An idiot is any child who never learns to communicate with his kind by speech—that is to say, one who can neither express his thoughts verbally nor understand the verbally expressed thoughts of others, this inability being due solely to defective intelligence, and not to any disturbance of hearing, nor to any affection of the organs of phonation.Since a normal child of two years of age can understand the speech of others, and can make itself understood by others, so far as its simple wants are concerned, it is evident that the distinction between an idiot and a normal child is easily made.
An imbecile is any child who fails to learn how to communicate with his kind by means of writing—that is to say, one who can neither express his thoughts in writing, nor read writing or print, or, more correctly, understand what he reads, this failure being due to defective intelligence, and not to any defect of vision or any paralysis of the arm which would explain his inability.One will not count a child an imbecile until he has had much more than the normal time to learn to read and write. The normal time in schools is six months. A child who does not yet know his letters after being at school for two years is likely to be an imbecile.
Spontaneous writing or writing from dictation must not be confounded with mere transcription from a copy. The latter is a kind of drawing, and may be acquired by some who are incapable, from defective intelligence, of writing from dictation. Nor must real reading be confused with reading which consists in transforming graphic signs into sounds without meaning to the reader. The distinction can easily be made by giving the child in writing some simple order which he is to carry out, such as "Shut the door," "Knock three times on the table."
A feeble-minded child is one who can communicate with his kind by speech or writing, but who shows a retardation of two or three years (according to the rules already indicated) in his school studies, this retardation not being due to insufficient or irregular attendance.
These distinctions are pedagogical. The inspector will make them easily. If he is ever in doubt, he has a doctor at hand who will advise him.
Obviously the idiot is a case for the asylum or hospice. Obviously also the feeble-minded is a case for the school. There remains the imbecile, about whom we may hesitate. From the moment the imbecile proves himself unable to learn to read or write, his place is in the workshop. We must find out to what extent he can profit by special education.
True and False Defectives.—We shall formulate a rule which will surely meet with no objection. It is thatnone but defectives should be admitted to schools for defectives.
The moment we begin to apply this rule in practice, however, we meet with difficulties. There are normal children who are very backward in their studies. They cannot profitably follow the proper class for their age. Such children are numerous, and of great interest socially.As they are really intelligent they can certainly be helped to make up for lost time. Various terms have been applied to them, but it will be simplest to call them "backward" or "ignorant." In Belgium many such "ignorant" children were admitted to the first school for defectives. In fact, they formed the majority, and one can understand how easily the teachers collected them. These are the cases which give such grand results, and are sometimes exhibited as genuine defectives who have been improved by teaching. In France it has been agreed that the ignorant are not to be admitted to the classes for defectives. The principle is sound. But let us not confuse the questions by approaching them both at once. Let us consider the defectives first, the ignorant or backward next. Even when we are agreed as to the principle, we find difficulties in practice. In the first place, there are the doubtful cases, children of whom we cannot say, even after prolonged examination, whether they are defective or backward. Demoor, in the return he published concerning the pupils of the first school for defectives at Brussels, noted a considerable number of these doubtful cases.[12]What should be done with such cases? The best thing to do is to admit them to the classes for defectives, writing on their schedule a large mark of interrogation in order to guard against future deception. Again, it is not always easy to establish irregular or insufficient attendance when this is the cause of the backwardness. The child may have been at several schools, and at some the teaching may have been faulty. There are some schools which practically produce mediocrity. In the next place, it is necessary to discover the causes of defective attendance. Sometimes these causes are completely extrinsic to the nature of the child—frequent removals, constant domestic disturbances, laxity of the parents, an infirm parent to be taken care of, etc.In such cases the interpretation presents no difficulty. But sometimes the case is more embarrassing. It may be a thin child, who has been out of sorts for a long time. Without being, properly speaking, of defective intelligence, he is weakly, anæmic, and consequently incapable of sustained attention. Would it not be advisable to admit such a case, at least as a temporary measure, into the class for defectives, until his system had recovered tone? Should we not also open the door to cases retarded by adenoids? And if we enter upon this work of charity, shall we not also accept some of those physically abnormal children who, affected by Little's disease or Pott's disease, are so little at their ease among their more robust companions? And what, lastly, is to be done with children retarded in their studies by an unrecognised myopia? It is evident that the question ceases to seem simple and easy when regarded closely. We may rigorously exclude from the class of defectives the child who is simply ignorant, but there is a whole series of complex cases intermediate between the ignorant and the defective. The inspector, let us say in anticipation, will consult his colleague the doctor with advantage about all these border-line cases. No breach of principle is involved here. It is necessary to be guided by circumstances.The essential point is to mark distinctly upon the child's schedule the special reasons for his admission, in order to prevent ultimate deception in the shape of presenting the child as an average defective who has been improved by tuition in the special class.
We now come to the normal, the really normal cases. There can evidently be no doubt as to what is to be done with them. They are provided for. They have only to remain in the ordinary school. We hope they will be kept there. We hope it; we even demand it with all our power. But we are not certain that it will be possible to save them from the special schools. How many vital interests areleagued against the keeping of that rule! And interests, when they are not looked after, are like the millions of ship-worms which slowly and silently corrode the most solid barriers.
In the first place, there is the interest of the parents. When it is a question of secondary education, of rich or middle-class parents, there is nothing to fear. The bourgeois do not love their defectives; they are ashamed of them. They send them to a distance, to some private institution. They never speak of them to anyone; they do not visit them; they abandon them. But the common people have more heart or less prejudice. They will not be afraid of the special school for defectives any more than they are of the hospice. When they have a really defective child in the hospice, they never cease to visit him. We can imagine the results which such a state of mind will bring about. If these fathers and mothers of the working class were to hear of the existence of a boarding-school where children receive board, lodging, and clothing, they would flock to obtain admission even for their normal children, although it were well known that the school admitted only the feeble-minded, defectives, and fools. If necessary, they would get municipal councillors to back up their demands. This abuse was practised recently in the case of a reformatory, which was rapidly filled with ordinary children, whose sole characteristic was this—that their parents had political backing.
This fraud—for it is one—will not be perpetrated in the case of the special schools and classes where no greater material advantages are given to the pupils than is the case in the public schools, but it is to be feared that it will recur in the case of special boarding-schools for defectives. Such schools, if they are not carefully looked after, will turn out plenty of normal young people!
And this is not all. It is not only the parents who will try to deceive. Think also of the heads of the schools fordefectives. What is their interest? Take note of it, for it is important. One should always try to foresee the results of human frailty. In every new school which is started one should watch that part of the organisation which gives most scope for charlatanism.
The head-masters and the teachers of the defectives will certainly have a tendency to show off before visitors children who have never been mentally defective, or who have been so to a very slight degree. They will take good care to say nothing about the condition of the child on admission. Or, if necessary, they will tell lies—pious lies, told in a good cause, and for the honour of the school! These children will be shown off as advertisements, which will be just as illegitimate as if the schools for deaf-mutes were to present to visitors the semi-deaf-mutes, or the deaf who had formerly been able to hear, and to claim the entire credit for the facility with which these pupils could read the lips or pronounce words.
All such impositions will continue to be practised as long as those who visit such institutions are content to look about and docilely question the children presented to them by the teachers, instead of personally selecting the pupils to interrogate.
There is another reason why the heads of schools for defectives will keep their doors wide open to normal cases. This is, that in some cases a dearth of pupils may arise. A school is opened; it begins its work; the staff signs on. There is not much to do; there is no gossip about the matter; everyone is happy. But the number of admissions slowly decreases. It begins to be feared that the inspector will in his report notice the decrease, and that the school will be closed as of no public utility. Pupils, therefore, must be found, and if they must be found, found they will be. Recollect those evening classes held in the elementary schools, where the teacher, fearing he will have to speak to empty benches, begs the head-master to send him someschool children as an audience. Think of those libraries, where the staff, uneasy at the desertion of the public, pays a gratuity to an industrious reader for show!
We strongly insist that the inspectors should be alive to this danger. They will be seated by the side of the manager of the special school. Let them take note that this manager has a direct vital interest to admit normal children. It is upon the inspectors that we rely to see that everything is done honestly and correctly.
Schedules of Particulars.—Full and detailed particulars regarding every child admitted to a class for defectives should be furnished by the head-master and teachers of the school from which he came. They will do this easily, for when a child is a little peculiar he attracts attention. Abnormal children never escape unnoticed. It is of the greatest importance that the future teacher of the child in the special class should be correctly informed, and that what has already been observed should not be lost. Let it be remembered that the education of defectives should be individual,made to measure, as has been said with picturesque exaggeration. Now, if the child is to be individualised, he must be well known, well studied.
The necessity of some definite method of collecting particulars has been experienced abroad. A scheme of questions has been prepared, to be answered by the teacher who sends the child. The plan is a good one. It avoids the worry of lapses of memory. We suggest the following questionnaire:
Concerning..........Admitted..........to the special class at .......... school.General Particulars.Original school:Full name of child:Date of birth:Standard to which he belongs:Is the child considered mentally defective?Is the child considered ill-balanced?Family History.Names of father and mother:Address of parents:Occupation of parents:Particulars of family which it would be useful to know:School Attendance.How long has the child attended school?What standards has he passed through, and how long was he in each?Regularity of school attendance: How many days was he absent each year?What were the most frequent reasons for absence, if any?What other schools has he attended, and at what periods?Instruction.What amount of intelligence has he (count from 0 to 20)?What do you know of his memory?In which subjects does he do least badly?In which subjects is he weakest?How many years behindhand do you consider him in school instruction compared with average children of the same age?Annex to the present sheet one of his exercise-books and samples of his drawing and manual work.Character and Discipline.Conduct in class. Does the child keep his place? Is he sleepy, unruly, talkative? Does he laugh without apparent cause? Does he disturb the class?Application. Is he attentive in class? Does he do his exercises? Does he learn his lessons? To what extent does his family assist him with the school work?What is his attitude towards the teacher? How does he receive remarks? Does he pay attention to them? How often? Is he indifferent? Is he restive?What are his relations with his companions? Is he kind, docile, compliant? Does he make himself liked? Is he the object of marked attention? Or is he indifferent? Does he keep apart from others? Is he bullying, brutal, irascible, untruthful, dishonest, wicked? Has he any special vices?Pedagogy.What moral influences are most successful for guiding him?What is the effect of punishment? Of severity?What is the effect of rewards? Of praise?Do you require to take any special measures with regard to him in class or in the playground?What are the most successful methods for advancing his instruction?State of Health.What do you know of his state of health? Has he incontinence of urine? Any motor affection? Any defect of speech? Fits? Has he been examined by a doctor, and do you know the doctor's opinion? Was any medicine prescribed? What?Date........Signature.................Position..................
Concerning..........Admitted..........
to the special class at .......... school.
General Particulars.
Original school:
Full name of child:
Date of birth:
Standard to which he belongs:
Is the child considered mentally defective?
Is the child considered ill-balanced?
Family History.
Names of father and mother:
Address of parents:
Occupation of parents:
Particulars of family which it would be useful to know:
School Attendance.
How long has the child attended school?
What standards has he passed through, and how long was he in each?
Regularity of school attendance: How many days was he absent each year?
What were the most frequent reasons for absence, if any?
What other schools has he attended, and at what periods?
Instruction.
What amount of intelligence has he (count from 0 to 20)?
What do you know of his memory?
In which subjects does he do least badly?
In which subjects is he weakest?
How many years behindhand do you consider him in school instruction compared with average children of the same age?
Annex to the present sheet one of his exercise-books and samples of his drawing and manual work.
Character and Discipline.
Conduct in class. Does the child keep his place? Is he sleepy, unruly, talkative? Does he laugh without apparent cause? Does he disturb the class?
Application. Is he attentive in class? Does he do his exercises? Does he learn his lessons? To what extent does his family assist him with the school work?
What is his attitude towards the teacher? How does he receive remarks? Does he pay attention to them? How often? Is he indifferent? Is he restive?
What are his relations with his companions? Is he kind, docile, compliant? Does he make himself liked? Is he the object of marked attention? Or is he indifferent? Does he keep apart from others? Is he bullying, brutal, irascible, untruthful, dishonest, wicked? Has he any special vices?
Pedagogy.
What moral influences are most successful for guiding him?
What is the effect of punishment? Of severity?
What is the effect of rewards? Of praise?
Do you require to take any special measures with regard to him in class or in the playground?
What are the most successful methods for advancing his instruction?
State of Health.
What do you know of his state of health? Has he incontinence of urine? Any motor affection? Any defect of speech? Fits? Has he been examined by a doctor, and do you know the doctor's opinion? Was any medicine prescribed? What?
Date........Signature.................
Position..................
All the terms of this schedule are readily intelligible to the teachers. They have filled up a hundred samples in a very satisfactory manner, and we thus have in our possession a veritable mine of valuable information. It is to be hoped that the teachers in the special school may enjoy the same advantage. The plan has been found of value in other countries. The bulletins which are used in Rotterdam, for example, scarcely differ from ours except that they are more laconic. We have included in our questionnaire all that is likely to interest not only the inspector, but the doctor and the psychologist.
And now to sum up, here are the steps we advise to be taken in collecting the defectives:
First.—The inspector has the pupils of each age in the schools arranged according to the "standard" or "course" they are in.
Second.—By examining the tabulated results, the inspector picks out the backward, and demands particulars regarding the school attendance of those who have a retardation of two years (when they are under nine years of age), and of three years (when they have passed their ninth birthday). In the same circular the inspector asks the teachers to name any of their pupils who appear to be mentally ill-balanced—that is to say, who, according to the testimony of at least two teachers, are rebellious to discipline and an annoyance in the class. The particulars with regard to want of discipline should be stated in each case.
Third.—After examining the returns relating to school attendance and to the faults alleged against the children supposed to be wanting in balance, the inspector will make his first choice.
Fourth.—The direct examination of the child bears specially upon his state of instruction and degree of intelligence. The inspector comes to a positive decision with regard to each child, and asks the opinion of the doctor, as well as of the head of the special school, who assists.
Fifth.—The inspector has a schedule of particulars regarding the children finally accepted for the special school filled up by their teachers in the schools from which they came.
The medical examination will be considered in the next chapter.
Let us add, in conclusion, that all the decisions arrived at are to be regarded as provisional; the children are to be admitted to the class for defectives on trial, to be kept under observation.
[6]SeeAnnée Psychologique, vol. xii., p. 1, and vol. x., p. 116. The method sometimes adopted, for other purposes, of asking the teacher to classify the children according to their intelligence is quite fallacious. Teachers make no allowance for age. Recently an excellent teacher pointed out to us, as the most intelligent in the class, a child who had really, when his age was taken into account, a retardation of two years; but in a class of younger children his age gave him an appearance of mental superiority. [Such facts vitiate much statistical work on the correlation of "brightness" in school-children with other qualities.—Tr.]
[6]SeeAnnée Psychologique, vol. xii., p. 1, and vol. x., p. 116. The method sometimes adopted, for other purposes, of asking the teacher to classify the children according to their intelligence is quite fallacious. Teachers make no allowance for age. Recently an excellent teacher pointed out to us, as the most intelligent in the class, a child who had really, when his age was taken into account, a retardation of two years; but in a class of younger children his age gave him an appearance of mental superiority. [Such facts vitiate much statistical work on the correlation of "brightness" in school-children with other qualities.—Tr.]
[7]Teachers have a troublesome habit of saying simply "attendance regular" or "irregular." The inspector should demand an exact return of the absences.
[7]Teachers have a troublesome habit of saying simply "attendance regular" or "irregular." The inspector should demand an exact return of the absences.
[8]There are two methods of stating the representative value of a group, theaverageand themedian. Everyone knows the average. The median is obtained by arranging the values in linear series from the smallest to the greatest and taking the middle one. When should one use the average, and when the median? It is not easy to give a general rule, but in this case of spelling, we have a good example. If we wish to calculate the number of mistakes for each age, to take the average might be a disastrous proceeding. A single child who made a hundred or so mistakes would obviously make the average unfairly high. The median is affected much less by such aberrant cases, and consequently is more suitable for very heterogeneous series, in which the difference between the maximum and the minimum is very great.
[8]There are two methods of stating the representative value of a group, theaverageand themedian. Everyone knows the average. The median is obtained by arranging the values in linear series from the smallest to the greatest and taking the middle one. When should one use the average, and when the median? It is not easy to give a general rule, but in this case of spelling, we have a good example. If we wish to calculate the number of mistakes for each age, to take the average might be a disastrous proceeding. A single child who made a hundred or so mistakes would obviously make the average unfairly high. The median is affected much less by such aberrant cases, and consequently is more suitable for very heterogeneous series, in which the difference between the maximum and the minimum is very great.
[9]By way of comparison, the following dictation was given to ninety-two children in an Edinburgh school. The progressive difficulties depend upon the non-phonetic spelling and the lesser familiarity of words. Most of the children came to school in their sixth year.1. Tom is a good boy. He has a book and a bat. He can run fast.2. The dog is bigger than the cat, but he cannot climb so well. He would if he could.3. The farmer walked through the wood till he came to the field. It was a fine day for sowing the corn. He hoped it would not rain till he had finished his work.4. The weather was very stormy. The boughs of the trees were blowing to and fro in the wind. Clouds were chasing each other across the sky. The crows were watching the ploughman in the field.Mistakes were marked according to the directions in the text. Thus "bows" for "boughs" counted three mistakes. The results were as follows:Age of Children.Average Mistakes in Test Sentences.1.2.3.4.6 to 7 years0.322.64——7 to 8 years0.221.773.456.188 to 9 years0.20.361.685.91
[9]By way of comparison, the following dictation was given to ninety-two children in an Edinburgh school. The progressive difficulties depend upon the non-phonetic spelling and the lesser familiarity of words. Most of the children came to school in their sixth year.
1. Tom is a good boy. He has a book and a bat. He can run fast.
2. The dog is bigger than the cat, but he cannot climb so well. He would if he could.
3. The farmer walked through the wood till he came to the field. It was a fine day for sowing the corn. He hoped it would not rain till he had finished his work.
4. The weather was very stormy. The boughs of the trees were blowing to and fro in the wind. Clouds were chasing each other across the sky. The crows were watching the ploughman in the field.
Mistakes were marked according to the directions in the text. Thus "bows" for "boughs" counted three mistakes. The results were as follows:
Age of Children.Average Mistakes in Test Sentences.1.2.3.4.6 to 7 years0.322.64——7 to 8 years0.221.773.456.188 to 9 years0.20.361.685.91
[10]The complete set of tests as revised in 1911 is given in the Appendix, with notes regarding their subsequent use in Britain and America.
[10]The complete set of tests as revised in 1911 is given in the Appendix, with notes regarding their subsequent use in Britain and America.
[11]"Les Débilités Mentales,"Rev. de Psychiatrie, 1902.
[11]"Les Débilités Mentales,"Rev. de Psychiatrie, 1902.
[12]Année Psychologique, vol. vii., 1901, p. 296.
[12]Année Psychologique, vol. vii., 1901, p. 296.
Hitherto we have been studying the defective from the point of view of his school relations. This point of view is incomplete, and should not make us forget that there is another—the medical. It is quite certain that in the organisation and the practical working of the special schools the doctor has a rôle, and an important rôle, to fill. All foreign countries recognise this, and give him a large place. It is even regretted in some countries that doctors detach themselves too much from such questions, and are content to make a rapid and superficial examination of children on their entrance to school, instead of collaborating actively in the important work of the teacher.
After this declaration of principles, it may not be without interest to fix precisely the rôle which belongs to the doctor and the services which he can render. It seems to us, in fact, that there is often some confusion as to his attributes, and two opposite tendencies may be recognised. According to one, the more widespread, the defective are often, if not always, invalids, and belong to him by right. It would be an encroachment upon his privileges to concern oneself with them. The opposite opinion consists in not committing to him any particular authority in the matter. This is the case in Germany, where there are schoolmasters who carry things with a high hand in the special schools. Let us add that the doctors themselves have done nothing to bring about an entente. Speak of defectives before them,and they say, "That is our business," and they are perfectly right; but having affirmed their right, they pay very little attention to the territory they defend.
It seems to us that the field is sufficiently great for everyone to glean, and the efforts of all will not be too great to clear it. There are some questions which escape the doctor, unless he is also an educationist and a psychologist. But there are also some, in our opinion, for which he has special competence, and where no one can take his place. To define his rôle is not to lessen it; on the contrary, it is to assure him an authoritative position. It is not his business to select the abnormal from the normal. But from the children picked out as abnormal he will differentiate certain types and prescribe certain measures with regard to their care and treatment.
There is a general misunderstanding with regard to the special knowledge and aptitude of the doctor. One tends to credit him with a kind of omnipotence and infallibility against which he protests in vain. He is made to judge questions which do not belong to his special province—namely, the medical, and upon which he expresses opinions which are neither more nor less valuable than those of any other intelligent person. Recently, at various congresses, we have seen doctors with the best intentions laying down educational programmes, comparing the educative value of science with that of letters, and expressing a variety of opinions, no doubt very sensible, but with which the medical art had nothing whatever to do. As regards the selection of defectives, one is influenced by the same prejudice. We have discussed this with many people, and especially with educationists, and when we have insisted on the difficulties of examination, they usually reply,"That is the doctor's business!" The prejudice we have noted is very tenacious, and will doubtless be difficult to overcome, for there are many people who have interests to maintain of a pecuniary nature. Let us consider this question from two points of view—the estimation of educational retardation, and the physical examination of defectives.
Estimation of the Degree of Mental Inferiority.—We have seen how easily, in spite of the commonly accepted opinion, experienced teachers and inspectors accomplish this part of their task. If a doctor were charged with it his embarrassment would be great. Just imagine a doctor introduced into a school of 300 children in order to pick out the defectives by strictly medical methods. No doubt every doctor, especially if he is an alienist, is called upon to estimate the intellectual level of children, and to sign certificates of idiocy, imbecility, and feeble-mindedness. But just consider how things are managed at the consultation. The parents bring the child. They know very well that he is "not like others." They bring him for that very reason, and consequently the doctor does not require to distinguish the child from a normal one. He only requires to sit and listen to the parents, who give him a crowd of particulars. When he questions and examines the child, it is only to verify what he has learned, and to add his own personal impression. As a general rule the case is a severe one; the deficiency is so evident that any sensible person would notice it. The task of the doctor is therefore narrowed. He has only to certify the mental deficiency of the patient, stating in technical terms the diagnosis which the parents have brought to him ready made. Even his estimation of the gravity of the case, apart from special investigations on his part, is not very different from that of ordinary people who readily distinguish between the idiot who cannot speak; the imbecile, who can make himself understood, though he cannot be educated; and thefeeble-minded, who can do some work, but is not able to provide for his wants, or to behave himself sensibly.
When the doctor thus certifies the intellectual level of the patient, does he try to do so with precision? By no means, for it is not expected of him. The parents do not come to him in order to ask him, "Is my child backward in his mental development?" Alas they see it only too well, and little it matters to them whether his backwardness amounts to six months or a year. But they do come to ask, "Why does this child not make the usual progress? Is there not some medicine, doctor, which can help his development?" When they come to the doctor, it is not even with the hope that some medico-pedagogical treatment will cure their child. They know very well that the devoted care which they have always bestowed upon him from his infancy is superior to anything which can be given to him at a dispensary for children; but their indomitable hope leads them to seek chimerical measures. In all this, let us repeat, the doctor does not require to estimate the degree of mental deficiency with any delicacy. But if he should try to do so, what methods would he use?
Here is a child of nine years of age, who has been selected for a class for defectives because he cannot follow the usual lessons in the elementary school. You, however, doctor, put to him some of your usual questions. You ask the child his name, his age, the occupation and address of his parents; the date, day, month, year; some details about his life; you even ask him to read or count. The replies are given to you quietly and correctly. Are you going to refuse to admit him to the special school, and by what right? You have the notes of one, of two, or of three teachers. He cannot follow; he is still with children of seven years of age, in spite of having been at school for three years. It is evident that he is not an idiot, nor an imbecile, nor even feeble-minded to any great extent. But you have been notified that he is behind other childrenof his age. There is therefore something peculiar about him. It is not a medical question whether he ought to remain in the ordinary school. The doctor cannot go against the opinions which have been given to him, in order to verify whether the retardation is genuine. To do so, it would be necessary for him to make a comparison with the normal condition. Now this varies according to age. The doctor does not know exactly, to two or three years, the normal condition of the mental faculties; nor, after such and such a period of school attendance, the habitual level of instruction reached. That, however, in such special conditions, is the very problem which faces him. We do not hesitate to express the opinion that, in such circumstances, the doctor would be incapable of estimating the intellectual level of the child. He has no more experience in this matter than any other person. Let a doctor seek to pick out a feeble-minded child from a number of normal ones, and he will find how little he is prepared to make the selection.
Physical Examination of Defectives.—But it may be asked: "Is not mental debility associated with physical signs which the doctor alone is able to appreciate?" About this question three kinds of facts may be considered: those pertaining to anthropometry, the stigmata of degeneration, and physiognomy. Let us consider in order what help may be derived from these.
Height and Head Measurements.—Numerous papers have been published upon height and cephalometry. The object of some has been to compare the less intelligent school children with those who are better endowed. Other authors have taken as their subject the study of asylum or hospital cases. The absence or paucity of results of the earlier studies seems to be due to a cause which we have referred to elsewhere (p. 39). The mistake has been made of judging the intelligence of the children by sole reference to the opinion of the teachers, although accountshould have been taken of the relationship between the age and the stage of instruction. The comparison between the height and head measurements of the hospital cases and those of school children is not subject to the same risk of error, and striking differences between the two have been noticed. But there is yet another factor which must be taken into account if the figures so obtained are to yield all they are capable of teaching. If one confines oneself to comparing the averages of the two sets of children, one finds them almost identical. We have shown that the only suitable method to use here is the method of arranging the figures in series. This proceeding has suggested to one of us a better method still, that of "frontiers." There is for each age a height limit below which the defectives become clearly more numerous. There are limits in the head diameters, upon each side of which are grouped the abnormally small and the hypertrophied heads, which are frequently associated with mental deficiency. We give here the table which one of us has published of the provisional frontiers for height and for the two cephalic diameters.
Age.Height.Antero-Posterior Diameter.Transverse Diameter.Sum of Diameters.Centimetres.Millimetres.Millimetres.Millimetres.6100164134298710516613581101691363059111171137101201721383101112417313912130174140314131351761411414017814232015142.5179143.51615418014532517147.518114618150182147329
What this table means is this: If we measure 100 children in an elementary school, we find only a small number (at most 10 per cent.) whose measurements are less than those indicated; if, on the other hand, we measure idiots and imbeciles, the proportion of those whose measurements are inferior is greater, amounting to over 25 per cent. Amongst 120 abnormal children we found not a single one who was below these frontiers in two measurements, whilst 10 per cent. of defectives were below. Certain measurements, therefore, are distinctly suggestive, although, no doubt, not absolutely diagnostic without reference to the subject examined.
The Stigmata of Degeneration.—Everyone has heard of the physical malformations which are called the stigmata of degeneration. Some of these are very apparent, such as a sixth finger on the hand, or a hare-lip, or those deformities of the head, which are calledplagiocephalus(obliquely oval cranium),scaphocephalus(boat-shaped cranium), etc. Other stigmata are less apparent, such as abnormal shapes of the ear, irregular growth of hair, of the teeth, alterations in the eye, etc. Some doctors, not all, have made a study of these various stigmata. But school directors and teachers know nothing about them except what the present-day widespread popularisation of medical knowledge has permitted them to know. Evidently it is no part of their business to take up the study, although no State diploma will prevent their doing so if it is their good pleasure. There is no law against it. But they would expose themselves to grave risks of erroneous interpretations owing to their ignorance of the manner in which stigmata are produced, and the ignorance of doctors on this subject is still great. The determination of the stigmata, their enumeration, and their description, belong, therefore, at any rate by preference, to the doctor. God save us from wanting to dispossess him!
But what help could their study render us in the question whether a particular child ought or ought not to beadmitted into a class for defectives? There is an opinion which is very widespread, especially amongst teachers and ordinary people, a souvenir of the doctrines of Gall, that the physical stigmata are signs of the original character, and that the possessor of a certain shape of head is certainly defective. "I have taken my son," a worthy mother said to us, "to consult Dr. P., because he was learning nothing in his class. He was sent away from every school I sent him to, and he is unbearable at home. The doctor felt all over his head. He evidently saw that there was something particular wrong with the boy." We do not smile at this good mother. Plenty of other intelligent people hold her opinions, if they are not so naïve in their language. They expect that the moment defective children are brought before them, they will find something peculiar, something ugly, in their physiognomy. And there are plenty of doctors, let us say frankly, who are equally naïve, and, more serious still, allow themselves to be influenced by unconscious suggestions. If, like our worthy mother, we present to the doctor a child as defective, the doctor will, as a general rule, have no difficulty in demonstrating that he must be so. How many of us are there without stigmata? None of us is built upon the model of the ideal man. It is always possible to discover some anatomical detail which will give support to a preconceived opinion. But the same doctor who, on seeing a defective child with adherent ear lobes, will say that that was just what he expected, will abruptly change his opinion if he discovers a whorl of frontal hair on a child who is presented to him as normal, and will refuse to attach to the fact any importance whatever. As a matter of fact, these questions have not yet been studied as they ought to be, by a comparison withoutparti prisbetween normal and abnormal children of the same age and in the same environment, and we do not yet know how stigmata should be interpreted. We can only suggest some provisional conclusions.
The first of these conclusions is that the presence or absence of a definite stigma has no exact significance for the individual who bears it; for on the one hand one meets with all kinds of malformations in average normal children, and on the other hand, some who are definitely abnormal are quite normal in their conformation. The stigma, therefore, has not the value of a definitely pathognomonic sign like the crepitating râle of pneumonia, or the transient unconsciousness of epilepsy; but if we compare a group of normal children with a group of abnormal, the total number of the stigmata will be much greater in the second group; and, moreover, the multiplicity of stigmata in a single individual constitutes a strong probability that that individual is abnormal. Here are some facts which support these two propositions:
Recently we made a rapid examination of the heads of fifty-eight school children, and noticed that eighteen of them had some stigma, especially an abnormal shape of the ear. We therefore find stigmata amongst children at the average school level. But of these fifty-eight school children only one had four abnormalities—malformed ears, strabismus, prognathism, and slight scaphocephaly. The others had a maximum of two. The first child alone is certainly defective.
In a class of nine defective children subjected to a similar examination, we found only one who had but one stigma, another had two, four had three, and three had five. Of the three last, one had a very high degree of retardation; another was mentally ill-balanced to no less a degree. Let us compare these two groups, the one of fifty-eight average children, the other of nine defectives, and group to group, the difference is very clear. The stigmata are usually more numerous when the children are mentally defective. The existence of stigmata is a presumption of deficiency, and this presumption is greater, the greater the number of stigmata.
If we consider which are the stigmata that are most commonly met with, we find that asymmetry of the face is almost constant, but we also find it sometimes in normal children. Malformations of the ear come next. We are often struck by the frequency of badly defective speech—three times in nine defectives, whilst we did not find a single example in the fifty-eight school children taken by chance.
Here, then, is a "group fact" which is of interest from a scientific point of view. But what use can be made of it for individual diagnosis? This is much more delicate, for even if one could state it as a general rule that defectives have more stigmata than the normal, this rule is subject to important exceptions.
One of our abnormal cases had only one stigma, another had two, and in both cases the anomalies were of a very ordinary kind—slight want of symmetry of the face and sticking out ears. Children with stigmata few in number, and little marked (though as a rule we note the presence of stigmata without measuring them), may therefore not be of normal intelligence. The same is true sometimes of children with no stigma at all.
We may therefore conclude that stigmata may be taken into account when we are making an examination, but they should never be regarded as of fundamental importance in diagnosis.
Physiognomy.—In addition to stigmata, we have to note another feature which is of more definite significance. Methodical studies made by means of a collection of sixty photographs of children, normal and abnormal, photographs taken by M. Bertillon in conditions comparable in all cases, have shown us that an intelligent teacher can scarcely go wrong in judging physiognomy. The photographs were beautifully taken, and the expression of the faces appeared extremely lifelike to anyone who was used to observing children. We asked various teachers to examine these portraits, and to express their opinion as to the mentalcapacity revealed. Mistakes were made, as was to be expected; but the correct estimations were always in the majority, and some teachers exhibited a truly remarkable talent for observation; they were practically never deceived. Let us say in passing that our list included a number of doctors amongst the teachers. They were far from distinguishing themselves. Their percentage was not so good as that of the schoolmasters. This difference in competence, which perhaps may appear surprising, suggests the following anecdote: One day, at the meeting of a commission, we had thrown upon the cloth a collection of photographs of children, the very one which we had been using for our methodical experiments. Everyone looked at the portraits and expressed his opinion. By way of a joke we tackled a medical alienist who had a seat on the commission. He was mistaken in his opinion as often as his colleagues who were most ignorant of medicine.
It seems to us, and the facts mentioned support us, that stigmata are only one part of the complicated whole which constitutes a physiognomy. A physiognomy includes many other things, especially the expression,—lively or sluggish, strong or weak, intelligent or lacking in intelligence; there is the fineness or coarseness of the features, the beauty or ugliness of the countenance, the ordinary or unusual appearance of the face. All this forms anensemblewhich the eye does not analyse, but judgesen blocby instinct, without considering the elements separately, and, above all, without being able to give reasons for its judgment. Will it be possible some day to analyse, to dissociate, and to describe all these very various elements? We do not know. In the meantime we think that every examiner, as a matter of fact, allows himself to be influenced by the general appearance of the subject, and that the impression so formed is not entirely without value.
Let us sum up regarding the physiognomy. There doesexist between the intellectual level of a subject and his physical development a real correlation, but, unfortunately, it is slight. With regard to the stigmata our knowledge of their significance is still very slight. We have no figures which allow us to place any definite value upon them either singly or in combination. There still remains the general appearance, whose significance is apparently indubitable, but which, at present, is too dependent upon individual estimate to be utilisable. Let us add that these relations between the mental and the physical appear to be of greater significance the lower the mental condition. Now, in a school it is the feeble-minded who are in the majority, and it is they who have to be recognised much more frequently than the idiot or the imbecile, and this lessens the importance of the physical examination. We may therefore conclude with this practical rule: a physical examination can never allow us to dispense with a direct examination of the intelligence. Anthropometry, stigmata, and physical appearance must take a second place as means for discovering in school the feeble-minded and the ill-balanced. Failing direct recourse to the teacher, these methods could, and ought, to be made use of. But in most cases, thanks to the assistance of the teacher, we have better means. In cases on the border-line they might help to incline the balance. Their principal use is not to assist in selecting children for special classes for defectives; their significance is quite different, as we shall see immediately.