Infirmities
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The total number of persons returned as afflicted by blindness was 22,832, being in the proportion of 879 to a million of the population, or one blind person in every 1,138. The proportion of the blind to the population has decreased with each successive enumeration since 1851, in which year account of them was taken for the first time; but the decrease in the decade ending in 1881 was much greater than in either of the preceding decennial intervals. This decrease may be fairly attributed to the progressive improvement in the surgical treatment of affections of the eyes, and to the diminished prevalence among children of such diseases as small.pox, to which a not inconsiderable amount of blindness was formerly due. The extent of the decrease may be stated in the following form. Had blindness been as common an affliction in 1881 as it was in 1851, there would have been 26,523 blind persons in the country instead of 22,832, or 162 per cent. more than there actually were. Of the blind, 12,048 were males and 10,784 were females, being in the proportion of 953 males and 809 females per million living of each sex. Thus one in every 1,049 males was blind, but only one out of every 1,237 females. In each of the four censuses in which account of the blind has been taken, the affliction has been found to be much more common among males than among females. This is what might have been anticipated, considering the differences between the two sexes in regard to their occupations, their exposure to accidents, and their liability to disease. This natural anticipation is, moreover, confirmed by the statistics of most other countries concerning which we have the necessary data. It is curious, therefore, to note that in Ireland the contrary was found to be the case, both in 1881 and in previous enumerations; and, further, that in this respect Ireland agrees with Finland and the Scandinavian countries in the north of Europe, and differs from the southern parts of Europe. This is shown in the following table:— BLIND PER MILLION LIVING OF EACH SEX
The proportion of the blind to the population of the same time of life in England and Wales increases rapidly in the successive age-periods, as is shown in the following table; and at each age-period, excepting the last, the male proportion is considerably higher than the female. That the female rate is exceptionally higher than the male in the last age-period, 65 years and upwards, is to be explained, at any rate in part, by there being many more extremely old persons, say of 85 years and upwards, among the females than among the males. The apparent irregularity in the series of rates would probably disappear were it possible to subdivide this age-period into smaller sub-periods.2
BLIND per MILLION of corresponding Ages.
Among the 22,832 blind persons enumerated were 1,958 who, according to the returns (see
Vol. III., Summary Table 14), had been "blind from birth." This term, however, must be interpreted as including not only those who literally answered such description, but those also who had lost their sight at a very early period of life; for it appears to be an excessively rare thing for an infant to be actually blind at the time of birth. It has been thought well to give a separate account, (see
Vol. III., Summary Table 18), of these persons who either never saw or lost their sight before their education began, because it is a matter of some interest to know what occupations are open to persons thus heavily weighted in the race of life. Here and of the blind, there a person thus afflicted, compensating the want of vision by increased attention to the indications of the other senses, learns to follow occupations that at first seem incompatible with his or her condition. One such man, for instance, was returned as ostler in an inn, and another as engaged in sea fishing.3
But, putting such exceptional cases aside, the occupations open to those who have been blind from infancy are very few. Among such of these blind as were 15 years of age and upwards, only 51 per cent. of the males and 19 per cent. of the females were returned as following any definite occupation, whereas out of the whole population of England and Wales of the corresponding age the proportion occupied was 94 per cent. for males and 37 per cent. for females. Of the 436 with definite occupations, 110 were musicians, including seven piano-tuners; basket-making gave employment to 95, brush and broom making to 25, mat-making to 23, and chair-caning to 14; the knitting of stockings or other hosiery occupied 44 persons, all women; 19 were agricultural or general labourers, and 18 wore street hawkers, leaving only 88 engaged in all other specified occupations. The table (Vol. III., Summary Table 17) which gives the occupations of the blind generally, irrespectively that is of the age at which the blindness occurred, shows a great variety of employments. This table, however, is not of much practical value, for the returns on which it is based did not allow of any separation between occupations carried on by blind persons and occupations followed by such persons previously to their loss of sight. The term "deaf and dumb" is used in the census returns in its popular meaning, that is to say, as comprising not only such persons as are absolutely without hearing and without speech, but also those persons who, though they might be vaguely conscious of loud noises made close to their ears, have yet from their birth, or from early childhood, been so deficient in the sense of hearing as to be unable to acquire articulate speech in the ordinary way. The returns, moreover, doubtlessly include a considerable intermixture of persons who had at first sufficient hearing to acquire speech, but who became deaf before they had firm hold on the faculty of articulation, and in consequence lost it completely. Possibly also there may be a few persons in the returns who, though completely deaf from infancy or childhood, have yet been taught to articulate by the modern method of instruction. The directions given to the clerks employed in the abstraction were to include all persons returned as "deaf and dumb" or as "dumb" only, and also those returned as "deaf" who were inmates of deaf and dumb institutions. All other persons returned only as "deaf" were to be omitted. There is no reason to suppose that the returns of the deaf and dumb were vitiated, as were those of idiots and imbeciles, by distinctly wilful omissions. But there can be no doubt that here also many excusable omissions were made in the first age-period, that is among children under five years of age. Parents are often not aware of the deafness of their infants; and, even when an impartial observer would have no doubt as to the fact, the parent not unnaturally hopes on against hope, and will not publicly acknowledge as a fact what he as yet refuses to accept as a certainty even to himself. There are two modes of meeting this deficiency in the returns: either we might ignore altogether the first age-period, and confine ourselves to the statistics relating to persons over that age, a method which, though it would not serve for estimating the absolute numbers of deaf and dumb, would of course be sufficient, if adopted universally, for purposes of comparison between different countries or different parts of a country; or secondly, we might suppose that the proportion of deaf-mutes under five to all children of that age was the same as the proportion in the next age-period 5 and under 15 years, in which the returns are probably fairly correct. This would enable us to estimate approximately the absolute number of deaf-mutes in the country but requires us to admit, what is probably not the case, that deaf-mute children are as likely to live as other children, and also ignores the fact that some few children become deaf, and in consequence dumb, after their fifth year.4
Still these two defects in the proposed method of estimation operate in different directions, and tend to neutralise each other; so that probably the method will give us a tolerable approximation to the actual facts. We shall, therefore, adopt this method. The total number of deaf-mutes enumerated was 13,295; of whom only 498 were under five years of age, being in the proportion of 141 per million children at that age, whereas the proportion in the next age-period, 5 and under 15 years, was 590 per million. Correcting the numbers in the first age-period, so as to get this same proportion, we have 2,077 probable deaf-mutes under five years of age, and a total of 14,874 at all ages. This is in the proportion of 573 deaf-mutes per million persons enumerated, or one in 1,746 persons. The proportion in 1871, after similar correction for the first age-period, was 572 deaf-mutes per million persons enumerated, or one in 1,748. It appears, therefore, that the proportion of the population suffering from deaf-mutism remained practically unaltered in the interval between the two last censuses. It by no means necessarily follows from this, that no improvement took place in regard to the infirmity in question in the course of the decade. Though at first it looks like a respect of paradox, yet it is plainly true that an increased proportion of deaf-mutes to the total population might really betoken an improvement; for it might be due merely to increased longevity among the deaf-mutes as compared with the rest of the population. If to such supposed increased longevity there were also superadded a diminished production of fresh deaf-mutes, a double improvement would have been effected, and yet the rate might remain practically unaltered. Fewer deaf-mutes would have been added to the register at the one end, but fewer would have disappeared from it at the other. Now, an examination of the deaf-mute rates at successive age-periods leads to a belief that something of this kind actually occurred. Indeed the figures in the following table seem inexplicable on any other hypothesis:— PROPORTIONS of DEAF-MUTES to POPULATION at successive Periods of Life.
In each of the three censuses preceding that of 1881 the proportion of deaf-mutes per million population of the same age diminished gradually in the successive age-periods, the first age-period (0 and under 5 years) being disregarded for reasons already explained. This gradual diminution in the rate was, of course, a plain and indisputable proof that the condition of deaf-mutism was unfavourable to vitality; for, had it not been so, the proportion of deaf-mutes to the population would have remained constant or without decrease throughout. But the figures for the census of 1881 give a perfectly different result. Here there is no gradual decrease in the proportion of deaf-mutes with advancing age. The proportions fluctuate somewhat irregularly; but it is distinctly observable, in the first place, that the proportions have considerably increased, as compared with 1871, in the three later age-periods, a fact which can only be accounted for by increased survival of former deaf-mutes; and, in the second place, that the proportions have considerably diminished in the earlier age-periods, a fact which can only be explained by diminished introduction of fresh deaf-mutes during the last and penultimate decades. The result of this double alteration has been that the unfavourable influence of deaf-mutism in regard to longevity, which was so conspicuous in the previous returns, has been completely masked. Of the corrected number of deaf-mutes in 1881, 8,043 were males and 6,831 were relation females, being in the proportion of one in 1,572 males and one in 1,952 females, Out of equal numbers living of each sex there would, therefore, be 124 male to 100 female deaf-mutes.5
This is in accordance with the fact, which will again present itself when we come to speak of idiocy, that congenital defects are, as a rule, much more common among males than among females, as also very probably are those infantile diseases which tend to destroy the auditory apparatus. As regards the distribution of deaf-mutism over the surface of the country, we have followed the same plan as will be described more fully when we come to deal with the statistics of idiocy, our object being to avoid the interference in the distribution caused by the presence in some parts of special asylums or institutions. With this view we have taken birth-place, and not the place of habitation, as our basis, and have calculated the proportion of deaf-mutes to the enumerated natives of each county, The proportions cannot be calculated with perfect accuracy, inasmuch as in nearly six per cent. of the cases the place of birth was not given. Moreover, as already pointed out, the returns of deaf and dumb in the earlier years of life are utterly untrustworthy. The figures, therefore, which we shall give will only represent the comparative, and not in any way the absolute, amounts of deaf-mutism among the natives of the several counties. The counties are arranged in order of prevalence of deaf-mutism; and the table may be read as follows: the same number of natives which in England and Wales gave 1,000 deaf-mutes gave in Anglesey 1,378, in Merionethshire 1,317, and so on. PROPORTIONATE AMOUNTS of DEAF-MUTISM amongst NATIVES of the several COUNTIES.
The totals on which this table is based, that is the actual number of deaf-mutes born in the individual counties, are very small, much smaller than the totals on which the corresponding table of idiocy is based, and consequently much irregularity must be expected in the results. This much, however, seems to be tolerably plain, that deaf-mutism is much more common among the natives of the mountainous parts of England and "Wales than elsewhere: for, though the county of Montgomery is at the bottom of the list, yet in the ten counties at the top are no fewer than six Welsh counties, and also Westmorland. In this respect deaf-mutism goes hand in hand with idiocy and imbecility, for these affections, as will be seen hereafter, are also disproportionately prevalent in the mountainous parts. The marked contrast, however, which is observable in the case of idiocy between the purely agricultural and the manufacturing or mining counties is not apparent in the case of deaf-mutism. It may possibly be that, were the data more abundant, this want of correspondence might disappear. But it must also be remembered that some 376
per cent. of the deaf-mutes owe their condition not to congenital deficiency, but to such diseases as scarlet fever and the like, and that these diseases are much more prevalent as a rule in the crowded industrial centres than in purely agricultural parts. There are, of course, some occupations from which deaf-mutes are necessarily debarred by their infirmity. These, however, are but few, and most occupations can be pursued by them, though doubtlessly with some disadvantage as compared with those competitors who can hear and speak. The female deaf-mutes at any rate find apparently no great difficulty in getting employment; for 40 per cent. of those of them who were 15 years of age and upwards were returned as having some special occupation, whereas this was the case with only 37 per cent. of the general female population of the corresponding ages.7
The male deaf-mutes, on the other hand, seem to be at a not inconsiderable disadvantage, for only 76 per cent. of those of them who had finished their fifteenth year were engaged in definite occupations, against 94 per cent. in the corresponding general male population. The occupations for which deaf-mutes show preference, or which they find most suitable to their condition, are naturally such as can be followed by individuals independently and do not require frequent communication with fellow workers. Agricultural "or general labour, shoemaking, and tailoring are the chief occupations of the men; while dressmaking and sewing, domestic service and charing, washing, and, in Lancashire, work in cotton mills, form the main occupations of the women. The following is a brief abstract of the chief occupations of these deaf-mutes:— Persons of unsound mind are variously returned in the schedules as lunatic, idiot, and imbecile. No accurate line of demarcation can be drawn between the several conditions indicated by those terms. Speaking generally, however, the term idiot is applied in popular usuage simply to those who suffer from congenital mental deficiency, and the term imbecile to persons who have fallen in later life into a state of chronic dementia. But it is certain that neither this nor any other definite distinction between the terms was rigorously observed in the schedules, and consequently no attempt has been made by us to seperate imbeciles from idiots. The term lunatic also is used with some vagueness, and probably some persons suffering from congenital idiocy, and many more suffering from dementia, were returned under this name. Still, as a rule, the term lunatic is not used to include persons suffering from such affections, but is limited to those afflicted by more acute forms of mental disease. We have, therefore, separated the lunatics from the idiots and imbeciles; the division being desirable for practical purposes hereafter to be mentioned. Some term, however, was required by us which should stand for all kinds of mental unsoundness, and for convenience we have taken the term insanity to include them all. The total number of portions returned as suffering from some or other form of insanity was 84,503, being in the proportion of 3,253 per million of the whole population, or one person of unsound mind in every 307. In 1871 the proportion was 3,034 per million, or one insane person in every 329, Thus a not. inconsiderable increase in the proportion of persons admitted to be insane occurred in the interval between the censuses of 1871 and 1881. Whether this apparent increase of insanity was a real increase, or whether it was explicable, as was thought to be the case with the similar apparent increase in the preceding intercensal period, 1861-71, by diminished unwillingness on the part of persons to admit the existence of insanity in their families, is a question to which answer must be sought outside the census returns. It may be noted, however, that the increase in the amount of admitted unsoundness of mind was entirely in the class returned as lunatics, that is an persons suffering from the comparatively acute forms of unsoundness, and not in the class returned an idiots or imbeciles, that is as persons suffering from congenital or chronic forms of unsoundness: and that it is in the case of these latter rather than of the former that. concealment would be most possible; for the former, or lunatics, are mostly lodged in institutions, public or private, whose superintendents would have no motive for concealment, while of the idiots and imbeciles a much larger proportion remain at home with their families, and are included in the householders' schedules. Of the 84,503 insane persons 39,789 were males and 44,714 were females, being in the proportions of 3,148 males and 3,353 females per million of the corresponding sex, or of one in every 318 males and one in every 298 females. 8
In a certain sense, therefore, it is indisputably true that there is more insanity among females than among males, namely, in the sense that out of equal numbers living of each sex and at all ages there are more insane females living than insane males. But it must be clearly understood that this statement is by no means identical with, another that is sometimes confounded with it, namely, that the proportion of females who are attacked by insanity is higher than the proportion of males similarly attacked. Not impossibly, nor improbably, the contrary is the case. It may very possibly be that mental disease attacks a larger proportion of males than of females, but that, owing to the enormously high, death-rate of the male insane as compared with the female insane, the number of the latter living at any given moment conies to be greater than the number of the former. The male cases that occur are on this, hypothesis more numerous, but are rapidly swept away by death, while the female cases, though fewer in number, live on and accumulate. This hypothesis squares with the figures in the following table; from which it appears that it is only in the last two age-periods, namely after 45 years of age, that the proportion of the female insane exceeds that of the male insane. NUMBER of INSANE, MALE and FEMALE, at successive AGE-PERIODS per MILLION of PERSONS enumerated of corresponding AGES and SEX.
According to the returns of the Lunacy Commissioners from 1872 to 1881 inclusively, the mean annual death-rate among the registered male insane was 11.94 per cent. of the average daily number on the register; while the death-rate of the females was only 8.13 per cent. The recovery rate of the males was 10.50 per cent., and that of the females 11.59 per cent. Thus the per-centage of the male cases of insanity that would annually disappear from the register, either by death or cure, or what for convenience we call shortly the discharge-rate, would be 22.44, while the per-centage of female cases that would disappear from the same causes would be only 19.72. Wow, if we assume that these discharge-rates, which were true for such insane persons as were under the observation of the Lunacy Commissioners, were true for all insane persons, whether under observation or not, we can make a very simple calculation. There were at the date of the census, as we have seen, 3,148 male insane and 3,353 female insane persons per million living of each sex respectively. Of these, 706 males and 661 females would be discharged either by death or recovery in the course of the year ending on April 3rd, 1882. In order, therefore, to maintain the same proportionate numbers of insane in each sex (neglecting as insignificant the slight increase in the population during the year), there would have to be 706 new male cases of insanity per million males living, and 661 new female cases per million females living, or out of equal numbers living of each sex there would be 106.8 new male cases to 100 new female cases. These figures, therefore, may be taken as probably representing with approximate accuracy the comparative liability of the two sexes, irrespectively of age differences, to mental unsoundness. Among the 84,503 persons enumerated as insane, that is either as lunatics or as idiots or imbeciles, 461 were stated to be dumb, and 355 were stated to be blind; while 17 others were both dumb and blind ((see
Vol. III., Summary Table 15). It has already been stated that though, speaking generally, neither idiots nor imbeciles are included among the persons returned as lunatics, yet the distinction has not been universally observed, and that a certain intermixture of congenital idiots, especially at the earlier age-periods, and a considerable intermixture of imbeciles, especially at the later age-periods, has almost certainly occurred. "We may, however, take the group of lunatics, as a whole, to represent all other forms of insanity than idiocy or imbecility. The total number of persons returned as lunatics was 51,786, or 1,994 per million of the population. The females were 28,102, and far in excess of the males, who only numbered 23,684. This excess, moreover, was not only absolute but relative; for there were 2,107 lunatic females and only 1,874 lunatic males per million living of the corresponding sex. It has already been explained that a difference in the proportions of existing
cases in the two sexes does not necessarily imply a corresponding difference in the proportions of occurring
cases. It may be, and very possibly is, the case, that the difference would disappear, or be inverted, if, the discharge-rates for the two sexes were taken into account. Unfortunately, we have not got the discharge-rates for lunatics as distinguished from the insane of all kinds. If, however, we assume the discharge-rates for the former to be the same as those for the latter, namely, 22.44 and 19.72 per cent. for males and females respectively, and make a similar calculation to that made in treating of the insane of all kinds, the result will be that the new male cases of lunacy exceed the new female cases, for equal numbers of each sex, in the proportion of 101.2 to 100. It is only in the later periods of life, from the 45th year upwards, that the female lunatics are, proportionately to the numbers living, in excess of the males. There is one exception to this statement, for in the age-period 15 and under 20 years, the female rate of lunacy very slightly exceeds the male rate, there being 302 lunatic females and only 293 lunatic males per million living of similar age in each sex. This is also, as shown by the annual reports of the Registrar-General,9
the age-period in which alone the female sex is equally disposed to suicide with the male sex; and again is an age-period in which the female death-rate exceptionally exceeds the male death-rate; and the explanation is doubtlessly in each case to be found in the critical changes that occur at this period of life in the female organisation. It appears to be generally admitted that the system of dealing with the insane which has for some years past been adopted in London is the one which has most to recommend it, not only from a medical, but also from an economical point of view. By that system the idiots and imbeciles, or, in brief, the harmless insane, are kept apart from persons afflicted by more acute forms of insanity, and are dealt with by special methods and in special institutions, these harmless persons being themselves still further, subdivided according to their ages. Although, therefore, no exact line of demarcation can be drawn between these two classes of the insane, we have nevertheless thought it expedient to give a separate account of those persons who have been returned as idiots or as imbeciles, so that possibly those concerned in the matter may be able to form some kind of estimate of the numbers with which they would have to deal should the system become general. The total number of persons returned as idiots or imbeciles was 32,717, being in the proportion of one such person in every 794 of the population. The proportion in 1871 was one in 771, so that as regards this kind of mental unsoundness a diminution had apparently occurred in the course of the decade. As there is no reason to suppose that the returns made in 1881 as regards this kind of insanity were less truthful than those made on the previous occasion, it is fair to conclude that the apparent was also a real diminution. But though the figures may be used for such purposes of comparison, it would be most unsafe to accept them as representing with even approximative accuracy the actual amount of idiocy or imbecility existing in the country. There can be no doubt whatsoever that the returns made by persons as to the mental capacity of their children or other relatives are far from trustworthy. In the earliest years of life this imperfection in the returns is unavoidable. It cannot be expected, for instance, that a mother will return her child, as yet only two or three years old, as an idiot, however much in her own heart she may believe or fear this to be the case; for to acknowledge it as such would be to abandon all hope. But when the child has reached such an age that no doubt as to its mental incapacity can any longer be entertained, concealment of the fact by omitting all mention of it in the schedule is no longer equally excusable; and yet it is certain that such omission is excessively common. We have taken much trouble to ascertain, so far as possible, to what extent the returns are vitiated by such suppressio veri
With this object we obtained from the managers of a large idiot asylum the addresses of the families of all those idiots who had been admitted into the institution in the year commencing with the day of the census. We then examined the schedules given in by these families, and found that in exactly half the cases of such of these indisputable idiots as were 5 but under 15 years of age, no mention whatsoever was made in the schedule as to the existence of any mental incapacity. We have no reason to suppose that the cases admitted into this institution were in any respect of exceptional character, or drawn from classes in which there would be any exceptional inclination to concealment; and consequently we are compelled to accept the conclusion that half the cases of undoubted idiocy or imbecility of children residing with their families, and from 5 to 15 years of age, altogether escape enumeration; and we cannot but suppose that the proportion of omissions would be still greater if it were possible to take into account not only such kinds of idiocy as render the sufferers fit for admission into an asylum, but idiocy of every degree. As regards idiots 15 years of age and upwards, the number of cases which we were able to investigate after a similar fashion was too small to furnish a basis for estimating the probable omissions; but, so far as we could judge from the obtainable data, the omissions are not very numerous, and we shall therefore assume that the returns of idiots and imbeciles 15 years of age and upwards are sufficiently correct, and that the omissions only affect the returns under that age. Now, the total number of idiots and imbeciles enumerated as 5 but under 15 years of age was 4,870; but of these 1,361 were in asylums or institutions, where all idiots would be correctly returned. There remain 3,509 who were with relatives or friends, and this number must at least be doubled, as explained above. This gives us a total of 8,379 idiots, of 5 and under 15 years of age, being in the proportion of 1,409 to a million living at such ages. But the proportion of enumerated idiots in the next age-period, 15 and under 20 years, was 1,536 per million living at those ages, and it is impossible to admit that the proportion could be less in the earlier age-period than in the later; for at these ages the cases of idiocy are almost exclusively cases of congenital idiocy, or, at any rate, of idiocy beginning soon after birth, and consequently the proportion of living idiots to a million of the same ages cannot possibly increase with successive age-periods, unless it be true that idiot children live longer than sound children., which is, of course, not the case. It appears, therefore, that the correction made by us for omissions was insufficient, and the insufficiency finds its explanation in the fact already noted, that only idiots of such character as to be selected for admission into asylums were taken into account. We must, therefore, make another correction, and this may be best done, though the correction will still be inadequate, by supposing that the proportion of idiots among children of 5 but under 15 years of age was the same as the proportion among young persons who were 15 but under 20. In all probability it was considerably higher, as idiot children are likely to die earlier than sane children; but at any rate we shall be within the mark if we only assume equality. This method gives us 9,136 idiots, of 5 but under 15 years of age, and, being equally applicable to idiots at the still earlier age-period, gives us 5,408 idiots under five years of age. Thus the total number of idiots and imbeciles at all ages may be estimated at 41,940, instead of 32,717, as enumerated, and this estimated total is doubtlessly still too low; for not only have we supposed that idiot children are as likely to live as other children, and that there were no omissions in the returns of idiots who were 15 and under 20 years of age, neither of which suppositions is likely to be true, but we have also necessarily taken no account of the great probability that some omissions are likely to have been made at the still later age-periods, owing to the want of any clear distinction between imbecile and lunatic, many harmless insane adults being returned under this latter designation. Persons returned as idiots or as imbeciles form two very distinct classes, which, however, the returns give us no means of accurately separating from each other, There are, firstly, those persons who, owing to defects either congenital or dating from early infancy, have never been of sound mind; and, secondly, there are those who have only become demented at a later period. As this latter form of imbecility rarely occurs in the earlier part of life, we may assume that the figures in our table for the first three age-periods, and perhaps for the fourth, relate mainly, if not exclusively, to cases of congenital or infantile idiocy; and, proceeding then to compare the figures for the two sexes with each other, we see that such congenital defect is, as are most congenital deficiencies, much more common among males than among females; for out of equal numbers living of each sex under 25 years of age, there were 133 male idiots enumerated to 100 female idiots. The distribution of idiots and imbeciles over the country is of course largely affected by the presence or absence of special institutions for their treatment or relief, and consequently very erroneous conclusions might possibly be drawn from the table which gives the proportion of such persons in each county to its total population. Although, therefore, we have given such a table (Vol. III., Summary Table 16) in accordance with previous usage, we have also attempted to construct another, which it appeared to us would be of more value, in which the birth-places are taken as the basis, and it is shown how many idiots and imbeciles there were to a million enumerated natives of each county. If, as there seems no reason to doubt, the omissions in the returns of the idiots and imbeciles were proportionately the same in all parts of the country, then this table would of course give us a strictly accurate account, not of the absolute, but, of the proportionate, numbers of idiots and imbeciles among the natives of the several counties. Unfortunately a difficulty presented itself which interfered with the satisfactory completion of this comparative table. We found that in the case of 12.7 per cent. of the enumerated idiots and imbeciles the place of birth was not stated, and this kind of omission was by no means equally common in all parts of the country, so that it could not be disregarded, like the other kind of omission, as affecting only the absolute and not the proportionate results. We were obliged, therefore, somewhat to modify our plan. So far as possible, that is in 87.3 per cent. of the cases, we took the birth-places, as stated in the schedules, for our basis; in the remaining 12.7 per cent. we made an assumption. The inmates of any county asylum with unstated birth-places were assumed to have been natives of that county, and a similar assumption was made in the case of workhouses and other purely local institutions. The inmates of the great asylums at Caterham and Leavesden were similarly assumed to have been born in London (though this was probably not true of a considerable proportion of them), and were distributed by us to the three metropolitan counties in the proportions in which the natives of such counties contributed to the population of London. When an institution received patients indifferently from all parts of the kingdom, those inmates whose birth-places were not stated were left out of account. These assumptions can scarcely have interfered in any material degree with the accuracy of the table, except, indeed, as presently to be pointed out, in the case of the metropolitan counties. The results were very curious, as will be seen in the following table, in which the counties are ranged in the order of frequency of idiocy and imbecility among their natives. The figures attached to each county do not represent the actual number of idiots per million natives, a number which, as has been shown, it was impossible to give with any accuracy, but represent the proportional amount of native idiocy in the several counties as compared with each other or with the entire country. It may be read as follows: the same number of natives which in the case of the whole of England and Wales gave 1,000 idiots or imbeciles gave in the case of Herefordshire 1,437, in the case of Cardiganshire 1,351, and so on. PROPORTIONATE AMOUNTS of IDIOCY amongst NATIVES of the several COUNTIES.
The one great fact that stands out conspicuously in this table is the much greater comparative amount of idiocy and imbecility that exists among the natives of agricultural counties, and especially of such agricultural counties as are also mountainous, than among the natives of manufacturing and mining counties. The former, as a rule, have proportional rates above the mean of the whole country; the latter, as a rule, have proportional rates below the average. There are some few apparent exceptions to this general statement. Thus there are one or two purely agricultural counties with low rates; but these are mostly very small counties, such as Huntingdonshire, Rutlandshire, and Brecknockshire, where the data on which the calculation is founded are so scanty as to furnish a very insecure basis. On the other hand, Middlesex, in spite of its mainly urban character, shows a rate considerably above the average; and it may be noted as tending to confirm the probability of a high rate of idiocy for this county, that it shows also an excessively high proportion in the table of deaf-mutism (cf., p. 64). There is, however, reason to suppose that the rate assigned to Middlesex in the idiocy table is unfairly high; for somewhat more than a fourth of the idiots and imbeciles whose birth-places were unknown were patients in the Caterham and Leavesden asylums, and all these were considered to be natives of London, and were distributed to the several metropolitan counties in accordance with the rule laid down by us and mentioned above. It is probable that many of these persons should have been assigned to other counties, in which case the proportion for Middlesex (and in a lesser degree those for Surrey and Kent) would have been lower than in the table. At any rate, the unfortunate deficiency of information as to the birth-places of the inmates of the Caterham and Leavesden Asylums makes the calculation as to the proportionate amounts of idiocy much less trustworthy in the case of the metropolitan counties than in that of the other counties. Another exception to the general rule is presented by Warwickshire, which county, notwithstanding its industrial character, shows a rate of idiocy far above the average of the country. Disregarding, however, these apparent exceptions, the general rule is unmistakable: agricultural districts produce numerous idiots and imbeciles, industrial districts produce few. What may be the explanation of this marked contrast we can but conjecture. It may be that the industrial centres attract from the rural districts those who are comparatively strong in mind and body; and that the children born to these stronger parents are less liable to congenital deficiencies than the offspring of the comparatively feeble parents, mentally and physically, who are left behind; and it may also be that the varied interests and quickened mental activities which accompany the industrial life of urban communities maintain the brain in a healthier condition than does the comparatively monotonous existence of an agricultural labourer, so that fewer adults become demented in the towrs than in the country. These, however, are questions of which the discussion hardly falls within our province. Thus much as to the several infirmities, mental and physical, concerning which we were directed by the terms of the Census Act to make inquiry. We have given much time and space to their discussion; for we felt bound to point out, as clearly as we could, bow very incomplete are the returns which relate to these afflictions, and more especially those which relate to idiocy and imbecility. We have done the best we could with these unsatisfactory data. We cannot, however, but express our decided opinion that statements made by persons as to the deficiencies, mental or bodily, of their children or other relatives are not worth the cost and labour of collection and tabulation. In the recent census in the United States of America the returns made by householders as to idiocy and lunacy were supplemented by a system of special inquiries by specially paid enumerators, and by correspondence with nearly 100,000 medical men.10
It is possible that, with such an elaborate and costly machinery, returns might be obtained of fairly approximate accuracy; but without it the returns will never, in our judgment, be of much value. The English Census did not embrace any inquiry as to the amount of other forms of sickness or infirmity existing in England and Wales. It may be noted, however, that 24,087 patients were enumerated in the General and Special. Hospitals (see Vol. II., Summary Table III). The patients enumerated in Hospitals were 7,619 in 1851; 10,414 in 1861; and 19,585 in 1871. The proportion of these hospital inmates, to 100,000 of the enumerated population of England and Wales, was 42 in 1851; 52 in 1861; 86 in 1871; and 93 in 1881. It is scarcely necessary to point out that the proportion of patients in hospitals to the general population is a measure rather of the relative amount of hospital accommodation, at these four Censuses, than of the relative amount of sickness prevailing in the country. It is an undoubted fact that in recent years the amount of hospital accommodation has increased at a greater rate than the population, mainly through the erection of a large number of Cottage Hospitals, and of Hospitals for Infectious Diseases. The number of Hospitals included in the list of Public Institutions, published in the Registrar-General's Annual Report for 1871, was but 346, whereas it had increased to 691 in the Report for 1881. In addition, however, to the patients in Hospitals, a very considerable proportion of the sick are constantly under treatment in the Workhouse Infirmaries, which are the legal hospitals for paupers. We have, however, no means of ascertaining what proportion of in-door pauperism was due to sickness. The special or pauper inmates of Workhouses (including Workhouse Infirmaries, the Metropolitan Asylum Hospitals and Pauper Schools) were 179,620 in 1881, against 120,978 in 1851; 125,722 in 1851; and 148,291 in 1871. The proportion of in-door paupers, to 100,000 of the population, was 676 in 1851; 627 in 1861; 652 in 1871; and rose to 692 in 1881. This increase in the number and proportion of in-door paupers was undoubtedly due, in great measure, to the action of Boards of Guardians in applying the "house-test" From the bodily and mental infirmities which fill the Asylums for the Blind, the Deaf and Dumb, the Imbecile, and the Lunatic, and the Hospitals for the Sick, and that also supply the Workhouses with a large proportion of their inmates, it is no difficult transition to the moral infirmities which provide the inmates of Prisons. Recent anthropometrical investigations, moreover, clearly prove that the criminal classes suffer from distinct physical deficiencies. The number of prisoners enumerated in 1881 was 27,889, and was equal to 107 per 100,000 of the entire population. It is satisfactory to find that the proportion of prisoners has shown a steady decline since 1851. It was 182 in 1851; 130 in 1861; 127 in 1871; and, as above stated, further declined to 107 in 1881. In addition, however, to the inmates of Prisons, 16,856 boys and girls were enumerated in certified Reformatories and Industrial Schools; whereas the number so returned in 1871 did not exceed 10,598. This large increase in the number of young persons under detention in these Institutions was probably attributable in great measure to the increase of accommodation for such detention resulting from the operation of the Education Act of 1870, and the necessity for dealing with incorrigible truants and street waifs. The decrease in the number of adult prisoners may, to some extent, be reasonably attributed to the remedial effect, upon the juvenile criminal classes, of the detention and individual training received in Reformatories and Industrial Schools. 1
The tables relating to persons suffering from Infirmities are in Vol. III., which has an index at p. 526. Summary Tables 14, 15, and 16 relate to their number, sex, and distribution; as also do Tables 14 to 21 in each Divisional Part. Summary Tables 17, 18, and 19 relate to their Occupations. 2
The mode in which the facts were abstracted in 1871 enables us to break up the age-period, 65 and upwards, into two sub-periods, 65 to 85, and 85 and upwards. The male blind-rate was 6,812 in the earlier sub-period, while the female rate was only 6,687. But in the later sub-period, 85 and upwards, the female rate was 25,810, and far above the male rate, which was 21,450. It would, therefore, appear that in very advanced life women are more likely than males to become blind. 3
Special inquiry was made in each of those cases as to the accuracy of the return. 4
Not many, however. Inquiries instituted in 1840 and 1858 in Bavaria, into the age at which deaf-mutism occurred in 5,403 cases concerning which the necessary data were to be had, gave the following results per 1,000 cases:— In Ireland, also, it was found at the recent census that 80 per cent. of the deaf-mutes were congenitally afflicted. 5
In the United States of America, according to the recent census returns, there were 117 male to 100 female deaf-mutes out of equal numbers of each sex. 6
(see
Census Report, 1871, vol. iv., page lxii. 7
The figures given above might seem to imply that female deaf-mutes find employment, more readily than females not so afflicted But probably the explanation is that a much smaller proportion of the deaf-mutes is married than of women generally; so that there is a larger proportion of these dependent for support on their own labour. 8
In the United States of America the recent census gave proportions of 3,367 per million persons; 3,516 per million males, and 3,214 per million females. 9
See 43rd Annual Report, p. xxviii. 10
Compendium of the Census of the United States, 1880. Vol. ii., pp. 1660-61.VIII.—INFIRMITIES.1
The Blind.
Gradual diminution in the proportionate numbers of the blind
YEAR.
Number of Blind.
Blind per Million
Persons enumerated.Persons enumerated to one Blind Person.
1851
18,306
1,021
979
1861
19,352
964
1,037
1871
21,590
951
1,052
1881
22,832
879
1,138
Blindness more common among males than females
—
Males.
Females.
England and Wales
953
809
Scotland
865
827
Ireland
1,141
1,219
Denmark
776
793
Norway
1,313
1,411
Sweden
767
843
Finland
1,514
2,938
German Empire
884
881
Hungary
1,280
1,123
Holland
499
394
Belgium
982
641
France
948
726
Spain
1,242
1,011
Italy
1,106
925
NOTE.—The proportions in this table for foreign countries are taken from "Die Verbreitung der Blindheit &c. in Bayern" By Dr. G. Mayer, 1877, p. 100.
Ages of the blind
Age-period.
1881.
1871.
PERSONS.
Males.
Females.
PERSONS.
Males.
Females.
0—
166
172
161
185
189
180
5—
288
312
263
306
345
267
15—
388
449
328
404
451
358
20—
422
491
359
451
518
390
25—
641
800
494
680
871
506
45—
1,625
1,947
1,336
1,720
2,002
1,459
65 and upwards
6,915
6,897
6,929
7,354
7,245
7,446
All ages
879
953
809
951
1,029
876
The blind from birth
2. The Deaf and Dumb
The deaf-mutes
Probable omissions in the returns of deaf-mutes
Correction for omissions
Probable improvement in the country in respect of deaf-mutism
[As enumerated and uncorrected.]Age-Period.
Per million Persons living at each Age-Period
1851.
1861.
1871.
1881.
0—
212
205
145
141
5—
818
799
625
590
15—
674
776
626
564
20—
632
647
611
593
25—
559
601
524
568
45—
497
603
511
534
65 and upwards
442
531
436
560
Deaf-mutism in relation to sex
Geographical distribution of deaf-mutism
Anglesey
1,378
Wiltshire
984
Merionethshire
1,317
Northampton
976
Cardiganshire
1,297
Shropshire
966
Herefordshire
1,200
Sussex
964
Middlesex
1,198
Carnarvonshire
962
Radnorshire
1,172
Lincolnshire
958
Flintshire
1,162
Buckinghamshire
945
Cornwall
1,160
Yorkshire
945
Westmorland
1,147
Norfolk
945
Carmarthenshire
1,141
Glamorganshire
945
Cambridgeshire
1,131
Lancashire
943
Warwickshire
1,129
Hampshire
941
Derbyshire
1,105
Cumberland
939
Gloucestershire
1,099
Somersetshire
935
Surrey
1,079
Cheshire
933
Pembrokeshire
1,075
Denbighshire
933
Suffolk
1,053
Monmouthshire
907
Worcestershire
1,036
Rutlandshire
899
Oxfordshire
1,030
Essex
891
Devonshire
1,028
Hertfordshire
867
Dorsetshire
1,028
Kent
853
Bedfordshire
1,024
Brecknockshire
808
Durham
1,016
Nottinghamshire
768
Northumberland
1,008
Leicestershire
731
Berkshire
1,006
Huntingdonshire
699
England and Wales
1,000
Montgomeryshire
556
Staffordshire
998
Occupations of deaf-mutes
MALES.
—
FEMALES.
—
Agricultural or general labourer
823
Domestic servant, charwoman
339
Boot, shoe, clog, patten maker
530
Dressmaker, seamstress
654
Tailor
344
Washerwoman
158
Textile manufacture
162
Cotton Manufacture
134
Carpenter, joiner
137
Tailoress
75
Mason, bricklayer
102
Painter, glazier, plumber
91
Cabinet-maker, upholsterer, French polisher
96
Printer, bookbinder
95
Miner
89
Iron and steel manufacture
76
Blacksmith
55
Harness maker
43
All other occupations
1,188
All other occupations
366
Total employed
3,381
Total employed
1,776
3.— The Insane
Different forms of mental unsoundness
Use of terms insane, lunatic, idiot, imbecile
The insane
Apparent increase of insanity
Proportions of insane in each sex
Comparative liability of each sex to insanity
AGES.
INSANE.
TOTAL.
LUNATIC.
IDIOT OR IMBECILE.
Males.
Females.
Males.
Females.
Males.
Females.
0—
159
103
3
3
156
100
5—
993
700
28
27
965
673
15—
2,034
1,634
293
302
1,741
1,332
20—
2,777
2,284
1,037
894
1,740
1,390
25—
4,854
4,729
3,298
3,117
1,556
1,612
45—
6,519
7,822
5,029
5,965
1,490
1,857
65 and upwards
6,946
8,864
4,776
6,137
2,170
2,727
All ages
3,148
3,353
1,874
2,107
1,274
1,246
Combination of insanity with other afflictions
Lunatics
Idiots and imbeciles
Untrustworthy character of the returns
Attempt to form a correct estimate
Congenital idiocy more common among males than females
Geographical distribution of idiocy and imbecility
Herefordshire
1,437
Westmorland
1,015
Cardiganshire
1,351
Montgomeryshire
1,015
Merionethshire
1,339
Lincolnshire
1,014
Carnarvonshire
1,330
Sussex
1,005
Denbighshire
1,312
England and Wales
1,000
Gloucestershire
1,289
Devonshire
995
Wiltshire
1,280
Kent
992
Anglesey
1,253
Surrey
985
Somersetshire
1,210
Essex
981
Northamptonshire
1,199
Bedfordshire
977
Oxfordshire
1,182
Nottinghamshire
977
Radnorshire
1,168
Cheshire
968
Berkshire
1,154
Norfolk
932
Carmarthenshire
1,150
Northumberland
910
Middlesex
1,147
Staffordshire
904
Hampshire
1,131
Lancashire
899
Warwickshire
1,129
Yorkshire
890
Buckinghamshire
1,124
Monmouthshire
882
Shropshire
1,108
Derbyshire
875
Cambridgeshire
1,097
Huntingdoushire
873
Hertfordshire
1,090
Rutlandshire
845
Worcestershire
1,076
Cornwall
782
Dorsetshire
1,076
Brecknockshire
755
Suffolk
1,057
Glamorganshire
728
Pembrokeshire
1,056
Cumberland
720
Leicestershire
1,048
Durham
614
Flintshire
1,028
4. Sickness and other Infirmities.
Hospitals
Workhouses
Prisons and Reformatories
—
Special Inmates of Institutions.
Number in 100,000 of the
Population.1851.
1861.
1871.
1881.
1851.
1861.
1871.
1881.
Total
167,593
186,577
246,476
303,069
935
930
1,085
1,167
Workhouses (including Pauper Schools)
120,978
125,722
148,291
179,620
676
627
652
692
Hospitals (General and Special)
7,619
10,414
19,585
24,087
42
52
86
93
Lunatic Asylums
15,243
24,345
39,246
54,617
85
121
173
210
Prisons
23,753
26,096
28,756
27,889
132
130
127
107
Reformatory and Industrial Schools
10,598
16,856
47
65
Congenital
799
Under 5 years
158
5 and under 10 years
35
10 years and upwards
8
1,000