Idiots, Imbeciles and Intellectual Impairment

by Catherine Slater, M.A. Cantab

Introduction-From early times to 1400 AD

The subject of learning disability has been neglected in ancient writings but there is enough evidence in historical records to show it existed. The causes were then as now congenital, chromosomal, intrauterine damage, premature or protracted birth, or infections and accidents in infancy and childhood. Infant mortality was high and most children with Down’s Syndrome, cerebral palsy or other disability where there was a weakened resistance to infection would have succumbed early to pulmonary infections, heart defects and gastroenteritis. However, some would have survived, like children who had a learning disability but no physical disability. At a time when most people lived by agriculture, herding sheep and goats, or fishing, and reading and writing were unnecessary, moderate learning disability would not have been important.

The Judaic Tradition

People with disabilities, whether physical or learning  disabilities were treated in different ways according to where they lived. The Bible in Leviticus described how people with any disability were forbidden to become priests or enter the sanctuary” And the Lord said to Moses, none of your descendents throughout their generations who has a blemish shall draw near, a man blind or lame, or one who has a mutilated face or a limb too long, or an injured foot, or an injured hand or a hunchback or a dwarf, or a man with itching disease….”

.However although people with disabilities might have been denied the priesthood, Jewish law stressed the duty to protect the defenceless-orphans, widows, aliens, cripples, the poor. Some parts of the Talmud advocated disability as a holy state and a means of getting to heaven and similar sentiments were expressed towards those who helped disabled people…At the heart of Jewish law was the idea that every human being newborn or adult , deformed or healthy , slave or free was made in the image of God. Abortion and infanticide were condemned while pagan religions sanctioned, condoned and encouraged the killing of malformed or sick infants.

The Greeks

Plato stated that pregnant women over the age of forty years should have an abortion and Aristotle recommended both infanticide and abortion if there was a risk of a deformed child. He supported a law to ensure the compulsory exposure of all malformed babies who were abandoned with their ankles pinned together .The birth of a child with a learning disability was interpreted by the Greeks as a punishment inflicted on its parents by the gods. Rearing a sick or disabled child was economically burdensome and unprofitable.

In Sparta, racial homogeneity was prized. Citizens had to be physically strong and mentally able. Plutarch wrote of Sparta that children were the property of the state not the father and that the father had to present the child shortly after birth to the elders of the tribe to make sure it was not ill-born or ill formed and if it were it should be left to perish on a mountainside or in a chasm called Paotheatum in the belief that the life which nature had not provided with health and strength was of no use either to itself or the state

There was a legal requirement to abandon deformed and sickly infants. If the disability was not obvious at birth, but the child was later found to have a learning disability  the child would be abandoned. And left to fend for itself.

The Celts

Meanwhile the Celts had a much more enlightened attitude. The social order was based on community, democracy and individual rights. Each clan or tribe occupied its own territory, and this was divided into three sections. The clan leader and his family had one section, another was set aside for the use of the poor, sick and disabled and the largest section was common ground for the whole tribe. Members working their own plots paid taxes which were used for the upkeep of the community and to support the poor, the sick and the aged. The Celts had hostels, orphanages and hospitals. The earliest known was in Armagh in Ireland in 300BC. Ancient Celtic laws show there was a well developed medical service and that each individual tribe was responsible for caring for  the sick, and wounded people and those with learning  disabilities. The Celts covered territory from Ireland to Hungary, from Sweden to Spain.

The Romans

Early Roman law gave power to the father to have absolute rights over his children. He could expose any female infant or a child of either sex who was deformed or disabled. Soranus a physician in the 1st and 2nd centuries AD wrote the earliest known treatise on gynaecology and in it he had a chapter entitled How to recognise the Newborn that is worth rearing. He gave a quite scientific and detailed analysis of the various medical examinations which should take place

The child should be perfect in all its parts, limbs and senses and have passages that are not obstructed including the ears, nose, throat, urethra and anus. Its natural movements should be neither slow nor feeble. Its limbs should bend and stretch. Its size and shape should be appropriate and it should respond to external stimuli

Some people with learning disabilities would have received asylum in sanctuaries as did other groups in the ancient world. However people with learning disabilities had their political rights curtailed and would not have been granted Greek or Roman citizenship. As Christianity spread, a far more compassionate view was taken of people with disabilities of any kind. Charity towards people with disabilities and illnesses was preached and the Church set up orphanages for abandoned children in the 3rd and 4th centuries and the earliest hospital was founded by St Fabiola in Rome in 399 A.D. St Nicholas, the Bishop of Myra showed particular compassion towards mentally retarded children and urged giving them tender care.

Islamic Society

In the Islamic world from the seventh century, people with learning disabilities were treated with respect. There was a belief that their minds were in heaven while their body moved around amongst ordinary mortals. Not all people we would think of as having a learning disability were thought to have any disability, but rather to be special individuals who were favoured by Heaven.

Little was known about the causes of learning disability , and medicine was based on “humours” and a close link between the body, mind and soul. Europe was still in the Dark Ages of science and medicine but in the Islamic world Avicenna (980-1037) wrote a textbook the Canon of medicine in which he mentioned hydrocephalus, meningitis and other mental disorders. He recognised and defined various levels of intellectual functioning and knew that brain injury could affect memory and speech. There were mental hospitals in Cairo and Baghdad in the 11th and 12th centuries. Ibn Al-Baitar also wrote about learning disabilities  during the first half of the thirteenth century.

Europe in the Middle Ages

From the time of the end of the Roman Empire in Europe until the late middle ages, life remained very rural By 1066 England had a population of less than one million. The majority lived in villages and hamlets surrounded by forests and marshes. Agriculture was the main occupation and the most powerful people were those who owned the most land. In a rural society literacy and intellectual ability were not important and every member of the family would have taken part in the daily grind of fetching water and fire-wood, ploughing the fields, or feeding the animals. People with a disability would have relied on relatives for their care but with poverty, malnutrition, poor hygiene and a feudal system of life this would have been hard. However, city life was beginning again and St Bartholomew’s hospital was founded in 1142 in London. In Prussia we have a record from the 12th century which said that  people with learning disabilities were put in prison. As the medieval period continued, the population gradually increased and life became more sophisticated as more people moved into towns and the generation of wealth meant that new phenomena such as urban beggars, some of them disabled became an issue and the importance of landed wealth led to the first law defining a distinction between people with mental health problems and people with a learning disability .


Children with learning disabilities could be born to anyone rich or poor. Medieval society was based on the preserving and transfer of landed wealth .If the heir to property had a learning disability, the King wanted to make sure that he was protected during his life time (or her lifetime) and that the property then went to the rightful successor.

Contracting out of services

During the second half of the 13th century a law was passed. It distinguished between “natural fools”, people with a learning disability  from birth and those who were “non compos mentis” who had a mental illness and might recover or have periods of lucidity. The King used to “contract out” care of people with learning disabilities to private individuals. In fact often private individuals would tell the king about a  person with a learning disability so that they might get custody it was a private but monitored guardianship. They would pay the King a lump sum called a fine and annual rents and they would enjoy the revenue from the land and provide the person with the necessities of life until they died and the land passed to their heirs For a  person with mental health problems, especially one who had periods of lucidity they had to be kept at the economic level suited to his rank and the guardian could not have the surplus revenues. If f they recovered the guardian no longer looked after the estate

Early Assessments

An inquisition would be set up by Royal commission to determine whether the person said to be a lunatic or idiot had a learning disability. If so from what time, how and in what manner, and did he has lucid intervals. What land did he possess? Who and how old was his next heir?

A record of an Examination of Emma de Beston in Cambridge 1383exists. Emma was asked whence she came, said she didn’t know. She knew there were seven days in the week but could not name them. She said she had had 3 husbands but couldn’t name one. She was asked how many shillings there were in 40 pence. She did not know. Asked if she would take 40 silver groats or 40 pence she said they were the same value. They found she was not of sound mind having neither sense nor memory nor sufficient intelligence to manage herself her lands and her goods. By inspection she had the face and countenance of an idiot.

Because of this 80% of cases coming to the court described the heir as a fool rather than a madman because the guardian got more revenue from a fool. When the law was changed in the 16th century the number of people described as having a learning disability  coming before Courts of Wards dropped to 30% in 1640.There was no dramatic decline in learning disability. It is simply that when it was no longer advantageous to the guardian to have custody of someone who had a learning disability  rather than mental health problems, more people were recognised as having mental health problems   than having a learning disability

Another document from the thirteenth century clearly distinguishes people with mental health problems l from  people with a learning disability. It stated that “women, serfs, people under 21, open lepers, idiots, attorneys, lunatics, deaf-mutes, those excommunicated by a bishop and criminal persons” were all barred from becoming judges.

Care in the Community

However during this time we see the beginnings of social welfare. In towns pious benefactors were beginning to found hospitals. Monasteries already provided hospitality for travellers and for old people, and this was widened to include the foundation of hospitals for orphans, widows, old folk, sick people and lepers. In due course hospitals became specialised centres of social welfare. St Bartholomew’s hospital had been founded in 1142 and soon after St Thomas Hospital. In 1247 St Mary of Bethlehem was founded first as a priory and became a hospital. King Edward III granted a protection to it as a hospital for distracted persons. It is now the oldest psychiatric hospital in the world having recently celebrated its 750th anniversary .It was first founded as a general hospital but by 1377 “distracted” patients were being looked after here. They were kept chained to the wall by leg or ankle and when violent ducked in the water or whipped. A 1398 inventory lists 4 pairs of manacles, 11 chains of iron, six locks and keys and two stocks for 20 patients. 1403 Visitation of Bethlem hospital mentions six insane men “viri mentecapti” and three others who were sick.

John Stowe describes how near St Martin in the Fields in the liberty of Westminster. “Then had you one house, wherein sometime were distraught and lunatic people, of what antiquity founded or by whom I have not read, neither of the suppression but it was said sometime a king of England not liking such a kind of people to remain so near his palace caused them to be removed further off to Bethlem without Bishopsgate of London and to that hospital; the said house by Charing Cross doth yet remain”. It was probably Richard II (1367-1400) who asked for the transfer of the Charing Cross lunatics. This very first mental hospital in London stood where Landseer’s lions now preside over Trafalgar Square.

In 1376 in Hamburg persons with a learning disability were confined to a tower in the city walls called the idiots cage. In Gheel in Belgium there was a saints shrine said to cure those with mental health problems and afflicted. Many people with learning disabilities and those with mental health problems went there. Eventually an adult care scheme grew up where families fostered people with learning disabilities. This is still going on.