A brief history of healthcare provision in London


Whilst the Counties provided asylums for the mentally ill poor, MAB was tasked with providing care for children and adults with mental deficiency who, until then, lived in workhouses.

Land was acquired and two asylums were built, one at Leavesden for north Londoners and one at Caterham for south Londoners.  Both opened in 1870 and quickly became overcrowded.

Patients were graded according to their ability to be trained for some kind of occupation.  Higher-grade mentally deficient patients learned a trade, while lower-grade ones helped with domestic and laundry work.

The Mental Deficiency Act, 1913, intended to provide care and protection of mentally defective patients, established four grades of mental deficiency:
  • The most seriously affected were 'idiots'. who were so deeply deficient from birth or an early age that they were unable to guard themselves from common physical dangers.  Their IQ was estimated to be between 0-25.
  • The second were 'imbeciles', with an IQ of between 26-50, who were incapable of managing themselves or their affairs and never progressed beyond a mental age of six.
  • 'Feeble-minded persons' or 'morons' required care, supervision and control for their own protection.  Their IQ was between 51-70.
  • 'Moral imbeciles' had some permanent mental deficiency with a strong vicious or criminal propensity on which punishment had little or no deterrent effect.  Unmarried mothers were included in this group (the Act gave local authorities the power to place people having sex outside marriage into institutions.  Homosexuals and people of transgender were also included.)
(Today these terms have been replaced by mild, moderate, severe and profound retardation.  Other diagnostic factors rather than IQ tests are considered in making a diagnosis). The Fountain Hospital opened in 1893, for low-grade children, and in 1898 another institution was built at Darenth Park for higher-grade patients.

In 1903 the Tooting Bec Hospital opened to relieve pressure on the other asylums.  It was intended mainly for elderly patients with senile dementia.

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Digby A, Wright D (eds) 1996  From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities. London, Routledge.


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