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VIII.—INFIRMITIES.

Scope of the Inquiry. —A column asking particulars of those suffering from infirmities was first introduced into the schedule at the Census of 1851, and the following statement shows the form in which the question has been put at each of the last seven Censuses.

1851 If Deaf and Dumb or Blind. Write "Deaf and Dumb" or "Blind" opposite the name of the person.
1861 If Deaf and Dumb or Blind. Write "Deaf and Dumb" or "Blind. opposite the name of the person; and if so from birth, add "from birth..
1871 If (1) Deaf and Dumb
   (2) Blind
   (3) Imbecile or Idiot
   (4) Lunatic
Write the respective infirmities against the name of the afflicted person; and if so from birth, add "from birth."
1881 As in 1871.  
1891 If (1) Deaf and Dumb
   (2) Blind
   (3) Lunatic, Imbecile or Idiot
Write the precise infirmity, if any, opposite the name of the person; and if the infirmity dates from childhood, add "from childhood."
Do not use such a general term as "afflicted" or "infirm."
1901 If (1) Deaf and Dumb
   (2) Blind
   (3) Lunatic
   (4) Imbecile, Feeble-minded
Write the precise infirmity, if any, opposite the name of the person; and if the infirmity dates from childhood, add "from childhood."
Do not use such a general term as "afflicted. or "infirm."
1911 If any person included in this schedule is:—
   (1) "Totally Deaf" or "Deaf and Dumb"
   (2) "Totally Blind"
   (3) "Lunatic".
   (4) "Imbecile" or "Feeble-minded"
State the infirmity opposite that person's name and the age at which he or she became afflicted.

It will be observed that this is the first occasion on which an attempt has been made to obtain any information regarding the deaf other than deaf mutes. This was felt to be desirable both because at previous Censuses many persons were returned as deaf who were not stated to be dumb, though the information was not sought for; and because, in view of the progress made in phonetic training of deaf mutes, it was felt that reasonable exception might be taken to the description as deaf-mute of persons who, while remaining deaf, had acquired the art of intelligible speech. In view of the obvious worthlessness of returns of the partially deaf, if the public were left without guidance as to the degree of defect of which cognizance should be taken, and of the impossibility of securing general and intelligent application by householders of any standard prescribed for their guidance in the matter, it was decided to reduce the inquiry to the simplest possible terms, namely, whether there was total deafness. By this means it was hoped that the need for prescribing any test of the degree of deafness referred to might be avoided. The similar difficulty as to degree of blindness referred to was dealt with in the same way and for the same reasons, it having been obvious at previous Censuses that the term "blind" was differently interpreted in different cases. An attempt was also made to ascertain the duration of the infirmity in every case and not only, as at previous Censuses, in those cases where the affliction dated from birth or from childhood. We regret to have to report, however, that these additions to the schedule have not led to the improvement in the statistics which might have been looked for. As regards the value of the figures for the totally deaf, it is impossible to speak definitely since the voluntary returns of deafness at previous Censuses are obviously incomplete; as regards the blind, however, it seems probable that a number of persons have been returned as totally blind who possess some degree of sight; for it was apparent, from discussion before the Census with those interested in the welfare of the blind, that the information desired in regard to this matter is rather that of the number of persons whose defect of vision is so serious as to forbid ordinary means of earning a livelihood. While in fullest sympathy with this desire, we have found ourselves unable to devise any means by which the ordinary mechanism of an English Census could be adapted to its accomplishment; but the fact that what may be referred to as economic blindness is, much more than total blindness, the defect of which the presence or absence is of real interest and importance, has probably led to its mention in many cases, even where some slight amount of vision is retained. The attempt to ascertain the duration of the infirmity was made by asking at what age the person became afflicted, but this apparently simple question has been widely misunderstood, and in many cases the number of years the infirmity has lasted has obviously been returned. Knowing that this error was widespread, but not being able to distinguish, in many cases, whether it was the age or duration which had been returned, we have deemed it best to make no use of these figures in the accompanying tables.

While fully realising the great importance of attempting to ascertain the numbers of persons afflicted with certain infirmities, we must submit that statistics of this nature obtained through a general population Census are most unsatisfactory; firstly, on account of the difficulty of framing a suitable form of inquiry defining the degree of disability which it is desired to include in the tabulation and, secondly, because the definition has to be applied by householders with no technical knowledge, who will interpret it in different ways and many of whom have a natural reluctance to admit that they or their relatives suffer from any defect—at least to the degree referred to in the inquiry. This was put most strongly by the Census Commissioners of 1881, who stated in their report (C. 3797, page 71):—"...we felt bound to point out, as clearly as we could, how 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." They also quoted the results of an investigation into the admissions into a large idiot asylum during the year following the date of the Census, which showed that in one-half of the cases of admissions as indisputable idiots between the ages of 5 and 15 no entry had been made on the Census schedule which had been filled in a few weeks or months before.

The Report on the Census of 1891 characterised these statistics as "in all probability excessively inaccurate," while in the Report for 1901 it is stated:—"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."

The Royal Commission on the Care and Control of the Feeble-minded reports as follows on the unsuitability of the Census as an agency for ascertaining facts concerning mental defect:—"....the census, it appears to us, is not an agency suitable for the ascertainment and classification of facts the nature of which in very many instances can only be learned by the personal observation of men and women whose judgement has been trained and well practised in a special branch of medical work. Both for administrative and scientific purposes it would be better, we think, to ascertain the facts by special investigation such as that which has been made by our medical investigators, or by means of the cumulative records which we hope may be compiled as confidential documents, as soon as the importance of the subject is recognised." (Cd. 4202, page 198.)

In this connexion it may be mentioned that the investigations of the Royal Commission in 1905 proved that the Census figures for the mentally defective had been much understated in 1901.

In foreign countries much the same impression prevails as to the unsatisfactory nature of the infirmity inquiry, and, therefore, in some cases a technical inquiry conducted by experts into the degree, cause, duration, etc., of the affliction follows the obtaining by the general census of the names and addresses of the infirm. In reply to a question on this point, the Census authorities of the United States of America wrote as follows:—

". one of the reasons for not including inquiries regarding physical and mental defects on the population schedule of the 12th census (1900) of the United States was the realisation of the impossibility of getting accurate information on these points in a large number of cases, not only on account of the difficulty of defining the degree of impairment which would constitute a defect, but because of the sensitiveness of persons affected and their consequent concealment of such defects in themselves and members of their families. These questions, at the 11th Census, gave rise to much criticism and complaint, and the attempt to secure these data was therefore abandoned."

It is observed, however, that at the 13th Census (1910) questions relating to blindness and deaf-mutism Lave been again introduced, with a view, we understand, to the subsequent professional inquiry referred to above.

The tables contained in Volume XL of the report give, inter alia , the sex, age, and condition as to marriage of the totally blind, totally deaf, deaf and dumb, lunatic, imbecile, and feeble-minded, and of those suffering from more than one of these infirmities in England and Wales and in each administrative county, inclusive of its associated county boroughs, but as our experience gives us no reason to hope that the figures are appreciably more accurate on this than on previous occasions, we have not felt justified in entering upon an elaborate analysis of the figures, and have therefore confined our comments within narrow limits.

The Blind. —The Report on the Census of 1901 recommended that expert opinion should be taken as to what constitutes "Blindness," but from the inquiries which we made prior to the Census of 1911, we found there were many diverse opinions as to how blindness should be defined. A definition which had met with a certain amount of international acceptance, and the employment of which might therefore have in some degree conduced to international comparability of the returns, was rejected by the English experts consulted as inadequate to their requirements. With a view, therefore, to making the question as definite as possible in order to obtain uniformity of results, the schedule asked only for particulars of the "totally blind," but, for the reasons previously stated it is extremely doubtful whether the figures obtained accurately represent their numbers. The numbers so returned were 26,336, of whom 13,257 were males and 13,079 were females —that is, one person in every 1,370 is blind, one in 1,316 males, and one in 1,424 females. Of the males, 5,434 were unmarried, 5,537 were married, and 2,286 widowed; of the females, 5,731 were unmarried, 2,899 were married, and 4,449 were widowed. The following table compares the number of "totally blind" in 1911 with the numbers returned as "blind" at previous Censuses. It will be seen that the decrease in the proportion of blind per million of the population in the last decennium while greater than in the previous decennium, was neither so great as between the Censuses of 1871 and 1881 or 1881 and 1891, nor so great as might have been expected owing to the limitation of the inquiry. In fact, it would almost seem that the question as to blindness, however framed, is answered in much the same way. Probably a householder accustomed to think and speak of himself or one of his dependants as "blind" would "in many cases return him so in the schedule, and if not so accustomed would not make the return in this form, however the question was framed and whatever definition of "blindness" was adopted.

TABLE CXV.—NUMBER AND PROPORTION OF THE BLIND AT EACH CENSUS FROM 1851 TO 1911.

Table CXVI shows the proportion of blind per million of each sex at twelve groups of ages for each of the last five Censuses. It will be seen that the proportion of males exceeds that of females at every age-period except the last two, and particularly in the working period of life, when the greater risk of accidents leading to blindness, involved by the occupations of males, would have most effect.

Comparing the figures for 1911 with those for 1901, it will be seen that improvement was recorded in each age-group except that of the females under 5 years, which shows a very slight increase. The improvement, as at previous Censuses, was somewhat greater among males than among females. It was particularly marked in both sexes at the age 10-15, which, for some reason, had shown at the previous Census a considerable increase in the proportion returned as blind in both sexes.

TABLE CXVI.—PROPORTION OF BLIND PER MILLION OF EACH SEX IN EACH AGE-GROUP, 1871-1911.

Table 89 of the Summary Volume gives the occupations followed by the blind; where an occupation is given inconsistent with the infirmity, it may generally be assumed that the former occupation of the afflicted person has been returned, or that he is an employer. The following table shows the chief occupations in which the blind are employed and the proportion per 1,000 blind persons of each sex engaged in each occupation. By far the greatest number of blind males are employed as willow, cane, rush workers, or as basket makers; the next highest number being musicians, music masters, singers; then follow coster mongers, hawkers, street-sellers; musical instrument makers (including tuners); brokers, agents, factors; mat makers; and grocers. Willow, cane, rush working and basket making also employ the largest number of blind females, the only other occupation employing more than one per cent, of the blind females aged 10 years and upwards being hosiery manufacture.

TABLE CXVII.—OCCUPATIONS OF THE BLIND AGED TEN YEARS AND UPWARDS AT THE CENSUSES OF 1901 AND 1911.

The Deaf (other than Deaf Mutes). —As previously stated, the Census of 1911 was the first occasion on which an attempt was made to ascertain the numbers of the deaf who were not also dumb. At previous enumerations, although no return was asked for, many persons were voluntarily returned as deaf, and in 1891 and 1901 these returns, though obviously incomplete, were tabulated. In 1891 they numbered 15,088, and in 1901 18,507, the numbers returned as totally deaf in 1911 being 26,649, of whom 10,640 were males and 16,009 females. Of the males 4,441 were unmarried, 4,661 were married, and 1,538 widowed; 6,344 of the females were unmarried, 5,174 were married, and 4,491 widowed. The following table shows that 610 in every million males were totally deaf and 860 per million females, and that this remarkable excess of females obtained at every age group after 15, previous to which the female rate of deafness did not differ very materially from the male rate.

TABLE CXVIII.—PROPORTION OF DEAF (OTHER THAN DEAF MUTES) PER MILLION OF EACH SEX IN EACH AGE-GROUP, 1911.

The Deaf and Dumb. —In addition to the 26,649 persons returned simply as deaf there were 13,427 who were also dumb, and 1,695 who were stated to be dumb, but not stated to be deaf; for convenience the dumb have been included with the deaf and dumb. Of these 8,167 were males and 6,955 females, being in the proportion of 468 per million males and 373 per million females. Of the males 6,362 were unmarried, 1,603 were married, and 202 were widowed; of the females 5,256 were unmarried, 1,393 were married, and 306 widowed. The following table shows the proportions of the deaf and dumb per million of the population of each sex at different ages at each of the last five Censuses:—

TABLE CXIX.—PROPORTION OF DEAF AND DUMB PER MILLION OF EACH SEX IN EACH AGE-GROUP, 1871-1911.

It will be seen that in 1911 the proportion of the deaf and dumb is lower than at any previous Census shown in the table, the improvement, which is considerably in excess of any previously recorded, being shown at nearly all the age-groups. Whether the last ten only or the whole forty years are considered, the improvement is, as might be expected, from the success of modern educative methods, much more marked in early than in later life. In marked contrast to the proportions for the deaf only, given in Table CXVIIL, it will be seen that among deaf-mutes the males outnumber the females, and that while the proportions of the deaf increase very rapidly with advancing years, no such increase, naturally, is observable in the proportion of deaf-mutes. Prom Table 89 in the Summary Volume showing the occupations followed by the deaf and dumb, it will be seen that those in which most of such persons were employed are as follows:—

MALES. FEMALES.
Farmers, Graziers, and their Relatives 76 Domestic Indoor Servants 292
Agricultural Labourers 358 Charwomen 88
Gardeners (Domestic and Others) 123 Laundry Workers; Washers, Ironers, Manglers, etc. 227
Coal Mine—Workers above ground 89 Cotton Manufacture 93
Blacksmiths, Strikers 54 Wool and Worsted Manufacture 40
Carpenters, Joiners (including Labourers) 165 Tailoresses 134
Bricklayers, Bricklayers' Labourers 53 Dressmakers 348
Painters, Decorators 100 Shirt Makers ; Seamstresses 52
Cabinet Makers 201 All other Occupations 486
French Polishers 104 Retired or Unoccupied 4,463
Brick, Plain Tile, Terra-cotta—Makers 57 Total aged 10 years and upwards 6,223
Saddlers; Harness, Whip—Makers 76    
Tailors 429    
Boot, Shoe—Makers 657    
Bread, Biscuit, Cake, etc.—Makers 55    
General Labourers 186    
All other Occupations 2,047    
Retired or Unoccupied 2,411    
Total aged 10 years and upwards 7,241    

The Insane. —The Census of 1911 was the fifth occasion on which an attempt has been made to ascertain the number of person suffering from mental infirmity, who for the sake of convenience will all be referred to as insane, whether lunatic, imbecile, or merely feeble-minded. Previous to 1901 a return was asked of persons who were ''lunatic," "imbecile," or "idiot," but in 1901, since it had been represented that the term "idiot" was considered to be somewhat opprobrious and therefore liable to lead to concealment of the truth, it was omitted, the term imbecile being used to include all the major degrees of congenital mental defect. At the same time the term feeble-minded was introduced for the first time in order to cover the minor degrees of this condition, to which a considerable amount of public attention had been directed. On the present occasion the question as to mental unsoundness was asked in the same form as in 1901. Although the substitution referred to destroys the value of the later figures for purposes of comparison with those of the earlier Censuses, the figures for all five Censuses are brought together in the following table for convenience of reference.

TABLE CXX.—NUMBER AND PROPORTION OF THE INSANE AT EACH CENSUS FROM 1871 TO 1911.

It will be noticed that the increase in the proportions between 1901 and 1911 is higher than in either of the two periods previous to the change in classification, and the question naturally arises whether the figures represent a real or only an apparent increase in insanity. On this point we quote the opinion of the Commissioners in Lunacy, expressed in their 65th Annual Report, that for 1910 (pages 11 and 12).

"The increase in the number of the insane recorded year by year is no proof of an actual growth of insanity in the community, although it is often assumed to be such. There are, in point of fact, no sufficient data for a correct judgement on the latter head, and such facts as are available tend to the conclusion that if insanity is increasing at all it is doing so very slowly and by no means proportionately to the increasing numbers of insane persons under care. . . . . It is probable that far more care is taken to segregate persons suffering from the milder forms, of, insanity than used to be the case, fitness for such detention being considered to imply the need for treatment of a disease quite as much as the fact that the insane person requires protection from himself or that the community has to be protected from him. . . . . Hence it happens that, without any actual marked increase in the prevalence of mental disorder, many such defectives are now being notified who a generation or two ago would have been left outside the pale of official recognition."

As at each of the previous Censuses, the proportion of the female insane was higher than the male proportion, but the excess was less than it had been at any Census since 1881. In equal numbers living there were to 1,000 male insane 1,043 females in 1871; 1,065 in 1881; 1,077 in 1891; 1,065 in 1901; and 1,054 in 1911.

The following table brings up to date a table printed in the 1901 report, and shows the insanity rate per million living at various age-groups at the last five Censuses, with the increase .or decrease per cent, between the Censuses.

TABLE CXXI.—PROPORTION OF INSANE PER MILLION LIVING IN EACH AGE-GROUP, 1871-1911.

If the figures for 1901 and 1911 are divided into the two categories "lunatic" and "imbecile or feeble-minded," as in the following table, it will be seen that while both forms of mental defect contribute to the large increase in the two age-groups under 15 and 15-25, the increase in the case of the lunatic is considerably in excess of that for the imbecile and feeble-minded, while beyond these age-groups the increase is wholly among the lunatic. The decrease in the number of imbecile and feeble-minded would seem to suggest that the term "feeble-minded" has been more restricted in its application than in 1901 to cases of congenital mental defect.

TABLE CXXII.—PROPORTION OF LUNATIC AND IMBECILE OR FEEBLE-MINDED PER MILLION LIVING IN EACH AGE-GROUP, 1901 AND 1911.

Of the 161,993 persons who were returned as suffering from mental infirmity 106,660 were returned as lunatic, 25,405 as imbecile, and 29,928 as feeble-minded. In 1901, 83,772 were returned as lunatic, and 48,882 as imbecile or feeble-minded; thus there was an increase of 22 per cent, in the insane taken as a whole, of 27.3 per cent, in the lunatic, and 13.2 per cent, in the imbecile or feeble-minded.

The following table gives the proportions per million living at various age-groups of the lunatic, imbecile and feeble-minded.

TABLE CXXIII.—PROPORTION OF LUNATIC, IMBECILE, AND FEEBLE-MINDED PER MILLION OF THE POPULATION.

As is to be expected, the proportion of persons suffering from one or other form of mental unsoundness increases with age, the proportion of insane among those of 85 and upwards being, for instance, ten times as great as among those of from 10 to 15—earlier than age 10 the figures are more than usually unreliable, for until that age and possibly even after, parents refuse to admit, even to themselves, that their children will not grow into normally-minded adults. It will be seen that, though the proportion of lunatics is far in excess of that for the imbecile or feeble-minded, the preponderance does not commence until the age-group 20-25 is reached ; the proportion then rises rapidly to the age-group 65-75, when, owing presumably to the greater mortality of lunatics, a slight fall is recorded. The proportion of the imbecile rises until the age-group 20- is reached, fluctuates between that and 65-, and is very high at 75- and 85-. Probably the term imbecile has not been restricted in later life to cases of congenital mental defect. The feeble-minded show a rising proportion in the first four age-periods, fall from 15- to 45-, and then rise continuously until they reach a proportion of 6 per 1,000 at 85 and upwards.

The following table shows how many of the various classes of the insane were enumerated in lunatic asylums (that is, in County, Borough, and State asylums, in registered hospitals and licensed houses, and in the imbecile asylums of the Metropolitan Asylums Board), workhouses, other institutions, and elsewhere; the figures for 1911 exclude the 1,965 insane persons who were also blind, deaf, or deaf and dumb.

TABLE CXXIV.—NUMBERS OF THE INSANE ENUMERATED IN WORKHOUSE INSTITUTIONS, IN LUNATIC ASYLUMS, IN OTHER INSTITUTIONS, AND ELSEWHERE AT THE CENSUSES OF 1901 AND 1911.

It may be observed that most of the lunatics are being cared for in asylums, only 795, or 0.8 per cent., being in the charge of private individuals, and that while the total number of the insane increased in the ten years by 27,374, or 20.6 per cent., the number of inmates in asylums increased by 23,590, or 26.1 per cent.

Owing to the fact that many institutions receive patients belonging to counties other than that in which they are situated, there is much room for fallacy in the comparison of the total numbers of the insane in the various counties. The figures for the insane under private care are also of doubtful value for purposes of comparison since they are subject to so many different factors in the different counties; they are doubtless affected not only by the accommodation available in institutions, but also by the varying accuracy in filling up the schedules. The following table may, however, prove of interest:—

TABLE CXXV.—ADMINISTRATIVE COUNTIES (TOGETHER WITH ASSOCIATED COUNTY BOROUGHS).—NUMBERS OF THE INSANE ENUMERATED IN WORKHOUSES, LUNATIC ASYLUMS, OTHER INSTITUTIONS, AND ELSEWHERE, ALSO PROPORTIONS OF INSANE PERSONS NOT IN INSTITUTIONS TO 100,000 OF THE POPULATION.

Of more value, however, for purposes of comparison are the figures given in the Report of the Commissioners in Lunacy showing the numbers of persons of unsound mind chargeable to the parishes or unions in the several administrative counties and county boroughs. The following table is based on figures relating to the 1st January, 1911, and given in Table 8 of Appendix A to the 65th Report of the Commissioners in Lunacy, and accounts for about 90 per cent, of the persons of unsound mind notified to the Commissioners.

TABLE CXXVI.—TOTAL NUMBER OF PAUPER LUNATICS, IDIOTS, AND PERSONS OF UNSOUND MIND BELONGING TO EACH ADMINISTRATIVE COUNTY, AND TO EACH COUNTY BOROUGH ON 1ST JANUARY, 1911.

It will be seen that the proportions in the county boroughs are, as a rule, higher than those in the counties, but that the proportions in the rural and agricultural counties are higher than in the urban and industrial; among the towns those of more recent growth have usually lower proportions than the older communities. The following is a statement showing the administrative counties and county boroughs having the highest, and those having the lowest proportions of pauper lunatics.

COUNTIES. Proportion
per 100,000
Population.
COUNTY BOROUGHS. Proportion
per 100,000
Population.
Highest   Highest  
London 604 Brighton 651
Herefordshire 557 Plymouth 597
Radnorshire 474 Bath 564
Wiltshire 417 Exeter 547
Oxfordshire 414 Canterbury 544
Montgomeryshire 406 Norwich 506
Cardiganshire 401    
     
Lowest   Lowest  
Durham 174 Blackpool 185
Northumberland 183 West Hartlepool 185
Derbyshire 190 Southport 186
Nottinghamshire 191 Coventry 200
Yorkshire, West Riding 196 Bournemouth 201
Glamorganshire 211 Barrow-in-Furness 216

Combined Infirmities. —In Table 86 of the Summary Volume will be found particulars of the 2,485 persons who were returned as suffering from more than one infirmity; the most common form of combination would seem to be that of blindness and deafness, from which 432 persons were stated to be suffering. There were 335 persons who were blind and lunatic, 333 dumb and imbecile, 228 deaf and lunatic, and 204 deaf and dumb and lunatic.

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