the public schools.” In his estimate of 2% he was probably thinking of care in special local schools and not permanent isolation.