The Health of The School Child
Book Reviews & Abstracts.
Annual Report of the Chief Medical Officer of the Board of Education for the Year 1927. H.M. Stationery Office. Price l/6d. net.
With the space we have at our disposal it is not possible to touch on more than one or two aspects of the School Medical Service, a Pub- lic Health Service which has rapidly expanded during recent years. This is the 20th Annual Report of the Chief Medical Officer and gives a full account of the progress and results achieved in medical treatment, inspection, in- vestigation and research, etc.
With regard to Medical Inspection, the Re- port states that ” provision for medical in- spection, which forms the basis of all other activities is reasonably complete.” During the year under review, an increase of 5% is shown on the number of school children examined? a proof of the recognition amongst School Medical Officers of the necessity both for early treatment of disease and subsequent after-care.
A notable advance during the year has been the extension of the provision for orthopaedic treatment. New schemes have been developed in 28 areas. Schemes for treatment by artificial light were also approved in 26 areas.
Several additional proposals are now under the consideration of the Board for the provision of Day Open Air Schools for delicate children, now established by 42 education authorities.
The number of mentally defective children as- certained during the year by Local Education Authorities wTas 33,000. Provision is available for approximately half of these children in Day and Residential Schools. There have been few fresh developments in this branch of the work during the past year. Two new Day Special Schools have been opened at Sunderland and Leyton and a Residential School for girls at Clapham. The Report draws attention to the amendment of Section 2 (2) of the Mental Deficiency Act, 1913, by the 1927 Act and the re-drafting of the Board of Education Regula- tions for the notification of children.
Attention is drawn to the need for the Pro- vision of Treatment for nervous, unstable and ” difficult ” children, a problem which has received much attention in medical and educational circles in the United States. Men- tion is made of the Child Guidance Clinic in London which is to be established by the Child Guidance Council in 1929 with the full co- operation of the London County Council.
Sir George Newman concludes his Report with a plea to both professional and voluntary workers ” to keep to the broad, straight, high road of Preventive Medicine,” avoiding the tendency to over-specialisation or the placing of false constructions on the findings of Science which may tempt the community to take short cuts and easy ways which are not likely to prove an answer to the questions which must be faced.
Mongolism. A study of the physical and men- tal characteristics of Mongolian Imbeciles. By Dr Kate Brousseau. Bailliere, Tindall & Cox. London, pp. viii. 210. 8vo.
The Author, who is Professor of Psychol- ogy in Mills College, California, and who has been assisted by Dr Bramerd, Professor of Neurology and Psychiatry in the University of Southern California, etc., has brought to- gether in this book the available information on Mongolian Imbecility from the literature of the subject, from case reports in medical literature, from personal observations and ex- perience with mental defectives of all kinds, extending over more than ten years, and from replies to a questionnaire submitted to work- ers in institutions and to physicians who have made clinical observations on Mongols.
After an introductory chapter giving a re- sume of the history of the subject and a general idea of the nature of Mongolism, the frequency of its occurrence and its geographical distribu- tion, a chapter is devoted to the various theories of its etiology. Then follow chapters in which pathological and physical characters of Mon- golian Imbeciles, their nervous and mental characteristics are very fully and carefully described, and diagnosis, prognosis and treat- ment are succinctly but carefully dealt with. These chapters are well documented and there is a very complete Bibliography.
Altogether, for statistical purposes, over a thousand recorded cases have been brought under review. Wherever the subject under dis- cussion is susceptible of statistical treatment, tables and charts based upon 400 or 500 cases or more are given which serve to set out the facts in a clear, convincing manner, and several questions which have been the matte^ of debate and uncertainty m the pas <^ be regarded as settled, especially in theories of causation.
The book is adequately illustrated. Inevitably, much that the author las o’ us has been told before but rai cl> >1 c ? such fulness and detail.
The question of diagnosis from ^ ^ ‘ Achondroplasia and Rachitis is veiy X^-iriv cussed and the distinguishing fcat^fcs c^. ( tabulated, but for the most part chagnobis ^ not a difficulty when familiarity has once b obtained with the characteristic featuie condition. Indeed it may almost be sa ‘ there is hardly any condition in me which is so readily diagnosible 01 so ,, distinguishable as this. The group beuv ? clearly marked off it should, one would sU pose, be relatively easy to ascertain e about it.
In spite of this, the causation of ^ 9?” dition, which has long been the subjec , search and debate, still remains an uns ? problem. The authors, after the most ex- haustive collection of the available ev and a judicial review of the various e? ? that have been advanced, come to the co sion that the etiology and pathology o - condition remains almost as obscure as 1 ? when attention was first called to this pecu condition; and this took place in 1866. There is a group of data, however, \hich is of special interest and on which much s re” ^ is laid by the author, namely, the occurren of Mongolism in twin births, whether m one only or in each of the twins. 1 hirty-tv* o cas ‘ of the former condition are cited and ve the latter. As the writer points out, i condition of the mother during pregnancy were the essential cause of the disorc er, y? should find it difficult to explain those ca.
where we find Mongolism in one of twins . deed, the occurrence of Mongolism in on? - of twins makes it difficult to accept any e.. 7 of an acquired origin during intra-uterine and strengthens the claims of a germu origin, and the explanation of Mongolism both twins is quite simple on the geimina theory if a one-egg pregnancy is suppose ? Halbertsma is cited as saying 41 It Jvou c,, difficult to imagine any disorder of the mo acquired during pregnancy and sumcient y grave so as to produce the many characteristic traits of Mongolism that would affect one twin and leave the other perfectly normal.” The conclusion is that Mongolism is germinal in its origin and the author is disposed to accept this view as it is on this ground that she throws doubt on disease of the maternal reproductive organs, or under-nourishment or overwork of the mother during pregnancy, as a possible cause.
This doubt would equally apply to any en- docrine derangement in the mother, and yet the author seems more disposed to accept such an explanation; for the only theory which she does not reject is that Mongolian imbecility is possibly induced by some obscure disturbance of the ductless glands. Such a factor must be either inherent in the germ or transmitted to the child during pregnancy as the result pf maternal endocrine disorders. But this latter explanation is ruled out by the inference from the facts about twins. We, therefore, are drawn back to the theory of the defects being inherent in the germ plasm. An examination of the facts has convinced the author that Mon- golian imbecility is not due to neuropathic heredity, nor to extremes of age in one or both parents, nor to the order of birth, nor to the number of children in the family; and the only remaining theory put forward which is com- patible with a germinal origin is some form of reversion to a primitive Mongol type. This theory she rejects ” since the resemblance to the Chinese or Japanese race is mainly super- ficial and since the condition is a pathological one.” Seeing the impasse into which we are led, one is impelled, to look more closely into these objections. On doing so one finds that the statement that Mongolism is truly a path- ological condition is laid down as axiomatic, that is, without any discussion of what such a statement means. It is further assumed with- out argument that a condition which is path- ological cannot also be atavistic. Why then, one asks, is this group of defectives so distinct from other defectives of germinal origin ? Is it not because it is something more than path- ological ?
Moreover, to state that the condition cannot be a reversion to a primitive type since the re- semblance to the present day Mongol races is mainly superficial is to deal with the question in far too summary a manner. That may be so but it does not dispose of the question.
Once more one is faced by the problem. Why do the members of this particular group have the striking family resemblance to each other such as is not found in the members of other groups of defectives of congenital origin ? Whatever may be the solution of this prob- lem, we are much indebted to the author for the way in which the facts have been mar- shalled and discussed. Perhaps further en- quiry into the frequencj’ of occurrence of the type in different countries and communities and its geograpical distribution, may throw more light upon the question; at any rate the author gives no explanation of the admitted differences in these respects. Why should Mongolian imbeciles constitute 20 per cent, of the deficient children in an institution in Russia while De Sanctis in Italy has only seen 20 cases in seven years, and Vogt estimates that only 1 per cent, of the mentally deficient are Mongols?
In a record containing so many observations gathered together from many sources it would be surprising if there were not some which do not correspond fully with the experience of other workers in the field, and differences may reasonably be expected in regard to the sig- nificance or value that may be attached to some of the facts adduced.
Thus the authors seem to have been rather unfortunate in the small number of higher grade Mongols that have come within their notice and correspondingly it would seem that they are ready to regard it as a proposition of too general validity that no attempt should be made to teach the ordinary school branches such as reading, writing and arithmetic to Mongol children of the higher grades. One can point to older Mongols, the delight of whose life is reading, even sometimes history, and writing either imaginative matter or copy- ing lists, etc., but who are ill-equipped for physical labour or for work requiring manual dexterity. It is indeed unusual that Mongols learn to play simple tunes on the piano, but instances of this are known and the capacity for learning dancing is more common than is suggested by the authors. Similarly, the authors seem to stress too much the likelihood of early death when they say that ” with few exceptions they die young, few reaching adult age.” It is possible to point to a group of 16 Mongols in one institution all over 21 years of age, three of whom are between 40 and 50, two between 50 and 60 and one man aged 63.
Be this as it may, we owe a debt of gratitude to the authors, seeing that in regard to every aspect of the matter they have given us in this work a most valuable store of information, lucidly set out and discussed in a judicial spirit. To those interested in mental deficiency as a whole as well as in this special variety of defect it will prove an invaluable work of reference.
R. Langdon Down. The Relation of the Skull and Brain to Crime. Henderson Trust Lecture. By W. Norwood East, M.D., Lond., M.R.C.P. Lond. Medical Inspector of Prisons, etc. Oliver & Boyd. Gd. net.
It is somewhat curious at the present day to meet with a set of lectures endowed for the advancement of Phrenology. Dr Norwood East praises the industry of the pioneers of this pseudo-science, but deplores their haste in proclaiming a new dawn. He sketches the effort to correlate conduct with cranial physiog- nomy from Gall (1758 to 1828) who has been described as the founder of criminal anthrop- ology, to Lombroso, and summarises the essen- tial evidence which led to its final ruin at the hands of Goring and others in this country.
While showing every recognition of the genius of Gall and of the germ of truth in his phrenological system he draws the useful moral that enthusiasm and haste can fall into just as much error again, particularly amongst the welter of uncertain psychological specula- tion current in our time.
It is interesting to read of how different schools of thought have, with varying success, offered their contributions towards solving the crime problem, how the anthropological inves- tigations of Lombroso paved the way for the more scientific work of Goring, and how we can to-day profit by the mistakes of workers in the past whose originality of thought and powers of observation must always be admired. This Lecture will be read with interest by all concerned with this problem.
John J. Landers. Children’s Branch of The Home Office. Fourth Report of, H.M. Stationery Office, 1928. Price 1/- The first three Reports of the Children’s Branch of the Home Office were published in consecutive years from 1923. As the object of these Reports is to present a ge survey of the problem of juvenile dehnque y, it was thought better to issue them Pe”?mcf * when changes and new developments ca for it. The Reports of the Departmental on mittee on Sexual Offences against oung e sons, together with legislative changcs brougn about by the Criminal Justice Act, Adop 1 of Children Act, the Guardianship of lntants Act and the Legitimacy Act, have made period since 1925 one of important deveop ments in the treatment of the young offender and in the protection of young people.
In a general account of Juvenile Courts it is shown that the satisfactory decrease m e number of cases brought before the Courts con- tinues. As the Report states, the statistics on this point must be accepted with some rcsere owing to the variations in the number of cases in which proceedings arc taken, the activities of the police, etc., but allowing for these yarV^~ tions, there has been a steady decrease in t e last few years, even during a period of Vkl^lC~ spread unemployment. For 1927 the numbei of children under 16 brought before Juvcm e Courts for offences was 25,478, which is 1^,0 less than the number in the year before the war. (During the war it reached the highes figure in 1917.)
The passing of the Criminal Justice Act in 1925 has brought about extensive develop- ments in the Probation System. The mam ob- jects of the Act were to ensure that every Court was provided with a Probation Officer, to secure better organisation of probation work in the country districts and to improve the position of Probation Officers. Every petty sessional division is now a probation area anc one or more Probation Officers must be ap- pointed for each probation area. The Act also gave recognition to Treasury grants in aid o the expenditure incurred by local authorities in connection with the probation service. Part III gives an interesting account of the progress of Home Office Schools. With regarc to the position of mentally defective and re- tarded children in these Schools the Repoi states that ” pains are being taken through- out the schools to try and ensure that full con- sideration is given to the cases of all children whose mental condition is seriously retarde or who are feeble-minded, so that any action considered desirable may be taken.”
House School, near Norwich, now admits a certain number of boys of doubtful mentality ?not those certifiably feeble-minded?with the main object of deciding if they are in need of care and control under the Mental Defic- iency Acts.
Other Sections of the Report deal with Farm Training, the Protection of Children and Young Persons, the Adoption of Children and International Work.
Full and interesting statistics are given at the end of the Report of the types of cases dealt with, subsequent histories, etc. Con- tinuity between this and previous Reports is maintained by the publication of statistics for the intervening years.
The Problem Child at Home. By Mary Buell Sayles. The Commonwealth Fund. New York. 1928.
This book is the latest of the Commonwealth Fund publications dealing with the work of Child Guidance Clinics, and is a fitting com- panion to ” The Problem Child at School.” It is primarily intended for the use of parents, for, as stated in the preface, it is written with the object of drawing from the ex- perience of parents and children seen at Child Guidance Clinics, helpful suggestions for other parents faced with the same problems. A glance at the cases quoted?or even at the titles under which they are grouped?will show only too plainly how common arc the problems dealt with, while a careful study of the detailed records given in the last part of the book, should be of great help to all who have the day-to-day handling of nervous and sensitive children.
The first chapters deal with the emotional needs of the normal healthy child, and with the parental ideals and mode of life, most likely to satisfy the natural demands of the growing personality. Few will be found to quarrel with the writer’s list of things essential for normal, happy childhood?viz., security and love? freedom and opportunity for growth?and a sense of companionship with parents. Em- phasis is laid on the need for conscious ideal- ism on the part of the parents as to what they desire for their children and a deliberate work- ing towards that ideal.
The second part of the book deals with cer- tain mistaken ideas which influence parent- child relationships, such as wrong ideas on dis- ciplinc, sex, heredity, etc. Cases are quoted with special reference to each specific subject, and help to bring home to the reader the power of ideas prevailing in the family circle, in in- fluencing the child. The same cases are often quoted to illustrate different subjects but as this entails isolating particular incidents or family situations from the entire picture, the effect is sometimes confusing, and apt to leave one with a feeling of incompleteness.
Part III?which makes up more than half of the entire book?consists of a detailed des- cription, in narrative form, of twelve cases, selected from among those studied at Child Guidance Clinics, in various cities of the United States. The problems they present, however, are not confined to any one country, and will be familiar to every social worker among children. The method of approach and the solutions found, however, will be new to many and will repay careful study. The root of a child’s difficulties and delinquencies are sought, not in the material conditions of his home, but in his own or his parents’ emotional life. That such exploration can only be under- taken with the greatest care and delicacy and with the active co-operation of all concerned, will be manifest, and it is impossible not to be impressed by the sympathetic and understand- ing way each individual family was handled.
The social workers must know their families intimately and well before all the factors res- ponsible for the child’s maladjustment can be gauged, and of different members of the family must of necessity be a long and almost imper- ceptible process. That it is worth all the work and effort involved, none who read this book will doubt and it should be extraordinarily helpful, not only to parents but to social workers.
The quotations at the beginning of each chapter are exceedingly well chosen and apt? in several instances they help to stimulate the reader to just the right frame of mind to appreciate the subject matter which follows.
At the end of the book a short list of books for parents is given. St. C. Townsend.
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