Physical Infirmities
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Concerning the number and proportion of the population returned at the recent Census as suffering from physical infirmities, full statistics are given in Tables XLIX.-LI. of the Volume of Summary Tables and in Table 41 in Appendix A. to this Report. With regard to the Blind and the Deaf and Dumb, both in Great Britain and in Ireland, inquiry as to the numbers thus afflicted was attempted, for the first time, at the Census of 1851. In that Division of the United Kingdom for which alone we are responsible, as also in Scotland, the plan adopted in 1851 was that of including in the "Occupier's Schedule" a column in which was to be written, against the name of any member of a family so afflicted, either the word "Blind," or else the words "Deaf and Dumb." At the three Censuses of 1861, 1871, and 1881, the persons making the Returns were further asked to specify cases in which the infirmity dated from Birth. In 1891 and 1901 they were asked instead to specify cases dating from Childhood. The Irish Census Commissioners, with the assistance of the Royal Irish Constabulary, have been able to pursue their inquiry to a much fuller extent; obtaining and tabulating Returns showing, not only the duration of the Infirmity, but the cause to which it was attributed. In the discussion of questions concerning the relative prevalence of Blindness in various Countries at the same period, or in the same Country at different periods, the main difficulty lies at the threshold, and consists in the adoption of a uniform standard to which all cases of Blindness should be referred. What is "Blindness," is the important point to settle. The question has long occupied the attention of philanthropists in England and other Countries, and we certainly think that the Commissioners who may be responsible for the arrangements connected with the next Census should take steps to obtain expert opinion as to what standard of vision, or defective vision, should be held to constitute "Blindness," and also to determine whether any additional methods should be adopted, in order to obtain, if possible, more accurate Returns as to the number and condition of the Blind. Relative to the inquiry into the number and condition of the "Deaf and Dumb," similar remarks are equally applicable to those persons returned as simply "Deaf" for, if the standard of absolute deafness is abandoned, no definite line can be insisted upon, and each individual must be left to adopt for insertion, in the "Occupier's" Schedule, his own definition what constitutes deafness. With regard to the Insane, it is noteworthy that the first attempt to ascertain their number was not made until the year 1871, the requisite authority for the insertion, in the "Occupier's Schedule," of a special column being for the first time given by the Census Act of 1870. Previous to the year 1871 it had been possible to give the number of inmates in Lunatic Asylums and other Establishments for the reception of the Insane only, no return being available of the number residing outside these Institutions. Concerning the above-named infirmities it should be clearly understood that the machinery of an ordinary English Census is but imperfectly adapted to furnish the required particulars with that degree of accuracy which is essential for statistical purposes. It is because experience has impressed us with this conviction that we have abstained from entering into minute details which, had the data been more reliable, would have proved highly instructive and useful. Before proceeding to analyse the figures concerning the total number of persons enumerated as Blind, if seems desirable again to refer to the fact that, in the Censuses from 1861 to 1881 inclusive, the instructions on the Schedule required the Occupier to distinguish those persons enumerated as "Blind from Birth" from those entered simply as "Blind". At the Census of 1891, however, the instructions on the Schedule were altered from "Blind from Birth" to "Blind from Childhood" and, in addition to this, every child under 10 years of age was classified as "Blind from Childhood" whether he was entered in the Schedule as such or merely as "Blind." Owing to this change in the wording of the instructions it is of course impossible to carry the comparison of these figures back to the Censuses prior to 1891. The number of persons enumerated as "Blind from Childhood" in the Schedules of the Census of 1891 was 4,005, or one in every six of the total number of blind, whereas in 1901 there were 4.621 (2,468 males and 2,153 females), or one in five of the total blind. Of the number enumerated in 1901, 1,983 were under 20 years of age, 2,485 were between 20 and 65 years of age, and 203 were over 65 years of age; amongst these, the males were more numerous than the females at all age groups under 45 years. The total number of persons returned as afflicted with blindness was 25,317, being in the proportion of 778 per million living, or one blind person in every 1,285 of the population. The following Table shows that the proportion of blind persons to population has diminished at each successive enumeration since 1851, in which year particulars of those afflicted in this manner were ascertained for the first time. It will, however, be noted that, although the decrease in the proportion of blind in the latest intercensal period was still considerable, yet the rate of decrease which had obtained between 1871 and 1891 has not been maintained since the latter year. The following Table, which gives the proportions of blind per million living at the earlier age-groups, shows that in the decennium 1891-1901, as also in recent previous intercensal periods, there has been a decrease in the proportion of blind children in England and Wales generally; it thus lends support to the contention, in the General Report for 1891, that the decrease is due either to the lesser prevalence, or to the more efficient treatment, of purulent ophthalmia and other infantile maladies which may result in blindness. But a closer examination of the age constitution of the blind, as shown in the next Table, suggests that there are other and more frequent causes of blindness which operate later in life: witness, for example, how rapidly blindness increases after the age of 35 years. The Table, which gives the proportions of blind males and females, per million living of each sex, at several age-groups at the last four Censuses, further shows that, except among very old people, males are, more frequently than females, the victims of blindness. From Table XLIX of the "Summary Volume," which gives particulars of the "Blind from Childhood," it would appear that this excess among males is not due to congenital blindness nor to blindness acquired early in life; for at all age-groups above 45 years more females than males were described as being blind from childhood. The explanation put forward in the Report for 1891 would seem to be probably correct — namely, that males are more liable than females to blindness caused by accident. If, with the help of the "Summary" Table just referred to, the number of the blind from childhood, above the age of 25 years, be calculated in the population living at corresponding ages, it will be found that their proportion does not increase at successive age-groups, whilst the foregoing Table shows that the proportion of the total number of blind continuously increases with advancing years. In the two accompanying Tables are set forth the chief occupations followed by the blind at the last two Censuses:— From these Tables it appears that, whilst of the total occupied blind males nearly one-half were either Brush, Basket, Mat, &c. Makers, Clergymen, Teachers, or Musicians, among the blind from childhood nearly three-fourths followed one or other of these callings. Of occupied blind females, whilst one-half were either Basket, Brush, Hosiery, Fancy Goods, &c. Makers, Teachers or Musicians, nearly three-fourths among the blind from childhood followed one or other of these callings. Attention may be directed to the largely increased proportion of blind males returned in 1901 mainly as Pianoforte Tuners, but classed under the head of Musical Instrument Makers. This increase is probably due to the additional facilities afforded for the requisite training by the many excellent Educational Institutions for the blind which now exist. In the Census Reports of 1861 and 1871, the Commissioners adverted to the attention which had been paid to the amelioration of the condition of the blind in this country, and gave interesting details in regard to the various Institutions and Charities which had been founded for their benefit. In the subsequent Census Reports no special reference has been made to the progress that has, in the interval, taken place in matters connected with the blind, and it may, therefore, be of interest to explain how the present position has been arrived at. In 1886, a Royal Commission on the Blind, Deaf and Dumb, was appointed by the Government, and, after taking much valuable evidence, issued an exhaustive and instructive report. Following on the practical recommendations submitted by this Commission, the Elementary Education (Blind and Deaf Children) Act, 1893, was passed, under which the education of the blind became for the first time compulsory. In terms of this Statute, the School Authorities were made responsible for the provision of suitable elementary education for blind children up to 16 years of age, and grants of £3 3s. for elementary subjects, and of £2 2s. for industrial training were contributed by the State towards the cost of educating children in schools certified as efficient within the meaning of the Elementary Education Act, 1876. The only blind children exempted from the provisions of the foregoing Act are:— These classes of children are still dealt with by the Guardians under 31 & 32 Vic. c. 122 and 42 & 43 Vic. c. 54. The principal aim of the Education Act of 1893 is to supply.education in some useful profession or trade which will enable the blind to earn their livelihood and to become useful citizens; but the weak spot is that no provision is made therein for the completion of their education and industrial training after the age of 16. The Education Act, 1902, however, contains in Part II. the following provision:— "The Local Education Authority shall consider the educational needs of their area, and take such steps as seem to them desirable, after consultation with the Board of Education, to supply or aid the supply of education other than elementary and.to promote the general co-ordination of all forms of education." In terms of this provision, the Board of Education are, we understand, prepared to consider any proposal submitted to them by a Local Education Authority. The Elementary Education (Defective and Epileptic Children) Act was passed in 1899. The Board of Education in their report for 1902-3, record their views of the educational administration in respect of blind, deaf, defective and epileptic children, and we would call special attention to the concluding paragraph of that section of their report which states:— "A most important step in the development of education for the blind, deaf, and defective, has been taken in the establishment of after-care Committees in London, Bristol, Birmingham and Nottingham, the members of which make it their duty to take over the children as they leave school, find them work, and keep them at their situations, generally supervising their whole welfare. The value of this kind of voluntary work, which makes the school training effective in after life, cannot be over-estimated; in fact such voluntary co-operation is really essential if much of the good that has been done in school is not to be lost." We are in complete harmony with this declaration on the part of the Board of Education which cannot be too widely disseminated. The question of how blind children should be dealt with after leaving school was regarded by the Royal Commission on the Blind as of paramount importance, and also formed one of the subjects discussed at the Conference on matters relating to the blind, organized by Gardner's Trust, which met in 1902. The system of after-care as regards the blind adopted in Saxony is probably the most effective in existence, and, in support of this system, Dr. Armitage, in his comprehensive work on "The Education and Employment of the Blind," comments as follows:— "The advantages of this system may be well seen by contrasting the result obtained where it is in operation with those observed in districts where it does not exist, other circumstances being similar. A few years ago some of the small States adjoining to Saxony made arrangements for their blind to be educated in the Dresden Institution. These children were educated in all respects like the Saxon children. They returned to their homes after completing their education; but, unfortunately, there was no organization there similar to that existing in Saxony, and the result was that they almost all failed, while their Saxon companions living under exactly similar circumstances, almost invariably succeeded. This difference could only result from the want of supervision, timely help, and advice in the case of the old pupils belonging to the smaller States. These have, however, now undertaken the necessary supervision, and the result is as satisfactory as it is in Saxony." It would no doubt be highly advantageous to the blind, if some co-ordinate plan of after-care could be devised for them by the State on the lines of the system successfully pursued in Saxony. Another urgent question relates to the method which should be permanently adopted for teaching the blind to read and write. The numerous systems now, and formerly, in vogue, are lucidly described (a)
by Dr. Campbell, the founder of the Royal Normal College and Academy of Music, in his interesting and instructive article in the latest edition of "Chambers' Encyclopaedia"; (b)
by Dr. Armitage in his work already referred to; and.(c)
by Mr. Wilson, the Secretary to Gardner's Trust, in his useful pamphlets showing the progress of events in connection with the blind. From these and other sources we learn that the "Moon" and other types are still in partial use, especially the "Moon" type, which is used by the aged blind and by those who cannot readily master a more difficult type. Under the auspices of the British and Foreign Blind Association, however, which was founded in 1868 for promoting the education and employment of the blind, the "Braille" type has steadily grown in favour, and, in fact, has now been almost universally adopted in the British Empire as well as in most European countries; moreover, in the United States a modification of it, known as the New York Point, is now generally accepted. The "Braille" type excels all other types in its ready adaptability to musical notation, and the Royal Normal College and Academy of Music has shown by practical results how high a standard of excellence in music the blind can attain by this method. It has also been successfully utilized in rendering the blind proficient typists, and we can testify to the marvellously accurate and expeditious manner in which typewriting is done by the pupils at the Royal Normal School. If only Office Centres for the employment of blind typists were established and properly organized by some competent authority, a comparatively new and remunerative field of occupation would be thrown open to the blind. The chief problem, however, as regards the future position of the "Braille" type which demands immediate attention, is what number of "Grades" and what variety of "Contractions" in each "Grade" should be finally adopted. We understand that a special "Contractions" Committee has recently been appointed by the British and Foreign Blind Association, in conjunction with Gardner's Trust, to consider and report upon these important details: and we trust that this Committee will ultimately be able to make some practical recommendations. If so, it may at last be found possible to arrive at a solution of the problem and to formulate a definite scheme for teaching the blind, based on scientific principles and suited to the requirements of the majority of the blind— a scheme which might ultimately be adopted as an International, as well as a National system. It is obvious that the realization of such a project would be of inestimable value to the blind in all parts of the world, as it would effectually secure a closer bond of union amongst them than can possibly exist under the present divergent systems. Societies and Charities established for promoting the well-being of the blind in England go on increasing, though not so rapidly as they used to do, and in London and other large cities, it would no doubt be advantageous if some Central Authority or Association were established to whom the several classes of Societies and Charities connected with the blind could apply for expert advice as to improved methods for providing instruction and employment for the blind. In fact, we think that, in this way, the various benevolent bodies might be brought into closer mutual relation and that their resources might be more economically utilized; we further believe that much of the time and energy of philanthropic workers might be saved by a more scientific distribution of individual and, in some cases, isolated labours. With the object of ascertaining the educational and industrial condition of those of the Blind who reside in public institutions, circulars were addressed from this Office, to the Authorities of the principal Blind Asylums and Missions in England asking for particulars on these points. We take this opportunity of thanking these Authorities for the information with which they have furnished us. Satisfactory replies have been received from nearly all the Institutions circularised on this subject; but as some of the replies are not sufficiently definite the figures given below may be regarded as approximate. At or about the date of the Census the 42 Institutions from which statistics have been obtained, contained 1,921 Inmates, of whom 1,197 were males, and 724 females. The returns show that of this number, 1,325 were able to read and write one or more of the various types, and 392 were able to read but were unable to write. The type in most frequent use appears to be the "Braille"; the number returned as being able to read and write in this type, either alone or in addition to others, was 1,309, and 94 others were returned as being able to read, but not to write, "Braille." The only other kind of type used to any considerable extent in these Institutions is "Moon," which 12 inmates were stated to be able to read and write, and 344 to read only. The number of persons returned as being familiar with more than one kind of type is not large, amounting to only 83 in all, and in the Institutions here summarised, it is almost unique for one inmate to be credited with a knowledge of more than two kinds of types, only two such cases being recorded—both from the same Institution. The returns may be summarized as follows:— The 29 Institutions returning complete occupational statistics, contained 1,260 blind inmates, 816 males and 444 females, of whom 415 (217 males and 198 females) were in schools, and 845 (599 males and 246 females) in workshops. A list of the chief occupations carried on in these 29 institutions is given in the accompanying Table:— In the Census Report for 1851, and in the reports for the four succeeding Censuses, particulars were given of the Deaf and Dumb in the aggregate. In the last of these reports, however—that for 1891—an addition was made that requires some explanation. As already stated, information had been asked on the Census Schedules concerning certain specified infirmities. It was found that in practice many persons volunteered information as to infirmities not named on the Schedule. One of these infirmities was deafness. It is of course, highly improbable that the Returns of Deafness, being made in the manner just stated, are even approximately complete. And, in addition to this, the difficulty of defining "Deafness" is manifestly greater than the difficulty, already referred to, of defining "Blindness." Nevertheless, in response to urgent requests from persons who were specially interested in the deaf and dumb, our predecessors consented to tabulate and publish the voluntary returns of deafness contained in the Census Schedules. They divided the Deaf and the Dumb into three groups, as follows:—(1) The Deaf and Dumb, including those simply returned as Dumb; (2) Those stated to be Deaf, without statement of mutism, from childhood or from before the end of their tenth year of life, and (3) Those persons above the age of 10 years who have been simply returned as Deaf. In the Tables for 1901, we have thrown the second and third of these groups together, making two main groups; namely (1) the Deaf and Dumb, including those simply returned as Dumb, and (2) those simply returned as Deaf. But in connection with each of these groups we have given a subsidiary group, consisting of those who had been afflicted from childhood.1
In all cases we have classed the afflicted persons according to sex, age and condition as to marriage. In the following Table are given the proportions of males and females at the several ages per million of the population at those ages (a)
among the "Deaf and Dumb" and (b)
among the "Deaf":— The total number of persons returned as "Deaf and Dumb" was 15,246, namely 8,242 males and 7,004 females: the proportion per million at all ages being 524 for males and 417 for females. The foregoing total of 15,246 includes 6,561) persons, namely 3,497 males and 3,072 females, who were returned as Deaf and Dumb from childhood. In Table XLIX. of the "Summary Volume" the Deaf and Dumb from childhood are given separately in detail for the first time. All children under 10 years old, who were described either as "Deaf and Dumb" or simply as "Dumb" are classed as Deaf and Dumb from childhood. The figures are exclusively derived from the Census Schedules, and can only be regarded as approximately correct. Inasmuch as the Census Schedule did not require persons who were Deaf without being Dumb to mention the fact of their deafness, the figures relating to the Deaf only must be regarded as very untrustworthy. The total number of persons who volunteered the information that they were Deaf was 18,507, of whom 7,699 were males and 10,808 were females. Of these, 1,087 males and 1,346 females were classified as Deaf and Dumb from childhood. The aggregate of persons returned, either as "Deaf" or as "Deaf and Dumb" was, therefore, 33,753, or 4,473 more than at the previous Census. With respect to the sex incidence of deaf mutism as compared with that of deafness alone, there is (as there had been in 1891) a very great difference. Among the deaf mutes the males far outnumber the females (in the proportion of 118 to 100). But among those who were returned as deaf, without loss of speech, the females largely outnumber the males (their proportions being 140 to 100). A Table on page 73 of the Census Report for 1891 shows that "while the proportion of the deaf without muteness to the population goes on increasing with the advance of age, the opposite is the case with the deaf mutes, putting aside the children under ten... the proportion of deaf mutes in each sex to the total population of the same age and sex decreases gradually, though with some irregularity, with the advance of age." On examining the figures for 1901, whilst we still find that the proportion of deaf persons who were not dumb increases enormously with advancing age, nevertheless the deaf mutes show an extremely irregular age distribution. The following Table shows for each of the four Census Years from 1871 to 1901 the proportions of the deaf and dumb per million of the population in each of several sex and age groups. The Table shows that among males the deaf and dumb are relatively less numerous now than they were thirty years ago, excepting at ages between 45 and 85 years; while among females they are relatively less numerous, excepting at ages between 25 and 55 years and at ages over 65 years. The chief occupations of the "Deaf and Dumb" at ages over 10 years are shown in the following Table. The general character of the Table corresponds closely to that of the Table furnished by our predecessors in their Report for 1891:— Doubt has often been expressed as to whether the value of the information relating to mental infirmities which may be obtained from the ordinary Census Schedules is sufficient to warrant the continued demand for such details at the hand of the English householder. Although at each successive Census from 1871 onwards the attempt has been repeated to ascertain the proportion of insane persons in the population, it has nevertheless been held by our predecessors that the returns obtained were unreliable, because of the unsuitability of the ordinary Census machinery for the collection of such information. For the first time, at the Census of 1871, the householder or occupier was asked to state whether any member of his family suffered from mental unsoundness; and this inquiry has been repeated at each subsequent Census. Prior to 1871 the only question as to infirmities was "If Deaf and Dumb, or Blind ?" The question was altered in 1871 to "If Deaf and Dumb, or Blind, or Imbecile, or Idiot, or Lunatic ?" This form of Census inquiry was repeated without change both in 1881 and 1891, and consequently the statistics of mental unsoundness published at the three Censuses 1871, 1881 and 1891 admit of comparison. In arranging the Occupier's Schedule for 1901 with a view to secure greater accuracy in the returns of the insane, a change was made by substituting the term "Feeble-minded" for "Idiot." This change was adopted, as an experiment, at the suggestion of persons officially concerned in the guardianship of the insane, who represented to us that the substitution would certainly lead to greater accuracy in the returns—the term "Idiot" being regarded as opprobrious, and as likely to cause concealment of the truth. Whilst unfortunately this substitution has on the one hand destroyed the comparability of recent returns with those of previous Censuses, still, on the other hand there is little doubt that the numbers as regards children last obtained approach more nearly to accuracy than did the numbers obtained under the former system. For although a parent might perhaps be forgiven for failure to brand as an idiot a child for whose recovery there remained some ray of hope—it can scarcely be imagined that he would willingly acknowledge the existence even of "feeble mindedness" among his family to a greater extent than truthfulness would require. The term Feeble-minded may be useful in the classification of cases of lunacy, but the effect of its adoption on the Census Schedule has, as already stated, been to destroy the value of the Census statistics of mental unsoundness in 1901 for comparative purposes. It is evident that large numbers of persons who would not have been returned either as Idiot or Imbecile or Lunatic were returned as Feeble-minded in the Occupiers' Schedules at the last Census. The total numbers of the insane enumerated at the Censuses in 1871, 1881 and 1891 were successively 69,019, 84,503 and 97,383; and the proportions of insane to a million of the total population were successively 3,039, 3,253 and 3,358. In 1901, the enumerated number of the insane, influenced without doubt by the change of nomenclature, increased to 132,654, and the proportion to a million of the total population rose to 4,078. The increase in the proportion of the enumerated insane to a million of the population was 7.0 per cent. between 1871 and 1881, and fell to 3.2 per cent. between 1881 and 1891. Between 1891 and 1901, however, under the changed nomenclature, the increase in the proportion to population was equal to 21.4 per cent., affording presumptive proof that the substitution of "Feeble-minded" for "Idiot" has destroyed the value of this enumeration of persons returned as mentally unsound for comparison with the results obtained at previous enumerations. It has been admitted that the substitution of "Feeble-minded" for "Idiot" in the Census Schedule may have produced figures, as regards children, which approximately represent the proportion of the population that are mentally unsound, although even this may be open to doubt, on grounds that we shall presently discuss. At each of four Censuses at which return of the insane has been obtained, the rate of recorded insanity to population has been distinctly higher among females than among males. The proportion of the male insane rose from 2,973 per million of the male population in 1871 to 3,946 per million in 1901; the proportion of the female insane increased from 3,102 per million of the female population in 1871 to 4,202 per million in 1901. In equal numbers living there were 1,043 female to 1,000 male insane in 1871; 1,065 to 1,000 in 1881; and 1,077 to 1,000 in 1891. The relative proportion of the female insane declined, however, and did not exceed 1,065 to 1,000 males, in 1901. The figures in the foregoing Table show clearly that, while during the 20 years 1871-91 the proportion of the enumerated insane at all ages continued to increase, the increase was relatively smaller in 1881-91 than it had been in 1871-81. The fact, moreover, that the proportion of insanity showed an actual decline under 25 years of age in 1871-81, and under 45 years in 1881-91, whereas the increase in the 20 years was practically confined to the ages above. 45 years, lent probability to the assertion that much of the increase of recorded insanity was really the result of what has been described as accumulation, due to the decrease of mortality among the insane. At the Census in 1901 the proportion of the enumerated insane showed a marked increase at each of the five age periods. This increase was relatively largest among those under 15 years of age, and above the age of 65 years. It had been noted and proved that the numbers of Idiot has or imbecile children enumerated at previous Censuses were considerably understated; and it may be presumed that the substitution of the term Feeble-minded for Idiot has resulted in a more correct enumeration of mentally unsound children. As regards the enumerated insane above the age of 65, however, it is doubtful whether the result of the change has been in the direction of greater accuracy. There has evidently been less hesitation in returning elderly persons of failing mental intelligence as of unsound mind in consequence of the suggested use of the term Feeble-minded. The term, moreover, is one which it is obviously difficult to define, and it is not easy to estimate the true value of the increased numbers resulting from the change. The Table shows that, while the recorded increase of the insane at all ages between 1891 and 1901 was equal to 21 per cent., it was 24 per cent. among children under 15 years of age, and 38 per cent. among persons aged upwards of 65 years; between 15 and 25 the increase was 19 per cent., while it was respectively 11 and 16 per cent. at the age-periods 25-45 and 45-65. It will now be well to consider under what conditions the 132,654 Insane were enumerated at the Census in 1901, and to compare the figures with the results obtained at the previous Census. Of the total Insane, 86,797 or 65.4 per cent. were enumerated in Public Lunatic Asylums against 66.6 per cent. in 1891; 3,689 or 2.8 per cent. in Private Asylums, against 4.7 per cent. in 1891; 14,972 or 11.3 per cent. in Workhouse Establishments, against 10.9 per cent. in 1891; and 27,196 or 20.5 per cent., including a large proportion in receipt of Out-door Relief, were enumerated outside those Institutions, residing with relatives or others, against 17.8 per cent. in 1891. The accompanying Table shows that the total number of the Insane enumerated in 1901 exceeded the number returned in 1891 by no less than 36.2 per cent.; the increase in those in Public Lunatic Asylums was 33.8 per cent., while the number in Private Asylums showed a decrease of 19.7 per cent. The increase of the Insane in Workhouses was 41.4 per cent., and among those enumerated outside these Public Institutions it was no less than 57.1 per cent. It should be noted that the increase in the number of inmates of Public Asylums could not be due to the change of nomenclature to which we have called attention, and that the marked decrease in the inmates of Private Asylums is obviously due to other causes. Bearing in mind, however, the constant tendency to transfer the Insane from Workhouses to special Public Asylums, and the decline in previous intercensal periods in the numbers of the Insane enumerated outside these Institutions, it is impossible to avoid the conclusion that the adoption of the term Feeble-minded in place of Idiot has caused a large increase in the enumerated number of the Insane, which cannot be accepted as trustworthy evidence of actual increase of existing insanity. The marked increase during recent years in the numbers and proportion of the insane under control and treatment in Public Asylums, concurrently with the marked decline in the proportion of the insane retained in Workhouses, or living with relatives in receipt of out-relief, is still more distinctly shown in the following Table which deals with this classification of the insane reported upon by the Lunacy Commissioners on the 1st January in 1881, 1891, and 1901. The proportion of the total insane known to the Lunacy Commissioners who were in Public and State Asylums was 64.2 per cent. in 1881, and increased to 70.4 in 1891, and to 76.5 per cent. in 1901. The percentage in Licensed Houses and Registered Hospitals was 10.3 in 1881, 9.4 in 1891, and further fell to 7.3 in 1901. In Workhouses 16.5 per cent. of the total insane were located in 1881, while the proportion fell to 13.0 per cent. in 1891, and to 10.6 in 1901. Lastly, the out-relief insane and private single patients declined from 9.0 per cent. in 1881, to 7.2 and 5.6, respectively, in 1891 and 1901. With a view of testing still further the effect of the recent substitution on the numbers of the enumerated insane in 1901, a special comparison has been made of the cases not returned in Institutions in 1891 and in 1901, in the three Counties of London, Devon and York. It appears that the number of cases not in Institutions rose in these three Counties from 3,740 in 1891 to 5,912 in 1901, the increase being equal to 58.1 per cent., against 57.1 per cent. in the whole of England and Wales. Under the age of 15 the increase of cases not in Institutions, specified in the Table, was equal to 39.7 per cent.; between 15 and 25 years it was 57.1 per cent.; between 25 and 45 years 51.8 per cent.; between 45 and 65 years it was 56.9 per cent.; whereas among the insane above the age of 65 years, the number in these Counties more than doubled, the increase being equal to 136 per cent. It can, therefore, scarcely be doubted that a considerable proportion of the elderly persons returned at the last Census as Feeble-minded were suffering from senile debility rather than insanity. The following Table throws further light on this point:— In 1871 the number of cases of Lunacy of all classes known to the Lunacy Commissioners was 17.8 per cent. below the number of Insane enumerated at the Census in that year; in 1881 the deficiency in the Lunacy Commissioners' number compared with the Census number had declined to 13.5, and in 1891 this deficiency had further fallen to 10.9 per cent. Under the influence of the substitution of Feeble-minded for Idiot in the Census Schedule, the excess above the number reported by the Lunacy Commissioners rose again to 18.6 per cent. in 1901, and actually exceeded the excess 30 years before, notwithstanding the constant transfer during that period from Out-door Relief to Workhouses or to Public Asylums. There appears, therefore, to be unquestionably good ground for declining to accept the large increase of the Insane returned in the Census Schedules in 1901 as a trustworthy indication of a real increase of insanity. The figures, however, in the following Table, showing the mean annual rate of existing certified cases per million of population, and the percentage of increase of this rate in quinquennial periods since 1859, which are abstracted from the Annual Reports of the Lunacy Commissioners, are not without interest:— The Table shows that the percentage of increase of the cases known to the Commissioners steadily fell from 1859 to 1893, since which it has persistently risen. For instance, the mean annual proportion of insane in 1864-68 was 12.9 per cent. higher than it had been in the preceding quinquennium; whereas the mean proportion in 1889-93 was only 2.4 per cent. higher than that in 1884-88. In 1899-1903, however, the mean annual proportion showed an excess of 6.2 per cent. upon the proportion in the preceding five years 1894-98. Census statistics of Insanity show the increase during recent years in the existing number of the insane, but they do not explain its cause. It is undoubtedly to a large extent an accumulation of cases, due to the skilled treatment in Asylums, which has caused a decline in the mortality of the Insane, and a consequent increase in their duration of life. Dr..William Farr, formerly a Superintendent in the General.Register Office, wrote more than 60 years ago:—" There may be ten times as many lunatics in civilised as in barbarous countries and times; not because the tendency to insanity is greater, but because the lunatics live ten times as many months, or years."2
The following Table shows the proportional age-distribution of the Insane, enumerated in England and Wales at each of the four Censuses in 1871-1901, and exhibits a marked and comparatively steady increase in the proportions at the advanced ages. Out of 1,000 enumerated at all ages, the number under the age of 25 declined from 208 in 1871 to 165 in 1901; at the ages 25-45 the number declined from 386 in 1871 to 367 in 1901; at the ages 45-65, however, the number increased from 298 in 1871 to 334 in 1891 and was 332 in 1901.; while the proportion of the insane aged upwards of 65 years rose steadily at each successive Census from 108 in 1871 to 136 in 1901. The largest increase in the proportion of the enumerated insane above the age of 65 occurred between 1891 and 1901, and was probably due partly to the increased longevity mentioned above, and partly to the inclusion of many old persons as "Feeble-minded" who would not have been returned as insane under the previous headings "Lunatic," "Idiot or Imbecile." Having regard to the result of the substitution of "Feeble-minded" for "Idiot" in the Occupier's Schedule on the statistics of Insanity derived from the Census returns in 1901, the question of the maintenance of this change will call for serious consideration when the time arrives for devising the Schedule for the next Census. 1
The definition of childhood which has been used for this purpose is the same as in the case of the Blind (see
page 146). 2
See
Dr. Farr's Paper entitled "Report on the Mortality of Lunatics," read before the Statistical Society in.1841.VII.—PHYSICAL INFIRMITIES.
1. The Blind.
Year.
Number of
Blind.Blind per million
of the
population.Persons living
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
1891
23,467
809
1,236
1901
25,317
778
1,285
Decrease in Blindness among Children
Age Period.
1851.
1861.
1871.
1881.
1891.
1901.
Under 5 years
198
196
185
166
155
129
5-10
297
256
259
}
288
{
188
192
10-15
365
366
359
290
323
15-20
416
415
404
388
370
329
20-25
481
443
451
422
385
359
Total under 25
339
322
317
298
269
261
Blindness in relation to sex
Age Period
1871.
1881.
1891.
1901.
Males.
Females.
Males.
Females.
Males.
Females.
Males.
Females.
All Ages
1,029
876
953
809
874
748
835
725
Under 5 years
189
180
172
161
168
142
151
108
5-10
294
223
}
312
263
{
204
172
214
169
10-15
401
317
309
272
353
292
15-20
451
358
449
328
419
322
380
278
20-25
518
390
491
359
457
321
409
314
25-35
664
438
}
800
494
{
558
374
535
382
35-45
1,138
595
932
576
857
530
45-55
1,606
1,013
}
1,947
1,336
{
1,470
885
1,320
920
55-65
2,598
2,119
2,474
1,856
2,333
1,731
65-75
5,123
4,893
}
6,897
6,929
{
4,343
3,962
4,187
3,825
75-85
11,785
11,551
9,693
9,967
8,546
8,907
85 and upwards
21,450
25,810
17,940
19,742
17,806
18,868
Occupations of the Blind
Of the Total*
MALES aged 10 years
and upwards returned as Blind.OCCUPATION.
Of the MALES aged 10 years and
upwards returned as Blind
from Childhood.Numbers engaged
in certain
occupations.Proportions per
1,000 engaged
in certain
occupations.Numbers engaged
in certain
occupations.Proportions
per 1,000
engaged
in certain
occupations.1891.
1901.
1891.
1901.
1891.
1901.
1891.
1901.
11,638
12,483
1,000
1,000
Total aged 10 years and upwards
1,551
1,815
1,000
1,000
7,009
7,836
602
628
Retired or Unoccupied
851
921
549
507
4629
4,647
398
372
Total Occupied
700
894
451
493
80
66
7
5
Clergymen, Priests, Ministers, Missionaries, Scripture Readers, Itinerant Preachers
14
16
9
9
48
47
4
4
Schoolmasters, Teachers, Professors, Lecturers
11
17
7
9
531
{
534
}
46
{
43
Musicians, Music Masters, Singers
}
184
{
229
}
119
{
126
80
6
Art, Music, Theatre—Service, &c. (including Organ Grinders)
8
4
11
179
1
14
Brokers, Agents, Factors
—
34
—
19
142
142
12
11
Farmers, Graziers
7
3
5
2
186
70
16
6
Agricultural Labourers
6
—
4
—
107
208
9
17
Musical Instrument Makers (including Tuners)
43
89
28
49
839
936
72
75
Willow, Cane, Rush Workes Basket Makers
203
277
131
153
172
158
15
13
Brush, Broom Makers; Hair, Bristle Workers
45
42
29
23
80
106
7
8
Newspaper Agents, News Room Keepers
13
23
8
13
140
157
12
13
Mat Makers
41
34
26
19
143
153
12
12
Grocers; Tea, Coffee, Chocolate Dealers
11
7
7
4
230
268
20
21
Costermongers, Hawkers, Street Sellers
21
35
14
19
277
123
24
10
General Labourers
7
8
5
4
1,643
1,420
141
114
All other occupations
94
72
59
40
1,372
1,793
118
144
Retired (not Army, Navy, Church, Medicine)
13
18
8
10
184
153
16
12
Pensioners
1
—
1
—
642
604
55
48
Living on own Means
34
38
22
21
4,811
5,286
413
424
Others aged 10 years and upwards (including Students)
803
865
518
476
*
Including those returned as Blind from Childhood.
Of the Total*
FEMALES aged 10
years and upwards
returned as Blind.OCCUPATION.
Of the FEMALES aged 10 years and upwards returned as Blind from Childhood.
Numbers engaged
in certain
occupations.Proportions per
1,000 engaged
in certain
occupations.Numbers engaged
in certain
occupations.Proportions
per 1,000
engaged
in certain
occupations.1891.
1901.
1891.
1901.
1891.
1901.
1891.
1901.
10,641
11,684
1,000
1,000
Total aged 10 years and upwards
1,266
1,656
1,000
1,000
9,630
10,655
905
912
Retired or Unoccupied
1,034
1,330
817
803
1,011
1,029
95
88
Total Occupied
232
326
183
197
41
53
4
5
Schoolmistresses, Teachers, Professors, Lecturers
12
17
9
10
57
69
5
6
Musicians, Music Mistresses, Singers
26
40
21
24
143
98
13
8
Domestic Indoor Servants
11
9
9
5
43
36
4
3
Charwomen
1
3
1
2
52
39
5
3
Laundry and Washing Service
4
3
3
2
1
33
—
3
Brokers, Agents, Factors
—
18
—
11
135
184
13
16
Willow, Cane, Rush Workers; Basket Makers
58
94
46
57
56
66
5
6
Brush, Broom Makers; Hair, Bristle Workers
20
29
16
18
10
43
1
4
Hosiery Manufacture
—
14
—
8
136
101
13
9
Fancy Goods (Textile), Small Ware, &c., Manufacture
65
38
51
23
52
28
5
2
Costermongers, Hawkers, Street Sellers
7
6
6
4
285
279
27
23
All other occupations
28
55
21
33
286
505
27
43
Retired
7
7
6
4
35
11
3
1
Pensioners
6
2
5
1
1,330
1,103
125
94
Living on own Means
66
88
52
53
7,979
9,036
750
774
Others aged 10 years and upwards (including Students)
955
1,233
754
745
*
Including those returned as Blind from Childhood.
Present position of matters relating to the Blind
The Blind in Public Institutions
Types used in Institutions for the blind
Number of Inmates returned as being able to
Read, or Read and Write, one Type only.
Braille.
Moon.
Other Types.
Read only.
Read and Write.
Read only.
Read and Write.
Read only.
Read and Write.
92
1,234
264
9
34
1
Read, or Read and Write, more than one Type.
Braille and Moon.
Moon and Others.
Braille, Moon, and Others.
Read Both,
Read and Write Braille and Read Moon,
Read and Write both,
Read and Write Others and Read Moon,
Read and Write Braille and Others, and Read Moon,
Read and Write Braille, Read Moon and Others,
2
70
3
6
1
1
Occupations
Occupation.
Males.
Females.
Occupation.
Males.
Females.
Basket-making
322
a
31
b
Upholstering
1
8
Brush-making
123
25
Rug and Carpet Weaving
8
—
Chair Caning
41
173
c
Cork Fender-making
8
—
Knitting and Sewing
—
90
Laundry
—
4
Mat Making
80
1
Reed Work
4
—
Piano Tuning, Musicd
16
4
Ash Bag-making
3
—
Mattress-making
19
10
Domestic Service
—
3
Skip-making
24
—
Firewood Chopping
3
—
Typewriting
10
5
Bent Iron
1
—
Fish Bag-making
9
4
Hawking
1
—
Woodwork
12
—
Masseuse
—
1
a
Of the 322 male basket makers, 22 were also chair-caners.
b
Of the 31 female basket makers, 6 were also engaged in hand loom weaving, 9 in chair-caning, and 3 in cane work.
c
Of the 173 female chair caners, 111 were also engaged in knitting, 9 in mattress-making, 7 in game bag-making.
d
In addition to the 20 persons included under this heading, 84 were being taught music as a profession, and 83 as a recreation. In 13 other Institutions, for which the Occupational Statistics were incomplete, 153 were being taught music as a profession, and 47 as a recreation.
2. The Deaf and Dumb.
Ages.
Deaf and Dumb.
Deaf Only.
Deaf and Dumb
together with Deaf.Males.
Females.
Males.
Females.
Males.
Females.
Under 5 years
114
91
23
25
137
116
5—10
457
354
95
100
552
454
10—15
613
466
200
210
813
676
15—20
593
477
226
287
819
764
20—25
654
470
265
306
919
776
25—35
586
453
356
413
942
866
35—45
564
480
523
712
1,087
1,192
45—55
607
517
877
1,092
1,484
1,609
55—65
617
475
1,399
1,729
2,016
2,204
65—75
569
413
2,436
2,973
3,005
3,386
75—85
387
452
4,376
5,136
4,763
5,588
85 and upwards
334
524
7,067
8,681
7,401
9,205
All ages
524
417
489
643
1,013
1,060
Deaf Mutes in relation to Sex and Age
Age-Period.
1871.
1881.
1891.
1901.
Males.
Females.
Males.
Females.
Males.
Females.
Males.
Females.
All Ages
566
451
563
464
548
434
524
417
Under 5 years
152
137
167
116
131
106
114
91
5-10
662
517
}
627
553
{
619
461
457
354
10-15
714
617
749
549
613
466
15-20
675
579
613
514
599
514
593
477
20-25
701
530
683
511
584
468
654
470
25-35
620
439
}
626
515
{
563
447
586
453
35-45
587
463
618
499
564
480
45-55
557
427
}
607
468
{
585
465
607
517
55-65
590
501
570
448
617
475
65-75
532
405
}
605
524
{
530
415
569
413
75-85
356
337
533
439
387
452
85 and upwards
621
474
493
364
334
524
Occupations of the Deaf and Dumb
Males.
—
Females.
—
Total over 10 years of age
7,235
Total over 10 years of age
6,215
Retired or Unoccupied
2,538
Retired or Unoccupied
4,247
Engaged in Occupations
4,697
Engaged in Occupations
1,968
Artists
33
Domestic Indoor Service
367
Domestic Offices or Services
86
Charwomen
79
Conveyance of Men, Goods, and Messages
143
Laundry and Washing Service
230
Agriculture
548
Textile Industries
234
Mines and Quarries
150
Tailoresses
140
Metals, Machines, Implements, and Conveyances
480
Milliners and Dressmakers
487
Building and Works of Construction
485
Seamstresses
81
Wood, Furniture, Fittings, &c.
443
Other occupations
350
Brick, Cement, Pottery, and Glass
132
Printing and Bookbinding
147
Textile Fabrics (Makers and Dealers)
173
Tailors
429
Boot, Shoe, Patten, Clog, Makers
587
General Labourers
257
Other occupations
604
3. The Insane.
DATE OF CENSUS.
PERSONS.
MALES,
FEMALES.
Number enumerated as Insane.
Proportion per million living.
Number enumerated as Insane.
Proportion per million living.
Number enumerated as Insane.
Proportion per million living.
1871
69,019
3,039
32,874
2,973
36,145
3,102
1881
84,503
3,253
39,789
3,148
44,714
3,353
1891
97,383
3,358
45,392
3,230
51,991
3,478
1901
132,654
4,078
62,063
3,946
70,591
4,202
AGES.
Insanity Rate per 1,000 living at several
Age-groups at the last four Censuses.Increase or Decrease per cent. of Insanity Rate in Intercensal Periods.
1871.
1881.
1891.
1901.
1871-81.
1881-91.
1891-1901.
All Ages
3.039
3.253
3.358
4.078
7.04
3.23
21.44
Under 15 Years
0.583
0.581
0.509
0.629
-0.34
-12.39
23.58
15-25
2.298
2.161
2.002
2.388
-5.96
-7.36
19.28
25-45
4.498
4.789
4.756
5.263
6.47
-0.69
10.66
45-65
6.158
7.205
7.831
9.087
17.00
8.69
16.04
65 years and upwards
6.950
8.000
8.612
11.922
15.09
7.65
38.43
WHERE ENUMERATED.
NUMBER of INSANE.
INCREASE
or DECREASE
PER CENT.PROPORTION PER 1,000
OF THE INSANE.Census of 1891.
Census of 1901.
Census of 1891.
Census of 1901.
Total
97383
132654
36.2
1000
1000
Public Lunatic Asylums*
64881
86797
33.8
666
654
Private Lunatic Asylums
4595
3689
-19.7
47
28
Workhouses
10592
14972
41.4
109
113
Elsewhere
17315
27196
57.1
178
205
*
Comprising County and Borough. Asylums, State Asylums, Lunatic Hospitals, Idiot Asylums, and the Imbecile Asylums under the jurisdiction of the Metropolitan Asylums Board.
Where Maintained.
1st January, 1881.
1st January, 1891.
1st January, 1901.
Number.
Proportion
per cent.Number.
Proportion
per cent.Number.
Proportion
per cent.Total
73,113
100.0
86,795
100.0
107,944
100.0
In Public and State Asylums
46,871
64.2
61,084
70.4
82,536
76.5
In Registered Hospitals and Licensed Houses
7,574
10.3
8,199
9.4
7,928
7.3
In Workhouses
12,093
16.5
11,259
13.0
11,389
10.6
Out-Relief Insane and Private Single Patients
6,575
9.0
6,253
7.2
6,091
5.6
YEAR.
NUMBER of INSANE.
Deficiency per cent. of
numbers returned by Lunacy
Commissioners.As enumerated at Census.
As returned by
Lunacy Commissioners.Persons.
Males.
Females.
Persons.
Males.
Females.
Persons.
Males.
Females.
1871
69,019
32,874
36,145
56,755
26,009
30,746
17.8
20.9
14.9
1881
84,503
39,789
44,714
73,113
32,973
40,140
13.5
17.1
10.2
1891
97,383
45,392
51,991
86,795
39,162
47,633
10.9
13.7
8.4
1901
132,654
62,063
70,591
107,944
49,188
58,756
18.6
20.7
16.8
QUINQUENNIAL
PERIODS.MEAN ANNUAL Proportion of Insane
reported by Lunacy Commissioners per Million
of Population.Increase per cent. between the
Quinquennial Periods.Persons.
Males.
Females.
Persons.
Males.
Females.
1859-63
1,972
1,840
2,097
}
12.9
13.2
12.7
1864-68
2,226
2,083
2,363
}
11.7
12.2
11.2
1869-73
2,486
2,337
2,627
}
7.5
6.5
8.5
1874-78
2,673
2,488
2,849
}
5.2
4.8
5.4
1879-83
2,811
2,607
3,004
}
3.9
4.1
3.7
1884-88
2,920
2,714
3,116
}
2.4
2.9
1.8
1889-93
2,989
2,793
3,173
}
5.1
5.7
4.6
1894-98
3,141
2,952
3,318
}
6.2
6.5
6.0
1899-1903
3,336
3,143
3,517
AGES.
PERSONS.
MALES.
FEMALES.
1871.
1881.
1891.
1901.
1871.
1881.
1891.
1901.
1871.
1881.
1891.
1901.
All Ages
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
Under 15 years
69
65
53
50
83
81
66
61
57
51
42
41
15-25
139
125
115
115
152
142
137
133
127
109
96
99
25-45
386
381
377
367
395
396
390
385
377
370
364
351
45-65
298
316
334
332
278
288
308
309
316
341
357
351
65 and upwards
108
113
121
136
92
93
99
112
123
129
141
158