Wasted Effort
- Author:
Travis,
Recorder of the Psychological Clinic, University of Pennsylvania.
Standing on the scales at the Psychological Clinic a few months ago, straight and lithe, with her serene gaze on the autumn sky beyond the window, she might have been one of Botticelli’s darker angels. The master would have freed her from the dingy white cotton dress, too short for her thirteen years, and draped her in a flowered blue robe to conceal her sturdy legs. With a golden trumpet in her upraised hand he would have painted her above an altar, to praise God everlastingly. She seemed without blemish until she smiled. Then one saw that her teeth were oddly malformed by a congenital disease which had left her beauty otherwise unspoiled. She bore the name of Italy’s queen dowager, Margarita1, yet when the examiner asked her to write it for him, she shocked his sense of the appropriate by writing Maggie in a sprawling hand. Maggie Fresco she is called at school. When the children want to tease her, they call her “cock-eye,”,because at moments one of her lovely eyes turns inward ever so little. She has been given glasses to relieve the strain on her eye muscles, but false pride, or mere indifference, keeps her from wearing them. She is as large as the average girl of fourteen, by far the largest child in her class, where she seems discouraged by her failure to keep up with girls of her size. She is fond of little children, and finds charming motherly ways of helping them, but they do not like her because they cannot trust her. She is a telltale, and runs to the teacher with every little story. Although she has improved marvelously in looks, Margarita’s mental development has been slight during the four years and a half since she first appeared at the Psychological Clinic in 1912, Then she was shy and apathetic. On the way to the University she hung back and had hardly a word to say to the agent of the Society for Organizing Charity, who was escorting her. In the warmth of the examiner’s genial smile she thawed out a little and became more communicative. Eight years and two months old, she tested at a little over five years on the Binet-Simon scale. A month later, when somewhat better acquainted with the Clinic staff, she passed all thr six year and one or two of the seven year tests. Her vocabulary in Italian as well as in English was very limited. She had been attending regularly a special class for foreign children, and had not 1 The names are all fictitious, but chosen to give as nearly as possible the same impression as the originals. learned to read and write. She could add 2 and 2, 3 and 3, and 3 and 2, but there her arithmetic stopped short; 4 and 4 she said made 7. She knew she had five fingers on one hand and five on the other, but said that on both together she had eight. She matched colors but could not name them, even in Italian. When the examiner took up two blocks in his hand, showed them to her for a moment, and closed his hand over them, she could tell there had been two. When he showed her three in the same way, she could not tell how many he had.
At this time it was observed that her appearance was good, considering her physical handicaps. She was a little large for her age, and stood leaning slightly to the left, her left shoulder drooping. Her hair was abundant, long and silky, though far from clean. Then as now her eyes were large, dark, and well set; her nostrils were small and delicately formed; so were her ears and mouth. Even then her clear olive skin and red cheeks were worth noticing, and her nutrition and circulation were good. Among her drawbacks were the malformed teeth and a box-shaped cranium, whose outline Was disguised by her hair. Her throat was in bad condition. The examining psychologist deferred his diagnosis with the expectation that her mental status would improve greatly when some of her physical handicaps were removed. He recommended a nose and throat examination, an eye examination, and a Wassermann test, physical treatment to be followed by six weeks of training in the special class conducted by the Department of Psychology during the summer session.
Through the social service department of the Clinic the cooperation of the public school was secured, and there were interviews with several other social workers and physicians who had exerted themselves in behalf of Margarita’s family. With one exception, they all pronounced Signora Fresco lazy, shiftless, and incompetent to look after her children. That one exception was a rather inexperienced young person who thought her an exemplary mother and housewife. The family were living in a wretched tenement, huddled m two small rooms that were dirty and dishevelled. The mother was complaining constantly of her children, and appealing for aid to one charitable agency after another. At one hospital Margarita had been given treatment for chorea and sent to recuperate at a seashore home, where she gained ten pounds. The physicians who treated her there apparently did not suspect that she had congenital syphilis.
With the cooperation of the S.O.C., money was raised to pay Margarita’s board in West Philadelphia during the six weeks of the summer session, and the teachers in her public school presented her with an outfit of underclothes. Toward the end of May she was brought again to the Clinic, where a physician in attendance diagnosed adenoids and enlarged tonsils, and took.a specimen of blood for a Wassermann test. A week later the Wassermann reaction was reported positive, and she entered the Woman’s Hospital for mercurial treatment and removal of tonsils and adenoids. Her eyes were also refracted at this time.
On the first of July, 1912, a much improved Margarita came to live in West Philadelphia. She was still a good deal of a savage, not easy to break in to the ways of a civilized household. Her caretaker reported that she was disobedient and sly, and sometimes made trouble among the other children. After three weeks an eruption was noticed on her body. The physician at the skin dispensary of the University Hospital said that while the breaking out in one or two places might be due to her disease, the real trouble was pediculosis. He prescribed a lotion for her hair, and advised that her clothing be separately boiled before being thrown in with the family wash.
At the end of the summer session Dr Lightner Witmer held a consultation over Margarita, with the two teachers who had had her in charge for six weeks. Her behavior, the}’” said, was typical of the little guttersnipe that she was. Without being really afraid of anything, she was very self-conscious and shy, but she paid no particular attention to the boys in the class. Of all the children, she was the most troublesome. She could not carry out simple commands, and was always wanting to do something else than the thing she had in hand at the moment. Her analytic concentration and distributive attention were very poor, so was her persistent attention for school work. In teasing she was persistent enough. When she wished to attract the notice of a teacher or classmate, she struck her first and spoke afterward. If the person thus addressed did not turn at once, she thumped her again. Her memory was slightly trainable, but not retentive. Her idea complexes were very deficient. She was careless and unreliable in doing her share of the dish-washing and cleaning up. Music was the only thing she loved. She could not read; could count to ten, but made frequent mistakes in counting objects.
Dr Witmer’s diagnosis, based upon the teachers’ reports and upon his own daily observation of the little girl was,?low grade imbecile, an institutional case. Margarita was returned to her family, and an application made out for her admission to a training school for feebleminded children. Her mother would not consent to let her go, so that plan had to be postponed, and in the fall she re-entered the special class in the public school. The teacher’s report on her work a year and a half later was that she was lazy and phlegmatic, not at all nervous. She worked only when scolded, and when praised she rested on her laurels and did nothing. All of her school work was of poor quality and meagre quantity.
Another year later a social worker who went to visit the family, found the tenement house where they had lived, but they had moved away and no one knew anything about them. Margarita was traced through the school, and finally in October of 1916, as we have seen, she was brought back to the Clinic with her mother by an agent of the S.O.C. She was now under somewhat irregular and intermittent treatment for rheumatism at a hospital in her home neighborhood. Whenever she felt ill, she went to the dispensary and they gave her some medicine. Just then she seemed to be in good health. Her manners were vastly improved, and she gave promise of becoming a very attractive (though feebleminded and dependent) young woman. In all the concrete tests Margarita did very well. She did the Witmer formboard in 35 sec.; the Witmer cylinders on the first trial in 225 sec., and on the second trial in 79 sec. with only two false moves. She copied four-block patterns with the design blocks very well indeed, but it must be remembered that she had had practice with these in school. Nevertheless, her performance was equally good with Healy construction puzzles A and B, which she had certainly not seen before. The smaller puzzle she did in 82 sec., and the larger one in 52 sec. In the latter problem her method of solution was particularly good. Her progress in school subjects in the past six years has been small. She can write her name and the date, and can. recognize a few words on a printed page. She does not read in the sense of reading as a means of getting information. Numbers mean little to her. She has not learned how to carry in multiplying, and she cannot even add; 24 -f 13 she put down as = 107; 27 -f 18 = 18. She can spell a few short words, like tree, baby, hope, and three, but nest she spells n-i-s-s-t; school is s-h-o-o-1, and she cannot spell teacher at all. Her auditory memory span is easily five digits, and she succeeded twice out of five trials in repeating a series of six digits. On the basis of this examination Dr Francis N. Maxfield confirmed the previous diagnosis, with the observation that she might possibly be classed now as a middle grade imbecile. Margarita is the eldest child of Signora Fresco by her second marriage. The mother is a character who has interested everybody concerned with the history of Margarita. Born near Naples, the daughter of a musician, Angela Fresco holds herself a little above the laboring people among whom fate has thrown her. Of her first husband she has nothing to say, beyond the jbare mention of his name. When tuberculosis took him and left her a widow with a baby son, she promptly married Feliziano Fresco, a longshoreman, who like herself came from Naples and was alone in the new world with a little boy to look after. This little boy has turned out badly, and been sent to a reformatory. Her own son has developed the disease which killed his father, and is too sickly to hold a steady job or make a good living.
By her second husband Signora Fresco has had five children, all born in America. Margarita, the eldest, we already know. Angelina, the youngest, died of pneumonia. Between them came two boys who are going to school and seem to be getting on well enough, and another child who died of kidney disease. Signora Fresco complains of her delicate health, but one suspects her health is better than she imagines. When she came with Margarita to the Clinic last fall, she had a good color and appeared well nourished and tastefully dressed. Her youthful brightness is amazing to those who remember that she is forty-two, and who know how early these Italian women begin to fade. How has she done it? Not by spending her strength in the care of her home and her babies. She has neglected them as much as she dared, and has leaned heavily on them as they grew big enough to be helpful. Margarita now does all the rough housework under direction, and her usefulness to her lazy mother is making it very difficult to get the parents to consent to place her in an institution, where she could have the training and protection she needs.
Margarita will never be capable of looking after herself, or having a heme of her own. It is not certain that all her children would be born feebleminded, if she happened to marry a man of sound stock, but they would be so badly disciplined and so poorly nourished that they would not have half a chance in the world. At thirteen she is in the third grade with children of eight and nine. Among 1375 girls whom Dr H. H. Young tested with the Witmer formboard, he found 78 who did it as slowly as Margarita?in 35 sec. or more? but they were all younger, the mode for this time being about six years. At Margarita’s age girls do the formboard in from 9 to 29 sec. Her performance in doing the Witmer cylinders in 79 sec. with only two false moves was remarkably good. During the last four years before entering her present grade, she was in a special class and had the devoted attention of one of the best teachers in the city. The effort whioh has been made to educate her has confirmed the opinion given by Dr Witmer in 1912, that she is trainable in many sorts of handwork, but is not educable beyond definite limits which have already been reached.
When she came for her first examination in April, 1912, she had been under the eye of the Society for Organizing Charity for about two years. She was referred to them by a magistrate before whom she appeared as plaintiff when only six years old. The defendant, who was convicted of attacking the child, was said to be a boarder with the family. He was sent to prison for a term of years, and Margarita was placed in the Philadelphia Hospital for treatment. Several physicians who saw her about that time ascribed her dulness and apathy to the effect of shock. It would appear now that from babyhood she had been so dull that she was incapable of being severely shocked, and that this experience had no appreciable effect upon her.
A social worker from the Psychological Clinic visited Margarita’s school last November and had a talk with her teacher. She is the largest child in the room, and her desk is entirely too small for her. She sits quietly dreaming most of the time, with her head on her hand. She does best in the simple operations of arithmetic and in geography, where she can commit to memory by many repetitions the brief facts which are sufficient to get her through. It is in spelling and reading that Margarita is weakest?not as one might think, because Italian is her native tongue, but because she makes nonsensical mistakes and cannot see why she is wrong. On the day the social worker visited the class, ten words were dictated as a spelling lesson. They were supposed to have been studied at home. The four most difficult words of the ten, Margarita spelled correctly; five easier words were spelled wrong, and one very easy word was left out completely. The dictated sentence, “We must study our notes,” was written by her, “We must hame are noter.” Her young teacher is to be ranked with the few who have been favorably impressed by Margarita’s plausible mother. She said Signora Fresco was a fine woman, and did as well as could be expected with the means at her disposal.
In January of this year the same social worker visited Margarita’s new home, and found that the girl was in a hospital undergoing treatment for rheumatism. While in the hospital she has good food and care, but when she returns home she quickly falls ill again, because her mother cannot provide the right kind of food and is incompetent to give her the care she requires. The father was temporarily out of work, as there was no ship to be unloaded that week, and the only wage earner for the time being was the consumptive son, aged seventeen, who was working in a tailor shop. He made five dollars a week, spent $1.20, a week for carfare and lunch, and gave the rest to his mother. He eats very little, she explained, coughs a great deal and neglects to take his medicine, because, as he says, he doesn’t care whether he dies soon or a little later. Though he pretends to have no fear of death, he has so much fear of losing his job that he will not take the doctor’s advice to give up his indoor work and try to get something to do out of doors.
The father and the two younger boys were all having bronchitis but were not in bed. Feliziano was out, and the little boys were playing in the kitchen. Signora Fresco herself was under dispensary treatment for various chronic minor ailments. She looked well and strong, but complained of bad headaches, and while talking to the social worker had to pause for breath every few minutes. Her little four-room house is in excellent repair, very clean, and sufficiently furnished. It is above the ordinary for an Italian family of their means and antecedents. The cooking range is exceptionally good, but it would seem that Signora Fresco does not make competent use of her resources for nourishing her family. The chief thing lacking, beside money of course, is a degree of energetic good management on the part of the housewife. The clothing of the family is substantial and of good quality. It is in the vital matter of food that they are poorly cared for.
A few years ago it was somewhat the fashion among social welfare workers to think that if all of a child’s physical defects ? of eyes, ears, teeth, posture, breathing, and digestion?could be remedied, that child was bound to get on all right in school ever after. Some even went so far as to imagine that a feebleminded child could be transformed into a normal citizen by removing his physical handicaps. Now we know that with an occasional exception so rare that the rule is all the stronger, once feebleminded means always feebleminded. Dr Witmer defines the feebleminded as those individuals who cannot maintain themselves in society without supervision, who cannot earn a living, marry, and take care of their families. Margarita could probably become almost self-supporting in an institution, where she could scrub, fold linen, or help the cook prepare vegetables and wash dishes. Surely she would be happier in an institution with companions of her own age and mental calibre, than in a schoolroom where she is conscious of being a misfit, or in a home where she is constantly falling back into a state of ill-health requiring hospital treatment. What is more she needs watching, and her mother has proved incompetent for the task.
Margarita is an impressive type of wasted human material and wasted educational effort as well. There are no less than three potent factors operating to spoil her life. Any one of the three in itself is almost incurable. Working together they form a vicious circle from which society is helpless to rescue her. First there is the congenital syphilis. Whether or not this is the sole cause of her feeblemindedness, no one can say. Certainly there are many feebleminded persons who are not syphilitic, and some congenital syphilitics who are not feebleminded. We can only say that both grave misfortunes have fallen upon this girl.
In the third place there is her miserable environment, and in that we have to include the depressing influence of the members of her family, as well as the economic stringency, the cramped quarters, bad air, and inadequate food. Even a well-born child might go under in such a setting.
Society may well ask itself, is there no way of saving a child like Margarita, pleasing to look upon, and capable of hard work willingly performed? One can only answer that all the ways have not yet been tried, all the experiments have not yet been made. There is evidence going to show that the history of a child in the first year or two, its nurture and discipline, may determine whether the individual is to be socially competent or incompetent in adult life. In Margarita’s case it is too late to experiment further. Experimenting costs much money, and no philanthropist has yet arisen to give a sum of money large enough to make a fair trial over a term years of the measures which have been proposed. If society really wants to conserve its human resources before they become liabilities, and is not ready to attack the whole problem of poverty, it may begin by taking handsome babies like Margarita out of their unfavorable environment at a very early age, and giving them a hygienic life, with prompt medical treatment, discipline, and wholesome food. Then perhaps we shall not have to maintain so many custodial institutions for wrecks who are past saving.
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