News And Comment
The Problem of Defective Children as Discussed in the International Congress on School Hygiene.
- Author:
Anna J. McKeag, Ph.D., Professor of Pedagogy, Wellesley College.
At the International Congress on School Hygiene, which held its triennial meeting in London, August 5-10, about five hundred delegates from governments and societies and fully fifteen hundred other visitors were in attendance. The range of topics discussed in the general and sectional meetings included almost every phase of hygienic science: the Physiology of educational methods and work; Medical and hygienic inspection in schools; the Hygiene of the teaching profession; Instruction in hygiene for teachers and scholars; Physical education and training in personal hygiene; Out-of-school hygiene; Contagious diseases; Special schools for feeble-minded and exceptional children; Special schools for blind, deaf and dumb children; Hygiene of residential schools; the School building and its equipment.
The medical and educational treatment of children who are physically, mentally, or morally defective, received a large share of the attention of the Congress, not only in the sections especially devoted to this subject, but also in many of the papers read in the other sections. There was abundant evidence that not only educators and physicians, but legislators and municipal officers as well, recognize the duty of the state to children who are subnormal, and who are therefore unfitted to profit by the methods of instruction in the regular elementary schools. Mr. J. Willis Bund, Chairman of the Worcestershire education committee, in a defense of the bills for medical inspection under consideration in Parliament, stated clearly to the members of the Congress the logical outcome of compulsory attendance laws in regard to the abnormal child: “As the case now stands, all children, unless taught elsewhere in a way that satisfies the magistrates, must attend the elementary school. … There is no excuse that the child is unhealthy or delicate, unless it is actually suffering from some infectious disease… . As every child can prima facie be made to attend school, what is wanted is to get, as far as practicable, some idea of the lines on which each child’s development should proceed?in fact, to educate the body exactly as the mind is educated… . We have at last recognized that the same treatment cannot and ought not to be applied indiscriminately to all children, but that there should be classification, and a proper course of treatment applied to each class… . Each child on coming to school should be submitted to a thorough examination as to whether it is or is not in a condition other than normal, and whether it has any tendency to any spocific abnormality. “It is obvious,” continued Mr. Bund, “that the method hero indi(210) cated would involve a great change in our present educational system, as it would necessitate a large number of special schools. At some of the special schools the children would have to be boarders. … But it must be borne in mind that if these abnormal children are allowed to grow up without some attempt at cure, it means that it is only a question of at what time in their lives they will have to be included in the class supported by the rates.”
The economic waste resulting from neglect of physical and mental defects was emphasized in several of the papers read before the Congress. Dr J. T. Cronin, assistant chief medical inspector, department of health, New York City, presented some interesting statistics on the subject. He states that in a school population of 650,000, 30 per cent of the children are from one to two years behind the proper class for their age. The cost per day of education for one child is about twenty cents. If 195,000 children lose one year out of the six years of compulsory attendance, the state really loses $1,666,666 every year. “Ninety-five per cent of these backward children,” says Dr Cronin, “were defective in eye, ear, nose, throat or nutrition. In one school a special class of 150 backwards showed 100 per cent defective. This class was studied collectively. Fifty-six of these children were operated upon at a private hospital and thirteen fitted with proper glasses; ci, ty- o ne were operated on in the school building. … The previous history of these children was very bad as to class conduct, effort and proficiency. A number of these children were sent to the country after operation. … A report on 76 of the children six months later showed that without exception all had improved in conduct, effort and school efficiency as measured by their promotion to a higher class.”
Further evidence of this economic waste was found by Dr Cronin in his investigation of the physical condition of inmates of the truant school. Over 90 per cent of the truants showed marked physical defects of such a character as to interfere with school work. In 70 per cent of the cases the defect was one of eyes, nose, or throat. Many of these children would never have become truants had these defects been corrected at an early stage in school life.
There was general agreement among those who discussed the subject that the chief agency for the detection of physical and mental abnormalities is to be found in the medical inspection of schools. The results of the medical examination should be recorded in permanent form. In many French schools two records are kept for each child: the livret sanitaire, which contains anthropometric data, vaccination record, list of absences on account of illness, etc., and which is the property of the pupil; and the fiche sanitaire, containing more detailed information concerning general health, family history, condition of eyes, ears, throat, nose and general medical observations: this is the property of the school physician. Although compulsory attendance laws coupled with rigid medical inspection allow few cases of abnormality to go undetected, it may be desirable to arrange for systematic exploration of the poor quarters of a city to detect cases not reached by the schools; and to bring about co-operation among philanthropic, educational and civil agencies in this work. The paidological laboratory, now established in several European cities, has been found of the highest value in the determination and classification of defectives, as well as in the solution of problems connected with the physiology and psychology of general school room methods.
The relation between the sociological condition of children and the percentage of physical defects was pointed out in many of the papers read before the Congress. Dr Clement Dukes presented a record of the physical examination of one thousand boys at their entrance to the English “public schools.” These schools are attended by the children of the middle and upper classes, who, supposedly, have had proper physical care in their homes. It is interesting to notice that only 3.4 per cent of these boys were defective in hearing, and only 5.7 per cent had defective (neglected) teeth. The percentage of eye defects was greater?20.8 pr cent. About half the boys were of approximately normal height and weight. In striking contrast to this record of wellto-do children is the report of Miss Ivens on the result of an examination of one thousand East London school children. Nearly one-third of these children were defective in hearing and about 74 per cent of these showed morbid conditions of the throat. Dr H. W. Thomson found that 35 per cent of 52,493 school children in the elementary schools in the poorer parts of Glasgow have defective vision; and in many cases there is evidence that this is due to malnutrition. In a detailed examination by Dr C. E. Wallis of the teeth of 245 children in a London school in a poor district, only four children were found to have the normal number of healthy teeth. Such facts as these demonstrate the necessity of improving the general hygienic conditions of the homes in which these children live, and of supplementing in some way the inadequate nutrition furnished by the home. The “Provision of Meals Bill” passed by the last Parliament authorizes local school authorities to furnish free of charge to children one meal a day where it is deemed necessary. In Finland such a law has been in operation for some time.
Parents and teachers are often ignorant of the existence of defects of sight and hearing in school children until these are revealed through medical inspection in the schools. Dr Stackler, of Paris, states that in almost half the cases of defective sight discovered by him as medical examiner in schools, the parents were unaware of the defect; and in all of the cases of defective hearing (3G per cent of 753 boys examined) both parents and teachers were ignorant of the fact that the child did not possess normal hearing.
It is impossible within the limits of this article to give an adequate account of all the important papers dealing with the educational treatment of defective school-children; a few are selected as illustrative of the work of the Congress.
A most interesting report on the mental characteristics associated with blindness of various causation was presented by Mr. N. B. Harman, oculist of the London County Council Blind Schools. From five years’ study of the partially and totally blind children of London, Mr. Harman believes the following to be a useful clasification for medical and educational purposes:
The blind from accidental causes, about 44 per cent of the total number, are usually normal except in sight, and may profitably be educated at the ordinary schools for the blind, using embossed type, etc.
The blind from constitutional disease, about 30 per cent of the total number, present serious physical and moral defects, and should be given only very elementary work, all nervestrain being avoided.
The blind from congenital deformity, about 20 per cent, are usually dull and incapable of education in academic subjects.
The blind from purely ocular causes, about 5 per cent, are usually only partially blind, being highly myopic. They should be taught to work with the hands without the use of the eyes.
Dr Adolph Bronner, of Bradford, accepting the usual definition of blindness, that “the vision of both eyes is so bad that the patient cannot see well enough to find his way about in daytime, or to count his fingers at twelve inches distance,” estimates that of the children under fifteen, in England and Wales, 423 out of every million are blind. But for school purposes those also who cannot see well enough to read school books are blind. There should be adopted “a universal standard of defining the various degrees of weak sight,” so that statistics may be uniform. For teaching purposes, children are divided at present into two classes, the seeing and the blind. There should be an intermediate class for those who can see a little. From this class some children would, in time, pass into the “normal sight” class, and some into the “blind” class.
Dr James Kerr Love, of Glasgow, presented a plan for the educational treatment of the deaf and the partially deaf. He points out three chief stages in the history of the education of the deaf. The first was the demonstration, by the Spanish monk, Ponce de Leon, of the fact that “deafness in a child is no necessary bar to the acquisition of speech.” The second was the discovery by the Abbe de l’Epee of the fact that not only picked scholars, such as those experimented on by Ponce de Leon, but also “the average unpicked, unselected deaf child could be taught language.” In recent years, “the great net of compulsory education has swept into the schools the poor deaf mute… . Ragged, underfed, badly-housed children, scrofulous, half-blind, defective deaf children, who were thought hardly worth keeping alive, much less worth educating, must now go to school, even if they be driven to it in a municipal carriage, or be led to and fro by a municipal nurse.” The third stage in the history of the education of the deaf, according to Dr Love, is “the scientific classification of the deaf for educational purposes.” In the clinical examination of deaf-mute children there are two important questions: When did the child become deaf ? How much hearing has he left ? Dr Love presents the following scheme for the education of deaf children who have been properly classified by clinical examination:
1. Hard of hearing children! _ . , . . , . _ . , n ? t X 1. ii r Special classes m hearing schools, f Semi-deaf, better cases.. j o o Zo *? l ” worse cases.. | Special day school or oral residenDeaf mute (average)… J tial school. ” (oral failures) ) Separate classes of manual alpha 3. 60% 4. 15% Deaf mutes {defective).) bet school (residential).
The advantages of institutional life for the deaf child are very great. Sixty per cent of the deaf children in Glasgow have defective sight; 30 per cent have adenoid growths. The institution provides medical care for these cases. The residential institution is especially desirable in such a city as Glasgow, where the deaf come largely from districts where bad housing prevails. Of seventy-eight homes of deaf children in Glasgow, only twelve showed proper sanitary and moral conditions. Only five could be called “excellent.” In his record of cases, Dr Love uses the following schedule: age of reported onset, assigned cause, deaf relatives, remnants of hearing (especially within the speech area), condition of tympanic membrane, hearing of speech, speech used, and intonation. According to Dr Ferrari, of Rome, the condition of the teeth of the deaf child should also be noted, as successful oral speech depends upon proper facilities for articulation.
Another class of defectives, epileptic children, formed the subject of a discussion by Dr F. J. Poynton, of London. These, according to Dr Poynton, cannot be dealt with by grouping them into two great classes, the mild and the severe cases, the former attending ordinary schools and the latter being sent to an epileptic colony. A large number of cases are intermediate between these classes, and should be dealt with in a separate school.
In dealing with epileptic children, two considerations should be kept in mind: the frequency and character of the epileptic fit, and the general mental condition of the child. As a general rule, the frequent recurrence of fits damages the mind. Mental degeneration may be counted on as a concomitant of epilepsy. Sometimes strange mental states follow immediately upon the fit, and are more or less transient, the most dangerous being mania.
Children originally normal, but who have become permanently damaged after some sudden brain disease, should receive, according to Dr Poynton, individual treatment. The medical officer of the school may be greatly assisted in such cases by a certificate from the medical attendant of the child “acting on this certificate to the best of his power, sometimes making use of a special school, or again, curtailing the hours of study.”
There was general agreement among those who discussed the subject that children of markedly defective mentality or morality should be segregated, and not taught with children whose defects are chiefly of a physical nature. In the cases of moral defectives especially, elimination from ordinary schools is imperative. Such children are hopeless, so far as ordinary school influence is concerned; and they do great harm to other children. The fact that they are often alert and quick in academic subjects should not deter school authorities from placing them in special institutions.
Existing classifications of mentally deficient children are still imperfect, and we need a more accurate terminology. For children properly called feeble-minded, Miss Dendy, of Manchester, who has made a special study of these cases, believes literary education to be a waste of time. “Special schools should be a step to permanent life-long care. These cases must be permanently segregated and employed.”
The term backward children is not found to be coextensive with the children one year or more behind their class. In an inquiry made by the medical inspector of the school of Dunfermline, 11 per cent of the children were found to be a year or more behind their class; only about half of these were cases of mental retardation, the others being due to irregular attendance, physical defects, migration and late enrollment. In one of the papers on the training of the feeble-minded, the interesting suggestion was made that teachers in schools for this class should be required to include, as part of their preparation for this work, a course of training in a college for the deaf, in order to obtain an extensive knowledge of the principles of articulation.
A special phase of the treatment of defective children in London was presented by Dr Reginald Elmslie in his report on the “Invalid Centres,” recently opened in London, “for the instruction of children who, owing to chronic ill-health or to physical defect, are unable to mix with their fellows.” There are at present 1,802 children enrolled in these schools, which are to be found in various parts of London. A mid-day meal is served to all these children. Dr Elmslie has personally studied 1,050 cases in these schools. He estimates that 20 per cent of these on leaving school at sixteen years of age will be able to earn a living in ordinary occupations; 50 per cent may earn a partial living in special occupations, and 30 per cent are likely either to die or not to be able to work. All these children are backward in their studies. “Schools of this kind,” says Dr Emslie, “may aim at either of two objects: (1) simply to educate the children as far as possible, then to turn them out into the world ignoring their defect; or (2) to do the utmost to arrest, alleviate or improve the physical defect, and by improving the child educationally and physically, to place him in such a position that he can support himself.” In London the first aim has been adopted, though with some modifications and improvements. It is highly desirable that the city or the state should adopt the second policy, since otherwise it will have left upon its hands a large number of physical defectives whose condition might have been improved. Among the methods advocated in the Congress for the improvement of the physical condition of poor children in cities, great stress was laid upon the establishment of country camps and vacation schools. Denmark especially has made great progress in this matter, as was shown by the report of Thomassen, Copenhagen. In 1906, 17,400 children of Copenhagen were sent to the country. The distinctive features of the Danish plan are
the placing of children singly in homes, as far as possible,
the granting of free transportation by railway and steamship companies, and
the establishment of camps for children who cannot be cared for in private homes.
In return, country children are given transportation to the city for a day or two of sight-seeing. In England and France, also, this work has developed in importance. Manchester built in 1903, at a cost of $3,000, a country school for town children, to which children from the elementary schools of Manchester are sent for two weeks at a time. Board, lodging and car fare cost lis. 6d., of which the parents pay 7s. The school is open from April to October. The improvement in the physical condition of the children has abundantly justified the establishment of the school.
While there was unanimity in the Congress as to the desirability of medical inspection of schools, there were differences of opinion as to the methods by which the recommendation of medical inspectors should be carried out, and the extent to which the state should relieve the family of responsibility. In thirty German cities, for instance, free dental service is furnished to poor school children. Some French schools provide shower-baths. The school nurse is already finding a place in English cities. Dr Stocker, of Luzerne, advocates the establishment of “school polyclinics” in every city for the treatment of physical defects discovered by the school physician. “School dispensaries” are advocated by many. Dr Bronner and many others believe that the state should provide glasses in all cases where children with defective sight are unable to pay the optician. A more conservative attitude in this matter was represented by one of the speakers who declared that “it is not the province of the school to provide spectacles, but to discover the educable and to educate, and to see that by other means and other agencies the deficiencies which make children ineducable are remedied.”
The most important results of the Congress are, doubtless,
the unmistakable emphasis placed upon the responsibility for the physical well-being of the child, which the state, in making education compulsory, has tacitly assumed; and
the demonstration of the necessity for a better classification of children on the basis of physical, mental and moral characteristics.
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