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i38 Annual Report of the London County Council, 1914.

Accommodation
for
children
suffering
from double
defects.
The provision of accommodation for mentally defective children suffering also from blindness,
deafness, or other physical defects, should be considered from the standpoint of the best interests of the
child and of the economical and efficient working of any institution. To secure classification, industrial
training and education, employment and the promotion of industry and good behaviour, it is essential
that the children should be in the immediate charge of those who have a special acquaintance with the
particular defects and the means of communication with the child, or of employing or exercising him
without strain. Each type of defect, and indeed each child, requires to be considered individually.
It has been found that the educational treatment required by the blind and the deaf, is of so specialised
a nature as to demand a separate training for the teachers and manual instructors. A certain number
of the deaf and blind appear to be more mentally defective than they really are, since the maximum
possible has not been obtained from them. In the case of the deaf the classification within the group
is all important; the deaf who can benefit by oral instruction should be kept away from those who cannot,
otherwise the mentality of the former suffers, and they tend to lose whatever degree of speech they
may have retained or acquired. There is the risk of the defective voice sounds of those deaf children
who cannot be taught by the oral method, being imitated by other feeble-minded children, since, Ln
many instances, they are hard to instruct in normal articulation without their receiving the detrimental
influence of bad vocal examples. Provided opportunity exists for separating these deaf who can communicate
with others by the oral method, and that all can be under the charge of those who thoroughly
understand their condition and potentialities, there would be little valid objection to deaf feeble-minded
children being lodged in special wards or pavilions of a large general institution for the defective. The
opportunities for classification, skilled instruction, and control would probably be greater and be obtained
at a more economical rate if a sufficient number of defectives of one class were gathered within a single
institution. It is understood that the "National Bureau for the Welfare of the Deaf" has approached
the Board of Control to urge on that body the advisability of securing special treatment for deaf defectives.
On educational grounds, there is less reason for segregation of the blind, provided there are officers
who understand and can communicate with them. Children with milder grades of mental deficiency,
such as may be found among those blind from injury or surface inflammation of the eye, can often be
educated with their normal fellows, while in the deeper grades of defect, such as may accompany deep
seated inflammation or maldevelopment of the eyeball, frequently associated with congenital syphilis,
there is often little capacity for manual work, and the cases are of a hopeless character. If it were
found convenient, such cases could well reside in a special ward of a general institution.
Those who are both mentally and physically defective need some consideration. Ordinary
crippling lesions may occur among the feeble-minded as among the normal population and need similar
treatment in either instance. The most important ailment to consider is tuberculosis. Tuberculous
patients are often kept in wards or shelters in the existing institutions for the feeble-minded, and should
this custom continue, the question would arise as to separating those suffering from open tuberculosis and
securing for them such medical and surgical treatment as their clinical condition may demand. Certain
forms of paralysis are especially associated with feeble-mindedness, with or without epilepsy. Many
of these cases after a brief period of improvement and educability, deterioiate and ultimately need
institutional treatment. There is a stage at which surgical care is required, and later the best can only
be got from them by the employment of suitable orthopedic exercises. Provided adequate nursing is
available, the only objection to the treatment of these children in a general institution is the depressing
influence the sight of cripples might have on the other inmates.
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