[page iii]

Sir George Newman, K.C.B.,
Chief Medical Officer,
Board of Education,
Whitehall, S.W.1.

Sir,

I have the honour to submit the report* of the Committee appointed by you as Chief Medical Officer of the Board of Education on the 23rd June, 1924, to consider the problems presented by the mentally defective child. As you are aware, the scope of our deliberations was extended early in 1925 so as to include adult defectives, and our report is accordingly being presented also to the Chairman of the Board of Control.

The Committee met on 42 occasions. In addition a number of meetings of Sub-committees were held to consider those aspects of the question of which particular members were more closely cognisant.

At an early stage we were forced to the conclusion that the only way of supplying an answer to the first of the questions which you put to us, namely, "How many mental defectives are there?" was to hold an investigation in a number of typical areas. We wish to express our thanks to the Board of Control and the Board of Education for having put at our disposal funds for this purpose. With this assistance we were able to secure the services, as Medical Investigator, of Dr. E. O. Lewis, whose report on his inquiry is attached to ours. His investigation covered six areas each containing a population of about 100,000. Within these limits we believe that his investigation was more comprehensive than any similar inquiry hitherto held in this or in any other country, and we are convinced that Dr. Lewis' findings can be accepted not only as furnishing a reliable answer in regard to the question of incidence of mental defect, but also as affording very useful guidance to the Committee in their consideration of your second main question, namely, "What is the best way of dealing with mental defectives?"

Apart from the use which we have ourselves made of his report, we believe that it will prove of the highest value to all those who are concerned in any way with the various aspects, administrative, scientific, or social, of mental deficiency.

We realised from the first that if Dr. Lewis were to be given adequate time in which to complete his field work, tabulate his data and prepare his report, a considerable period must elapse before our own report, which is necessarily based to a large extent on his findings, could be completed, though all possible progress was made with its preparation while Dr. Lewis was at work. The preliminary arrangements for his inquiry, the investigation itself,

*Since this letter was written the form of the report has been altered on the lines indicated in the Prefatory Note.

[page iv]

and the writing of his report occupied three and a half years, after which a further period was required by the Committee for the completion of their report. We are conscious that our report has grown to dimensions which we did not contemplate at the outset, but it seemed to us impossible to make our recommendations for the future fully intelligible unless on the one hand we related them to the background of a clear and detailed description of present conditions and on the other broke away from piecemeal suggestions and tried to look at the problem as a whole. We hope that sufficient value may be found in Dr. Lewis' report and in our own to compensate both for their length and for the delay in presenting them. The questions with which we have had to deal constitute one of the major social problems of our time, and we are convinced that treatment less thorough could have been of little or no permanent use to the Departments concerned, and through them to the country at large.

I have the honour to be, Sir,
on behalf of the Committee,
Your obedient Servant,
(Signed) A. H. WOOD,
Chairman.

Romeyns Court,
Great Milton,
Oxford.
19th January, 1929.

Arthur H. Wood, M.A., C.B., late Assistant Secretary, Medical Branch, Board of Education, Chairman.
Ralph H. Crowley, M.D., M.R.C.P., Senior Medical Officer, Board of Education, Vice-Chairman.
Cyril L. Burt, M.A., D.Sc., Professor of Education, University of London, Psychologist, London County Council.
Cecil Eaton, M.A., Assistant Secretary, Medical Branch, Board of Education.
Miss Evelyn Fox, Honorary Secretary, Central Association for Mental Welfare.
Mrs. Hume Pinsent, M.A., C.B.E., Commissioner, Board of Control.
Miss Hilda Redfern, Head Mistress, Monyhull Colony School for Mentally Defective Children, Birmingham (since 1927, Inspector, Board of Control).
Frank C. Shrubsall. M.D., F.R.C.P., Senior Medical Officer, London County Council.
Alfred F. Tredgold, M.D., M.R.C.P., F.R.S. Ed., Lecturer in Mental Deficiency, London University, Assistant Physician in Psychological Medicine, University College Hospital, etc.
F. Douglas Turner, M.B., Medical Superintendent, Royal Eastern Counties Institution, Colchester.
N. D. Bosworth Smith, Principal, Medical Branch, Board of Education, Secretary.

[page v]

To the Right Hon. Lord Eustace Percy, M.P.,
President of the Board of Education.

My Lord,

I have the honour to submit the Report of the Special Committee appointed by me in 1924, to consider the problems presented by Mental Deficiency among children of school age.

The Report is a most valuable survey of the whole problem, and, as I understand that you are anxious that Local Education Authorities and others interested should be afforded the opportunity and advantage of seeing the Report at the earliest possible moment, I submit it forthwith.

I have the honour to be,
My Lord,        
Your obedient Servant,
GEORGE NEWMAN.

WHITEHALL,
January, 1929.

[page vi]

[page vii]

[page viii]

[page ix]

[page x]

[page xi]

The Committee in their Report as originally presented, while naturally distinguishing between the functions of Local Education and Mental Deficiency Authorities and between the requirements of older and younger defectives, endeavoured to deal comprehensively with mental deficiency, a subject which must be regarded as a unit problem. The Board of Education however were of opinion that it would be more convenient for their purposes if the Report were divided into two parts, one dealing with children and the other with adults, and inasmuch as the Committee were appointed with the object of advising the Board in matters affecting their administration they felt bound to comply with their wishes. The Committee are conscious that this division increases the difficulty of presenting the several aspects of the problem in their proper sequence and in the right perspective, but they hope that the advantages which the Board are anxious to secure will compensate for any loss of coherence and force which the Report may thus have suffered.

The Report is now arranged on the following broad lines:

Part I, consisting of Chapters I, II and III describes the functions and work of the Committee, discusses the meaning of Mental Deficiency and states the legal basis on which administration rests. This Part forms a general introduction to the whole Report.

Part II, which consists of Chapters IV to IX, deals with the problem of the mentally deficient child. A brief description of the contents of this Part of the Report is given in Chapter I.

Part III describes the present provision for adult defectives, makes suggestions and recommendations for the future in the light of the findings of the Committee's special investigation and discusses the wider aspects of Mental Deficiency as a social and genetic problem.

Part IV is the Report of the special investigation into the incidence of mental deficiency by Dr. E. O. Lewis.

[page 1]

1. The Mental Deficiency Act, 1913, which first laid upon Local Education Authorities the duty of discovering all the mentally defective children in their areas between the ages of 7 and 16, came into force on the first of April, 1914. The Elementary Education (Defective and Epileptic Children) Act, 1914, which first laid upon these Authorities the duty* of providing education for these children, came into force on August 1st, 1914. On August 4th, 1914, began the Great War.

2. These dates are of obvious importance. The ascertainment of mentally defective children is a difficult and laborious business and makes considerable inroads upon the time of the staff, especially the medical staff, of the Local Education Authority. The provision of new schools for all the mentally defective children for whom the Authority became responsible under the Act of 1914 clearly entailed a large amount of new building and the expenditure of much time and money. Inevitably the war made it hardly possible so much as to make a beginning with the activities imposed by the new Acts and it was not till something approaching normal conditions had been re-established after the war that it became feasible for Local Education Authorities or the Board of Education to give any serious attention to their new obligations. When this time arrived and the returns made by Local Education Authorities to the Board of Education of the number of mentally defective children in their areas were tabulated and scrutinised, the results were somewhat surprising. Some considerable variation was only to be expected, but the actual figures went far beyond anything that was reasonable. It was found that according to these returns the incidence of mental defect varied from 0.73 per thousand children in average attendance in one area to 16.14 in another, with a complete range of intermediate figures in the other areas. In other words, the returns appeared to show that the incidence of defect might be as much as twenty times as great in one area as in another, a conclusion which could only be regarded as fantastic. It is obvious that no sound administration could be built on such figures, and that little progress could be made until the number of mentally defective children who were likely to be found in any area could be known with reasonable accuracy. An Authority might take a census, conclude that it had, say, 100 mentally defective children to provide for, and decide to

*Local Education Authorities were given the power but not the duty to provide special education for mentally defective children by the Elementary Education (Defective and Epileptic Children) Act, 1899.

[page 2]

build a school for that number. But what guarantee was there that the number of children was correct? Other areas, with the same total number of children, would claim to find 50 or 200 mentally defective children. Which was right? Should the Board of Education restrict each of these areas to 50, or urge them all to provide for 200? It is safe to say that no trustworthy data existed upon which a reliable answer to these questions could be based. Some, or even many, of the causes of the variations in the Authorities' returns were known and could be allowed for. But when every allowance had been made, it remained true that the margin of variation was still large and unexplained. No one really knew whether, in fact, the variations were due merely to such reasons as differences in diagnosis or even in thoroughness of search, or to a real difference in the actual incidence of defect in different areas. Until this information was available, any Authority which desired to fulfil its obligations towards mentally defective children was, in fact, working in the dark.

3. A further consideration of fundamental importance came up inevitably for discussion when Authorities and the Board of Education addressed themselves to their new duties under the Acts. Was it clear that the methods of providing for mentally defective children which had been in vogue on a voluntary basis before the new Acts were passed, were the right ones? The new Acts involved an enormous extension of work of a kind that would clearly be very costly to the State. Was it not prudent at this stage to pause and consider whether all that was needed was a mere extension of the existing system, or whether the experience gained in the years that had passed since 1899 might not suggest some modifications and improvements?

4. We understand that it was with a view to finding an answer to these questions that the Chief Medical Officer of the Board of Education decided in the summer of 1924 to call together a small Committee which should meet and discuss these fundamental problems. The Committee was to consist of representatives of the Board of Education and the Board of Control and of persons outside these Departments who had intimate and expert knowledge and experience of different aspects of the question. The intention at the outset was that the discussions should be quite informal and no specific terms of reference were drawn up. The Committee was merely invited to assist the two Departments by considering such aspects of the problem of mental deficiency in children as may be summed up comprehensively in two simple questions - first , how many mentally defective children are there? and secondly, what is the best thing to do with them ?

5. At an early stage of their proceedings the Committee came to the conclusion that the scope of their discussions could not profitably be confined to children falling within the province of the Board of Education, but must extend to children of all grades of mental defect.

[page 3]

Problems similar to those affecting the educable child had arisen in regard to the child who was merely trainable, and other problems arose in regard to the still lower grade children. Any solution of the problem of dealing with the one category depended upon, and at the same time affected, the solution of that of dealing with the other category. The Committee felt, therefore, that if they were to arrive at any fundamental conclusions they must consider the problem of mentally defective children as a whole.

But it soon became clear that a still further extension of the field of inquiry was necessary. The Board of Control were no less concerned than the Board of Education to know how many defectives there were in the country who were or might become subject to be dealt with under the Mental Deficiency Act. Local M.D. Authorities were asked, directly the Mental Deficiency Act of 1913 came into force, to undertake and complete the work of ascertainment. But this work was for many reasons extremely difficult and the returns of these Authorities were no more reliable, taken as a whole, than those of Local Education Authorities; in fact, in many cases they were less so. They did not furnish trustworthy statistics to show the extent of the problem and the Board of Control had no accurate information to guide them in advising Local M.D. Authorities for how many cases in each of the various categories they were likely to have to provide. The Committee were driven, therefore, to the conclusion that if their labours were to be really fruitful, their deliberations must not be confined to children, but must range over the whole field of the mentally defective.

6. These views commended themselves to the two Boards concerned and early in 1925 the Committee became in effect a Joint Committee of the Board of Education and Board of Control, though never formally so constituted. No specific terms of reference were laid down, a large discretion being allowed to the Committee so to organise its work as to afford the best assistance it could to the two Departments in accordance with their known wishes.

7. The first problem which the Committee set themselves to solve was the vexed question of the numbers of mentally defective children and adults. Very little consideration of this problem convinced them that the only way to attack it successfully was to arrange for intensive investigations to be held in a number of different areas. The areas to be selected should so far as practicable be typical areas, representative, that is, of particular racial characteristics, of particular industrial groups (the textile industries, coal mining, agriculture), of different social strata (the population of a prosperous town, of a slum district, of a rural area), and they should be geographically well distributed over the country. Each area should contain a sufficiently large population to admit of reasonably accurate estimates being formed of the numbers of defectives likely to be found in similar areas, and the investigation should cover a sufficient number of areas to ensure that the data

[page 4]

and the conclusions arrived at on those data would be accepted as being generally applicable to the country as a whole. The principal consideration however which the Committee had in mind was that these investigations should all be conducted by a single individual so as to eliminate entirely the risk of a difference of standard being adopted in different areas, a defect which had been present in all previous enquiries of the kind. It was felt that in this way uniformity of standard would be secured and the value and reliability of the findings greatly enhanced.

8. We were fortunate in securing both the means to pay for these investigations, and an Investigator admirably fitted for the work. The Board of Education and the Board of Control put at our disposal sufficient sums to enable us to conduct the investigation as desired in six typical areas, and the Board of Control very kindly seconded for service as our Investigator one of their Officers, Dr. E. O. Lewis. Dr. Lewis possesses a wide combination of qualifications and experience for this particular work. He served for some years as a teacher in both elementary and secondary schools; he graduated in Natural Sciences at the University College of Aberystwyth and obtained further Degrees at the Universities of Cambridge (Mental and Moral Sciences Tripos) and London (D.Sc., Psychology). He was Demonstrator in Experimental Psychology and Lecturer in Educational Psychology at the Universities of St. Andrew's and Cambridge and served for several years as Master of Method at Caerleon and Islington Training Colleges. He later qualified medically and also held for three years at the University of Cambridge a Studentship for Research into the problem of Mental Deficiency. Later Dr. Lewis was an Assistant Medical Officer of the London County Council, and in this post he gained experience of the administrative problems of mental deficiency. His knowledge and experience of these problems was further widened by his subsequent appointment to be a Medical Inspector of the Board of Control. He could thus view the work from the standpoint of the teacher, the administrator, the psychologist, the inspector, and the doctor.

Dr. Lewis had the assistance of Miss S. Catherine Turner as social investigator and field worker. Miss Turner was a trained social worker, and for some years had held the post of Organising Secretary of the Voluntary Association for Mental Welfare in Staffordshire. The Medical Investigator received additional assistance in two areas from Miss M. O. Charlton, and in the Welsh areas Mrs. N. Williams-Jones undertook the work of the social investigator. Mrs. Lewis acted throughout as his Secretary.

9. It may of course be urged that even a single Investigator must adopt some standard of mental defect for his work and that that standard may not in itself be more correct than that of many of the certifying officers employed by Local Authorities. To some extent no doubt this is true; but the point seems to be met conclusively by the two following considerations. In the first place the standards

[page 5]

adopted by Dr. Lewis were those which were agreed upon by the Committee after very careful consideration. They were not so much those of a single expert, however competent, but those which seemed correct to this Committee as a whole. Secondly, and this is the really vital point, these standards are uniform for the whole enquiry and, even if too high or too low, can be adjusted accordingly. So far as the relative incidence of defect is concerned, we are confident that Dr. Lewis' returns are completely trustworthy.

10. In February, 1927, the Board of Education included in their Circular 1388 to Local Education Authorities the following statement: "With regard to provision for mentally defective children, Authorities will be aware that this very difficult problem is now being explored by a special Committee, and, save in exceptional circumstances, it would not seem prudent to incur heavy expenditure at the present moment on new schools for such children or on enlargements of existing schools." This statement indicates the second main problem which the Committee have had before them, namely, what are the best methods of dealing with mental defectives when they have been ascertained. So far as this issue is concerned we propose in these introductory remarks only to make clear the general lines on which we have endeavoured to work and to frame our report. Everyone who has been connected with the problem of mental defect is aware of its extreme complexity. It involves intricate and sometimes very obscure points both of law and of medicine; it raises difficult questions of administration; it touches very intimate conditions of home life; and it is closely concerned with such social questions as the liberty of the individual and the protection of the community. In any consideration of such a problem, an effort to be comprehensive may result in getting lost in a maze of detail; while an effort to be brief may lead to the omission of what is really essential. It has been the endeavour of the Committee, both in their discussions and in their report, to steer a reasonable course between over-elaboration on the one hand and the omission of relevant considerations on the other.

11. As indicated in the Prefatory Note, the Report in its original form dealt with the problem of mental deficiency as a whole, but has now been divided so as to deal with children and adults in separate parts. Those sections of the Report which relate more specifically to adult defectives are not contained in this volume, but will be found in Part III, which has been presented to the Board of Control and the Ministry of Health. The structure of that portion of the Report which is now published is framed on the following general lines.

12. In the forefront of their Report the Committee have deemed it essential to set out in some detail the position - medical, legal and administrative - as it exists to-day. No doubt this involves a repetition of much that is common knowledge, but it is only in the light of a clear statement of the present position that any criticism of its sufficiency or the reverse can be fairly or usefully made. The Committee have therefore begun their Report with three preliminary chapters - the

[page 6]

first dealing with the origin and purpose of the Committee; the second discussing the most fundamental point of all, the nature of mental defect from a scientific and medical standpoint; and the third setting out the legal position as it now applies to mental detectives of all grades and ages. Chapters I, II and III, which form Part I of the Report, must be regarded as in the nature of an introduction both to Part II (children) and Part III (adults).

Chapter IV describes the present provision made for mentally defective children under the existing laws.

Chapter V contains a short discussion of the more general findings of the investigation made by Dr. Lewis, and in particular of the findings in regard to children. The discussion of the findings relating exclusively to adults, and the conclusions drawn from them, are contained in Part III of the Report.

In the following Chapters (VI to IX) the Committee proceed to a discussion of the position in regard to defective children as they find it to-day in the light of their investigation; they state where, in their opinion, it is open to criticism; and they formulate their recommendations for the future.

[page 7]

13. In view of the misunderstanding which exists in some quarters regarding the nature of mental deficiency and the persons who should be regarded as mentally defective, we consider it essential to deal with this question at the outset of our Report. Mental Defectives are defined in two Acts of Parliament, namely, the Education Act, 1921, and the Mental Deficiency Act, 1921. Since, however, these respective Acts are intended to serve different purposes - the one the provision of suitable education and the other the provision of suitable care and supervision - their definitions are based upon different criteria, and this has undoubtedly resulted in some misconception as to the nature of mental deficiency. We therefore think it advisable, before attending to the legal definitions, to consider the subject from the general standpoint.

14. In the first place it is necessary to draw attention to the very wide variations in general mental capacity, scholastic educability, special aptitudes, emotional response, temperament and character, which exist in different individuals. This fact is well recognised and such individual variations are so great that it may truly be said that no two persons exist who are mentally alike. In spite of this, for practical purposes, the members composing a community may be broadly divided into two groups. First, there are those whose mentality is such as to allow of the independent performance of their duties in some social situation in a reasonably satisfactory and efficient manner. Secondly, there are those whose mentality is such as to render such independent and efficient adaptation impossible, and who consequently need some form of special surroundings or some degree of external assistance, control, or supervision. The second of these groups, which we may term that of the mentally incapable, is a very heterogeneous one, and the individuals composing it are divisible into three main classes. The first class consists of those persons whose incapacity is due to their minds having failed to reach what may be termed a normal degree of development. The second class consists of those whose minds have attained this degree of development, but who are suffering from a disorder of mental function which renders them temporarily incapable. The third class consists of those whose minds have similarly reached normal development, but who are undergoing progressive deterioration and decay. It is true that in actual practice these divisions not infrequently overlap. Thus, whilst mental disorder is often only temporary, it frequently passes into progressive and incurable deterioration. Further, the mind which is imperfectly developed may undergo disorder or decay. Nevertheless, for descriptive and practical purposes these three divisions are useful and hold good.

[page 8]

Speaking literally, it may be said that an individual falling within any one of these three classes suffers from a defect of mind, and the term "mentally defective" was, in fact, used in this generic sense in the Report of the Royal Commission on the Feeble-minded in 1908. This term, however, has gradually been acquiring a more restricted and specialised meaning, and it is now limited in ordinary use to the first class only, that is, to those persons suffering from an imperfection of mental development, whether inborn or acquired, or as it is technically termed "Amentia". It is this concept of mental deficiency, namely, that of a state of imperfect or incomplete mental development, with which alone we are concerned in this Report, and the important questions which we have to answer are: What do we mean by incomplete development, and how is this to be gauged?

15. At first sight it would appear both logical and justifiable to regard any individual whose mind fell in any way short of complete mental development as being mentally deficient. But the complete or perfectly developed mind is purely an abstract conception and has no real existence. As we have mentioned, individuals vary very greatly in the degree of development of their mental attributes. It is even doubtful whether the majority of individuals attain that degree of development of which they are inherently capable. So that, judged by such a standard, we should have to admit that most, if not all, persons were in some respect mentally deficient; which would be absurd.

If we consider the question from the biological and psychological aspects we arrive at the conclusion that whilst the human mind is made up of an almost infinite variety of activities, many of which are unquestionably of the utmost value in contributing to the advantage of the individual as well as to the advance of human knowledge, there are certain functions which are of fundamental importance. These essential functions are those by which the mature individual is enabled to adapt himself in such a satisfactory, efficient and harmonious manner to his social surroundings as to be capable of an independent existence, without, under normal conditions, the need for any special external care, supervision or control. It is, of course, obvious that a person may fail in some sphere of life because of a special mental disability; but so long as he is not deficient in the fundamental and essential factors he should be able to maintain an independent and efficient existence in some situation in the social fabric. On the other hand, if he is deficient in these essential factors, he will be unable thus to maintain himself without some form or degree of external supervision, and we consider that he will then come within the category of the mentally defective.

16. Recent psychological researches have thrown considerable light upon the nature of these essential functions or factors. It is now recognised that independent social adaptation is largely dependent upon the presence of certain inborn capacities and tendencies, some of a general character, others specific in nature. The most important of the general factors are "general intelligence"

[page 9]

and "general emotionality". These general factors of intelligence and emotionality are essential for normal behaviour and any serious lack of such endowments will make it impossible for a person so affected to adapt himself satisfactorily and efficiently to the social environment appropriate to his age and class. On the other hand defects of specific abilities have no such widespread results and it is possible for a person to be efficient socially even though decidedly lacking in one or other of such abilities and of the attainments normally based on them. Nevertheless, in actual practice it is found that a wide range of special disabilities is suggestive of a defect of general intelligence. Educational attainments, general knowledge, practical ability, are all acquisitions in part dependent on intellectual capacity, so that failure in these directions is suggestive of the presence of mental defect, the absolute existence of which can only be determined by direct examination.

17. The respective importance of these general and specific factors will be exemplified if we consider another commonly proposed standard of mental deficiency, viz., the educational standard. In all civilised communities the school is a very early and important testing house of human material. Certifying Officers seeking evidence of mental deficiency at an early age in any particular case rightly attach value to the school records. Broadly speaking, the children who manifest a general failure in the school environment show a similar failure in after life and become the adults who are incapable of leading an independent, tolerably efficient and harmonious social existence. The reliability of the school test depends chiefly upon the fact that all round success at school is determined largely by the child's native endowment in general intelligence and emotionality. The child who fails to make satisfactory progress in many of the school subjects, who is also definitely subnormal in the practical activities of the school and who fails conspicuously to develop those instinctive and emotional tendencies necessary to harmonious social life, will be inefficient and incapable after leaving school. At the same time it must be admitted that in some cases the so-called educational standard taken alone has proved misleading for the reason that a narrow scholastic standard of proficiency in a few subjects, more especially reading, writing and arithmetic, has been adopted instead of a broader and more comprehensive concept of education. In other words, specific abilities have been stressed unduly and the general factors have been overlooked. It is therefore necessary to point out that failures to read, write or manipulate numbers are not in themselves adequate criteria of mental deficiency. There are boys and girls who, although they left school at the age of fourteen with minimum attainments in one or another of the three R's, have proved themselves possessed of sufficient mental capacity to be independent and efficient citizens, albeit perhaps only in a humble walk of life. To designate these as mentally defective would be an injustice.

[page 10]

18. Our concept of mental deficiency, therefore, is that of a condition of incomplete development of mind of such degree or kind as to render the individual incapable of adjusting himself to his social environment in a reasonably efficient and harmonious manner and to necessitate external care, supervision or control.

19. Although we think it would be beyond the scope of our Report to enter into any details regarding the causation of such incomplete mental development, it seems advisable that we should give a brief general outline of this. Incomplete development occurs under two main conditions, namely: (1) in consequence of an inherent incapacity for development; (2) in consequence of the arrest of development by external causes. The development of mind is primarily dependent upon an innate potentiality for or impetus to such development. The amount of this developmental potentiality varies in different individuals, and in the first group of cases mental deficiency is due to the potentiality being insufficient to result in the degree of mental growth necessary for independent social adaptation. The deficiency of this group is termed "Primary Amentia". It may happen however that the inherent potentiality of the individual is normal, but the development of mind is interfered with by some external factor operating directly upon the growing brain. This may occur before, during or after birth and constitutes what is known as "Secondary Amentia". Familiar causes in this second group are injuries and the various forms of meningitis and encephalitis incident upon the brain before its growth is complete. The result in these cases will naturally be dependent upon the situation and extent of the lesions and the age of the individual at which they occur. Generally speaking, it may be said that the earlier the age of incidence the more serious will be the impairment of mental development. It is clear, however, that serious lesions of the brain occurring at any time before development is complete may interfere with that development to such an extent as to render the individual socially inefficient and in need of care. Such an individual will be a mental defective. On this point, we may say, it is now generally accepted that mental development may not be sufficiently complete to ensure independent social adaptation until late adolescence. It follows that an innate developmental potentiality which is insufficient to carry the individual up to this stage will, and a brain lesion occurring before this age may, produce mental defect.

20. It will be apparent, from what we have said regarding causation, that the degree of mental deficiency may vary very considerably both in cases arising from inherent defect and in those produced by external causes, and since this question of degree is one having important administrative bearings, it is necessary for us to deal with it. It is customary to divide mental defectives into three groups designated respectively Idiots, Imbeciles and Feeble-minded. At the outset we think it desirable to make it quite clear that, although this division is convenient for practical purposes, it

[page 11]

is not based upon any hard and sharp lines of demarcation or on any real difference in kind. As a matter of fact, the mentally defective form a continuous series ranging from the very deepest to the very mildest degree of defect, so that rigid classification is impossible and any division must be largely artificial and arbitrary. So long as this is borne in mind there is no objection to artificial gradings; they are, in fact, exceedingly useful, provided they can be defined with tolerable accuracy. This we shall now attempt to do, it being understood that the description which we shall give may not be applicable to the individual, but applies to each of these respective grades of defect taken as a whole. As to the criterion which should be adopted for the purpose of grading, we consider that the social criterion, which forms the best practical means of separating the normal from the defective, is also the best which can be used for the differentiation of the various grades of defect from one another. Adopting this, we describe these three grades as follows:

Idiocy This is the lowest grade of defect. The mental development of idiots is so incomplete that they are unable to appreciate and protect themselves from the common physical dangers which threaten life; many of them are even lacking in the primitive instinct of self-preservation. They are incapable of any scholastic education; they only understand the simplest spoken language, and can only speak a few monosyllables; they cannot perform any kind of work, and they have to be washed, dressed and looked after all their lives like little children.

Imbecility This is the medium grade of defect. Imbeciles stand above the idiots in that they can be taught to understand and protect themselves from many common physical dangers. They stand below the feeble-minded in that, whilst many of them can be trained to perform simple routine tasks under supervision, they are generally incapable of earning their living, or of contributing materially towards their keep. They require supervision in washing, dressing and looking after themselves. They are markedly defective in educational capacity; and as a class they cannot be taught to read beyond words of one syllable, to spell more than a few 2 and 3 letter words, or to do simple mental addition and subtraction beyond the smallest units. Speaking generally, it may be said that if an individual has not a higher mental ratio (or intelligence quotient) than between 40-50 per cent he is probably an Imbecile.*

Feeble-mindedness This is the mildest grade of defect, and the feeble-minded form a connecting link between the imbeciles and the dull or backward members of the normal population. They are superior to the Imbeciles in that they can be trained

*This and the other mental ratios mentioned in this Chapter are based on a maximum divisor of 14. The upper borderlines given are in the main applicable to children and are somewhat higher than those applicable to adults. This is especially true of the feeble-minded. See Dr. Lewis' Report, Chapter 2.

[page 12]

to perform work which will contribute materially towards or entirely pay for their keep. They are inferior to the lowest grade of the normal inasmuch as they cannot adapt themselves to circumstances outside their previous experience; they are lacking in certain features of intelligence, such as the capacity to look ahead and to make sensible plans for their future, and also in the control and common sense needed to achieve such plans and to maintain an existence independently of external supervision. Where they can earn their keep, they cannot of themselves lay out the money so earned so as to provide for their wants. In a small proportion of cases these defects are less prominent, but they are accompanied by such a marked lack of sense of right and wrong, of responsibility and social obligation, together with such strongly marked antisocial propensities as to cause the individual to be a grave danger.

The educational capacity of the feeble-minded varies within very wide limits. Generally speaking, it is decidedly below that of the normal but superior to that of the Imbeciles. Most feeble-minded individuals are capable of learning elementary reading and writing. Many can perform simple mental arithmetical calculations and can acquire and understand simple items of scholastic knowledge, whilst a few of them are sufficiently educable to be capable of profiting by the instruction in the ordinary public elementary schools. The mental ratio similarly varies rather widely in different individuals. Speaking generally, it may be said that a person with a mental ratio of between 50 and 70* per cent is probably feeble-minded; but to this there are exceptions.

21. In the preceding paragraphs we have endeavoured to describe the nature of mental deficiency, and the chief characteristics of the various grades of defectives, without reference to any legal definitions. We shall discuss the legal definitions in the next Chapter, but we may here remark that we consider them to be in substantial agreement with the concept we have formulated.

As we have pointed out, and as we again desire to emphasise, mere lack of educational attainments cannot, in itself, be regarded as constituting mental deficiency. There is no doubt, on the one hand, that persons exist whose scholastic educability has been so low that they have been admitted to special schools, but who, after training in such schools, have proved quite capable of efficient adaptation and of earning their living and fending for themselves without supervision. On the other hand, there is equally no doubt that persons exist who have passed through ordinary schools, but have subsequently proved to be so lacking in the mental functions necessary for independent social adaptation as to be permanently in need of external care and supervision.

Whilst we consider it desirable to make this clear, we are nevertheless of the opinion that, if the reaction and response of the

*See footnote on previous page.

[page 13]

individual to the environment of the ordinary schools be considered in its entirety, it will be found that a very high correlation exists between educational failure and social failure. Satisfactory adaptation to school life, as well as to home life in the pre-school period, necessitates the possession of mental functions similar in kind, although less in degree, to those which are required for independent social adaptation after leaving school. These functions consist in the ability to compare, discriminate and form judgments; to look ahead, foresee consequences and make plans; to learn from experience; and generally to control and co-ordinate behaviour in accordance with such plans and with the requirements of the community. There is no doubt that the general response to school life affords an important indication as to what will be the nature of the response in later life, and that consequently the child's reaction to his school environment, taken in its entirety, is of much diagnostic significance. It has become increasingly the practice to require evidence on these points, based not only on history, but on tests applied by the Certifying Officer designed to elucidate the degree of development of the above mentioned functions. At the same time, it must be borne in mind that the general controlling functions of mind to which we have alluded are normally the latest to attain completion of development, and that in consequence of this an individual whose behaviour has shown no marked abnormality during the school period, may, when he is required to face life on his own responsibility, prove incapable of doing so, owing to insufficient impetus to full normal development, or to the arrest of development by external causes. If the insufficiency is such that the individual needs care and control, he must be regarded as coming within the category of mental defect. In short, the only really satisfactory criterion of mental deficiency is the social one, and if a person is suffering from a degree of incomplete mental development which renders him incapable of independent social adaptation and which necessitates external care, supervision and control, then such person is a mental defective.

[page 14]

22. We cannot attempt within the confines of this Report any detailed review of past and present enactments affecting the mentally defective, but we think it desirable to sketch in outline some of the chief landmarks in that legislation and also the main provisions of the present law with particular reference to two questions:

I. The legal conceptions and definitions of the various types and grades of persons of defective mind; and
II. The principal methods devised by the Legislature for dealing with these persons.

23. In or about the reign of Edward I a distinction was for the first time made between the "born fool" or idiot* (fatuus naturalis) and the lunatic or person who "hath had understanding, but by disease, grief, or other accident, hath lost the use of his reason". In the Statute of Prerogatives in the reign of Edward II, a similar distinction was made between the "born fool" and the person unsound in mind with certain intervals of understanding (non compos mentis, sicut quidam sunt per lucida intervalla).

Unfortunately this simple distinction recognised by early laws between idiots and lunatics became clouded in obscurity in later centuries. The chief importance of the distinction in feudal times was a practical one. If a man were found by Inquisition to be a lunatic, the Crown took possession of his property only during his lunacy; whereas, if he were found to be an idiot, the Crown assumed permanent possession of his property subject only to an obligation to find for his person and estate. With the increasing complexity of civilisation, however, it became necessary to deal with the unsound in mind in various Statutes, and discrepancies arose between the criteria of law and of medicine.

By the nineteenth century the old distinction was to a large extent lost, as is shown by the various Acts passed in that century relating to lunatics and mental defectives. Cases which came before the Courts during the early part of the century seem to show that the term lunacy was often held to include idiocy, and that idiocy, though it usually connoted a congenital defect in mind, was sometimes

*The term "idiot" was used broadly as including imbeciles and feeble-minded persons. The higher grades of defectives were either not recognised or at least not differentiated in early times.

[page 15]

regarded as the extreme degree of "imbecility of mind" which might or might not be "original", that is to say, might date from birth or might be brought on through disease. Moreover no distinction was made between persons suffering from amentia and mental diseases and disorders in the Poor Law Amendment Act of 1868, which conferred on Guardians certain powers applying equally to idiots, imbeciles and insane paupers, nor in the Lunacy Acts of 1890 and 1891 (which are still in operation), under which not only lunatics, but idiots and even imbeciles and feeble-minded persons, if certified as of "unsound mind", may be sent to asylums, registered hospitals, licensed houses and Poor Law Institutions.

24. The first clear distinction in modern legislation between lunatics on the one hand and idiots and imbeciles on the other is to be found in the Idiots Act of 1886, but this distinction differs from that of the earlier laws. This Act provides that one who is an idiot or imbecile from birth or from an early age may be placed by his parent or guardians in any registered hospital or institution for the care, education and training of idiots or imbeciles. The Act thus marks certain important changes in nomenclature and administration; it recognises for the first time a sub-class of the mentally defective by using the term "imbecile" as denoting one who is less defective than an idiot; it suggests, though it does not specifically state, that idiocy and imbecility must exist from birth or from early age; and it indicates that both these classes may be capable of education and training, whereas the idiot at any rate of earlier times has been held legally to be completely incapable mentally.

25. Before long a further sub-division came to be recognised. Largely owing to the operation of the Education Act of 1870 it was realised that in the case of children there was yet another group, namely those who, though defective in mind, were capable of being educated to a greater extent than those who could be certified as imbeciles, and to these the term "feeble-minded" was given. The Royal Commission on the Deaf and Dumb, appointed in 1889, were asked to consider also "such other cases as from special circumstances would seem to require exceptional methods of education". They accordingly inquired how many idiots and imbeciles were capable of education and they came to the conclusion that there was a class of children whom they described as "educable imbeciles" and a further class of "feeble-minded children" who should be separated from ordinary scholars and receive special instruction. In 1897 a Departmental Committee was set up "to inquire into the existing systems for the education of feeble-minded and defective children not under the charge of Guardians and not idiots and imbeciles ... and to report particularly upon the best practicable means for distinguishing on the one hand between the educable and non-educable children and on the other hand between those children who may be taught in ordinary elementary schools by ordinary methods and those who should be taught in Special Schools." The

[page 16]

Committee agreed for the purposes of their inquiry to regard the words idiot and imbecile as denoting children who were not capable of being educated so as to be wholly or partially self-supporting, and described the feeble-minded, that is to say, those who ought to be taught in special classes, as "children who are capable of earning their own living wholly or partially in after life". It was as a result of the Report of this Committee that the Elementary Education (Defective and Epileptic Children) Act, 1899, was taken in hand, and we think it may be assumed that Parliament in framing that Act had in mind the distinction drawn by the Committee between idiots and imbeciles on the one hand and the feeble-minded on the other, that is, the distinction between those who could and those who could not be sufficiently educated to become at least partially self-supporting in after life. At the same time the Act itself says nothing of this criterion, but in Section 1 defines defective children as those who

"not being imbecile, and not being merely dull or backward are ... by reason of mental defect incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in ..." Special Schools or Classes.

[page 17]

27. In the Mental Deficiency Act, 1913, four categories of defective are for the first time clearly defined, namely:

"(a) Idiots; that is to say, persons so deeply defective in mind from birth or from an early age as to be unable to guard themselves against common physical dangers;

(b) Imbeciles; that is to say, persons in whose case there exists from birth or from an early age mental defectiveness not amounting to idiocy, yet so pronounced that they are incapable of managing themselves or their affairs, or, in the case of children, of being taught to do so;

(c) Feeble-minded persons; that is to say, persons in whose case there exists from birth or from an early age mental defectiveness not amounting to imbecility, yet so pronounced that they require care, supervision, and control for their own protection or for the protection of others, or, in the case of children, that they by reason of such defectiveness appear to be permanently incapable of receiving proper benefit from the instruction in ordinary schools;

(d) Moral imbeciles; that is to say, persons who from an early age display some permanent mental defect coupled with strong vicious or criminal propensities on which punishment has had little or no deterrent effect."

In Section 2 (2) (a) of this Act a further subdivision appears to be contemplated, similar to that referred to in the terms of reference of the Departmental Committee of 1897. The Local Education Authority are required by this Section to give notice to the Local Authority under the Mental Deficiency Act of all children who have been ascertained to be incapable by reason of mental defect of receiving benefit or further benefit from instruction in Special Schools or Classes. Had this Section said explicitly that the Local Education Authority were to notify all idiots and imbeciles, no ambiguity would have arisen. By refraining from this clear direction as to the type of child to be notified, the Section may be held to imply that there is a class of non-educable feeble-minded child less defective than the imbecile but more defective than the mentally defective child contemplated by the Elementary Education (Defective and Epileptic Children) Act, 1899. This interpretation has been accepted by the Board of Education for the purposes of their Mental Deficiency (Notification of Children) Regulations, which were issued in 1914, and also for the purposes of the revised Regulations issued in 1928.

[page 18]

Sub-Section 2 (b) of Section 2 of this Act should also be mentioned.

This Sub-section empowers Local Education Authorities to notify to the Local M.D. Authority the names of children -

"who on or before attaining the age of 16 are about to be withdrawn or discharged from a Special School or Class, and in whose case the Local Education Authority are of opinion that it would be to their benefit that they should be sent to an institution or placed under guardianship."

We shall discuss later* these two questions arising out of Section 2 (2) of the Act.

The only other matter to which we need for the moment refer in connection with this Act and the Regulations made thereunder is that it appears to be the duty of the Local Education Authority to notify to the Local M.D. Authority the names of all children who are certified by the Certifying Officer of the former Authority as idiots or imbeciles; thus indicating that in the view of the legislature no idiot or imbecile is capable of deriving benefit from such education as it is the Local Education Authority's duty to provide.

28. The description of the class of child who was to be certified as mentally defective under Section 1 of the Act of 1899 was incorporated in Section 55 of the Education Act, 1921, and is still therefore in force, but the definitions contained in the Mental Deficiency Act, 1913, have now been superseded by those in the Mental Deficiency Act, 1927. The present definitions which are contained in Section 1 (1) of this Act are as follows:

"(a) Idiots, that is to say, persons in whose case there exists mental defectiveness of such a degree that they are unable to guard themselves against common physical dangers:

(b) Imbeciles, that is to say, persons in whose case there exists mental defectiveness which, though not amounting to idiocy, is yet so pronounced that they are incapable of managing themselves or their affairs or, in the case of children, of being taught to do so:

(c) Feeble-minded persons, that is to say, persons in whose case there exists mental defectiveness which, though not amounting to imbecility, is yet so pronounced that they require care, supervision and control for their own protection or for the protection of others or, in the case of

[page 19]

children, that they appear to be permanently incapable by reason of such defectiveness of receiving proper benefit from the instruction in ordinary schools:

(d) Moral defectives, that is to say, persons in whose case there exists mental defectiveness coupled with strongly vicious or criminal propensities and who require care, supervision and control for the protection of others."

"For the purposes of this section, 'mental defectiveness' means a condition of arrested or incomplete development of mind existing before the age of eighteen years, whether arising from inherent causes or induced by disease or injury."

29. We have thought it necessary to set out in some detail the terms used in successive Acts of Parliament to describe the various classes of defectives, in order that we may be in a position to draw attention to certain apparent obscurities and inconsistencies that have given rise to administrative difficulty, particularly in regard to the category of cases whom the Local Education Authority ought to certify as mentally defective within the meaning of Section 55 (1) of the Education Act, 1921, and the categories whom they ought to notify to the Local Authority under the Mental Deficiency Act. Only a Court of Law can interpret these two Acts with any authority, and we claim no such authority for ourselves; but we think it essential to point out in the following paragraphs that these Acts contain definitions of, at any rate, the highest grades of mental defect which, though possibly not inconsistent, do lend themselves to different interpretations.

30. In Section 55 (1) of the Education Act, 1921, mentally defective children are, as stated above, defined as those who "not being imbecile, and not being merely dull or backward, are ... by reason of mental defect incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in such Special Classes or Schools as under this part of this Act may be provided for defective children." Two difficulties at once arise when we consider carefully the meaning of this Section. In the first place it will of course be obvious that the definition depends to a large extent upon the respective standards of the ordinary Public Elementary School and the Special School.

[page 20]

A child might lag behind his fellows in a school with a very high standard to such an extent that he might not derive proper benefit from attending that school, whereas he might be at least up to the average standard of another school where his fellow pupils were less advanced and might in consequence derive proper benefit from instruction in that school. It would be a very serious matter if such a child were certified as mentally defective merely owing to the accident of his attending the former school. But in practice this danger is more imaginary than real. Though the standard adopted in different areas for mental defect no doubt differs considerably, it may be safely asserted that Certifying Officers do not certify children as mentally defective because they do not derive benefit from the instruction given in the particular school they happen to attend, but rather because they fall definitely short of the level of intelligence attained by normal children of their age.

31. The second and more real difficulty is not whether children reach a certain educational level; the question which arises is whether any test of educable capacity, when taken by itself, is the proper measure of mental defect for the purpose of the Act. This point is so vital to the whole problem of the defective child that we must set out in some detail the two possible interpretations of the Act.

It is obviously possible to hold that the Education Act does in fact contemplate that mental defect in children should for the purposes of this Act be estimated on a purely scholastic basis and on no other. Section 55 does not refer to children who are incapable of receiving proper benefit from attendance at the ordinary Public Elementary School, but to those who are incapable of receiving such benefit from the instruction at those schools, and there can be no doubt that some children who are socially and temperamentally unstable and incapable of being taught to lead an independent life are yet quite capable of deriving proper benefit from instruction so far as their intelligence is concerned. The fact that all the other relevant Sections of the Education Act appear to be consistent with this view and intolerant of any other and that the Authority concerned with these children is the Education Authority, would seem to furnish very strong evidence in favour of the view that the mental defect contemplated by the Education Act is what may be conveniently described as a defect in educational capacity.

This interpretation appears to be confirmed by the fact that both the Education and the Mental Deficiency Acts contemplate that there are persons who, though they are recognised as mentally defective under the former Act when children, will not be recognised as feeble-minded under the latter when adults. Section 55 (4) of the Education Act, 1921, provides that -

"When a child is discharged from a Special School or Class on the ground that he is no longer defective ... the Local Education Authority shall return to the parent of the child any Certificate certifying that the child was defective ... "

[page 21]

Section 56 (5) of this Act provides that -

"The Local Education Authority acting under this Section shall make provision for the examination, from time to time, of any child dealt with under this Section, in order to ascertain whether that child has attained such a mental ... condition as to be fit to attend the ordinary classes of Public Elementary Schools ..."

The Education Act however is, as we have seen, intimately bound up with the Mental Deficiency Acts 1913-1927 so far as mentally defective children are concerned and if we turn to these latter Acts we find at once that they are governed throughout, (possibly with one very important exception), by an entirely different conception of mental defect. The definitions given in the first section of the Act of 1927 refer almost wholly to a mental defect which prevents its victims in varying degrees from managing themselves or their affairs. There is no suggestion here of any purely educational deficiency. The criterion is the ability of the person concerned to suit himself to his environment and live an independent life as an ordinary citizen. The nature of the deficiency in fact is essentially one which manifests itself in failure of social adaptation.

But while this conception of mental deficiency appears to govern the Mental Deficiency Acts as a whole there is, as already noted, one very important exception, and that exception relates precisely to the group of children which is most closely analogous to the children who are certifiable as mentally defective under the Education Act, namely the group defined in the Mental Deficiency Acts as feeble-minded.

Two diametrically opposed views may be and are held as to the interpretation to be placed on the definition contained in Section 1 (1) (c) of the Mental Deficiency Act, 1927, which we have quoted above, so far as it relates to feeble-minded children. The first view is that the only consideration to be taken into account is whether the child is permanently incapable of receiving proper benefit from the instruction in ordinary schools and that the question whether there is need of "care, supervision and control for their own protection or for the protection of others" arises

[page 22]

only in the case of adults. The other view (which to the Committee appears to be the more reasonable and desirable interpretation to adopt and also to be in accordance with the intentions of the Act, even though it may be held by some to be inconsistent with its terms) is that both considerations - the social and the educational - apply equally to children and that weight must be given to both in determining whether a child is feeble-minded within the meaning of the Mental Deficiency Act.

Now if it were agreed that the first part of the definition of feeble-minded persons applied to adults only, and if the Mental Deficiency Acts made no other mention of feeble-minded children, it might fairly be concluded that the definition of these children in these Acts corresponded almost exactly with that contained in the Education Act and that in both cases the criterion of mental defect was an educational one. But those who think that it is at least probable that the definition given in the Mental Deficiency Acts to feeble-minded adults applies equally to feeble-minded children point out in support of their contention that in any case Sub-section 2 (a) of Section 2 of the Mental Deficiency Act, 1913, as amended by the Act of 1927, appears to throw considerable doubt on this alleged similarity of definition between the mentally defective child under the Education Act and the feeble-minded child under the Mental Deficiency Acts. This Sub-section requires the Local Education Authority to notify to the Local M.D. Authority the names of all defective children over the age of 7 "who have been ascertained to be incapable by reason of mental defect of receiving benefit or further benefit in Special Schools or Classes, or who cannot be instructed in a Special School or Class without detriment to the interests of the other children, or as respects whom the Board of Education certify that there are special circumstances which render it desirable that they should be dealt with under this Act by being placed under supervision or guardianship or sent to an institution." The Sub-section in fact appears to contemplate that there will be children coming within the definition of Section 1 who fall into three categories, namely (1) children who fail in a test of educable capacity, (2) children whose character or behaviour makes them detrimental to the interests of other children, and (3) children who for special reasons need supervision, guardianship or institutional treatment. Now, if it be accepted that children may be incapable of receiving benefit in a Special School without being idiots or even imbeciles*, that they may be "detrimentals" without being moral defectives, and that there may be special reasons for putting them under supervision or guardianship or sending them to an institution under the Mental Deficiency Act although they are neither idiots, imbeciles nor moral defectives (and the Board of Education Notification Regulations which were

*See para. 27.

[page 23]

framed to carry out the intentions of the Act allow for all these possibilities), then it must follow that all these types of defect in children are included in the definition of feeble-minded as given in the Mental Deficiency Act, 1927; in other words, that the inability to receive proper benefit from such instruction does not refer exclusively to an educational incapacity, but may include such incapacity as arises from defects of character and temperament.

It will be seen at once that if this is the correct interpretation of the definition of the feeble-minded child in the Mental Deficiency Act, 1927, it may have a very important bearing on the definition of the mentally defective child in the Education Act. It may be argued that the general concept of the feeble-minded child in the Mental Deficiency Acts, even apart from any doubt whether the definition of the feeble-minded adult applies also to the feeble-minded child, must correspond with the general concept of the mentally defective child in the Education Act. But if the definition of a feeble-minded child in Section 1 of the Mental Deficiency Act, 1927, namely a child who is permanently incapable of receiving proper benefit from the instruction in ordinary schools, is found to include children whose defects are not only defects in educable capacity but also defects of character, temperament or general adaptiveness, then the same must apply, ex hypothesi, to the mentally defective child under the Education Act. The Mental Deficiency Act, using much the same words as the Education Act to define a type of child, proceeds to develop the definition by the inclusion of other than scholastic defects. Unless the two Acts are inconsistent, what applies to one must apply to the other.

We have no authority to decide which of these interpretations is correct, but we are bound for practical purposes to accept one or the other. We do not admit that the term "mental defect" can correctly be restricted to mean a defect in educational capacity only, but we are inclined to think that as a matter of fact the Education Act does primarily contemplate educational defectiveness, and we shall adopt that interpretation for the practical purposes of this Report. In other words, when we use the expression "mentally defective within the meaning of the Education Act", we shall mean primarily defective in educational capacity, although we realise of course that many of these children are also defective in social adaptiveness. On the other hand, we propose to adopt what has been described above as the reasonable interpretation of the Mental Deficiency Acts, and to use the term "mentally defective within the meaning of the Mental Deficiency Acts", when applied to children or adults, as meaning defective in social adaptation. Whether any alteration of the Education or Mental Deficiency Acts is required to remove such uncertainty of interpretation as we have described is a matter to which we shall refer again when we come to make our recommendations for the future.

[page 24]

32. We turn now from the legal definitions of the various grades of defectives to the provision contemplated for their care. We have already had occasion to refer to some of the provisions of early legislation for dealing with idiots, to the gradual extension of that term to include what are now known as imbeciles and feeble-minded persons, and to the powers vested in Lunacy and Poor Law Authorities to make provision for their care. All the principal Acts relating to lunatics which were passed in the 19th century (both those of 1845, 1853 and 1886, and those of 1890 and 1891, which are still in operation), dealt with the powers of the Lunacy Authorities to provide for idiots and other defective persons, and the only statutory provision that was made for these defectives until comparatively recent times was made under these Acts. Early legislation, indeed, enabled the Poor Law Authorities to deal with defectives, but under those Acts they were to be dealt with as paupers without reference to the special necessities of their mental condition. The Poor Law Amendment Act of 1868, it is true, provided for the transfer of idiots and imbeciles who might lawfully be detained in a workhouse from the workhouse of one Union to that of another - presumably with a view to securing that these defectives should be accommodated in institutions more or less specially adapted to their needs. But the first Act that contemplated the provision of ad hoc accommodation for idiots and imbeciles and provision for their care and training was the Idiots Act of 1886. This Act did not authorise the provision of institutions by any local or central public bodies, but enabled a few institutions which had already been founded by charitable effort to be legally registered under the Idiots Act and to admit defectives at the wish of their parents or guardians, without a Magistrate's Order and all the restrictions which had previously been necessary under the Lunacy Acts. They received both children and adults who were maintained by their parents or by charitable funds or occasionally by Board of Guardians. The candidates for admission had to be certified by a Medical Practitioner as idiots or imbeciles; but the term "imbecile" had at that time a wider connotation, and many patients who would now be classified as feeble-minded did in fact obtain admission.

33. We need refer but briefly to the later enactments relating to the education of mentally defective children - the Elementary Education (Defective and Epileptic Children) Act, 1899, which empowered School Authorities to ascertain one group of the mentally defective children in their areas and to establish Special Schools for them, and made it obligatory on parents of certified mentally defective children to cause their children to attend such schools if within

[page 25]

reach of their homes and to keep them at school up to 16; the Education Act, 1902, which created the Local Education Authorities and vested in them the powers referred to above; and the Elementary Education (Defective and Epileptic Children) Act, 1914, which made it the duty of the Local Education Authority to provide for the education of mentally defective children between the ages of 7 and 16 in Special Schools or Classes certified by the Board of Education. The principal provisions of these Acts have been incorporated, with modifications, in the Education Act of 1921.

34. So far as provision for the care and control of defectives is concerned the present law is in the main the result of the recommendations of the Royal Commission on the Feeble-minded, which was appointed in 1904 and reported four years later. We do not propose to discuss the general findings of that Commission; it seems necessary, however, to mention certain guiding principles which the Commissioners emphasised in framing their recommendations:

(i) That those persons, who, by reason of mental defect, cannot take part in the struggle of life, should be afforded State protection according to their needs.

(ii) That it is the mental condition of these persons and neither their poverty nor their crime which is the real ground of their claim for help from the State, and that they should therefore be dealt with primarily on the ground of their mental defect.

(iii) That the State, if it is to protect the mentally defective, must necessarily ascertain who they are and where they are, and that once they are ascertained the power of the State to protect them should continue as long as protection is necessary for their good.

[page 26]

steps should be taken for his continued care. The recommendations of the Royal Commission led to the passing of the Mental Deficiency Act, 1913, and this Act has now been amended in certain particulars by the Mental Deficiency Act, 1927.

35. The present law with regard to the mentally defective is in the main contained in the Education Act, 1921, and in the Mental Deficiency Acts, 1913-1927, though defectives may still also be dealt with under the Lunacy Acts, the Poor Law Acts or the Children Act, 1908. For the purposes of our report we propose to confine our discussion for the most part to the principal forms of provision contemplated by the Education and Mental Deficiency Acts and to refer in particular to certain directions in which we consider that the purpose of the Acts has not been fully achieved. Though some Sections of the Acts are closely inter-related and though the exercise of their powers by the Local M.D. Authority is directly dependent, at least so far as concerns children between 7 and 16 years of age, upon the manner and thoroughness with which the Local Education Authority exercise their powers and perform their duties under the Education Act, we think it will make for clarity if we discuss these Acts separately, dealing first with the functions of Local Education Authorities and subsequently with those of Local Authorities under the Mental Deficiency Act.

(a) Under the Education Act, 1921

36. Section 53 of the Education Act, 1921, makes it the duty of the parent of a child who has been certified as mentally defective under Section 55 to cause that child to attend a Special School or Class certified by the Board of Education for the admission of such children, provided that such a school or class is within reasonable distance of the child's home. Section 54 enables the Local Education Authority to enforce attendance at such a school if the parent is not providing otherwise for the suitable education of the child. Section 58 provides that the Local Education Authority shall consult the parents as to their wishes in regard to the education of their mentally defective children, and shall so far as possible give effect to those wishes.

Sub-section (1) of Section 55, which has already been quoted, requires the Local Education Authority to ascertain all children in their area who are mentally defective within the meaning of that Section, and further Sub-sections provide that a certificate that a child is mentally defective must be given by a duly qualified medical practitioner, approved by the Board of Education; that this certificate may be accepted as evidence in legal proceedings; that parents must cause their children to be examined for this purpose, if so

[page 27]

required by the Authority; and finally that in case of doubt whether a child is mentally defective, the matter shall be determined by the Board of Education.

Having laid down the procedure for ascertainment and defined the duties of parents, the Act proceeds to describe the duties of Local Education Authorities. It requires these Authorities to provide for the suitable education of all ascertained mentally defective children between the ages of 7 and 16 (and gives them the power of providing for children under 7 years of age, if the parent agrees) by means of Special Schools or Classes certified by the Board of Education or by boarding the children out near a Special School or Class which they can attend. It empowers Authorities to provide or maintain boarding schools or to contribute towards the establishment or maintenance of boarding schools provided by other Local Education Authorities or by voluntary bodies, but it does not make it their duty to provide boarding schools, unless the Board of Education are satisfied that provision for the education of the children cannot be made in any other way and that the number of children in the area for whom such provision cannot be otherwise made is not less than 45.

Lastly Section 55 (7) provides that -

"The Local Education Authority shall also perform such duties in relation to defective children within the meaning of the Mental Deficiency Act, 1913, as are imposed on them by that Act."

37. The duties imposed on Local Education Authorities by the Mental Deficiency Acts include as indicated above the duty of ascertaining what children in their area are defective within the meaning of those Acts; of ascertaining which of these children are incapable by reason of mental defect of receiving benefit or further benefit from instruction in Special Schools; and of notifying to the Local M.D. Authority the names and addresses of the children who are incapable of receiving such benefit or further benefit and also of the following classes of children - those who cannot be instructed in a Special School or Class without detriment to the interests of the other children; those in respect of whom the Board of Education certify that there are special circumstances which render it desirable that they should be dealt with under this Act by way of supervision or guardianship or by being sent to an Institution, and those who, on leaving a Special School at the age of 16, would in the Authority's opinion benefit by being dealt with under the Mental Deficiency Act either under supervision or guardianship or by being sent to an Institution.

In case of doubt whether a child is capable of receiving benefit or further benefit from instruction in a Special School or whether he

[page 28]

can be taught in such a School without detriment to the interests of the other children, the matter is left to the determination of the Board of Education.

38. The above provisions are perfectly clear up to a point. To begin with they make it quite plain that in the case of all children between the ages of 7 and 16 who may fall to be dealt with as mentally defective children (except in the case of Poor Law Children and children in Home Office schools whose position we discuss elsewhere)* the duty of ascertainment rests with the Local Education Authority, subject in certain cases to the overriding decision of the Board of Education. The Local Authority under the Mental Deficiency Act have no duties (except in the case of certain children falling within Sections 8 and 9 of the Mental Deficiency Act, 1913) in respect of any defective children between the ages of 7 and 16, unless and until their names have been notified to them by the Local Education Authority. It is, of course, hardly possible to exaggerate the importance of this provision. It means, as already stated, that to a large extent the successful working of the Mental Deficiency Act depends upon the way in which Local Education Authorities carry out their duties. By means of their School Medical Officers and Nurses, their Teachers and their School Attendance Officers, these Authorities are able to pass under review every child in the Public Elementary Schools of the country and thus have a means of discovering practically every case of mental defect in childhood which falls within the definitions of either Act. In this respect their powers differ vitally from those of the Local Authorities under the Mental Deficiency Acts in that Local Education Authorities can put through a sieve the whole population of their schools and bring within the working of the Acts every defective child between the ages of 7 and 16. It is not necessary for the child to be neglected or to have committed any offence. The mere fact of mental defect brings him, ipso facto, within the meaning of the law, and entitles him to the care and special education which the law provides. On the other hand should the Local Education Authority fail to carry out their duties thoroughly and should the child reach the age of 16 without having been notified, the Local M.D. Authority can do nothing for him until he gets into serious trouble, except in the rare† case of defectives whose parents have applied to them to provide for their care and training.

A further point in the law is equally clear. It is the duty of the Local Education Authority, having ascertained what children in their area are defective within the meaning of the Acts, to divide them into two categories, those who should be educated in Special Schools and those who should be notified to the Local M.D. Authority.

*See para. 49 et seq.

†It is anticipated that these cases will be more common in future in view of the amendment made by Section 2 of the Mental Deficiency Act, 1927, in Sub-section 1 (b) (i) of Section 2 of the Act of 1913.

[page 29]

The former they must retain under their own jurisdiction and provide for in the manner laid down in the Education Act; the latter they must notify and hand over to the Local M.D. Authority, subject, of course, to the regulations already referred to.

39. There are, however, one or two provisions in these Acts which, whether on account of their obscurity or of altered circumstances which have arisen since the passing of the Mental Deficiency Act of 1913, have given rise to administrative difficulty and have, in fact, militated against the successful working of what we believe to have been the intention of that Act, namely, the affording of special forms of protection for those defective children and adults for whom no other form of public assistance or protection was available.

40. (i) The compulsory age for attendance at an ordinary Public Elementary School normally ends at 14, while that for attendance at Special Schools extends to 16. The question has arisen whether a Local Education Authority who have failed to certify a child as mentally defective before it reaches the age of 14 may certify it between the ages of 14 and 16. It may on the one hand be argued that, if no sign of mental deficiency justifying certification under Section 55 of the Education Act was detected before the child left school at 14, it is doubtful whether between that age and 16 any sufficient evidence could be adduced to justify certification. It may on the other hand fairly be contended that, since under Section 61 of the Education Act, 1921, the period of compulsory education extends in the case of a mentally defective child until he attains the age of 16, the child cannot be free from the liability to certification before reaching that age. It must, moreover, be borne in mind that mental defectiveness as defined in the Mental Deficiency Act, 1927 may be caused by disease or injury at any time up to the age of 18 and that in these circumstances it is difficult to hold that a Local Education Authority may not certify, and if necessary notify, between the ages of 14 and 16, a child who has not been certified as mentally defective before the age of 14. There are, indeed, many cases in which the mental defect, though due to inherent causes, may not become manifest until the age of 14 or even later.*

41. (ii) The Local Education Authority are required under Section 2 (2) (b) of the Mental Deficiency Act, 1913, subject to the regulations, to notify to the Local M.D. Authority all children who are about to leave Special Schools at the age of sixteen in whose case the Local Education Authority consider that notification would be to the child's benefit. They have, however, no corresponding power to notify a similar child who, from lack of a place in a Special School or for other reasons, happens to be in attendance at a Public Elementary School and is about to leave that school at the age of

*This difficulty is discussed and suggestions for its solution are made in Chapter VII, paras. 129, 130, 140 and 143.

[page 30]

fourteen, unless the child can be certified to be incapable of benefitting from instruction in a Special School or to be "detrimental" or unless the Board of Education can certify that there are "special circumstances".* It is notorious that the supply of Special Schools is totally inadequate to meet the needs of all certifiable mentally defective children, and consequently large numbers of these children are, in fact, attending Public Elementary Schools. The absence of any specific provision enabling a Local Education Authority to notify a mentally defective child who is leaving a Public Elementary School at fourteen similar to that which enables them to notify a child leaving a Special School at sixteen has resulted in large numbers of children who are in fact defective within the meaning of the Mental Deficiency Acts going out into the world without that protection which the Acts were intended to secure for them.

42. (iii) The Mental Deficiency Act, 1913, as already stated, provides under Section 2 (2) (a), as amended by Section 2 of the Act of 1927, that certain children may be notified by the Local Education Authority to the Local M.D. Authority if the Board of Education certify that there are "special circumstances which render it desirable that they should be dealt with under this Act by being placed under supervision or guardianship or being sent to an Institution". The children who may be thus notified are children who have been certified as feeble-minded but as not incapable, by reason of mental defect, of receiving benefit from instruction in Special Schools, and who, therefore, if it were not for these "special circumstances", would continue to fall within the purview of the Local Education Authority. There is no evidence to show what precise "special circumstances" the legislature had in view in making this provision, but it is clear that in general the intention was to secure proper care for children for whom the Local Education Authority were unable to provide under their own powers. It was, no doubt, contemplated when the Act of 1913 was passed that before long Local Education Authorities would have provided sufficient Special School accommodation for the whole group of educable mentally defective children and that the only members of this group for whom their existing powers were not sufficiently extensive to enable them to provide would be those who, for some reason other than educational incapacity or detrimental behaviour, could not receive at Special Schools the particular forms of care and control that they required. If adequate provision of both day and residential schools had been made the number of these children would, no doubt, have been extremely small, but, as we have seen, the supply of Special School accommodation has lagged far behind the demand and there is, in fact, a large body of high grade mentally defective children who have remained in the Public Elementary Schools throughout their school lives. In theory the Local Education Authorities' powers were sufficient to meet the

*See (iii) below.

[page 31]

needs of these children who were ex hypothesi suitable for admission to Special Schools; but in practice the inadequacy of Special School accommodation made it impossible for Authorities to provide for these children themselves. Moreover, the very fact that the children were not attending Special Schools kept them, as we have seen in the preceding paragraph, outside the scope of Section 2 (2) (b) of the Mental Deficiency Act, 1913, and the only means by which provision for their care could be secured was notification under that part of Section 2 (2) (a) which we have quoted above.

This brief account of what has occurred in this connection since the passing of the Act of 1913 will show that the "special circumstances" have necessarily come to be given a different and a wider connotation than was originally contemplated. Most of the cases in which children have been notified on account of "special circumstances" have been those of boys or girls of some twelve years of age and upwards, who may or may not have been attending Public Elementary Schools but were not attending Special Schools, and who owing to unsatisfactory home circumstances or for other reasons were exposed to moral dangers or were likely to be a danger to others. Other cases have been those of mentally defective children who were also suffering from blindness, deafness, epilepsy or some other physical defect, for whom no suitable Special School accommodation existed, even though the provision of such accommodation was within the powers of Local Education Authorities. Other cases again in more recent years have been those of children suffering from the after effects of encephalitis lethargica, whose conduct, behaviour or moral character, even though they might not be "detrimental", was such as to render it necessary for them to be dealt with under the Mental Deficiency Acts.

Local Education Authorities have perhaps not made such wide use of their powers of notifying children on the grounds of "special circumstances" as they might have done, partly because the Act required that all such proposals must be submitted to the Board of Education. We believe moreover that the Board, having in view the Parliamentary history of this section and the fact that it was intended to cover cases which could not be dealt with under any of the Local Education Authorities' existing powers, have administered it with considerable restraint and have in general been unwilling to regard the impossibility of securing a child's admission to a Special School as a "special circumstance" justifying the issue of their certificate. Whatever the reasons for the small use that has been made of this Section of the Act, we are convinced that it has resulted in considerable numbers of children who were in urgent need of the protection afforded by the Act being prevented from obtaining it.

The three questions which we have discussed in the preceding paragraphs appear to us to reveal a somewhat serious weakness in the Mental Deficiency Acts and certainly to have hindered their

[page 32]

successful working. In formulating our proposals for the future with regard both to the certification and notification of children and to the allocation of responsibility between the Authorities concerned, we will make certain recommendations which will, we hope, overcome these difficulties.

43. We have so far discussed the powers and duties of Local Education Authorities with regard to mentally defective children; we will now turn to the functions of the Local Authorities under the Mental Deficiency Acts in respect of those children and adults who fall within their province.

(a) Statutory Duties

44. The Act of 1913 set up the Board of Control as the central body and the County and County Borough Councils as the Local Authorities for the purposes of the Act. These Local Authorities are required by Section 30 of the Act of 1913, as amended by Section 7 of the Act of 1927,

(a) to ascertain what persons in their area are defectives subject to be dealt with under the Act (apart from children between 7 and 16);

(b) to provide suitable supervision for these persons or if such supervision affords inadequate protection to secure that they shall be dealt with by being sent to institutions or placed under guardianship;

(c) to provide suitable and sufficient accommodation for those who are sent to institutions and to maintain them in those institutions;

(cc) to provide suitable training or occupation for defectives under supervision or guardianship or in institutions;

(d) to make provision for the guardianship of those who are placed under guardianship.

The Local Authorities are, however, under no obligation to deal with any defectives who are already being dealt with under the Education, Poor Law* or Lunacy Acts.

*The repeal by Section 14 (4) of the Local Government Act, 1929, of the latter half of Section 30, proviso (ii) of the Mental Deficiency Act, 1913, while placing no obligation on Local M.D. Authorities to deal with defectives now being dealt with under the Poor Law, removes the embargo hitherto placed on action by those Authorities. Moreover Section 5 of the Local Government Act empowers County and County Borough Councils to declare by scheme that any assistance that could be provided, either by way of poor law relief or by virtue of the Mental Deficiency Act, 1913, shall be provided under the latter Act.

[page 33]

(b) Limitations on the powers and duties of Local M.D. Authorities

45. Now the powers and duties of the Local Authorities thus described appear at first sight to be sufficiently comprehensive and to be limited only by the three exceptions referred to in the preceding paragraph. There is, however, a further limitation, which, when taken in conjunction with these exceptions, greatly restricts their functions. Section 30 (1) of the Act of 1913 gives the Local Authorities powers and duties in respect of defectives who are "subject to be dealt with" under the Act, and the only types of defective who are subject to be dealt with are those described in Section 2 (1) (b) as amended by the Act of 1927, namely those:

(i) Who are found neglected, abandoned, or without visible means of support, or cruelly treated, or with respect to whom a representation has been made to the Local Authority by the defective's parent or guardian that he is in need of care or training which cannot be provided in his home;

(ii) Who are found guilty of any criminal offence, or who are ordered, or found liable to be ordered, to be sent to a certified Industrial School;

(iii) Who are undergoing imprisonment (except imprisonment under civil process), or penal servitude, or undergoing detention in a place of detention by order of a court, or in a Reformatory or Industrial School, or in an Inebriate Reformatory, or who are detained in an Institution for Lunatics or a Criminal Lunatic Asylum; or

(iv) Who are habitual drunkards within the meaning of the Inebriates Acts, 1879-1900; or

(v) In whose case such notice has been given by the Local Education Authority as is hereinafter in this Section mentioned; or

(vi) Who are in receipt of Poor Relief at the time of giving birth to an illegitimate child or when pregnant of such child.

[page 34]

repetition, since it lies at the root of the matter. It must moreover be borne in mind that considerable numbers of defective children are in the hands of Poor Law Authorities and are thus in the main outside the province of the Local M.D. Authorities.

We desire to point out that the limitations imposed by the Legislature on the powers of the Mental Deficiency Authorities have operated in a sense and to an extent which we do not think was contemplated by Parliament. It was, we believe, anticipated that once the Acts of 1913 and 1914 were passed, practically all defectives (except possibly those under the Poor Law) would in future be caught in the sieve of the Local Education Authority before they reached the age of 16, and that consequently, apart from those who had already passed the age of 16 when the latter Act came into operation, the only defectives whom the Local M.D. Authorities would have to ascertain for themselves would be a small residue who developed tendencies dangerous to themselves or to the community after they had passed out of the jurisdiction of the Local Education Authorities. We believe that it was for this reason that the Act of 1913 so closely limited the classes of adult defectives whom the Local M.D. Authority might themselves ascertain as "subject to be dealt with" under the Act. However this may be, it remains true that large numbers of adult defectives who need care and control are deprived of it owing to the working of these limitations and that one of the main purposes of the Mental Deficiency Acts cannot be achieved unless Local Education Authorities ascertain all the defective children in their areas and notify all who require supervision, guardianship or institutional care.

(c) Permissive powers

46. Mention should also be made of what may be described as the permissive powers enjoyed by the Local M.D. Authorities. There are certain classes of person for whom they have the power, but no duty, to make provision. They may under Section 30 (e) of the Act of 1913 "if they think fit, maintain in an Institution or approved Home, or contribute towards the expenses of maintenance in an Institution or approved Home, or the expenses of guardianship of any defectives other than aforesaid", i.e. other than those who are "subject to be dealt with". The assistance given in these cases however is discretionary, and is not aided by contributions from the Exchequer; moreover the expense which may be incurred by the Authority in rendering it must not in any one year exceed the produce of a penny rate. The facts that the Local Authorities are under no obligation to exercise their permissive powers and that the whole of the limited expenditure which they may incur in dealing with these defectives must come out of the rates have resulted in very little use being made of these powers

[page 35]

(d) Forms of provision

The various forms of provision which may be made for defectives under the Mental Deficiency Acts may be summarised as follows:

(i) State Institutions may be established and managed by the Board of Control for the maintenance of defectives of dangerous or violent propensities.

(ii) Certified Institutions may be established by Local Authorities, by Societies or Associations, or under certain conditions by Poor Law Authorities.

(iii) Approved Homes may be conducted, for private profit or otherwise, for the reception of defectives supported wholly or partly by voluntary contributions; no defective under Order can be sent to or detained in such a Home.

(iv) Certified Houses. The Board may grant a certificate to a person desirous of receiving defectives into his house for private profit. No Local Authority however can contribute towards the expenses of maintaining a defective in a Certified House.

(v) Under the guardianship of a suitable person nominated by the Judicial Authority, or

(vi) Under statutory supervision.

(e) Safeguards

47. We have already referred to some of the limitations imposed by the Statutes and otherwise on the activities of Local M.D. Authorities. We need only add that from the point of view of the defective the Legislature has been equally careful to provide the fullest possible safeguards against the improper curtailment of individual liberty and the undue detention of defectives. No defective may be placed under guardianship or sent to an Institution (except in certain cases at the instance of his parents) without an Order from a Magistrate, and this can only be given under Section 5 of the Mental Deficiency Act, 1913, after the presentation of a petition accompanied by two medical certificates. The Magistrate's Order can only be given, in the first instance, for one year and is subsequently subject to review from time to time. Moreover defectives may be discharged by the Visitors on attaining the age of 21, or by the Board of Control at any time. Similar precautions are taken in regard to defectives dealt with under Sections 8 and 9 of the Act.

[page 36]

48. It will be apparent from what has already been said that Parliament in framing the Act did not in fact place all defectives under one Central Authority, or under a single Local Authority in each area, as recommended by the Royal Commission on the Feeble-minded. The Mental Deficiency Acts not only contemplate a division of responsibility between Local M.D. and Education Authorities, but also leave outside the sphere of either of these Authorities large numbers of defectives who, in the words of the Royal Commission, "cannot take part in the struggle of life" and so "should be afforded State protection according to their needs", and whose claim to help from the State is not their poverty nor their crime, but their mental condition. We have already discussed the functions of (1) Local Education Authorities, and (2) Local M.D. Authorities; let us now turn to the three principal groups of defectives who fall outside the province of these Authorities and are dealt with by (3) the Poor Law Authorities; (4) the Lunacy Authorities; and (5) the Home Office.

(a) The functions of Poor Law Authorities*

49. Boards of Guardians under their ordinary powers for the relief of the poor - and in particular under the Poor Law (Certified Schools) Act, 1862, the Poor Law Amendment Act, 1868, Section 4 of the Poor Law Amendment Act, 1851, and Section 10 of the Poor Law Act, 1879 - may send any mental defective chargeable to their Union to any appropriate institution. They are empowered to select the proper form of relief for a poor person requiring relief on account of sickness, accident or bodily or mental infirmity. Special powers have been given in London to the Metropolitan Asylums Board. Thus, Guardians have ample powers to maintain any defective in a workhouse or in an appropriate institution, and practically the only stipulation is that this provision shall be made "on the advice of the Medical Officer". Wide use has been made by Guardians of these powers and there is reason to believe, as we shall show later, that there are many defective children in Poor Law and other institutions maintained by Guardians. With certain exceptions these defectives are not within the purview of the Mental Deficiency Acts, are not detained in accordance with the provisions of these Acts and do not benefit from the safeguards or protection which they provide. For example, their cases are not periodically reviewed in conformity with Section 11, nor can they be licensed from the institutions by the methods applicable to cases which are detained under the Act. Moreover, it is left to the discretion of Guardians whether defectives shall be treated as paupers or as

*This Report, except where expressly indicated, does not take account of alterations in the law which have been brought about by the passing of the Local Government Act, 1929, since the Report was presented.

[page 37]

mentally defective persons. It is true that Boards of Guardians have the power, under Regulations,* to report cases to the Local M.D. Authority, but they have no duty to do so. Defectives dealt with by Guardians are under no certificate and may be discharged by the Guardians or withdrawn by their parents or relatives at any moment. Guardians are under no obligation to establish special institutions or colonies for defectives, though some of them have set up institutions of this sort. The defectives attending them, however, cannot be sent out on licence or transferred by a varying Order to guardianship, they enjoy none of the safeguards provided by the Mental Deficiency Acts, and however great their need of institutional control, they may take their discharge as soon as they cease to be children.

50. The position of mentally defective children under the Poor Law seems particularly anomalous. Section 30, proviso (iv), of the Mental Deficiency Act, 1913, provides that the duty of ascertaining what children in the area between the ages of seven and sixteen are defective rests with the Local Education Authority and that the Local M.D. Authority shall have no duties as respects defective children except those whose names and addresses are notified to them by the Local Education Authority. Section 30, proviso (ii), however, provides that "nothing in this Act shall affect the powers and duties of Poor Law Authorities under the Acts relating to the relief of the poor, with respect to any defectives who may be dealt with under those Acts."

These two provisos are extremely hard to reconcile and we understand that divergent views have, in fact, been taken as to their meaning. It is widely held that Local Education Authorities have no right of entry into Poor Law Institutions and, unless requested by the Guardians, are consequently precluded from ascertaining or notifying mentally defective children who are in the hands of the Poor Law Authorities. We understand that a working arrangement has been made between the Board of Education and the Board of Control with a view to minimising the administrative difficulties which have arisen under the provisos referred to above, but the fact remains that proviso (ii) has undoubtedly operated against the transfer to the Local M.D. Authority of many children who were in urgent need of the protection afforded by the Act.

Again, so far as education is concerned, the position is not altogether clear. The fact that Local Education Authorities cannot ascertain mentally defective children in Poor Law Institutions may deprive these children of the educational facilities which are open to other mentally defective children. It appears to be the duty of the Guardians to present children for examination by the Local Education Authority under Section 55 of the Education Act, 1921,

*The Regulations in question are made under the Mental Deficiency Act, 1913, latter part of Section 30, proviso (ii), which is now repealed.

[page 38]

though this duty is not easy to enforce. It also appears to be the duty of the Local Education Authority to examine children in the hands of the Guardians under that Section, but as already stated there is some doubt as to the extent to which these Authorities can in fact exercise their powers and duties with regard to such examination and ascertainment. Again, it appears to be the duty of the Local Education Authority, at the request of the Guardians, to provide for the education at day schools of any mentally defective children for whom the Guardians may be responsible; but the Local Education Authority are under no obligation to provide for the education of such children in Residential Schools unless the whole cost is repaid to them by the Guardians. In one or two cases the Guardians have themselves provided Special Schools* for mentally defective children in Poor Law Institutions and the Guardians have also sent a limited number† of children to Residential Special Schools certified by the Board of Education. Apart however from these cases and cases in which there is a Day Special School available for mentally defective children in Poor Law Institutions or boarded out by the Guardians, very little suitable educational provision can, in fact, be made for these children.

(b) The functions of Local Authorities under the Lunacy Acts, 1890-1911

51. Section 30, proviso (iii) of the Mental Deficiency Act, 1913 provides that -

"Nothing in this Act shall affect the powers and duties of Local Authorities under the Lunacy Acts, 1890-1911, with respect to any defectives who may be dealt with under those Acts, nor shall Local Authorities under this Act have any duties or powers with respect to defectives who, for the time being are, or who might be, provided for by such Authorities as aforesaid except to such extent as may be prescribed by Regulations made by the Secretary of State with the concurrence of the Lord Chancellor."

*There are two certified Residential Special Schools for mentally defective children provided by Poor Law Authorities, with accommodation for some 350 children (of whom almost half are maintained by Local Education Authorities) and there are also a certain number of Residential Schools provided by Guardians for similar children, which are not certified by the Board of Education.

†In recent years the number of children maintained by Poor Law Authorities at Residential Special Schools provided by other Bodies and certified by the Board of Education has ranged round about 250.

[page 39]

children and adults are still frequently certified under the Lunacy Acts and are seldom subsequently transferred to the care of the Local M.D. Authority. Mental Hospitals are, as a rule, far from suitable for the treatment of mental defectives, particularly children and young trainable adults; moreover the presence of these defectives may be detrimental to the interests of the other inmates and may and indeed does result in overcrowding.

Defectives attending Mental Hospitals can like other patients be discharged by the visiting committees without reference to the Board of Control or to the Local Authority and without any of the safeguards, such as licence, guardianship or supervision, provided by the Mental Deficiency Acts.

(c) Functions of the Home Office

52. Under Section 57 of the Children Act, 1908, youthful offenders between the age of 12 and 16 may be committed to certified reformatory schools, and under Section 58 children under 12 years of age, and in certain circumstances children over that age but under the age of 14, may be committed to certified industrial schools. Section 62 (2) of the Act further empowers the Court to transfer to a certified "Special" School youthful offenders or children who are unable by reason of mental or physical defect to receive proper benefit from the training in an ordinary certified school. Again, children may, if found to be mentally deficient, be transferred by Order of the Secretary of State under Section 69 of the Act from an ordinary reformatory or industrial school to a special reformatory or industrial school, as the case may be, for mentally defective children. Moreover children attending such a school who are found before discharge to be likely to require care and control under the Mental Deficiency Acts may by Order of the Home Secretary be transferred to an institution for defectives certified under the Mental Deficiency Acts, or be placed under guardianship under those Acts, while in cases where the child does not require institutional treatment or guardianship arrangements may be and occasionally are made by the Local M.D. Authority to provide suitable voluntary after care and supervision for the child on his discharge or his release on licence, and this voluntary supervision may be exercised both during the period of statutory supervision by the School Managers under the Children Act and subsequently.

These provisions are good so far as they go, but it must be pointed out that there is no obligation that mentally defective children attending schools under the administration of the Home Office should be reported to and dealt with by the Local M.D. Authority, nor have Local Education Authorities any clearly defined powers or duties with regard to the ascertainment of children attending Home Office schools. Moreover the powers of the Home Office with regard to these children cease at 18 or 19 and there is no

[page 40]

provision to ensure that such defectives will be reported on leaving school or after their period of probation or licence to the Local Authority. Even if a child is reported to that Authority under a voluntary arrangement after leaving a Home Office school. the fact that he is so reported does not render him subject to be dealt with under the Act and the Local M.D. Authority cannot therefore take any action in regard to him unless and until he has met with one of the social disasters referred to in Section 2 of the Act of 1913.

[page 41]

As has been shown in the preceding Chapter, the responsibility for discovering all the mentally defective children in the country between the ages of seven and sixteen, subject to certain exceptions, rests with the Local Education Authority, whose duty it is in general terms to provide for the education in Special Schools of those who are capable of benefiting from such education, whom for the purposes of this Chapter we will term educable mentally defective children (or simply mentally defective children when the context makes the meaning obvious), and to notify to the Local M.D. Authority those who fall below this standard, whom we will term notifiable or notified children. The responsibility for making provision for the care and control of all notified children rests with the Local M.D. Authority. In order to be in a position to consider how far the present arrangements contemplated in the Acts and Regulations meet the needs of the case, we propose to describe briefly

I. the actual working of the administrative arrangements, and

II. the actual provision now made in Special Schools, Centres and Institutions or otherwise for the care, education and training of all grades of mentally defective and notified children.

53. As already noted, the fundamental conditions on which the successful working of the administrative arrangements depends are first that the Local Education Authorities should ascertain all the mentally defective children in their areas, and secondly that they should notify all those who require protection under the Mental Deficiency Acts. In so far as the educable mentally defective children remain undiscovered and uncertified under the Education Act, the Local Education Authority can make no suitable provision for their education in Special Schools; and in so far as the notifiable children are not in fact notified, the Local M.D. Authority cannot provide for their care, supervision and training. Let us now consider how far these fundamental conditions are met.

[page 42]

54. There are two stages in the ascertainment of a child -

(a) the initial discovery or finding of a defective child; and
(b) the special examination of that child by a certifying officer.

Another fruitful source of discovery is the routine medical inspection of the School. Local Education Authorities are required* as part of their School Medical Service arrangements to provide for the routine medical inspection of all children attending Public Elementary Schools on three separate occasions during each child's school career - in the first year after their admission, at the age of 8, and again at the age of 12. These regular inspections should afford the Medical Officers an opportunity of discovering almost all defective children at some period during their school life.

(b) When the existence of a supposed mentally defective child is brought to light in one or other of these ways it is the practice to present him to the Certifying Officer for special examination. The Certifying Officer is usually the School Medical Officer or some other Medical Officer on the Local Education Authority's staff, who must, before being approved by the Board of Education under Section 55 of the Education Act 1921 and Section 31 of the Mental Deficiency Act, 1913, have had adequate theoretical knowledge and practical experience of mental deficiency work. This Officer proceeds to subject the child to a full and exhaustive examination, the results of which he must record in the form of a report, which may in certain circumstances have to be submitted to the Board or possibly produced in a Court of Law. The form in which these reports are generally made provides for full information to be given about the child's parentage, medical history, home circumstances, social proclivities and educational attainments. The report should also include an assessment of the child's intelligence on the basis of one or

*Board of Education Special Services Regulations, 1925, Article 17.

[page 43]

other of the accepted Scales of Intelligence, a diagnosis and a recommendation as to the appropriate treatment for the child. The Certifying Officer will have the advantage in connection with this examination of a report or reports by the Head Teacher of the school which the child is attending, and often also of a report on the child's home conditions by a Care Committee visitor, a social worker, a school nurse, or some other officer of the Authority.

It would appear at first sight that the arrangements we have described above would be such as to ensure the discovery of all mentally defective children before the end of their school career. This unfortunately has not proved to be the case. In the first place the process often breaks down at the initial stage. Many teachers are perhaps not unnaturally reluctant to take steps which might lead to the certification of a child as mentally defective, with all that this may involve. The classes are often too large to enable the teacher to give that measure of attention to individual children which is required if he is to be in a position to distinguish between retardation due to extraneous causes and that resulting from low intelligence; and in these circumstances he naturally tends to minimise the child's shortcomings and to regard him as merely backward rather than defective. Moreover, teachers are not infrequently apt to present to the doctor children who, in addition to being backward, are troublesome in school rather than those of poor mental endowment. Then, again, the School Medical Officer who conducts the routine medical inspection may not on the first or even on the second occasion detect a child's mental retardation; he is primarily concerned in the examination of the child with a view to discovering whether he is suffering from one or other of the commoner physical defects, and since, particularly in the large towns and to a less extent in country districts, he has to examine a given number of children at each session, he has little or no time to spare for the more detailed and lengthy examination of the child's mental condition. It thus frequently happens that a mentally defective child, particularly one who is of relatively high grade and shows no marked anti-social characteristics, may escape notice until far on in, or even up to the end of, his school life.

Again, at the second stage the process often fails, though for different reasons. On the one hand Medical Officers, especially in recent years, have felt reluctant to issue a formal certificate of mental deficiency except in the clearest possible cases; and on the other hand, in many areas, they regard it as useless to certify a child as defective when they know that such action will not lead to any special provision being made for his education or care. We shall have occasion to refer further to this matter in subsequent parts of our Report.*

*See especially paras. 94, 104 and 138.

[page 44]

55. The number of educable mentally defective children actually ascertained by Local Education Authorities as mentally defective within the meaning of Section 55 of the Education Act is 33,000; that is to say, six out of every 1,000 children on the registers of the Public Elementary Schools. It appears, however, from the Report for 1923 of their Chief Medical Officer that the Board of Education, being convinced that the actual ascertainment was far from complete in many areas, decided, on the basis of returns from a number of Local Education Authorities, to accept as a minimum standard to which the ascertainment in all areas ought to attain the ratio of 7.5 per thousand.* On this basis the number of educable mentally defective children in England and Wales between the ages of 7 and 16 would be approximately 42,000 at the present time. It was realised, however, that even this figure was almost certainly an under-estimate, and that in all probability the number of these children was appreciably greater. That this is in fact the case is shown by the findings of the investigations undertaken by this Committee, which will be discussed in the next Chapter.

56. The number of Special Schools provided for educable mentally defective children at the present time is 180, of which 159 are Day Schools with accommodation for some 14,850 children, and 21 are Residential Schools with accommodation for some 1,900 children, a total accommodation of approximately 16,750. The whole of these schools, except for twelve residential ones which accommodate some 1,350 children, were provided and are administered by Local Education Authorities. The actual number of children on the registers of these schools is approximately 16,000. It appears on these figures that the schools only provide for half the children ascertained.

(a) General Observations

57. Under Section 30 of the Mental Deficiency Act, 1913, it is the duty of the Local M.D. Authority "to ascertain what persons within their area are defectives, subject to be dealt with", and, as we have already seen, those "subject to be dealt with", as defined in Section 2 of the Act, are broadly speaking those who have been notified by the Local Education Authority and those who are neglected or delinquent or who have got into trouble in other ways.

*The actual figure given in the report in question was 8.6 per thousand children in average attendance at Public Elementary Schools. This is equivalent to a ratio of 7.5 per thousand of the average number of children whose names were on the registers of those Schools in that year.

[page 45]

To these categories the Act of 1927 has added those in whose case the parents or guardians have applied to the Local Authority to provide care or training. Thus, the Local M.D. Authority to a very large extent have to depend upon the Local Education Authority and to a less, but still considerable, extent upon other Authorities who are concerned to deal with persons falling within the other categories mentioned in Section 2 of the Act of 1913.

The duty of ascertainment must necessarily be the starting point of all work under the Mental Deficiency Act. Failure in ascertainment means failure in the whole Act. Unfortunately, ascertainment has been adversely affected by the following facts:

(i) The lack of institutional accommodation which has led both Local Education and M.D. Authorities in many instances to feel that unless the defective ascertained can be sent to an institution it is of little use to know of his existence.

(ii) The want of realisation that supervision affords the best means (apart from the limited cases which can be dealt with under guardianship) of keeping in touch with defectives and enabling them to be transferred to institutions as soon as their need is urgent and a vacancy occurs.

(iii) The want of knowledge on the part of officials, social workers and the public generally of the possibility of certifying high grade defectives.

(iv) The fact that Local M.D. Authorities have no power to ascertain for themselves defectives who are in Poor Law Institutions or Mental Hospitals.

The process of ascertainment for the purposes of the Mental Deficiency Acts, 1913-1927 involves two distinct processes, one predominantly of a medical character; the other of a social character. For the purpose of medical diagnosis it is necessary to establish that the subject actually displays serious inefficiency whether in the home, at school or in the working world; that this inefficiency is not the result of causes such as physical disability or an unfavourable environment, but that it is primarily and essentially due to mental defectiveness; that the arrest or incomplete development of mind has arisen from inherent causes or been induced by disease or injury and that it existed or arose during the first 18 years of life: and that the subject falls within one of the classes of defectives defined in the Mental Deficiency Acts. Each of these criteria must be satisfied in every case, but the actual materials for a decision naturally vary with the age of the subject. In general it may be said that a diagnosis is founded upon a critical evaluation of the social, personal and family history in conjunction with a careful interpretation of the data found at the time of the individual medical examination.

[page 46]

The diagnosis of mental deficiency may be established without a full history from the data observed by the medical examiner, but it can never firmly be sustained, however much it may be suspected, on the evidence of history alone. Moreover since any action taken may interfere with the full and free liberty of the subject, it is essential that the accuracy of all statements made by informants should be confirmed wherever possible. A full and proper study of the alleged defective individual therefore demands not only clinical observation and diagnostic acumen on the part of the Medical Officer, but a knowledge both of individual mental differences and of the technique of social work on the part of the officer who makes the ancillary inquiries. Training in these matters is the more important since the judicious assessment of capacities, motives and actions necessitates an ability on the part of the Officer to put himself into the position of others and arrive at a judgment without being swayed by personal predilections.

If these postulates be admitted it is clear that specially trained officers are needed for the purpose of ascertainment and that this task cannot satisfactorily be carried out without previous experience of the type of inquiry demanded. In certain areas the work of ascertainment has been assigned to special Medical Officers assisted by a staff of inquiry officers, who may again be assisted by a local Voluntary Mental Welfare Committee. In a few areas there is a whole time ad hoc Medical Officer; in others the help of the Medical Superintendent of a local Mental Hospital has been enlisted; but in most areas the duty of ascertainment has been assigned to the Medical Officer of Health (who is usually also the School Medical Officer) or to some of the other Medical Officers of the Local Authority who may or may not have been dealing with the mentally defective children in the schools. In many of these areas the investigation of the individuals who are alleged to be defective is carried out in considerable detail. In some other areas, however, there is no specially assigned Medical Officer and the duties are carried out by the lay officer who also acts as the executive officer of the Local M.D. Authority. This lay officer either himself or through his assistants investigates cases primarily with a view to determining whether, if found defective, they could be regarded as subject to be dealt with; and it may well be that he will only ask for a medical report on doubtful cases or on those in which it is proposed to present a petition.* In such areas there is at least a possibility of error, since the form of care required in any given case is dependent upon the nature and degree of the mental defect found.

Even when the fullest provision for staffing has been made, the efficiency of ascertainment depends on the liaison established between the Local M.D. Authority and other Authorities, Institutions, Mental Welfare Associations and other Societies in the area.

*In urban areas a medical opinion will more often be secured.

[page 47]

As yet only a small, though far from negligible, number of defectives has come to light as a result of applications for assistance on the part of relatives. It is to be anticipated that the amendment made by the Act of 1927 in Section 2 (1) (b) (i) of the Act of 1913 will lead to a material increase in these numbers, but even so the main source of information will continue to be the other Authorities referred to above.

Of these other Authorities, the most important are the Local Education Authorities and the Poor Law Guardians. Local Education Authorities as already explained are themselves ascertaining authorities, and there is as a rule reasonably adequate liaison between them and the Local M.D. Authority so far as the Counties and County Boroughs are concerned, since in these areas the Council is the Authority under both Acts. In the case of those Boroughs and Urban Districts, however, in which the Council is the Local Education Authority for Elementary Education but not the Local Authority under the Mental Deficiency Act, the measure of co-operation with the County Mental Deficiency Authority is by no means always satisfactory. Some Local M.D. Authorities accept the submission of the Report and Certificate by the Local Education Authority's Certifying Officer as the equivalent of the medical side of ascertainment for the purposes of the Mental Deficiency Acts, and in areas where school ascertainment is carefully performed there is little need of further medical examination unless and until it is deemed necessary to present a petition since, the Local Education Authority and their Officers should be able to supply full information.

At the same time we must bear in mind that the powers of Local Education Authorities to ascertain defective children between the ages of 7 and 16 if they are under the Poor Law are limited. This is a serious leakage for which neither Authority is responsible. As many of these children have no homes, or bad homes, they are often in need of protection under the Act when they leave the care of the Guardians. Where the Local Education and Mental Deficiency Authority are working in close co-operation with the Poor Law Guardians this leakage might be minimised, but it exists in most areas in the country.

Co-operation between the Mental Deficiency Authorities and the Guardians is essential if the work of ascertainment is to be efficiently performed, since, owing to the operation of Section 30, Proviso (ii)*, of the Act of 1913, the Local M.D. Authority have no power to ascertain defectives who are in the hands of the Poor Law Authorities; and as these constitute a large proportion of the total number of defectives in the country, the functions of the Mental

*The repeal of the latter half of this proviso by Section 13 (4) of the Local Government Act, 1929, removes an obstacle in the way of the ascertainment by the Local M.D. Authorities of defectives who are being dealt with by the Poor Law Authorities. See note on page 32.

[page 48]

Deficiency Authority are to a great extent dependent on the attitude of the Guardians. If the Guardians are friendly, cooperative and alive to the importance of the problem, they can report to the Local Authority all defectives requiring the forms of care contemplated in the Mental Deficiency Acts and the Authority may accept responsibility for these cases if they are "willing" and "able" to do so; if, on the other hand, the Guardians prefer to keep the defectives in their own hands, they may do so, and the Local Authority can do nothing. Many Boards also are influenced by their knowledge of the shortage of accommodation, and not realising that supervision enables the Local Authority to keep in touch with an the defectives they make little use of the regulations* made under Section 30 (proviso ii) and the defective leaves the Poor Law Institution with no more protection than the normal person. The failure on the part of Guardians to make wider use of these regulations for the purpose of reporting defectives to the Local M.D. Authority is largely due to lack of close cooperation between the two Bodies, but its use is in practice further restricted by the fact already noted that the Local Authority are under no obligation to accept responsibility for these cases unless they are "willing and able" to do so.

We have already referred to the fact that the Local Authority cannot ascertain defectives in the Mental Hospitals. Many defectives, who as the result of psychosis have been certified under the Lunacy Act, are discharged, when the acute condition has been cleared up, without reference to the Local Authority and are then lost sight of.

(b) Ascertainment of children under seven

58. The sources of available information naturally vary with the age of the subject. For children under the age of 7 the information for the most part comes from such sources as private medical practitioners, general and children's hospitals, charitable organisations, infant welfare centres, parents and friends of alleged defectives, local voluntary Mental Welfare Associations and other societies. A smaller number come to light through the Poor Law Guardians, while from the age of 4 or 5 or even earlier, information, but not formal notifications, may be received from the School Medical Service. In Scotland, where the school service is formally connected with the task of ascertainment of children from the age of 5, the value of this source of information in the earlier years is naturally greater. School Attendance Officers and other Officers of the School Service often have information as to the existence of defective children below the school age and in several areas these Officers act in concert with those of the Local M.D. Authority by giving them data as to children who should be ascertained. It must be

*These regulations are no longer operative. See note on page 37.

[page 49]

remembered however that, apart from those notified through the Poor Law sources and those whose parents or guardians apply for help, a child under seven is in precisely the same position as an adult and although defective is only subject to be dealt with if in some measure neglected or abandoned or without visible means of support. This group of cases is a small one, for there is no doubt that many of the more defective younger children are dealt with primarily on the grounds of poverty and pass into institutions of the Guardians, and that a relatively small proportion of those requiring the forms of care contemplated in the Mental Deficiency Acts are brought to the notice of the Local M.D. Authorities.

Even when brought to the notice of these Authorities many cases under the age of 7 are found not to be "subject to be dealt with". In a few areas the wise practice has been adopted of making preliminary inquiries in these cases and, if the home conditions are satisfactory, of invaliding the children from school attendance if necessary, placing them under friendly supervision and noting their names so as to secure re-examination within three months of their attaining the age of 7, when, if deemed idiot or imbecile or for other reasons unsuited for Special School education, their names may be notified to the Local M.D. Authority, subject if necessary to the concurrence of the Board of Education.

(c) Ascertainment of children of school age

59. In the case of children between 7 to 16 ascertainment is conducted under the aegis of the Local Education Authority who thus constitute the chief source from which names are supplied to the Local M.D. Authority. The action taken by the Education Authorities has already been described and there is no need to discuss it further here. Apart from this source a small number of cases are brought to the notice of the M.D. Authority through the Juvenile Courts or the industrial and reformatory schools under sections 8 and 9 of the Mental Deficiency Act and a few from Poor Law sources. The extent to which information is received and action taken through the Juvenile Courts depends on the arrangements, if any, which are made for the examination of delinquent children while on remand. It is only in the case of a very few areas that any arrangements exist for the medical examination of mentally defective children coming before the Courts. Many Courts do not realise the importance of a medical examination as a first step towards claiming for the defective child or young person the protection of the Mental Deficiency Acts. In those few areas where it is the practice to give a mental and medical examination to every such child who has ever been suspected of mental deficiency or proposed for a Special School examination or whose conduct shows any abnormality or in whose case the teachers, or the Superintendent or Medical Officer of the place of detention, or needless to say the Court, think such an examination would be desirable, the bulk of

[page 50]

the cases that prove to be defective can be dealt with either by being sent to a certified institution under the Mental Deficiency Act, to a Special Industrial School under Section 62 (2) of the Children Act or by arrangement with the Local Education Authority to a Residential Special School. In the case of some children who are sent to Industrial or Reformatory Schools information and warnings as to the need for observation can be passed on to the Authorities of these schools. In areas where the Local Education Authority provide for this action there is a close liaison with the Medical Officers of the juvenile branch of the Home Office and a regular exchange of information takes place to secure that, if need be, at a later date action shall be taken under Section 9 of the Mental Deficiency Act. Similarly in some areas at least steps are taken to watch the children during their probationary period after discharge from a Home Office school, during which they are liable to recall. There is, however, reason to fear that these detailed arrangements only apply in the case of some of the larger Local Education Authorities.

60. It will be remembered that the Local Education Authority are required, subject to the Regulations, to notify to the Local Authority under the Mental Deficiency Act all mentally defective children, whether idiots, imbeciles or feeble-minded, who are incapable of deriving benefit or further benefit from instruction in Special Schools; all mentally defective children, whether moral defectives or not, who cannot be taught in those schools without detriment to the interest of the others; all those mentally defective children in whose case (though they are capable of benefit from instruction in Special Schools) the Board of Education, after considering reports submitted by the Local Education Authority, certify that there are special circumstances which render it desirable that they should be dealt with under the Act by way of supervision or guardianship or by being sent to an institution; and all those who on or before attaining the age of 16 years are about to leave a Special School, and, in the opinion of the Local Education Authority, require to be placed under supervision or guardianship or sent to an institution.

The actual number of children in all these groups notified in each of the past four years has been approximately 2,400. Of these, some 200 were certified as idiots, 1,300 as imbeciles, 30 as moral imbeciles, and 250 as incapable of receiving benefit or further benefit in Special Schools or as "detrimentals". Some 40 children who were capable of receiving benefit from instruction in Special Schools were notified each year on account of "special circumstances", and the total number of children notified annually on leaving school at 16 as being in need of guardianship or institutional treatment was about 550.

[page 51]

This last figure* is of interest since it shows that only about one out of every four children who leave Special Schools each year is notified to the Local M.D. Authority.

There is no doubt that the numbers given in the last paragraph are much lower than they should be. This would be fairly obvious in any case in view of the fact that so many children leave school and go out in the world without any statutory supervision or control, only to break down later and come to the notice of the Local M.D. Authority when they get into serious trouble. But any doubt on the subject is removed by the findings of the Committee's own investigation to which we shall refer later.

There is no available information as to the total number of children under 16 years of age ascertained by Local M.D. Authorities, but the number of defectives of all ages reported to those Authorities in England and Wales according to the latest returns that are available, is 61,522, or approximately 1.57 per thousand of the total population. The ratio of defectives reported to these Authorities ranges from 0.03 to 4.66 per thousand - a fact which of itself shows how wide must be the variations in completeness of ascertainment and how little these Authorities can do in the numerous areas where the number of defectives reported is no greater or is even less than the average. Of those defectives who have been reported to the Local Authorities, 38,979 (or not quite one per thousand of the total population) have been ascertained as subject to be dealt with; in 5,285 cases no decision has been reached; and in the remaining cases, numbering 17,258, it has been found that the persons reported, though defective, are not subject to be dealt with.

61. The three forms of statutory provision which may be made by Local M.D. Authorities for notified children are the same as those for adult defectives, namely, supervision, guardianship and institutional care, including licence from an institution, though, of course, the methods of dealing with defectives must be adapted to their ages and personal needs.

As all these forms of care are applicable to all ages, the available statistics do not differentiate between children and adults; but of those defectives returned as being under statutory supervision, numbering some 18,000, we may safely assume that at least 6,000 are children and that the number under guardianship and licensed from institutions is from 500-600. Accurate statistics as to the number

*It should be borne in mind that, until the Mental Deficiency Act, 1927 came into operation, children leaving Special Schools could be notified only for guardianship or institutional care. Now that it is open to Local Education Authorities to notify such children for supervision it is probable that the number of cases notified on leaving Special Schools will in future be largely increased.

[page 52]

of children in institutions dealt with under the Mental Deficiency Act are also for the same reasons difficult to obtain without a special inquiry. As nearly all the larger institutions receive both children and adults under the Mental Deficiency Acts and also children under the Poor Law, Education and Children Acts, we cannot give any accurate estimate of the numbers of children sent to institutions under the Mental Deficiency Acts, though we believe that number to be approximately 7,000.

We will describe later in this Chapter what is being done for children by way of institutional care and of training in Occupation Centres, but will defer till Part III of our Report our description of the various forms of institution that may be provided and also our account of the present provision both for children and for adults under supervision, or guardianship, or on licence from an institution.

62. We turn now from the administrative arrangements with regard to mentally defective and notified children to the actual provision made for their education, training and care, and we propose to describe that provision under the following headings:

(A) Educable mentally defective children:

(1) Education in Day or Residential Special Schools.
(2) Proportion of children for whom Special School accommodation is, or can be made, available.
(3) Education and care of children not attending Special Schools.

(B) Notified children:

(1) Training and care in Institutions.
(2) Training and care in Occupation Centres.

(a) History and Growth of Schools for Educable Mentally Defective children

63. No special educational provision for educable mentally defective children was made in England until the middle of the nineteenth century. The first Institution to provide for their care and training was the Royal Earlswood Institution founded by Dr. Andrew Reed in 1847 and opened at Highgate in April, 1848, for the reception of patients. This was followed about 1850 by the opening of Rock Hall House,* Bath. Earlswood was moved to its

*This House, formerly known as the Magdalen Hospital, was founded in the Twelfth Century as a hospital for lepers, but subsequently became a home for idiots. The date of this change is not known, but it may be taken that its formal establishment as an Institution for defectives took place about 1850.

[page 53]

present site in 1855 and the Royal Eastern Counties Institution, also founded by Dr. Andrew Reed, was opened at Colchester in 1859. In October, 1864, there followed the opening of the Western Counties Institution at Starcross in Devonshire and a few months later that of the Royal Albert Institution at Lancaster. The last of the larger Institutions to be started about this period was the Midland Counties Institution at Knowle (formerly known as Dorridge Grove) which was opened on the 1st January, 1868. All these Institutions were technically known as Asylums for idiots, both children and adults, but all of them in fact made considerable and rapidly extending provision for the training and education of the higher grades of defective children who were admitted to them.

The Royal Commission on the Blind and Deaf and Dumb which reported in 1889, in recommending that mentally defective children should be separated from ordinary children and should receive special instruction, introduced a second stage. The Leicester and London School Boards, after considering the results of efforts abroad in setting up Special Day Schools, established similar schools in 1892. In 1898 a departmental committee on the education of the feeble-minded issued a report which resulted in the passing of the Elementary Education (Defective and Epileptic Children) Act, 1899. This Act empowered School Boards to provide for the training of defectives and epileptics in Day Schools and Institutions. At this date about forty centres had been established in Birmingham, Bradford, Brighton, Leicester, London and Nottingham and other towns for the education of feeble-minded children. A number of residential schools for feeble-minded children were also established about this time by voluntary bodies, amongst the first of these being that at Sandlebridge in Cheshire, which was opened in 1902.

Under the powers given to Education Authorities the facilities began steadily to increase, and by 1909, ten years after the passing of the Act, there were 159 schools recognised by the Board of Education of which all but five were provided by Education Authorities. In 1914 an amending Act was passed which made it obligatory on Local Education Authorities to provide for the suitable education of all mentally defective children in their areas between the ages of 7 and 16. Owing to the war the increased provision that would no doubt otherwise have followed on that Act has been but small, the total number of schools at the present time being as already stated 180, with accommodation for some 16,750 children.

(b) The pioneer work of the Special School

The institution of these Special Schools, both Day and Residential, has proved a landmark in educational progress in this country. From the experience of the past thirty years there has developed an understanding of the ideal and aim in the education of mentally defective children, of the appropriate content of the school

[page 54]

curriculum, of the technique to be followed in instruction and of the measures necessary to be taken to ensure that full benefit may be obtained from the specialised training given, particularly in relation to the after-care of the child. Further, the institution of these schools with the opportunities and facilities available for experimental work, has been of great value not only to the children for whom they were immediately provided, but indirectly to the main body of normal children also. This has been true especially in regard to the purpose and place of manual occupations in the education of the child. In earlier days manual work held a limited place only; accidental rather than integral, in the school curriculum; its claim as a fundamental factor in education and the recognition now given to it in the curriculum of the Public Elementary School are in no small degree due to the pioneer work among this small group of defective children.

(c) The problems presented by the Special School

The task of the teacher in the Special School for the mentally defective has not been an easy one. Though all the children in this type of school belong to one recognised group and have in common certain characteristics upon which depend their separation from their fellows, they present nevertheless among themselves great variety in character and educational capacity. We are accustomed to think of them for purposes of organisation in the school in terms of children of high, medium, and low mental grade, but the educational requirements of a high grade mentally defective child are as widely separated from those of a child of low grade as they are from those of the normally bright child in an ordinary Elementary School. Moreover the teacher has not only to consider the educational capacity of the child; there are character traits, personal and social, differing widely in kind and extent, and bearing no necessary relationship to the degree of educational retardation. Added to all this, the teacher is concerned except in comparatively large Special Schools, with children of both sexes and of great variety in age. Again the high grade mentally defective child of 7 or 8 years of age may well be superior both in its potentialities and even in its attainments to another child 14 or 15 years old attending the same school. In the light of these considerations, it may be useful to indicate the main principles and features in organisation and education which have become established as the result of the experience of the past thirty years. We shall then be in a better position to relate to this experience the problem of the defective child as it presents itself to-day.

(d) Aims and practice of the Special School

What then are the main aims upon which the Special School has concentrated to ensure that the lives of these children are developed to the utmost of their capacity? They may be summed up as the establishment of the child's self-respect, self-confidence

[page 55]

and self-control. To attain these ends the aims of the Special School have necessarily included the development of a sense of responsibility within however limited a sphere and of application and concentration by the careful selection of opportunity and material; training the child's innate intelligence to function rightly; training in the practice of health habits; encouragement of initiative and of the performance of the simple individual and social activities of every day life; instruction in forms of manual work designed to contribute to the general education of the child and later to serve, so far as may be, as vocational training; and finally instruction in reading, writing and arithmetic, in so far as the child is capable of profiting from it.

For the establishment of these aims and the carrying out of this programme the Special School has proved in the case of many children an effective instrument. It has possessed the advantage of freedom to adapt means to the required end, and its system of small classes has permitted full use to be made of this freedom. Again, despite the fact that, as the Special School teacher recognises, the good work of the school is often counteracted by adverse home circumstances, it has been, generally speaking, more practicable in the Special School than in the ordinary elementary school to deal with the child as a whole - with the physical and social sides as well as the mental - and to establish an effective association with the parent and the home. We do not for one moment suggest that such association is not established and maintained in the case of large numbers of Public Elementary Schools or that the physical and social sides of the children attending those schools are neglected. Admirable work in these directions is done in many areas. But the Special School does possess certain facilities, social, educational and physical, which are not so readily or generally available in ordinary schools. It has been the practice in many Day Special Schools for the child to remain at school during the middle of the day, when a substantial dinner is provided. In this way the child has not only benefited physically, but advantage has also been taken of the educational opportunity afforded by the preparation, service and partaking of the meal. Bathing facilities also are often available. Then a varied curriculum has been worked out on lines suited to the peculiar requirements of children presenting great variation in age, capacity and temperament. Much valuable technique related to the teaching of simple reading and arithmetic, through activities on the part of the child, has been evolved. Considerable attention has been given to music, singing, dancing, physical exercises and games, which are of real value in the development of the child's mind as well as of his body, and the claims of drawing have not been neglected. As already indicated, handwork has become a potent instrument both in the general education of the child and also in fitting the child for its after-school career. The forms of handwork most suitable for all-round educational purposes are, fortunately,

[page 56]

also the best available for trade training. Those most usually employed include gardening, boot repairing, tailoring, carpentry and metal work for boys; and for girls, domestic work of all kinds - housewifery, laundry work, cookery, sewing, simple garment-making and embroidery. These occupations provide an all-round training such as is calculated to give the boy or girl confidence in entering upon a job. This will, in many cases, necessarily be of a simple order as, for example, in the case of the boy, that of employment on a mechanical process in a factory or workshop, or as an errand boy, or labourer, and in the case of the girl, the simplest forms of domestic work or mechanical work in a factory. In selected cases however the properly trained boy can take up, as a labourer if not as a craftsman, such trades as gardening, tailoring, boot repairing or even carpentry, with results satisfactory both to himself and his employer. If the necessary facilities for training obtain, other trades may be open to him, such as brick-laying, metal work or even painting. Similarly, the girl may, under supervision, do skilled laundry work, take her share in most forms of domestic work, or she may become fitted for work in a milliner's shop, or in a mill in a textile area, or she may obtain employment in, for example, a chocolate or cardboard-box factory.

In one area where classified lists have been made of the occupations followed by children who have been in attendance at Special Schools for mentally defective children, it appears that a large proportion (about 25 per cent) of both boys and girls are engaged in skilled or semi-skilled engineering operations and a somewhat smaller number in unskilled work in engineering establishments, while other occupations which absorb appreciable numbers of these children include warehouse work, electro-plating, French polishing, window cleaning, leatherwork, painting, errands, distributing milk, printing, as well as other forms of employment.

(e) School organisation

The organisation of a Special School to meet these needs has been found quite practicable in the case of a reasonably large school where the numbers justify the establishment of appropriate forms of instruction, especially in regard to manual work, but it is difficult and may be impossible in the case of a small school containing a score or two only of children. Where the numbers of defective children are large, as for example in London, one may see the best form of organisation namely the provision of mixed Day Special Schools for juniors up to the age of approximately 11 years and for older boys and girls respectively from 11 years of age upwards. In other large towns, such as Birmingham and Liverpool, the Day Special School is organised for children of all ages; but the need for a break at the age of 11 or 12 has been fully realised and a feature has been made of special forms of manual occupation both for older

[page 57]

boys and girls. In a small mixed school it is usually impossible to meet in an adequate manner the special educational requirements of older children, particularly of older boys.

While we have set out in the preceding paragraphs what is being done in the best Special Schools and have claimed, we think with justice, that these schools have in certain respects led the way in the development of educational methods and technique, we do not wish to imply either that all these schools are equally good or that they are by any means generally in advance of other schools at the present time in these respects. We readily admit that the methods and technique in large numbers of Public Elementary Schools are now better than those employed in many Special Schools. Each type of school in short has learned much and still has much to learn from what is best in the other.

64. Before concluding our review of the present provision for the education of mentally defective children, let us consider for a moment to what extent this provision covers the ground, or how far it is capable of expansion on the lines that have been followed hitherto.

(a) Residential Schools.

For obvious reasons it is only in the larger towns that it has been found practicable to establish Day Special Schools. Special educational provision therefore of the type contemplated in the Act for mentally defective children living in rural areas has to be made, if made at all, by the establishment of residential schools. Of the total number of educable mentally defective children hitherto ascertained, namely, 33,000, some 9,000 live in county areas. We have seen that the Residential Special Schools provide accommodation for no more than 1,800 children, and since some of this limited accommodation is required for children living in the towns, who for some reason are unsuitable for Day Special Schools, it may be assumed that the number of places available in these schools for country children probably does not exceed 1,200, or one residential school place for every seven or eight children actually ascertained.

If finance were of no importance, it would of course be possible to multiply the provision of residential schools until they sufficed to meet the needs not only of the remaining 7,500 ascertained children living in rural areas, but also of the far larger number of educable mentally defective children in those areas whom our investigations have revealed. The establishment of residential schools for anything like these numbers would, however, be economically unjustifiable, even if it were otherwise desirable. This we are convinced is not the case, since the large majority of the children could be suitably taught

[page 58]

in day schools if these were available and do not require the special and continuous care which residential schools provide. Moreover, few of the parents of these for the most part high grade, quiet and well-behaved children, would ever be persuaded to send them away from home. While therefore some further residential school accommodation is required for educable mentally defective children living in the country (as well as for many of those living in the towns), the indefinite multiplication of residential schools for rural children would, in our view, be as unnecessary as it would be extravagant, and some other means of dealing with these children must be devised.

(b) Day Special Schools.

65. Let us now consider the position in the urban areas. For the 24,000 ascertained children living in these areas there are available from 15,000 to 16,000 places in Day Special Schools, or approximately two places for every three children actually ascertained. The position of these urban children is therefore very much better than that of the rural children, and it might at first sight be felt that all that was required for them was a relatively small increase in the number of Day Special Schools.

It is, however, by no means clear that such an increase is practicable. It is generally agreed that the establishment of a Special School for educable mentally defective children of all grades of defect, of both sexes and of all ages from 7-16, is unsatisfactory unless there is an enrolment of at least 40 children. It is also found as a general rule that an area containing a school population of some 8,000 children or a total population of about 55,000 is the smallest area in which it is in practice possible to establish a Day Special School with 40 mentally defective children on the registers. It is of course true that a certain number of smaller Day Special Schools have been established and some of these have attained a fair or, indeed, a considerable measure of success. But it is unfortunately the case that a number of them have had to be closed for various reasons - difficulty of organisation, immense difficulty of teaching children when all ages and several different grades and both sexes are indiscriminately mixed, undesirability of mixing them in this way, difficulty of providing for the special needs of older boys and girls respectively, unwillingness of parents of higher grade children to let their children associate with those of lower grade, etc. In most instances all those concerned with the administration and conduct of these small schools have found the problem of maintaining their efficiency almost insuperable.

The difficulties inherent in the establishment and organisation of the smaller Day Special Schools can perhaps best be shown by a brief general review of the facts in regard to them. Single class schools taking children of all ages between 7 and 16, when conducted as isolated units, are so unsatisfactory that the Board of Education have, we believe, in recent years refused to sanction any increase in

[page 59]

their numbers. There are seventeen towns in England and Wales with a population of less than 50,000 which have established Day Special Schools. Nine of these schools have accommodation for 20 children only, and the remainder, with the exception of one school with 65 places, can take from 25-45 children, but even in these the average attendance ranges generally from 15-25. In one or two instances the Day Special School for mentally defective children forms a part of or is attached to a school for physically defective children, an arrangement which minimises the difficulties inherent in the conduct of small schools. But apart from these cases, the experiment of segregating a small number of mentally defective children in isolated schools has not proved successful. One of the main reasons for this is that there has been perhaps a not unnatural tendency on the part of Local Education Authorities which have established the schools to admit to them first of all the lower grade children and those whose presence in the ordinary schools was detrimental to the interests of the other children. Some of these children should no doubt have been notified as ineducable or as detrimental, but the fact that they have not been notified (largely because it was known that no provision would as a rule have been made for them by the Local M.D. Authority), has made it far more difficult for the Local Education Authorities to secure the attendance of higher grade children. The result has been that as we have seen some of the schools have had to be closed, that the others remain half empty, and that the educational facilities intended equally or mainly for the higher grade feeble-minded child, have in fact been confined largely to children of lower grade including some who were incapable of benefiting from it or were otherwise unfitted for a day school.

The position is of course very different in the larger schools where proper classification has been possible, and where the Authorities have been able to limit the schools to children of a generally more uniform and higher grade. But even in the larger towns, in which the establishment of a larger school, i.e. one containing at least two or three classes, should be practicable, no small difficulty is often experienced in securing the attendance of the right type of child, and the teachers' best efforts are hampered by the presence of lower grade or troublesome children. This fact appears to have been recognised by many Local Education Authorities and to have constituted one of the principal obstacles to the provision of Special Schools in towns of sufficient size to justify their establishment. There are some 100 towns in England and Wales with a population of over 50,000, of which no less than 40 are without any Special School provision for mentally defective children. Most of these are towns with between 50,000 and 60,000 inhabitants, that is to say, towns which, so far as numbers go, on the present basis of ascertainment, should be able to maintain a Day School for some 40 or 50 mentally defective children. We understand that a number

[page 60]

of these Authorities have had under consideration from time to time the question of establishing Day Special Schools, and have come to the conclusion, not necessarily from motives of, or .on account of the demand for, economy only, but on educational and administrative grounds, that schools even of this size would not prove a satisfactory solution of the problem.

Here then is the present position. The picture is presented to us of a number of Day Special Schools established in the larger county boroughs, boroughs and urban districts, making, with certain reservations in the case of older children, particularly older boys, admirable provision for certain types of mentally defective children, and staffed by a singularly devoted body of teachers many of whom have exceptional capacity and qualifications. A careful survey of this present position indicates that apart from considerations of expenditure the system embodying this particular type of Day Special School for educable mentally defective children cannot well be extended appreciably beyond its present limits, and that while such schools could still profitably be established in a few large towns which have none, and while the number of schools could well be increased in some few other towns which have hitherto made provision for only a portion of the children ascertained, the time has come when consideration must be given to alternative methods of meeting the needs of those defective children living in the country and in the smaller towns (i.e. in those with up to, say, 60,000 inhabitants) who are suitable for attendance at Day Special Schools, but for whom it is not practicable to provide such schools. We shall discuss this matter in a later Chapter and shall suggest alternative methods of dealing with the problem.

66. We have seen that at least half of the ascertained educable mentally defective children and a very large number of children of similar educational capacity who have not been "ascertained" are in attendance at Public Elementary Schools.* It must not be thought that nothing has been done to meet the needs of these children. Indeed, much thought has been given and valuable experimental work has been done in regard to their education by means of the establishment of special classes for them within the Public Elementary Schools, by grouping them within the ordinary classes, by individual methods of instruction and in other ways. Some of these children have been certified, but many have not, and in any case they have all alike been dealt with, so far

*There are also a number of lower grade children attending Public Elementary Schools and a still larger number attending no school or centre of any kind; see Chapter 4, pages 95 and 96 of Investigator's Report.

[page 61]

as legal provision and administrative arrangements are concerned, as normal though dull or backward children and not as mentally defective. Inasmuch as these children have not been treated as mentally defective we do not propose here to discuss the methods which have been adopted in regard to their education, though we shall have occasion to refer later* in some detail to this question.

We must however say a few words about the provision made for their care. In one or two areas the Care Committees which have been set up by the Local Education Authorities comprise within their activities the care of mentally defective children whether attending the Public Elementary Schools or the Special Schools. In a large number of areas ad hoc Care Committees have been established in connection with the Special Schools, or the work is done by School Nurses or Health Visitors, or, again, arrangements have been made for the carrying out of the duties of Care Committees in regard to the mentally defective children by local voluntary bodies, such in particular as the Local Mental Welfare Associations. In areas where ad hoc Committees have been established or the work has been undertaken by Local Mental Welfare Associations, arrangements have usually been made for visiting all the mentally defective children, particularly those who were not in attendance at any school, at least two or three times each year, and these arrangements have been of great assistance to parents and of no small value to the Local Education Authorities in keeping them informed of any difficulties which may arise in connection with the care of the children at home, and in helping them to decide on cases in which it becomes urgently necessary to send the children to residential schools, or to consider the question of notifying them to the Local M.D. Authority.

The importance of keeping under constant supervision mentally defective children who are not in attendance at Special Schools - or possibly at any school - cannot be over-emphasised. These children are deprived of all the training and stabilising influence of the schools and, in the absence of supervisory arrangements by the Local Education Authority, are left in the sole charge of their parents, who without any assistance or advice from persons familiar with the problems of mental deficiency are ill-equipped to look after them. Local Education Authorities are coming to recognise the need of strict supervision of the mentally defective children who are approaching adolescence, and are making somewhat more (though still, we think, insufficient) use of the provision in the Regulations which enables them to notify these children in "special circumstances" to the Local M.D. Authority.† They are also, we believe,

*See Chapters VI, VII, and VIIl.

†We have already commented on the fact that the relatively small use that has been made of this provision is in no small measure due to the interpretation placed upon it by the Board of Education.

[page 62]

more generally adopting the suggestion made by the Board of Education* that they should supply the Mental Deficiency Authority with lists of those children who are approaching the age of 16 and are likely to require some form of friendly supervision even though they are not formally notifiable.†

67. As has already been explained notified children are those broadly between the ages of 7 and 16 who have been notified by a Local Education Authority to a Local M.D. Authority and have, by reason of that notification, become subject to be dealt with under the Mental Deficiency Acts. Our description of the provision made for the training and care of these children will also apply however to those lower grade children who have been ascertained by the Local M.D. Authority before reaching the age of 7.

The mental grade of the notified children has varied very much in different parts of the country. This has been partly due to the fact that the Act contemplates the notification not only of children who are unable, but in certain circumstances also of those who are able, to benefit by instruction in a Special School, partly to real differences of opinion as to where the dividing line should be drawn between these two groups, partly to the varying methods of teaching in different Special Schools, and partly because it has been easier in some areas to get residential accommodation under the Education Act, while in other areas it has been easier to get it under the Mental Deficiency Acts. If a child, either because of bad home conditions, moral danger or for any other reason, urgently needed institution care, in practice it has been regarded locally as relatively unimportant whether he obtained it in a Residential Special School under the Board of Education or as a notified child in one of the certified institutions under the Board of Control which has a proper school department and arrangements for teaching the higher grade children. If a bed were available in a Special School, the child remained under the Education Acts; if no bed were available in a Special School but one could be obtained in one of these certified institutions, the child was received under the Mental Deficiency Act. The first consideration was the good of the child.

Children can, like adult defectives, be dealt with by supervision or guardianship or by institution-care and licence. Under the Mental Deficiency Act, 1927, supervision and guardianship must also, like institution-care, include training. We shall confine ourselves here to a description of the care and training of lower grade

*Circular 1341 dated 12th September, 1924.

†See Chapter III, para. 41, with regard to the notification of children leaving Special Schools at 16, and also Chapter VII, paras. 128 and 143, where it is recommended that Local Education Authorities should in future be empowered to notify mentally defective children leaving ordinary schools.

[page 63]

children sent to institutions or occupation centres and shall defer to Part III of our Report our description of the arrangements made by Local M.D. Authorities for the community care of defectives, whether children or adults, since supervision, guardianship and licence are used chiefly for adult defectives and the legal and administrative arrangements with regard to these forms of care are much the same for defectives of all ages.

Since the forms of training of low grade children are less well known than the methods of teaching the higher grades in Special Schools, it will, we think, be desirable to describe them in somewhat greater detail. But the fact that our description of the training methods adopted in the best institutions occupies more space than we have devoted to our account of Special Schools must not be taken as implying that we consider the problem of dealing with the lower grade child as more difficult or more important. On the contrary, the problem is a far easier one in many respects and it is only because the methods are less generally known that we propose to describe the system of training somewhat fully, in the belief that our account of what is being done in some of these institutions may prove helpful by suggesting ways in which the conditions in other institutions may be improved.

68. In order that a child may receive the benefit of institution care two things are necessary. The child must be certified under the Mental Deficiency Acts and sent to the institution under an Order made by a Magistrate in accordance with all the requirements of the Acts, and the institution must be a certified institution under these Acts. Some institutions are certified under the Mental Deficiency Acts only, others are also certified as Residential Special Schools under the Education Act and a few are, in addition, certified as industrial schools under the Children Act, 1908.

Whether however a child goes to one of the institutions working only under the Mental Deficiency Act but with a proper school department, or to an institution working also under either or both of the other Acts, he goes to school if it is in any way possible to train him - and the term "training" is here used in the widest possible sense, including even learning to walk, training in clean habits and in dressing. There is one great and important advantage which the child in an institution or a Residential Special School has over the similar type of child attending a Day School; he is being trained seven days a week and all day long, and what he learns out of school hours is often more important than what he learns in school.

(a) Lowest grade children

69. A certain though small proportion of the children are of too low a grade to be able to benefit by any kind of school training.

[page 64]

Most of these children are physically as well as mentally defective. In institutions where the best provision is made for such children, it is an axiom that unless actually ill they shall not stop in bed or cot, but shall be got up and dressed and spend the greater part of their time in the open air.

(b) Medium and higher grade children

70. But for all, except those of the lowest grade, the good institution means to the children under its care the advantages of regular attendance at a school with its training in games, habits and manners. The description that follows shows the methods of instruction in a certified Institution which has an organised school department run on the right lines. It must be admitted that there are institutions where the school department is not properly organised, and some where it does not exist. In these, unfortunately, it is often the case that little or nothing is done for the lower grade children, that there is no proper classification, no real teaching, no occupation, and little or no provision for recreation. The children are allowed to sit all day or to run wild without any endeavour to instruct or interest them. Such an institution reaps, both in the present and the future, the reward of its own slackness, because the child without instruction or occupation or amusement is in the present more difficult to manage and more destructive, and in the future when grown up will be not only more unmanageable and more destructive, but also of no use in the work of the place.

The school is run much as the Day Special School, with registers and progress books, with head teachers and other teachers. The teachers in these schools are often, though not always, certificated or uncertificated teachers; but much of the teaching in the classes for lower grade children is carried out by the Nurses and Attendants. Some of these have undergone special courses of instruction in their own institution, and some have attended the courses of training given by the Central Association for Mental Welfare.

(c) Importance of practical and useful work

71. A very large proportion of the school work is manual work, and if there is one principle which is never lost sight of, at all events in the best institutions, it is that all the work must be for a definite object. No one realises more quickly than a defective child the folly of being asked to do work which will be of no use when it is finished. Most teachers have realised that it is essential that all the manual work shall be either for use in the school or institution, or for sale. Practice work is waste work and has a bad moral effect on the children.

In describing the training it is easier to begin with the lower classes and work upwards.

[page 65]

(d) Lowest grade classes

In these classes the early training consists almost entirely of efforts to educate the bigger muscles of the body. Training is given in walking, in very simple physical exercises, in marching to the children's own toy band, where the aim is rhythm rather than tune, or to a piano, and in singing songs when most of the children's speech is so defective that the ordinary person cannot understand what is said.

Any number of exercises are devised out of the simplest materials, such as a couple of nine-inch wide planks, a small step ladder, a large step ladder, one with a platform at the top, two or three old corned beef boxes, a skipping rope, a cushion, a box of big ninepins, two or three wheelbarrows, some soft balls made by the children. The child is trained to walk or crawl up and down a plank, to mount a step or later a ladder, to wheel a barrow along a straight line, to jump, to balance objects on the head, and to do the simplest manipulative exercises. All these can be made to contribute in various ways and by means of pleasant games to the child acquiring control over his body and over the movements of his arms and legs. There are also exercises with brightly coloured wooden bricks of different sizes and shapes and with concrete objects, such as ninepins, which enable simple lessons in number to be given.

(e) Elementary manual work

In addition to all these forms of training and many more which any intelligent teacher can invent, and which may be likened to school work proper, these children are given lessons in manual work, even though it be of the simplest type. To begin with, this may mean only polishing the spoons and tins or the stair rods or cleaning knives, but it is wonderful how soon children whose speech cannot be understood and whose intelligence is no more than that of a child of four, do advance from these simple beginnings to real productive handwork, such as the making of simple leather cushions. Later some of the best of these children can attempt the simplest types of leather and raffia bags or the painting and decorating of pots and bowls.

(f) Higher grade classes

A large number of the children sent to institutions under the Mental Deficiency Act have, however, a capacity far above the level of this work. The school classes are graded according to the children's capacity, and as we reach the medium and higher grades the work becomes less and less of the kind which requires the use only of the bigger muscles until it merges gradually into the ordinary work of the Special School including reading, writing and arithmetic. Below what mental age it is waste of time teaching children to read and write is a debatable question. Many children are taught writing far more for the pleasure it gives their parents to receive a copied

[page 66]

letter from them than for any use they will ever make of it themselves, and there is little doubt that even yet far too much time is wasted at this. Hardly a single child who has a mental age below seven when he leaves school learns enough reading to make any use of it afterwards. The manual work with the higher grade children also approximates to that of the Special School and includes the usual raffia and leather work, simple weaving, gardening, stencilling, needlework, carpentry and woodcarving.

In an institution school it is easy to find "worth while" work. For instance, comparatively low grade girls can each have their own locker in school for their underclothes, and repair them and make them tidy when they come back from the laundry, and they make the simpler garments they will wear, such as pinafores and vests. One or two school sessions are given up each week to definite instruction in housework and laundry work as actual school subjects and as preparatory to future work in the institution. Boys also learn to do simple repairs with a needle. As the boy approaches fourteen years of age it is usually found that he has learned as much as he can at school, including school manual work, and he is then drafted first for half a day and later for the whole day to the real trade shops of the institution or to the gardens. There he works under a skilled tradesman actually making things for sale or for the institution use. When a boy is thus transferred does not depend on his age, on whether he is sixteen or not, but only on his actual mental capacity and his progress.

The usual drill and physical exercises with and without clubs, wands and rings, and preferably to music, eurythmics, dancing and singing are all thoroughly enjoyed. These things all appeal to the defective child, and partly for this reason, partly no doubt because institutions devote more time to this than the normal school can, he reaches a creditable standard in them all.

(g) Out-of-school training and socialisation

72. Besides all this training in school, the child in an institution has the benefit of skilled training and supervision throughout the 24 hours. He learns clean habits, how to dress himself, how to do his boots up, how to manage a spoon and afterwards a knife and fork, and at a much later stage how to wash himself; he learns to help about the place and to make himself useful. Perhaps above all else he becomes socialised and learns that he is as good as the other boys in his class. Outside an institution he is looked down on and told that he is not good enough to play with the other children. In the institution he can join in all the games, he counts, his help is wanted, he can play in the football team, he may even aspire to the first eleven. Scout Troops and Guide Companies and Brownie Packs are found in many institutions, and are a great help to the children. It is to the highest credit of the Scout and Guide administration that these troops and companies are allowed to attend Rallies and join

[page 67]

in all the activities of the movement on an equality with normal children. The children go to summer camps under canvas and thoroughly enjoy them. Perhaps one of the greatest helps in bringing out the child is through entertainments and school plays. These children love dressing up.

This is necessarily only a short description of the many activities of the child in an Institution, but it will be seen that his life can be and is a very full one, and that though he may miss many things because of his defect, he will rarely be conscious of his loss and he will, in the very large majority of cases, live a far happier and more useful life than he could ever have done in the outside world.

73. The first Centres for low grade children excluded from School were started by Miss Arnould at Lillie Road, London, and by Miss Woodhead of Brighton some twenty years ago. Miss E. Rathbone's Lilian Greig Centre was the first opened, after the passing of the Mental Deficiency Act, 1913, on the lines suggested by the Central Association for Mental Welfare in 1914. Centres are developing gradually; there are now 111 of them, 106 provided by Local Mental Welfare Associations, but largely financed by Local Authorities, and 5 directly provided by those Authorities. The number of children on the registers of these centres is about 1,200.

The centres are mainly for lower grade notified children, but there are also Industrial Centres and some Handicraft Classes for older boys and girls of both low and high grade.

(a) Junior Centres

74. It must be understood that the aims of the Occupation Centre differ in their fundamental underlying principles from those of a Special School. The Special School is designed to fit as many of the children as possible by careful training, special educational methods and in the last few years of attendance by a measure of vocational training, for some place, however humble, in the outside world, in competition with their fellows, where they may be wholly or partially self-supporting. The Occupation Centre aims only at fitting the child for the strictly limited environment of its own home, where it may lead a life of happiness for itself, sometimes of usefulness to others, but in any case a life in which it ceases to be an intolerable burden to others and has its own place in the family circle.

Once this underlying principle of centres is grasped, the whole of the training given will be shown to minister to this purpose. There should therefore be no confusion as to the respective spheres of work of the Special School and the Occupation Centre, for they serve separate and distinct ends. Neither is complete in itself. If there is a Special School in a town where there is no Occupation

[page 68]

Centre, it inevitably happens that the former is not confined only to "educable" children, but that its work is hampered and made less effective by the presence of too many "ineducable" ones. If an Occupation Centre exists without a Special School it will be called upon to take a certain number of children who, being only feeble-minded, need more than it can undertake to provide. Each, to reach its highest point of efficiency, needs the other to supplement it; only in those areas where there are both can it be said that adequate provision for the care of mentally defective children exists.

The actual methods of training children in the centre do not differ from those used in schools or institutions for children of a similar grade which we have already described. Good habits are essential for life at home; simple personal hygiene, therefore, tidiness, obedience, self-control, are all part of the training underlying every activity of the day. The lower grade child at home is generally a-social for he has never formed part of a group; he must therefore be taught the obligation as well as the advantages of social intercourse, and his personal relation to others must be made to conform to a simple code of kindness and helpfulness.

Simple hand work, useful domestic work, shoe-cleaning, dusting, laying tables, scrubbing, are all part of the centre training and all render the defective useful at home; singing games, bands, rhythmics develop co-ordination of movement as well as quick response and social adaptation, and so on right through the whole activities of the day. All are based on these principles and are guided by the knowledge of the limitations which the child's mentality imposes on them.

Centres, which are always in towns, vary greatly in size; according to the facilities for transport. It has so far been found that about 30 to 40 is the largest number which can be collected by guides and taken by trams, buses, etc., in urban areas. They are open for either five whole days, or in some cases for five or even fewer half-days in the week. The premises consist of one or two rooms and are often lent by the Local Education Authority or some social organisation. The Supervisor is not generally a trained teacher, but is a woman with knowledge of dealing with children and ability to teach simple handwork, music and physical exercises. As a rule, she is given training by the Central Association for Mental Welfare in their special training centre or in an institution, or at one of the many Short Courses organised by the Association.

In addition to the direct benefit to the children, parents, who often visit the centre regularly, learn methods of training and discipline which can thus be continued at home; they are also in constant touch with the social workers of the Association, to whom they can apply in difficulties. The knowledge gained in the centre regarding the young lower grade defective is of inestimable advantage and in securing maintaining adequate social control of the lower grade adult.

[page 69]

The great difficulties in conducting centres for lower grade defectives are the classification and staffing; but despite these difficulties the devoted work of the Supervisors has resulted in Occupation Centres becoming definitely established as part of the educational and training provision for defectives.

(b) Industrial and Handicraft Centres

75. These are only just beginning to make headway, as they have been seriously handicapped by lack of funds. In Leeds there is a large Industry and Occupation Centre which provides training and employment for feeble-minded men and boys, and there is a similar centre at Bristol, both of which are most successful. There are in addition Handicraft classes for boys and girls, often attached to the Occupation Centres. These cater both for low and high grades.

Occupation, Industrial and Handicraft centres are financed by grants from the Local M.D. Authority (which rank for the 50 per cent Government Grant) and by small direct grants from the Board of Control. Education Authorities frequently lend premises or rent them at a nominal sum, but have no power to make direct grants.

76. In the last two chapters we have briefly reviewed the provision made by the legislature with regard to the mentally defective, the working of the legal and administrative arrangements and the actual provision now being made for mentally defective children who have been ascertained and certified by the Local Education Authorities and for those who have been notified to the Local M.D. Authority. Having regard to the object with which the Committee was appointed, we have felt bound to emphasise in particular those parts of the law which, owing to their obscurity, have given rise to different interpretations and to administrative difficulties, and to point out those directions in which we believe that the intentions of the Acts have not been achieved, or in which we consider some amendment of the law is required in the interests of defectives and of the community. We have seen that the ascertainment of mentally defective children is far from complete, and that, though the work which the Special Schools are doing is in many ways admirable, their numbers are insufficient even for the children hitherto ascertained. We have further seen that this form of provision is not capable of any wide extension within the existing legal system, and that other methods of meeting the needs of the educable mentally defective child must be considered. On the other hand we have found that, while the system of training lower grade children in occupation centres and the provision made for their training and care in institutions are suitable so far as they go, the number of institutions and centres is totally inadequate and must be increased, especially when regard is had to the far larger

[page 70]

number of children who, in our view, should be notified in future. In a later part of this Report we shall make certain recommendations for the amendment of the law with a view to filling the gaps which appear to exist and to clarifying what now seems ambiguous, and certain suggestions for the devising of further methods for the education, training and care of defectives in the light of the findings of our investigation.

[page 71]

77. As stated in the first Chapter of this Report, we decided at an early stage of our deliberations that, if accurate information was to be obtained as to the numbers of mentally defective children and adults in the country generally and as to the provision that was being or should be made for them, it was essential to conduct a series of intensive investigations in certain selected areas in different parts of England and Wales. We cannot within the confines of our Report attempt to give any full description of these investigations or any detailed discussion of the findings. An account of the areas visited, the methods, procedure and standards adopted in the investigations, together with a detailed description of the findings, will be found in Dr. Lewis' own Report, while the statistical data obtained are fully set out in the series of tables contained in Appendix A to that Report. All that we propose to do is to give a brief summary of the nature of the investigations, to draw attention to the most important of the findings, and to discuss certain questions arising out of those findings and certain conclusions which may be drawn from them. We shall include a summary statement of the numbers of defectives of different grades and ages and of the magnitude of the administrative responsibilities of Local Education and M.D. Authorities charged with the care of mentally defective children.

78. We were fortunate in obtaining the services of Dr. E. O. Lewis, who was specially seconded by the Board of Control, as our Investigator, and we arranged for him to hold investigations in six areas each containing a population of approximately 100,000 persons. The areas we selected were an extra-metropolitan urban area, a north country cotton town, a coal mining district in the midlands, an agricultural district in the eastern counties, a rural area in the south-west containing a large town, and a thinly populated rural area comprising two counties in Wales. These areas were chosen because of their geographical position and general industrial features and may be regarded as fairly typical of England and Wales as a whole except in regard to the relative populations of urban and rural areas. The selected areas contain approximately equal urban and rural populations, some 300,000 of each, whereas in England and Wales as a whole the urban population is about four times as large as the rural. In discussing the findings of the investigation therefore it is necessary to distinguish between the numbers in urban and

[page 72]

rural areas, and no general deduction can be made from any figure which merely gives the total incidence of mental defect in all the six areas combined.

It was arranged that our Investigator and his staff, consisting of a field worker of special experience and a secretary, should spend not less than three months in each area and that he should endeavour in this time to ascertain and examine individually all the mentally defective children and adults whose homes were within the areas investigated. Dr. Lewis drew up a programme of procedure for the investigation and submitted a statement of the standards he proposed to adopt. This programme was duly submitted to and approved by the Committee.

Broadly speaking, the programme postulated the co-operation of the Local Education and Mental Deficiency Authorities, Boards of Guardians, Prison Authorities and other public bodies in each area in supplying all the possible information at their disposal as to all mental defectives known to them; the enlistment of the help of all local Mental Welfare Associations and of any other voluntary bodies and persons interested in social work; the visiting of all Public Elementary and Special Schools, and, so far as practicable, all private and preparatory schools in the area and also of any Residential Schools and Institutions outside the area at which there were known to be children or adults whose homes were within any of the investigated areas; and lastly, the visiting of the homes of all defectives reported or discovered during the investigation.

79. The main source of information in regard to children was, of course, the Public Elementary School. It was in respect of the section of the population represented by the children of school age, particularly those between the ages of 7 and 14, that the investigation was most complete and the selection most careful. There can be little doubt that all children of these ages attending the Public Elementary and Special Schools who were mentally defective were in fact seen and individually examined by the Medical Investigator. The only mentally defective children of school age who may have escaped detection would be the relatively small number attending private day and boarding schools and some of the youngest children attending elementary schools. The carefulness and thoroughness of the investigation in respect of children may be gauged from the fact that no child was entered on the returns as mentally defective until he had passed through three processes - selection by the Head Teacher, examination by Group Tests, and individual examination by the Medical Investigator. This triple process was calculated on the one hand to ensure that all possible defective children came to the Investigator's notice and on the other hand to be effective in eliminating doubtful cases. While therefore the ascertainment was necessarily incomplete as we shall show below in respect of certain sections of the population, it may fairly be claimed that in respect

[page 73]

of children between the ages of 7 and 14 it was almost certainly as complete, accurate and thorough an ascertainment as could be secured by any investigation of this nature.

80. For the ascertainment of adults reliance had to be placed in the first instance on information supplied by the Public Authorities and their Officers, by Voluntary Mental Welfare Associations and other Societies and by Institutions of all types, especially the Poor Law Institutions. If these had been the only sources of information the figures for adult ascertainment would have been rather a measure of the numbers known to public authorities than an indication of the total numbers in each area. In the case of adults, however, as well as in that of children the Public Elementary Schools proved one of the most valuable sources of information and considerable numbers of adult defectives not previously known to the Authorities were in fact discovered through visits to the homes of mentally defective children, and through inquiries about the family histories of these children and about former pupils who were known to have been backward at school. The personal examination of adult defectives was a more difficult matter, but every effort was made to secure that all adults reported as being likely to be found defective should be visited and, so far as practicable, thoroughly examined. In respect of criminal defectives the ascertainment was admittedly incomplete. It was felt that for this class an ad hoc investigation, clearly impossible in the time available, would be required.

81. The standards adopted for the purpose of determining whether any individual child or adult should be classified as feeble-minded, imbecile or idiot are clearly set out in Dr. Lewis' Report. So far as we are aware, the standards adopted in previous investigations of this character have never been described so fully or in such detail. The description given in Chapter 2 of our Investigator's Report of the standards and criteria applied by him should prove most useful both to Certifying Officers and to future investigators in this field of work. We do not propose to discuss these standards further here, but will merely say that we believe they were in some respects more strict than those generally adopted and that the findings of this investigation may therefore be regarded as conservative or minimum findings.

82. In the following brief discussion of the principal findings of our investigation, it will probably be convenient if we deal first with certain general features and subsequently with some of the more important data relating to mentally defective children* The first portion of our discussion will accordingly be concerned with the gross ascertainment and the gross incidence of mental deficiency in the more scientific sense of the term and with the findings of our

*Our discussion of the specific findings in relation to adult defectives and of the problems - legal, administrative and social - raised by those findings is contained in Part III of our Report.

[page 74]

investigations in relation to certain social problems of general interest and importance, while in the latter part of this chapter we will discuss the figures relating to children in the light of their bearing upon the administrative problems of Local Education and Mental Deficiency Authorities.

83. It will be seen from Table 3 in Appendix A to Dr. Lewis' Report that in the investigated areas, which contained an estimated population of approximately 623,000, the total number of defectives of all grades and ages, who were actually ascertained on the basis of the standards followed, was 5,334, giving a mean rate of incidence of 8.56 defectives per thousand population. This incidence rate cannot, however, be applied as it stands to England and Wales as a whole, and in order to arrive at an estimate of the total number of mental defectives in the country two fundamental considerations must be borne in mind; first, the marked difference in the rates of incidence in the investigated urban and rural areas,* and secondly, the fact to which we have already referred, that the urban population in the whole country is approximately four times as large as the rural population. According to Table 9 the incidence of mental defect in children and adults in the investigated urban areas was 6.71 per thousand, while the incidence in the rural areas was 10.49 per thousand. If these incidences are applied to the whole of England and Wales it is estimated that there would be approximately 202,600 mentally defective children and adults living in urban areas, and 86,000 living in rural areas. On this basis we should arrive at a total estimate of 288,600 defectives of all grades and ages in England and Wales as a whole.

This gross figure is, however, a composite one, since it comprises not only all persons who are mentally defective within the meaning of the Mental Deficiency Acts, but also all children who are mentally defective within the meaning of the Education Act. This latter group, as we have seen, includes a number, estimated at approximately one-third, whose defect is educational rather than social, and who should probably not be included among mentally defective persons in the sense which we give to that term in Chapter II and which we believe to be broadly the meaning underlying the definitions given in the Mental Deficiency Acts, namely, incapacity for social adaptation. Now the total number of feeble-minded

*See para. 88 on page 79 for a discussion of the wide disparity between the findings in urban and those in rural areas.

[page 75]

children* under 16 is estimated approximately at 111,000† (Table 10 (A)). If one-third, namely, 37,000 of these were deducted from the total of 288,600 given above, it would be found that the total number of persons of all ages who are definitely mentally defective within the meaning of the Mental Deficiency Acts would be about 250,000.

There is abundant internal evidence, however, in Dr. Lewis' Report to show that his total ascertainment was not equally complete in respect of all groups of the population. While it may, as already stated, be assumed that practically all defective children between the ages of seven and fourteen in the investigated areas were ascertained by him, the ascertainment in respect of the adults, particularly in the urban areas, and still more that in respect of the children under seven years of age, was necessarily incomplete. We believe that when due allowance has been made for this a conservative estimate of the mean incidence in England and Wales as a whole would be about 8 per thousand.‡ On this basis the total number of persons of all ages in England and Wales who are defective within the meaning of the Mental Deficiency Acts would be approximately 300,000.

If, however, the children to whom we have referred above as being educationally rather than socially defective were added to these, the total number of persons of all grades and ages who are mentally defective within the meaning of either Act would not fall far short of 340,000.

The above estimates indicate the total burden which mental deficiency imposes upon the community. For practical and administrative purposes, however, it is necessary to divide the defectives into various groups and we shall accordingly proceed in Section VI of this Chapter to give more detailed estimates of the numbers of mentally defective children with whom Local Education and M.D. Authorities are concerned. We will deal with the specific findings in relation to adult defectives and with the total burden on Local M.D. Authorities in Part III of this Report.

84. One of the most striking features of this investigation is that the incidence of mental defect in the investigated areas was very

*We use the term "feeble-minded children" for the purposes of this Chapter in the sense in which it is used throughout our Investigator's Report, namely, as equivalent to "mentally defective children" within the meaning of Section 55 of the Education Act, 1921.

†Of these approximately 105,000 were between 7 and 16 years of age and the remaining 6,000 were under 7.

‡A detailed description of the basis on which this estimate of 8 per thousand is made is given in Chapter 3 of Dr. Lewis' Report, page 82.

[page 76]

much higher than that of any previous inquiry of this nature which has been held in England or Wales, and that in the case of children it was considerably higher than the ascertainment of any Local Education Authority. The mean incidence figure which we have quoted above of 8.56 per thousand population in the areas investigated by Dr. Lewis is almost twice as great as that given in the Report of the Royal Commission on the Feeble-minded in respect of the areas which they investigated, namely, 4.6 per thousand.* So far as feeble-minded children are concerned, the mean incidence in our investigation is 3.36 per thousand population, as compared with an incidence of 1.47 per thousand given in the findings of the Royal Commission.

These marked differences between our findings and those of the Investigators under the Royal Commission require some comment. We believe that the standards laid down in both investigations were broadly the same, though those applied by the Royal Commission were described in less detail than will be found in the description in Dr. Lewis' Report of the standards applied by him. The standards in the two investigations were based, so far as feeble-minded children were concerned, both on the definition of mentally defective children contained in the Elementary Education (Defective and Epileptic Children) Act of 1899 (now Section 55 (1) of the Education Act of 1921), and also on the definition of "defective" children laid down in the Memorandum of Instructions to the Medical Investigators under the Royal Commission and subsequently enacted in Section 1 of the Mental Deficiency Act, 1913. The definitions were thus the same in both investigations, though no doubt they were somewhat differently interpreted. It is probable that while a number of children who were educationally but not socially defective were included amongst the "defective" (i.e. feeble-minded) children in the earlier inquiry, a relatively larger number of these children were classified by Dr. Lewis as feeble-minded. In the case of imbecile and idiot children and of all grades of adult defectives, there is no reason for thinking that the standards adopted or their interpretation differ in any material respect from those of the earlier inquiry.

It must, however, be remembered that that inquiry was carried out by no less than ten different Medical Investigators, and though they were all working upon the same body of instructions the personal factor must necessarily have affected the standards taken by each of them and thus have influenced the individual findings. In our investigation on the other hand the standards adopted in all the six areas were uniform and the findings in one area are strictly comparable with those in another so far as the personal equation is concerned.

*It should further be noted that the figures of the Royal Commission included among defectives, in addition to definite cases of mental deficiency, sane epileptics and also uncertified insane and mentally infirm persons in Workhouses.

[page 77]

(a) TIME DEVOTED TO THE WORK

85. One obvious, though certainly only partial, explanation of the difference in the findings is that our investigation was more thorough and our ascertainment more complete. The Investigators under the Royal Commission devoted not more than two or possibly three months in all to each area, and the areas they investigated contained populations ranging from 150,000 to 700,000. In our investigation none of the areas contained a population of more than 110,000; from three-and-a-half to four months were devoted to each area; the total population covered was under 625,000 and the total time actually spent on the investigation was 24 months, exclusive of holidays. Moreover our Investigator had the assistance of one or sometimes two full-time specially trained social investigators and of a full-time personal Secretary who worked continuously with him during the two years, whereas each of the earlier Investigators had at his disposal only the services of a single clerk.

(b) GREATER COMPLETENESS OF ASCERTAINMENT AMONG SCHOOL CHILDREN.

As we have already mentioned, a special point was made of ascertaining all the mentally defective children who were attending any school and there is no doubt whatever that the ascertainment in this group of the population was far more complete in our investigation than in that of 1906. Not only had Local Education Authorities themselves a far better knowledge of the defective and retarded children in their areas, but the methods employed by Dr. Lewis for ensuring that all potential defectives were brought to his notice were more thorough than those adopted in the earlier inquiry.

(c) ASCERTAINMENT FACILITATED BY GROWTH OF SOCIAL SERVICES.

Moreover, the development in the organisation of social services during the past 20 years has undoubtedly greatly facilitated the work of ascertainment. In 1906 there was no Local Authority specially concerned with mental deficiency. The Lunacy Authorities made little differentiation between mental defectives and persons suffering from mental disorder; the Local Education Authority, though they had the power, had no duty to ascertain defective children, and although some provision had been made for these children in the larger voluntary residential institutions, there were but few Day or Residential Special Schools except in one or two areas; the Education (Administrative Provisions) Act, 1907 which inaugurated compulsory medical inspection of all children attending Public Elementary Schools - one of the most fruitful of all sources of

[page 78]

ascertainment of mentally defective children - was not in operation; Boards of Guardians who no doubt had many defectives under their charge made little special provision for them and were in very many cases unaware of their existence as a separate group of paupers needing special care; Public Health work was less developed; there were no central or local Mental Welfare Associations; the public generally were less enlightened on the subject; and the criteria and methods for assessing mental deficiency were less well defined. It is only to be expected therefore that the volume of information available for an investigator at the present time should be far greater and more accurate than it was twenty years ago and that his ascertainment should be more complete. We can well believe that many high grade defectives would escape detection in those days when the problem of the feeble-minded was only beginning to be recognised, and it would not therefore be in any way surprising to find that the 1926 ascertainment of high grade cases should be considerably greater than that of 1906. Moreover no psychological standards for the assessment of mental deficiency had been formulated or at any rate adopted in this country, such intelligence tests as were in existence had not been standardised, and the methods of diagnosis were less well defined or understood in the country generally.

86. The above considerations lead us to what is probably the most interesting and important problem raised by Dr. Lewis' findings, namely whether there is any evidence that the incidence of mental deficiency is actually increasing. The chief evidence relative to this point lies in the higher ascertainment of imbeciles and idiots and in the increased disparity of incidence in urban and rural areas.

87. According to the findings of our investigation the incidence of lower grade defect, that is of imbecility and idiocy, in the areas investigated was 1.87 per thousand population, a figure which is almost exactly double that found by the investigators under the Royal Commission, namely, 0.98 per thousand. It is highly improbable that the earlier investigators would have failed to discover any large proportion of the lower grade defectives, since these must have been recognised by the various Authorities, Clergy, Doctors, Social Workers, Police Officers and others who formed the main sources of information, and the large majority of them must therefore have been brought to the Investigators' notice. No doubt

[page 79]

our ascertainment was more complete than the earlier one, even in respect of lower grade defectives, but this factor would certainly not account for the doubling of the numbers found.

It is moreover a striking coincidence that notwithstanding the disparity between the numbers of lower grade defectives found, the relative incidence of the three grades should have been almost identical in the two investigations. Dr. Tredgold* has calculated on the basis of the figures of the 1906 investigation that in every hundred aments in England and Wales there were found to be six idiots, eighteen imbeciles and seventy-six feeble-minded persons. According to Dr. Lewis' investigation the corresponding numbers were five idiots, twenty imbeciles, and seventy-five feeble-minded persons. One would naturally have expected from what has been said above that the lower grade defectives would have borne a considerably higher ratio to the feeble-minded in the earlier investigation, and the strikingly close similarity between the findings of the two investigations in this respect is by no means easy to explain.

88. Apart from the disparity between the numbers of lower grade defectives found in the two investigations, one of the most disturbing features that tend to show that there has been an increase in incidence is the marked difference between the figures in Dr. Lewis' findings for rural and urban areas. Table 7 shows that the incidence of all grades of defect in urban areas was 6.71 per 1,000 total population as compared with 10.49 in rural areas. This feature has been observed by previous Investigators, but so far as we are aware the incidence in rural areas in this country has not hitherto been found to be as much as 55 per cent† higher than that in urban areas. The findings of the Investigators under the Royal Commission show that the incidence in rural areas, particularly in agricultural districts, was generally higher than that in the urban areas and industrial towns which were visited, though the disparity was not nearly so marked as in our investigation.

If this disparity were confined to adults it could no doubt be partly explained by the facts that it is easier to ascertain the adult defective in a rural area, that our Investigator's actual ascertainment of adults in urban areas is admitted by him to have been less complete owing to the lack of social cohesiveness‡ in some of these areas, that mental defectives born in urban areas are not infrequently sent when grown up to the more congenial country districts to

*"Mental Deficiency", Tredgold, Fourth Edition, pages 12 and 13.

†According to Table II, which is based on sex incidence, the rural incidence is as much as 64 per cent higher than the urban.

‡See Dr. Lewis' Report, Chapter 1, pages 3 and 4 where he discusses this and other factors which militated against complete ascertainment of adults in urban areas.

[page 80]

live and that defectives seem to live longer in the country than in town. Moreover, the migration of the more enterprising members of the rural community to the towns would in itself cause a slightly higher incidence of mental deficiency in the rural areas and would tend to lower that in the towns. These extrinsic factors, however, do not seem to afford an adequate explanation of the difference of incidence in urban and rural areas especially when it is remembered that this difference is most marked in respect of the children between 7 and 14 years of age in whose case it is certain that the ascertainment was most complete and was also equally thorough in both types of area. Table 14 shows that in this group the rural incidence was 39.7 as compared with an urban incidence of 20.9 per thousand school children.

Is there any obvious factor to account for this disparity between the incidence of mental defect in children in urban and rural areas? It is, of course, known that rural children experience a considerable handicap when subjected to mental tests as compared with urban children who have greater verbalistic ability. Our Investigator was naturally much on his guard against allowing this handicap of rural children to influence his findings. Moreover, the Group Tests which were applied were certainly not verbal in character or otherwise specially favourable to urban children. It is of course admitted that most Scales of Intelligence Tests have a verbal bias, but those adopted in our investigation included a fair proportion of tests of a practical character, and in the individual examinations our Investigator also applied several Performance Tests. Again, as is clearly indicated in our Investigator's Report, no child was classed as feeble-minded merely on the basis of his mental ratio as assessed by intelligence tests; full weight was given to his educational attainments, his general behaviour at the examination, reports by teachers on his conduct in school and in the playground, the results of physical examination and all available information as to his family history. It seems clear, therefore, that the possible verbal bias of these tests was not allowed to deflect our Investigator's judgment.

Dr. Lewis had had wide experience of testing rural children prior to this investigation and was fully aware of the allowances that have to be made in their case. In fact it appears from an examination of the distribution of mental ratios* among children in urban and rural areas that his standards in this respect were somewhat less exacting in the latter, in that the proportion of ascertained children with the higher mental ratios was smaller in the rural areas.

What has been said in the two preceding paragraphs applies mainly to the higher grade defective children. When we turn to the lower grade defectives, both adults and children, the evidence that the incidence is definitely higher in rural areas is

*Appendix A, Table 18.

[page 81]

still more conclusive. In ascertaining lower grade defectives of whatever age it is highly improbable that the application of the same criteria by a single investigator could have varied as between urban and rural areas. Yet, although the standards were admittedly identical, the incidence of lower grade defect was found to be 40 per cent higher in rural than in urban areas. It seems incontrovertible therefore that there is a marked disparity in incidence between these two types of area.

89. A possible explanation of this disparity is that the great industrial revolution of the last century has brought about a distribution of the population in this country that would be conducive to an increase in mental deficiency. It is possible that the selective migration of the better stock from the rural districts has left behind a population inferior in mental quality at any rate, and that the inter-marriage of this inferior stock has produced a larger number of mental defectives during the last 50 years than in previous centuries, when the population was more evenly distributed. Now there is some evidence in the findings of our inquiry* that though mental defectives, particularly the lower grades, are found indiscriminately in all social strata, the incidence of feeble-mindedness both among children and adults is likely to be greater in any given group of persons below the normal in general intelligence than in a normal or super-normal group. We do not desire to attach undue weight to this argument, but we believe that it may afford at least a partial explanation of the higher ascertainment in our investigation than in those that have preceded it. It is of some interest and importance to know that the increase in mental deficiency, if there has been an increase, has been caused not by the deleterious industrial conditions of the large towns but by selective hereditary features operating in isolated rural areas where the environment is most conducive to the birth and maintenance of a healthy stock.†

There are some indications that the peak of migration from the country to the towns may have been reached, and that with the increased transport facilities, the growth of rural industries, the establishment of factories in country districts and the increasing attention being given to agricultural problems, the flow of migration may before long tend to be rather out of the town into the country and that the isolation of the rural communities may diminish.

*See Table 22 in Appendix A and also the Investigator's Report, Chapter 4, pages 129 et seq.

†The figures in Table 17 (E), as well as the statistics of infant mortality in the investigated Urban and Rural areas, support this contention. It is worthy of note moreover that according to the vital statistics for England and Wales the general death rate and the infant mortality rate have for many years been higher in urban than in rural areas, while the average age of the population of both sexes is appreciably higher and the number of persons over 60 years of age considerably greater in the latter than in the former.

[page 82]

90. We have considered with the greatest care all the evidence before us on the question whether mental deficiency is increasing. We recognise that the increase in the number of defectives found in our investigation is probably due in the main to more complete ascertainment; partly to the lowering of infant mortality and to the greater longevity of defectives consequent on improved hygienic conditions and the growth of health services; and partly also to a somewhat different interpretation of the standards. We recognise too that much careful and prolonged research is required before any final conclusion can be reached on this question. Nevertheless, after due allowance has been made for these and other considerations to which great weight must be attached, the facts that (1) our investigation revealed twice as many lower grade defectives as did that of the Royal Commission twenty years previously, (2) that the ratio of the different grades to each other remains the same in the two inquiries, and (3) that the disparity in the ascertained incidence in the urban and rural areas has markedly increased - all these make it hard to believe that there has not been some increase in the incidence of mental deficiency during this period.

91. The possibility that the higher incidence of mental defect found in the rural areas was due to the lower cultural level of the rural stock brings us to the last of the more general features of our investigation to which we wish to call attention, namely, the distribution of higher grade defectives in the various areas. Lower grade defectives were found indiscriminately in all types of district and in all classes of family and there is no reason to think that the incidence of idiocy or imbecility is distributed in any way unevenly among the different social strata of the population. But in the case of feeble-mindedness there were great differences of incidence in different schools and villages and in different parts of the same town. The town schools which contained the largest proportion of feeble-minded children were generally situated in the slum areas, and in the villages with the largest number of adult defectives there were generally found to be correspondingly large numbers of feeble-minded children. There were thus what appeared to be certain clearly marked geographical foci of mental deficiency. When, however, these came to be investigated more closely, they were found in fact to be family foci. This was certainly the case in many of the villages, where the defective children were found in a small restricted number of families, often interrelated by marriage. The family focus was more difficult to establish in the towns, though there were many indications of it there also.

[page 83]

Now the importance of this feature of our findings is that it seems to establish the fact that feeble-mindedness is more likely to occur among populations of a generally low mental and physical level than elsewhere, that is to say, in slum districts and in rural areas with a poor type of inhabitant, and that broadly speaking it is likely to be most prevalent in a certain limited group, which may be termed the sub-normal group, of the general population. The evidence is not conclusive, but it does at least point to there being some relation between the slum problem and the problem of mental defect, as we shall see below.*

Certain other features in Dr. Lewis' Report point in the same direction. It is generally accepted that certain diseases and physical defects - defects of growth and nutritive conditions such as undersized stature, subnormal nutrition, rickets and anaemia, certain eye diseases such as blepharitis and conjunctivitis, certain skin affections - are more commonly to be found in slum areas and in association with poor and dirty home conditions than elsewhere, and it is not without interest to know that according to the findings of our investigation the occurrence of these very diseases and defects is many times more frequent among mentally defective children than it is among the general school population.† Again, a fact which has some bearing on this question and which has been observed elsewhere was noted in one of the investigated areas, namely, that after a slum area has been cleared and the population moved to well-designed houses and to generally hygienic surroundings, the very conditions which it was hoped to remedy soon recur and oblige the Local Authority to intervene to prevent the emergence of a new slum area. It was in such a district as this that our Investigator found one of the highest incidences of mental defect found in any area of comparable size.

If, as there is reason to think, mental deficiency, much physical inefficiency, chronic pauperism, recidivism, are all more or less closely related, and are all parts of a single focal problem, can it be that poor mental endowment, manifesting itself in an incapacity for social adjustment and inability to manage one's own affairs, may be not merely a symptom but rather the chief contributory cause of these kindred social evils? If so, then the problem of mental inefficiency, of which mental deficiency is an important part, assumes a yet wider and deeper significance and must indeed be one of the major social problems which a civilised community may be called upon to solve.

*See Part III of the Report where the question is fully discussed in the chapter on "Mental Deficiency as a Social and Genetic Problem". See also Dr. Lewis' Report, Chapter 4, pages 129 et seq., and Table 22 in Appendix A.

†See Dr. Lewis' Report, Chapter 4, pages 104 et seq.

[page 84]

92. In considering the findings relating to feeble-minded children we propose to confine ourselves to children between the ages of 7 and 16 since feeble-minded children under the age of 7 do not as a rule present any special educational or administrative problem, and since it is, broadly speaking, only with those over 7 and under 16 years of age that Local Education Authorities are at present concerned. We shall first give certain estimates of the total number of feeble-minded children between these ages in England and Wales and then discuss very briefly certain of the more important administrative problems raised by the findings.

(a) ESTIMATED NUMBERS IN ENGLAND AND WALES

93. Estimates of the total number of feeble-minded children between 7 and 16 years of age in England and Wales could be framed in several different ways from the findings in the investigated areas. We have come to the conclusion, however, that the most simple and reliable estimate is that given in Table 24 (3), which is based upon the actual incidence per 1,000 total population of feeble-minded children between the ages of 7 and 16 ascertained in the investigated urban and rural areas. It will be seen that on this basis the total number of children in this age-group in England and Wales who are certifiable as feeble-minded on the standards adopted in our investigation is estimated at approximately 104,509, or in round numbers 105,000. We think that this figure may be accepted as the most reliable one that can be obtained from our investigations, and we are satisfied that it is not an overestimate.

Of these 105,000 children, approximately 75,000 are living in urban areas and 30,000 in rural areas, the corresponding incidence rates per 1,000 total population being 2.42 and 3.59 respectively. It is desired to call attention here to these differences of incidence, since they will have an important bearing on the problems that we shall have to discuss later of making suitable provision for feeble-minded children in both types of area, and particularly in the more sparsely populated country districts.

(b) FEEBLE-MINDED CHILDREN IN PUBLIC ELEMENTARY SCHOOLS

94. A fact of no small administrative and practical importance, which has long been generally known to educationists, has been confirmed by this investigation, namely, that very large numbers of feeble-minded children remain in the ordinary Public Elementary Schools throughout their school lives. No less than 1,614 out of 2,091 feeble-minded children, or 77 per cent of those ascertained, were in attendance at these schools. In rural areas this can be explained by the fact that the numbers are too small to permit of the establishment of Day Special Schools while the cost of sending

[page 85]

them all to Residential Schools, even if accommodation were available, has been regarded as prohibitive. In urban areas the administrative difficulty of making separate provision for the relatively small numbers of defective children no doubt operates also, but our Investigator received the impression that factors of greater importance were the difficulties connected with certification - unwillingness of teachers to send children forward for special medical examination and of Certifying Officers to certify children as mentally defective, parents' objections to their children being certified; the strong prejudice felt by parents to their children being segregated from normal children, particularly where the Special School was attended by children of lower grade; and the feeling among many teachers that large numbers of these children can be dealt with within the ordinary elementary education system. It would not be safe to generalise from the findings in the two selected areas where Day Special Schools have been established, but it may be pointed out that even in these areas over 69 per cent of the feeble-minded children over 7 years of age ascertained were in Public Elementary Schools and only 16 per cent were attending the Day Special Schools, although there was accommodation at these schools for between two and three times as many children as had actually been admitted.

We shall have occasion to refer later* to this matter, which appears to us to raise certain fundamental issues on which our principal recommendations in regard to children will be based.

(c) FEEBLE-MINDED CHILDREN SUFFERING FROM OTHER DEFECTS

95. The incidence of physical defect amongst feeble-minded children was found to be very high. So far as it is possible to draw general conclusions from the relatively small numbers of children concerned, or to compare the results of our investigation in this respect with the somewhat incomplete returns furnished by Local Education Authorities, it would appear that the incidence of blindness and deafness, both total and partial, is many times as high amongst feeble-minded† as amongst normal children. The figures in regard to other physical defects are less conclusive though there is reason to think that the incidence is unusually high among the feeble-minded. So far as "severe" epilepsy is concerned the incidence among the ascertained defective children was found to be 5.2 per cent, a figure which should be compared with an incidence of 0.06 per cent as returned by Local Education Authorities and 0.07 per cent found by the Royal Commission amongst the total normal school population.

*Chapters VI, VII and VIII.

†The discussion in Dr. Lewis' Report (Chapter 4, pages 104 et seq.) of the incidence of physical defect relates to the whole group of mentally defective children of all grades, but his main conclusions are certainly applicable to feeble-minded children who formed the large majority of those ascertained.

[page 86]

We shall refer later to two questions arising out of these findings: the administrative problem of providing for the education and care of children suffering from multiple defects,* and the necessity of paying particular attention to the health of mentally defective children.†

(d) SUGGESTED CLASSIFICATION OF FEEBLE-MINDED CHILDREN FOR ADMINISTRATIVE PURPOSES

96. In the course of his investigation Dr. Lewis endeavoured to determine so far as possible what form of educational provision contemplated under the present Acts and Regulations was the most suitable for each of the feeble-minded children whom he ascertained, and to classify the children in two categories - those requiring Residential Special School education, and those suitable for Day Special Schools. It is of course obvious that practically all feeble-minded children living in the more thinly populated rural areas must under the present system be sent to Residential Schools if they are sent to Special Schools at all, because of the impracticability of establishing Day Special Schools in country districts. In classifying the children, however, Dr. Lewis did not take this consideration into account, but based his recommendations on such factors as personal character traits, home conditions, etc. - in other words, on the question whether the child could be adequately dealt with and provided for in a Day Special School, if such a school were available. On the basis of his recommendations it is estimated that about 81,000 of the feeble-minded children could suitably attend Day Special Schools, if such schools were or could be made available, while some 23,000 would require to be sent to Residential Schools. (Table 24 (3)). In this latter group he included all the feeble-minded children for whom the Poor Law Authorities were at present responsible, amounting to about 5.6 per cent of the feeble-minded children between 7 and 16 ascertained, or in the whole of England and Wales to nearly 5,000 children between these ages.

(a) ESTIMATED NUMBERS IN ENGLAND AND WALES

97. On the basis of the actual ascertainment in the investigated areas it would appear that there are approximately 30,000 lower grade children in England and Wales as a whole, about 24,000 of these being imbeciles and about 6,000 being idiots (Tables 9 and 10).

*This question is dealt with in Part III of our Report, where the suggestion is made that the State might provide institutional accommodation for mentally defective persons, both children and adults, who suffer also from blindness, deafness or other physical defects.

†See Chapter VII, paras. 120 and 140.

‡Throughout this Chapter the term "lower grade" means idiots and imbeciles.

[page 87]

These figures include children of all ages up to 16. Our Investigator's ascertainment of younger children was naturally not so complete as it was in the case of those over 7 years of age; in point of fact the mean rates of his ascertainment of lower grade defectives in urban and rural areas respectively were 0.17 and 0.15 per 1,000 population in the case of children under 7 years of age as compared with 0.59 and 0.74 in the case of those between 7 and 16.

It is obvious that the incidence of lower grade defect amongst children under seven years of age is at least as high as it is amongst those over the age, and we should probably arrive at a more accurate estimate if we were to base our calculations on the incidences found in this older group of children. On this basis it would appear that there must be at least 40,000 lower grade children under sixteen years of age in England and Wales as a whole.

(b) SEX INClDENCE

98. It is somewhat surprising to find that the incidence of lower grade defect was as much as 30 per cent higher among boys than among girls. In the case of adults the disparity was even greater, the incidence being 33 per cent higher among men than among women. It is difficult to account for this feature, especially when it is seen that in the case of the feeble-minded the excess of males was only 14 per cent among children and in the case of adults the numbers were practically equal. Our Investigator suggests that these figures support the view which is held by some scientific writers that pathological conditions and variations from the normal are more frequent among males than females. The higher rates of infant mortality among boys would also tend to support this view. We draw attention to the fact here mainly because it is of some administrative importance in connection with the planning of institutional accommodation for lower grade defectives.

(c) PRESENT DISTRIBUTION OF LOWER GRADE CHILDREN

99. It will be seen from Table 16 (B) that of the 513 lower grade children under 16 who were ascertained no less than 212, or 41 per cent, were living in their homes, attending no school or centre and in most cases receiving no training or supervision so far as any public authority was concerned. It will further be seen that no less than 122, or 24 per cent, of these lower grade children were in attendance at Public Elementary Schools, and a further 11 per cent were at Day or Residential Special Schools. Only some 13 per cent of the whole number were being maintained by Local M.D. Authorities in institutions, and more than one-third of these were in Poor Law Institutions approved under Section 37 of the Mental Deficiency Act, 1913. These three facts in regard to the distribution of lower grade children actually ascertained in the investigated areas - namely, that 41 per cent of them were at home,

[page 88]

that 35 per cent of them were being educated at schools recognised or certified under the Education Act, and that only 13 per cent were receiving any form of institutional care at the hands of the Local M.D. Authority - furnish convincing evidence that the burden of providing for the care of lower grade children is not being borne by those Authorities on whom Parliament placed the responsibility.

(d) SUGGESTED CLASSIFICATION OF LOWER GRADE CHILDREN FOR ADMINISTRATIVE PURPOSES

Of the 30,000 lower grade children it is estimated, on the basis of the recommendations made by Dr. Lewis in regard to the allocation of defectives in the investigated areas, that in England and Wales as a whole there are some 17,000 who require institutional treatment. All of these should be sent to fully equipped Colonies conducted on modern lines, where adequate classification could be secured and every facility for training and employment would be available. It is further estimated that the remaining lower grade children amounting to nearly 14,000 could be left in the general community. Practically all of these would have to be placed under either supervision or guardianship. Rather more than half of them could attend Occupation Centres, while the remainder would be left at home and provided with such training or occupation in their own homes as it might be practicable to supply.

[page 89]

100. In discussing the findings of our investigation in the previous Chapter we laid some emphasis on the fact that a large proportion of certifiable mentally defective children remain uncertified, and indeed often unrecognised as mentally defective, and continue to attend the ordinary Public Elementary Schools along with normal children throughout their school lives even in areas where Special Schools have been established. On the basis of our investigation it appears that the numbers of these certifiable mentally defective children are far larger than had previously been thought and amount to about 90,000, or nearly six times as many as those attending certified Special Schools.

Now it might be suggested that the fact that our Investigator classed as feeble-minded* so large a number of children attending the Public Elementary Schools was simply due to his having taken an unduly high standard for the diagnosis of mental deficiency and having included many children who were not strictly certifiable under Section 55 of the Education Act. The description† of the standards adopted in this investigation makes it clear, we believe, that they were not more stringent than those normally followed by Certifying Officers in areas where the work is well done. Indeed we think that it will be generally admitted that no standards materially differing from those adopted would be compatible with the definitions of mentally defective and feeble-minded children in the Education and Mental Deficiency Acts respectively. Moreover, the number of mentally defective children actually ascertained by several of the most progressive urban Local Education Authorities corresponds very closely with Dr. Lewis' ascertainment in two of the urban areas which he investigated, even though his findings include children in Poor Law Institutions who are in many cases excluded from the Local Education Authorities' figures. There is also some evidence in the findings of recent investigations, confined to more limited areas, that the incidence of mental deficiency in both urban and rural areas is as high as that found in our investigation.

*The term "feeble-minded" as applied to children is used in this chapter in the sense in which it is used throughout our Investigator's Report, namely as equivalent to the term "mentally defective" for the purposes of Section 55 of the Education Act, 1921.

†See Dr. Lewis' Report, Chapter 2 and Appendix B.

[page 90]

101. We recognise that, as will be shown later, endeavours have been made by some Local Education Authorities so to organise their elementary schools as to provide for the needs of these children. Such efforts have, however, at the best been but spasmodic and haphazard, and most of these children are dealt with on exactly the same lines as the normal children in the schools. The unsuitability of the present curriculum and methods of instruction in the ordinary schools for the feeble-minded children ascertained in the present investigation is indicated by the results shown in Table 19 in Appendix A to Dr. Lewis' report. From this Table it is seen that about 12 per cent of these children had no educational attainments whatever. In a random selection of 836 feeble-minded children who had some educational attainments and whose average age was 11.4, the average educational age was found to be 6.4, indicating an average educational retardation of five years. Even children aged 14 who were in their last year of school life had only on an average the attainments of a normal child of 6.7 years of age. Such meagre educational attainments can scarcely be said to be of much practical value to these children especially when it is remembered that even these would be to a great extent lost during the first year after leaving school. These results, which can be borne out by evidence collected from other inquiries, make it clear that feeble-minded children receive very little profit from the ordinary scholastic curriculum of elementary schools.

102. We have seen in an earlier Chapter* that there is not only no prospect, but in fact no possibility of any considerable expansion of the Special School system in its present form and under present statutory conditions except in a few of the largest towns. Even in these towns increasing difficulty is being experienced in the certification and transfer to Special Schools of numbers of mentally defective children who should properly be certified and transferred. It is true that, if the difficulties inherent in certification could be overcome, the large urban Authorities would be able to secure the attendance of considerably larger numbers of these children at Special Schools. Apart from the largest towns, however, it seems abundantly clear that no appreciable expansion of the present Special School system is possible and we are accordingly driven to the conclusion that the system itself and the legal basis on which it rests must be modified if suitable educational provision is to be made for these 90,000 mentally defective children for most of whom Special Schools, as that term is now understood, will never be available.

*Chapter IV, paras. 64 and 65.

[page 91]

103. Now it must not be thought that those children who are certifiable as mentally defective (whether actually certified or not) are the only group of children who are unable to derive full benefit from the ordinary education in the Public Elementary Schools. Our Investigator formed the opinion in every school that he visited that for every child whom he classified as feeble-minded there were two or more children of only slightly higher mental and educational capacity. He was conscious throughout his investigation of the existence of a large marginal group who were clearly not deriving proper benefit from the instruction in the schools.

The existence of this group is universally recognised. Investigations by competent educational psychologists have shown that at least ten per cent of the children attending Public Elementary Schools are two or more years retarded educationally, and these children present a serious problem to teachers and others concerned with the administration of the schools. It is obviously difficult to fit these children in with their fellows. A child of 10 should be in what is generally known as Standard* IV. If he is two years retarded educationally he cannot derive benefit from most of the lessons given to other children of his age, whilst his transfer to a class (e.g. Standard II or lower) containing children two or more years his junior is admittedly undesirable.

104. We have already seen that the statutory requirement that a child must be certified as mentally defective before he can be provided with the special form of education contemplated in the Education Act, though it has resulted in the transfer of a number of children to Special Schools in the large towns, has in fact militated against the provision of suitable education in the country generally for the large majority of the 90,000 other mentally defective children. Moreover it is now recognised that in addition the large marginal groups of dull and backward children, who under Section 55 of the Act are explicitly excluded from the benefits of Special School education, are also unable to derive proper benefit in the broad sense of that term from the ordinary scholastic curriculum of the Public Elementary Schools. The need of providing for these is recognised by many educationists and teachers, but the mere fact that there is a special group of certified mentally defective children for whom Local Education Authorities are required by Statute to provide has tended to overshadow the claims of, and to distract attention from, the larger group in respect of whom no such specific duty has been imposed on those Authorities.

*See note † on page 143.

[page 92]

105. It is generally held by teachers and educationists that most of the feeble-minded children of the type ascertained in the present investigation could be taught by the educational methods appropriate to retarded children who are left in elementary schools. The whole group of retarded and higher grade defective children in fact present a single educational problem. Of the school children at present designated mentally defective, a considerable proportion are lacking not so much in social capacity as in educational capacity. They make incompetent pupils rather than incapable citizens. What they need is not special care and control but a special form of instruction, special teaching methods and a special syllabus of work. By the time they reach the age of leaving school, at least a third, as we have seen, will cease to be regarded as mentally defective in any legal sense. Hence such children should be regarded as educationally defective rather than as mentally defective in the stricter sense of the term; and they should not be certified merely to secure their attendance at a Special School. In point of fact, as we have noted already, they form simply the lower section of that large group of children broadly termed "retarded". During school years they need an education which should approximate rather to the instruction received by the more backward among the normal than to the limited training received by those who, when they are grown up, will need the care and supervision of a residential institution or some form of community care.

This view of the educationally defective makes it impossible for us to ignore the wider problem of the retarded child in general. If, as we have throughout maintained, the defective merge into the normal by insensible gradations, then the intermediate cases of a borderline type must lie also within our province. The "merely dull or backward" do not as such, fall directly under the terms of our inquiry. Yet adequately to discuss the measures required by the brighter of the mentally defective is impossible, unless at the same time we also briefly review the measures required by the dullest of the nominally normal. The anchorage, indeed, of the educationally defective is rather with the dull or backward than with the socially defective. Why, therefore, should not the two former groups be dealt with together in one comprehensive scheme?

There is yet a further reason which renders it essential for us to consider this marginal group. The two groups of mentally defective and retarded children are not merely contiguous groups; there is scientific ground for thinking that a causal relationship exists between them. The findings of our investigation, as already mentioned, point to the conclusion that the majority of the feeble-minded are to be found within a relatively small social group, a group which may be described as the subnormal or social problem

[page 93]

group, representing approximately 10 per cent of the whole population. Most of the parents in this subnormal group are themselves of poor mental endowment and would no doubt have been classed when children, among the dull or retarded. Similarly the dull children of the present generation, who form a large majority amongst the children in this subnormal group, are the potential parents of many feeble-minded in the next generation. Therefore from the standpoint of the prevention of many social evils it is of the utmost importance that the problem of the education and social care of the borderline retarded child should be effectively tackled.

106. In the light of all these considerations we have come to the conclusion that these two groups - the mentally defective child who is educable and the child who is dull or backward - can no longer be regarded as separate and distinct entities, but must really be envisaged as a single group presenting a single educational and administrative problem. This new and single group, which we shall later describe in more detail and with more precision, we designate the "retarded" group. This group consists broadly of all children who though educable in a true sense are unable to profit from the instruction in the ordinary Public Elementary Schools as these are now generally organised. It is largely on the essential unity of this whole group that the scheme which we shall propose in the next chapter is based.

We recognise that a full and detailed discussion of the methods, curricula and organisation of education for the non-certifiable retarded children is not within our scope. As, however, the large majority of the certifiable mentally defective children are now being and must always continue to be educated, together with those who are merely retarded, within the general elementary school system, we must necessarily in propounding our scheme raise problems which fall more properly within the province of the educationist than in that of a Committee which is concerned with the mentally defective.

107. One of the principal objects for which this Committee was set up was to endeavour to formulate some scheme which would render possible the provision of better educational facilities for the large body of mentally defective children already known to be attending Public Elementary Schools, for whom the provision of Special Schools was found to present increasing difficulty. In order to enable us to do this we must consider for a moment what methods have been adopted to meet the needs of these children

[page 94]

who, whether certified or not, are in fact being dealt with, so far as legal and administrative considerations are concerned, as normal children within the Public Elementary School system.

These children exist in a variety of circumstances among the general school population and it will be readily understood how diverse must necessarily be the ways of dealing with them. There is no one ideal method. The rural school can offer little choice; the large urban school with many hundreds of children can offer much; and any one of the methods available may find a rightful place according to the age of the child, the accommodation and staffing of the school and the keenness of the Head and his staff in attempting to bring within the reach of the retarded child the best educational facilities available.

There are several modern tendencies in educational theory and practice which help the retarded child. Among the more important of these are, first, the movement in the direction of smaller classes; secondly, the practice of group teaching within the class; thirdly, the fuller recognition given to individual methods of instruction. This last movement is especially significant from the point of view of the retarded child who promises to receive as much benefit as his intellectually brighter companion from the application of principles and methods, largely originating in Seguin's teaching[*] and subsequently developed by his successors, for securing individual response and activity. The actual methods of organisation include the following:

(i) Grouping of children within the ordinary schools. In very large schools children are sometimes grouped according to their capacities and those who move more slowly are formed into a group or class following such modification of the ordinary curriculum appropriate to each stage as may seem desirable. In this way it has been found possible to make provision for the majority of the retarded children, without any obvious separation of them from their fellows. In smaller schools more reliance has had to be placed upon grouping of individuals within the class.

These methods, however, are insufficient to meet all requirements and some special provision is often required. This has taken the form of

(ii) Special Classes into which are gathered children either junior or senior, some two or three years retarded. Special methods of instruction are followed and after a year or two some may be able sufficiently well to join with their fellows in the ordinary classes, while others may pass first from a junior to a senior special class.

[page 95]

(iii) The special class may not be so complete an entity. Children may attend for special subjects, for specified times, joining in with their fellows whenever possible, as for example, for singing and physical exercises and games, or, in the case of older children, for manual occupations and training. It has been found practicable to arrange these classes so that no stigma shall attach and, where they can be organised as Open-Air Classes, there may indeed be competition for admission.

(iv) It must be remembered that the Open-Air School proper affords an important indirect contribution to the solution of the problem. A large proportion of delicate children selected for admission to Open-Air Schools are retarded often as much as two or three years.

(v) In addition to arrangements made within the ordinary class or school or the Open-Air School, provision is sometimes made for a separate department or school comparable with a Special School for mentally defective children, but designed for children less retarded. A modified curriculum is followed, the ordinary scholastic work not passing beyond that of say "Standard IV", and special emphasis is laid upon practical work.

(vi) In the rural school comparatively little may be practicable in the way of grouping, but this applies to all the children in attendance whatever their mental attainments. The teacher is obliged to rely largely on individual methods of teaching and this affords a better opportunity of dealing with the retarded child than exists in some of the large classes that are common in urban schools. In one or two places peripatetic teachers have been employed in rural areas to advise the school teachers on methods of individual and group instruction.

[page 96]

109. In previous chapters we have dealt with the nature of mental defect, the provisions of existing laws affecting mentally defective persons, the means provided for dealing with such persons, and the number of children and adults falling within the various categories of mental deficiency. We have also had occasion to call attention to that large group of retarded children who together with the educable mentally defective children form, in our opinion, a single educational unit. It is obvious that these facts form a complicated tangle in which legal, medical, educational, social and administrative difficulties all play their parts, and that the task of sorting them out cannot be an easy one. We believe however that it is possible to extract from all this mass of detail a few clear principles, and to derive from them certain guiding lines of action.

The two fundamental questions to be answered are these: first, what public authorities should be responsible for mental defectives of various grades and ages, and secondly what provision should be made by these authorities. We propose in this chapter to address ourselves to these questions so far as they relate to children and to defer to a later chapter the discussion of these problems in relation to adults. Moreover it will be obvious that, though we shall have occasion to refer to the education of the large marginal group of retarded children, this chapter will be confined so far as allocation of responsibility is concerned to children who are mentally defective within the meaning of the Education or the Mental Deficiency Acts.

110. Broadly speaking, and ignoring some small and exceptional cases, we may say that the general position at present is as follows. There are two main groups of Authorities charged with the duty of dealing with mentally defective children, the Local Education Authorities and the Board of Education working under the Education Acts and the Local Mental Deficiency Authorities and the Board of Control working under the Mental Deficiency Acts. It is the duty of the Local Education Authorities to put the whole child population between the ages of 7 and 16 through a sieve and divide them into three categories: (1) normal children, including those who are merely dull or backward, (2) those who, while unable by reason of mental defect to profit by instruction in the ordinary Public Elementary School, are not unable to profit by instruction in Special Schools, and (3) those who fall below this mental level. The duties of the

[page 97]

Local Education Authority towards these three groups are as follows: to provide for the first group in the ordinary Public Elementary School system; to "certify" each member of the second group and provide for them in Special Schools; to "notify" to the Local Mental Deficiency Authority, the third group and also all those children in Special Schools who when they leave school at 16 seem likely to need institutional care, guardianship or supervision. The Local Education Authority have no further duties towards children who have been so notified, nor have they any further duties towards those falling within the first two groups after they leave school unless they have elected to exercise powers under Section 107 of the Education Act, 1921, in regard to Choice of Employment for young persons up to the age of 18. On the other hand the Local M.D. Authority are concerned with two groups of mentally defective persons: (1) the children between 7 and 16 "notified" to them by the Local Education Authority, (2) defectives under 7 and over 16 who fall under the definitions of the Mental Deficiency Act, 1927. It should also be mentioned that there are in addition a number of mentally defective children who are dealt with by the Poor Law Authorities and some who fall within the province of the Home Office. Their position will be considered later.

111. We have considered with the greatest care whether this allocation of mentally defective children is the best possible and we have come unanimously to the opinion that it is not.

We have already indicated some of the disadvantages of the present system and hope to make clear in the following pages in what way we consider that this system should be modified. Suffice it to say here that we are satisfied that, though much has been achieved for the education and care of defective children under existing statutory provisions and administrative arrangements, these provisions and arrangements have for various reasons deflected attention from some of the most vital problems affecting retarded and mentally defective children, have tended to hinder the wider development of educational provision for them and have to no small extent hampered the actual work in the schools, centres and institutions.

There are of course various possible bases for allocation. In the first place it is at least theoretically possible that all mentally defective children should be regarded as falling within the jurisdiction of the Local M.D. Authorities. This proposal hardly merits consideration. We feel quite confident, for one thing, that no proposal to hand over to these Authorities all the children who are now regarded as suitable for Special Schools would stand any chance of securing public approval, and in any case we do not think that such a proposal is desirable in itself. Many of the children at present in these schools are educable in the real sense of the word and it is clearly to their advantage that they should be left in the care of the Authority which knows best how to provide that education. Moreover it would be wrong to deprive these children of the immense

[page 98]

benefits of association with their fellows and to stigmatise as a class apart children for many of whom the only hope for their future lies in their being trained in childhood and adolescence to regard themselves as members of the general community of normal people. It would involve an expenditure altogether disproportionate to that now being incurred or to what would be required under the scheme we propound later in this chapter; it would in our opinion fail to achieve the main purpose we have in view, namely the fitting of as many mentally defective children as possible for life as useful members of the community; and it would render impossible, for many years to come, by reason of its costliness, the adequate care of those who cannot live independent lives.

112. In the second place, it is possible that all mentally defective children of whatever grade should remain in or be transferred to the care of Local Education Authorities. We shall refer to the arguments advanced in support of this contention presently; but we may say here that this course is also one which we do not recommend for adoption. The Local Education Authorities' primary concern is education and as idiots and lower grade imbeciles at any rate are incapable of profiting from education even in the widest sense of that term, it would in our view be neither advisable nor practicable to make the Local Education Authority responsible for children who must always remain outside the education system.

113. We are forced back, therefore, to the position that mentally defective children must in fact be divided between the two Authorities and the practical question is not whether there should be any division but what that division should be. If this is agreed to, there are two alternatives. The division can either be left as it is, or the boundary line between the children allotted to the two Local Authorities can be shifted in one direction or the other.

114. As a broad general principle we consider that, as at present, Local Education Authorities should be called upon to make provision for all those children who are capable of deriving proper benefit from education in the ordinary acceptation of the term; that is to say, children who can profit from instruction in ordinary school subjects including manual work, such as are taught in the type of school now known as a Special School, and can thus be fitted into the framework of existing educational machinery. On the other hand, children whose mental defectiveness, of whatever nature, is such as to make it impossible to fit them into that framework, children who are not fit to attend a day school or who fail to make any substantial progress in scholastic or manual work, even with a curriculum specially designed to meet their needs, should be transferred to the Local M.D. Authority.

[page 99]

In the following paragraphs we hope to show that our detailed proposals for the application of this board general principle will render it possible to make appropriate provision for the much larger numbers of children for whom it is now seen that provision is required, and at the same time will result in a fairer distribution of the burden between the Authorities concerned.

115. We will deal first with those mentally defective children who fall within the present age limits for attendance at Special Schools, namely, those between seven and sixteen years of age. We shall suggest later a change in the age limits, but the recommendations we make both for the education and training of the children and for their allocation will be unaffected by any such change.

It is now coming to be recognised as a fundamental principle of Elementary Education that there should be a break at about the age of eleven and that all children should at that stage be transferred to some form of post-primary school. We are of opinion that this principle of an educational break at the age of eleven is no less applicable to the subnormal than to the normal child on purely educational grounds, while there are obvious administrative advantages in having a more or less uniform organisation throughout the whole elementary school system. The administrative advantages require no argument, though they will perhaps become more apparent as we proceed to describe our proposals. It may be convenient, however, if we state briefly the reasons for our view that the principle of a break at eleven should be applied on educational and other grounds to the subnormal child.

In the first place, it is found in practice that the mentally defective child under eleven, even where his defect is clearly recognised, can in many cases be fitted into the ordinary Public Elementary School system without detriment to the interests of the other children. A child of ten who is some three or more years retarded mentally and educationally can often be taught, without any serious inconvenience, with children two or three years junior to himself. His defect shows itself mostly in the form of serious retardation rather than in that of social maladjustment. In short, the young feeble-minded child is able to derive appreciable benefit from many of the activities in the junior departments of Public Elementary Schools without interfering with the education of the other children in attendance, whereas such a child when older is frequently a serious source of disturbance and anxiety in the senior department. The second reason, closely related to the last, is that the older the subnormal child becomes the more seriously does he lag behind his fellows. Whereas the mental ratio of normal children remains fairly constant throughout their school life, both our own and previous investigations show that the mental ratio of the mentally defective

[page 100]

child definitely begins to fall about the age of eleven. There is yet another reason which convinces us that the principle of a break at eleven is applicable to the subnormal child. There are obvious difficulties in diagnosing mental deficiency in its milder manifestations in young children and in assessing with accuracy the degree of defect from which a child is suffering. This is well recognised, but its truth is further confirmed by the fact that, for reasons explained in his report, our investigator ascertained a far smaller number of feeble-minded children under than over eleven years of age. The difficulty of determining whether a child of seven, eight, nine or even ten years of age is incapable of deriving benefit from instruction in an ordinary school naturally leads the Local Education Authority to give these children the benefit of the doubt. Most of them are in fact retained in Public Elementary Schools, only those of lower grade being sent to Special Schools. This natural tendency is, in our view, a sound one in principle. We believe that this period between the ages of seven and eleven should be a period of probation and salvage, and that it should be used to give a two-fold opportunity - to the child of showing whether he is capable of responding to the education and influence of the school and whether his continued retention in the educational system is justified, and to the Local Education Authority, the medical officers and the teachers of forming a definite judgment on the question whether a child is really feeble-minded or merely educationally retarded. By the time a child reaches the age of 11 he will have shown his potentialities, and those responsible for him will have been able to assess his mental ability. There is thus strong ground for dealing on somewhat different lines with children under and with those over 11 years of age.

Let us now consider on what basis the responsibility for the training and education of the younger and older mentally defective children respectively should be allocated between the two Authorities concerned.

116. The Local M.D. Authority have (subject to certain minor exceptions), no powers or duties with regard to a child over 7 unless his name has been notified to them by the Local Education Authority, and the primary responsibility for dealing with all mentally defective children over 7 rests therefore with the Local Education Authority. We consider that, subject to the exceptions mentioned in the next paragraph, all children up to the age of 11, when the period of primary education ends, should remain in the sphere of the Local Education Authority.

There will of course be certain children who cannot properly attend a day school, such as Idiots who cannot guard themselves against common dangers, children who are restless and uncontrollable and whose attention to school work cannot be secured, children who are persistently wet and dirty, those who are detrimental

[page 101]

to others, those who have vicious or immoral habits. There will, moreover, be some children who, though fit so far as educational capacity is concerned to attend a day school, live in places too remote to enable them to reach a suitable school and also those whose home circumstances are such as to render it advisable to send them to a Residential School. The case of these groups of children will be considered later.*

All the other mentally defective children however between 7 and 11, that is to say all who can attend a day school and whose presence there would not be detrimental to the interests of the other children, and all who are thought likely to prove capable of deriving appreciable benefit from school training and instruction, should in our view be kept with their fellows in the general education system, and should be given the opportunity which the day school environment provides of developing such potentialities as they possess. This period spent within the elementary education system, whether in ordinary infants or junior departments, or, in the larger centres of population, in special classes for retarded children, conducted on modern individual methods or in schools similar to existing Special Schools for younger children, will enable them to be kept under the observation of teachers and doctors who will thus have every opportunity of forming an accurate estimate of each child's intelligence and educational capacity by the time he attains the age of 11. It is of course assumed that Local Education Authorities will so far as practicable provide the specialised forms of education that retarded children require and will keep these children under closer supervision, both medical and educational, than is provided for normal children.

117. There will still however be some children who, though capable of attending a Day School without detriment to the other children and with some prospect of profit for themselves, are yet ineducable in the broad sense of the term. These children whom we describe as "ineducable" will not be capable of profiting from ordinary school instruction in reading, writing and arithmetic, or even in manual work, though they will doubtless derive benefit from other sides of school life-association with other children of their age, training in social habits, learning to look after themselves and adjust themselves to some extent to their surroundings. It may be contended that these are matters which fall outside the sphere of the Local Education Authority, and that it is inequitable to expect that Authority to make provision for these children who, ex hypothesi, cannot benefit from education as ordinarily understood. We think there is much force in this contention, and we accordingly recommend that these "ineducable" children and also those children who, though not ineducable, are in immediate need of care and control, should be notified to the Local M.D. Authority as soon

*See paras. 131-134.

[page 102]

as it can be said that they are ineducable or in immediate need of care and control. We further recommend that the Local M.D. Authority should have the financial responsibility for all children so notified and moreover that it should be the duty of that authority to provide such care and supervision as may be required for these children out of school hours. At the same time we recommend that it should be the duty of the Local Education Authority, in return for payment by the Local M.D. Authority, to provide facilities for the training and instruction of these children, in such a way as, having regard to local circumstances, may best meet their needs.

118. On the face of it these recommendations may appear to be paradoxical. How, it may be asked, can an "ineducable" child be educated? Why should the Local Education Authority whose function is to provide education be charged with duties towards children who cannot benefit from education and therefore fall outside their sphere? Why not hand these children over entirely to the Local M.D. Authority if all they need is care, supervision or control? What justification is there for dividing the responsibility in this way between the two Authorities? A brief answer to these objections is that these children, though ineducable in a broad sense, can benefit to some extent from certain sides of school life, such as training in social habits and in the simplest forms of manual work; that their numbers are so small as to render separate provision for them uneconomical if not impossible; and that their retention in the schools (whenever possible in suitably graded classes with a modified curriculum) appears to us to be the only practicable way of dealing with them, at all events in most areas. For while we are aiming first and foremost at securing what is best for the child, we have not lost, and must not lose, sight of practical considerations. The Local M.D. Authorities have made little provision hitherto by way of Occupation Centres or otherwise for very young children who do not require institutional care, and though the Act of 1927 (Section 7 (2) (i)) gives them power "to provide suitable training or occupation for defectives who are under supervision or guardianship", we believe that the provision of such facilities for young children by these Authorities would be a matter of great difficulty in all parts of the country, and particularly in sparsely populated districts, and that at the best many years must elapse before any general network of centres for young children could be set up even in many of the larger urban areas. Further, such provision by the Local M.D. Authority would in many cases necessitate the appointment of special staffs - Medical Officers, Attendance Officers, instructors or teacher attendants, and clerical staff - and would result to some extent in duplication of buildings, whereas the Local Education Authority already have on their staffs officers of these types, and in many cases also possess buildings suitable for the purpose. The Local M.D. Authority in fact would have to create a fresh organisation, while the Local Education Authority would

[page 103]

merely have to utilise, and in some cases develop, their existing machinery. We contemplate that in the largest towns, where the numbers of these children justify it, provision on the lines of existing Occupation Centres would be made for them by the Local Education Authority in separate premises. In the medium sized towns and in urban areas generally the Local Education Authority would have relatively little difficulty, either by means of additional classes or centres, in fitting the younger children of this type in to their existing elementary school system, which includes what are now called Special Schools.

119. In the more sparsely populated areas it is and always will be difficult to provide separate schools or classes for retarded children of any grade, and it will sometimes be found that the lower grade children cannot be fitted into any type of Day School or Centre which the Local Education Authority can provide. These children will accordingly fall into the category referred to above of those "who cannot properly attend a Day School", but must be sent to a Residential Institution and, since they will in any case have been notified to the Local M.D. Authority, the full responsibility, financial and other, for making provision for them should rest with that Authority. Their numbers will however be relatively small, for it must be borne in mind that in small schools in which children of all ages with widely varying degrees of educational capacity are under the charge of a single teacher possibly with one assistant, the educational methods adopted are necessarily largely individual and the conditions are pro tanto [to that extent] more favourable to the retarded child; for where individual methods of education are followed, mere backwardness, even though serious, in educational ability becomes less of a barrier.

We do not of course suggest that children of vicious or objectionable habits, whose presence would be detrimental to the interests of the other children, should be retained in the day schools, but rather that the rural school can often provide reasonably satisfactorily for the quiet, well-behaved, younger lower grade children.

120. The ordinary Public Elementary Schools are now in general organised in departments for infants, for junior and for senior children, and it is as already stated becoming the general practice to transfer children from the junior schools or departments to secondary, central or other post-primary schools between the ages of 11 and 12. It appears to us that the machinery employed for selecting children at this age for admission to the several types of post-primary school could well be utilised with but little adaptation and with the addition of a special examination, in which specially qualified teachers or inspectors and, wherever practicable, an educational psychologist should be associated, for sifting out the various grades of retarded children and assigning them to the types of school or class best suited to their individual capacities.

[page 104]

We understand that in some areas the practice has been adopted in connection with the examination at the age of 11+, of subjecting the children to some form of group test and in the case of some schools of measuring each child's intelligence by means of one of the recognised forms of individual Intelligence Tests. An extension of this practice would in our opinion prove of value in determining to what type of post-primary school each child, whether normal or subnormal, should proceed. As a result of this general or special examination Authorities would be able to select the most seriously retarded children and those who exhibited marked abnormalities of character or temperament for examination by a specially appointed Medical Officer, whose duty it would be to decide which of them should be certified as mentally defective with a view to their notification to the Local M.D. Authority and which of them should remain, at all events for a further period, within the province of the Local Education Authority. This occasion should moreover be utilised for a special medical examination by the School Medical Officer in regard to the physical condition of these retarded children, who should in any case be kept under regular medical supervision such as now obtains in Special Schools. We suggest therefore that the principal general survey of retarded and mentally defective children should normally be held at this stage in their school life.

121. On the results of the general examination at the age of 11+ the brightest children attending Public Elementary Schools are selected for admission to secondary schools, or to selective senior schools in areas where these exist (e.g. the London and Manchester Central Schools). The organisation of senior schools differs from area to area, but in areas where the non-selective type of senior school is adopted and all older children are transferred to these, the curriculum is necessarily modified to meet the particular needs of the various types and grades of children in attendance, including those who are commonly described as dull or backward. We anticipate that Local Education Authorities will, as the organisation of post-primary education develops, be necessarily led to make more comprehensive provision for retarded children as a whole, and we recommend that in making this provision they should consider the needs of that group of children who are now certified as mentally defective under the Education Act. In some areas this provision will take the form of schools for older mentally defective boys and girls, such as exist already in London and elsewhere; in other areas provision will be made as already indicated in ordinary senior schools, differentiating between the needs of the brightest children not transferred to secondary schools, the children of average ability, and the dullest children, whose needs will best be met by more definitely vocational training. Whatever organisation be adopted, we believe that it will be found practicable, and that it will be in the best interests of the children, to include within the general system of post-primary education

[page 105]

the great bulk of the higher grade mentally defective children, and to regard what are now described as Special Schools for older children as particular types of central or senior school.

122. In the case of certain of these older children however, as in the case of those under 11 years of age, we do not consider that the Local Education Authority should be called upon to bear the cost of providing the education and training. We recommend therefore that those children in whose case it is apparent that they have failed to derive appreciable benefit from instruction at school, that is to say to make any substantial progress in scholastic or manual work, up to the age of 11+, and that they will eventually require care and control under the Mental Deficiency Act, should be notified at this stage to the Local M.D. Authority, and that the full responsibility for providing for their care, education and training should thereafter rest with that Authority and not with the Local Education Authority. By this means continuity of control will be secured during the later years of childhood, throughout the period of adolescence and so on into adult life. Moreover notification at this age will have the advantage of enabling the Local M.D. Authority to take steps to see that those children who later on will require institutional treatment shall receive during adolescence the type of training that will best fit them to become useful members of the community in which they will find themselves in later life; it is of course assumed that this Authority would be given power to compel the attendance of notified children, not requiring institutional treatment, whatever their age, at suitable Day Schools, Occupation or Training Centres.

123. Difficulties in carrying the Committee's proposal to its logical conclusion. Now the strictly logical outcome of the scheme we propose would be that the Local M.D. Authority should establish a complete system of Day Training and Occupation Centres for all the older children who have been notified to them, other than those who require institutional care, and that the Local Education Authority should no longer be concerned with these children in any way. In some areas no doubt our scheme, if adopted, can and will be followed out to its logical conclusion, and the Local M.D. Authority will set up centres for the training and occupation of children from 11 years of age and upwards under the powers conferred on them by Section 7 (2) (i) of the Mental Deficiency Act, 1927. We believe that this course is likely to be adopted in urban areas where the numbers of suitable children are large and where a system of handicraft centres for the older defectives will in any case have to be established. But we cannot shut our eyes to the fact that in many of the smaller urban areas and in most rural areas the numbers* of older, lower grade notified defectives will be too small

*The question of numbers is fully discussed in Chapter VIII and in Appendix I.

[page 106]

to admit of the possibility of providing separate Occupation Centres for them, or, even if such provision were possible, to justify the heavy expenditure on staffs, buildings and administration that would be involved. The only alternative method by which the Local M.D. Authority could themselves deal with these children in all but the larger urban areas would be by the provision of institutional accommodation. In view of the serious existing shortage of residential accommodation for those cases which are in urgent need of institutional care, and further of the large numbers of older children who in any case fall to be dealt with by the Local M.D. Authority, the cost of making institutional provision for all those for whom day centres could not be provided would be prohibitive.

124. Objections to the Scheme. If this view is correct why, it may be contended, should not the recommendation made in the case of the younger notified children, namely, that it should be the Local Education Authority's duty to provide for their training, apply also to these older children? Some of our members are of opinion that this contention is sound and that all the arguments used in support of the proposal that the Local Education Authority should be required to provide educational or training facilities for all the younger children capable of attending a day school or centre in return for payment by the Local M.D. Authority have equal force in regard to children over 11 or 12 years of age. They urge that the provision hitherto made by a few Local M.D. Authorities and now required by Section 7 of the Act of 1927 for the training or occupation at Day Centres of defectives under supervision or guardianship had better be confined to adolescents and adults and that it should not apply to children under 15 or 16 years of age because this would involve the creation of entirely new machinery. The Local M.D. Authority would either have to set up separate staffs of School Attendance Officers and teachers or teacher attendants or to utilise those employed by the Local Education Authority, and they would have to establish a complete system of school provision and management (including arrangements to perform the work done by Sites and Buildings, Health and Staffing Committees and the appointment of medical officers, nurses, dentists and architects) or alternatively to make use of the organisation already established by the Local Education Authority. Duplication of organisation and staff would be uneconomical and the use by one Committee of the Council or by one Authority of the organisation and staff of another Committee or Authority would at the best be cumbersome and at the worst would lead to friction and difficulty. Moreover they feel that when Local Education Authorities had undertaken to provide for children under eleven, it would be found that, not only in the more sparsely populated districts but even in the large urban areas, the numbers of defectives falling within the province of the Local M.D. Authority would be insufficient to justify the establishment of separate

[page 107]

administrative and training arrangements by that Authority and so small that their inclusion in the Local Education Authority's educational system could create no difficulty.

Those who hold this view further point out that all mentally defective children of whatever grade or age require education and training according to their capacity and that, apart from the lowest grade children who cannot guard themselves against common physical dangers and such others as require institutional care, the majority must receive that education or training at some sort of Day School or Centre. They contend that it is impossible to draw a satisfactory line at the age of eleven and therefore that one Authority should provide for all children capable of receiving benefit from any form of Day School, Class or Centre until they have reached the ordinary school leaving age. They think that if the duty of providing training for these children is transferred from one Committee or Authority to another half-way through their school career great administrative difficulties will arise. In the first place, since the decision to transfer a particular child will be based upon the opinion and diagnosis of an individual Medical Officer, it is considered unlikely that any uniformity of standard will be attained, and the Medical Officer of the Local M.D. Authority may disagree with the standard adopted by the Local Education Authority's officer. This it is urged will inevitably lead to friction between the two Authorities. In the second place, the lack of uniformity will make it difficult, if not impossible, for either Committee to forecast how much provision it will have to make, how many children will fall to be retained in the Local Education Authority's schools, and how many will have to be dealt with by the Local M.D. Authority. They argue that as some form of Day School, Class or Centre is needed for all, no practical or scientific line of demarcation can be drawn. One Authority should therefore provide for all these children and that Authority should be the Local Education Authority. Such an arrangement they consider would not only be possible but would prove more economical and efficient than any scheme of divided authority during school age.

These members believe that once it is made clear that the duty of providing for the education and training of all defective children who can attend a Day School or Occupation or Training Centre, rests with the Local Education Authority, there would be no more difficulty in framing satisfactory schemes to meet the needs of those over than of those under eleven years of age. They further contend that the Local Education Authority's experience fits them to deal with Day Schools more efficiently than the Local M.D. Authority and that, thanks to the training and influence of the Local Education Authority's experienced teachers, it will in many cases be found unnecessary to send to institutions defectives of eleven years and older who would otherwise have required institutional care. They believe therefore that the only clear line of demarcation between

[page 108]

the two Authorities is (1) that those who can profitably attend a Day School or Centre should remain under the Local Education Authority; and (2) that those who require institutional care and training should fall to be dealt with by the Local M.D. Authority.

125. The answer to these objections. Though due weight must undoubtedly be attached to these arguments, and though it is quite possible that in theory the retention by the Local Education Authority of full responsibility, other than financial, for all children of school age who are capable of attending a Day School, Class or Centre, would have considerable advantages, the large majority of the Committee would not be prepared to recommend the imposition on the Local Education Authority of a duty to provide training facilities for older lower grade children.

In the first place, there is in the opinion of most of the members, a real difference between fitting the younger lower grade children into the system of elementary schools and dealing in that system with the older children of similar grade. The former can, in large measure, be absorbed in the existing types of schools and classes for retarded children; a defective child of 9 or 10 who is 3 or 4 years retarded can, as already stated, be kept with younger normal or retarded children of approximately the same mental age and can be dealt with in junior schools or departments or in schools such as those now known as Special Schools for younger mentally defective children, where these have been established. With the older children no such arrangement would be possible, since the post-primary or senior schools for retarded children would contain but few children with a mental age of under seven, and it would wherever practicable, be necessary for the Local Education Authority to make special provision distinct from any form of school hitherto conducted by those Authorities, on the lines of existing Occupation or Training Centres, for the lower grade notified children.

In the second place it should be pointed out that, under the Mental Deficiency Act of 1913, there have been set up in all Counties and County Boroughs, statutory Authorities who are charged with the duty of providing for the care and control of all defectives who are subject to be dealt with under that Act, whether they be children or adults, and whether they require institutional treatment or can be dealt with by way of guardianship or supervision. Further, Parliament has by Section 7 of the Mental Deficiency Act of 1927 expressly made it the duty of those Authorities "to provide suitable training or occupation for defectives who are under supervision or guardianship or have been sent to institutions", and this duty is not in any way limited to older defectives, but clearly applies as much to those of school age as to adolescents and adults. In the case of the younger children we have seen that practical considerations render desirable some modification in the administrative methods by which the training is to be provided, though even in their case the responsibility should, in our opinion, remain with the Local M.D.

[page 109]

Authorities. To suggest that these Authorities should be relieved of the duty of providing suitable training for the older defective children would be to make a much more serious - and in our opinion quite unjustifiable - inroad on the duties of these Authorities as recently laid down by Parliament.

In the third place, the majority of the Committee do not believe that the bodies most closely concerned - the Local Education and the Local M.D. Authorities - would regard such a proposal as sound or equitable. Some of the former might object to being saddled with a responsibility which should not be theirs, and some of the latter might resent being deprived of the power and opportunity of dealing as they thought best with those children for whose care and control they are by statute responsible. It is obviously important that Local M.D. Authorities should have some effective control over the training in the latter years of their childhood of defectives for whom they will in any case have to provide as adolescents and adults.

126. After giving the most careful consideration to the whole problem, the large majority of the Committee have come to the conclusion that it would be in the best interests of the children, most consistent with public policy and most conducive to national economy, to allow considerable latitude of organisation and administration. They accordingly recommend that while the Local M.D. Authority should retain the full responsibility for providing for the care, training and control of children who have been notified to them at or after the age of 11 as having failed to derive appreciable benefit from instruction in schools (including the type of schools now known as Special Schools), and as being in need of care under the Mental Deficiency Acts, the Local Education Authority should be given the power, but not the duty, of providing facilities for their training in return for payment by the Local M.D. Authority. They believe that this scheme will provide an elasticity which would not be possible in any other arrangement; that it will result in a fair distribution of the financial burden so far as Local Authorities are concerned; and that it will enable the necessary training to be provided at a lower total cost, both to the rates and to the Exchequer, than would be involved if this provision had to be made exclusively by one Authority.

127. As indicated above, it is contemplated that in some of the larger urban areas the Local M.D. Authority will themselves set up Training and Occupation Centres for these children under the powers conferred on them by Section 7 of the Act of 1927. Where this is done it may prove the most convenient course for the Local M.D. Authority to allow a few of the most defective of the children who still remain under the Local Education Authority to attend these centres in return for payment by the latter Authority. In the majority of

[page 110]

areas, however, it is believed that the best and most practical course will be for the Local Education Authority to provide for the training of the lower grade defectives over 11, in return for payment by the Local M.D. Authority, whether by setting up separate centres with a system of training and a staff appropriate to the children's needs, or where this is not practicable by absorbing some of the lower grade children (provided their presence would not be detrimental to the interests of the other children) in the schools and classes established by them for higher grade defective and for retarded children. There is every reason to anticipate that in large numbers of areas the Local Education Authority, having already provided for the lower grade children up to the age of 11, will be willing to continue the provision after that age. It is assumed that the Local M.D. Authority would have the right of access to any school, class or centre, provided by the Local Education Authority, where lower grade children were being taught or trained and that similar facilities would be afforded to the Local Education Authority to visit centres provided by the other Authority and attended by children for whom the Local Education Authority were still responsible.

Whatever arrangement may be adopted in a particular area, the majority of the Committee feel sure that a system which leaves it to the responsible Authorities to determine by mutual agreement in what way the provision can best be made, having regard to the particular circumstances of the area, will in the long run prove to work smoothly and will undoubtedly be more economical than any other system.

128. Notification of children over the age of 11 to the Local M.D. Authority. It is clear that certain children who are regarded at the age of 11 or 12 as fit to remain in the educational system and within the sphere of the Local Education Authority may subsequently exhibit or develop tendencies which render their continued retention in school undesirable or their transfer to a certified institution essential. While, therefore, we recommend that the principal general survey of retarded and defective children should be held between the ages of 11 and 12, we consider that Local Education Authorities should keep under their observation those retarded children for whom they remain responsible, with a view to notifying to the Local M.D. Authority any child who is in need of care or control under the Mental Deficiency Acts, or whose presence in the schools is detrimental to the interests of the other children. It should be open to the Local Education Authority to notify such children at any period throughout their school career, and Authorities should take adequate steps to see that no child who is in need of statutory care or control passes out of their hands on leaving school, without provision having been made to secure his supervision by notification to the Local M.D. Authority. Where a child is notified as a result of the general survey or subsequently, the responsibility for dealing with him thereafter should rest wholly with the Local

[page 111]

M.D. Authority, though, as suggested above, the Education Authority should have power to provide for his education or training in return for payment by that Authority.

129. We have, so far, confined our discussion to those children who fall within the present age limits for compulsory attendance at Special Schools; that is, children between 7 and 16. We see no reason however why any differentiation should be made in this respect between the children with whom we are now concerned and less retarded and normal children. It is true that mental defect, except in the case of lower grade children, is difficult to diagnose and is often not recognised before the age of 7, and it is also true that many mentally defective children gain much during their last year at Special Schools. But we understand from recent pronouncements by the Board of Education that it is probable that within the near future the upper age-limit of compulsory attendance at ordinary Public Elementary Schools will be raised throughout the country from 14 to 15, and we suggest that the same age limits, broadly 5-15, should apply also in the case of mentally defective children (whether attending Day or Residential Schools) who will then have the same limits of school age as normal children.

130. As regards the upper limit, we are not convinced that the reasons for retaining mentally defective children in Special Schools up to 16 are sufficiently strong to counterbalance the disadvantages of differentiating in this respect between them and other retarded children, provided that the safeguard we have suggested earlier is observed, namely, that no child who is in need of statutory care, supervision, or control passes out of the sphere of the Local Education Authority without being notified to the Local M.D. Authority. At the same time we fully realise that much of the best trade and character training in Special Schools is given during the last few years of school life, and we would strongly deprecate any proposal to allow seriously retarded children to leave school at the end of the term in which they attain the age of 14. If the school leaving age is raised generally to 15, we should not consider it necessary or desirable to compel mentally defective children to remain at school any longer than other children, though their continued attendance up to 16 should certainly be allowed, and, when necessary, encouraged. The retention at school of defective children up to 15 is an integral part of our whole scheme, without which it would fail in its object of securing balance and stability in the child of the type who now attends Special Schools for elder boys and girls. We do not, however, anticipate that any difficulty need arise in this connection, since as stated above there is a prospect of the age for leaving Public Elementary Schools being raised to 15 in the comparatively near future, and we assume that this raising of the age will apply to all types of post-primary school.

[page 112]

131. We have so far been concerned only with those children who can attend a day school or centre. We will now turn to those who, for whatever reason, require residential care. These children fall broadly into two groups.

First, there are the children of very low grade, those whose presence would seriously interfere with the education or training of the other children, those who are in moral danger, children guilty of repeated delinquency, those suffering from temperamental abnormalities - in a word children who are in need of care or control under the Mental Deficiency Acts and cannot receive the care they require except in certified institutions. The second group will consist of those of medium or even of high grade who, because there is no suitable Day School or Centre within reach of their home, have to be sent to a Residential School if they are to receive any education, those who have no homes of their own and for whom no suitable arrangement for guardianship or boarding-out can be made, and those living in unsatisfactory homes exposed to bad influences and inadequately controlled by their parents. The first group are in the main personally unfitted for Day School education; the second group for external reasons cannot be taught in Day Schools. The former will naturally fall to the Local M.D. Authority to deal with and the latter to the Local Education Authority.

132. Inasmuch, however, as the large majority of these children will be likely to require colony care and training for some time after they have ceased to be of school age and as the majority of them will have to be notified to the Local M.D. Authority as being in need of care and control under the Mental Deficiency Acts, we recommend that the responsibility for providing such residential or institutional accommodation as may be required should rest with the Local M.D. Authority, who already possess the organisation and machinery for, and in many cases have experience in, conducting these institutions.

Some of these children however will have been notified on social rather than on educational grounds, and will be of sufficiently high grade to be capable of deriving benefit from suitable forms of education; and it will therefore devolve on the Local M.D. Authority to adapt the organisation and curriculum of the Residential Institutions to the varying grades of defectives accommodated. If, as is now generally the case, the institutions are conducted on these lines and provide suitable forms of education and training, there is no reason why they should not receive in addition to notified children others who have not been notified as being in need of care and control under the Mental Deficiency Act. Indeed, many of the best Residential Institutions have for years past received children both from the Local Education

[page 113]

Authority and from the Local M.D. Authority without encountering any difficulty in organisation and administration or any opposition on the part of parents or guardians. To meet the case of this last group of non-notified children who will for the most part be those living in rural areas, we suggest that Local Education Authorities should be empowered to send to these institutions children for whom they are responsible, but for whom they consider that residential treatment is essential, and that the Local M.D. Authority should be empowered to receive these children into their institutions in return for payment by the Local Education Authority.

Though, for the reasons stated above, we believe that, in practice, Boarding Schools for feeble-minded children will usually rightly form part of the provision of a colony, there may well be a place also for provision by a Local Education Authority, or a combination of Local Education Authorities, of boarding schools for higher grade children for whom it seems improbable that colony life will eventually be required. On educational, social and other grounds there can be no doubt as to the benefit many of these high grade children would receive if afforded the opportunity of attendance at a boarding school, especially those from the most sparsely populated areas where the provision of suitable facilities for day school education are in large measure impracticable.

133. There are, of course, also a number of voluntary residential schools and institutions, some certified by the Board of Control, some by the Board of Education and some by both Departments. These last admit defectives under both the Mental Deficiency and Education Acts. We hope that these schools and institutions will continue to carry on the valuable work they are doing for the various types and grades of defectives, and we see no reason why they should not continue to admit children falling within the purview of either or both Authorities, though in so far as they cater for children for whom the Local Education Authority are responsible, they will cease to be certified* by the Board of Education as Special Schools and will be recognised by that Department as voluntary Boarding Schools for certain types of retarded children. All Residential Schools or Institutions which admit children under both Acts should continue to be open to inspection by both Departments.

Whatever form the boarding school provision may take the general principles of educational organisation that we have advocated in the case of day schools should be observed. There should be proper classification of the children, the lower grade being taught separately from the higher, there should be a definite educational break at the age of 11 and the normal age for compulsory school attendance should extend from 5 to 15. The fact that the school or institution will usually contain both high and low grade children should not imply that these two groups should be

*See para. 139.

[page 114]

trained or taught together or be in any way associated in their daily life; on the other hand full advantage should be taken of the fact that the school forms part of a Colony and full use made for the benefit of the higher grade children of the facilities - craftsmen, workshops, gardens, farm land, etc. - possessed by the colony for the training of older and lower grade defectives.

134. Need of residential treatment in itself no reason for notification. The standards upon which it should be determined whether the responsibility for a child, whether under or over 11 years of age, should rest with the Local Education Authority or be transferred to the Local M.D. Authority, are fully discussed in the following chapter. We need only add here that we consider that the same standards for notification should hold good whether the child attends a Day School or is sent to a Residential Institution, and that the liability of a child for notification should be unaffected by the fact that there is or is not a day school which he could attend. A child who could properly attend a day school, if there were one within reasonable distance of his home, should remain within the purview of the Local Education Authority who, in the absence of such a day school, would have the responsibility of sending him to a suitable residential school or institution. The cost of providing for his education and maintenance would rest with the Local Education Authority, whether the child attended a boarding school provided by that Authority or by some other Local Education Authority, or a residential school or institution provided by a Local M.D. Authority or by a voluntary body. On the other hand the cost of providing for the maintenance, education and training of all notified children at residential institutions would fall on the Local M.D. Authority.

Moreover since residential institutions should, we believe, normally be provided by the Mental Deficiency Authority, our recommendation that Local Education Authorities should have the duty of providing facilities for the training of notified children under 11 in day schools or centres should not apply to those requiring institutional care, and we do not consider that these Authorities should have any duty to make residential provision for notified children whether over or under 11 years of age, though we see no reason why they should not, if so requested, admit suitable notified children to boarding schools provided by them in return for payment by the Local M.D. Authority.

135. The Local Education Authority for Elementary Education are required, broadly speaking, to provide for the education of all children over 5 years of age. Younger children are admitted to Public Elementary Schools in many areas, but we may take it that the normal age of admission to these schools is about 5 years, which is the age at which compulsory school attendance begins.

[page 115]

The responsibility for the education of those retarded children between the ages of 5 and 7, who can be taught In ordinary Public Elementary Schools, rests with the Local Education Authority, but this Authority have at present no duty to make provision for the education of a mentally defective child in a Special School, and no power to notify a child to the Local M.D. Authority, until it has attained the age of 7. Similarly parents of mentally defective children are under no obligation to send their children to such a school until that age.

The Local M.D. Authority are responsible for children under the age of 7 who are defective within the meaning of the Mental Deficiency Acts and are subject to be dealt with under those Acts, though for various reasons it may be assumed that the majority of the children under 7 for whom these Authorities make provision are the very low grade children, that is those who can be certified as idiots and possibly a few of those who, though of slightly higher grade, have been definitely diagnosed at this early stage as imbeciles.

136. We do not wish to suggest any general modification in the allocation of responsibility for these younger children as between the two Authorities, but as already indicated we propose that the age at which a parent should be required to cause his child to receive efficient elementary instruction, and a Local Education Authority should be under an obligation to provide that instruction, should be the same for all children, whether it be the age of 5, or such other age as may be provided for under local bye-laws or otherwise. As a corollary of this, we consider that it should be open to the Local Education Authority to notify to the Local M.D. Authority any mentally defective children who have attained the age at which they are required to attend school, provided that it is clear that the children are in immediate need of care and control under the Mental Deficiency Acts. In practice the number of children to be notified under the age of 7 will no doubt be extremely small; they will be confined for the most part to those who can be described as idiots or low-grade imbeciles, and to those who show marked emotional instability and will include few, if any, children other than those who under the present law become subject to be dealt with under those Acts. Small though the numbers may be however we think it desirable that the responsibility for notifying these children should be placed upon the Authority which provides for the education of all young children, and thus has facilities not possessed by the Local M.D. Authorities for discovering which of these children are in real and urgent need of the protection afforded by the Mental Deficiency Acts. If and so far as a child thus notified is able to consort with other children and to attend a day school or class for infants, the provision for its education should be made by the Local Education Authority, though the Local M.D. Authority would be responsible for its supervision and care, and, as we have already recommended in the case of children over 7, should repay

[page 116]

to the Education Authority the cost of its education. Many of these children however will require institutional care and will thus fall wholly within the province of the Local M.D. Authority.

137. We would, further, suggest that the Maternity and Child Welfare Authority, who are in the main responsible for the care of children not yet admitted to school should be encouraged to utilise the facilities they possess for ascertaining such of these children as appear to be mentally defective and for bringing their names to the notice of the Local Education or M.D. Authority. The Local Education Authority will then be in a position to cause each of these children to be medically examined as soon as it reaches the age for admission to school, with a view to considering whether it requires special educational provision or is suitable for notification; and the Local M.D. Authority will be afforded an opportunity of considering whether any of these children are defective within the meaning of the Mental Deficiency Acts and are in immediate need of care and control under those Acts. Some such general arrangements for co-operation between the several Authorities concerned will go far to fill the gap which now exists owing to the Local M.D. Authorities' lack of effective power or machinery for the ascertainment of very young defectives.

There remain some questions of administration and procedure to be discussed.

138. Under the present law it is the duty of the Local Education Authority to "ascertain" and to "certify" all mentally defective children in their area, and no child can be sent to a Special School unless he has been "certified" as mentally defective. It is notorious that this "certificate" has been the cause of much heart-searching in the past. It is greatly resented by some parents and may form a handicap to the child when it leaves the Special School and tries to resume a normal life. There is reason to believe that in some areas Local Education Authorities and their Certifying Officers have refrained from certifying mentally defective children solely on the ground of the supposed hardship caused by the certificate. The child in such a case is deprived of the training in the Special School which it badly needs, because the responsible Authority feels that this deprivation is a lesser hardship than certification. This is a really serious objection to the present arrangements and one which in any case calls for early redress.

139. It will of course be said at once that if the Section in the Education Act which requires the certificate to be given be repealed, the Local Education Authority will have no power either to compel a

[page 117]

mentally defective child to attend a Special School or to enforce its attendance up to the age of 16. Does this, it will be asked, mean the abolition of Special Schools? Certainly not. We are much too impressed with the admirable work of the Special Schools to countenance any recommendations that would interfere with their development. We should expect that, were the policy we recommend for the classification of all retarded* children in a single educational unit adopted, the substance of the Special Schools would remain intact while their numbers and scope would materially increase. We do however contemplate that these schools would exist with a different legal sanction, under a different system of nomenclature and under different administrative provisions. If the majority of the children for whom these schools for retarded children are intended are, ex hypothesi, to lead the lives of ordinary citizens, with no shadow of a "certificate" and all that it implies to handicap their careers, the schools must be brought into closer relation with the Public Elementary School system and presented to parents not as something both distinct and humiliating, but as a helpful variation of the ordinary school. There has no doubt existed in the past an unwillingness to mix children suffering from the different degrees of retardation, not solely because it was thought inadvisable to teach them together, but mainly because it was considered unfair to children who were only dull or backward to compel them to associate with children who had been formally certified and were officially labelled as feeble-minded. These objections would to some extent disappear if the necessity of certification were removed. The Special School or Class, retaining all its beneficent activities, its specialised methods of individual approach to children with varying degrees of mental retardation or defect, its elastic and varied curriculum, its freedom from examination, would continue under a new name as a particular type of Public Elementary School, offering educational opportunities to all children unable to derive full benefit from the education provided in the ordinary schools, using this expression in a wider sense than that which it bears in the Education Act. So far from this resulting in the abolition of the Special School in the true sense of the term, that is to say a school in which special methods of education are employed suitable to the needs of particular children or groups of children, it necessarily follows from our recommendations that the numbers of schools and classes of this type and the numbers of children attending them will largely increase. The grouping of the children would no longer depend upon their certification or non-certification, but would be based solely on their innate capacity and

*In this term we include not only those children now known as dull or backward, but also many, if not most, of those who are now certifiable as mentally defective under Section 55 of the Education Act, 1921, or as feeble-minded under Section 1 of the Mental Deficiency Act, 1927, and we exclude only those feeble-minded and lower grade children who are notifiable to the Local M.D. Authority.

[page 118]

educational attainments. There might well be - particularly in large towns - various grades of schools for retarded children; in some areas the Special Schools might continue in the main as at present, in others they might develop into separate schools or classes for older or younger, less or more retarded children. In areas where no Special Schools or classes for retarded children exist the mere fact that there would no longer be the barrier of the certificate separating one group of retarded children from another would often make it possible to start classes for them all. In any case there would be far greater elasticity; each child would have a better chance of obtaining the type of education best suited to its needs, and the more retarded child would have the opportunity of associating with other children of its own age in some sides of school life and some forms of work while receiving special instruction in other subjects.

Under such a scheme there should be no difficulty in allotting retarded children to their appropriate classes, nor as we shall endeavour to show below* in securing their attendance at them by means of the ordinary procedure for making children go to school, particularly when it is remembered that in future the age limit for compulsory attendance at school will, if our recommendations are adopted, be the same for all children whether normal or retarded.

140. In order to secure the elasticity that we consider essential and to make it easier for Local Education Authorities to provide every child with the particular type or grade of education best suited to its needs we recommend

(i) that Local Education Authorities should be relieved of the duty of "ascertaining" and "certifying" children as mentally defective so far as such ascertainment and certification merely serve as a necessary preliminary to providing these children with the type of education they require; and

(ii) that the Board of Education should no longer "certify" as Special Schools the schools in which that education is given.

*Paragraph 141.

[page 119]

continuous medical supervision, such as now obtains in the case of children attending Special Schools, will not be diminished and may well be enhanced by our proposal.

Moreover, the Local Education Authority will still be responsible for the notification to the Local M.D. Authority of children who are defective within the meaning of the Mental Deficiency Acts. The abolition of certification for the purposes of Section 55 of the Education Act, 1921, will go far to remove the ambiguity, to which we have referred in Chapter III,* between the conception of "mentally defective" under the Education Act and "feeble-minded" as applied to children under the Mental Deficiency Acts. Even so however some obscurity will still remain in Section I (c) of the Mental Deficiency Act, 1927, and in order to remove this we recommend that the Section should be so amended as to make it clear that the criteria applicable to feeble-minded adults apply also to feeble-minded children, that is to say, that by reason of mental defect they are in need of care, supervision and control.

141. If the certification of children for the purposes of the Education Act be abolished, how, it may be asked, will it be possible to enforce the attendance of what are now described as mentally defective children at the particular schools which are best suited to their needs? This question we have considered with great care. If, as we have suggested above, Local Education Authorities are already tending to make increased and better provision for retarded children as a whole and if, as we recommend, this practice is universally adopted, we have very little doubt that most parents will be only too ready to avail themselves of the opportunity of securing the most appropriate education for their children. There is little or no difficulty in securing the attendance of the brighter children at Secondary or selective senior schools, because parents realise that these schools provide just the kind of education they wish their children to obtain. We believe that if education for retarded children is generally organised, as it is already in some areas, in such a way as to make parents realise its value and appreciate its results, there will be no need of compulsory powers except for isolated cases. We should greatly prefer to see compulsion abolished and the schools for retarded children, where necessary, reformed and improved until the demand for admission to them outstrips the supply. We see no reason why this stage should not be reached in the near future and when it is reached we anticipate that parents will be glad not only to let their children attend these schools, but in many cases to keep them at school beyond the normal leaving age.

*Paragraph 31.

[page 120]

There will still remain, however, certain cases in which parents will object to sending their children to particular schools. So far as the lower grade children are concerned no great difficulty should arise, since all these children will have been notified to the Local M.D. Authority and as already stated we assume that that Authority, if they do not already possess the power, will be enabled by legislation to require the attendance of particular children at particular schools or centres. Similarly, in those rural areas where the establishment of separate schools for younger retarded children would be impracticable, no difficulties would arise. It could only be in towns and more thickly populated districts, where separate provision was made for these children, that parents would be likely to object to the removal of their children from one school to another. We are inclined to think that, though persuasion will suffice in almost all cases, the Local Education Authority should retain some general power in the last resort to require a child to attend the particular type of school which is best suited to its educational requirements.

142. While advocating the abolition of certification for purposes of education, we consider that the duty of "ascertaining" and "certifying" children as mentally defective for the purposes of notification under the Mental Deficiency Acts should remain. The real objections to certification, where regarded solely as a necessary preliminary to providing a child with the sort of education he requires, cease to hold good when the object of certification is to transfer the responsibility for the child from one Authority to another, when its purpose is to ensure that he shall be placed under proper care or control and when its result may be a curtailment of the child's freedom not only in his own interest, but in that of the community. We are, of course, aware that even when a child has been notified and has thus become subject to be dealt with under the Mental Deficiency Act, the Local Authority cannot place him under guardianship or send him to an institution until the legal procedure laid down in Section 6 of the Mental Deficiency Act, 1913, has been complied with, and it may be contended that these requirements, involving as they do the presenting of a petition accompanied by two medical certificates to the Judicial Authority and the making of an Order by that Authority, are in themselves sufficient safeguards. We do not accept this contention. We consider that a certificate by the Local Education Authority's Medical Officer that the child is mentally deficient, that is to say is, in the Medical Officer's opinion, by reason of mental defectiveness in need of care and control under the Mental Deficiency Acts, is essential for two reasons: first, because it will be a safeguard against the improper transference of responsibility from one Authority to another; and secondly,

[page 121]

because it is only right to take all possible steps to ensure that the Local M.D. Authority shall be in possession of the fullest information in regard to the child before deciding on action which may impose restrictions on his liberty. The Medical Officer of the Local Education Authority should be qualified in mental deficiency and should in our view continue to be specially approved by the Board of Education for this purpose. It should be the duty of the Authority to provide him with every opportunity of examining the child, and of satisfying himself as to all the facts both in this way and by calling for reports from teachers and others familiar with the child and his home conditions. Moreover, if our earlier recommendation is adopted, that all retarded children be kept under regular medical supervision such as now obtains in Special Schools, the Medical Officer of the Local Education Authority will have had ample opportunity of observing the child and forming an accurate opinion as to his mental condition His certificate should only be given after he has sifted all available information and it should, therefore, be a document to which great weight must necessarily be attached, The retention of the statutory requirement that the duty of ascertainment and certification of children as a preliminary to notification should rest with the Local Education Authority will ensure that the children are presented for medical examination under the best possible conditions. We think it would be unfair to the child, to the Education and to the Mental Deficiency Authority to forego the advantages and safeguards which this certificate will afford.

143. We recommend moreover that the Local Education Authority's duty to ascertain and certify mentally defective children for purposes of notification should no longer be restricted to children between the ages of 7 and 16, or, as in certain circumstances is now the case, to children actually attending Special Schools, but should be extended so as to apply in the case of all children within the ages of compulsory school attendance, whether those children are actually attending school or not.

There may of course be cases in which the Local Education Authority feel some doubt as to whether a child is mentally defective or in which there is a difference of opinion between the two Authorities concerned. As a general rule we believe that the Authorities will be content to leave these cases to the judgment of an independent mental expert and to abide by his decision, and that it will only in the last resort and in the most difficult cases be necessary to refer the matter to the Government Department for determination. Where it is a question of doubt in the mind of the Local Education Authority the case should be referred to the Board of Education; where however there is a difference of opinion between the two Authorities we recommend that reference should be made to the Board of Control who should consult the Board of Education before issuing their decision.

[page 122]

144. In a previous Chapter of this Report we have set out very briefly the position of mental defectives who come within the provisions of the Poor Law and fall to be dealt with by Guardians*. We will discuss the position of adults later† and will here confine ourselves to the children. From the account we have given three points stand out in special prominence. The first is that if the findings of our investigation in the selected areas can be applied in this respect to the country generally, as we think they may, there are at the present time more than twice as many feeble-minded children in Poor Law Institutions and Cottage Homes or boarded out by the Guardians as there are in Residential Special Schools maintained by Local Education Authorities or voluntary bodies. The second is that the defective children who fall under the Poor Law are in many cases deprived of the advantages afforded by the Education Act and debarred from the safeguards and protection provided by the Mental Deficiency Acts. The third is that Guardians are primarily concerned to deal with defectives as paupers and not as children requiring special care on account of their mental condition, and that they have as a rule (with some notable exceptions) no facilities for providing suitable education or even appropriate care for these children.

These three facts taken together furnish in our opinion cumulative and convincing arguments in favour of a speedy and drastic change in the law relating to defective children who fall under the Poor Law. We must expressly guard ourselves from appearing to suggest that Guardians as a whole have not treated the defectives for whom they are responsible with such care as has been possible with the means at their disposal. We have made no inquiry into the matter and make no statement one way or another. But we are quite clear that as a matter of principle it is as wrong as it is anomalous that while careful, almost meticulous, safeguards have been provided by statute to protect the individual and the community in the case of non-Poor Law defective children, no one of these safeguards extends to the case of those under the Poor Law. We would venture to suggest that in any legislation‡ dealing with the reform of the Poor Law the question should be considered of ensuring that no distinction in the administrative arrangements for the ascertainment, education and care of children should be made on the ground of poverty, that every provision of the Education and Mental Deficiency Acts should, where relevant, be made to apply to defective children now under

*Chapter III, paras. 50 and 51.

†Part III.

‡The Local Government Act will go some way towards meeting the situation.

[page 123]

the Poor Law, and that the principles we have advocated in this Chapter should extend to these as to other defective and retarded children. Every care should be taken in ascertaining them, in providing them with suitable education and training and in putting them where necessary under certificate. The question whether the financial responsibility for dealing with these, as with other children in their appropriate spheres, should be transferred to the Local Education and M.D. Authorities or should continue to rest with the Authorities who in future will exercise the other functions of Poor Law Guardians is outside our purview and on this question we accordingly make no recommendation.

145. We have described in Chapter III the procedure provided by the Children Act, 1908, and by the Mental Deficiency Act, 1913, with regard to the care of mentally defective children attending reformatory and industrial schools. The legal and administrative provisions to which we have there referred would appear prima facie to supply adequate safeguards such as would ensure that all mentally defective children and young persons attending Home Office Schools would be discovered and suitably dealt with. It must however be remembered that so far as ascertainment and notification are concerned these children are removed from the purview of the Local Education Authority and from that of the Local M.D. Authority (except in certain specified circumstances) and are dealt with at the Order of the Secretary of State or by the Court, and that those responsible for dealing with these delinquent children and young persons have not at their disposal the administrative machinery nor the expert staff possessed or employed by the Local Education Authority. It would not be surprising therefore if a certain proportion of mentally defective children were to pass through the schools and be discharged without their defect having been discovered. It has indeed come to our notice that there is some leakage and that an appreciable, though no doubt relatively small, number of children who have been educated in reformatory and industrial schools for normal children are brought to the notice of the Local M.D. Authority within a comparatively short period after their discharge as having fallen into crime or failed in social adjustment and as requiring care and control under the Mental Deficiency Acts, while in some few cases children who have been discharged from the special reformatory or industrial schools subsequently get into trouble and have to be sent to a certified institution under these Acts.

146. In order to reduce this leakage, which may of course have disastrous consequences to the individual and to the community, to a minimum, we would suggest that early consideration should be given to the question of putting into operation, if and in so far as these have not already been implemented, certain of the recommendations made by the Departmental Committee on the Treatment of Young

[page 124]

Offenders.* In the first place we feel sure that it would be of great assistance to the Court to have before it in every instance full reports from the Local Education Authority as to the child's or young person's family history and home circumstances, as to his school record, educational attainments, medical history and mental capacity, and we would further suggest that the practice already adopted in some areas of asking for a special report on the child's mental condition by the Certifying Officer either of the Local Education or M.D. Authority, as the case may be; might be advantageously adopted in all cases in which the ordinary medical and educational reports give prima facie indication of mental retardation or defect. Such a report, by a Medical Officer with special experience of and qualifications for the examination of children for mental deficiency, is in our view particularly desirable in the case of young persons brought before the Juvenile Courts in view of the close association between crime or delinquency and mental defect. The general adoption of this practice would ensure that the same standards in the diagnosis of mental deficiency would be applied to juvenile offenders as to all the other children who pass through the hands of the Local Education Authority; it would go far to prevent the possibility of a young defective being committed to an ordinary certified industrial or reformatory school; and it would render far less likely the subsequent discharge of any person who was in need of care and control under the Mental Deficiency Acts.

Similar precautions should be taken, as suggested by the Departmental Committee, in the case of young offenders on remand in custody or on bail.

147. We have already recommended that, in association with the general review at the age of 11 of all children attending Public Elementary Schools, those children who are mentally retarded should be subjected to a special examination, psychological and medical, with a view to determining first what form of post-primary education they require, and secondly which of them are in need of care and control and should be certified as mentally defective and notified to the Local M.D. Authority; and we have further recommended that all retarded children in these schools should be kept under special medical supervision throughout their school career with the object of securing that any child may be so notified as soon as it becomes clear that he needs care and control under the Mental Deficiency Acts. It appears to us that a similar survey of children attending Home Office Schools might advantageously be held on admission and that similar medical supervision should be exercised over these children so long as they remain at the school. The value of such a procedure would be enhanced and general agreement facilitated if arrangements were made for the medical examination

*See particularly pages 34-35, 43, 72-73 and 113-114 of the Report of this Committee (Cmd. 2831) which was presented to Parliament in March, 1927.

[page 125]

and supervision to be carried out by or in association with the specialist staff of the Local Education Authority and in particular if, in the case of all children showing signs of mental retardation, the Certifying Medical Officer of that Authority were called in in consultation for their special examination for conditions of mental deficiency. We believe that the school authorities would welcome such a scheme, and that the Local Education Authorities would be pleased to place at the disposal of the schools the experience of their specialist and other officers.

148. Owing to the complexity of the problems discussed in this Chapter we have felt bound to state in considerable detail the possible alternatives and the arguments for and against them. For purposes of convenience we have included in Chapter IX a full summary of the conclusions we have reached and the recommendations we make. We will only add here that though we have given no estimate of the expenditure that would be required to carry out the scheme we recommend, we have satisfied ourselves that it is financially practicable, and that its cost would be considerably less than that of putting the existing legal and administrative arrangements into full operation.

[page 126]

149. Having described in the preceding Chapter the general scheme which we recommend in regard to the allocation of responsibility for subnormal children between Local Education and M.D. Authorities and in regard to the education and training of the groups of children for whom each Authority would be responsible, we must now proceed to consider in some detail the manner in which this scheme can be applied in areas of different types and sizes, and to indicate some of the special educational problems which it presents.

The scheme we propose involves to some extent a fresh orientation in our conceptions and a fresh terminology. We are no longer concerned only with children who have been actually certified as mentally defective under Section 55 of the Education Act, 1921 - indeed we contemplate the abolition of such certification; as already indicated we have in mind also all those other children of similar grade and educational capacity who, according to the findings of our investigation, are properly certifiable under that Section, and further the still larger group of dull or backward children. For the purposes of this chapter we propose to use the term "retarded"* as applying to all these children, and to confine the term "mentally defective" to those children, whether feeble-minded, imbecile, or idiot, who have been notified by the Local Education Authority to the Local M.D. Authority as "ineducable" in the sense in which that term is used in the preceding Chapter,† or as in immediate need of care and control under the Mental Deficiency Acts.

The principal object we have had in view in formulating the scheme set out in the preceding Chapter has been to secure better educational facilities for this comparatively large group of children for whom, under the present system, little special provision has been or could be made. But at the same time, we have aimed at facilitating provision for the training of the smaller group of lower grade children, whose presence in the ordinary or Special Schools has been a hindrance to the education of those of higher grade. This latter problem is of narrower scope, but it is one which by reason of the small number of children concerned presents peculiar difficulties.

*This group of "retarded" children will of course contain a certain number of children who are mentally defective in the sense in which that term is used in the Mental Deficiency Acts, i.e. incapable of independent social adaptation, and who will subsequently require to be notified to the Local M.D. Authority.

†Chapter VII, paras. 117, 118 and 122.

[page 127]

The following discussion of the detailed working of our scheme in the light of the findings of our investigation and of the extent to which it can be generally applied throughout the country will relate to both these groups.

Our proposals are we believe in conformity with the general trend of events in the educational world since they centre upon the educational break at about the age of 11 and the reorganisation of education for the post-primary school child, and they contemplate that the normal age range for compulsory school attendance will in future extend generally from 5 to 15. In discussing the application of our scheme, we will accordingly deal separately with junior and senior pupils, applying the term junior to children between 5 and 11 years of age and senior to those between 11 and 15. We will further divide these children into the two groups already mentioned, namely, the "mentally defective"- mostly lower grade - children, and the "retarded" children.

We propose to deal with our subject under four main heads:

I. The detailed working of the scheme in areas of different types and sizes.

II. The standards to be observed for the administrative disposal of children.

III. Description of that part of the group of "retarded" children which is known as the "dull or backward" group.

IV. The educational problem of the retarded child.

150. In the following pages we propose to describe the general educational organisation that we contemplate for the older and younger children in these two groups, to estimate the total numbers of children falling into each of the groups and their subdivisions and to indicate the form of provision which will be practicable in areas of different types and sizes. The first part of our discussion will relate to the country generally, and we shall consider later the particular form in which our scheme can be applied to the largest towns. Our estimates of numbers are in the main based upon the findings of our investigation, but as this was confined to children who could be regarded as certifiable under the Mental Deficiency and Education Acts, we have co-ordinated these findings so far as the higher grade children are concerned with those of previous investigations made by Professor Cyril Burt, in order that we might deal with the whole range of educationally retarded children for whom special provision is required. Our estimates are necessarily based on averages and are intended to be applied to what may be termed "typical" urban and rural areas respectively.

*A diagram illustrating the general educational system contemplated for defective and retarded children is given at the end of Appendix I.

[page 128]

In order to assist Local Education and M.D. Authorities in applying our scheme in the event of its being adopted to their own areas or to separate portions of those areas, we have included in an Appendix* to this Report a full and detailed statement of the methods of calculation which have been followed and of the basis on which our estimates have been framed. We have also set out at the end of that Appendix in tabular and diagrammatic form the broad conclusions we have reached with regard to the disposal of children at various schools and centres.

(a) MENTALLY DEFECTIVE CHILDREN

151. We will deal first with the mentally defective children, not because we consider their training more important than that of the educationally retarded, but rather because as already stated, the very smallness of their numbers renders the organisation of that training peculiarly difficult. Among these children we include all those who can be certified as idiots or as imbeciles, that is, broadly speaking, children with mental ratios under 50, though in the case of those over 11 years of age we shall further include most of those with mental ratios between 50 and 55 and possibly a few of those with mental ratios between 55 and 60†.

152. (i) Junior Children. We estimate that there are in the whole country some 13,000 mentally defective children in the school population between the ages of 5 and 11. The financial responsibility for dealing with these children will rest with the Local M.D. Authority, but the duty of providing for the training of those who do not require institutional treatment will rest with the Local Education Authority. It is assumed that practically all the idiots and approximately half of the other children in this group will have to be sent to institutions and the total number for whom it is desirable that provision should be made by means of some sort of Day School or Centre will therefore be about 5,000. Some of these children are at present attending Occupation Centres where these have been organised; a larger number are attending Day Special Schools; a still larger number in the country generally are attending ordinary Elementary Schools; while probably the largest group remain at home and receive no special training. It is

*Appendix I.

†Suggestions as to the criteria which should be applied in determining whether a child should be dealt with by the Local Education Authority or by the Local M.D. Authority and whether it should be trained or educated in an Occupation Centre or in a School are made in para. 163, which should be read in conjunction with Chapter 2 and Appendix B of the Investigator's Report. While the children have for the purpose of this Chapter been divided on the basis of mental ratios, since this is the only basis on which estimates of actual numbers could be made, it should be clearly understood that all the other criteria would have to be taken into account by Authorities in applying our scheme to their own areas.

[page 129]

proposed that in future it should be the duty of the Local Education Authority (in return for payment by the Local M.D. Authority) wherever practicable to establish centres, on the lines of existing Occupation Centres, for these younger lower grade children who, though not requiring institutional treatment, are able to derive little or no benefit from the instruction and training given in any ordinary school or in the schools now known as Special Schools, and whose presence often impedes the work of these schools.

The smallest number of children for whom a full time Occupation Centre could be provided with due regard to economy may probably be put at 20 on the roll, since the cost of staffing alone for anything less than this would be excessive. Although we consider however that it would be advantageous for Occupation Centres to remain open both morning and afternoon, we believe that for financial and other reasons the establishment of half time centres will be not uncommon. In some of the larger towns there might well be two Occupation Centres each open for half time and the two centres might have a common staff. In this event and also in cases where, as should usually be possible, the person engaged for training the children at the centre can be employed in some other way during the rest of the day, as for example on visiting defectives in their homes, giving instruction to children who cannot attend the centre, or on other suitable work, the cost of staffing the centre would be halved. We accordingly contemplate that where an enrolment of 20 children is not practicable half time centres for not less than 10 children will be established. The smallest town or urban area in which a centre even for 10 children could be established would be one with a population of some 85,000. The total population of all the towns of this size in England and Wales is nearly 17 millions. So far therefore as mere numbers are concerned, and irrespective of travelling and other difficulties, we conclude that the establishment by Local Education Authorities of Occupation Centres for younger mentally defective children would be theoretically possible in areas containing in all about 43 per cent of the whole population of the country.

If this is the case the possibility of the Local Education Authority setting up Occupation Centres for the younger children alone will be excluded in the smaller towns and in all rural areas, and some other means of providing for the training of these children will have to be devised. Some who are quiet and well behaved may safely be allowed to attend the ordinary schools including special classes for retarded children where these have been established; some may be left at home and provided with such training as can be given by home teachers appointed by the Local M.D. Authority or by mental welfare visitors or social workers or by the staff of part time Occupation Centres in neighbouring towns; but in some cases the only practicable means of obtaining training for these children will be to send them to institutions.

[page 130]

153. (ii) Senior Children. The number of mentally defective children, that term being used here to denote all children with mental ratios under 55, over 11 and under 15 years of age in England and Wales is estimated at nearly 20,000. Our scheme contemplates that the whole responsibility for dealing with these children should rest with the Local M.D. Authority and that that Authority should provide not only institutional care for those who require it, but also training at day centres for those who can safely be left at home. The number of this latter group may be taken as about 11,000*.

In the case of these children also it is suggested that the minimum enrolment for an Occupation Centre should be 20 if the centre is to be full time or 10 if it is only to be open for one session each day. On this basis it will be possible to establish full time centres for older children alone in towns or urban areas with a population of 80,000 or more and half time centres in towns of half this size. The population of the 137 towns of 40,000 inhabitants and upwards amounts to nearly 21 millions, and the Local M.D. Authority could therefore establish Occupation Centres for older mentally defective children in areas comprising in all about 54 per cent of the total population of the country.

In the small towns and in rural areas provision for these older children would have to be made in some other way either by absorbing them into the Industrial and Handicraft Centres which the Local M.D. Authority may establish for defectives over school age (though the training and employment of older children with adults is open to objection), by providing them with some home training or by sending them to institutions.

154. (iii) Junior and Senior Children together. While we consider that the general principle of our scheme is fundamentally sound, namely that the Local M.D. Authority should be responsible for all mentally defective children of whatever age and at the same time that the Local Education Authority, in return for payment by the former Authority, should have the duty of providing training facilities for the younger, but only the power of making this provision for the older of these children, we believe that in practice it will be found to be the most convenient course, in all but the largest towns, for the Local Education Authority, who under our scheme will already have provided training facilities for the younger children, to extend their provision to the older children also. If both Authorities confine themselves to their proposed statutory duties only, some 60 per cent of the younger children and 50 per cent of the older children in the country will fail to obtain the benefits of Occupation Centre training. If, on the other hand, the Local Education Authority are willing to exercise their powers of providing

*This estimate is based on the assumption that all the idiots, one half of the imbeciles and one fifth of the feeble-minded children included in the 20,000 older mentally defective children will be sent to institutions. For detailed calculations see Appendix I.

[page 131]

for the older children, the proportion of children who will be able to receive this training will be appreciably increased. We estimate that where the training facilities for all the children are provided by a single Authority it should be practicable to establish full time centres in towns with from 50,000 to 60,000 inhabitants and half time centres in those with a population of from 25,000 to 30,000, while part time centres might be practicable in a few rural areas containing a small town, with a total population of some 16,000*. There are no less than 323 towns with 25,000 inhabitants and upwards and the total population of these towns is 23,700,000, that is approximately 60 per cent of the population of England and Wales. While the large majority of the Committee feel convinced that it would not be advisable to place an obligation on Local Education Authorities to make the provision for older children, they believe that practical considerations will often in fact lead to agreements being reached between the two Authorities whereby the Education Authority will provide training facilities for all the children in those areas where separate provision for older and younger children is not possible†.

155. We have so far confined ourselves to the consideration of the problem of the younger mentally defective children with a mental ratio of under 50, and the older children with a mental ratio under 55. We are doubtful whether the inclusion in these Centres of older children with still higher mental ratios would be found desirable as a general rule; provided however that all children of objectionable habits or behaviour were rigidly excluded and were either left at home or sent to institutions, we should see no objection to the admission of some older children with mental ratios up to 60 in those areas (particularly the small towns and certain rural or semi-rural districts which contain a small town or urban centre), where the numbers of children would otherwise be insufficient to justify the establishment of an Occupation Centre. It is a matter in these areas for consideration by the Local Authorities concerned and we do not wish to make any recommendation on the subject. We need only say that we estimate that, if these children were included, full time centres for older children only could probably be set up in urban areas containing a population of some 46,000, and in rural‡ areas with some 25,000 inhabitants, and half time centres in areas with half these populations; while full time centres taking children of all ages would be practicable in towns of say 35,000 and rural‡ areas of say 20,000 inhabitants and half time centres in areas of half these sizes.

*The incidence of mental deficiency in respect of children in rural areas was, as already stated, found by our investigation to be practically twice as high as in urban areas. For a full explanation of the calculations see Appendix I.

†See discussion in paras. 120-127 in Chapter VII.

‡See first note on this page and also Appendix I. This calculation does not take account of distances and transport facilities, on which the possibility of conducting centres in rural areas would largely depend.

[page 132]

It should be repeated that in making the above calculations we have assumed that one half of the total number of imbecile children will be sent to institutions, since it was found in our investigations that almost exactly this proportion of the imbecile children ascertained were, in fact, definitely in need of institutional care. The present shortage of institutional accommodation, however, will clearly make it impossible for Local Authorities to send all these children to institutions for some years to come, and it may well be found that for the time being the only way in which these Authorities can make any provision for them will be by means of Occupation Centres.

(b) RETARDED CHILDREN

156. The children whom we describe as retarded will, broadly speaking, have mental ratios between 50 or 55 and 80. As we are now considering day school accommodation only, we exclude from this category for present purposes those children (probably amounting to one-fifth of those now certifiable as feeble-minded) who for various reasons should be sent to Boarding Schools or Residential Institutions, and also those under 7 years of age, since these can as a rule be fitted into the Infants' Departments or Kindergarten classes of Public Elementary Schools, provided that the classes are not too large and that special individual methods of instruction are adopted.

According to the findings of our investigation it is estimated that there would be no less than 75,000* children in the school population of England and Wales between the ages of 7 and 15 who could properly be certified as mentally defective under the Education Act, 1921, and regarded as suitable for admission to Day Special Schools. On the basis of surveys carried out by Professor Cyril Burt† it is further estimated that there are some 300,000 other children whose mental ratios range from about 65 to 80‡, children who may be regarded as requiring special educational provision similar to that required by the mentally defective and who can properly be taught with them. The problem we have to consider concerns therefore some 375,000 retarded children in all, half of whom are between the ages of 7 and 11 and half between 11 and 15.

In the largest towns considerable numbers of the mentally defective children are at present in attendance at Day Special Schools, and it is the unanimous opinion of the Committee that the development of this type of educational provision offers the best

*Table 13 figures applied to estimated school population 7-15 (less 1/5th).

†See Appendix I to the Committee's Report.

‡Children with mental ratios between 80 and 85 must also be regarded as retarded children requiring some measure of special educational provision, but these could not be suitably taught in classes containing children with mental ratios below 55 or 60 according to age.

[page 133]

solution. Therefore, we have considered how best to arrange that this much larger group of retarded children may have the advantage of training and instruction similar to that so far restricted to children attending Special Schools; and we have made two proposals which if adopted will probably do much to ensure this. The first has already been mentioned in this Chapter, namely the removal of lower grade defectives to Occupation Centres. If this is done one of the chief factors that has hampered the growth and efficiency of Day Special Schools will be eliminated. The other proposal, namely that the children admitted to these schools need not in the future be certified as mentally defective, is of still greater importance. If this proposal be accepted we believe that it will result in suitable provision being made for far larger numbers of retarded children who are known to require more individual attention and special methods of instruction. The removal of certification will result in the advantage of Day Special School education being extended to retarded children; and this is all to the good provided the mental capacities and temperamental characteristics of the children are not too varied to allow them to be taught in the same school. Not only will the schools now described as Day Special Schools receive many more pupils, but Education Authorities who hitherto have felt that there were not sufficient children whom they could certify as mentally defective to form such a school, will no doubt adopt a different view and make special provision for retarded children. The enlargement of the scope of these schools will also enable them to be more closely associated with the ordinary elementary schools, with mutual benefit. The general method of training and instruction will develop along the lines of the best Day Special Schools of the present, but the increase in the numbers and in the variety of pupils admitted in the future will inevitably call for a new orientation in some respects. All these children will have the advantage of being no longer associated with the lower grade children, and the suggested raising of the upper limit will automatically raise the general educational attainments of the school; all the children will moreover have the stimulus of the possibility of returning to the ordinary school if they make sufficient progress.

Again we shall discuss the younger and older children separately.

157. (i) Junior children. We do not contemplate that Local Education Authorities will as a rule set up separate schools or departments for the younger retarded children except in the largest towns to which we shall refer later. We rather assume that they will adopt one of the alternative methods which have been tried in some areas, as already described in a previous Chapter*. Where the numbers are very small, they may group the children within the class or separate particular children for particular subjects. Where

*Chapter VI, para. 107.

[page 134]

the numbers are larger, they may group the retarded children in one or more separate classes or possibly in separate departments for the whole or part of the time, while still retaining them within the ordinary school. Now the smallest unit which can be economically grouped or efficiently taught in this way consists we believe, of not less than 20 children. This number of younger retarded children sufficiently equal in grade and capacity to he taught together will generally be found in any urban area with a population of not less than 5,700 and in most rural areas* with anything between 2,000 and 2,500 inhabitants. In larger towns two or more separate classes could be formed at a single school or in different schools, or separate schools or departments could, if thought fit, be established. If reasonable transport facilities are available the suitable grouping of younger retarded children in separate classes should accordingly be practicable, if considered desirable, in all but the more sparsely populated parts of county areas.† Again the increasing attention which will, we hope, be given in urban areas throughout the country to the problems of the mentally defective and retarded children will undoubtedly stimulate the interest of the rural teachers in these children. Moreover the general adoption of the expedient which has been tried with marked success in one or two places, that of appointing peripatetic teachers specially trained in methods of dealing with retarded children, to visit periodically the schools in a rural area will assist the teachers in these schools to deal more effectively with the retarded and defective children remaining under their care.

158. (ii) Senior children. It is this group of children that is likely to benefit most by the proposal we have made, namely that retarded children should be transferred at the age of 11+ to schools or classes where they will receive education and training along lines similar to those already followed in the existing senior schools for mentally defective boys and girls in our large towns. The best achievement of these schools in the past has been not so much the proficiency of the day training given, efficient as this has been, but the general stabilising influence they have brought to bear upon defective and retarded boys and girls, and this has been achieved because teachers and social workers have taken a comprehensive view of all aspects of the children's activities, at school, at home and at recreation. The general re-organisation of post-primary education that is likely to occur in the near future, taken in conjunction with the enlarged view of the term "retarded

*These urban areas would on the average contain a school population of some 800 children between the ages of 5 and 15, and the rural areas one of about 350.

†The solution of the problem of day school provision in the scattered rural areas will in part depend upon the extent to which Local Education and M.D. Authorities avail themselves of any powers which they possess or may be given to board out retarded and defective children near suitable schools or centres.

[page 135]

children", that we suggest should be adopted will give Education Authorities the opportunity of making suitable provision for older retarded children in many areas where hitherto this has been impossible. This provision will be made not only for the majority of children of the grade now attending these senior day Special Schools, but also for large numbers of other retarded children who show no aptitude for the ordinary school subjects; and these latter children can be included in the future because under our scheme there will be no necessity for certification. The schools we contemplate will form one group of the post-primary or central schools. Even areas where it would not be possible to establish separate schools for the younger retarded children will be able under the new system to establish these schools for the older retarded children, because the older pupils in all the schools in the area will be grouped, according to their natural capacities and interests, in secondary, or selective or non-selective senior schools.

The retarded children will not necessarily be grouped in separate schools. We anticipate that different Authorities will adopt different policies, but that in all areas some special provision will be made for these children. The senior school course for normal children will extend over four years and the children will usually be grouped in four classes or forms, one for each year of the course, so that no form will contain children differing from one another by more than one year in age. We believe however that it will be found practicable to organise senior schools for retarded children in two classes only, and that a unit of this size could provide suitable and efficient education and training for all the children attending it, since with two classes the educational attainments and capacity of the oldest of these retarded children in each class are not likely to be more than two years in advance of those of the youngest. The range of their mental ratios will of course to some extent depend upon the ratio taken as the upper limit for older children admitted to occupation centres. If the mental ratios are restricted to a range of from 55 to 80, provision could be made for a unit of 40* children in two classes in an urban area containing some 12,000† persons or a rural area with a population of 4,500.

159. We now turn to the largest towns, that is to say broadly towns which contain a population of 200,000‡ and upwards within the administration of a single Local Education and M.D. Authority.

*While we suggest a minimum enrolment of 20 for a single class or 40 for a two-class unit, we contemplate that the classes for the retarded in urban areas should normally contain about 30 children.

†These areas would contain a school population between 5 and 15 of approximately 1,800 and 700 children respectively.

‡There are nineteen towns in England and Wales with a population of 200,000 and upwards and the total population of these towns amounts to nearly 12,000,000.

[page 136]

The application of our scheme in the cases of these large towns will be somewhat different in form, though the principle of the scheme will remain the same. The larger numbers of children living in these towns will permit of a greater differentiation than is possible elsewhere in administrative methods in regard to the education of the new unit group of retarded children which forms the basis of our scheme.

It is important when applying a new scheme to ensure that it should develop and not destroy the good features of the present system. The value of the work done by the day Special Schools which have been established in all these towns, has been emphasised throughout this Report. The existence of these schools will facilitate considerably the application of the proposed scheme to the large towns, as the scheme is to a great extent a development of this type of school. At the same time it is necessary to emphasise that this development should be made judiciously and cautiously so as to ensure that the special features of these schools, which have enabled the teachers to achieve such good results, may be retained. Therefore whilst our recommendations envisage the extension of the educational advantages which these schools have afforded in the past to the much larger group of retarded children in the future, we would urge that in the larger towns where the day Special Schools have been thoroughly organised they should continue to function on similar lines to the present, although under modified and, as we think, more advantageous statutory provisions.

The greater differentiation possible in the larger and more densely populated towns will enable Local Education Authorities to subdivide the unit group of retarded children into two sections, which we shall name (1) the more retarded* and (2) the less retarded.* Accordingly in the large towns the whole body of children who require special provision for education or training will be classified as follows:

(a) Mentally defective - (i) junior, (ii) senior, or (iii) all ages together.

(b) Retarded children -

(1) More retarded - (i) Junior, and (ii) senior.
(2) Less retarded - (i) junior, and (ii) senior.

*The "more retarded" section corresponds broadly with the group of children who are now certifiable as mentally defective under the Education Act; the "less retarded" section comprises those children who are generally known as "dull or backward".

†See Table B in Appendix I to this Report.

[page 137]

160. (i) Junior children, i.e. children between 5 and 11 years of age with mental ratios under 50. On the basis of the figures of mental defectives ascertained in the present investigation in the urban areas, it is estimated that there will be about 25 children of this category who should attend an occupation centre.

(ii) Senior children, i.e. children between 11 and 15 years of age with mental ratios under 55. We estimate the number of children in this category to be approximately 50.

(iii) Junior and Senior children together. A town of 200,000 would have 75 children between the ages of 5 and 15 who could attend occupation centres. Classification for training purposes would be easier if all these could attend a centre that was centrally situated. But it is unlikely, especially as many of these children would be of a low mental grade, that it would be possible to collect them into one centre. Two or at most three centres will however be ample to meet the needs of this group of children.

(1) The more retarded

161. (i) Junior children, i.e. children between 7 and 11 years of age, with mental ratios between 50 and 70. The establishment of Occupation Centres in the larger towns should obviate one factor that has proved a serious handicap to the present system of Day Special Schools, namely the presence of the lower grade mentally defective children in these schools. The allocation of these children to Occupation Centres will make it possible to transfer a number of the more retarded children, who up to now have remained in the ordinary elementary schools, to junior schools or classes which will correspond with the present Special Schools for junior mentally defective children.

We estimate that in a town of 200,000 there will be about 170 children in this category. It will probably be impossible to collect all these younger children in one central school as this would necessitate some of them travelling long distances. Two small schools would however meet the needs of this group, or alternatively some half-dozen special classes in the ordinary schools might be formed.

(ii) Senior children, i.e. children between 11 and 15 years of age, with mental ratios between 55 and 70. Although a certain number of the children in the junior group of the more retarded will have failed to make any substantial progress by the time they reach the age of 11 and will therefore be transferred to an Occupation Centre, it is certain that a still larger number of the less retarded children also will have failed to such an extent that it will be desirable to transfer them to the schools for the senior more retarded children. Therefore this group will at any rate not be any smaller than the

[page 138]

corresponding junior group; we estimate their number at about 180.* These children could be well provided for in one centrally situated school.

The junior and senior children in this group correspond largely with the group now certified as mentally defective under the Education Act. The chief proposals we have made in our Report in respect of this group are the abolition of certification and the cleavage at the age of 11. The first of these proposals would give much greater elasticity in dealing administratively with this group of children. It has already been the practice for many years in some of the largest towns to transfer these children at about the age of 11 to a senior department such as the elder boys' and girls' schools in the London area, and our proposal would be in harmony with this practice.

The Committee wish to urge that the special provision made in large towns for this group of children should still continue and indeed in some towns be further extended. There is nothing in the Committee's scheme that need in any way impede the development of the valuable work done by Special Schools. If any fear is felt that the large numbers of retarded children in the bigger towns may cause the special needs of the more retarded members of the group to be overlooked, such fear we believe to be groundless. Under our scheme it is assumed that the Education Authorities in these towns will continue to differentiate between the more and the less retarded children and will continue to make educational provision for the former in separate schools. Moreover, the existence of these schools, so far from resulting, as in the past, in the neglect of the dull and backward, should facilitate the establishment of suitably graded classes for the less retarded. These classes, moreover, will be better adapted to the needs of these children and will be more satisfactory educationally, since the children attending them will be of a more or less uniform grade.

(2) Less retarded children, i.e. those with mental ratios from 70 to 80

162. (i) Junior children. It is estimated that a town with a population of 200,000 would contain almost 550 children of this category.

(ii) Senior children. The numbers in this group correspond approximately with those in the junior group. The schools for these children, as well as those for the elder boys and girls of the more retarded group, will form a part of the post-primary school system of the future. Whereas the curriculum in these schools will be more practical in character than that in the schools for normal children, the basis will be decidedly wider than that adopted in senior schools for more retarded children.

*This number does not tally with the figure given in Appendix I, Table B, since for the purposes of that Table no account could be taken of the fall in mental ratios in this group of retarded children. See Chapter 4, pages 100 and 101 of the Investigator's Report.

[page 139]

The numbers in each of these groups are large enough to enable the Education Authority to establish one or two separate schools for each. Probably it would be found desirable to admit to these schools some children with mental ratios between 80 and 85; if this were done the numbers would be considerably increased.

163. In the event of our scheme being adopted Local Education and M.D. Authorities may find it convenient to have before them some indication of the standards and borderlines which we suggest should be used for determining questions relating to the administrative disposal of children under that scheme. Our suggestions should be read in conjunction with Chapter 2 of our Investigator's Report, which contains a full description of the standards observed in his inquiry, and with Appendix B to that Report which gives a summary of the actual tests applied by him.

The standards here laid down are average standards, not invariable standards; that is to say, they give a concrete expression to the general borderlines that we have in mind, but are not to be rigidly enforced for every particular case. The formulation of psychological standards in no way implies that the diagnosis of deficiency or mental retardation can be reduced to the mechanical application of a series of tests; and accordingly, in considering the standards suggested in this Chapter, the cautions laid down in Chapter 2 of our Investigator's Report must be carefully borne in mind.

The person whose duty it is to determine whether a child can be regarded as mentally defective or as retarded must necessarily be concerned with the child's mind as a whole. In assessing the intellectual aspect of it, however, he will, in the main, rely upon standardised tests, while in assessing the temperamental aspect he will be largely guided by observations and reports on the child's general behaviour. Responses to test questions and to test situations can be standardised only in the roughest way. Hence the examiner will do well to assess the intellectual and the temperamental aspects separately, and then consider the two together before arriving at a final decision. The fact, therefore, that we formulate our standards in terms of tests of intelligence and educational attainments only, should not convey the idea that these are the sole criteria to be considered.

There are two main borderlines with which we are concerned - first that which separates the retarded* child, who should remain within the province of the Local Education Authority and be provided with special educational facilities, from the mentally defective* child who should be notified to the Local M.D. Authority and sent

*See first footnote on page 126 for an explanation of the sense in which these terms are used in this chapter.

[page 140]

to an Occupation Centre or to an Institution; and secondly the line to be drawn between the retarded child who requires some special educational provision and the normal child who can remain in the ordinary school. These lower and upper borderlines again will differ according to the age of the child.*

(i) For Junior children. In the case of younger children, that is to say children under 11 years of age, we have suggested a mental ratio of 50. At the age of 7 this ratio would imply a mental age of 3½. Such a child will probably be able to repeat a sentence of 6 to 8 syllables and to enumerate a few objects in a picture; he may be able to choose the longer of two sticks, but will probably fail to give the right responses required by the Seguin[*] form board or to choose the prettier of two faces or to copy a square.

We contemplate, however, that in some cases it will be necessary to notify children before the age of 7. At the age of 5 a mental ratio of 50 would imply a mental age of 2½; and this in turn means that, even if the examiner is successful in getting a response, the child will do no more than answer the two or three easiest questions in the whole Binet Scale[*]. He may perhaps be able to name one or two objects in a picture, to give his own name, and in response to such questions as "Show me your eyes", "Show me your mouth", point to the correct part of his face. At this stage however the emotional response of the child and his environmental conditions may make all the difference to his replies.

(ii) For Senior children that is to say for those between the ages of 11 and 15 we have suggested a slightly higher mental ratio, namely 55 per cent. At the age of 11 a mental ratio of 55 would be practically equivalent to a mental age of 6 years. As regards intelligence, this means that the child might be able to reply to all, or nearly all, of the test questions set out in Appendix B of our Investigator's Report for a child aged 6, but would fail in all, or nearly all, the tests for aged 7 and upwards. Thus he may know the 4 commonest coins, repeat 5 numbers, give simple descriptions of pictures and define well-known objects in terms of their use. It would be beyond him to state the differences between concrete objects, to add up 3 pennies and 3 halfpennies, or to repeat 3 numbers backwards.

As regards educational attainments such a child is likely to be well below the level of an average child of 6. Hence ability to do the work of what is generally known as Grade iii will be exceptional. The best of these children will seldom be able to read more than simple 3 letter words and a few familiar longer mono-syllables by the look-and-say method. They will only be able to scrawl 3 or 4 letters with a pencil, they will hardly be able to spell a single word and rarely be able to add and subtract beyond 5 or 6.

*See Chapter VII, para. 115, where this point is discussed.

[*Edward Seguin, 1812-1880, French educationist who devoted himself to the education of 'mentally defective' children. For more on Seguin, Binet and Terman (all mentioned in this chapter) see Chapter I of the 1924 Hadow Report on this website.]

[page 141]

Broadly speaking any child who falls below the standards we have briefly sketched above should be notified and should be provided with training in an Occupation Centre, while those who attain these standards may, as a rule, properly be kept within the educational system and afforded some form of special teaching. The former will correspond with the definition we have given earlier in this Chapter of "mentally defective" children, the latter to our definition of "retarded" children.

For the upper borderline for retarded children of all ages we suggest a mental ratio of 80 per cent.

(i) For Junior children a mental ratio of 80 at the age of 7 will give a mental age of from 5½ to 6 years. The responses of a child of this mental grade are again indicated by the tests given for the age 6 group of the children in Appendix B of our Investigator's Report. A child of 7 who grades to age 6 on tests could, as a rule, be properly kept in the ordinary school with normal children.

(ii) For Senior children a mental ratio of 80 at the age of 11 would give a mental age of a little under 9. A child of this grade will probably give correct responses to most of the tests in the age 8 group of Appendix B; that is he would be able to count backwards from 20 to 1, state the similarities between two concrete objects, give change out of one shilling, and would have a vocabulary equivalent to the first 20 words of Terman's test[*]. He would possibly be able to repeat 6 digits, or 4 digits backwards, but would be incapable of naming all the coins or of re-arranging a simple mixed sentence. Educationally he would just manage to read most of the words of the age 7 group, but would fail with most of those in the age 8 group of the reading tests. His educational attainments in respect of spelling and arithmetic would be of a corresponding level.

We have already indicated that in the largest and most populous towns further differentiation may be possible and the retarded children may be divided into two sections with an education more specifically adapted to the particular needs of each. The lower of these sections will correspond generally with the type of child now attending the Day Special Schools in the larger towns, while the higher section will consist generally of what are now known as dull or backward children. The lower borderlines which we have suggested for use in the country generally will apply in the largest towns also but the upper line may be somewhat extended in these towns, possibly up to 85.*

*See para, 162 above, and also para. 164 below.

[page 142]

There remains to be discussed the borderline that should be drawn in the largest towns between the two sections of retarded children. For all ages we would suggest for this borderline a mental ratio of about 70 per cent. In the case of a child of 7 a mental ratio of 70 would correspond with a mental age of nearly 5, while at the age of 11 it would correspond with a mental age of rather less than 8. The educational attainments of such a child at the age of 7 would be practically negligible, though he would show some promise of capacity for educational progress. He might be able, for instance, to copy and even recognise a few letters or to count 3 or 4 objects. At the age of 11 his educational attainments would be below those of a normal child of 7.

164. The Chapter in our Investigator's Report which describes the Standards adopted in his inquiry indicates clearly the types of child whom he classified respectively as imbeciles and as feeble-minded, and the account that he gives of the borderlines followed by him in distinguishing between these two groups, when read in conjunction with the description in the preceding Section of this Chapter of the lower borderlines to be observed in future, should afford a fairly clear conception both of the type of child to be trained in an occupation centre, namely that which we have defined as the "mentally defective" child, and also of the lower grade members of the group of "retarded" children who could be retained within the elementary education system. This latter group, as already stated corresponds broadly with the type of children now attending Day Special Schools.* The retarded group as we have seen however contains a still larger proportion of children who could not be certified as mentally defective under the Education Act, but who can certainly be described as dull or backward. These children did not come within the scope of our Investigator's inquiry and his Report consequently contains no description of them. It is of this group therefore that we now propose to give some definition and description.

This definition must for present purposes be based upon practical needs. Recent educational surveys have shown that the mental differences between individual children are far wider than had previously been suspected. No longer do we expect all children to progress at the same average speed - one standard per annum; the cleverest child will progress nearly twice as fast, and the dullest twice as slowly. Other things being equal, the class that is most easy to teach is the class that is most homogeneous. Hence, in the

*i.e. feeble-minded children. There are of course at present a number of lower grade children also at these schools, but they do not belong to the type of child for whom the day Special Schools are intended and should be excluded from them.

[page 143]

interests both of the pupils and of the teacher, a differential scheme of classification is required. These individual differences, moreover, increase progressively from year to year. Children as they grow older diverge more and more the one from the other; the child who is backward by one year at five, is likely to be backward by two years at ten, and by three years at fifteen. Hence, it is during the final years of school life, between the age of eleven and puberty, that a maximum degree of differentiation is essential.

The Report on the Education of the Adolescent* has drawn attention to the need for classifying normal children according to their educational capacity, and educating each group in schools of an appropriate type. Here we desire to insist on the equal need for grading the subnormal, and providing each section with the kind of instruction that fits it best. Special provision is plainly needed both for the dull or backward and for the more seriously retarded child. But not every child who is retarded a fraction below the general average is in need of special instruction in a Special School or Class. The boy who is backward by no more than one year can well be accommodated in a class whose average age is a little younger than his own. This is everywhere a common practice which brings little or no disadvantage, so long as the ages are not too freely mixed. The children belonging to a single age-group - those aged ten last birthday, for example, may easily be spread over three consecutive standards† - Standard III (whose average is 9.5), Standard IV (whose average age is 10.5) or Standard V (whose average age is 11.5). Accordingly in educational articles, in official reports and in teachers' discussions on the subject, the phrase "backward child" is usually restricted to mean one who is backward by about two classes or two years. Where schools or classes specially designed for the backward have already been instituted and exact measurements made of the children's intelligence, we find that the mental ratios of the pupils usually range between 70 and 85, that is to say, a mental age of 7.0 to 8.5 at the chronological age of 10.

We suggest that the trend of the teachers' spontaneous selections in the past may form a rough guide for similar selections in the future. The ground for these limits is obvious from what has just been said. Let us consider more closely the classification of pupils in the middle of the present senior‡ departments. Those

*Report of Consultative Committee of the Board of Education, under the Chairmanship of Sir W. H. Hadow. Published by H.M. Stationary Office in 1926, price 2s.

†We use the word "standard" simply to indicate a class in which the educational capacity and attainments of the children correspond roughly to that of a single year of development, Standard I to age 7 to 8, Standard II to age 8 to 9, and so on. Even if their classes are not organised on this basis, most teachers still attach a fairly definite meaning to the levels so named.

‡i.e. where there is no educational break at the age of 11+ and where the school is organised in (a) an Infants department and (b) a mixed department or departments for older boys and girls separately.

[page 144]

aged 10 last birthday should normally be taught in Standard IV. If retarded by but a single year, they can be placed in Standard III without detriment to their fellows. If retarded by two years, they would (if strictly classified according to their attainments and capacity) be placed in Standard II. Standard II however should receive the cleverest children aged only seven or eight. Such an assortment of big and little, side by side in the same classroom, is not usually advisable and the drawbacks become more and more serious as the backward child grows older.

Now the average age of the normal ten-year-olds in Standard IV is 10.5 years: and Standard III ranges roughly from a mental age of 9.0 to 10.0. A ten-year-old, therefore, who is unfit for Standard III is retarded at least 1.5 years, or 15 per cent of his age. If he is retarded by 30 per cent of his age, he is usually deemed fit, not for a backward class, but for a Special School where Special Schools exist. These limits - a backwardness of 15 to 30 per cent - coincide with the limits just mentioned, namely, a mental ratio between 70 and 85, and correspond with what has been the interpretation usually given to the words "merely dull or backward" in Section 55 of the Education Act, 1921.

The children with whom we are concerned are therefore those who, without being mentally defective, are so deeply retarded in mental development or attainments that by the middle of their school career they are unable to profit by the instruction given even in the class below that which is normal for their age. And, generally speaking, it may be said that by a retarded child we mean one who is retarded by more than 15 per cent of his chronological age. While this figure may be taken as the upper limit of that group of retarded children with whom we are now concerned, it will be remembered that it is only in the largest towns where exceptional facilities for educational differentiation exist that it would be possible to extend the special provision to children with mental ratios between 80 and 85; and for practical purposes in the greater part of the country the upper limit of children included in our retarded group will be about 80.

This definition, though given in quantitative terms, is not meant to be pedantically pressed. Every area will adopt the lines of classification most suited to its needs. We have attempted a precise definition solely because it has been necessary to give calculations of the probable numbers. If the limits be expressed in terms of the mental ratio, then a range of 70 to 85 will perhaps be most convenient in the larger towns, where the numbers are high enough to make such a classification desirable. In the smaller towns and in rural areas the classification will doubtless be less finely differentiated.

Our scheme, of course, rests on the assumption that the educational system will be reorganised on the basis of a clean cut at the age of 11+ and we have advocated the institution of a special survey

[page 145]

of children at this age with a view to the selection of pupils for classes or courses of instruction suited to their special abilities. Not for one moment however do we suggest that the backward child should be ignored until he reaches the age of 11 and his backwardness becomes a conspicuous handicap both to himself and others. This is like waiting until the consumptive breaks down at his work before giving a thought to his trouble and its treatment. The sooner the retarded child is discovered and the sooner he receives a special measure of attention, the greater is the hope of remedying or compensating for his particular disability. If scientific methods of case-study are employed, the majority of those who are likely to be dull or backward can be detected soon after the age of seven. One of the greatest obstacles to accelerating the progress of the retarded child is the child's growing consciousness of his own inferiority. Before the age of eleven he may hardly have realised his unfortunate position. But with the increase of self-consciousness that the approach of puberty brings, he begins to contrast himself with his normal fellows and strongly resents the babyish methods that are used in trying to teach him the elements of reading and of number. Here lies one of the most important reasons both for attacking his difficulties at an early age, and for placing him when he is older with those who are on a level that more nearly corresponds with his own.

We feel then that the recognition of the dull and backward as a definite group needing special attention, and the systematic organisation of schools and classes along the lines just described, form one of the most urgent educational needs at the present moment. In view of the suggested reclassification of children at different ages - at the age of seven or eight when the child leaves the infants' department and again at eleven when the whole school population is regrouped - such a plan should not present great difficulties. In support of our proposal we have already pointed out that recent inquiries have shown that it is chiefly from the ranks of the dull and the backward, rather than from those who are mentally defective in the stricter sense, that the majority of our criminals, paupers and ne'er-do-wells are drawn. The institution of special classes for the retarded child would lead to attention being drawn at an early age to the social, temperamental and intellectual difficulties of each one, and so save many from a life of hopeless poverty or crime.*

165. While much thought has been given to the educational problems of those children who have been described in the past as mentally defective children, that is to say, the lower section of our

*In a recent survey of juvenile delinquency in London, it appeared that "nine out of every ten delinquent cases fell below the middle line of average educational attainment, and five out of every six were so far below it as to be classifiable as among the technically 'dull or backward'."

[page 146]

group of retarded children. the special educational problems presented by the upper section of this group, namely the dull or backward, have hitherto been accorded but little consideration save in a few areas and in a relatively small number of more or less isolated schools. Though, as we have seen in an earlier chapter, valuable experiments have been and are being made here and there for dealing with these children within the Elementary School system, there has been little co-ordination of effort and little pooling of experience. The "dull or backward" class is, moreover, too often little more than a refuse heap for the rest of the school; the child is not selected on the basis of any systematic tests; he is not studied individually to discover the causes of his backwardness; no one troubles to find out whether his backwardness is remediable or not; and many a teacher, being human, instead of realising that he has been honoured with the most interesting psychological cases in the whole of the school, groans because he will have nothing to show for his efforts and longs to be relieved or promoted to the scholarship class instead.

Our reasons for referring in this Report to the special problems of the dull and backward are two-fold: first, because they are necessarily connected with those of the lower section of the retarded group, so that the one cannot be considered apart from the other and that there is no possibility of making satisfactory educational provision for the majority of the children in the lower section except in association with those in the upper section*; and secondly because, realising as we do their extent and some of their complexities, we wish to suggest certain aspects of these problems which we feel might well form the subject of a special investigation.

(1) CAUSES OF EDUCATIONAL RETARDATION

166. Researches on this question have already been carried out in several urban areas, and a wide variety of causes has been revealed. While much further inquiry is needed, in particular so as to show in what way the known causes operate to produce their undoubted effects, to discover other possible causes and to indicate how these causes may most effectively be attacked either on a wholesale scale or in individual cases, we think it may prove helpful if we state here the commonest causes that have been brought to light by previous inquiries. It has been shown in the first place that a distinction must be drawn between (a) children suffering from an innate and permanent retardation, and (b) those suffering from an acquired and curable retardation; in other words, between those usually distinguished as the specifically "dull" and those more generally known as the "merely backward".

(i) Inborn inferiority in general intelligence, that is in all-round intellectual capacity, appears to be the commonest cause of all. In such a case, not the child, nor the teacher, nor the parent, but nature is

*See Chapter VII where this question is fully discussed.

[page 147]

to blame. The dull in fact are suffering from a mild form of that congenital inferiority which differs in degree, but not in kind, from mental defect: it is useless to expect such children ever to reach beyond the level of Standard IV.

As we have seen, there are all degrees of dullness. In some the dullness may be so extreme as to amount to mental defect in the sense implied in the Education Act, in that the innate condition of the child is of itself sufficient to render him incapable of profiting by instruction in the ordinary school. In others the dullness is not grave enough to prevent the child from being kept within the ordinary elementary school system, but other factors, combined with the innate inferiority, hinder the child's progress and call for special attention.

(ii) Special disabilities such as bad memory, unstable attention, poor auditory or visual imagery, incapacity for verbal or abstract symbols as distinct from practical or manual work, and

(iii) Temperamental defects such as emotional instability, emotional apathy, emotional conflicts, petty moral or disciplinary difficulties, worry about conditions at home, antagonism to a particular teacher or subject - may often aggravate the child's general incapacity, and perhaps in rarer instances be sufficient of themselves to turn a normal child into a backward child.

The remaining factors are either physical (arising within the child himself), administrative (arising within the school organisation), or environmental (arising mainly within the child's own home). The following are the commoner:

(iv) Physical handicaps, such as poor health, defective vision, defective hearing, defective speech, left-handedness, tonsils, adenoids, rickets, rheumatism, recurrent catarrh, minor ailments, malnutrition, lowered vitality from many different causes. These contributory causes are nearly all of them of a remediable type, and are often so slight as to escape attention and treatment unless an intensive study is made of each backward individual.

(v) Absence from school, including late entry and irregular attendance from a variety of causes - excusable and inexcusable - (illness of the child himself, infection in the home, migration from district to district, negligence on the part of the parents, dislike of school on the part of the child).

(vi) Defects within the school itself - bad teaching, uninspiring or ill adjusted teaching methods, too slow or too rapid promotion, sudden break in teaching methods (particularly when the child is transferred from the infants' to another department or from one school to another).

(vii) Social or environmental handicaps - poverty and its concomitants, insufficient or inappropriate food, lack of sleep, overcrowding, insufficient recreation, lack of culture in the home, lack of parental sympathy with the school and its work, overwork out of school hours.

[page 148]

The teacher should be on the watch for causes of these various kinds, in every case. Usually he will discover in each instance not one cause but several, all co-operating to drag the child backward; and he will need the assistance of the School Nurse, the School Medical Officer, the Attendance Officer and the social worker to support his efforts in the classroom. Otherwise all that is done during five hours on five days each week may be undone directly the child leaves the school premises.

(2) SIZE OF CLASSES

167. The outstanding need of all retarded children is greater individual attention. Hence, the first requisite will be a small class. We have provisionally suggested that the class for the retarded should contain about 30 children. Is this the ideal or the best practicable size? Again should not the classroom itself be not one of the smallest but one of the largest in the department, so as to allow plenty of room for manual and practical work and for the children to move about more freely than the ordinary pupil engaged for the most part in reading, in sitting and listening to the teacher, or in doing written work at the desk? What name should be given to the class, so as to avoid casting any slur on the pupils or the teacher sent to it? Should it not be termed a "practical class", an "industrial class", an "opportunity class", "VI.c", or even (as in one department) "Ex-VII", or indeed be given any title rather than the "backward class", or "standard 0"?

When the retarded cases are not sufficiently numerous for the formation of a special class, the question of employing a visiting teacher specially qualified to give assistance or advice in methods of group or individual teaching might be considered.

How far children of different ages, sex, attainments and capacities can conveniently be housed together in a single room is a problem needing further inquiry. Experience points to the need for classifying the retarded amongst themselves; wherever possible, not one retarded class but several should be organised (not necessarily in the same school), so that the retarded as well as the normal can be graded and promoted according to age and progress.

(3) SELECTlON OF PUPILS

It is clear that as the causes of retardation are so numerous, retardation may be of many varying degrees and types. Of all the sources of failure in the backward class as it exists at present perhaps the commonest is the haphazard way in which the children are selected. Should it not be the general practice to use standardised tests both of intelligence and of educational attainments as the main basis of selection, and to keep case records or "progress-books" giving the results of subsequent tests or examinations and full details as to the case-history of each individual child - his home circumstances, his physical defects, his

[page 149]

special disabilities, and his temperamental peculiarities? The appointment of a visiting psychologist, of an educational expert, or of an inspector of retarded classes trained in psychological methods, would be of great help to the teachers themselves. Of course all retarded children should, as we have already recommended, be submitted to special medical inspection and where necessary be referred to a mental expert. The institution of psychological clinics for child guidance would be of further assistance in this direction. Each of these plans has already been attempted in different schools and areas; and one of the most urgent questions for inquiry is that of determining the special merits and the special limitations of these different schemes.

(4) EFFECT OF PHYSICAL CONDITIONS ON MENTAL RETARDATION

It is clear that the selection of retarded children is primarily an educational problem. Yet, as we have just seen, physical defects so often constitute an important factor that a special and thorough medical examination of each retarded child is an indispensable preliminary to his proper treatment. One of the most important points, therefore, for further inquiry is the possibility of closer cooperation between the doctor, the teacher and the social worker in such cases. How far are measures of modern medicine, surgery and general hygiene followed by mental improvement, and how far can the effects be made permanent by more intelligent aid within the schoolroom when tonsils have been excised, spectacles prescribed, minor disabilities successfully cured? What, for example, is the value of the open-air class for children of this type?

(5) SOCIAL MEASURES

As we have seen, backwardness at school and poverty in the home are closely associated. In itself, no doubt, poverty may be an effect of the dullness of certain members of the family quite as often as its cause. Yet, directly or indirectly, poverty is undoubtedly a serious factor, nearly always aggravating any inherent backwardness in the child himself. It is in the poorest districts that backward pupils are most numerous. Hence there is a need for active social service in connection with the backward classes.* A systematic inquiry into what has already been done in this direction, and what is still needed and practicable, is greatly to be desired.

(6) TRAINING OF TEACHERS OF RETARDED CHILDREN

It is obvious that the teacher of the retarded child will need special qualifications. If he is to be successful he must regard his work,

*The need of social service, particularly in connection with the care and supervision of mentally defective children out of school hours, was emphasised in the Board of Education's Circular No. 1341 issued in September, 1924.

[page 150]

not as a thankless burden, but as a privilege and as a unique opportunity for studying types of mind, at once the most puzzling and the most fascinating that the elementary school can show. He must be endowed with a peculiar degree of human sympathy and patience, and at the same time possess a scientific attitude towards his pupils and their difficulties. He must be familiar with modern educational methods for instructing the more immature minds and at the same time appreciate the more worldly interests possessed by the older. He must be capable of dealing with his class as individuals rather than in the mass, and have as great an interest and skill in manual work as in work of a more academic type.

Many of these qualifications are to be acquired, and often can only be acquired, through actual experience and training. An inquiry is therefore desirable to show how far existing courses organised by the training colleges or otherwise meet, or should be modified for, teachers of experience and others who intend to specialise in this kind of work. The impending reorganisation of training college courses makes the present moment opportune for calling attention to this special aspect.

Several methods of training teachers for the retarded have been tried -

(a) by Training Colleges

(i) as part of the ordinary training course;
(ii) as a third year or deferred third year course;

(b) by Training Colleges and other Organisations in short intensive courses of varying lengths;

(c) by Local Education Authorities for their own teachers.

(7) CURRICULA

It is obvious, and universally admitted, that the curricula of these classes should devote less time than the ordinary school to formal subjects such as reading, writing and arithmetic, and more time to practical subjects, such as bear directly upon the

[page 151]

child's future life, either in the home, or in industry, or in his hours of leisure. Here is one of the most urgent problems for future investigations.*

(8) TEACHING METHODS

Even when the retarded child is being taught the more abstract academic subjects, they should be presented to him in a concrete and practical way. What is the special value to such a child of expressive and aesthetic work, such as that involved in homely crafts, in decorative art of various kinds, in music, dancing and dramatic display? Mechanical work seems to keep the mind occupied, but actually allows it to daydream and often does more harm than good. How can all the work be made active, stimulating, provocative; made to appeal to the child's special interests; to encourage him to feel the joy of success; and be so graded throughout as to lead him by easy stages to higher, harder and more abstract work? The answers to these and kindred questions are no doubt familiar to the best teachers. Could not the knowledge and experience of these be placed more readily at the disposal of others?

By what particular methods, and with what degree of success these various aims may be achieved are problems that require a far greater amount of experience, experiment, collaboration, and discussion than has hitherto been allotted to the problem. They point to the urgent need for systematic inquiry into the whole situation.

*Detailed recommendations on these and kindred points have already been put forward in the Board's recent Handbook of Suggestions to Teachers.

[page 152]

168. In the course of this Report we have described the nature of mental defect, the existing statutory provisions with regard to mentally defective children and the administrative arrangements made for their care, training and education. We have reviewed the findings of the special investigation held by Dr. Lewis into the incidence of mental defect in certain urban and rural areas, and have discussed the application of those findings to England and Wales as a whole. We have considered the problems submitted to us in the light of those findings, and have set out fully in the appropriate chapters of this Report the conclusions we have reached and the recommendations we make in regard to each of the questions that we have had under review so far as children are concerned. We propose here to confine ourselves to a concise statement of our main conclusions and recommendations, indicating in respect of each of them, for convenience of reference, the numbers of the relevant paragraphs in the body of our Report. Our conclusions and recommendations relating specifically to adult defectives are given in Part III.

1. THE MEANING OF MENTAL DEFECT

Some doubt exists as to the meaning of the definition of "mentally defective" children in Section 55 of the Education Act 1921 and of "feeble-minded" children in Section 1 (c) of the Mental Deficiency Act 1927. It is sometimes held that the only criterion of mental defect for the purpose of these definitions is the educational one. In the light of all the other definitions contained in the Mental Deficiency Acts and of the best scientific opinion, we have taken the view that, whatever may be the correct legal interpretation of these definitions, the real criterion of mental deficiency is a social one, and that a mentally defective individual, whether child or adult, is one who by reason of incomplete mental development is incapable of independent social adaptation, (Chapter II, para. 21.)

2. POWERS AND DUTIES OF LOCAL AUTHORITIES

(a) We find that the powers and duties of Local Education Authorities with regard to the ascertainment and notification of children to the Local M.D. Authority are in some respects obscure,

[page 153]

and in some respects more narrowly restricted than we believe to have been intended by Parliament:

(i) The terms of Provisos (ii) and (iv) of Section 30 of the Mental Deficiency Act 1913 - provisos which appear to be contradictory - throw considerable doubt on the question whether Local Education Authorities may ascertain, certify and notify children who are in the hands of the Poor Law Authorities. (Chapter III, paras. 37, 50 and 51.)

(ii) In the case of a child who is leaving an ordinary Public Elementary School at the age of 14, and is in the opinion of the Local Education Authority in need of supervision, guardianship or institutional care under the Mental Deficiency Acts, that Authority have no power of notification corresponding to the power they possess in the case of a child leaving a Special School at 16. (Chapter III, para. 41.)

(iii) Owing to factors which have arisen since the passing of the Mental Deficiency Act, 1913 and the interpretation which has been placed on the term "special circumstances" in Section 2 (2) (a) of that Act, little use has been made of the power of notifying educable mentally defective children of school age who are in need of care and control under the Mental Deficiency Acts. (Chapter III, para. 42)

(iv) There is some doubt whether a child who has left a Public Elementary School at 14 without having been certified as mentally defective can be so certified between that age and 16, and, if necessary, notified to the Local M.D. Authority. (Chapter III, para. 40.)

The facts:

(i) That only a small proportion of mentally defective children have been so notified;

(ii) That numbers of defective children are in the hands of Poor Law Authorities; and

[page 154]

(iii) That the Local M.D. Authority can only themselves "ascertain" and provide for defectives who are "subject to be dealt with" under the Mental Deficiency Act by reason of having been found neglected or cruelly treated, or having come into contact with the law or got into serious trouble;

(c) Though Poor Law Authorities have power to maintain children who are defective in their institutions, these institutions are not as a rule suitable places for their retention. Moreover, defectives so maintained are dealt with either as paupers or as persons of unsound mind and are deprived of all the benefits and safeguards of the Mental Deficiency Acts. (Chapter III, paras. 50, 51 and 52.)

(d) Defective children in Home Office Schools are also, broadly, outside the province of the Education and Mental Deficiency Acts, and though well looked after in the schools are to some extent debarred from the continuity of care which those Acts are intended to confer. (Chapter III, para. 53.)

3. NUMBERS OF DEFECTIVES ASCERTAINED AND DEALT WITH BY THE LOCAL EDUCATION AND M.D. AUTHORITIES

(a) Local Education Authorities have ascertained 33,000 educable mentally defective children in England and Wales and the total Special School accommodation available for these children consists of 1,800 places in Residential Schools and some 15,000 places in Day Schools, accommodation which is only sufficient for half the children hitherto ascertained. (Chapter IV, paras. 55 and 56.)

(b) The numbers of children notified by Local Education Authorities to Local M.D. Authorities amount annually to some 2,400 children between 7 and 16 years of age. (Chapter IV, para. 60.)

(c) Local M.D. Authorities' returns do not indicate how many mentally defective children have been reported to them. Their latest returns, however, show that they have knowledge of some 62,000 defectives of all ages, that is to say 1.57 per 1,000 total population. Only 39,000 of these (or 1 per 1,000 population) have been "ascertained" to be "subject to be dealt with" under the Mental Deficiency Acts. Of these some 20,000 have been sent to Institutions; 1,100 have been placed under Guardianship and the remainder numbering some 18,000 have been placed under supervision. (Chapter IV, paras. 60 and 61.)

(d) There are only 111 Occupation Centres, nearly all provided by voluntary bodies, though financed by Local Authorities, and the total number of defectives (most of them being children) who are being trained at these Centres does not exceed some 1,200. (Chapter IV, para. 73.)

[page 155]

4. NUMBERS OF DEFECTIVES IN ENGLAND AND WALES CALCULATED OR ESTIMATED ON THE BASIS OF THE FINDINGS OF THE COMMITTEE'S SPECIAL INVESTIGATION

(a) The total number of children between the ages of 7 and 16 who are mentally defective within the meaning of Section 55 of the Education Act, 1921, is approximately 105,000, that is to say, rather more than three times as great as the number actually ascertained and certified by Local Education Authorities. (Chapter V, paras. 83 and 93.)

(b) The number of lower grade defective children, i.e. imbeciles and idiots, under 16 years of age on the actual basis of our investigation is at least 30,000. We are, however, convinced that this figure is an under-estimate, because the ascertainment of younger children was necessarily incomplete. (Chapter V, para. 97.)

(c) The total number of adult defectives of all grades in the whole country is certainly not less than 150,000. This number is two and a half times as great as that given in the returns submitted to the Board of Control of defectives of all ages brought to the notice of Local M.D. Authorities. (Chapter V, para. 83.)

(d) Of the 105,000 children referred to in paragraph (a) it is estimated that about one-third, or 35,000, are educationally rather than socially defective, while the remaining two-thirds, that is 70,000, are mentally defective within the meaning of the Mental Deficiency Acts. If we add to this figure (70,000) the 30,000 lower grade defective children and the 150,000 adult defectives, we find that the total number of persons of all ages in England and Wales who are mentally defective in the true sense, that is, who are by reason of incomplete development of mind incapable of independent social adaptation, is 250,000. We know that this number, which is based directly upon the actual numbers ascertained in this Investigation, is an under-estimate, and, after allowing for the inevitable incompleteness of the ascertainment and making certain corrections, we estimate that the total number of persons in England and Wales who are mentally defective in the true sense is at least 300,000*, which is equivalent to an incidence of mental defect of eight per thousand total population. (Chapter V, para. 83.)

(e) All these figures which are based on the findings of our Investigation show clearly that the numbers of defectives ascertained and provided for by Local Education and M.D. Authorities are far smaller than they should be.

5. OTHER FINDlNGS OF THE COMMITTEE'S INVESTIGATION AND CONCLUSIONS ARISING THEREFROM

(a) The incidence of mental defect as ascertained in the Committee's investigation is approximately twice as high as that found 20 years previously by the Royal Commission on the Care and

*This number (300,000) does not of course include the 35,000 children whose defect is educational rather than social.

[page 156]

Control of the Feeble-minded. This increase is probably due in the main to greater thoroughness and improved methods of ascertainment. But, after allowing for these and other factors, we believe that the evidence available suggests that there may have been some increase in the incidence of mental defect even during the past 20 years. (Chapter V, paras. 84 and 86-90.)

(b) The Committee's investigation shows that there is a marked difference in incidence of mental defect between urban and rural areas. The mean incidence of defect for all ages in the urban areas was 6.49 per 1,000 population as compared with 10.66 in the rural areas. There is evidence that this disparity is connected with the problem of rural depopulation and with other important social problems. (Chapter V, paras. 88 and 91, and Investigator's Report Appendix A, Table 11.)

(c) In the investigated areas 77 per cent of the feeble-minded (i.e. educable mentally defective) children ascertained were found to be in attendance at ordinary Public Elementary Schools, and even in the two areas where unused Day Special School accommodation existed 69 per cent of the feeble-minded children were attending the Public Elementary Schools. The reasons underlying these facts, taken in conjunction with (i) the prohibitive cost of establishing Residential Special Schools for all feeble-minded children living in rural areas, and (ii) the impracticability, save in a strictly limited number of towns, of any material increase in Day Special School provision, have convinced us that a change of system is essential. The existing system has in fact broken down except in the larger towns and is, we believe, incapable of being applied in the country generally. (Chapter IV, paras. 64 and 65, Chapter V, para. 94 and Chapter VI, paras. 100-106.)

(d) Our Investigator had also presented to him large numbers of children who, though he could not class them as feeble-minded, were patently retarded both mentally and educationally, children who form the group generally known as dull or backward. No special educational provision was being made for the large majority of this marginal group, which is estimated to contain as many as 300,000* children between 7 and 15 years of age in the country as a whole. The close genetic as well as educational relationship between the "dull" portion of this group and the mentally defective makes it impossible for the Committee to overlook the problem which the whole group presents. (Chapter VIII, para. 156.)

*This figure is based on surveys carried out by Professor Cyril Burt and comprises children with mental ratios broadly between 65 and 80. If we took the whole group of children with mental ratios below 85, which would include all the dull and backward and all mentally defective children of whatever grade, we should find that it would comprise at least 10 per cent of the school population.

[page 157]

In the light of the foregoing facts and conclusions we make the following recommendations for the modification of the present system of education for mentally defective and retarded children, for the redistribution of the functions of Local Authorities and for the amending of the law.

1. NEW EDUCATIONAL UNlT

(a) We recommend that all those children hitherto known as educable mentally defective children and all those known as dull or backward children (as defined in Chapter VIII)* should be regarded as a single educational and administrative unit, and should be given a similar type of education adapted to their degree of retardation. We suggest that this unit should be known as the "Retarded" Group. (Chapter VI, para 106.)

(b) We further recommend that all these children, except of course those who are in need of immediate care and control under the Mental Deficiency Acts, be retained within the Public Elementary School system and that Local Education Authorities modify the organisation of the schools in their areas so as to provide suitable education for the whole group. (Chapter VIII, paragraphs 156-162.)

2. CERTIFICATION FOR PURPOSES OF THE EDUCATION ACT

(a) We recommend the abolition of the requirement that the Local Education Authority should certify a particular type of child as mentally defective as a necessary preliminary to providing him with the type of education he requires.

(b) This recommendation involves a modification of the legal status of Special Schools for mentally defective children, though the substance of these valuable institutions should be retained. The schools should become part of the general Public Elementary School system, with appropriate modifications of curriculum and organisation.

(c) As the special powers and duties of Authorities and parents with regard to these Special Schools would lapse, it would be necessary to give Local Education Authorities a general power to enforce attendance in the last resort of individual children at whatever school was best suited to their educational capacity: The Local M.D. Authority should also be given power to compel the attendance of children at suitable Day Schools or Centres.

(d) The abolition of certification must not be taken as in any way diminishing the obligation of Local Education Authorities to discover, classify and provide suitable education for all retarded children of whatever grade. (Chapter VII, paragraphs 138-141.)

*Paragraph 164.

[page 158]

3. ORGANISATION OF EDUCATION FOR RETARDED CHILDREN ON THE BASIS OF A BREAK AT THE AGE OF 11

(a) We understand that it is in accordance with the recommendations of the Hadow Report and the general trend of modern practice to make a break in the education of normal children at the age of 11. We consider that there are definite advantages in making a similar break in the case of retarded children both in the interest of these children and in order to bring this group into line with general educational administration.

(b) We recommend that, so far as practicable, separate classes or departments should be established for retarded children under 11, and that in all areas courses for retarded children over 11 should form an essential part of the Local Education Authorities' provision of Senior or Post-primary Schools. In the larger towns greater differentiation in classification will be possible, and we recommend that in addition to the establishment of separate classes or departments for the less retarded children under and over 11, Junior and Senior Schools for the more retarded, on the lines of existing Special Schools for the Mentally Defective, should be continued and extended. (Chapter VII, paras. 115, 120 and 121, and Chapter VIII, paras. 157- 159 and 161-162.)

4. ALLOCATION OF RESPONSIBILITY FOR MENTALLY DEFECTIVE AND RETARDED CHILDREN WHO CAN ATTEND A DAY SCHOOL OR CENTRE

(a) Younger children. Children under 11 years of age, who are able to attend a Day School or Centre, would be divided into two groups, a higher and a lower, in accordance with the standards set out in Chapter VIII.* The Local Education Authority would remain entirely responsible for the higher group, i.e. broadly the retarded group, but would notify those in the lower group - that is to say broadly those who are now classed as idiots and imbeciles, and those feeble-minded children who are in immediate need of public care or control - to the Local M.D. Authority. This latter Authority would be responsible for these children, but it would be the duty of the Local Education Authority, in return for payment by the Local M.D. Authority, to provide for their education and training at suitable Centres or otherwise, in such a way as, having regard to local conditions, may best meet their needs. (Chapter VII, paras. 116-119.)

(b) Older children. At the age of 11+ when the normal period of primary education ends, there will be a general survey of all children whether normal or retarded, with a view to determining the type of post-primary education to which each child should proceed. This survey with the necessary modifications, including appropriate medical and psychological examination, should be used

*Paragraph 163.

[page 159]

for sorting out the various groups of retarded children and determining what further children, being mentally defective, should now be transferred to the Local M.D. Authority. Those who are found to have made hitherto no substantial progress in scholastic or manual work, and are also found to require care and control under the Mental Deficiency Act, would be notified to that Authority who would become entirely responsible for their care, education and training.

While in the case of notified children under 11 the Local Education Authority would have the duty of providing for their education and training in return for payment by the Local M.D. Authority, in the case of notified children over 11 the Local Education Authority would have the power at the request of the Local M.D. Authority, but not the duty, to make such provision in return for payment. The arguments for and against thus differentiating in our recommendations in regard to the responsibility for notified children between those under and those over 11 years of age are fully explained in our Report. (Chapter VII, paras. 120-127.)

The notification of the lower group of children, whether under or over 11, if properly carried out in accordance with the standards and criteria indicated in our Report, will ensure that the children in the schools for the retarded group will not be brought into contact with low grade or detrimental children, whose presence has been a serious handicap to many Special Schools in the past. (Chapter VII, para. 128.)

5. ALLOCATION OF RESPONSIBILITY FOR CHILDREN WHO REQUIRE RESIDENTIAL OR INSTITUTIONAL TREATMENT

Those children who are of too low a grade to attend a Day School or Centre or are for other reasons unable to do so should be sent to Residential Institutions or Colonies, unless they can safely be left in their own homes. Residential accommodation should as a rule be provided by the Local M.D. Authority, though Local Education Authorities should be empowered to provide Boarding Schools for selected retarded children who are not likely to require permanent care and control. It should be open to either Authority to send children for whom they are responsible to institutions provided by the other Authority or by a Voluntary Body. The financial responsibility for notified children would rest with the Local M.D. Authority and that for non-notified children with the Local Education Authority. (Chapter VII, paras. 131-134.)

6. AGE LIMITS FOR COMPULSORY SCHOOL ATTENDANCE

On the assumption that the upper age limit for normal children will be raised to 15, there should no longer be any differentiation in age limits either upper or lower between normal children and those of the grade that has hitherto been certifiable as mentally defective under the Education Act. (Chapter VII, paras. 129, 130 and 135-137.)

[page 160]

7. CERTIFICATION FOR PURPOSES OF NOTlFICATlON TO THE LOCAL M.D. AUTHORITY

The Local Education Authority should retain the duty of certifying those children whom it is proposed to notify, and their power to notify a child should not be limited to those over 7 years of age, but should be co-extensive with the ages of compulsory school attendance and should apply to all children within these ages whether attending school or not. (Chapter VII, paras. 142, 143.)

8. CERTIFICATION OF FEEBLE-MINDED CHILDREN UNDER SECTION 1(c) OF THE MENTAL DEFICIENCY ACT, 1927

In order to remove any obscurity in the law the wording of this Section should be amended so as to make it clear that the educational criterion alone is not sufficient and that the criteria applicable to feeble-minded adults apply also to feeble-minded children. (Chapter VII, para. 140.)

9. MENTALLY DEFECTIVE CHILDREN UNDER THE CARE OF POOR LAW GUARDIANS

We recommend that all the relevant provisions of the Education and Mental Deficiency Acts, in so far as these do not now apply to mentally defective children who are in Poor Law Institutions or otherwise dealt with by the Guardians (or the Bodies that are to replace them), should be made to apply to them and that the fact that a child is mentally defective should automatically bring him within the jurisdiction of the Local Education or M.D. Authority, as the case may be. (Chapter VII, para. 144.)

10. MENTALLY DEFECTIVE CHILDREN CHARGED BEFORE A COURT AND IN HOME OFFICE SCHOOLS

(a) We recommend that the Local Education Authority should be consulted in all cases of children or young offenders brought before a Court under conditions rendering them liable to be sent to a Reformatory or an Industrial School, and that such children should be subjected to a special medical and psychological examination.

(b) We further recommend that all children in Home Office Schools in whose case there is reason to suspect mental retardation should be examined in the same way as retarded children in Public Elementary Schools, with a view to proper educational classification and action under the Mental Deficiency Acts if necessary. (Chapter VII, paras. 145-147.)

11. ASCERTAINMENT AND NOTIFICATION

Finally we would urge in the strongest terms that Local Education Authorities should leave no stone unturned in their endeavours to ascertain all children in their areas who are in need of care and control under the Mental Deficiency Acts and that they

[page 161]

should so organise their arrangements as to ensure that no child who requires such care and control should leave any school without having been notified to the Local M.D. Authority. Ascertainment and notification of all such children is fundamental to the successful functioning of the latter Authorities. (Chapter VII, paras. 120, 140 and 142.)

12. NEED OF FURTHER RESEARCH

We recognise that many of the problems which we have had under consideration require much further research before any final conclusions can be reached, and we recommend that special investigation and research be made particularly in regard to the causation and prevention of mental defect; the further elucidation of the difference of incidence of defect in urban and rural areas; the relationship between mental defect and other social problems; and the educational problems presented by the whole group of retarded children. (Chapter V, paras. 88-91, Chapter VIII, paras. 165-167).

169. Before concluding this Report the Committee wish to place on record their deep obligation to many persons who have helped them in their work.

As regards their Investigator, Dr, Lewis, the report which he prepared and which accompanies the Committee's own report, will speak for itself. The Committee would like however to express their own view that it is in every respect a document of the first importance. The data on which it is based were secured with great thoroughness in the face of great difficulties; they have been tabulated with extreme accuracy; and the general results of the inquiry have been described with a delightful lucidity. The Committee are profoundly indebted to Dr. Lewis for his work and they are confident that his report and his tables will be found a mine of useful information for many years to come by all who are concerned in the welfare of the mentally defective.

The Committee also desire to record their appreciation of the valuable work done by Miss S. Catherine Turner, as social investigator, and they heartily endorse the tribute to the value of her work paid in the covering letter which Dr. Lewis has addressed to the Committee with his report. The thanks of the Committee are also due to Miss M. O. Charlton and Mrs. N. Williams-Jones for their assistance as field-workers in some of the areas investigated.

They also wish to express their warm appreciation of the conscientious and valuable work done by Mrs. Lewis who not only acted as the Medical Investigator's personal Secretary throughout the whole investigation, but also herself took part in the preliminary selection of retarded and defective children in the schools.

[page 162]

The Committee feel that special thanks are also due to the public Authorities of the areas selected for the special investigation, both for allowing the investigation to be made in their areas and for the whole hearted support which they and their officers - and especially their teachers - gave to the investigators. The investigations could not have taken place at all without their concurrence; they could not have been so successful but for their skilled and courteous assistance.

The Committee are also indebted to the Board of Education for the clerical assistance placed at their disposal. In particular they wish to record their appreciation of the work of Mr. Sage, whose marked ability was of great help to them and to their Investigator in the preparation of the statistical tables and their application to administrative problems.

Finally to their Secretary the Committee wish to express their warmest thanks. Throughout their inquiry his work on their behalf has been as indefatigable as it has been of uniform excellence. The Committee are unanimous in the view that they could not have had put at their disposal an Officer better qualified for the difficult work that was expected of him.

ARTHUR H. WOOD (Chairman)
RALPH H. CROWLEY (Vice-Chairman)
CYRIL BURT
C. EATON
EVELYN FOX
ELLEN F. PINSENT
HILDA REDFERN
FRANK C. SHRUBSALL
A. F. TREDGOLD
F. DOUGLAS TURNER

N. D. BOSWORTH SMITH (Secretary).

[page 163]

It will be our purpose here to show in some detail the methods and calculations which have been adopted in estimating the extent of the provision required for mentally defective and retarded children of various grades, and in applying our proposals to areas of different types and sizes. These calculations, the results of which have been embodied in Chapter VIII, have been based almost entirely on the data relating to school children between the ages of 7 and 14. This group of children was most thoroughly and completely investigated, and we are consequently enabled to draw conclusions relating to the school population which we feel will be of considerable assistance to Local Education Authorities in applying our proposals to their own areas should our scheme be adopted.

We fully recognise, however, that this question of the organisation of education for defective and retarded children - involving, as it does, personal factors, psychological problems, questions of geographical distribution, communications, etc. - cannot be treated as if it were a simple problem of arithmetic. In discussing the possibilities of establishing Schools and Occupation Centres in different types of area, we have not lost sight of this consideration; but inasmuch as our estimates of the minimum sizes of urban and rural areas which will yield sufficient numbers of children of various grades to enable schools and centres to be established are perforce arrived at by arithmetical computation, the variations which will naturally occur from area to area scarcely warrant our figures being regarded as invariable standards to be applied indiscriminately to individual areas. We believe that they are fairly representative of the country as a whole; but it must again be emphasised that the areas which are described in this Appendix and in Chapter VIII as "urban" and "rural" can only be regarded as areas typical of their kind, and that in assessing the actual requirements of any one particular area, more especially if this should contain both urban and rural districts, it will be necessary for the Local Authority to apply our figures in the light of their knowledge of local conditions.

We have seen in Chapter V that the incidence of mental defect as revealed by the Committee's investigations differs widely in urban and rural areas. It is necessary therefore to consider these two types of area separately. We have adopted the census classification of districts; the "urban" areas are composed of the County Boroughs, Municipal Boroughs and Urban Districts, and the "rural" areas include all Rural Districts. Many Local Education Authorities' areas do not, of course, correspond with this classification, and in these cases it may be necessary for the Authority to determine, from their knowledge of local conditions, what modification of our incidence figures is necessary in order that they may be applied with reasonable accuracy to the area in question. Of course, if the population in an area of this kind can be divided with any degree of certainty between urban and rural districts, the appropriate incidence figures can be applied separately.

As we have already stated, our calculations are based on findings in respect of mentally subnormal children between 7 and 14 years of age who were included among the "school population".* Apart from these children

*For a definition of the" school population" see Footnote (*) to Table 1 in Appendix A of the Investigator's Report.

[page 164]

however, there are groups who attend preparatory or private schools, and there are also some in Poor Law Schools or Institutions or not attending school at all. The incidence of defect among the preparatory and private school children at any rate is no doubt considerably lower than that among the "school population"; but the lower rate of incidence in this group is probably more or less counterbalanced by the higher rate prevailing among the other groups of children outside the school population. However this may be, we are here considering administrative questions, and for this purpose we think that conclusions based on the numbers of defectives found among the school population will fairly represent the practical problems with which Local Authorities will be confronted.

The school population between 7 and 14 does not, however, include the whole age range of children with whom Local Education Authorities will have to deal. We have assumed for the purposes of our scheme that the normal school age will in future range from 5 to 15; and in order to estimate the numbers of children in the extended school population of the investigated areas we have increased the numbers given in Column (3) of Table 1 by one-ninth so as to include the children between 14 and 15. Similarly, to find the proportion which the school population between 5 and 15 will bear to the total population of England and Wales, we have taken the actual numbers of children whose names were on the registers of Public Elementary and Special Schools on 31st March, 1927, between the ages of 5 and 14, and have increased this number by one-ninth. The number thus arrived at is almost exactly 15 per cent of the total population of England and Wales in July, 1927, as estimated by the Registrar-General. In considering the size of town or rural district in which different types of schools and centres could be established, we have therefore assumed that the school population will be approximately 15 per cent of the total population, though we recognise, of course, that the proportion will vary in different areas. It may be mentioned also, as has recently been pointed out by the Board of Education,* that the number of pupils under 11 will increase and that of pupils over 11 will decline until 1930; the number of older pupils will then rise until 1933, in which year it is estimated that there will be 185,000 more pupils between 11 and 14 in the Public Elementary Schools than there are at present. These fluctuations in the school population will affect to a certain extent our estimates of the minimum sizes of areas in which Centres and Schools can be set up.

We will turn now to a more detailed explanation of the methods employed in estimating the numbers of defective and retarded children falling to be dealt with under our scheme and the minimum sizes of typical areas, the results of which are embodied in Chapter VIII. So far as mentally defective children are concerned, we have based our calculations on the data given in Tables 14 and 18 (A) and (B) in Appendix A of the Investigator's Report. Table 14 shows in respect of the investigated urban and rural areas, the actual rate of incidence of each of the three grades of mental defect in children between 7 and 14 years of age ascertained among the school population; Table 18 (B) gives particulars of the mental ratios of children ascertained at each year of age between 5 and 15, while the numbers of children whose mental ratios were not determined are given in the lower part of Table 18 (A). The figures in these latter Tables include a small number of children other than those ascertained among the school population; we shall, however, be making use of these Tables only so far as they relate to feeble-minded children,

*See the Board's Circular 1397, issued on 18th May, 1928, and their Educational Pamphlet No. 60 on "The New Prospect in Education". Reference should also be made to the report of the Government Actuary enclosed with the Board's Circular 1395 of 23rd January, 1928.

[page 165]

and in fact the numbers of such children between the ages of 7 and 14 ascertained outside the school population were too small in proportion to all the feeble-minded children ascertained between those ages to affect our results to any appreciable degree.*

Our scheme contemplates the establishment of schools and classes not only for children who under the present system could properly be certified as mentally defective under the Education Act (that is to say, the children who were classified as feeble-minded in our investigation), but also for large numbers of dull and backward children. The figures given in Dr. Lewis' Report do not extend to children of a higher grade than the "feeble-minded", that is, to children with mental ratios up to 65 or 70.† For retarded children of a higher grade, Professor Cyril Burt has kindly supplied us with the results of extensive investigations carried out by him in London and Warwickshire relating to children with mental ratios up to 80. The data of these two independent investigations have been amalgamated, and from them we have been able to compile Table A, which shows the approximate distribution of mental ratios below 80 per cent among the general school population.

The percentages given in this Table will, we believe, apply with a reasonable degree of accuracy to typical urban and rural areas and to the whole school population of the future, that is to children between the ages of 5 and 15.

We may now proceed to show, by means of a few detailed examples, the statistical methods which were employed in estimating the incidence rates and minimum sizes of areas for various groups of children which have been given in Chapter VIII of our Report and are summarised in Tables (B) and (C) at the end of this Appendix.

The following calculations refer only to children who are left in the general community. The provision of institutional care is discussed in Chapter 5 of the Investigator's Report.

*Out of 1,630 feeble-minded children ascertained between 7 and 14 only 23, or less than 1½ per cent, were outside the school population.

†See Table 18 (B) and the discussion of this Table in Chapter 4 of Dr. Lewis' Report, pages 99-101.

‡A chart based on the data in this Table appears on page 169 of this Appendix.

[page 166]

(a) Occupation Centres

In discussing the applicability of our scheme to areas of different types and sizes, we propose to deal only with those lower grade children who can attend a day centre. Most, if not all of the idiots, and a proportion, which we will take to be about one-half,* of the imbeciles, will require to be sent to Institutions. Therefore, in any given urban or rural area the incidence per 1,000 school population represented by imbeciles for whom provision should be made in day centres will be approximately one-half that given in Table 14 (C). These incidence rates will have to be applied to the new school population from 5 to 15 years of age, which we assume to be the normal period of compulsory school attendance in the future.

To estimate the provision required for children under and over 11, it is necessary to arrive at a reasonable method of splitting up the incidence figures in question so as to get separate rates of incidence for the age-groups 5 to 11 and 11 to 15 respectively. We cannot adopt the simple expedient of apportioning the figures between younger and older groups in the proportion 6:4, because the numbers of imbecile children ascertained by Dr. Lewis varied appreciably according to their age, the rate of ascertainment in the older group being considerably higher than in the younger. Actually, 177 imbeciles were ascertained between the ages of 5 and 11, and 166 between 11 and 15. We think, therefore, that the division of the incidence rates in Table 14 (C) between the two groups should be based upon the relative proportion of the actual numbers of imbeciles ascertained in each of these groups. Applying this method, we find that after allocating one-half of the group to Institutions, the estimated rate per 1,000 total school population represented by imbeciles between 5 and 11 for whom provision should be made in Occupation Centres is 0.78 in urban areas and 1.24 in rural areas. The corresponding rates for the 11 to 15 group of imbeciles are 0.73 for urban areas and 1.17 for rural areas. On the basis of these rates of incidence the smallest urban area in which an Occupation Centre for 10 imbecile children between the ages of 5 and 11 could be established will be one containing a population of (10 x 1000/0.78 x 100/15) approximately 85,000 persons,

The next group referred to in Table B is that of children between 11 and 15 years of age with mental ratios below 55. We have already estimated the rate per 1,000 school population represented by imbeciles between the ages of 11 and 15 who will be suitable for training in Occupation Centres to be 0.73 in urban areas and 1.17 in rural areas, and to these must be added similar rates for the lower grade feeble-minded children of the same age with mental ratios between 50 and 55. Table 18 (B) gives the numbers of children ascertained between the ages of 5 and 15 together with their mental ratios, and we may safely assume that all children shown in this table to have ratios of over 50 were feeble-minded. It will be seen from this Table that the numbers of children aged 14 to 15 were considerably lower than in any single year in the 11-14 group. In order therefore to obtain a more accurate estimate of the actual numbers of feeble-minded children between the ages of 11 and 15 in the investigated areas, we will assume that the number in the 14 to 15 group was equal to one-third of the total number found in the 11-14 group. This gives us 69 children with mental ratios between 50 and 55 in the urban areas and 89 in the rural areas. A certain proportion of these children will, however, be more suitable for teaching in Residential Schools than in Occupation Centres, and the figures given in Table 24 (3) indicate that the numbers of such children will be about one-fifth of all the feeble-minded children ascertained. We will, therefore, reduce the numbers given above by one-fifth, which leaves us with 55 children in the urban areas and 71 in the rural areas, representing respectively 0.97 and 1.63 per 1,000 total school population.

*This assumption is broadly substantiated by the figures in Table 25 (A).

[page 167]

We find, therefore, that when this group of feeble-minded children is added to the imbeciles between 11 and 15, the estimated rate per 1,000 school population represented by children with mental ratios under 55 who may be deemed suitable for training in Occupation Centres for older children will be about 1.70 in an urban area and 2.80 in a rural area. This means that in order to find 10 children of this grade we should require an urban area containing a total population of (10 x 1000/1.70 x 100/15) approximately 40,000 persons. In a rural area a population of about 24,000 persons would be necessary.

The more general scheme that we contemplate, however, is that provision will be made for younger and older children together. If similar calculations are made in respect of this composite group, consisting of children between 5 and 11 with mental ratios under 50 and children between 11 and 15 with mental ratios under 55, we find that an Occupation Centre for ten children can, so far as numbers go, be established in an urban area with a population of 27,000 and in a rural area containing some 16,000 inhabitants.

(b) Classes and Schools for Retarded Children

Here we are concerned with children between the ages of 7 and 15. The school population between the ages of 7 and 14 in the areas which were investigated is shown by Table 14 to be 37,743 in the urban areas and 28,637 in the rural areas. We will assume for the purpose of these calculations that the school population from 7 to 15 under the new system would be 8/7ths of these numbers, and that this population would be equally divided between the age-groups 7 to 11 and 11 to 15. This latter assumption may perhaps not be quite accurate at present, but it should be approximately correct when the birth-rate has attained some measure of stability.

The first group referred to under (2) of Table B is that of children between 7 and 11 years of age with mental ratios between 50 and 80. The method of arriving at an estimate of the proportion which this group of children bears to the total school population, together with the minimum population in urban and rural areas which will be necessary to yield sufficient numbers of feeble-minded and retarded young children, is as follows.

The percentage of children in urban areas with mental ratios between 50 and 70 is shown in Table A above to be 1.84. From this we will deduct one-fifth as representing the proportion of feeble-minded children who will need to be sent to Residential Schools. Adding the percentage for the 70-80 group (4.64) we get 6.12 per cent as the total for the whole group who may be deemed suitable for junior retarded schools or classes.

The school population between the ages of 7 and 11 in the investigated urban areas we will, as stated above, take to be (1/2 x 8/7 x 37,743) approximately 21,570. 6.12 per cent of this equals 1,320. The estimated school population between 5 and 15 in the investigated urban areas is (50,889 x 10/9) say 56,540. In other words, in a school population of 56,540 children we find 1,320 feeble-minded and retarded children between the ages of 7 and 11. On this basis therefore 23.35 out of every 1,000 children in the total school population in an urban area may be expected to prove suitable for instruction in junior schools or classes such as we contemplate.

The method of arriving at an estimate of the minimum total population of an urban area which may be expected to yield a sufficient number of children of this group to establish a class of 20 now becomes similar to that adopted in the case of occupation centres. The population of the urban area in question may be estimated at (20 x 1000/23.35 x 100/15) approximately 5,700.

Similar calculations to those detailed above have been used in assessing the sizes of areas necessary for the other group of children shown in (2) of Table B.

[page 168]

[page 169]

[foldout sheet following page 169]