The Hygiene of the School Child
- Author:
BLewis M. Terman
Reviews and Abstracts. Published by George G. Harrap and Co. Price 10s. Gd. net.
This book is stated to be published for the use of teachers and those training for this profession, but a careful perusal of it demonstrates quite clearly that school medical officers, health visitors and others will find in it a real storehouse of knowledge. The author has spared no pains in delving deeply into a perfect mass of literature in order to unearth facts and opinions as may be seen by the voluminous bibliography appended to each chapter. From each of these well-chosen sources he has extracted the kernel of the matter in question with a logical and accurate appreciation amounting almost to uncanny insight and in this small volume of about 400 pages he has condensed and marshalled his findings in extremely well-reasoned sequence.
The book is a veritable thesaurus of wellgleaned material.
Some few sentences will indicate the aptness of the author’s conclusions. ‘ ‘Thinking, biologically speaking, is never its own end but a means towards adaptation, which is essentially motor.” “Whatever else play may mean, Aristotle’s conception of it as a catharsis is essentially correct.’’ “Nervousness, as some one has said, is not one disorder but a whole cohort.’’ ‘ ‘Sanity is a relative term,?Mental balance is the exception, not the rule.”
The several chapters on mental hygiene besides being essentially sound and wellbalanced shew a deep and sympathetic appreciation of child psychology and the suggestions for observation of abnormal children as tabulated 011 pp. 297-8 might well be memorised by those responsible for the care of children whether normal or abnormal.
The book is well illustrated with plates, charts and diagrams, is carefully indexed and contains a glossary of technical terms. The only criticism we have to offer is a small one, viz., that we cannot quite appreciate the insertion of a plate shewing the “primary incision for separating the hypertrophies tonsil from its attachments”: if this be intended to give a view of the fauces, one without three surgical instruments in situ to compl1” cate it would have been preferable. Everything considered, however, this book is one for the desk and not the library shelf and is one which the reviewer intends to keep elose at band. G.A.A.
“A Comparison of Three Methods for Making the Initial Selection of Presumptive Mental Defectives.” ‘ ‘Of What Use is a Psychological Clinic ?’’ By J. E. Wallace Wallin, Ph.D., Director of the Psycho-Educational Clinic, St. Louis, Missouri, U.S.A. “Suggested Rules for Special Classes.’ “Progress in the Field of Mental Hygiene in Missouri.” “The Concept of the Feeble-Mind ed , Especially the Moron.”
The first two of these pamphlets are concerned primarily with the value of Group Tests of Intelligence which?originally devised to allow of the systematic testing of recruits for the American Army?are now being extensively used in schools and institutions throughout the States. Wholesale testing of this kind obviously cannot yield results so reliable or accurate as those obtained from individual tests, but for conducting preliminary surveys and for the purpose of ascertaining e.g. what children in a school should be referred for examination by a mental expert, they have in them elements of value which must not be overlooked.
At the St. Louis Psycho-Educational Clinic?opened in 1914 with the primary object of sifting out from the ordinary schools children who are too mentally defective to derive any benefit from them?this question of “selection” has from the outset received Dr. Wall in’s close attention, and he recently instituted a special enquiry to ascertain whether Group Testing would be of material assistance for the purpose.
His conclusions, which will be of special interest to teachers, may be summed up as Allows:? (1) That the Group Test, as an aid in selection, is not superior to the judgment of the trained and experienced teacher, and the prevalent view as to the incompetence ?f such a teacher to determine without resorting to tests which children are most defective, cannot be generally upheld.
(2) That the Group Test gives occasionally unreliable and misleading results, the possibility of which must always be borne in mind, and that it cannot therefore take the Place of psycho-clinical examinations.
But (3) that it is of value if used as one amongst many aids to classification. In another pamphlet Dr Wallin gives th e rules and regulations for Special Classes as drawn up by him and adopted by the State Superintendent of Schools in Missouri.
The section of these Regulations concerned ith schools for feeble-minded children (Special Schools for Individual Instruction or Opportunity Classes, as they are termed) contains, amongst others, the following provisions in which teachers in similar schools in this country will be interested:?
Admission to the Classes is limited to children who have been properly examined by means of standardised individual mental tests, and it is generally understood that the children for whom they are intended are those having an Intelligence Quotient between 30 and 70.
The importance of an investigation beforehand into the condition of each child, together with his history and home environment is urged.
No class must contain less than 10 children and a teacher should be able successfully to manage from 15 to 18.
As a general guide it is suggested that 35% of the time in school should be devoted to brain work, 35% to manual work and the rest to physical and sensory training, and a list of suitable occupations, etc., is given in full. It is assumed that special training will be taken by all teachers who undertake the work, such training to include psychology and pedagogy, the application of mental tests, practical experience in teaching the feeble-minded, and industrial and manual work. It is interesting to note in this connection (see Progress in the Field of Mental Hygiene in Missouri) that although the State has had since 1919 a law making the establishment of such Special Classes compulsory, it has for the most part, as in this country, remained a dead letter. Another failure regretfully recorded is the creation of a ‘ ‘Bureau for Mental Defectives” for the purpose of providing recognised and widespread facilties for the examination and classification of alleged defectives?a provision which Dr Wallin regards as perhaps the most essential item in any programme of work for the feeble-minded. In St. Louis itself the Psycho-Educational Clinic does what it can to fill this need, but, owing to the lack of financial support, it cannot do so adequately. ?
In The Concept of the Feeble-minded Especially the Moron, Dr Wallin sums up the views he has arrived at after his long and intensive experience in this field of work, and the result makes must suggestive reading. The diagnosis of mental deficiency, he urges, should not be undertaken by anyone without scientific training and prolonged experience. He severely condemns the prevalent practice of labelling persons as feeble-minded on the ground that they are not able to pass beyond the 12 year old Binet Tests.
His opinion that this standard is far too high has, he points out, received striking confirmation during the War in view of the fact that the Army Intelligence Survey revealed an average mental age in the white American soldier of 13.1, and in 47% of less than this. If, therefore, the 12 year old standard is adhered to it follows that probably some 50 million citizens of the United States are ‘ ‘high -grade morons,’’ and moreover that the age of the average citizen is only one-fifth of a year above the level of feeble-minded? a result which he can only describe as ‘’inane.”
A revision of this conception has therefore been rendered necessary and he suggests that the borderline of feeble-mindedness should be drawn between the upper limit of 7 and the upper limit of 9, or at most 10?or in terms of I.Q. between 60 and 80. With an adult or adolescent it will vary from 4 to 6 years of intelligence deficiency based on the adult level of 13 in the Army. But, if this standard is accepted, there follows the somewhat disquieting conclusion that the vast majority of delinquents and criminals classed in the last decade as defective are not defective at all?or at any rate not more so than millions of their fellows countrymen who are regarded as normal citizens,?unless the conception of feeble-mindedness is widened to include what he terms “conative and emotional feeblemindedness”?and this extension Dr Wallin does not advocate. He admits its convenience but considers that it flies in the face of the historically fixed connotation of the term as being essentially an intellectual defect.
This is, he points out, recognised in our own Mental Deficiency Act which has a special definition for “moral imbeciles.” Moreover he considers that no objective test can possibly measure emotional temperamental and moral instability or deficiency, and as its diagnosis must largely depend on the subjective opinion of the examiner based on his own or other’s people’s observation, the standards adopted will inevitably be widely divergent. His own experience forcibly illustrates this for out of at least 60 alleged moral imbeciles sent to him for examination he has only felt justified in corroborating the diagnosis in one case. This type of individual does, of course, need special treatment and care, but in his opinion it should emphatically not be given in the same institution or school as that to which ordinary defectives are sent, but in a special home set apart for “defective delinquents.”
Word Blindness. ————-Miss Lucy G. Fildes, Holder of the Board of Control Research Studentship at Cambridge has recently published* the results of “A Psychological Inquiry into the Nature of the Condition Known as Congenital Word-Blind* ness’’ to which we draw the attention of those who are interested in the subject.
The object of the enquiry was to ascertain as far as possible whether inability to learn to read or the loss of the power of reading is due to specific or to general defect, and if the former, whether the defect shows itself only m reading or whether there is any general lowering of visual power.
Twenty-six children were experimented upon, aged between nine and sixteen, of whoni twenty-two were attending a Special School and four an ordinary Elementary School. AH were selected on the grounds of finding special difficulty in reading, though the extent of the difficulty in each case varied. As the result of a preliminary test with the Stanford revision of the Binet Scale it was found that their Intelligence Quotients ranged from fifty to a hundred and eleven, and thus the fact was revealed that no relationship existed between their Intelligence Quotients and their power in reading. The suggestion was therefore established at the outset that “inability to learn to read depends on a specific rather than a general defect although in school life such a defect may, because of its nature, simulate one more wide-spreading in character. This assumption was afterwards confirmed.
A series of experiments was then undertaken with a view to investigating each child’s ability to carry out the various forms of mental activity known to be involved in the act of reading in so far as it is limited to the recognition of words, letters and figures previously taught.
The experiments fall into three groups according to the special power they aimed at testing:?
(1) Experiments to test the Powers of Visual Discrimination and Retention.
Experiments to test Auditory Discrimination and Retention.
(3) Experiments to test the power of making Audito-Visual Associations.
The experiments established the fact that non-reading children have powers ? ?’Brain,” Vol. XLIV., Part III. Macmillan & Co., Ltd. 6/-. ec]Ual to the normal in discrimination between totally unlike forms whatever the length of exposure time, and in learning from visual Material when the method of learning is free and the forms easy to distinguish: but that they are inferior to the normal in distinguishjng between forms only slightly different and *n learning from visual material when the Method employed must be chiefly visual, and when the forms are easily confused, such as digits. These special difficulties are probably attributable to slow discrimination of similar visual presentations, and faulty association between a visual impression and its appropriate name. Probably both causes operate in every case.
In the second series of experiments such Jnferiority as was shown by the non-readers Was not so great as was the case when dealing with visual material, and there seemed to be n? c?rrelation between them. Defect in either opacity seemed to be specific rather than general. Thus there were certain children specially bad in reading whose auditory difficulties also were abnormally great, but whose general mental capacity was comparatively high.
From the “Associations” Experiments it Was found that the non-readers made associations between meaningful material as easily as did the readers: but that they dropped behind when the similarity between the forms and sounds presented was increased. Miss Fildes’ main conclusions are as follows :?
(1) That, as non-readers are found to be of all degrees of intelligence and the degree of failure in reading shows little correlation with the degree of general defect, it may be inferred that the defect underlying inability to read is to a certain degree specific in nature.
(2) There is nothing in the results of the experiments to indicate the existence of any such region as a “visual-word” centre, the absence of or injury to which will make the visual recognition of words impossible. The defects found are not so strictly localised as such a hypothesis would demand, for the word -blind individuals reveal special difficulties in dealing with material other than words. Further the implication of this theory that ability to read depends on the power to store up images of words has no psychological support; the recall of images is not in question.
(8) The theory that the experiments do support is that “word-blindness” is but one aspect of a more general, yet still in itself specific, defect in either the visual or auditory regions or in both.
It is interesting to note that side by side with her purely experimental work Miss Fildes took in hand the teaching of reading to the word-blind children concerned, and at the end of nine months she was able to report that she ‘ ‘had not found one of them entirely incapable of learning any words or figures.” It may be of interest to readers to compare the above conclusions of Miss Fildes with those of Dr Wallace Wallin, which are recorded in a pamphlet ‘’ Congenital Word Blindness. Some Analyses of Cases,” giving an account of a special examination of a group of 95 Word-Blind children carried out in 1920, and may be summed up as follows:? (1) Word-Blindness appears to be due to defective visual word imagery and its interpretation, not to defective apprehension or retention of ideas; but how far the seat of the trouble may be in the connection between the centres for images for spoken words and those for printed words has he considers yet to be investigated.
(2) The Word-Blind children in the group examined were found to be superior to the others of the same Intelligent Quotient in powers of general auditory and visual imagery and no lowering of general intelligence is necessarily involved in children suffering from this condition.
(3) The incidence of word-blindness, if the milder form is included, is greater than is commonly supposed and is apparently to some extent a sex limited disability. Thus in the group of cases examined it was four times as prevalent among the boys as among the girls.
It was also found that the milder form (dyslexia) was about five times as prevalent, as the more serious form (visual aphasia). Dr Wallin concludes his pamphlet by urging the organisation of “special reading disability” classes where various methods and devices of teaching reading may be tried, and not until it has been demonstrated that a child has failed to respond to such intensive treatment should it be assumed that to attempt to teach him reading is an impossible task.
Backward Children. ——————There has recently been published by the Birmingham Education Committee the report of an investigation carried out by Mr. Cyril Burt and Dr B. R. Lloyd into the incidence and origin of educational backwardness in the schools of that city which no one interested in this particular branch of “Mental Inefficiency” should fail to study.
During the investigation Mr. Burt psychologically examined a limited sample of between 500 and 600 “Backward” children. These had all been also examined physically by Dr Lloyd who continued his investigation until over 1,000 cases had been through his hands.
The results of the two enquiries are embodied in the pamphlet under consideration. Regarding as backward all children whose mental ratio is on an average below 85% and over 70%, or in terms of standards all children who at 11 years of age or more are three stand dards behind or at 10 or under, two standards behind, the investigators calculate that Birmingham has 800 such children. This is roughly 10%, the same proportion that Mr. Burt found in London.
The question as to the causes of backwardness is considered under three heads:?(a) Physical Defects; (b) Psychological Defects; (c) Administrative and Social Factors. The data collected under (a) revealed an unexpectedly small difference in health between the normal and the backward groups dealt with, and the most that Mr. Burt can say on this point is that while the average child has three physical defects the backward child has four. Ill health cannot therefore be regarded as a fundamental factor, though it is of course ft contributory one and one that must be attended to. The prevalence of catarrh amongst the backward children examined is specially commented upon. Many of them, Mr. Burt reports, “were said to be scarcely ever without the symptoms of a cold,” a condition which not only must, increase inattention, but is frequently the forerunner of an unhealthy general diathesis resembling those termed rheumatic or tubercular. In only 5% of these cases, however, was physical defect the sole discernible factor.
Psychological defects on the other han’-l were found to be of great importance. From the investigations made it is estimated that 60% of backward children suffer from marked defect in general intelligence or educational capacity, apparently permanent and probably congenital. In nearly 20% of these cases this inborn capacity seemed the sole and sufficient cause, although in most instances there was associated with it some other extraneous factor such as ill-health or poverty.
With regard to administrative and social factors such as poor attendance, poor teaching, poor organisation in schools, poor home conditions, they appear in only 10% of the cases to be of more importance than intrinsic defect and the most frequent of such factors was bad attendance at school which was noted in nearly one-third of the backward children examined.
Dealing with the general question of causation Mr. Burt sums up his conclusions in the statement that backwardness is far more ft psychological problem than a medical problem , being due primarily to inherent incapacity and only secondarily to ill-health or bodily disease.
But this inherent incapacity,?though the root cause?cannot, in the present state ol our knowledge, be dealt with directly; the physical disabilities accompanying it can, and the need here is an investigation of their nature followed by an effort to remove or alleviate them.
To compensate for the mental disability, the most urgent need is the establishment ol Backward Classes where each individual child ca.il be “studied, treated, and taught,” a^d the report has sections containing suggestions as to the organisation of such classes and the educational methods suitable for use in them.
. Mr. Burt, concludes his report by emphasising the great need for further investigations into the whole problem in order that through the co-operation of the Medical Officer, the teacher, the social worker and the Psychologist the best solution may be found. The last half of the Report is written by r ? Lloyd on his Physical Examination ot backward Children. His conclusions were Arrived at quite independently of Mr. Burt ut the two found themselves to be in strikUl8ly close agreement.
The Report is published by the Birmingham Education Committee. Copies may be obtained from the Education Officer, Council House, Margaret Street, Birmingham. Mentally Deficient Children : Their Treatment and Training. By G. E. Shuttleworth , B.A., M .D., etc., and W. A. Potts, B.A., M.D. etc. 5th edition. H. R. Lewis and Co., Ltd. 10s. 6d. This invaluable book has for some time been ?ut of print and we cordially welcome its reaPpearanee in a 5th edition.
The bulk of its material is unchanged and the book is too widely known to need a review, but there are useful amendments and additions to which we should like to draw attention as they niay be taken as an indication of the ej?tent and nature of recent developments in Cental Deficiency work in both its administrative and scientific aspects.
The “Historical Retrospect” has been reused and brought up to date, perhaps the ‘Host notable addition being an account of the New York Mental Deficiency Law of 1919. The increasing stress which is now being |aid on the significance of the endocrine glands ln regard to development is specially referred to both in the chapter on “Etiology, Diagnosis and Prognosis” and in that on “Treatment,.”* Attention is drawn to the importance these glands in connection with toxemic infeetions during pregnancy and to the possibility of averting the mental defect in the child which may result therefrom by glandular treatment of the mother at an ante-natal clinic?a suggestion of great interest.f A further new feature of Chapter V which will be found very useful is a section on Mental Tests in which the various systems of tests now in use are recorded and discussed. In the Chapter on the “Psychopathies of Puberty” an additional paragraph is introduced on the necessity of bearing in mind in diagnosing certain nervous affections the possibility of “Encephalitis Lethargica.” A brief discussion as to the value and limitations of the use of psychotherapy in cases of “Psychic” Epilepsy has been added to Chapter 8,j and at the end of the chapter on “Moral Training” the possibility of such treatment for moral delinquency is alluded to. This Chapter also contains a new section dealing with the work of Dr Potts and Dr. Ilamblin Smith in connection with the psychological examination of delinquents brought before the Birmingham Courts.
Lastly we would note in the Chapter on “Results and Conclusions” a summary of Dr. Fernald’s Report on “After-Care Study of the Patients discharged from Waverley for a period of Twenty-Five Years.”
A few changes have also been made in the illustrations.
If there are any workers amongst Mentally Defective children who have not yet read this book, we would strongly urge them to repair their omission without delay.
We would refer those of our readers who were specially interested in Dr Robert Hughes’ article on “The Mentally Unstable Child and its Needs” in our last number* to his recently published Annual Report where in the section entitled “Mentally Abnormal Children not included in the Mental Deficiency Act 1913,” his views on the psychology of this type are re-stated a 1 ittle more fully. Applications for copies of the Report should be made to Dr Hughes at the Education Offices, Stoke-on-Trent.
Page 102-3. ?j” Page 207. 1 Page 204. *Vol.3. No.l.
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