Clinic Report. XIII
Deborah was brought to the Clinic at the age of 13 years 1 month by two social workers because of backwardness in school subjects, especially arithmetic. Her appearance immediately suggested insufficient nourishment, which the principal of her school gave as the cause of her backwardness He thought it unwise to place her in a special class as he said that she was behind her grade in only one subject.
In height Deborah is below the mean for a girl of 12 and her weight is only the mean for a girl of 11 years; her head girth is the mean for a child of 8. She is the oldest of five living children. Both the father and mother drank, and in the few months before Deborah’s birth, the man was out of work and the mother did not have proper food. There was nothing unusual about her birth or childhood. For three months the mother gave her “Mother’s Comfort.” They then refused to sell it at the store, saying that it contained a drug.
The mother said that she walked, talked, and cut her teeth as soon as the other children, but she could not give the dates. She showed a photograph of a plump little girl of about three years to prove that Deborah was a healthy child, although she said she recognized now that she was different from the other children, and she thought that her own drinking and lack of food during pregnancy, or the medicine which she gave to her might have caused it. The only differences that she could describe were absent-mindedness and inability to learn arithmetic. An old gentleman, a friend of the family, would teach her numbers at night and in the morning she had forgotten them. She was proud of Deborah’s ability to read and she said that she read her Bible a great deal and loved to go to Church and Sunday School. None of the children were allowed to play with the neighborhood children as the mother felt that they were bad and rough. A social worker reported that Deborah did a great deal of housework and the stories which her mother told to illustrate her absent-mindedness corroborated this. The child’s present health is good although she tires easily. Dr Rhein diagnosed the case as anemia and gave her a tonic. She has had only measles and whooping cough, no accidents or operations, and she has not yet menstruated. Her eyes are refracted and the eye defect has been pronounced serious. Deborah began school at 7 years, 9 months. She was one term each in 1A and IB; three terms in 2A when she changed schools twice; two terms in each of the other grades to 4B to which she was promoted in February of this year. The teacher in whose grade she was for a year, said that she was very good in all her subjects but arithmetic. She could reproduce what she read if she wrote it out. She was nervous and might not always do well if she had to tell the story. She thought it too bad to keep her back because of the one study and had promoted her. She said that many other children were as bad in arithmetic as Deborah.
Her present teacher has had her only since February 1st. She was surprised to find that she could remember nothing of a geography lesson that she had just been studying. The day before she had missed 7 of the 15 words in spelling. In language and reading her last standing was 8 but in the other subjects she barely passed and in arithmetic she stood at 5. Deborah acknowledged that she knew nothing about fractions which she was studying. In reproducing the Legend of St. Valentine she failed, although she could answer some questions about it. In writing she was the only child who misunderstood the teacher s order to hold her pen-holder upside down, and the day before she had evidently made the circles with the pen in that position when they were expected to make them with the pen-point. There were only two others in the class whose writing lesson showed as little understanding of the teacher’s orders as Deborah s did. The teacher had just come from a class of backward children and the children in 4B seemed very bright to her with the exception of Deborah who, however, did not seem to her feebleminded. She thought that she was very suggestible. The day before she had denied having anything in her mouth, but when told to take what she was eating out of her mouth and put it into the scrap basket, she immediately did so. She is usually obedient in school, likes her teacher and the school, does not have difficulty in getting along with other children and her teachers like her. A social worker who took her to a summer hotel several years ago, found her most adaptable. Her home is in a poor neighborhood in a three story brick house out of repair. Tfce mother is not a good housekeeper, acknowledges that her busband has to do the baking for the week on Sunday and that she cannot cook well. She usually has one thing for a meal, as potatoes or cornmeal mush, but the first are so high now that she is not buying them. Deborah does not like cornmeal and eats bread and molasses with tea, as she does not like milk. She is very fond of ham when she can get it. A neighbor made some tomato soup which the child enjoyed. The mother had never heard of putting milk into tomato soup. She was willing to have someone teach her how to cook, and seemed pleased that a teacher in a nearby settlement house would give her lessons.
The family owe nearly a hundred dollars. Most of the debt was contracted when the man was drinking, but about $15 is due on furniture recently bought. His earnings are from $15 to $18 a week and he tries to pay from $3 to $5 on his loans. Three years ago he was persuaded to give up drinking and unite with the Church. He goes regularly, belongs to a Bible Class and to the Men’s Club which meets Monday evenings. He is 46 years old, a machine repairer, has had & high school education and might get better work, but his employer has been very kind to them, loaning them money for coal in the middle of the week and not taking the full amount out of the man’s wages at the end of the week if he could not spare it, so he does not want to leave him.
The woman was in the third grade at thirteen when she ran away from home because her parents were strict with her. She got work in a factory. Although her husband was drunk when she first met him, he was kind to her and gave her good advice and she was lonely, so at seventeen years she was married. She had him bring the beer home and drank with him until seven years ago. Just before her first child was born, her husband was drinking harder than ever and not working, so that she was hungry and followed him around to the saloons. Her mother, to whom she had become reconciled, died and she felt the loss. This eldest child was recently examined at the Polyclinic Hospital and her Binet age was given as 1 year. The principal of the school says that she can learn nothing. There are three other children, 8, 6 and 3 years, all bright looking and well nourished. The two older ones are in school and are respectively in the 3B and 2A grades. The woman said that she had had about ten miscarriages. She is now 34 years old and is not well. As she seemed very suggestible and uncertain about dates, one could not be sure of the accuracy of her statements. She could tell of no relatives who were diseased or mentally deficient.
Deborah’s mental examination showed more than backwardness in arithmetic. In the formboard her median time was longer than that of a girl 6 years old and the performance was qualitatively poor; she failed in the cylinder test and the Healy puzzle A and had to be prompted in the design blocks. Her memory span was 6 digits and her Binet age 8.7 years.
The diagnosis was not higher than middle grade imbecile, Barr classification, and she will eventually need institutional care. In studying the cause of Deborah’s mental condition, one’s first impulse is to attribute it to the alcoholic condition of both the father and mother, especially as the sister is also feebleminded and born during the period when the mother was drinking. After she gave up liquor, there were three children born who seem to be normal.
Four other interesting alcholic cases have recently come to the attention of the Clinic. They are as follows:
2. J. H., 7 years, 8 months old, tentatively diagnosed as middle grade imbecile (Barr) has a father who drank just before he was born and his mother said that she did not get enough to eat when she was pregnant. The father’s father died of alcoholism. Other significant facts are that the boy’s paternal grandmother, after being a nervous invalid for 8 years, died of specific paralysis; that the father of the boy left school at 14 years, and his sister said he was always bad.
3. M. M., 11 years, 4 months old, diagnosed as probably a middle grade imbecile (Barr), has a mother who was so drunk when a visit was made at the home to get information about the family, that she went to sleep while the visitor was there. Fourteen beer bottles on the table would indicate that others in the family drank as well as the mother, but no information could be obtained about the family history.
4. M. D., 13 years, 8 months old, whose school record showed 5 years of school retardation, has a mother who was drinking before Margaret was born and is so constantly under the influence of liquor now that it is impossible to persuade her to do anything for the good of the child. A significant fact in Margaret’s history is a positive Wasserman test.
5. J. M., 18 years old, brought to the Clinic because of his criminal tendencies, has a father who has been drinking for the past 14 years. At that time the man was threatened with tuberculosis. Three brothers have died of the same disease and one is now at Mt. Alto.
With these five cases as a text one might preach an excellent temperance sermon, showing how alcohol injured the germplasm of the child, leaving its mark upon the brain. But in each case, where the family history could be obtained, there were other factors that have been assigned by psychologists as causes of mental deficiency. In the first there was the mental condition of the mother which might have made the case one of heredity, or the insufficient nourishment of the mother might have affected the germ plasm* or the mental condition might have been inherited from the father, but so little is known of his history that no statement can be made. There is simply the significance of the age at which he left school.
The same may be said in the third case. In that it is not even known when the mother began to drink. In the fourth case the presence of syphilis might be as definitely a cause as alcoholism.
The last history shows the necessity of learning the age of the parents when they began to drink, for the boy was four years old before the father used liquor, * In the second case there was also given a history of insufficient nourishment of the mother. so that alcoholic inheritance could not have caused his non-conformed behavior, although both the father’s alcoholism and the boy’s behavior might have been due to the same inherited tendency.
These cases would indicate very conclusively that, before alcohol can be given as a cause of mental deficiency, proof must be offered that it is the only factor in the case. Anna B. Pratt, M.A, Graduate Student. XIV. Judith was brought to the Clinic by the woman with whom she is now living, at the suggestion of the Social Service Department of the University Hospital, mental deficiency being suspected.
We have only partial knowledge of the family history, but we know that the mother died six years ago of tuberculosis after which the father ceased to support the family. Just why the home was broken up we do not know, but it is thought that the father was alcoholic and had little interest in the children. He has, however, again obtained control of an older sister who has reached the working age, and he has given indication of wanting control of Judith as soon as she can go to work. We are told that both this sister and an older brother appear dull and failed to go beyond the fourth grade in school.
Judith is fifteen years and two months of age, but does not look more than twelve. Her physical retardation is from two to three years and the physiological retardation is as great. She is still in the preadolescent period. She has the mobile features and far-away look so commonly found in cases of feeblemindedness. She has been under treatment for enuresis, from which her sister has also suffered.
The pedagogical history is badly confused. There was probably some school attendance before the sickness of the mother, but before she came to her Present home in 1912 there is no evidence of any progress. During the next three years she made good progress but was then sent to a Catholic Home because of the illness of her benefactress. From that time until the present school year she did not attend regularly. She was placed with a family about a year ago, but ran away one rainy winter night and came to her present home, some twelve blocks away. She gives as a reason for this that the other woman drank and abused her, which may have been true, though the abuse seemed to be confined to language. Since then she has been sent to a Catholic school, where her work has been unsatisfactory. She wants to leave school and gives the usual excuse, that she does not like her teacher. She is now in the fifth B grade.
Being of a pleasant disposition, Judith does not give a great deal of trouble and gets along quite well with the other children at school and at home, there being three younger girls in the home in which she now lives. She plays but little, often standing around merely looking on when the others are at their games, and even when she does take part, her actions are not normal. She plays at such times very violently and breaks into harsh, uncontrollable laughter. Little is asked of her in the nature of household duties and even these she cannot perform without repeated instruction and constant oversight. She takes very little interest in her personal appearance, combing her hair only when told^to and giving no attention to her clothing. What has given the most concern in the home has been the periods of stubbornness of a depressed kind, which ari from slight causes and last for hours, during which she is said to look like arise a totally different child.” The description of these may have been overdrawn, as is not uncommonly done in the attempt to justify bringing a child to the Clinic. They do not seem unlike the spells of stubbornness frequently found in children of low mental status, ,but it would be well to watch for evidences of insanity.
The mental examination of Judith gave us less than we might have desired. The cylinder test, the design blocks, the Healy completion and similar tests gave fair results, though none were above the normal for thirteen years. The Binet tests (Stanford revision) gave a rating of ten years, eleven months, or an intelligence quotient of .72, which is rather significant. She fatigued quickly, showed a slow rate of movement, though with good control and coordination. Several times when concentration was demanded of her, she stopped completely, remained looking at the task with no response of any land despite continued urging, then would suddenly break out with some childish response, as when looking at a picture for some time she said, “George Washington is going to leave her and she is crying,” or again when she retraced her steps about the entire field in the ball and field test after an interval of several minutes during which she had not moved her pencil.
Upon a basis of the history, modified by the mental examination, a diagnosis of high grade imbecile (Barr classification) was made. It is probable that under pressure Judith will be able to do housework, with a certain amount of guidance, but owing to an unfavorable disposition toward work, she may prove incapable of supporting herself. We would not recommend her for institutional care because of the fact that she would be displacing others who could not be cared for outside. XV. This case illustrates the abnormalities of conduct to be found in cases of hydrocephaly.
Moses is a colored boy of eight years and eight months, who was brought to the clinic by his mother and teacher because of his bad behavior and his inability to make progress.
The parents are a particularly high grade of colored people, of excellent habits and able to give the boy a good home and the proper kind of care. This boy is the fourth child; the first and third died following injuries at birth. All the births were instrumental. He had an injury to his head at that time, the mark of which still remains in the form of a lump. He was born at three weeks overtime.
Up to one year he was nursed, walked and talked at normal time and showed then no abnormalities. From the age of one year up to five, he was under the supervision of physicians because of stomach trouble, indigestion. The mother gave close attention to his diet and in time this was overcome. His physical history has been otherwise negative.
His pedagogical history has given more evidence. He was in the first grade A class for two terms but has since been passed each time, and this fall he entered the second grade B class. Last spring it was found necessary to send him to a backward class, but after he had been there a week without the knowledge of his mother, he was removed because she objected to keeping him where she considered his associates to be very bad. A truant school is in the same building and the children from the two groups intermingle. At present he is not making satisfactory progress at school. He works well at manual work, basket making, etc., but does not study at all.
In the mental examination, Moses presents the type of results commonly found among negroes. The formboard, cylinder test and design blocks are handled very well, his performances being above the mean for his age. In the Binet tests, he is found to rank at seven years, two months, with an intelligence quotient of .83. His best performances are on such tests as the drawing of the diamond, the ball and field, and patience. On the more abstract questions, he completely fails, such as the definitions, similarities and making change without coins. The mental examination may be said to show his intelligence to e normal.
The abnormalities are to be found in his behavior. The mother has no complaint to make of him in the home, except that he is cruel to his younger sister. He is honest, carrying the clothes for her and returning with the money, running other errands promptly and correctly. She has followed him in order to discover whether he does anything that he should not when sent on errands, and has seen nothing. No trouble is experienced with him on the way to or from school, but when once there he causes trouble for the teachers and disturbs the classes by going anywhere he wishes without permission, kicking and pinching other children, talking aloud when he should be studying, and doing numerous other petty things. Yet these seem to be done in no spirit of meanness, for he is surprised when reproved, and immediately breaks into tears. His own account of some of these things seems to indicate that he is merely playing and has no desire to hurt, but he wants to do something other than study, for he does not like his books. So much of tliis has occurred that the teachers feel they cannot bear his presence longer.
His bodily development is at least in the maximum group of the tenth year. His head has a girth of over 55 cm., greater than the maximum for the sixteenth year. His face is not as large proportionately as his skull, and the upper part of the forehead protrudes slightly. The mouth hangs open.
The diagnosis of this case is hydrocephaly, coupled with an overdevelopment of the body. His acts are particularly objected to, because they are those of a seven year old boy with the bodily force of an eleven year old. To this disproportion is due the seriousness of his playful acts. His general attitude, his restlessness under restraint and his lack of inhibition are due to the hydrocephalic condition.
The recommendation was made that Moses be placed in a special class, where he could have the supervision that is needed and where his actions are less likely to cause disturbance than in a crowded school room. There he may be given work of a kind to occupy his mind and he will gain more than he would do in the ordinary class room. As the mother objects to placing him in the particular backward class in her district, it may be necessary for them to move to a part of the city where a satisfactory school can be found. Franklin C. Paschal, M.A. Harrison Fellow in Psychology.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.