Two Feebleminded Maidens? A Clinical Lecture.1
- Author:
Lightner Witmer, Ph.D.,
University of Pennsylvania.
One Saturday morning in December, two girls were brought to the Psychological Clinic by their teacher, Miss Margaret Kemble, whose special class they had attended for four years. Jane was nearly sixteen; Ethel was fourteen and a half. Not related by blood, they were yet so much alike in mentality and behavior that they might well have passed for sisters. They had worked together and played together during these four years and were very congenial friends. This was Jane’s first visit to the Clinic. With her came her father’s sister whom she called mother and who had adopted Jane on the death of her real mother when she was only two weeks old. The father had died of tuberculosis when she was between two and three. There was very little in the history to throw light upon Jane’s mental condition. She was apparently a normal baby, healthy though very small; and gave no trouble. She was an only child, and her parents were of sound stock. The aunt reported that during her pregnancy, for reasons not known, the mother began to drink, and this affected her mind. All the relatives on both sides were said to be normal and there is no other case of feeblemindedness or intemperance known among them.
Jane was a little slow in learning to walk and talk, but not slower than a great many normal children. Her health was fairly good. She had measles, scarlet fever, whooping cough, and bronchitis. At present she has catarrh and her physician suspects adenoids, but she has been too nervous and excitable to endure a thorough examination of her throat.
She is very slow in everything she does. She is a rather agreeable companion, and gets on well with other children. She is particular about her appearance and has a certain taste in dress. Her aunt finds her a help with the housework.
Ethel had been here before, in November, 1910. Like Jane, she was an only child and appeared to be a normal baby, giving no trouble before she was two years old. On the mother’s side of the family there was a good deal of tuberculosis, but the mother herself was healthy. There was no feeblemindedness or insanity known among any of the relatives.
Ethel has always been irritable and emotional, and does not get on particularly well with other children. Her general health has been good since her tonsils and adenoids were removed by Dr George C. Stout in December, 1910. She still holds her mouth open, and her voice is nasal. The two girls were taken by Dr Witmer before the class in Clinical Psychology, and under his eye were put through the mental tests by two advanced graduate students, Mrs. Ide and Mr. Humpstone.
Jane used both hands in doing the Witmer formboard. Her fingers were thick and clumsy, and a slight tremor of the hands was apparent as the work progressed. On the first trial she placed all eleven blocks correctly in 32 sec., and in the same time on the third trial. On the second trial she spent 44 sec. and left the isosceles triangle lying upside down over its recess, a very significant error. Her shortest time of three trials with the formboard was 32 sec., and Dr Young1 found this to be the median for girls of 6 years and 9 months. The Witmer cylinders she was unable to place without instruction. At the end of 84 sec. she stopped with two cylinders still unplaced and only three right. Then Dr Witmer asked her,?”Does that look right? Try and find the place for them.” Jane hesitatingly removed one cylinder that was right. Dr Witmer continued,?”Now we will assume that she can’t do this. I am trying to get a little more standardization in our instructions. See, Jane, that sticks up too far. Try to find one that goes in there. That’s right, now go on.”
Jane stopped again with one unplaced. Dr Witmer said to her,?”You haven’t got them all in. Get them right, you haven’t got them right;” and then to the class, “I am trying to see how well she can do this, and with how little teaching. She quite overlooks the one that is not right, separated by one from its own socket. That probably indicates a very high threshold of discrimination, due to faulty analytic attention. She has gone by it time after time. Now I will tell her:
“That one’s wrong” (rattling it with one finger). “Don’t you see that’s too loose? Now get those right. You will notice a difference of one she let pass, but a difference of two she will not let pass; it sticks up too far. “That one isn’t in the right place, Jane. Don’t you see it’s too low? Try it in the right place. It’s right now. Now put the right one in that open hole.” Jane stopped with two cylinders interchanged. Dr Witmer contined to the class,?”She succeeded in getting all the blocks away with twelve to fifteen elements of instruction. I don’t know what we will call these. I want to standardize these elements of instruction before long. I only once put a block in position for her, but half a dozen times a block was pointed to and said to be wrong. Now we will take them all out again, and we will see whether she can do the thing after having done it once with the minimum amount of instruction necessary to get her to accomplish it.”
At the end of the second trial Jane stopped with one pair of large and one pair of small cylinders interchanged. Dr Witmer said,?”Look at them. Is that right?”
She corrected the two large cylinders, which differed by one, in 10 sec., then after looking at them for 20 sec. longer, she corrected the two smaller ones. Dr Witmer remarked,?”Miss Kemble says this slowness is very characteristic of Jane. There you see the mental process spread out over five to ten times the ordinary amount. What she did with those last two blocks, many children do in trying to remember the multiplication table, or some passage they have read or heard read.”
On the third trial Jane replaced all the cylinders without help in 4 min. 57 sec. Her performance in copying patterns with four design blocks was not significant, except that it showed her characteristic slowness and inability to recognize her own mistakes. In the third reader she read one word at a time and made a few careless mistakes. Afterwards she gave a faithful reproduction of the story she had just read.
1 young, H. H. The Witmer Formboard. The Psychological Clinic, X, 4, 93-111. Jane’s arithmetic was very uncertain. Miss Kemble had drilled her on the multiplication table as far as the seven-times. Nevertheless Jane said 4X4=44, 4X8=48; 5X10=50, but 10X5=15. She stared blankly when Mrs. Ide explained that 5X10 and 10X5 are the same thing. Even when she gave the correct answer to simple multiplications, she had to repeat the problem first, and sometimes went over the preceding stage in the table as well, showing that she depended entirely upon rote memory for her associations. Counting by twos to 20, she slapped 12 and 18. Attempting to count by threes she said, 3, 6, 8, 9, 10. She would not even try to count by tens.
Jane named the six colors, red, green, blue, yellow, white, and black when shown to her. Her auditory memory span was limited to four digits.
Sent to the blackboard, she wrote from dictation See The little boy, using a capital T for The. She wrote her name; then her birthday as Febrdy 27,1916, but corrected the year to 1901 when her aunt prompted her. Her hand seemed feeble, and the chalk marks on the board were very pale. She knew the date, said it slowly, and then wrote it. In writing easy words from dictation she made many careless mistakes, as “bage” for cage, “daink” for drink, and “bax” for box.
Jane knew it was morning, but could not tell why she knew it. The Healy Completion Test was an utter failure. No reasons were developed until after Mrs. Ide had made many suggestions. Then two or three correct placements were made.
While Jane was being tested by Mrs. Ide at one table, Ethel was tested at another table by Mr. Humpstone. With the Witmer formboard she did much worse than Jane. She used her left hand. Her fingers are long and she has fairly good coordination. In the first trial she put the circle over the square and the square over the circle; the star over the cross and the cross over the star; the diamond over the isosceles triangle; the hexagon over the semicircle. She placed the rectangle, ellipse, and equilateral triangle; laid the semicircle over the diamond, and the isosceles triangle over the hexagon. Then she corrected the circle and square, also the cross and star, and the semicircle, placing the hexagon over the diamond. She placed the isosceles triangle, and put the diamond over the hexagon, trying to force it into the hexagon and the hexagon into the diamond before correcting them. The whole time was 3 min. 36 sec., no final errors, and no instruction given.
On the second trial she confused the triangles with the hexagon and diamond, and corrected them by a method not much better than trial and error. She reduced her time to 2 min. 42 sec. On the third trial she made very few mistakes, and finished correctly in 60 sec. This was her shortest time, but was so long that there is nothing in Dr Young’s results with which to compare it. With the Witmer cylinders she placed the three largest correctly, then put a cylinder into a socket one size too large for it, and overlooked the mistake. After that she placed only four correctly and had one still unplaced at the end of 10 minutes, when she stopped as if unable to go further. Mr. Humpstone then gave instruction,?”Take out all the blocks that you think are wrong, and put them in the middle.”
Ethel removed the wrong placements, and one right one as well. Mr. Humpstone said,?”I will show you where they belong. See that? All right, you put them in where they belong.”
Ethel made several changes, and returned to the incorrect placements^ Mr. Humpstone suggested again,?”Take out all that are wrong.” Once more Ethel removed all but two wrong ones, which were left projecting. After many changes she had still three small cylinders wrong; then, after a great many more moves she corrected one of these. Mr. Humpstone observed, ?”They aren’t right yet. There are two that are wrong.”
She removed one right and two wrong ones, but succeeded finally in placing all three correctly, finishing the first trial in 17 min. 15 sec. The second trial proceeded largely by the method of trial and error. After placing all but one cylinder she stopped and took out the wrong placements, apparently remembering the instruction given in the previous trial. When she had all placed excepting four small cylinders, she corrected these by trial and error, even removing an adjacent correct placement to try a wrong cylinder in that socket. When she stopped she had two large cylinders interchanged. Mr Humpstone asked,?”How do you know when they are all right? How do you tell?” Ethel pointed at random to several correct ones. Mr. Humpstone continued,?”Now I will show you; those two are not right. No, that one’s all right, how do you know it’s right?”
Ethel did not answer, except by putting her hand upon the cylinder. She changed the two large ones that were wrong, and finished in a total of 8 minutes. On the third trial, at the end of 4 minutes she had only three correctly placed. Mr. Humpstone remarked,?”Now I will show you how to tell when it is right. Feel it with your finger” (illustrating with a vibrating movement of the finger on the end of the cylinder). “This one’s right, and this one’s right, and this one’s right, and the rest are not right. Put them back again and get them perfectly smooth.”
Ethel completed the test, but the time of this trial was not taken. On the fourth trial she stopped at the end of 4 minutes with two large cylinders wrong, separated by a difference of one. She was unable to correct them until after Mr. Humpstone asked,?”Which are wrong?”
Her performance with the design blocks was likewise much worse than Jane’s. In copying with four blocks the pattern having a red square placed diagonally in a white square, she first turned up the right surfaces and placed them at random in a square. After getting three out of the four positions right, she was told,?”You had it pretty nearly right; try again.”
She picked up a block in each hand and bumped them down against the table as if exasperated, but failed to correct her design, and had only one right position out of four when she stopped. Mr. Humpstone showed her how to put the pattern together block by block. Ethel separated her blocks, but put them together exactly as before, and kept turning her head to see what Jane was writing on the blackboard.
She named the six colors, red, green, blue, yellow, white, and black. She could not add two blocks and two blocks without counting. She counted listlessly, in a singsong, droning voice, with many mistakes, and smiled up at the examiner in a silly way.
In the second reader she read with such a nasal tone and poor articulation that she was almost unintelligible. She had to be prompted on words of six letters, like spread. Usually she omitted the final consonant,?reading “sa” for shall, “bone” for bones, “can” for can’t. After reading the fable of the ant who found three pieces of money while sweeping, and decided for various reasons not to buy fish, bread, peaches, com, or apples with it, but to buy a piece of red ribbon, Ethel’s reproduction was as follows,?
Q. What did you read about? A. Ant home, sweep, find some money, buy fish, ant buy. Q. Did she buy fish? A. Yeh. Q. What else did she buy, bread? A. Yeh. Q. And cake? A. Yeh. Q. And candy, did she buy candy? A. (Ethel shakes her head). Q. What else did she buy? A. Bread and cake. Q. And peaches? A. Yeh. Q. Did she buy tea? Any tea? A. (No answer).
Ethel’s auditory memory span, like Jane’s, was limited to four digits, but she did not get more than three digits right unless her attention was roused and held by the imperative tone of the examiner. In the first ten trials on four digits she succeeded only once, but later succeeded on several trials in succession. She repeated the digits in a droning voice. The mental examination being completed, and the girls dismissed, Dr Witmer proceeded to a discussion of these two cases:?
Ethel is fourteen and a half years of age. She came here first in November, 1910, six years ago, when she was only eight years old. She was brought then by her father and mother because she was backward. She started school at six years of age, and at eight years she had been three terms in the first grade. She was sent to us by a Philadelphia physician, a nose and throat specialist. I suppose she had been taken to him for that open mouth of hers. He must have recognized her condition and suggested that she be brought to us here. You see therefore that she has not wanted care. Ethel was seen at the Psychological Clinic by Dr Arthur Holmes, and no diagnosis was made, but it was planned to examine her again. For our own scientific satisfaction we ought to have made a diagnosis of this child when we first saw her six years ago, but we were loth to tell her parents.
Miss Kemble met Ethel four years ago, in December, 1912. In the meantime she had been in another special class since the fall of 1911. She had been in Miss Kemble’s class since September, 1912, when Miss Kemble took charge of it in December. Then she was very nervous, easily annoyed, irritable, and troublesome. She worried the other children, and didn’t seem to have mind enough to find her way home. At five o’clock when Miss Kemble came out of school, she would find Ethel standing leaning against a tree, and would take her home. When asked to read for people she either cries or laughs. Some days she just whines. If a strange teacher takes the class for a day, Ethel cries all day long. She was the worst case in a class of fifteen, excepting one child, a profound idiot, who did not work at all. At present Miss Kemble has eleven pupils.
In the four years she has given Ethel a great deal of time. On Thursday afternoon I was telling my class that a college instructor in English had tested his freshman class, and found that a large percentage of them could not read. The ability to read words in a second or third reader as Jane and Ethel did this morning) does not constitute the ability to read. A great many of our tests are being applied to supposedly normal people. I once tried the reading test on my class in aesthetics. I gave them a text book on aesthetics by Professor Santayana. Many of them could not read a single paragraph and there was not one of them who could read it all. There are a great many college students who cannot read psychology, and very few indeed can read philosophy.. The college instructor I have spoken of said that his students could not read a passage in a newspaper; he did not try them with difficult matter. That is what causes us to say that low grade imbeciles in Barr’s classification cannot learn to read and write. They cannot acquire reading and writing as tools which they can use in their further educational development. They can read and write in parrot fashion perhaps, but even a dog or a horse has been trained to spell. To my mind that is part of the very acceptable definition of a low grade imbecile in Barr’s classification, that he is a child who cannot read and write in the proper sense of the word. That is our criterion of low grade imbecility, and when I diagnose these two girls as low grade imbeciles, that is what I mean, that they never could have learned to read and write, and Miss Kemble has proved it in her efforts to teach them. She has got them along to the point where they are able to do a little reading and writing, but what good does it do them? None whatever. It is of no use to them, and never will be.
These two girls are very typical cases. I suppose they represent about the kind of material you get in a special class. They also represent the kind of material that should not be in a special class. Low grade imbeciles ought not to be in a special class. It is undeniable that the public school system makes at least a pretense of teaching reading and writing. In fact it is a fundamental aim of the public school system to teach reading and writing, and therefore these low grade imbeciles as defined from the standpoint of the public school are uneducable cases. The low grade imbecile is below the performance level of the literate. His condition is one of permanent illiteracy. That is what we mean when we say they cannot learn to read and write. If we put these children in Miss Kemble’s class, we ask her to teach to read and write, children who by diagnosis we have said cannot be taught to read and write. Here you have the impossible task of educating two uneducable children in a special class.
You may say, it is the function of the public schools to give instruction below the level of reading and writing. Of course, the public school does this in the kindergarten, but it does it theoretically as a preparation for reading and writing, not as a finality in and of itself. If you say it is the public school’s task to train children who will remain permanently below the reading and writing level, then I suppose it is the task of the public school to handle children of this type. That brings up the more general question as to what is needful in the training of children of this sort, and without going into detail we can say that institutional training is needful. From the appearance of these two girls they are pretty well cared for. Both have good homes. Jane is able to dress herself, even to arranging her hair and tying her own hair ribbon. She is very tidy about the house, and a good worker in keeping the schoolroom in order. Ethel is able to dress herself, too, and can be sent on errands to the store. This brings out another thing. It shows you why parents are reluctant to send girls to institutions: their behavior is so well conformed. The feeblemindedness of these two girls is in the intellectual sphere much more than in the sphere of general behavior, and it is only now, having reached maturity, that they are beginning to cause anxiety. Unless they are very carefully safeguarded, they will both get into trouble. They already show the characteristic sex reactions of the low grade imbecile. They are the type that makes advances, in the sense that their reactions are perfectly unrestrained. In an institution for feebleminded, the male attendants will never go into the female wards where there are custodial cases, because of the unrestrained sex behavior of the inmates. The feebleminded male is much more apt to be restrained in institutional life; or perhaps the ones who are decidedly unrestrained get into other institutions where they are under special confinement. In institutions for the feebleminded, they can allow women to manage the older boys without much trouble, but I don’t know any institution in which men do not consider it somewhat dangerous to go unattended into the women’s wards. Of course, it is not only what they might do but what they might say in the way of false statements, which adds to the danger.
While we are on the subject, I might as well tell you what I mean by the characteristic sex behavior of these two girls. I asked one of them to show me her hand, and I took her hand. She giggled, and the other one giggled, and she put her finger in her mouth and looked up sidelong,?a perfectly silly reaction. In some situations that would carry a train of consequences with it. Miss Kemble has to watch them closely because there are both boys and girls in the room, and Jane shows a tendency to be with the boys all the time, and her actions tend to be improper. Both these girls are capable of bearing children. There is an institution at Vineland exclusively for feebleminded women of child-bearing age. Jane’s aunt is a sensible woman and asked Miss Kemble where she could put her, as she feared that harm might come to her. They are in moderate circumstances, and could probably pay something for the girl’s care, but not a large amount.
These girls are physically of the type you see in institutions. They even smell feebleminded to my olfactory sense. I don’t know whether others are keen enough to notice that or not. But as soon as you get near either of them, you can tell it, and when you get a lot of them in a ward, you cannot help noticing it. Some of these children don’t have the odor, but some of them you can wash as much as you please, and hang their clothes out in the air all day long, and you can’t remove it. It is a very distinctive odor, which must accompany the secretions from the sweat glands.
There is another point to be considered. You can see perfectly well what these two girls are: there is not much question about them. The educational test has been made with them, and we know all the aspects of the case. The question is,?what ought we to do, what ought society to do, what ought the State to do? Of course we are agreed that the State ought to have enough institutions to care for all whom we can put in them. Some of my friends are trying to get laws on the statute books to compel mothers who will not place their children in institutions for the feebleminded, to do so by forcibly dragging the children away from them. I say to these friends,? what is the use of putting such laws on the statute books when we haven’t got enough institutions to hold the children whose parents are perfectly willing to put them there? Build an institution outside of Philadelphia to hold a thousand children, and it will be filled inside of three months. Why make compulsory laws to put children into institutions, when we haven’t the institutions in which to put them?
In the second place, we can speak of a further duty which society owes to itself, and that is to prevent these children having more children. There are only two ways to prevent it. One of them is permanent segregation in an institution. You may not know it, but I don’t think any children can be held permanently in this state. Of course, one of the elementary rights we have is the right of habeas corpus. At any time we ought to be able to employ that to review a case, but if a parent like this aunt, for instance, is willing and able to support this girl at home, then if you are not able to show that she is running the streets and visiting houses of ill repute, if you cannot prove against her immoral conduct and some kind of neglect on the part of the parents or guardians, I do not think you can keep the child away from her. Now society might step in here and say,?if this girl is well behaved in the home, assists in the housework, and is happier at home, as I think this girl is, she may stay there on one condition. If I were a relative of these people I doubt very much if I would want this girl sent to Spring City. I don’t like the looks of Spring City, and I don’t like Elwyn very much either. In certain cases, I recommend them as good places to send children, but here you have a girl nicely dressed and well cared for, getting on well at home where the surroundings are apparently agreeable.
Now the alternative for society is an operative ligature of the ovarian ducts,?castration. That is technically a major operation, because it means going into the abdominal cavity, but it is not a serious operation. In the male it is not even a major operation, and is very easily performed. If the State is unable to provide for the permanent custody of these children, and the family is unwilling to permit the State to make such provision and remove the children from the custody of the family, the State ought to step in and insist upon an operation. From the scientific point of view I think it ought to be done, and I urge upon parents to have such an operation performed. But science has not been very successful as yet in getting the community aroused to the point where this operation can be performed without the consent of the parents, and the question we have to consider at the present time is,?is it worth while to stir up the community? In cases like these two girls, is the community ready to have the operation performed against the wish of the parents? Both these girls you would say come of fairly good families, the kind of families which form the solid part of the electorate in this state, and of course what they say right away if you talk about putting such laws on the statute books is,?would we be willing to have it done to Jane or Ethel? They see the thing in a personal light and most probably in its application to some one case of this kind. I suppose everybody would decide this as a personal reaction. When you are putting this before the people of a community, you want to get them to act, and I think you are much more likely to get people to consent to an operation in cases of this kind than you are to consent to permanent segregation. In fact, I don’t quite see how you can make the segregation permanent. Sooner or later these people are going around until they find a judge who will let these girls out. Under our system of laws that is bound to happen. In New York State they commit feebleminded women until they are fifty years old, but they are frequently taken out on habeas corpus proceedings, or dismissed by a board of trustees. They will let out a case which threatens to give trouble, rather than have a test case come up before the Supreme Court and have the laws providing for commitment declared unconstitutional. In order to keep the laws in force, they have to let some cases go. Moreover, the girls often run away from institutions, and if the girls are difficult to manage they don’t try very hard to get them back. It is also difficult to keep men from hanging around the institutions and enticing girls away. In Washington I am told they commit for life with the consent of the parents,?once in they cannot get out, and a test case has never yet come up before the courts.
With regard to this operation, even if you could get it put on the statute books, as they have done in a few states in the middle west, the law cannot be enforced except in a very few cases. At the House of Detention here in Philadelphia, cases are not recommended for this operation. Even ordinary medical attention, such as removal of tonsils and adenoids, is not given without the consent of the parents. In Chicago the parents are compelled to sign a card giving consent if the child needs medical attention. In the case of institutional care, children are not sent by the Juvenile Court to institutions with the consent of the parents. The question is always as between custody by the parents and custody by some society like the Juvenile Aid or the S.P.C.C. The society in turn may commit a child to an institution. The only exception is the House of Refuge, which is a semi-penal institution, where children may be sent until they are twenty-one years of age. Certain facts having been ascertained, the Court, for the good of the child, removes him from the guardianship of his parents and places him in the guardianship of the State through the institution known as the House of Refuge. Then the managers of the House of Refuge place that child at Glen Mills, if he is a boy, and keep him there usually not more than two years, and then let him out on probation. They might keep him only six months, or only a day or an hour, if they chose, or they might keep him there until he is twenty-one years old. The technical form is that there is a change in guardianship, and not commitment to an institution; so that if an action to review the case should come up, as to whether the boy had been cruelly treated at the House of Refuge, and so on, it isn’t like the question as to whether the inmate of a prison had been cruelly treated, it is a question of guardianship. The House of Refuge is one guardian, and the other is the parent who has been deprived of his guardianship on account of certain facts.
That gives us the clue to the treatment of feeblemindedness. I believe the campaign that we should wage throughout the state is that the parent is not the proper guardian of children like these. That is the better way to proceed, rather than talk so much about the menace to society. In the case of such children, owing to the fact that the parents are not acquainted with the phenomena of feeblemindedness, they are unable to handle a feebleminded child. It is a necessary condition of the treatment of feebleminded persons, adult or infant, to be under the technical guardianship of the State. Then let the State decide whether the child should remain with its parents or not. Something like that has been achieved in Germany in the compulsory education act. A child must be getting an education somewhere, must be accounted for during the school-going period. If he goes to school, and it is discovered that he is feebleminded, the question then is, is he being educated? The State makes a demand on the parent,?is he being educated in some private institution, or has he got a private tutor at home? If not, he must go to an institution for feebleminded to be educated. There the State is the guardian of the education of the child and can come to any parent and ask that parent whether the child is really being educated. We might take hold of these children, these girls for instance when they are younger, these children in classes for backward children, and ask the public school,?does it make provision for these children? Adequate provision must be accompanied by custodial care. Therefore they ought to be in some sort of institution.
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