Six Weeks with a Supposedly Hopeless Case
The Psychological Clinic Copyright, 1915, by Lightner Witmer, Editor. Vol. VIII, No. 8. January 15, 1915
- Author:
Alice C. Hinckley, M.A.,
New Haven, Conn.
J. R., a boy of twelve, as a last resort was brought to New York by his parents for help, after they had tried many physicians in various parts of the country in vain. Here he was declared hopelessly deaf by a specialist, who recommended that he be placed in a school for the deaf. The schools refused to admit him on account of his repulsive appearance. The parents were referred to the writer who, with many misgivings, agreed to see what could be done. The boy was slightly below normal in height, very thin and emaciated, probably due to exhaustion from continuous muscular contortions. There was general inco-ordination with spasticity. He was not able to hold up his head or sit alone until he was eight years old. He walked?if his spider-like movement could be so designated?with his feet about eighteen inches apart, and hands, cramped downward at wrist, waving sideways; his knees bent outward instead of forward, and indeed every joint seemed to work the wrong way. When sitting his head frequently lolled to one side, his eyes involuntarily rolled upward, and saliva ran from the mouth which hung open. He appeared idiotic. The parents said, however, that while he could neither hear nor talk, he understood them and was able to make himself understood for the most part by signs largely of his own devising. By agreement, he was to be under the care of a physician lest the mental stimulation should overtax his nervous system.
The clearest understanding of the treatment and progress of this case will probably be secured from a narration of the main incidents as they occurred in successive interviews. He was seen at least one hour each day, five days in the week. The first week was given to observation and experimentation with a view to working out some plan of procedure. My decision was to teach him at home where his setting would be natural and to keep him as serene mentally as was possible; then to present stimuli and observe his responses, encouraging or discouraging them as they were helpful and constructive or harmful. His muscular activity was also followed closely. Sept. 25.?In the first interview or lesson the following observations were made: Inco-ordination of muscles; rose to his feet suddenly and with precision; had better control of feet than of hands. He had a code of signs of his own. He was not accustomed to feed himself. He wanted a cantaloupe that he saw and I suggested to the mother that she hand it to him without any offer of help so that I might observe his behavior. She cut the melon in two and indicated by a gesture that the seeds must be removed. He went into the dining room and opened two drawers of the sideboard before he found the silver. He used the left hand for this; then took one fork and one spoon out with the left hand and placed them in the right. When he handed them to his mother he laughed heartily? he did not know which she wanted. At first he wanted both pieces, but agreed that I might have one. His piece was on a box before him while he sat on a chair. Leaning over to it was uncomfortable, so he grasped the melon in the left hand, and with a good deal of aiming ate it all. In using the spoon in the right hand, he grasped it in his fist, bowl downward, then experimented with the bowl upward, but returned to the first plan. He showed satisfaction when he succeeded in getting a spoonful into his mouth and looked up for approval. He objected when the rind was taken away, but accepted the explanation that it was no longer good. Instead of moving the box out of the way with his hands, he lifted his right leg over the box when he wished to get up.
He keeps busy; observes closely; and notices omissions in familiar things. He knows how to start and stop the automobile and likes the chauffeur. He manipulates the typewriter rather intelligently?puts in and removes the paper and imitates from a copy the words mama, Cecille, and a few other names, and indicates who they are. His mother has taught him this. He appears to remember fairly well.
He likes to make a noise by striking on something, a characteristic which Dr Currier, of the New York Institute for the Deaf, finds quite common among the deaf, and attributes to the rhythm instinct. Piano playing, of the ragtime order, disturbs him?he says it hurts his head?but he makes no objection to the violin. A brass band was unnoticed until it was pointed out to him. He objects to loud talking into his ear.
His voice is soft, though without inflection, even in protest, and he laughs audibly. He shows his satisfaction by laughing. He wished his mother to draw a picture of a boat, but she could not understand the details of the one he had in mind, so he left the room in disgust, went into another room and shut the door (to sulk, she said). When she went to find him, he came out laughing. He has had some teeth filled and likes to play dentist to the rest of the family by using a discarded switchboard as an engine and a compass as forceps.
Sept. 26.?Tested his hearing with the Currier conversation tube, which comes in three sizes or degrees of amplification. Of these the larger two seemed to reach him. He laughed hysterically and seized the tube with both hands, refusing to let go until he was assured that he should have one. The proof that he heard was in his change of expression and his effort to repeat mamma, papa, boat, Ethel, when the speaker’s lips were not in view. Whether the word had one or two syllables was clearly indicated. While experimenting with it by listening to his own voice, he used a succession of three tones in a rising scale, and was highly pleased at the sound of his voice. When the tube was wrapped in paper he would allow no one else to carry the package, and as soon as he reached home he explained about the tubes to his sister and had her use them. It was interesting to see him show her how to place the opening horizontally below her mouth. Sept. 27.?Dr Currier very kindly tested the boy’s hearing at the Institute for the Deaf. The tuning fork of lowest pitch could not be heard at all; the highest was heard most noticeably. The electrophone gave very good results and so did the dentaphone. He was delighted with the tests and was quick to see what was wanted of him. When he was particularly pleased (ostensibly on account of hearing) he put his finger into his ear, and once he tried verjr hard to talk. After the tuning fork test, the three forks were held out to him and he chose the one of highest pitch. After the whole test, all the apparatus used was spread out before him and he chose the same tuning fork. Testing showed that the hearing was a little better in the right ear. Dr Currier thought he had considerable sensibility to vibration and that it was susceptible of development but would require long and persistent exercise. He cited instances where students of his own had had no more hearing at first, but by patient work had been able to enter college with normal individuals and complete the course with credit.
Sept. SO? J. showed me, with great delight, how well he could blow his new harmonica. Then he produced his new slate and pencil. His efforts at using these were wildly inco-ordinate. I drew a crude outline of a boy and told him it was his picture. He asked me to put in features and pointed to each of his features as directions. He thought it a great joke. We took a ride that lasted two hours. He sat between his mother and me and was unusually quiet physically. He enjoyed the moving crowd on the streets. He shouted when he saw a mule in a cage hoisted by a derrick to an upper story.
Oct. 1.?He had some new toys to show me; among them a toy telephone that we used. He wanted a boat drawn and his mother could not understand him, so he took the slate to his sister and gave the directions where to put the lines. It was the vessel on which he had come to New York. He brought the picture in great glee to show us and pointed out the pilot-house, the anchor and the propeller which he explained was broken. (This was true of their vessel.) He is very exact about details. Sometimes he laughs at their efforts to follow his directions, and at other times rubs their drawing out in impatience.
Oct. 2.?Our first formal lesson was with the slate, and wooden blocks one and. a half inches square containing raised letters colored red and blue. The reverse side of these blocks showed uncolored figures of animals in relief. His cap was shown. I placed the blocks to form the word, as a copy. He readily got the meaning and reproduced it with other blocks. He repeated this. I mixed all the blocks and had him make it from memory. He asked for the tube to hear the word and tried to say it, but without any resemblance. He asked to have it on the slate, so I printed it. I showed his father’s cap and he made the word cay again. Then he asked for the words that meant coat, pants, engine. He insisted, so I made each word with blocks and he copied it twice, then heard it. He was very much disturbed because the o was blue while the rest of the letters were red, and could not see why a red c would not be better than a blue o. He worked in a good spirit for about half an hour.
Oct. 3.? J? was glad to see me. He was lying down when I arrived, which was quite unusual, though he is encouraged to lie down as much as he will. We went at once to our lesson. I tried him first from memory. While he got the right letters, placing them in the right order troubled him, so I helped and then the correct word was used as a copy. He soon tired and wanted to make coat. When I insisted on his doing the other once more, he complained that his head ached and his eyes hurt him. After he had made coat and heard it a few times, I arranged cushions on the floor for a bed and he lay very still for six minutes, and did not attempt to rise for ten minutes. He worked fifteen or twenty minutes but was evidently not feeling well.
Oct. J+.?He met me at the door and immediately began to tell me something about his blocks. His mother explained that yesterA SUPPOSEDLY HOPELESS CASE. 217 day his father thought of the scheme of modifying a red q into an o, but he came in and caught his father defacing one of his blocks. He became very indignant, would have nothing to do with the mutilated block, put it and all the red letters into a box and insisted that they should be returned to the store and exchanged.
When I arrived, only the box of blue letters was on the table with his slate and pencil. He took the blue o out and did much explaining about it, but I asked for the other box. He picked out the red substitute o, showed it to me with much grumbling and pushed it and all the red ones away.
This mood persisted throughout the whole lesson. In the hope of diverting him I made the word pants which he had asked for in a previous lesson. He wanted to know the word for pants, but kept an eye, as it were, on the offending letter. I used only blue ones. He worked nearly fifteen minutes matching up the letters. I printed the word on the slate and told it to him through the tube, which elicited the usual delight.
He tried to make cap and chose the right letters, but was slow about getting them in the right order, so I suggested it. The word coat caused trouble. He refused to use the red o though he saw it, and even refused to use that block for the a that was on another side. I placed the red o and the blue o before him and he chose the blue. Then we both laughed.
I printed the words so far studied on a strip of cardboard to be saved as copies. He made the word box once and I gave him the sound. He liked it and repeated the word fairly well, omitting the x. The lesson comprised thirty minutes of attentive work. Oct. 5.? J? was perceptibly calmer. The lolling of the head to one side had almost disappeared. His sensitiveness to the piano was tested by placing the palms of his hands against the piano box while a succession of chords and an easy flowing rhythm were played. He was especially pleased with the latter. When the playing first began he took his harmonica from his pocket and began blowing it, then he vocalized as he blew. He used his voice more frequently than formerly.
On account of the analytic process involved, and the effort necessary to hold the word in mind while its elements are found, with the quick fatigue he has shown in doing it, I have decided to keep his mind in as easy and natural a condition as possible?like that of a little child before it has learned to talk. He must be told the names of things, as he wants them; and hear some of the usual conversation about the home.
Oct. 7.?He was at breakfast when I arrived. When he came in I took the tube and said ” Good-morning.” He smiled. I said, “What did you have for breakfast?” Pie began telling me by signs that there was a maid in the kitchen and she was black. He led me to the kitchen; where she was washing dishes. He wanted to hear the name of a glass and of other things. He took me into the dining-room to ask the name of the cups belonging to a crystal punch set. I told him that was a glass, too. He asked the name of other things he wanted to know, but when I offered to name some fine apples sitting on the table, he would not listen.
In the kitchen I named knife, and he took it out of my hand and pretended to stab himself; then laughed heartily at my pretended alarm. I showed him some milk, naming it; and with my lips out of his sight I said, “Do you want some milk?” He said “mm,” nodded his head (his usual assent) and waited expectantly while it was poured into a glass for him. He asked the name of the fire hose hanging in the hall?he demonstrated that he knew its use?also the name of the carpet-sweeper, which he opened to show me how to get the dust out. He asked the name of the dust. He made some vocal effort for nearly everything that was told him. He wanted the name for his finger, so I said, “That is your finger, this is my finger,” with appropriate gestures.
Oct 8.?He showed me some new blocks, oblong, with cars and engines on one side. These he made into train^. He was so closely occupied I thought it a good time to print some of the words we had used the day before. In a little while he came over to see what I was doing and for some reason disapproved of it. He slapped his hand down on the printed words and tried to rub them out, then seized the sheet of pasteboard as if to tear it. His mother took it away from him and removed both it and the type from the room. He wTent back to his cars, still grumbling and wishing to destroy the cardboard, and finally began to cry. Nothing would pacify him till his mother told him she would tear it up. In a little while his good humor gave way and he insisted on the destruction of the cardboard, so it was produced and he tore it up with great satisfaction. He seemed generally out of sorts. Oct. 9.?No reference was made to the printing. He did not wish to use the tube?said it hurt his ears. He heard my voice without it, several times, when I called him and when I told him the names, always making some vocal effort. Once he indicated that I talked too loud?sometimes he pretended not to hear, then looked around, laughing, and pleased with himself.
When I called him from a distance about eight feet, with his back to me, there was a pause of about two seconds before he looked around. The response, even when he was facing me and nearer, showed the same definite pause.
His muscular action was more unsettled than for some days previous. He used his left hand a little more certainly. Oct. 10.?He played with the new blocks but refused the tube, making gestures to his right ear and putting his finger into it. He seemed to hear some things I said and tried to repeat them. Once he put his hand back of his right ear to catch a word. He called my attention to the fact that he had his feet crossed one over the other. Previously when he worked at the table his feet were rigidly stretched out wide apart and waved about with every effort of his hands. From that position he moved his feet easily well back under the chair and resting on the toes. He sat in a camp chair which was nearly low enough to allow the whole foot to rest on the floor.
Once he gave a prolonged cooing sound (like a baby) when he was delighted, then talked off a whole paragraph of vowel sounds, working the lips to the shape or position for w, with rising and falling inflection, and gesticulating to help out his meaning. He works his lips, tongue, and facial muscles a good deal, suggesting the involuntary movements of an infant. He wiped his harmonica on his stocking and offered it to me to play, but he could not hear it. When he walked, I found the new fidgety movement was due to his knees bending forward instead of sideways as before. It is a much more limber movement. The right foot lifts higher than the left.
He brought out his Indian suit, head-gear, bow and arrows and we played Indian. He did the sighting and I the shooting. He used his doll as a target. He heard the names of these things without the tube and tried to say them?said “bow” fairly well. He did not want me to leave and held my hand with both of his. Then he tried to squeeze hard enough to make me cry out. At the first he could not grasp, so he was using one of his new accomplishments.
Oct. 11.?The knee movement was not so regular as on the previous day. He played quietly with the square blocks, animal side up, sitting in the camp chair, with his feet comparatively quiet. He selected the animals he liked and pushed the others away. He wanted to know the names of some of them, but not with the tube. He seemed to hear my voice at medium pitch and intensity and made some effort to say each word. For the gun and the cock he seemed to try to imitate their sound. At sight of the goat, he went through the pantomime of butting. After I said its name several times, he leaned his left ear toward me, thus turning his eyes away. I said it again and he repeated “go” distinctly.
He gave one or two shrieks of delight -with mouth open very wide. He now has a low, childish, rippling laugh.
Oct. 14.? J? was in a mischievous mood. The knee movement fluctuated from the old to the new. We played dominos about fifteen minutes. He matched them up fairly well, but wanted to throw away the blank one until he saw how it was used. Made no objection to my turn at playing. When his supply did not afford one that would match, he borrowed one of mine with my permission: they were all lying face upward. Once he shook his right fist in my face for fun and it touched my nose, so I immediately became an Indian and shot him. He used the canvas seat of a chair held in his lap as a barricade and shrieked as I crept up to it with my hand shading my eyes (his sign for Indian).
He put the chair on the table and piled blocks on the seat of it, then gradually tipped the chair until they all slid to the floor. He tried putting two chairs on the table. He made a tent by stretching a buffalo robe from a chair to a settee, sat under this on a cushion, and called his mother to find him.
He motioned his mother out of the room then wanted me to follow him to the kitchen. There he got his tin pail tied to a rope which he is very anxious to let down on the outside of the window. His mother told him he would lose it, so he secured the door of her room with the rope to prevent her interfering or seeing what he was doing.
In the forenoon he had heard the cannon of the naval review on the Hudson by laying his mouth-piece of his speaking tube over the window sill (he did not appear to hear the sound without it). Now, the cannon firing began again, and he gave no indication of hearing it. As soon as he was told of it, he got his tube, placed it to his ear and handed me both mouth-pieces. I placed them, well apart, outside the window (about three blocks from the river) and with the first shot he gave a great start, then laughed heartily?as he did after each report?changing the tube from one ear to the other. The consonant sounds which he has produced so far are initial m, b, g (once).
His eyes at times become dull and expressionless with the iris inclined upward. This occurs less frequently than formerly and after prolonged attention. It seems now an indication of fatigue, whereas at first the attentive expression was the unusual one, lasting one or two seconds at a time. He fell twice during the hour. Oct. 15.?The lesson was largely with the blocks. He set them in rows with the two similar blocks together and worked hard on the words one (wii’), two (oo). He also tried boy (bu), girl (gu’i, after a long struggle in his throat). He attempted the names of all the animals except the elephant and the camel. The first effort on the word lion was by slowly opening his mouth as wide as he could and giving a deep explosive sound. He was delighted with this achievement and so was I, but whether it was the word or a roar is hard to say.
He set up a row of animals and knocked them down with blocks after much aiming. He aimed at the nose of the monkey and the mouth of the goose (indicating this by pointing to his own features) and laughed in anticipation. For missiles he chose blocks having engines and guns on them. He held up fingers to show how many were knocked off each time. When one fell to the floor I told him to say “Get it,” and, as soon as he made the effort, I picked it up. The effort was only a double grunt.
Oct. 16.?I found him in bed as the result of a serious fall on the floor the evening before. There was an ugly cut on his head near the Broca speech region and another on his chin in which the doctor took a stitch. During this performance he was very heroic but extremely nervous.
I did not encourage him to talk much and nothing new developed. He was in good spirits and had an unusually animated expression.
The tube was not used. We played with the blocks and he got some excellent lip exercise in his effort to say one, two. It amused him to see my lips form a circle for one and he imitated the movement about eight times, each time ending in a laugh. The successive tension and relaxation of the lips may have given him the impression that I was laughing. He made a great throat struggle over the two, and it came out “oo.” He thought he had said it right and I applauded.
Oct. 17.?Again the tube was not used. J was perfectly contented and unusually composed in bed. He enjoyed a picture book containing firemen, engines, and ladders, and made his usual effort to repeat words after me; but all his communication was by signs. He showed me by the sample sheet that he wanted me to make 9 on a magnetic toy that has movable bits of tin manipulated by a horseshoe magnet. In his delight he went off into a combined squeal and shriek, quavering up and down a bit, crescendo and short stop. This seems to have taken the place of the cooing of a few days before. He also had his eyes turned away from the object, with a fixed, wrapt expression.
I named the numbers to nine and he gave a little grunt after each. I called him several times and he looked around in a roguish way. Once he tapped his lips in fun, to mean that he heard but would not answer.
Oct. 18.?The tube was not used. His mother reported that he had signified to her that the ear-piece of the tube was too small and went too far into his ear. He wanted it made larger and one of the tubes taken off (probably for convenience in carrying it about). He told me the doctor had been there and opened the place on his head. This was done with a lancet, but he hardly murmured. He let the doctor do it while his mother was out of the room. A little further opening was necessary after she returned and he asked her to hold his hand.
He was in good spirits. We played dominos, and he matched them fairly well. I counted the spots for him. He struggled with one, two?with about the same result as formerly. Several times he matched wrong numbers, to see what I would do. He insisted that two and one matched three and blank.
He tried to tell me something about the wings on my hat, and when I could not get his meaning he yelled loudly until his mother came to explain. Once or twice he took spells of yelling, only onetone vowel sounds ending with a short stop and sometimes ending in a laugh. He seemed to enjoy the sound of his own voice. He uses his voice nearly all the time while he is relating things by gesture.
Oct. 21.? J? Had had fever two days and was not yet entirely free from it. He was still languid, but was glad to see me, and in a few minutes brightened up and told me the doctor had been to see him and was coming again at two o’clock, showing the number on his watch. He had me use the watch to count his pulse, but pretty soon he began to play pranks by wiggling his fingers so I could not count. I shook my fist at those fingers, which amused him and served as a challenge to keep it up. He began his little squeal, then experimented with different tones (loud staccato in middle range), then went as low as he could and lower than he could give any clear tone, lowering the chin to get a throaty effect,?the low tones on u, the high ones on e with lips moving slightly from tense to lax. He gives a, in “mama,” “ba-ba” (papa), equal force on each syllable.
He wanted to tell about the ships and introduced the subject by imitating the guns,?a deep explosive sound on the vowel sound of French (f)eu or German ce rather than our oo. Said “gu” (gun) with exhausted breath and uncertain vocalization, “bo” (boat) clearly after much preparation and effort at imitation.
We played “Ding, dong, bell” with his watch on a string. I showed him by rhythmic movement of my finger that the watch said “Tick, tick” and asked him if he wanted to hear it. I put it against his right ear, and both his delight and the tick?tick movement of his hand showed he heard it. I caught its rhythm and said “tick, tick” with it, to make certain he would get the real meaning in a correct association. Afterward, I put the watch under the pillow at the same ear and he heard it. I had first experimented with the watch under the pillow and he gave no indication of hearing it. He asked me to put the watch under the pillow when we finished playing with it. He patted my cheek as a suggestion that he wished to have his cheek patted.
For the first time, his tongue appeared between his teeth. It moves a good deal, but well back in the mouth. This time the movement was a random one, but I followed the cue by extending my tongue and placing it to the upper lip. He thought that very funny and worked his tongue but it did not come out. Once he clapped his hands audibly, the whole palms touching.
Oct. 22.?He was still in bed but without fever. His eyes were still swollen, the wound on his head discharging freely. He was languid when I came in, but soon became so excited that I persuaded him to quiet down.
He did his vocal exercise almost the same as at the previous lesson; this time apropos of nothing, unless to challenge me to a frolic.
He fired guns on “eu”; said “mama”; and made all sorts of efforts to explain something to me. His lips are becoming very flexible and once his tongue showed itself. When I repeated my tongue exercise he suddenly reached out his left hand and knocked my chin up to make me bite my tongue. He laughed and became so excited I told him he must rest and sat back in my chair out of his reach. He beckoned me to come closer and quick as a flash he seized my wrist and held me.
He said “m-by” (good-by).
Oct. 23.?He had just got up for the first time since the accident, and was walking about the house. His muscular action was weak and uncertain, but his knees were bending forward with feet about eight inches apart. There was exaggerated and backwardbending movement of the back and arms. He was glad to see me and expressed great satisfaction at being out of bed. I took him a picture of a little boy playing doctor to a dog which was covered up in bed. He shrieked a little and tried to say dog, but could not get the d at all. He makes strenuous efforts to talk on a continuous strain, and to emphasize and explain both by gestures and with sounds (lip, tongue, and throat movements). We played dominos most of the time,?apportioned them by each taking one alternately. He has very little trouble matching them. I showed him the number of spots and gave the name each time. He tried very hard to say them. For four and five he placed his lower lip correctly but got no breath force on the /. Both sounded like “bvo;” once he said “bvi.” He worked hard for three and for the first time consciously placed his tongue well out between his teeth. When he drew it back quickly, instead of the right word, it ended in mama (“thmama”). He felt as though he had gained a victory. Six was impossible?only 1. For play he said “pay,” clearly. For pick it up he said “pi.”
His hearing was unusually acute. Whenever the elevator door (in the hall, with an intervening door closed) was opened or closed he looked in that direction. Once or twice he indicated that some one was at the door, but I told him, by signs, it was the elevator. Once he insisted that he heard the door-knob turn, and it was the door to the opposite apartment across the hall. He heard his mother’s step as she came down the long hall from the kitchen and stopped playing while he waited for her to come. A shrill whistle sounded in the neighborhood. He paid no attention to it until I reproduced the sound, when he laughed, waved his hand toward the window and took up the same tone.
Oct. 2Jt.?I found him in bed although it was early in the afternoon. He was playful but not so boisterous as the day before. Had two spells of yelling, but each time it was his usual call for his mother with variations. We played with the blocks. He gave more continuous and analytic effort at reproducing words than ever before, though there was little improvement in the result. Some of the words he tried were: hat, a; wing, in (nasal); bird, bu; four, pfo; bump, bum (nasal); papa, baba; train whistle, oo; something falling down, ooi (chest sound); two, oo; elephant, e; play, ba; five, va.
He likes to pretend he does not hear, looks away, and laughs. He tapped his lips, turned away and stopped his ear with his finger; then looked around laughing. I asked him if he wanted me to stop talking and he said “tin” (yes). I held my mouth shut with my hand, to his great amusement. Pretty soon he wanted me to talk and made every effort to-persuade me to remove my hand, but I pretended not to understand. He called his mother and indicated to her that I would tell what he wanted. I moved a little nearer to him and quick as a flash he snatched my hand awa3^ in great delight. He was in the front of a long apartment and heard his mother laughing quite down the hall in the dining room. He also heard her call him from the next room.
Oct. 25.?He was in the kitchen. Made some protest when his mother told him to come in, but forgot it when he saw me. Shook hands with a wide slap and hard squeeze.
The play was with the long blocks and the slate. I made an outline of the blocks on the slate and drew pictures of the different kinds of cars on them. The words wheel, steps, smoke, bell, window, man, play, slate, he tried without noticeable improvement. Instead of leaning toward me, as formerly, to hear better, he put his left arm around my shoulders and drew me nearer to his left ear, then turned his right ear to get the same word.
We practiced a little on elementary sounds like p, s, k, sh, as they were needed. He gave the g in goodbye, but faintly. He has a good understanding of what is required of him, but the muscles do not respond correctly. Sometimes he thought he had said the word when there was no resemblance to it. He did not yell so much. His tongue is improving in flexibility. Eyes have good expression and are under perfect control. Knees bend forward; not much improvement in arm movements.
Oct. 28.?We played dominos, but he was too unsettled from an outing he had had to give much connected speech effort. I did most of the talking, repeating a given expression in connection with the act:?as, “You take one,” “I take one,” “now,” “get it,” “my turn,” “your turn,” “sit down,” “count;” “one, two, three, four;” ‘’play;” etc.
I was talking to him about his pocketful of letters and he allowed me to use the tube. While we used it I whistled softly a little call. That pleased him and he put his mouth into shape, but no whistle came. He produced the same tone in a little shriek and laughed; then said something that sounded like “puppy,” but I had never heard him say it before.
Oct. 29.? J? opened the door for me and showed me that he had heard the bell,?repeated the word bell (“be”) after me. He was in fine spirits and ready to try anything. The tongue came well out in trying to say three; intelligent effort in four and five, but without appreciable improvement in the result.
We played train with the dominos and his notion was to have the cars run off the table into a box. This was utilized for too, “ch, ch,” bump (“bum”), down, under, out, get it. He turned one ear and then the other to catch the sound of words. We used the tube for some of them, especially get, and I placed his hand on my throat to feel the vibration. He wanted me to feel his throat while he did it. I whistled softly into the tube, but he did not try to imitate. He had one short shrieking spell, the first in several days.
He made the long blocks into trains and ran the cars off the table. He asked for the square blocks and, for the first time since our lessons began, he built one upon the other. Because his uncontrollable movements kept knocking them down he asked me to do it. I built something like a fireplace and chimney, then asked him what it was and he made his sign for Santa Claus. When he had enough of it, he used it for a target. The blocks would not go straight enough to knock it down, so he kicked the under side of the table till it fell.
He tried most of the old words. He came near crying when it was time for my departure, but was pacified when his mother told him I had to go and see another little boy. I told him I would come back tomorrow (he said “mo”). He shook hands and said “oo-by.”
Oct. 30.?His sister was practicing the violin when I arrived. The tones were hard and grating but I had her continue to see if he could hear it. He indicated that he did hear it and dismissed her and the violin from the room,?would none of them. My purpose was to have him get the soft tones through the tube. He had no patience with it. I was uncertain of the cause, whether it was that she does not make pleasing tones,?he always objects to her playing (?),?or he did not wish her to interrupt our game. This incident seemed to make an unpleasant beginning for our lesson. He was more easily ruffled than usual; gave up more quickly; and once, when I wanted him to practice a sound, he said his head hurt.
We played dominos. Instead of making his usual effort to say “Get it,” when one fell to the floor, he began to cry for it. I did not pick it up, and when he began to yell for his mother to get it for him I showed him how to call her by saying “Mama.” As soon as she handed him the domino he was all smiles again. I thought there might be an exultant feeling; but later, when a block fell, he made his usual effort to say “Get it.” He wished to play more than to talk. There was no particular advance in articulation. The tongue was flexible. The expression of his eyes was good but a little weary (he had not long been out of bed). He used the right hand more than usual, and the first fingers of both hands in grasping things (formerly his grasp has been with thumb and second finger). In extending the tongue it deflects slightly to the left. Oct. 31.?I found him playing with a collection of cinders which he indicated had been gathered on the roof. He showed me how high he had gone and how far he could see?tried to repeat high, roof, cinders, far, river, water, see. He heard some of these words through the tube, which he had been using to listen to a little whistling sound in the radiator. He tried to reproduce this sound. It was on a very high key.
We played with the dominos. J was interested in getting them equally divided between us and had me check off with paper and pencil the number each of us received. After he had counted his fourteen dominos and mine, and had seen the figures representing the numbers, he asked me to extend the figures to successively higher numbers. Then he wished to see the names of different people as he indicated them written by the side of these figures. This made a column of printed names which he extended to sixteen. These he repeated several times by imitation, though he sometimes objected to saying a word more than once. His articulation was not particularly clear on account of exaggerated throat activity. He extended his tongue when asked to do so. His expression was intelligent. For the first time, he heard the clock strike (a very soft, musical tone). It was two o’clock, and at the second stroke I called his attention to it. He heard it at once. To my surprise, the clock continued striking at least twelve times. He heard each stroke; laughed, pointed to the clock, then to his right ear which was toward the clock.
Nov. 1.?A very rainy day. J was glad to see me and tried to say rain, wet, water, He played violently for an hour with the long blocks?making them into a train and running them over the edge of the table into a box and later into a wire tray. This he emptied on the table with as much noise as possible, imitating the sound. He whistled for the train on a rather low-pitched tone, tried to say over when turning the blocks out of the tray, and horse when the blocks were drawn from under the tray through the doorway made by the open place in its rim.
So far as I know he has never voluntarily used the name of a thing, but makes the gesture for it accompanied by a general open sort of sound?nearly always u, or oo. A few times he has said aba. In this lesson he gave his usual yell for his mother, ending it with “mama” in a lower tone. When a block fell, he refused to say “get it” and picked it up himself rather than make the effort:?said it hurt his head (his usual excuse when he wishes to have his own way). I smiled and said, “James is a big boy to get it.”
For several days he has been very emotional, falling over on the couch when amused and crying when displeased; also more inclined to play than to make a serious effort at talking. He made some effort at most of the words, but the throaty action was prominent. Recognized most of the names on the list made in a previous lesson, as shown by signs, also tried to repeat the words. For sit down he said “ow” very well, twice.
He heard the clock again, after his attention was directed to it. He enjoyed the sound of a call bell which he tapped with a good deal of difficulty and with undue force. He wished me to ring the bell, which I did after the tried to say the two words. When luncheon was ready he heard the rather soft and indistinct sound of a little call bell in the dining room, some distance down the hall. lie looked up, reached for his bell and began to ring it. For several days he has shown signs of wilfulness and expects me to indulge him. This would probably disappear if lessons were given away from home, in more of a school atmosphere. At this point, for unforeseen reasons, the work was discontinued. This case is interesting from several view points. While the primary purpose was intellectual development (by means of speech, if possible; and speech was to be acquired by auditory means, if possible), the emotional and the physiological progress were equally marked.
The very first lesson was effective. In fact, the trial of the speaking tube in the factory, when he heard a sound for the first time, seemed the starting point for improvement. A new and inspiring experience had entered his consciousness, and this opened up a new avenue to information that the instinct of curiosity was not slow to appropriate.
He was too busy getting original impressions of real things, as well as an acquaintance with their auditory and oral representatives, to admit of training in symbols. Before he had heard the names of many things, I experimented with large print letters and he learned a few short words well enough to reproduce them with lettered blocks. All of the directions were given by signs and to him it was a game. He had no patience with anything like drill, or having the same words over, but wanted me to print the names of things lie chose, and among these were elephant, locomotive, automobile, fireengine, and the like. The method of applied or directive psychology soon gave place to a passive, sustaining psychology that provided the stimulating situation and then kept hands off as long as the spontaneous response tended toward wholesome development. This plan revealed the fact that he was in the intellectual stage of curiosity, imitation, dramatization, and pranks of all kinds; and toward the close of the period of treatment he showed a tendency toward teasing and wilfulness. He was very methodical in the arrangement and care of his possessions and held tenaciously to an idea. He learned to await his turn at a game of dominos, but he did not like to be the first out; he always borrowed from me, though not without getting my permission. It was not my purpose to return to the symbols until he had learned to use voluntarily the spoken names of objects. This he had not yet done beyond the one word mama a few times in a soft voice (his usual call for his mother was a loud, harsh cry). He readily repeated a number of words that were spoken to him, but when he wanted anything he used his own sign for it. Six weeks was evidently not long enough to replace the old habit of years’ standing.
In the care of this case I was especially fortunate in having the assistance and sympathetic co-operation of a physician of unusual personality and skill, and the development achieved in so short a time is doubtless due to this combined observation and treatment of both mind and body.
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