Pamela Dale

Special Education at Starcross before 1948

Recent comments by Baroness Warnock have reignited controversy over the relative merits of policies designed to promote inclusion and address special educational needs. These debates, conducted mainly between practitioners and parents, do not encourage input from historians but can usefully contextualize earlier models of service delivery. This paper concentrates on the interwar period when provision for children, whom we would now understand to have a moderate to severe learning disability, was shaped by the requirements of the 1913 Mental Deficiency Act. Existing studies that have examined the implementation of this legislation have tended to concentrate on the management of long‐stay institutions. This has led to a focus on medical care and the social control of adolescents and adults. Education has featured in these accounts but often in a fairly limited way, with more emphasis on school failure leading to admission than the educational potential of either the mental deficiency institution or its inmates. This paper seeks to redress the balance by offering a brief survey of the way education served as a way in, through and out of one of the largest specialist institutions in the South West of England before 1948.

Institutional care for the mentally defective, 1914-1948: diversity as a response to individual needs and an indication of lack of policy coherence.

In recent years mental deficiency policy and the wider issue of the history of people with learning difficulties have attracted much attention. Important publications by Mathew Thomson, Anne Digby, Mark Jackson, David Wright and others have led to a reassessment of mental deficiency provision.1 These scholars have firmly placed mental deficiency services within a mixed economy of care, with statutory and voluntary sector organizations providing institutional and community-based services in cooperation, and also in competition, with one another. The politics of service-delivery provided an important strand of analysis in Thomsons The problem of mental deficiency, but he did not seek to investigate any one institution, preferring instead to concentrate on the wider debates that informed service-development.2 This enabled him to link changes in the sector to much wider social, economic, political and intellectual trends in ways that have stimulated a great deal of interest and research. To date most attention has concentrated on case studies of specialist institutions before 1914 and the development of community care in the twentieth century. This leaves something of a gap in the literature because institutions (created before and after 1914) are relatively neglected in studies of the implementation of the 1913 and 1927 Mental Deficiency Acts. The place of such institutions within the mixed economy of care therefore remains uncertain. This paper places institutions at the core of provision after 1914 and suggests diversity in schemes of institutional and community care as a new way of understanding the relationship between the two. Within the mixed economy of care there were groups identifiable as “purchasers” and “providers” of care, if we borrow twenty-first-century terminology. The key purchasers of care were the local authorities with statutory responsibilities for mental deficiency work. Identifying the providers of care is more difficult, because they were more numerous and subject to change over time. The 1913 Mental Deficiency Act (MDA) recognized that a number of specialist facilities as well as general institutions (including prisons and workhouses) already provided accommodation for people classified as “defectives” within the meaning of the act. For commentators like David Garland,3 this firmly locates mental deficiency services within an increasingly elaborate penal-welfare system. Yet, in the Edwardian period, institutional care for the mentally defective was advocated by individuals concerned to improve the care of, as well as control over, people who later became subject to the provisions of the MDA. This meant that the broad ideological consensus, which is apparent from Thomsons work, was able to support the MDA, despite continuing debate about the most appropriate balance of care and control.4 Campaigners who supported the legislation were, however, concerned that the accommodation provided before the MDA was inadequate. On one level it was insufficient for the number of “defectives” they expected to identify and bring under the control of the act, but there was also concern that the care regimes offered by many of these pre-existing institutions were inappropriate. This led to attempts to curtail the use of unsuitable general institutions (especially prisons and workhouses), adapt the regimes of existing specialist institutions to bring them into conformity with the new agenda for care heralded by the 1913 act, and create new institutions (controlled by local authorities and run on “colony” lines) to enable the full implementation of the legislation. Supporters of the 1913 MDA tended to view mental deficiency as a national problem but the implementation of this legislation was a task for local government, overseen by a newly created Board of Control. Different local authorities responded in a variety of ways, their actions often being conditional on a range of factors that to date have been unexplored beyond general statements about unequal amounts of financial resources and political will. This paper considers the three different schemes for mental deficiency work developed by the Somerset, Devon, and Dorset county councils. These three local authorities have been chosen because they shared a partnership agreement with the managing committee of the Royal Western Counties Institution (RWCI) at Starcross in Devon (a former voluntary idiot asylum established in the 1860s and a major provider of institutional accommodation after 1914). They also shared a good deal of data with each other and often conducted joint negotiations with the Board of Control. All three made repeated commitments to developing a comprehensive mental deficiency service, and expressed continuing support for institutional segregation. These important similarities did not, however, result in a common strategy for mental deficiency work. A combination of local preferences and local circumstances dictated different approaches to the problem of creating a mental deficiency service. It will be shown that Somerset benefited to an unusual extent from a very active voluntary sector that had been interested in the problem for many years before 1914 (and this included links to the voluntary asylum at Starcross). Somerset pioneered a scheme based on a cluster of institutions closely integrated with each other and community-based services. Devon and Dorset had fewer resources to draw on but at an early stage adopted two different approaches. The statutory authority in Devon was determined to be a provider of institutional care as well as a purchaser of services. The goal of a county asylum dominated long-term planning in Devon, although in the short term the county council acceded to Board of Control requests to work in cooperation with the RWCI. Dorset was equally determined not to become a direct provider of mental deficiency services and instead supported eugenic policies to limit future numbers while utilizing workhouse beds and specialist out-of-county placements. In a limited way this included the RWCI. Institutional care (though not necessarily the RWCI) was at the heart of all these local authority schemes for mental deficiency work. Beds in institutions were, however, relatively scarce and expensive because the development of new institutions was severely hampered by financial and organizational difficulties. Elsewhere Pamela Dale has argued that the slow development of new institutions had a long-term impact on the development of both institutional and community care.5 This occurred not least because pre-existing institutions exerted a strong influence over service development that had not been anticipated by campaigners who had pressed for the legislation. The cost and shortage of beds also arguably led to a situation where community care was developed as an adjunct, rather than real alternative, to institutional care. Institutions were vital to the implementation of the Mental Deficiency Acts. They provided a distinct locus of care and supported arrangements for extra-institutional care. Mark Jackson and others have gone further by arguing that institutions operated as a site where the meanings of normality and deficiency were constructed.6 This is undoubtedly true, although it could be argued that the diversity of institutional provision discussed in this paper allowed the construction of alternative and competing definitions. This led to a situation where diversity in provision was both a response to individual needs and an indication of lack of policy coherence.

Medical officers of health, gender and government responses to the problem of cancer in Britain, 1900-1940.

International efforts to maintain and improve the physical and mental condition of mothers, workers and warriors have often figured in national campaigns to raise human efficiency. Such concerns formed an important setting for the renewed interest in cancer at the beginning of the twentieth century, as a “medical, social, economical and political issue”. These features of national cancer debates during the twentieth century have attracted notice in important recent research on the subject. Scholars have noted the tendency of contemporaries to deploy metaphor to depict both the disease and attempts at cure. Contemporary rhetoric frequently portrayed the battle against cancer as a national crusade of embattled peoples, winning international recognition for their heroic efforts to confront a terrible scourge. Historians have similarly inclined towards vivid images in depicting the progress of medical approaches to cancer. For Patrice Pinell “the organized fight against cancer” relied on the convergence of both the medical profession’s various interests in the disease and the emergence of groups, separate from the scientific societies, keen to combat cancer on a number of fronts. In the British case, royal patronage for cancer charities has also been historically important. While there are parallels with professional and popular responses to other public health problems, Pinell has argued that internationally the evolution of cancer policy drew its distinctive features from the specific character of the disease itself. The present article addresses and extends this significant research. Broadly agreeing with Pinell’s conclusions, we revise and also problematize the narrative of cancer treatment and service administration which he provides. In particular, it is argued here that a

Revealing and concealing personal and social problems: family coping strategies and a new engagement with officials and welfare agencies c.1900-12

Abstract Researchers from many disciplines have identified new forms of health and welfare services emerging in the late 19th and early 20th centuries. Attention has focused on the growth of direct provision by the local and national state, and new relationships between the statutory and voluntary sectors. The literature describes an important transition from the general workhouse to more specialist institutions, and the rise of community care. It also suggests that the increasing number of women employed by statutory and voluntary sector organizations forged new relationships with clients, but to date this research has been limited by a lack of sources and an emphasis on controlling practices. This new research on the work of female sanitary inspectors parallels this interpretation in the sense it was often intrusive, and certainly created new routes into institutional care. However, it also supports the idea that the inspectors were welcomed by some sections of the community and thereby made a distinctive contribution to the evolution of health and welfare services.

Contrasting Municipal Responses to the Provision of Birth Control Services in Halifax and Exeter before 1948

Research exploring the development of the birth control movement in Britain continues to reveal new insights. Local case studies highlight the contentious nature of birth control debates and the significant obstacles that had to be overcome before services could be provided. Moving away from a focus on the activities of birth control campaigners and organisations, such as the Family Planning Association, this paper highlights other local actors in the statutory and voluntary sectors to map why clinics emerged when and where they did. The contrasting examples, provided by Exeter and Halifax, demonstrate the importance of multiple points of contact between local authorities and supporters and opponents of birth control. They also suggest that the attitude of local medical and political elites is not sufficient to explain the success or failure of any clinic.

Implementing the 1902 Midwives Act: assessing problems, developing services and creating a new role for a variety of female practitioners

Many practitioner‐historians have noted the importance of the 1902 Midwives Act in securing the development of professional midwifery in England and Wales before the creation of the National Health Service. Other scholars contest the view that 1902–1948 represented a golden age for independent, autonomous midwifery and point instead to the constraints imposed by an act designed to protect the public rather than practitioners. This article suggests that the historiography has been more concerned with the campaign for the Midwives Act than its implementation. This approach tends to underestimate its impact on the ground. Most local case studies focus on interwar legislation concerned with midwifery services, which also form the basis for important work comparing the situation in the United Kingdom with international developments. There is an earlier history that needs to be considered and this study, drawing on evidence from Bradford, shows the real impetus the 1902 Act gave to a process of assessing problems, developing services and creating a new role for a variety of female practitioners.

THE BRIDGWATER INFANT WELFARE CENTRE, 1922-1939: FROM AN AUTHORITARIAN CONCERN WITH 'WELFARE MOTHERS' TO A MORE INCLUSIVE COMMUNITY HEALTH PROJECT?*

Abstract The infant welfare movement in Britain has received considerable scholarly attention but continues to generate controversy and debate. Many of the services began with nineteenth-century voluntary initiative but were later developed by local authorities. Critics have drawn attention to the limitations of such provision; arguing that it was predicated on unattractive assumptions about class and gender roles. Under this interpretation working-class mothers were viewed with suspicion and targeted for advice aimed at inculcating middle-class standards of childcare and housekeeping. This paper accepts that there was an authoritarian character to much of the early welfare work but suggests that over time this gave way to more inclusive approaches that sought to provide clients with the services that met their real rather than assumed needs. This paper reviews the recent historiography, develops an overview of national trends, and then takes a detailed look at the Bridgwater Infant Welfare Centre. The case study benefi ts from unusually comprehensive records and, by drawing on evidence from a small Somerset town, adds to our understanding of infant welfare work that has previously been developed from research on major urban centres.

The kiss of death or a flight of fancy? Workers' health and the campaign to regulate shuttle kissing in the British cotton industry, c. 1900–52 1

The history of occupational health remains a peculiar and uneven narrative. Some occupational diseases and industries have attracted significant attention from historians. Others remain poorly researched. Historians know more about the hazards posed by the limited use of phosphorus in the match industry and the outbreak of anthrax among textile workers than more mundane but arguably more deadly risks presented by mineral, chemical and organic dusts which have surrounded workers for centuries. These disparities in our understanding of responses to work-related injury and illness reflect, to some extent, a genuine diversity in historical experience, including the uneven response of medical professionals, employers and governments to the hazards of industrial life. The history of workplace diseases has also been shaped and obscured by the complexities of legal responsibility, as struggles to demonstrate employers’ liability and achieve compensation frequently overshadowed attempts to identify the origins of occupational illness.

Training for work: domestic service as a route out of long-stay institutions before 1959

Abstract The preponderance of women patients in long-stay institutions has long interested historians. Examination of the path to the asylum has drawn attention to the control exercised by male-dominated professional groups over dependent and vulnerable females. Within the institutions the focus has been on the limitations of the care provided and the essentially dehumanising regimes of the total institution. Recently the historiography has started to reassess the provision of care to re-emphasise the problems experienced by patients prior to admission, the asylum offered by mental health and mental deficiency facilities, and the possibility of discharge. Gendered policies of reform and rehabilitation have been part of this analysis but to date little attention has been paid to opportunities for earning and learning. This article suggests that specialised institutional training coupled with a demand for domestic servants worked to the advantage of female patients, whose licence and discharge from institutional care was supported by emerging groups of lady social workers.

Poverty and mental health: the work of the female sanitary inspectors in Bradford (c. 1901–1912)

Although there are many excellent studies of the work of pioneer women public health officers, few accounts dwell on mental health issues or discuss any relationship that such staff might have understood to exist between poverty and mental health in the early twentieth century. This is a remarkable omission considering that social and feminist historians have highlighted the problems created by the way early practitioners sought to manage poverty and arguably the poor. Drawing on records created by Female Sanitary Inspectors (FSIs) in Bradford, this study chronicles distressing economic and social conditions but also reveals encounters between the staff and people experiencing mental health problems and mental health crises. The ways in which the FSIs chose to both make and deny links between the abject poverty witnessed in the slum districts and cases of mental disorder forms an important strand to the analysis that follows. Interestingly, it is the well-being of the staff that emerges as a persistent and even over-riding concern.