Читать книгу Deficiency and Delinquency: An Interpretation of Mental Testing - James Burt Miner - Страница 22

The Social Isolation Group. We are now ready to consider some of the important estimates which throw light upon the reasonableness of the percentages we have named. First, what percentage would we be justified in socially isolating? In the United States Census Report on the Insane and Feeble-Minded in Institutions in 1910, we find that the number then actually in institutions for feeble-minded was only about 0.02% of the population. At the most frequent ages this rises to about 0.05%. It is evident that the number actually isolated is of little significance except as a check on the estimates. The report, however, refers to the special estimate made by the public authorities in Massachusetts which also included feeble-minded in state hospitals for the insane, other asylums, those reported by the overseers of the poor and those enumerated in the general population. The U. S. report says: “The census was not regarded as being complete, but it is of interest to note that if the number of feeble-minded in proportion to the total population was the same for the entire United States as it was in Massachusetts according to this census, the total number of feeble-minded would be over 200,000. Probably this may be regarded as a conservative estimate of the number of feeble-minded in the United States and would indicate that not over one-tenth of the feeble-minded are being cared for in special institutions” (205, p. 183). This estimate, which thus amounts to about 0.2%, may probably be considered as a reasonable program of expansion from the institutional viewpoint. The diagnostician who is considering the individual and not the mass must supplement it by considering who should be isolated if facilities were available. If the census bureau can contemplate institutional care for ten times those at present thus provided for, it gives us some indication of a reasonable limit as to the increase in institutional care that can be assumed to be reasonably contemplated at present.

Dr. W. D. Cornell, director of medical inspection of the Philadelphia public schools, after the personal examination of those cases which in the opinion of the teachers should be sent to institutions, places the “institution cases” at a minimum of 15 per 10,000 school children. He adds: “The number of evidently feeble-minded above 6 years of age may be said to be 1 to every 500 of the population. These figures are conservative and have been accepted by experts for years.” This then is the minimum estimate and quite clearly refers to institutional cases.

A committee of the Public School Alliance of New Orleans, of which Prof. David Spence Hill was chairman, reported in 1913 a careful census of the public school children in that city the previous year made by the teachers in co-operation with the Newcomb Laboratory of Psychology and Education. Each teacher was asked to state her opinion as to how many in her room were “feeble-minded or insane children who should be under institutional or home care, rather than in the public schools.” Also the number of backward children not in the above class “who urgently need special educational methods in special classes within the special schools.” About a fifth of the total of the 38,000 school children in the city are colored. The grand total showed 0.28% in the first class mentioned above, and 7.7% in the second. Speaking of those “thought by teachers to be feeble-minded” and needing institutional care the report says:

“The figure 0.28 of 1% coincides exactly with the estimate of the Philadelphia Teachers' Association made in 1909 in a census of 150,000 school children. Secondly, while the teacher's estimates are open to revision, nevertheless her judgment, as inevitably evidenced in her attitude toward the child, is the practically effective judgment” (157, p. 6). It is a well-known fact that teachers tend to underestimate the frequency of mental deficiency, so that it would certainly be a matter of regret if this were to continue to be the “practically effective judgment.”

Another census of the institutional type of feeble-minded made by the Director of Public Health Charities in Philadelphia and reported in 1910 enumerated 0.2% of the population as in this group. It included cases in the institutions for feeble-minded, the insane hospitals, almshouses, hospital, reformatories, orphanages and known to charity workers (168, p. 13).

One of the most careful surveys of individuals who, because of mental abnormalities, show such social maladjustment as to become the concern of public authorities was made under the auspices of the National Committee for Mental Hygiene in 1916.^[5] It selected Nassau County as representative of New York state. Part of the survey consists of an intensive house to house canvass of four districts of about a thousand population each. The result disclosed that 0.54% of the population of this county were socially maladjusted because of “arrests in development” and 0.06% more, because of epilepsy. This was in a population of 115,827.

The Children's Bureau in the U. S. Department of Labor in 1915 made a census of the number of “mental defectives” in the District of Columbia. The census included only those whom we have termed feeble-minded. The report states that 798 individuals, 0.24% of the population, were found to be “in need of institutional treatment; and the number reported, allowing for the margin of error in omission and inclusion, is probably a fair representation of the number in the District who should have custodial care” (88, p. 13). Over a quarter of the population of the District is colored. The census was taken in connection with plans for immediate care. The same Bureau also made in 1915 and 1916 a Social Study of Mental Defectives in New Castle County, Delaware.^[6] This county had a population of 131,670 and the survey disclosed 212 “positive cases of mental defect” and 361 “questionable cases,” a total of 0.44% of the general population in this county. Among the positive cases, 82.5% were in need of public supervision or institutional care. Among the questionable cases, information was obtained about only 175, and 165 of these were either in institutions, delinquent or uncontrollable, or living in homes where proper care and safeguarding were impossible.

Two other important attempts to enumerate carefully all the feeble-minded in definite areas in the United States have been made in recent years. Lapeer County, Mich., was chosen for such a study, as it was of average size and contained no large city. The census as reported in 1914, showed 36 feeble-minded from that county in the state institution and 116 others living in the county, a total of 1 from every 171 inhabitants (145). A special children's commission was appointed by the state of New Hampshire to investigate the welfare of dependent, defective and delinquent children. Its report in 1914 contained a section by its chairman, Mrs. Lilian C. Streeter, on feeble-mindedness (40). This comes the nearest to a complete enumeration for an entire state which has ever been attempted. The commission tested with the Binet scale the inmates of the State Hospital for the Insane, the County Farms, the State Industrial School and the Orphanages within the state. The borderline which it used for the scale was high. It counted all those testing three or more years retarded and under XII as feeble-minded. Taking its figures as they stand we find that they listed 947 as feeble-minded in institutions and 2,019 outside, a total of 0.69% of the inhabitants of the state. Outside the institutions the commission sent a questionnaire to all school superintendents and to chairmen of school boards, physicians, overseers of the poor, county commissioners, probation and truant officers, district nurses and charity workers throughout the state, by which means they listed 792 additional cases. This questionnaire gave the following description of the type of case it was trying to list as feeble-minded.

“The high grade imbecile, frequently known as the moron, is one who can do fairly complicated work without supervision, but who cannot plan, who lacks ordinary prudence, who cannot resist the temptations that are common to humanity. The high grade imbecile is most dangerous because, except to the expert, he is apparently not feeble-minded and is, therefore, usually treated as normal, and permitted to multiply his kind, and to corrupt the community.”

This description would tend to include cases above our isolation group. Besides the questionnaire the commission made an intensive study of 52 towns in which it says practically complete census returns were obtained by consulting doctors, school and town officials. With these supplementary cases it secured a list of 2,019 cases outside of institutions, making a total of 2,966 recorded cases within the state or 0.69% of the population. When it estimated the proportion for the entire state on the basis of the rate of canvass returns to questionnaire returns, this proportion rose to 0.95%. The commission does not advocate compulsory isolation for all of these people although it recommends custodial care for the feeble-minded women and girls of child-bearing age, apparently of the degree of deficiency represented by its criteria. This enumeration of 0.69% of the people of a state as feeble-minded is the most liberal general census of the feeble-minded in any large area. It clearly shows the trend of diagnosis since the British Census.

The Extension Department of the Training School at Vineland, N. J., states regarding estimates of the number of feeble-minded in the general population: “Conservative estimates give one in three hundred as the probable present number.” Under the discussion of estimates of the general population I have already cited Goddard's estimate which was approximately 0.3 to 0.4% and the enumeration of 0.4% by the British Royal Commission in 16 districts with over two million population. While all of these estimators are speaking broadly of the feeble-minded, in the general population, we shall not be far wrong in supposing that they are considering mainly those deficients for whom the state might well expect to provide care for life, isolating all those who cannot be eugenically guarded at home. We shall later quote the estimate of Van Sickle, Witmer and Ayres of 0.5% of the school population as “institution cases.”

Our estimate of 0.5% in the group justifying isolation on the ground of intellectual deficiency seems to be conservative and to harmonize fairly this type of estimate.

The Social Assistance Group. Passing now to the next higher group of deficients, those needing special training in order to get along with social assistance, the estimates have been based almost entirely upon the study of school children. Francis Warner was the moving spirit in the early investigations in Great Britain, which were made without tests from 1888 to 1894. The census which he directed included about 100,000 school children who passed in review before medical examiners. As cited by Tredgold (204) the estimate growing out of this work was that 1.26% of the school population should have instruction in special classes. Of these 0.28% required special instruction because of physical defects only (204).

About the same time Will S. Monroe (155) on the basis of a questionnaire sent to California teachers, who reported on 10,842 school children, found that they estimated 1,054 of these as mentally dull in school, 268 feebly gifted mentally, and 6 imbeciles and idiots. He summarized his conclusion as follows: “A long experience teaches that every school of fifty pupils has at least one child that can be better and more economically trained in the special institutions than in the public schools.” In his estimate of 2% he was probably thinking of care in special local schools and not permanent isolation.

A government inquiry of school teachers in Switzerland, who had charge of 490,252 school children, reported that 1.2% were so feeble mentally as to need training in special classes. Only about a tenth of this number were then being instructed in separate classes (181, p. 17).

Great Britain first gave legal recognition to the class of feeble-minded above the imbeciles in its Education Act of 1898, following a report of a departmental committee of its National Board of Education growing out of the inquiries of Francis Warner. This committee estimated the proportion of this class as approximately 1% of the elementary school population (181). In discussing the comparative estimates on the general and school populations I have already referred to the estimate of Tredgold based upon an elaborate analysis of the most extensive data ever collected,—that gathered by the British Royal Commission on the Care and Control of the Feeble-Minded. While the Commission's investigators enumerated 0.79% among the school as mentally defective, Tredgold's estimate based on his analysis of their report was that 0.83% of the school population in England and Wales were above the grade of imbecile but still feeble-minded (204, p. 157). The variability of the estimates collected by the Royal Commission from various cities probably indicates the subjective character of the standards of deficiency. They varied from an estimate of 0.24% of the elementary school population in Durham to 1.85% in Dublin (204, p. 159). The Commission says regarding estimates as to communities other than those reported by their medical investigator, for Newcastle the “number of feeble-minded children of school age” (morons) was 0.25%, for Leeds the estimate was 0.80%, for London 0.50% or 0.60%, for Bradford 0.50%, for Dublin about 1% and for Birmingham about 1% of the school population. Dr. Francis Warner's general estimate was 0.8%. We have thus variations in estimates from 0.25%, 0.5%, 0.80% to 1% and some 2% (167, p. 90). For the rural areas the estimates were generally less.

A careful estimate has been made with a different method by Karl Pearson on the basis of a classification by teachers of school children in Great Britain into nine different classes each especially defined and extending from the imbecile to the genius. This distribution of the children was then fitted to the normal probability curve. On this basis Pearson estimated that 1.8% would fall in the “very dull group,” defined as having “a mind capable of holding only the simplest facts, and incapable of grasping or reasoning about the relationship between facts; the very dull group covers but extends somewhat further up than the mentally defective.” Lower down would be 0.1% in the imbecile group. He says further regarding this estimate: “It is deduced from three series covering between 4000 and 5000 cases, and the three separate results are in several accord. It will, I think, be possibly useful for other inquirers, and it endeavors to give quantitative expression to our verbal definitions of the intellectual categories” (166).^[7]

In 1914 Pearson cites estimates of mentally defective children in several cities by teachers and medical officers based upon the recommendation of elementary school children for special schools and classes. These were, for London: boys, 1.59%; girls, 1.09%. For Liverpool: boys, 0.827%; girls, 0.618%. The corresponding figure for both sexes in Stockholm is 1.23%. He concludes that “something between 1% and 2% is true for England. Dr. James Kerr, Medical Research Officer, thinks that the final estimate will be nearer the latter value.”

After giving a table of the percentages at each age in the elementary schools of Stockholm, Pearson says: “Judged from this table it would seem that the most reasonable estimate of the prevalence of mental defect is to be formed when all the mental defectives have been definitely selected and the normal children have not yet begun to leave school, i. e., at the ages 11 and 12. For Stockholm this leads up to a mentally defective percentage of about 1.5” (167, p. 6-8). In another place he says that the members of special classes are selected practically for the same reason, i. e., because they are school inefficients, the bulk of whom will, no doubt, unless provided for become “social inefficients” (164, p. 48). Since some were not selected because of intellectual deficiency, our social assistance group should be somewhat smaller.

In 1909-10 the actual number in the schools for mental defectives maintained by the London County Council was 0.9% of the enrollment of the London elementary Schools (143). The 1912 report of the London County Council shows 7357 children enrolled in its local schools for mental defectives, which is 1.1% of the average attendance from 1912-1913 in the elementary county council schools and voluntary schools of London (144, p. 44).

Following a discussion in the Australian Medical Congress of 1911 the Minister of Public Instruction called for returns as to the number of feeble-minded in the Australian public elementary schools between 5½ and 14 years of age inclusive. The questionnaire used the definitions of the British Royal Commission as a description of the various degrees of retardation and brought returns from 2,241 of the state schools, all except 57. For their average attendance of 175,000 children, these teachers classified 1.9% as backward from accidental causes, 2% mentally dull, 0.42% feeble-minded imbeciles or idiots, and 0.6% epileptics. To this would be added 0.19% for children in the idiot asylums. The report states that “the teachers' estimates will thus be realized to be an absolute minimum, dealing only with the intermediate grades, and not including the gross cases (idiots, etc.) on the one hand and the less marked high grades of feeble-minded on the other” (70).

The census made by the Bureau of Health of Philadelphia through the principals of schools in 1909 covered 157,752 elementary school children of whom 1.9% above the 0.28% who could “properly be in custodial institutions 'were classed' as backward children who require special instruction by special methods in small special classes” (168).

A survey of the school population in the Locust Point District of Baltimore was made by Dr. C. Macfie Campbell.^[8] The district surveyed was, however, not considered typical of Baltimore, but was a sample of an industrial district in which the majority of families are “close to the poverty line, and too often below it.” Out of a school population of 1,281 children, 166 (13%) were “found to have special requirements on account of their mental constitution.” Among these, 22 (1.7%) “showed a pronounced mental defect, which eliminated any prospects of their becoming self-supporting.”

The city of Mannheim (147), which perhaps cares for its exceptional children better than any other in the world, was in 1911-1912 caring for 0.7% of the children in its Volkschule in Hilfsklassen which do not take them beyond the fourth grade. There were 12% more who were backward in school and being taught in Forderklassen where they may reach the sixth grade. Including the exceptionally bright who were also in special classes, 18% all together of its school children were not in the regular Hauptklassen of the eight grades. To these would be added those sent to special institutions. When we estimate, therefore, that we are justified at present in sending 1% of the children in school to special classes because their intellectual deficiency is such that the bulk of them cannot get along without social assistance, we are naming about the proportion already thus cared for in several foreign cities.

Among the authoritative estimates of the number of feeble-minded, which have been made by estimators who had in mind the evidence from mental tests, is that made by James H. Van Sickle, Lightner Witmer, and Leonard P. Ayres in a bulletin published by the United States Bureau of Education in 1911 (209). They state that, “if all children of the public schools could be ranked, it is probable that a rough classification would group them about as follows—Talented, 4%; Bright, Normal, Slow, 92%; Feeble-Minded, 4%. The 4% may for administrative purposes be divided into two groups. The lower one includes about one-half of one per cent. of the entire school membership.... They are genuinely mentally deficient, and cannot properly be treated in the public schools. They are institution cases, and should be removed to institutions. Ranking just above these are the remaining three and one-half per cent. who are feeble-minded but who could be given a certain amount of training in special classes in the public schools.” The estimate of institutional cases practically coincides with that adopted above in this paper. The extension of the term feeble-minded to include the lowest 4% seems to be extreme. The authors do not suggest what portion of these they think might require social assistance indefinitely, but are interested primarily in provision for special classes in the public schools. If the term feeble-minded were to mean only unfit for regular school classes and not socially unfit, I have already suggested that the limit for special instruction might be increased indefinitely. In Mannheim 18% are not cared for in the regular classes.

The only estimate of feeble-minded which I have found that is so large as this 4% is that of Binet. It is also intended to cover all cases that should be sent to special classes regardless of subsequent social survival. His statement as to those who are so abnormal or defective as to be suitable for neither the ordinary school nor the asylum is as follows:

“As to France, precise information has not been available until the last year, when two inquiries were held—one at the instance of the Ministerial Commission, the other organized by the Minister of the Interior. According to the former inquiry we find that the proportion of defectives amounts to scarcely 1% for the boys, and 0.9% for the girls. These percentages are evidently far too small, and we ourselves have discovered, by a small private inquiry, that many schools returned “none” in the questionnaires distributed, although the headmasters have admitted to us that they possessed several genuine defectives. In Paris, M. Vaney, a headmaster, made some investigations by the arithmetic test, which we shall explain presently, and reached the conclusion that 2% of the school population of two districts were backward. If we were to include the ill-balanced, whose number is probably equal to that of the backward, the proportion would be about 4%. Lastly and quite recently a special and most careful inquiry was made at Bordeaux, under the direction of M. Thamin, by alienists and the school medical inspectors, and it was found that the percentage of abnormality amongst the boys was 5.17. Probably the true percentage is somewhere in the neighborhood of 5. All these inquiries are comparable because they deal with the school population” (77, p. 8).