THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES THE PSYCHOLOGY OF SUBNORMAL CHILDREN JSrief Course Series in Eoucation EDITED BY PAUL MONROE, PH.D., LL.D. BRIEF COURSE IN THE HISTORY OF EDUCATION PAUL MONROE, Director of School of Education, Teachers College, Columbia University. BRIEF COURSE IN THE TEACHING PROCESS GEORGE D. STRAYER, PH.D., Professor of Educational Administration, Teachers College, Columbia University. THE PSYCHOLOGY OF CHILDHOOD NAOMI NORSWORTHY, PH.D., formerly Associate Professor of Educational Psychology, and MARY THEODORA WHITLEY, PH.D., Assistant Professor of Education, Teachers College, Columbia University. DEMOCRACY AND EDUCATION JOHN DEWEY, PH.D., LL.D., Professor of Philosophy, Columbia University. SCHOOL HYGIENE FLETCHER B. DRESSLAR, PH.D., Professor of Health Edu- cation, George Peabody College for Teachers, Nashville. PRINCIPLES OF SOCIOLOGY WITH EDUCATIONAL APPLICATIONS FREDERICK R. CLOW, PH.D., Teacher in the State Normal School, Oshkosh. THE PSYCHOLOGY OF SUBNORMAL CHILDREN LETA S. HOLLINGWORTH, PH.D., Assistant Professor of Edu- cation, Teachers College, Columbia University. VOCATIONAL EDUCATION DAVID SNEDDEN, PH.D., Professor of Education, Teachers College, Columbia University. THE PSYCHOLOGY OF SUBNORMAL CHILDREN BY LETA S. HOLLINGWORTH, PH.D. ' ASSISTANT PROFESSOR OP EDUCATION TEACHERS COLLEGE, COLUMBIA UNIVERSITY Wefo gorfc THE MACMILLAN COMPANY 1922 All right* reserved COPYRIGHT, 1920, BY THE MACMILLAN COMPANY. Set up and electrotyped. Published June, 1920. NortaooS J. 8. Gushing Co. Berwick & Smith Co. Norwood, Mass., U.S.A. . Name, objects. J Picture.. YEAR HI. _ Eye. . Mouth __ . Penny Knife Watch. Pencil. .. 5. Name . _ 6. Repetto tyllable Al. Repeat. 3 digit. I. Compare, line. _.. 1. Form. 1. Count. 4 pennies.*. 4. Copie. square 6. Repeat. 4 digits .Al. Repeat. 1 2-U syllable. -^- I. Comparison of weigh _f_2. Color., r -H- y j ......iTBr*lr Al. Six coins Al. Dictation 1. Date. 2. Weights. 4. Make change. 4. Repeats 4 digits backwards . i. Three words, a b _, c_.._ 6. Rhymes, a Al. Months. Al. 1. Vocabulary... 2. Absurdities, a. 3. Designs....- ., . . 4. Reading. Time errors memories_ 6. Words (free association)...,... Al. Repeats digits...-.,^^.. Al. Repeats syllable._( Al. Form hnarH - , Stanford Scale for Measuring Intelligence, showing unevenness of abili- child is 12 years 2 months). line represents her mental age. The dotted lines con- necting points above and below this heavy line repre- 124 PSYCHOLOGY OF SUBNORMAL CHILDREN sent her performance in single tests of mental and motor ability, as named at the foot of the graph. CASE D. Name: K _ . M -- Examined by Dr. H Clinical Date: Aug. 5, 1916 Type: MentM Defective Date of Birth: Aug. 3. 1894 Education: Left school from 4th Class in Ireland Nationality: Irish (in U.S.A. 4yrs.) Adult - 18 - - 18 17 - - 17 16 - - 16 IS - - 15 14 - - 14 13 - - 13 12 - - 12 1" in 11 t ft |U 9 _ X/ N 7\ 1U Mental Age 8 - l > / x Y X 8 1 -< VGR. U B GRADE ill IV V - - - - 1. Arithmetic .... 18.0 29.0 11.0 68 270 30 2 Less than 2. Reading 1.9 8.8 2.8 13.5 '^51 86 1% 3. Language 25.5 24.0 10.3 59.3 ?6? 269 13 3' 4. Total Percent at M. A. 26.6 36.6 19.0 = 82 % of all cases Many similar studies should be made, covering all mental ages, and all school subjects, and giving the amounts of deviation from expected score, with the frequency of each amount. It is possible that spe- cial abilities among defective children may be de- serving of more attention than has hitherto been ac- corded in education. Idiots-Savants. The unevenness of abilities which characterizes all persons in some degree, is strikingly exemplified in the idiots-savants (wise idiots). Very rarely a feeble-minded child or adult 128 PSYCHOLOGY OF SUBNORMAL CHILDREN is found who shows some particular ability to a re- markable extent. Tredgold tells of an idiot-savant who could " remember the day when every person had been buried in the parish for thirty-five years, and could repeat with unvarying accuracy the name and age of the deceased, and the mourners at the funeral. But he was a complete ament. Outside of the line of burials he had not one idea, could not give an intelligible reply to a single question, nor be trusted even to feed himself." The special talents of idiots-savants have usually consisted in ability to draw, to perform feats of arithmetical calculation, to memorize by rote, or to play musical instruments. Four idiots-savants have come within the experience of the present writer. The first was a man, an inmate of an institution for the feeble-minded. As this was before the technique of intelligence examination had been developed, his mental level was not known, but he was very defi- nitely an institutional case, with stigmata of degen- eration, and a childish manner. His special ability lay in the fact that he could very quickly tell the day of the week for any given day of the month and year, and took a great delight in this performance. The second was a boy, also an inmate of an institution for the feeble-minded, whose mental level was six years, his chronological age being seventeen years. This boy's special gift was musical. He could play very difficult compositions on the piano, and could repro- IRREGULARITY OF 'ABILITIES 129 duce " by ear " complicated music which he heard played. In other respects he was no more competent than a six-year-old child. The third was a boy of eighteen years, whose mental level was eight years. When seen by the present writer he was an inmate of the Psychopathic Ward of Bellevue Hospital in New York City, having been arrested for vagrancy, and committed there for observation as to his mental con- dition. His special gift was the ability to draw pic- tures of mechanical objects, especially of locomotives. He occupied himself for hours during his detention in this fashion, offering to " do one " for first this then that attendant on the ward, and finally deciding to keep the product himself, in every instance. The fourth was a woman, about twenty-five years of age, an inmate of an institution for the feeble-minded. She was regarded as imbecile in all respects save one : she could plan and execute elaborate designs in cro- chet. It should be emphasized that these cases of phe- nomenal special ability, occurring in the mentally de- fective, are exceedingly rare. Practically no scien- tific study has been made of such persons, and re- marks touching upon them are limited to mere de- scription of their idiosyncrasies. Implications for Education. The psychological facts which have been set forth in this chapter are clearly of much value for the education of subnormal children. The implications may be briefly summa- 130 PSYCHOLOGY OF SUBNORMAL CHILDREN rized thus: (1) The feeble-minded as a group, both as children and as adults, are inferior to the norms in all respects. (2) They are, however, not equally far from the norms in all respects. (3) They are nearest to the norms in physical size and strength, in sensory acuity, and in motor control. (4) They are farthest removed from the norms in intellectual ca- pacity, especially in all those subtler capacities which are involved in abstract thinking, and which in nor- mal persons develop after the age of childhood. (5) The feeble-minded as a group will therefore profit most by instruction which will lead to skill in eye-hand coordinations, and in tasks where phys- ical and sensory capacities are useful. They will profit least from instruction which involves abstract think- ing, and the comprehension of symbols. As adults they will be able, if properly taught, to perform many useful, routine industrial tasks, under supervision. These facts have great significance for those whose duty it is to establish the curriculum for special classes. (6) In any individual defective there will be found more or less unevenness of abilities. Very few feeble-minded children are equally deficient in all respects. On the other hand, very few show ex- treme unevenness of abilities, such as the idiots- savants show. It is possible that after much further study has been made on this point, it will appear that education can utilize special abilities among the subnormal more fully than has been feasible hitherto. IRREGULARITY OF ABILITIES 131 REFERENCES 1. Bronner, A. F., The Psychology of Special Abilities and Disabilities. Bobbs-Merrill Co. Boston. 1917. 2. Farrell, E. E., Variability in School Attainment in Read- ing and Arithmetic of Children Who Have Identical Binet Score of Eight. Nineteenth Annual Report of the Superintendent of Schools. New York. 1916-1917. 3. Galton, F., Notes on Prehension in Idiots. Mind. 1887. 4. Johnson, G. E., Contribution to the Psychology and Peda- gogy of Feeble-Minded Children. Pedagogical Seminary. 1895. 5. Lobsein, M., Einige Untersuchungen iiber das Gedachtniss bei Schwachbefahigten. Zeitschrift fur Kinderforschung. 1903. 6. Mead, C. D., The Relation of General Intelligence to Certain Mental and Physical Traits. Teachers College Contri- butions to Education. No. 76. 1916. 7. Merrill, M. A., The Abilities of the Special Class Children in the Three R's. Pedagogical Seminary. March, 1918. 8. Norsworthy, N., The Psychology of Mentally Deficient Children. Archives of Psychology. Columbia University. 1906. 9. Ordahl, L. E., and Ordahl, G., Qualitative Differences be- tween Levels of Intelligence in Feeble-Minded Children, Journal of Psycho-Asthenics. June, 1915. 10. Otis, M., A Study of Association in Defectives. Journal of Educational Psychology. 1915. 11. Petersen, A. M., and Doll, E. A., Sensory Discrimination in Normal and Feeble-Minded Children. Training School Bulle- tin. Nov. and Dec., 1914. 12. Renshaw, S., The Measurement of Abilities of Pupils in the Prevocational Classes. Special Classes of the Public Schools of Detroit. 1918. 13. Wreschner, A., Eine Experimentelle Studie iiber die Asso- ciation in Einem Falle von Idiotie. Allgemeine Zeitschrift fur Psychiatric. Bd. LVII. 14. Wylie, R. T., Taste and Reaction Time of Feeble-Minded. Journal of Psycho-Asthenics. Vol. IV, 3. 15. Wylie, R. T., A Study of the Senses of the Feeble-Minded. Journal of Psycho-Asthenics. Vol. IV, 4. 16. Wylie. R. T., Motor Ability and Control of Feeble-Minded. Journal of Psycho-Asthenics. Vol. V, 2. CHAPTER VIII PHYSICAL TRAITS OF THE FEEBLE-MINDED The Correlation between Physical Traits and Mental Traits. The history of human thought shows many efforts to arrive at a knowledge of mental traits by a study of the physique and physiognomy. This was, perhaps, the most natural primitive ap- proach to the very important problems involved in " reading character." Few matters are of greater moment for any person than the correct interpreta- tion of the mental life of those about him. This is, however, mysterious and hidden ; it is not presented to the senses directly ; it can be inferred only from in- direct manifestations. In seeking to know it, it was very natural that men should first examine atten- tively that which they can see, and which is inti- mately connected with the mind, namely the body. This method of approach was finally systematized in the pseudo-science of phrenology. According to phrenology, the intelligence of an individual, like other mental traits, is to be ascertained by measuring and scrutinizing his body. The criminology of Lombroso is based on similar premises. Lombroso was an Italian, who undertook 132 PHYSICAL TRAITS OF THE FEEBLE-MINDED 133 the study of criminals by the methods of anthropom- etry. He undertook to establish that " the criminal type " is to be recognized by deviations from the nor- mal in proportions of physique and physiognomy, and by the presence of anatomical peculiarities, called stigmata of degeneration. Subsequent research has shown that the relation between anatomical and mental is not very close, and that in any given case the greatest possible er- rors may be made in an attempt to infer the one from the other. Nevertheless, when large groups are measured and treated statistically, certain general tendencies are seen to hold, on the average, though not with very much reliability for single cases. It will be necessary to examine the facts somewhat at length, with respect to the physical characteristics of the mentally subnormal. Height and Weight. It has already been stated in a previous chapter that in physical development the feeble-minded as a group approach much nearer to the norms than in mental development. When curves of physical growth are platted from the meas- urements of hundreds of feeble-minded children, and are then compared with the curves of growth for children chosen at random, it is always found that the former average shorter and lighter than the lat- ter, age for age. It is seen furthermore, that the dif- ferences increase with the increase in degree of men- tal defect. Morons are slightly below the average 134 PSYCHOLOGY OF SUBNORMAL CHILDREN for normals, imbeciles are below morons, and idiots are lowest of all. These facts are presented graphically in the charts, Figure 13, which are taken from the published re- search of Dr. Goddard. The upper curves represent height in inches, and the lower curves represent weight in pounds. The normal curves are con- structed from data collected by Dr. Boas, Dr. Burk, and Dr. Donaldson. The curves for the feeble- minded are based on measurements of the inmates of institutions scattered over the United States, and include 5923 individuals. The ages range from birth to sixty years. The total distributions from which the averages are made, are not given by Dr. Goddard, so that it is not possible to state the exact amount of over-lap- ping between normal and feeble-minded, and between different degrees of feeble-mindedness. With aver- ages which approach each other as closely as these do, however, we are safe in assuming that the amount of over-lapping is very great; that many of the feeble-minded, even those of low grade, will be as tall and as heavy as the tallest and heaviest normals, age for age. The facts shown in the curves reproduced from Dr. Goddard's study have been verified by other investi- gators. It has also been found that in sitting height, as in standing height, the feeble-minded of all grades are below normal, on the average, though with a great amount of over-lapping. PHYSICAL TRAITS OF THE FEEBLE-MINDED 135 6 8 10 12 14 16 Ifi 20 22 24 Over 24 Years 66- BOYS 1: 150 140 130 120 110 100 90 80 70 60 50 40 6 8 10 12 14 16 18 20 22 24 Over 24 Years FIG. 13. Curves showing the height and weight of feeble-minded in- mates of American institutions, as compared with normals, age for age. (From Goddard. Reproduced by courtesy of The Journal of Nervous and Mental Disease.) Cranial Measurements. Although the subject is interesting and important, cranial development as 136 PSYCHOLOGY OF SUBNORMAL CHILDREN related to general intelligence has not been very ex- tensively studied, by scientific methods. Such re- sults as we have, indicate that in cranial measure- ments the amount of over-lapping between normal and feeble-minded is the most conspicuous feature of comparison. This holds true of whatever measure- ment we consider, whether it be circumference, ca- pacity, diameters, or cephalic index. No diagnosis of mental deficiency can be made by measurement or inspection of the head. It is true that in certain cases of mental deficiency, there is marked deviation from the normal in one or more of the cranial meas- urements ; but it is equally true that a great propor- tion of the feeble-minded fall well within the nor- mal limits. Even among children so low in general intelligence as to be considered fit subjects for detention in an in- stitution, the Research Laboratory at Vineland has found that about 30 percent fall within the normal limits in all cranial measurements. About 70 per- cent of the institutional cases lie outside the normal limits in one or more of the measurements taken, which were, in this instance, capacity, diameters, and cephalic indices. These deviating cases doubtless in- clude children suffering from such pathological con- ditions as hydrocephalus, though on this point the in- vestigators have not furnished exact information. Extensive and exact measurements of the cranium and of general intelligence, will most probably yield PHYSICAL TRAITS "OF THE FEEBLE-MINDED 137 a result similar to that yielded in the case of height and weight. There will doubtless be found a differ- ence in the medians and in the distribution of large groups of defectives, as compared with large groups of normals, although with a great amount of over- lapping between the two. Vital Capacity. Vital capacity is the measure of the amount of air that can be held by the lungs in a single inhalation. Measurement is made by means of an instrument called a spirometer. It has been found that the feeble-minded have a lower average, age for age, than normals in vital capacity. Indeed, the correlation between vital capacity and mental age as reported by Mr. Doll is very high (r=.64). This very high correlation raises the question as to whether the lack of intelligence itself is not to some extent involved here, as ability to comprehend and follow directions constitutes a part of the spirometer test. It may be that actual vital capacity of the feeble-minded may not be so closely in correspond- ence with mental age as is indicated by the figures obtained. Height, weight, and cranial measurements may be determined independently of the ability of those measured to understand and follow directions, so that no such complicating factor enters in the case of those traits. Motor Ability. Under the subject of physical traits, motor ability is often considered. Motor con- trol has already been considered in our discussion in 138 PSYCHOLOGY OF SUBNORMAL CHILDREN Chapter VII. It would be superfluous to repeat in detail what has been said. In all tests of motor strength and control the feeble-minded are inferior to the normal, on the average, though with a con- siderable amount of over-lapping. In grip, in coordi- nation, and in speed of voluntary movement the feeble-minded are inferior. The two hands are more nearly alike in the feeble-minded than in the normal, and there is a greater tendency to left-handedness in the former. Gait is often awkward and shambling in the men- tally subnormal. In the lower grades of defect this is quite noticeable. There is difficulty in learning to hop, skip, and jump, and to go up and down stairs. Quite often the feeble-minded have to be specifically trained to do these things, which normal children learn to do spontaneously. Variability. A by-product of the various investi- gations in the anthropometry of the mentally defi- cient has been the discovery of the fact that they are more variable in physical traits than are normals, age for age. A thousand mentally defective ten-year- olds, for example, will scatter over a wider range of height or of weight, or of grip or of vital capacity, than will a thousand ten-year-olds who are mentally normal. This greater variability may be due to the fact that secondary cases, whose condition is due to a pathological cause, have been included in the meas- urements. The inclusion of a score of cretins among PHYSICAL TRAITS OF THE FEEBLE-MINDED 139 ten thousand defectives will spread the range down- ward in the direction of shortness, because one of the outstanding features of the disorder is stunted phys- ical growth. If all secondary cases were excluded, the greater variability of the mentally deficient, age for age, might disappear in anthropometric tests. Stigmata of Degeneration. By a stigma of degen- eration is meant a physical anomaly, a congenitally deformed or misshapen part of the anatomy. Very elaborate tables of the stigmata of degeneration have been compiled since the time of Lombroso. The enthusiasm over this phase of the study of degener- acy has waned very decidedly in recent years, for it has been demonstrated that healthy normal children in public elementary schools, as well as ordinary, competent members of society in general, often show the presence of "stigmata." In fact if we were to class as " undesirables " all persons who fall within the categories prescribed by some writers on this subject, few would escape. The presence of a single stigma cannot be regarded as significant. But Lom- broso's observations were not wholly invalid. When several pronounced stigmata occur in one individual, usually a condition of mental subnormality accom- panies. In other words, it has been found that stig- mata, though not by any means confined to neuro- paths and mental defectives, are far more common among them than in the population at large. It is true also that in number and severity they are 140 PSYCHOLOGY OF SUBNORMAL CHILDREN proportionate to the degree of defect. Morons usu- ally have few or no stigmata; imbeciles often have several ; while idiots usually bear exterior anomalies, which accompany their mental status. Nearly any portion of the anatomy may be in- volved so as to become a stigma. Any feature which is too large or too small; too thick or too thin; too long or too short ; misplaced ; or otherwise deviating markedly from the usual may be so classified. It will suffice to call attention to certain of the more com- mon and gross stigmata. Abnormal developments of the skeleton are often seen among the lowest grades of the feeble-minded. The cranium, palate, and jaws are the parts most con- spicuously affected. The head may be much too small, or much too large; it may be asymmetrical (one side larger than the other) ; it may be symmetri- cal, but of peculiar formation. Extreme smallness of the skull, with sloping forehead and receding chin, gives rise to one so-called clinical variety of mental defect, namely microcephaly (small-headedness). In the case of the hard palate, it may be saddle- shaped, in which malformation it extends upward to a considerable distance, where the nasal cavity is. In consequence it appears like the inside of a saddle, and so derives its name. Or the palate may be V-- shaped, that is, narrowed to a V as it comes forward. In this case we see overcrowding and protrusion of the front teeth. The most thorough investigations of PHYSICAL TRAITS OF THE FEEBLE-MINDED 141 the palate, made by means of instruments of pre- cision, indicate that malformation is about as com- mon among the mentally normal as among the men- tally deficient. Cleft palate and hare-lip do not seem to be any more frequent among the deficient than among the normal, and by some authorities are not included as stigmata of degeneration. The lower jaws may be either receding or pro- truding. Both of these deviations have been called stigmata. As for the teeth, a really good set of teeth is comparatively rare in mental defectives. They appear later than they should, according to the course of normal development, and are likely to be irregu- lar in arrangement. Curiously enough, in a large per- centage of cases the " wisdom teeth " do not appear at all. Occasionally one sees a set of double in- cisors. Various deformities of fingers and toes occur by way of supernumerary digits, or absence of one or more digits. It may happen that two fingers are webbed together, two sets of bones being palpable within one covering of muscle and skin. Cases may be seen in which the hand consists of a thumb, and a shapeless mass resulting from the failure of the four fingers to differentiate. This stigma is called " lobster hand." The special sense organs appear in a great variety of malformations, which it is impossible to enumer- ate. In the case of the ear, defects of the lobule 142 PSYCHOLOGY OF SUBNORMAL CHILDREN are most frequent. The outer ear may be large, fleshy, and heavy, or it may be much diminished, or even entirely absent. The writer recalls an inter- esting case of ear deformity in an imbecile woman. There was no outer ear whatever, nothing but a hole in each side of the head, with a wrinkle of skin around it. She had just given birth to a child, who displayed exactly the same feature. Among anomalies of the eye, strabismus (more commonly called cross-eyes) is one of the commonest, and, of course, occurs quite frequently in persons of normal or superior intelligence. But it occurs often also among the feeble-minded. Strabismus may be either internal or external. In internal strabismus, one or both eyes are turned inward toward the nose ; in external strabismus, one or both eyes turn outward away from the nose. In either case vision is im- paired. Many anomalies of the eyes besides stra- bismus occur. The eyes may be each of a different color; one eye may be set high in the face, and the other low ; but one eye may be present. In the clin- ical type called mongolians the eyes are set in small, obliquely slanting openings. The nose is subject to wide variation and deviation from type. It may be a mere button, or it may be large and broad. Quite often it is crooked, owing to deviation of the septum. Of other prominent fea- tures of the physiognomy, the mouth may be crooked, or loose and flabby, and in idiots there is likely to be drooling of saliva. PHYSICAL TRAITS OF THE FEEBLE-MINDED 143 The generative system may remain infantile, or the organs of reproduction may be malformed. In idiots and imbeciles the advent of puberty is often delayed. It is necessary to emphasize again the fact that all the stigmata mentioned here, and indeed all stigmata, may occur in human beings independently of mental status. A diagnosis of mental deficiency cannot be made on the basis of stigmata. It is not difficult to find imbeciles and morons who are very handsome, with excellent physiques. A case in point is that of a boy known to the present writer, who was the ward of a charitable organization. This child had been selected by four different families, each having the intention of adopting him; and in each case he had finally been returned, with the complaint that he " could not learn anything." The organization never had any trouble in placing the child anew, because he was very attractive in appearance, with large blue eyes, curly hair, and well-molded features. When he was returned for the fourth time, it was decided to ask for a mental examination. The examination showed that this child was between six and seven years in mental development, whereas his actual age was ten years. It is almost impossible to convince the ordinary observer of the facts in the case, because he is so pleasing in appearance. He has a defective sister, who is almost as handsome as he is. This case illustrates in a practical way the 144 PSYCHOLOGY OF SUBNORMAL CHILDREN vagueness of the relationship between mental and physical traits. Physically the mentally defective approach very near the norms. It is only when scores of cases are measured and compared that we find a small difference in the averages of two groups, one defective and the other normal mentally ; and the amount of over-lapping is very great, even with chil- dren so low in mental status as to belong in institu- tions for the feeble-minded. Mongolians. A few mentally defective children present a peculiar and marked combination of physi- cal characteristics, which has won for them the desig- nation mongolians. Their eyes are set in obliquely slanting slits, the skull is rounded and flat behind, and the tongue is large and fissured, with hyper- trophied papillae. In addition to these chief char- acteristics, the hair is generally dry, scant, and wiry ; the cheeks are flushed; the fingers and toes are short; the little finger often curves in a peculiar fashion ; and the joints of all the limbs are very lax. This last characteristic gives rise to hypermotility of the joints, so that it is possible to bend them to an extraordi- nary degree. The writer has in mind a mongolian imbecile, one of whose favorite tricks is to bend her lower limbs back behind her arms, in such a position that her feet touch the nape of her neck. The mucous membranes of mongolians seem espe- cially irritable, and they suffer with chronic catarrh, colds, bronchitis, and often contract tuberculosis. PHYSICAL TRAITS OF THE FEEBLE-MINDED 145 As a rule they do not live to adult years, the average age of death being about fourteen years. In the early months of life mongolians are some- times mistaken for cretins, but as development pro- gresses the differential diagnosis becames easy. The characteristic combination of features, occurring re- peatedly, has led to the expectation that research may some time reveal some specific pathology un- derlying the condition, just as has been found in the case of cretinism. It is not unreasonable to suppose that this, too, may be an endocrine disorder. How- ever, no cause of mongolianism has ever been estab- lished, and no endocrine substance has been discov- ered to ameliorate the mental and physical state. Microcephalies. Mental defectives who have ex- ceptionally small heads have been designated micro- cephalies. They present no special features other than extreme smallness of the cranium, with recession of chin and forehead, and suggest no possible endo- crine disorder, as the mongolians do. By the term micro cephalic is usually signified a person whose skull is not more than seventeen inches in its greatest circumference. The contour of face and head is that made familiar by the " Sunny Jim " advertisements, which were formerly displayed so freely. The microcephalies represent the ex- tremely low end of the curve of distribution for cra- nial circumference. Physical Education. Since the feeble-minded 146 PSYCHOLOGY OF SUBNORMAL CHILDREN approach much nearer the norms in physical traits than in any other respect, it would be expected that they will respond to physical education relatively well. That such is indeed the case is repeatedly shown when special class children are seen in the drills of gymnasium or swimming tank. A spectator who sees them at this can scarcely believe that he is witnessing the performance of children who cannot learn to read or write acceptably, or to comprehend the fundamentals of arithmetic. The principles of physical education are the same for the feeble-minded as for any other children. If defects are present which corrective gymnastics can improve, they should be applied. Physical exercise will do for the mentally subnormal just what it will do for children in general, that is, it will keep the body in condition, and conduce to muscular develop- ment. Physical education will not raise the intelligence level, as the enthusiastic but uninformed have some- times thought. From time to time one hears of a new system of " physiological training," or of " med- ico-pedagogical treatment/' which purports to affect the growth of intelligence. No such system has ever been shown to have any effect upon the intelligence level. Birth Rate and Mortality. At what rate are mentally defective children being born? This ques- tion assumes particular significance when asked in PHYSICAL TRAITS OF THE FEEBLE-MINDED 147 this way: At what rate are mentally defective chil- dren being born, as compared with children in gen- eral? All reliable figures on the birth rate indicate that for many decades past the birth rate has been in inverse relation to intelligence ; that the lower the in- telligence, the higher the birth rate, and the higher the intelligence, the lower the birth rate. Parents who are of that degree of intelligence which is capable of passing through college and university have very few children, while the feeble-minded bear an un- limited progeny. Dr. Goddard believes on the basis of facts collected that the birth rate among defective parents is two to six times as great as the birth rate for the population as a whole. This differential birth rate is due to the fact that where there is lack of in- telligence there is also lack of prudence. The unin- telligent are at the mercy of instinct, which takes no thought for the future, and perceives no consequence. Late marriage from economic motives plays no part in reducing the birth rate among them, for they marry at will, regardless of circumstances, or pro- create illegitimately. They are never restrained by the reflection that there is not enough to feed those already in existence. Their standard of living is exceedingly primitive. All of the prudential checks to procreation which operate through the intelligence are lacking in the feeble-minded, and in consequence an undue proportion of subnormal children are born. 148 PSYCHOLOGY OF SUBNORMAL CHILDREN If left to the mercy of the natural laws of selection and survival, the death rate would also be very much higher among the subnormal than among the popula- tion at large. Many would starve, many would freeze, many would meet with fatal accidents, many would die of disease through not recognizing the laws of hygiene. But we do not allow the natural laws of selection and survival to operate in civilized society. We provide means of caring for the helpless. Thus the high birth rate among them is not offset by a high death rate. Society does not interfere effectively with the former, but it does interfere with the latter. Nevertheless, though social agencies in the form of public and private charities, do all they can to carry the social burden humanely, and to prevent the high death rate which is a natural consequence of mental deficiency, mortality among the feeble- minded is somewhat higher than among the popula- tion in general. The data upon which this state- ment is based come from institutions for the feeble- minded. The two commonest causes of death are tuberculosis, and pneumonia. From this it might be inferred that the vitality of the feeble-minded is lower than that of children chosen at random, on the average. REFERENCES 1. Case, I., The Correlation between Mental Defect and Anomalies of the Hard Palate. American Journal of Insanity. April, 1919. PHYSICAL TRAITS OF THE FEEBLE-MINDED 149 2. Channing, W., and Wisler, C., Comparative Measurements of the Hard Palate in Normal and Feeble-Minded Individuals. A Preliminary Report. American Journal of Insanity. Vol. 61, pp. 687-697. 3. Doll, E. A., Anthropometry as an Aid to Mental Diagnosis. The Training School. Vineland, N. J. 1916. 4. Goddard, H. H., The Height and Weight of Feeble-Minded Children in American Institutions. The Journal of Mental and Nervous Disease. April, 1912. 5., Goddard, H. H., The Menace of Mental Deficiency from the Standpoint of Heredity. Boston Medical and Surgical Jour- nal. Aug. 24, 1916. 6. Mead, C. D., Height and Weight of Children in Relation to General Intelligence. Pedagogical Seminary. 1914. 7. Norsworthy, N., The Psychology of Mentally Deficient Children. Archives of Psychology. 1906. 8. Porteus, S. D., Cephalometry of Feeble-Minded. The Training School Bulletin. June, 1919. 9. Shaw, T. C., Measurement of the Palate in Idiots and Im- beciles. Journal of Mental Science. July, 1876. 10. Shuttleworth, G. E., The Health and Development of Idiots Compared with Mentally Sound Children of the Same Age. Proceedings of the Association of Medical Officers of the Ameri- can Institute for Idiotic and Feeble-Minded Persons. 1876-1886. CHAPTER IX THE INSTINCTS AND EMOTIONS OF THE FEEBLE-MINDED General Consideration of Instinct and Emotion. At the very inception of life every organism is in- nately gifted with tendencies to respond to the situ- ations which life offers, apart from all training. Of these tendencies, those which are fairly complicated in character, and which have not been learned as a result of experience, are called instincts. Some of the clearest examples of instinct that can be adduced in illustration are found among insects. The locust goes through the fairly elaborate be- havior of flying, eating, " singing," and depositing its larva? in such a way that offspring will come forth in due season ; yet all this is done without any learn- ing whatever. There is no elderly locust to teach the new generation what to do in the situations of- fered by life. No ideas of remote ends to be attained guide the locust. These activities are instinctive, innate in the organism, as a result of centuries of natural selection. It is no part of the purpose of this volume to undertake an exhaustive discussion of human 150 INSTINCTS OF THE FEEBLE-MINDED 151 instincts. Such discussions are to be sought in stand- ard texts on social and educational psychology. We shall note briefly here only a few of the human in- stincts, which are most significant for the under- standing of the behavior of the mentally defective, as related to the social ideals of our day. Among these are (1) the tendency to acquire and possess objects of attractive size and appearance, (2) the tendency to resist the abstraction of objects once acquired, (3) the tendency to seek, seize, and ingest food, (4) the tendency to notice, approach, and mate with members of the opposite sex, (5) the tendency to be angry when thwarted in the pursuit of a desired end, (6) the tendency to seek the company of fellow beings rather than isolation, (7) the tendency to feel pleased at the approval of others, and to feel miserable at their scorn or disapproval, (8) the tend- ency to be satisfied when others are happy, and to be dissatisfied when others are wretched or in pain, (9) the tendency to flee from large, strange objects which approach, (10) the tendency to manipulate the environment, (11) the tendency to behave sub- missively in the presence of those who are obviously superior in power, and to behave aggressively in the presence of inferiors, (12) the tendency to try to " get ahead " of others, who are engaged in the same activities. These are a few of the responses which human be- ings make by original nature, without training. Rarely 152 PSYCHOLOGY OF SUBNORMAL CHILDREN is it necessary to teach any child to make such re- sponses. The great problem of moral education, on the contrary, is to teach children to inhibit and control these strong innate tendencies, to an extent which will make social relations possible. It is of the essence of an instinct that it is aimless, blind, in the sense that it is not guided by conscious purpose or thought of consequence. Purpose and consequence can be apprehended only by the intelli- gence. 1 They must be apprehended as ideas, and in- stinct functions without the direction of ideas, by original nature. Since instincts are blind to purpose and conse- quence, how is it possible to secure that control and inhibition of them, that we call moral conduct? The answer is that moral conduct is secured through the agency of the intelligence, through the agency of man's capacity to learn and to make adaptations on the basis of experience. Codes of morals and ethics rest primarily on the intellectual recognition that, on the whole and in the long run, life is more satisfying if tendencies to act are controlled and inhibited in certain ways. This recognition is passed on from one generation to another under the name of moral education, and the younger generation receives the instruction partly through its ability to comprehend ideas of purpose and consequence, partly through its 1 Intelligence, also, may be listed as an instinct, in the sense that it is inborn. INSTINCTS OF THE FEEBLE-MINDED 153 own personal experience of punishment when certain responses are made, and of reward when certain others are substituted. Thus moral conduct is di- rectly dependent upon ability to comprehend ideas, and capacity to profit by experience. It is now clear why the young child or the feeble- minded person cannot be depended upon to act in accordance w r ith the code of morals and ethics. Children and the feeble-minded need supervision in their social relations, because intelligence is inade- quate for the complicated task of controlling and in- hibiting the instincts, in situations which arouse them. To act on an immediate impulse is always easy; to postpone a present satisfaction for the sake of remote consequence, which exists only as an idea, is always difficult. Small wonder, then, that a being who is incapable of formulating ideas of consequence should act in whatever way will bring immediate sat- isfaction. A word concerning emotion will be timely at this point. Every instinctive act, and the thwarting of every instinctive act, carries with it an affective ex- perience of some degree. To follow out instinctive promptings without hindrance is satisfying; to be thwarted, or to be compelled to act against instinctive promptings is unsatisfying. These satisfactions and dissatisfactions are expressed in the form of the emo- tions. Popularly certain well recognized words such as anger, shame, disgust, joy, terror, have been used 154 PSYCHOLOGY OF SUBNORMAL CHILDREN to designate emotional behavior. No analysis of these terms can be undertaken here, but it may be stated that man is usually aware of his emotional re- actions, so that emotion has been called " the con- scious side of instinct," since the two are inseparably associated. The Instinctive and Emotional Life of the Feeble- Minded. No prolonged and systematic study has been made of the instinctive and emotional life of the feeble-minded. The intelligence of the defective has claimed most of the interest of investigators. This fact is to be explained, no doubt, by the greater difficulty of devising an experimental technique for the study of instinct and emotion. We are indebted to Binet for a few direct observations upon the char- acter of imbeciles and morons, but these have not been amplified by psychologists, as his observations upon the intelligence have been. As long ago as 1736 Felix Platter, in his Praxeos Medicae, writing upon " Mental Imbecility, Mental Consternation, and Mental Alienation," noted that " Friendly emotions and affects may be encountered with intellectual backwardness." Indeed, there seems no possible doubt that in respect to instincts and emotions the feeble-minded approach much nearer the norms than they do in intellectual traits. It is to be observed, also, that children are much more like adults in instinct than they are in intellect. Anyone who has worked much with and among INSTINCTS OF THE FEEBLE-MINDED 155 mentally deficient children knows that they differ greatly in character, just as all children do. There are all degrees of docility, of aggressiveness, of in- stability, of stolidity, and so on, through all the traits of temperament. Perhaps the simplest way to ap- proach the instinctive and emotional life of the feeble-minded for our present purpose will be through an analysis of their crimes and misdemeanors. The commission of a crime or misdemeanor constitutes objective evidence of the existence of an instinct, since violations of the moral code (which eventually becomes the legal code) by instinctive acts, are called crimes and misdemeanors. Analysis of the Crimes and Misdemeanors of the Feeble-Minded. In 1913 a number of children who had been referred from the Children's Court in New York City for mental examination were studied, and the charges made against the mentally defective were in order of frequency as follows : theft and accomplice in burglary, truancy, sexual misbehavior, incorrigi- bility, disorderly conduct, fighting and assault, truancy and theft (double charge), associating with vile and vicious persons, murder and attempted mur- der, vagrancy, intoxication, arson, begging, peddling without a license, destroying property, intolerable nuisance, and violating child labor laws. Theft is the commonest offence committed. The tendency to acquire and possess objects of suitable size and attractiveness is involved here, as is also 156 PSYCHOLOGY OF SUBNORMAL CHILDREN the tendency to seek, seize, and ingest food. These mentally deficient children stole such objects as money, old brass, tin foil, copper wire, apples, ladies' dresses, a rabbit, a baby-cart, peanuts, bicycles, news- papers, a cake of ice, and a horse and buggy. The instinct to acquire and possess is very well developed in these children. The same is true of the instincts connected with food. In the adult feeble-minded, food-getting is one of the chief incentives to petit larceny, which is one of the commonest charges made against them in the courts. The following conversation ensued with an ado- lescent boy of sixteen years, with an IQ of 51, who had been arraigned in the courts for burglary. His mother was a janitress in an apartment house, and he worked about the place, helping her. In the course of the day's work, he had entered the apartment of a tenant, which was conveniently accessible, and had stolen a small sum of money. Q. Why are you here? A. I done wrong. Q. What did you do that was wrong? A. Stole three dollars. Q. From whom did you take it? A. A lady in the apartment. Q. Why did you take the money? A. I seen it lyin' there. Q. What did you do with the money? A. Bought fruit and crackers. That's all. INSTINCTS OF THE FEEBLE-MINDED 157 Q. Why is it wrong to steal? A. Because a cop will get you. Because you get in bad. Q. Why do you get in bad? A. (No response. Shakes head.) Don't know. Q. What place is this? A. A room, with windows. Q. Why should you be sent to this place? A. I don't know. The next most common offence is truancy. To the question, " What do you do when you go on the hook? " Miss Irwin elicited interesting answers from subnormal children. " Oh, I go all round," was often the response. Others went " to the Park to see the animals." Still others joined gangs, and went to fly pigeons from the roofs of the tenements. In other communities these pursuits would be re- placed by fishing, playing marbles, shooting craps, and the like. The instincts which underlie truancy are doubtless many. General manipulation of the environment, the tendency to seek one's kind, dread of disapproval and scorn, are prominent. The tru- ant is he who is isolated in the midst of children hope- lessly beyond him in ability and interests, who is al- ways " at the bottom of the class " and hence the object of the teacher's disapproval and the pupils' scorn. He cannot manipulate the environment of the classroom, so he seeks an environment which he can manipulate. 158 PSYCHOLOGY OF SUBNORMAL CHILDREN In the frequency of charges which have to do with the sexual instinct, we see that this element is well developed. If the sexual instinct were weak in feeble-minded persons, the problem of mental defi- ciency would be largely self-solving, and no eugenic program would be necessary. The indication is that the feeble-minded approach the norms in this par- ticular. The inhibitions due to ideas being weak in them, this well-developed instinct determines con- duct, and in adolescent and adult defectives we have, as a result, illegitimacy, illegal co-habitation, and all the other violations of the rules which organized society has set up for the regulation of the sexual in- stinct. Incorrigibility and disorderly conduct cover such specific acts as cursing, throwing stones, staying out nights, quarreling, and the like. There is a revela- tion of instincts in great variety here, and the charges result from habitual yielding to minor impulses. Fighting, assault, and murder result in the major- ity of cases from anger at being thwarted. A few concrete cases will make this clear. R N , a boy thirteen years of age, with a mental age of eight years, drew a knife on the teacher. The teacher had reproved him for something he had undertaken, and had asked him to stop. He had been placed with this teacher, who was a good disciplinarian, because he had thrown a heavy flower-pot at his former teacher, when thwarted in some act. He remained INSTINCTS OF THE FEEBLE-MINDED 159 good-natured and grinning, so long as he was per- mitted to have his way. Sometimes fighting and assault are motivated by the tendency to resist the abstraction of goods ac- quired. The following is the verbatim story of a woman thirty-four years old, with a mental age of six years, six months, an inmate of an institution for the feeble-minded. She appeared before the exam- iner with a blackened and swollen eye, and the fol- lowing conversation took place. Q. How did you get that black eye? A. You know we have chicken for dinner on Sun- day, and I took that girl's chicken away from her plate. So she pulled my hair first, and she knocked me on to the floor, and she landed on my stomach, too. But I give it to her back though. I pulled her hair. That's all. See, that girl didn't want me to do it. And then I went up to wash my hands, be- cause they was all greasy from holding on to the chicken. She didn't like me, that girl. Again, fighting and assault, and at times murder, may be motivated by resentment at being scorned, as in the account of a feeble-minded girl fifteen years of age, also an inmate of an institution, who ap- peared with a black eye. Q. How did you get that black eye? A. (After a sulky silence.) Well, there's a girl, and she called me a sheeney, and I called it to her back a guinea, and she hit me in the eye, and I hit her in the nose. 160 PSYCHOLOGY OF SUBNORMAL CHILDREN As for the other offenses listed, vagrancy often results from destitution, with consequent aimless wandering about in search of food and shelter ; arson may result from curiosity and general manipulation of the environment, including matches, and inflam- mable materials ; begging, peddling without a license, and violating the child labor laws are infrequent charges, and come from the attempt to get food and shelter indirectly, without, however, taking cogni- zance of the rules ; being an intolerable nuisance may result simply from general lack of control, such as is found in any creature with strong tendencies to ac- tivity, but without much intelligence. Dr. Glueck classified the crimes of ninety-eight feeble-minded offenders committed to Sing Sing Prison on the basis of instinct, as follows. Crimes which had their impulse in the instinct of acquisi- tiveness 58 Crimes which had their impulse in the instinct of pugnacity 26 Crimes which had their impulse in the instinct of sex . . 13 Arson (no instinct assigned) 1 The instinct of submission to those who are ob- viously more powerful is an important factor in the misdoings of the defective, because through it they easily become the tools of those " higher up." The guardians of feeble-minded children reiterate the complaint, " He does all that other boys tell him to do, and believes everything they say." This instinct to submit is sometimes discussed as suggestibility. INSTINCTS OF THE FEEBLE-MINDED 161 The feeble-minded are credulous and gullible, being unable to combat the judgments of those about them, because they lack the power of formulating judg- ments for themselves. To assent without motive to any obscure statement made in a tone of authority, is characteristic of the majority of human beings, but it becomes increas- ingly characteristic as we go downward in the scale of intelligence. In the case of idiots and imbeciles it is often sufficient to look at them, and to say in a tone of authority, " Isn't that so? " without ever hav- ing made any preliminary remark at all. Immedi- ately they nod, or reply, " Yes," as though a truth had been uttered. In his discussion of suggestibility Binet notes that little children under three or four years of age can be made to react in the same way almost invariably, and many children older than this will react so. Above the age of seven or eight years, however, a normal child remains unmoved, does not reply, " looks at one in a scandalized manner," or demands an explanation. Binet tells of various experiments in submission performed on imbeciles, where the suggestions were such as to outrage common sense, and which could not possibly have succeeded except with subjects very low in the scale of intelligence. Binet would rise, take a chair, and show it to the imbecile, whom he was studying, with the following results : M 162 PSYCHOLOGY OF SUBNORMAL CHILDREN Q. What is this? A. A chair. Q. Dreadful mistake! It is not a chair; it is a corkscrew. (Pause.) Now let us see. What is this? (Again showing the chair.) A. A corkscrew. Q. Now, upon what are you sitting? A. A corkscrew. The following conversation with an imbecile pris- oner shows at the same time the instinct of submis- sion, leading him into absurd contradictions, and his inability to grasp the social organization under the rules of which he had been eight times committed to workhouse and penitentiary by the time he had reached his thirty-fifth year. This prisoner had been arraigned on the occasion of this conversation for breaking into a freight car, in winter, in search of shelter. His mental age was found to be six years, four months. The conversation ran thus : Q. What place is this? (Room in observation ward.) A. A room. Q. What kind of a room? A. A big room. Q. Why were you sent here? A. Judge said I'd be well took care of here. Q. How did you get before the judge? A. I was in Bronx Park. Little drunk. Q. (In startled, disapproving tones.) You were drunk? INSTINCTS OF THE FEEBLE-MINDED 163 A. (Hastily.) No, ma'am, not drunk. Q. And where were you before you were in the Park? A. In penitentiary. Q. What's a penitentiary? A. Place where you stay and work. Q. What do you stay for? A. Place like Blackwell's Island. Q. What kind of place is Blackwell's Island? A. Place where you work. Like a prison. Q. What's a prison? A. Place where you do housework. Q. And you weren't drunk this time, were you? A. No, ma'am, not drunk. Q. (In tone of authority.) But you were drunk, weren't you? A. (In hasty agreement.) Yes, ma'am, drunk. Under the circumstances in which he finds himself, it would be easy to make this imbecile agree to any- thing. Whether he responds in the affirmative or in the negative depends upon the form of the question, the tone in which it is put, and the attitude and facial expression of the examiner. It is unnecessary to comment at length upon the ease with which such a mind becomes the tool and dupe of others more powerful. Of course a six-year mentality would be of little use in the performance of a complicated crime, but eight-, nine-, and ten- year mentality can be very useful, and what is true 164 PSYCHOLOGY OF SUBNORMAL CHILDREN of this imbecile is also true of those of higher grade, though true in lesser degree. The feeble-minded are, however, not submissive to each other, nor to those lower in power than they themselves. Like others, they show all degrees of submissive and of aggressive behavior, in response to situations which by nature call these reactions forth. Certainly it seems that instincts are nearly as strong among the intellectually subnormal as they are among the normal and superior. It is this dis- proportion between the strength of instinct and the amount of intelligence which is responsible for the unsocial and anti-social behavior of the mentally defi- cient, which in turn makes of them such objects of concern. If there were a perfect correlation between instinct and intelligence, so that a feeble intel- lect would always insure equally feeble instincts, many of the difficulties of life would disappear auto- matically. Of the instincts which do not ordinarily lead to crime, such as the tendency to feel pleased at the ap- proval of others, and the tendency to be satisfied by seeing others comfortable and happy, there is every reason to suppose that these are as well developed in the subnormal as are the instincts which lead more readily into difficulty. Mentally deficient children are as susceptible as others to nods and pats of ap- proval, to smiles, praise, and rewards, and their INSTINCTS OF THE FEEBLE-MINDED 165 affection attaches as readily to those who win their confidence. The study of the instinctive and emotional life of the feeble-minded may prove most valuable for nor- mal psychology. One of the great obstacles to the scientific study of instinct has been the difficulty of distinguishing between what is really innate and what is learned, in the behavior of human beings. If it were possible to study human beings who approach the norm in their equipment of instincts, but who can learn relatively little, many questions about in- stinct might be illuminated. Legal Responsibility. It has long been recognized in courts of law that children are not to be held re- sponsible for their acts below a certain age. This age varies considerably in different times and differ- ent countries. In old English law the child could not be legally punished for his acts before the age of seven. According to the Jewish code, the sins " go on the parents " until the child is twelve years old, when he becomes responsible. The laws relating to juvenile courts usually place the age of responsi- bility at sixteen years, by allowing only those under that age to be arraigned in the children's court. The age of legal responsibility does not at present rest upon the results of scientific research, but upon the " general notion " of lawmakers as to the age at which the intelligence is sufficiently developed to take the instincts in charge. 166 PSYCHOLOGY OF SUBNORMAL CHILDREN It is possible that as civilization advances and the environment becomes more and more complex, the age of legal responsibility should be advanced also. Perhaps it was right that centuries ago the age of responsibility should have been seven years, and right that now it should be sixteen years. At all events, the problem remains temptingly open to sociological and psychological research, as does also the question of the age of consent, which is now determined with- out regard to psychological principles. This matter of the age of legal responsibility is important for students of the feeble-minded. Pre- sumably all persons below a given mental age, re- gardless of chronological age, should be held irre- sponsible before the law. Responsibility should not be determined by the number of years an indi- vidual has been in existence, but by the mental level which he has attained. It is therefore very impor- tant to determine at what mental age the intelli- gence is sufficient to constitute " responsibility." Present practice in the courts is much confused on this point. In New York City, for example, all in- dividuals who have been in existence less than six- teen years are held to be irresponsible or partially responsible, regardless of mental acuity. This would lead to the supposition that a mental age of sixteen years is regarded as the criterion of full legal re- sponsibility. This is not, however, the case, for adult prisoners of a mental age of about nine years and over INSTINCTS OP THE FEEBLE-MINDED 167 are not provided for in law in any way other than by the procedure for conviction and punishment, common to all who have been in existence for more than sixteen years. These discrepancies in practice will, of course, disappear as knowledge grows and be- comes disseminated. Moral Imbeciles. The term moral imbecile has been used with many different connotations. When used to designate a person whose intelligence is de- fective, the term is superfluous, for mental imbeciles are moral imbeciles also, since " having morals " in- volves a use of ideas of which they are incapable. The term is meaningful only when applied to des- ignate persons of good intelligence, who are defective or perverted in instinct. There exist persons who are intelligent, yet incorrigible; persons who persist in criminal behavior, who do not feel the emotions or- dinarily felt, and who seem incapable of responding to ethical ideals. These may properly be called moral imbeciles. The Moral Training of Mental Defectives. Can the school do anything to instill morals in the men- tally defective children? Can the school aid at all in preventing the crimes and misdemeanors which they commit, as children and as adults? We must refer forward for a moment to the discus- sion of the way in which improvement takes place in the feeble-minded. It takes place only through the formation of specific habits. What is true of skill, is true of morals as well. 168 PSYCHOLOGY OP SUBNORMAL CHILDREN If it were possible for the school to foresee and re- produce every situation involving instinct to which the defective would have to respond in the course of life, and could by repetition connect permanently the desired response with each situation, it might insure morals just as it can insure skill. This being ut- terly impossible, the school can only select certain general situations, and strive to connect the desired response with each, by many repetitions. To the situation * a dumb animal ' it may strive to attach the response ' be kind ' ; to the situation ' an object that is not mine ' it may strive to attach the response ' don't take it ' ; to the situation ' being angry ' it may strive to attach the response ' don't strike/ The difficulty always is that the very limited in- telligence is usually not capable of even this amount of generalization. The instruction tends to degener- ate in the mind of the instructed into the much more concrete situation ' being angry at Johnny ' and the response ' don't hit him' without affecting relations with Tom, or Joe, or with people at whom he will be angry ten years after leaving school. It is true, of course, that these same limitations apply, though with less and less force, as we go up through all the degrees of intelligence. With the ma- jority of us the moral code is to some extent a matter of specific instruction, and it is only the exceptional intellect that can construct for itself a code of morals on an independent basis, if once the orthodox code INSTINCTS OF THE FEEBLE-MINDED 169 handed down by specific instruction has been under- mined. Normal intelligence is capable of learning the response ' don't take it ' to the situation ' some- thing that is not mine.' Yet it tends to apprehend the words very concretely, and seldom makes the generalization to include the time of busy persons, taxes that the state forgot to collect, or sacrifices of others who toil in its behalf. In amenability to moral education, as in all other respects, the feeble-minded differ from the normal not in kind, but only in degree. REFERENCES 1. Binet, A., and Simon, Th., The Intelligence of the Feeble- Minded. Trans, by E. Kite. The Training School. Vineland, N. J. 1916. 2. Ellis, F. W., and Bingham, A. T., Mental Examinationa. New York Probation and Protective Association. 1915. 3. Fernald, W. E., The Imbecile with Criminal Instincts. American Journal of Insanity. April, 1909. 4. Goddard, H. H., The Criminal Imbecile. The Macmillan Company, New York. 1915. 5. Grossmann, W. H., The Atypical Child Its Instincts and Moral Status. Bulletin of the American Academy of Medicine. April, 1907. 6. Hastings, G. A., What Shall be Done with Defective De- linquents? New York Committee on Feeble-Mindedness. New York. 1918. 7. McDougall, W., Social Psychology. Methuen and Com- pany, London. 1908. 8. McLear, M., The Fact of Personality in the Development of an Atypical Child. Pedagogical Seminary. March, 1913. 9. Moore, F., Mending Immoral Morons. National Prison Congress. Oct., 1911. 10. Thorndike, E. L., The Original Nature of Man. Teachers College, Columbia University. 1914. 11. Weidensall, J., The Mentality of the Criminal Woman. Warwick and York, Baltimore. 1916. CHAPTER X HOW DO THE MENTALLY DEFECTIVE LEARN? The Learning Process. In Chapter V we showed that the feeble-minded differ from the normal and superior not in kind, but only in degree. Thus the nature of learning will be of the same kind in them as in ordinary children. It is not a part of the pur- pose of this book to present in full the psychology of the learning process. For these facts a standard text on educational psychology should be consulted. Briefly it may be stated that all behavior, both learned and unlearned, may be reduced in the last analysis to specific responses to given situations. We spend our days being stimulated by our envi- ronment and responding to it. The responses of which men and other animals are by original nature capable are instinctive, or unlearned. It is the task of education to modify and amplify these responses in such a way that the individual may become as well adapted as may be to the purposes of the social body of which he is a member. The extent to which edu- cation is effective varies greatly with individual differences in original nature, which were discussed in Chapter I. The psychology which underlies such 170 HOW DO THE MENTALLY DEFECTIVE LEARN? 171 modification is, however, the same in kind for all animals, both brutes and men. A definite response is made over and over again to a given situation, and a bond is formed in the nervous system of the learner, so that when that situation is presented to him he makes that response. This is the principle of prac- tice, upon which all learning depends. Its basis is physiological. The elements of the nervous system having acted in a certain way, tend more easily to act in that way again, (provided that the action be not followed by pain or discomfort). When the response through long practice comes very easily and quickly, we say that a habit has been formed. The kinds and complexity of habits which an in- dividual can form depend, of course, not only on prac- tice, but also on the sensitivity and complexity of his nervous system. A baby of one year cannot form habits of reading and writing, because he is not as yet sensitive to the situation ' a white page contain- ing numerous tiny black marks, each of which has a definite meaning peculiar to it.' Human beings learn that which they can learn according to the same general laws, but not all are capable of learning the same things, even with a maximum of practice. How Do the Feeble-Minded Compare with Nor- mals of the Same Age? Some years ago, before any experimental study of the feeble-minded had been made, it was often affirmed that they are character- ized by incapacity for sustained voluntary effort, by 172 PSYCHOLOGY OF SUBNORMAL CHILDREN lack of attention, in short by inability to learn. These conclusions came no doubt from general ob- servation of the fact that compared with normal per- sons of the same age they are unable to profit by in- struction. This general observation was later borne out by experimental studies of feeble-minded children, as compared with normal children of their age, or with normal children in the same school grade. Figure 14 shows graphically the rate of learning of a subnor- mal school child, as compared with a normal member of his grade in school. It is noticeable that the curve for the subnormal child rises slowly, and never at- tains the goal finally attained by normal children, who are as old as he is. How Do the Feeble-Minded Compare with Nor- mals of the Same Mental Age? The comparison of the feeble-minded with normals of the same chron- ological age is not the only, nor yet the most fruitful method of gleaning the desired information about the learning processes of the former. Another method of analysis is to compare the learning of the feeble-minded with the learning of normal children of the same mental age. We know very well, both from common observation and from experiment, that a fifteen-year-old defective, with a mental age of eight years, cannot learn as a normal fifteen-year-old can. The question is, can he learn as well as, or better than, an average eight-year-old can? 15 20 45 40 35 30 25 15 10 T I I j J r LEARNING CURVES (Strong) ACHIEVEMENT OF TWO CHILDREN OF EQUAL BIRTHDAY AGE i i i TR.ALSOF.ON.EM.NUTEEACH , , , , -45 4.0 -35 30 25 20 15 10 15 20 FIG. 14. Curves showing the course of learning in a defective child, and in a normal child, of equal birthday age. (From Strong. Repro- duced by courtesy of The Psychological Bulletin.) 173 174 PSYCHOLOGY OF SUBNORMAL CHILDREN Dr. Woodrow studied this question, at the State School for the Feeble-Minded, in Faribault, Minnesota. A group of feeble-minded inmates, averaging a mental age of 8 years, 10 months was compared with a group of normal public school chil- dren, averaging 9 years, 1 month in age. (Both of these groups may be said to have been 9 years old mentally.) These children in both groups were of equal initial ability in the tasks which were set them, namely, sorting sticks into boxes, sorting col- ored pegs, cancelling letters, and cancelling geometri- cal forms. These two groups, almost exactly equal in mental age, and in initial ability in the situations named, were given thirteen days of practice in sorting gun wads, on which were pasted labels bearing the printed outlines of simple geometrical forms. There were five different kinds of these labels, and wads bearing the same kind of label had to be sorted into the same box. It is easy to see that this task has many ele- ments in common with simple factory operations. After thirteen days of practice (consecutive ex- cept for Saturday and Sunday) the records of both the feeble-minded and the normal were scored, in order to compare the two groups in learning. The facts can be conveyed most clearly by presenting the complete table of results. The table shows the ini- tial trial, the final trial, and the improvement (amount of learning) is given for each child, both HOW DO THE MENTALLY DEFECTIVE LEARN? 175 feeble-minded and normal, in terms of the number of wads correctly sorted. The percentage improvement is also given. THE ABSOLUTE AND PERCENTAGE IMPROVEMENT OF EACH CHILD OF BOTH NORMAL AND FEEBLE-MINDED GROUPS (Woodrow) FEEBLE-MINDED NORMAL Child Initial Trial Final Trial Im- prove- ment T % Imp. Initial Trial Final Trial Im- prove- ment T % Imp. 1 129 175 46 36 147 197 50 34 2 94 146 52 55 144 176 32 22 3 154 201 47 33 130 191 61 47 4 112 203 91 81 119 166 47 39 5 120 193 73 61 114 197 83 73 6 108 167 59 55 118 159 41 35 7 127 144 17 13 107 173 66 62 8 94 209 115 123 125 163 38 30 9 136 166 30 22 100 132 32 32 10 120 142 22 18 122 213 91 75 11 138 184 46 33 113 186 73 65 12 125 182 57 46 104 163 59 57 13 83 111 28 34 99 144 45 45 14 127 212 85 67 121 156 35 29 15 122 103 -19 -16 155 204 49 32 16 104 149 45 43 129 199 70 54 17 124 179 55 44 18 140 214 74 53 19 142 208 66 47 20 114 203 89 78 Av. . 121 175 54 49 122 176 54 46 It is worth while to dwell at some length upon this investigation, because the results of such an experi- ment are worth more than all the surmises and ex- 176 PSYCHOLOGY OF SUBNORMAL CHILDREN pressions of personal opinion that could be collected. The time has passed when educators were satisfied to base their procedure on dogmatic opinions. They are now seeking the basis of sound experimentation. The question whether feeble-minded children show the same improvement with practice as do normal children of the same mental age, is answered affirma- tively in this experiment. They learn as much, and they learn at the same rate, as do the normal nine- year-old children. In actual (chronological) age the two groups were, of course, very different. The feeble-minded learners ranged from nineteen years to ten years, with an average age of thirteen years, eight months. The normal children ranged between ten years and eight years in actual age, with an aver- age of nine years, one month. The curves in Figure 15 present a graphic picture of the comparative performance of the two groups. They travel together, crossing and re-crossing each other from trial to trial. If we had a curve showing the performance of nor- mal children, of an average age of fourteen years, it would undoubtedly travel above these two curves, even in a process as simple as this of sorting forms. The older normal children would learn faster and would learn more than would the younger normal children, or the feeble-minded of their own age. One further experiment in the learning of the feeble-minded as compared with normals of the same HOW DO THE MENTALLY DEFECTIVE LEARN? 177 mental age has been carried out. In order to meas- ure the amount of material learned in a year by feeble-minded children, as compared with normal children of the same mental age, Dr. Murdoch stud- ied a number of inmates at the Pennsylvania School LEARNING CURVES OF MENTAL DEFECTIVES AND OF NORMAL CHILDREN OF EQUAL MENTAL AGE 12 FIG. 15. Curves showing the course of learning in defectives and in normal children, of equal mental age. (From Woodrow. Reproduced by courtesy of The Journal of Educational Psychology.) for the Feeble-Minded, whose mental ages had been ascertained. First the ability of these children was determined by educational measurement, in reading, spelling, arithmetic, handwriting, composition, draw- ing, and language. Exactly one year later they were 178 PSYCHOLOGY OF SUBNORMAL CHILDREN remeasured in the same abilities. Since it is known how much average children of each school grade improve in these abilities in a year, and since it is known what the average age in each grade is, com- parison between the feeble-minded and the normal on the basis of mental age seems permissible. The outcome of the investigation was that of chil- dren starting the year's work with the same mental age, the normal learn much more within the allotted period than do the feeble-minded. From this result the investigator drew the conclusion that the feeble- minded learn much less than do normal children of equal mental age, in those school subjects which she studied; and that Woodrow's results, show- ing equality of improvement in sorting forms, was not substantiated for the presumably more complex abilities, reading, spelling, arithmetic, handwrit- ing, composition, drawing, and language. Analysis will soon show us, however, that there is no discrepancy between the results of the two experi- ments. The fact simply is that in the case of a learn- ing process, which extends over a period as long as a year, the children do not remain of equal mental age. If we start a year's task with a group of feeble- minded, who are nine years old mentally, and a group of normal children who are nine years old, at the end of the year the feeble-minded will still be approxi- mately nine years old mentally, whereas the normal children will have reached the mental age of ten years. HOW DO THE MENTALLY DEFECTIVE LEARN? 179 This is true because the normal children are growing mentally at the average rate, while the feeble-minded are not. In the lapse of thirteen days the two groups do not have time to draw apart appreciably in growth. Hence in the first experiment, that of Dr. Woodrow, we really have a comparison of groups of equal mental age throughout. In three hundred and sixty-five days, however, the two groups draw very definitely apart. Hence in Dr. Murdoch's experiment we soon cease to have groups of equal mental age for comparison. The superior records of the normal children are due, most probably, to growth, and not to superior ability to practice at the mental age specified. The results of these two studies are thus in no way contradictory. On the contrary, they supplement each other. Transfer of Training in Normal and Feeble- Minded Children. It is a fundamental principle of educational psychology that by practicing for a pe- riod of time in the performance of a given task, an individual will be aided in the performance of other tasks, which have elements in common with it. This principle is usually called the principle of trans- fer of training. Now it might be that normal and feeble-minded children of equal mental age show the same improvement in an activity practiced, but un- equal transfer of that learning to related activities. That there is no spread of improvement in the case of the feeble-minded has been affirmed. As in the 180 PSYCHOLOGY OF SUBNORMAL CHILDREN case of the question of improvement in a task specifi- cally practiced, this statement has rested on com- mon observations, comparing the feeble-minded with normal persons of equal chronological age. Many anecdotes are current in illustration of this point. For instance, an imbecile by prolonged practice un- der instruction learned to make beds very well, work- ing by herself. After a time it was desired to expe- dite the bed-making, and another girl was assigned to work with the first, in the performance of her task, the plan being to have them work simultaneously on a bed. It was then found that the imbecile who had learned to make the beds by herself had to be re- taught to make beds with a helper. As soon as the situation became different in certain elements, what she had learned ceased to function. Another illustration may be cited in the case of three imbecile men who were asked to scrub a large floor. Each man had learned to scrub a floor by himself, bringing the water and soap, scouring the boards, rinsing off the soap, and wiping up as he went. Each of them began in this manner on a sec- tion of the floor. The psychologist of the institution decided to introduce cooperation as an experiment. She showed how one of them could bring the water, another could scour, and the third could wipe up the suds after him. This innovation resulted in much confusion. As compared with what would have been the case with normal men of their chronological age, HOW DO THE MENTALLY DEFECTIVE LEARN? 181 there appeared to be no transfer of training in the one activity to the other so closely like it. But it is necessary to remember in all these instances that the mental ages of these imbeciles ranged between three and five years. The transfer of skill may well have been fully as great in their case as it would have been with normal children of three to five years. In order to throw light upon this question in the learning of the feeble-minded, Dr. Woodrow experimented further with his groups of children. At the end of the thirteen days of practice in sorting geometrical forms, all the children were again tested for sorting sticks and pegs, for cancelling forms and letters. It is not necessary to rehearse the procedure in full detail here. It is sufficient to say that all the requirements of scientific method were fulfilled in the experiment (including " control groups " of both normal and feeble-minded children, who took the end tests in each instance, but who did not practice sorting forms during the thirteen in- tervening days). The result showed that no differ- ence in amount of transference of improvement could be demonstrated, between the normal and the feeble-minded of equal mental age. The Importance of Mental Age in Learning. It is obvious that none of these facts of educational psy- chology, so illuminating to the teacher of defectives, could have been discovered before means had been devised for determining mental age. Mental age, 182 PSYCHOLOGY OP SUBNORMAL CHILDREN not chronological age, is the basis of the learning curve. Ability to profit by instruction depends not FIG. 16. Writing of feeble-minded individuals, as compared with that of normal children of equal mental age ; illustrating the importance of mental age in achievement. on how long the individual has been in existence, but on the complexity and sensitivity of his nervous system. This complexity and sensitivity is repre- HOW DO THE MENTALLY DEFECTIVE LEARN? 183 sented by the concept of mental age, which shows the stage of intellectual growth attained. S3. m BM d- Ale nt*. I A<|ft FIG. 17. Drawings of a house, comparing a feeble-minded adult with a normal child of equal mental age; illustrating the importance' of mental age in achievement. In children the nervous system becomes sensitive to a greater number of situations, as it grows from year to year. This is true of all children, but the 184 PSYCHOLOGY OF SUBNORMAL CHILDREN rate of growth and the ultimate limits of growth vary greatly from individual to individual. The kind and number of habits an individual can form at any given time are conditioned by the stage of mental growth 8 y^. I'WU). FIG. 18. Drawings of a man, comparing a feeble-minded adult with a normal child of equal mental age ; illustrating the importance of mental age in achievement. which he has then reached. Thus one of the first questions which a teacher needs to have answered about the child placed under her care is this: What is his mental age? It is for the psychology of the immediate future HOW DO THE MENTALLY DEFECTIVE LEARN? 185 to discover much more than is now known about the kinds of habits which are learnable at various mental levels. As far as the standard school curriculum is concerned this has been worked out by the rough method of trial and error, so that on the whole there is given in each school grade that which can be grasped and learned by children of the age which is average for that grade. For tasks not included in the conventional school curriculum, we are almost al- together without this information. At what mental age is it possible to form adequately the habits of a chauffeur? of a gardener? of a cook? of a paper-box maker? of a chemist? In answer to these questions we have only preliminary data collected from the mental tests in the army, and a few preliminary studies of ungraded class children whose industrial careers have been followed after they left school. Mental Age Is Not the Sole Condition of Learning, though it is the single most important condition. We have already seen that children of the same mental age vary somewhat in their ability to per- form given tasks. The human mind is far too com- plex to be completely inventoried by a single figure representing the general level of intelligence. We find cases of very marked special ability or disability in the feeble-minded, just as we find them in children of every other quality of general intelligence. This has already been fully discussed in a previous chap- ter. Moreover, differences in temperament, interest, 186 PSYCHOLOGY OP SUBNORMAL CHILDREN and control, which are not intellectual traits, are found among persons of equal mental age, and they too exert an influence on learning, by determining attitude. Sensory defects and physical defects sometimes play a part, also, in producing differences in improvement among those of the same degree of general intellectual capacity. Summary of the Psychology of Learning in the Case of Subnormal Children. We may summarize our present knowledge of the learning process in the feeble-minded thus: (1) The feeble-minded cannot learn as well as the normal of equal chronological age. They cannot learn simple tasks at the same rate, and they cannot learn the more difficult tasks at all. (2) The feeble-minded learn at the same rate, and in the same way, as normal children of equal mental age, in tasks in which both have been experi- mentally tested. 1 (3) There is no necessary relation between ability to learn specific tasks appropriate to a given mental age, and ability to grow from one mental age to another. (4) No difference in amount of transference of training from practice in one task to the performance of other tasks having common elements, has been demonstrated to exist between 1 1 am informed by Dr. S. S. Colyin that the unpublished data from his experiments on the learning of the feeble-minded as compared with normal children of equal mental age, show that the former learned as much as did the latter, in the tasks which were set; but that the learning curves of the feeble-minded were decidedly more irregular in outline than were those of the normal children. HOW DO THE MENTALLY DEFECTIVE LEARN? 187 the feeble-minded and normal children of equal mental age. The spread of improvement is appar- ently the same for both. Implications for Education. The teacher who has thoroughly mastered the results of these studies will be in position to understand many of the most essen- tial principles underlying the educational treatment of subnormal children. In the first place it is ap- parent that no intelligent plan for the instruction of a child can be instituted until his mental level is known. Under ideal conditions this will be deter- mined by the school psychologist, whose work it is to make mental examinations and determine traits and aptitudes. At present only a few state depart- ments of education are equipped to furnish the serv- ices of well trained psychologists. In the larger cities such services are rapidly becoming available, particularly where special classes have been organ- ized. In the second place, the child will generally be ca- pable of performing school work which can be mas- tered by average children of his mental level. If his mental age is eight years, he will be able to learn sub- ject matter becoming to ordinary eight-year-olds. Eight-year-olds are normally in the second or third grade (according to community). However, where special classes have been organized it is usual to prescribe a special curriculum for the subnormal children, since their ultimate achievement 188 PSYCHOLOGY OF SUBNORMAL CHILDREN will be very limited at best. It is a waste of time and effort to teach deficient children the subject matter which underlies the understanding of fractions, or of syntax, when it is known that no matter how long they may live they will never attain a mental level which is capable of learning fractions and syntax. From these practical economic and social considera- tions a modified curriculum has been worked out, and will continue to be worked out as our knowledge of applied psychology increases. The content and or- ganization of this curriculum cannot, however, be determined by psychology, but by educational aims and educational methods, emanating from current social philosophy. REFERENCES 1. Baldwin, B. T., The Learning of Delinquent Adolescent Girls as Shown by a Substitution Test. Journal of Educational Psychology. June, 1913. 2. Colvin, S. S., The Learning Process. The Macmillan Com- pany, New York. 13th ed. 1918. 3. Colvin, S. S., Aspects of the Learning Curve. Proceedings of the American Psychological Association. Psychological Bulle- tin. 1915. 4. Johnson, B., Practice Effects in a Target Test. A Compar- ison of Groups Varying in Intelligence. Psychological Review. July, 1919. 5. Kuhlmann, F., Experimental Studies in Mental Deficiency. American Journal of Psychology. 1904. 6. Murdoch, K., Rate of Improvement of the Feeble-Minded as Shown by Standardized Educational Tests. Journal of Ap- plied Psychology. Sept., 1918. 7. Strong, E. K., The Learning Curve as a Diagnostic Meas- ure of Intelligence. Psychological Bulletin. Vol. XIV, p. 153. 1917. HOW DO THE MENTALLY DEFECTIVE LEARN? 189 8. Thorndike, E. L., The Psychology of Learning. Educa- tional Psychology, Vol. II. Teachers College, Columbia Univer- sity. 1913. 9. Woodrow, H., Practice and Transference in Normal and Feeble-Minded Children. Journal of Educational Psychology. Feb., 1916 and March, 1917. CHAPTER XI CAN THE MENTALLY DEFICIENT BE MADE NORMAL BY ANY SYSTEM OF EDUCATION? Is it Possible to Overcome Mental Deficiency? It has already been stated that the proper treatment of mental deficiency is educational. Science knows of no medical or surgical treatment which has any re- medial effect, except in cretinism, and in those few cases which result from injury to the nervous system in children who were potentially normal. These facts are well stated by Tredgold, who is the most scientific and authoritative writer on the subject among medical men : " In view of the fact that primary amentia to which form the great majority of cases of mental deficiency belong is due to a diminished innate potentiality for development in other words, to a formative defect of the tissue which constitutes the physi- cal basis of mind it is hardly to be expected that medicaments would have any remedial effect, and, as a matter of fact, there is no drug which has the slightest direct or specific influence upon this condition. Cases of secondary amentia, however, stand on a different plane, in that in them the mental defect is not due to an innate blight, but to the fact that development has been handicapped or arrested by some external factor, and where this can be overcome by the administration of drugs, a considerable improvement, or even cure, may be brought about. ... At the same time the cases which may possibly be treated in this way are very few in number, and in the great majority of instances of . 190 CAN MENTAL DEFICIENCY BE OVERCOME? 191 secondary as well as of primary amentia it must be said that drugs have no direct effect. " The same must be said of surgical treatment. When the theory was propounded that microcephalus was due to premature synostosis it was natural that the surgeon should suggest relief by craniectomy. During the year 1890, and for a time after, a considerable number of operations were performed by eminent men. . . . The mortality was exceedingly high (about 25 per cent), and those who survived showed no mental improvement. It is not surprising that the operation should have been gradually abandoned by reputable surgeons, and to-day it is practically unheard of. It was indeed founded upon a mistaken notion of the pathology of this condition, and it may be said that to-day operations of this kind upon cases of primary amentia are abso- lutely unjustifiable." We say that the appropriate treatment of mental deficiency is educational. Do we mean by this that by training we can bring a mental defective up to nor- mal? Or do we mean only that we can improve his condition? And if we can bring about improve- ment, in just what does such improvement consist? These are questions which are asked with burning interest by those who are responsible for subnormal children. Can Innate Capacity for Learning Be Increased? Parents, and indeed all who are interested in the wel- fare of human beings, hope most eagerly for an affirmative answer to this question. Unfortunately the answer of science is a negative one. Centuries ago it was observed that man by taking thought cannot " add one cubit to his stature." Just so, by taking thought no educator can add to the intelli- gence quotient of a defective child. Accident or 192 PSYCHOLOGY OF SUBNORMAL CHILDREN disease may degrade to the level of idiocy an intelli- gence that was potentially normal or superior, but no means has ever been discovered of increasing the intellectual capacity of the inferior and the mediocre. Children in state training schools, whose educa- tion has been scientifically directed, and whose men- tal growth has been carefully studied in the mean- time by psychologists, have not tended to become normal as a result of their training. On the contrary, they show the same very slight and gradual decrease of the intelligence quotient which is shown by sub- normal children in general, as the years of their de- velopment pass. Intelligence, the capacity for learning, the capac- ity for comprehending and making adaptations to the environment, is the result of growth, and can- not be acquired by any course of training. As has been reiterated in these pages, its basis is physiologi- cal, and dependent upon the inherited potentiality of the nervous system to become complex and sensitive. Nervous systems vary in respect to this potentiality, just as eyes vary in color, and teeth in hardness, from individual to individual. Education cannot supply complexity and sensitivity. Education can only di- rect and control such complexity and sensitivity as are constitutionally present in the individual. Fallacies Based on Inadequate Experimentation. Mistaken conclusions have sometimes been drawn in the past by well-meaning persons, without sufficient CAN MENTAL DEFICIENCY BE OVERCOME? 193 knowledge of scientific method. For example, the present writer knows of various cases in which a child has been measured at the beginning of a course of training, and then remeasured at the end of a year or two, and in which the experimenters have enthu- siastically ascribed the rise in mental level found on the last examination to the training undergone in the meantime. The humane desire to demonstrate that " there is hope for such children " has in such in- stances supplanted ideas of scientific procedure. The fact is not considered that mental development would undoubtedly have taken place in the interim, even if the child had had no special training. The question never is, Has development taken place? The question is, Has greater development taken place than would have taken place without the spe- cial education? The investigation of this question may properly be undertaken in either of two ways. The investi- gator may measure a number of feeble-minded sub- jects who are past the age when any spontaneous growth will take place. After measuring them, he may subject them for a long period to whatever edu- cational system he may deem desirable. Thereafter he would remeasure them by the same tests as be- fore or, better still, by a new set having exactly equal value. If the second test showed a real gain in capacity, educational treatment might properly be said to have raised the actual intelligence level, for 194 PSYCHOLOGY OF SUBNORMAL CHILDREN iii adult subjects the improvement could not be ascribed to spontaneous growth. However, it might be deemed that such experi- ments are inconclusive, because the possibility would remain that during years of development growth might be accelerated, though it could not be stimu- lated to begin again in the adult feeble-minded. The second method of inquiry, therefore, would be to take two groups of feeble-minded children of equal initial capacity as measured by standard tests, and after measuring them, to subject one group to the desired system of instruction, letting the other group go free. If at the end of a period of time, upon being remeasured, the instructed group showed a reliable gain over the uninstructed group in mental level, the training could properly be said to have raised the intelligence quotient in and of itself. It is true that psychological experiments as pre- cise and extensive as those here suggested have never been reported. We have only the information that the feeble-minded inmates of state training schools do not tend to become normal as a result of the instruc- tion given them. We have also Dr. Terman's report of repeated measurements of mentally deficient chil- dren in the public schools, which show that they do not tend to improve intellectually as a result of their school training. Thus all the data at present avail- able point in a consistent direction, indicating that educational treatment cannot increase the innate capacity of a child. CAN MENTAL DEFICIENCY BE OVERCOME? 195 What Can Educational Treatment Do for Sub- normal Children? If the actual intellectual level cannot be raised, what are the advantages to be gained by the training of defective children? What is the use of bestowing any educational attention upon them? The answer is to be found in the psy- chology of habit formation. The same considera- tions apply to them that apply to all other children, only with special emphasis in their case, since they will need to be taught many habits which are spon- taneously acquired by ordinary children. It is pos- sible to impart to the feeble-minded specific informa- tion, and to inculcate in them specific habits, up to the limits of their capacity, whereas without skilled training they grow up savage, filthy, antisocial, helpless, a great social burden. It is in these facts that the most important principles of the train- ing of the mentally deficient are grounded. Such improvement as they are capable of must come through education, and their education must be grounded on their capacity for forming specific asso- ciations and specific habits of conduct, up to the limits of their intelligence. To make this clearer let us cite concrete matters. Suppose a teacher to be confronted with a ten-year- old child with an intelligence quotient of 50. She cannot by any educational effort raise him to 70 or 100 intelligence quotient. She can, however, by an educational process teach him to eat with his spoon 196 PSYCHOLOGY OF SUBNORMAL CHILDREN instead of with his fingers; to drink from his glass without spilling the fluid all down the front of his clothing; to comb his hair instead of leaving it a matted and tangled mass; to obey when spoken to, instead of yelling and kicking; and to perform simple manual tasks which will occupy him, and in doing which he may gradually become useful, instead of leaving him to a savage and helpless existence. All of these improvements can be brought about by edu- cation, and by no other means. Even though this child be destined to an ultimate level of only eight years, he may be when adult either a clean, orderly individual, happily occupied with some appropriate work under intelligent guidance, or a helpless, filthy and disorderly person, without any appropriate means of employing his time. Which he shall be de- pends on training, and thus directly upon teachers. In undertaking the education of any child it is wise to learn, if possible, what his stage of mental development is, but with exceptional children this is especially important. Mental level being known, the next step is to begin the formation of habits and the imparting of information suitable to the state of intellect. For example, it would be folly to spend time trying to teach a mentality of four years to read and write. The formation of reading and writ- ing habits is not possible at this level of intelligence. But cleanliness in personal habits, proper ways of feeding oneself, and intelligible speech are all pos- CAN MENTAL DEFICIENCY BE OVERCOME? 197 sible at this level, and can be taught. Thus low- grade imbeciles, who without education would be filthy, unintelligible, and disgusting may be rendered presentable by training, and that without modifying the intelligence quotient in the slightest. The Nature of Improvement in the Feeble- minded. It is in the way just described that im- provement takes place in the feeble-minded. A par- ent or guardian is often highly gratified at the im- provement that is shown by a defective child during a year of residence in one of the very good boarding schools for the feeble-minded, or under the tutelage of a skilled teacher. They find that the child who formerly could not dress himself, speak intelligibly, or write his name is now able to do all of these things, and much more. Their inference almost invariably is that he is " getting brighter." Of course some ac- tual growth will have taken place in the young child, but the improvement which is noted is due to the formation of specific habits, and to the inculcation of specific information, far more than to mental growth. The child is not really " getting brighter " in any true sense. He is simply being trained up to the limits of his capacity. No hope is to be entertained that this newly acquired ability to dress himself where formerly he could not, implies the growth of ability to keep out of trouble on the streets, or to compete successfully with his fellows in school work. Such erroneous inferences are very naturally 198 PSYCHOLOGY OF SUBNORMAL CHILDREN drawn by persons who have no knowledge of the psychological facts. For instance, a very intelligent young woman recently came to consult the present writer about a relative who is mentally defective. This deficient woman is now over thirty years of age, and psychological examination shows her to have a mental age of seven years. The young woman who came to consult about the case felt that mental de- velopment must be taking place in the defective rela- tive, because the latter had now been taught to lace her own shoes since removal to her aunt's home, whereas formerly her mother (now dead) had always been obliged to lace them for her. It was desired to learn whether in view of this improvement it would not ultimately become possible to trust this relative to go about like others, and to be responsible for her affairs. It seemed to her family that since she had now learned to lace her shoes she must be " getting brighter." This difference between intelligence and specific habit is very nicely illustrated in defectives who have been trained by persistent effort to write a certain number of words, but whose mental level does not permit of the formation of general reading and writ- ing habits. Often one finds a defective who can write his name, but little or nothing else. Such a one was Edward, whose performances are illustrated in Figure 19. Asked to write his name he wrote " Edward." Asked then to write " Ed " he grinned CAN MENTAL DEFICIENCY BE OVERCOME? 199 sheepishly, chewed his pencil, muttered, " I can't," but being commanded in a tone of authority to write " Ed," he finally scrawled " cat," which was one of the half-dozen other words which he could fashion. He could not adapt his behavior even slightly, but was able to respond to the new demand only with another specific habit, because he was not Stimulus : Write your name. [ Response: Stimulus : Now write, Ed. Response (after much hesitation) : FIG. 19. Responses of a feeble-minded man who is able to write "Edward," but cannot write "Ed," which he has never been specifically taught to write ; illustrating the fact that specific training is powerless to raise the level of general intelligence. intellectually at a level where such adaptations are possible. Scores of anecdotes are current among students of the feeble-minded which illustrate this power of specific habits in their lives. A feeble-minded man was sent out under the supervision of a farmer to drive a team during the haying season. After a week the farmer reported on his new "help" as follows: " He helps fine. Drives the team back and forth all day long. There's only one thing against him. He 200 PSYCHOLOGY OF SUBNORMAL CHILDREN will go to bed every night at seven o'clock, no matter what happens." In the institution where this man had lived for years, the retiring hour was seven o'clock. The Importance of Early Diagnosis. Since train- ing, consisting in the formation of proper specific habits, is the chief instrument for the improvement of the feeble-minded, it is of first rate importance to make a diagnosis at the earliest possible moment. The hopeful laissez faire notion that the child " will outgrow" his weaknesses is all too frequently held, and parents are encouraged to suppose that their offspring will become normal later in life, most prob- ably at the age of puberty. The primitive myth of a new birth at puberty survives among us in this form. All that is wrong with children is supposed to come right at puberty. Some change of personal- ity is hoped for, whereby the dull will become bright, and the bad will become good during adolescence, though the hope is rarely sustained in the actual ex- periences of life. Over and over we hear the parents of defective children and others interested in their welfare, hoping and believing that all is destined to be corrected later on. The really kind thing in such cases is to disillusion them, for after all it is only the truth that can make them free, in this matter as in others. Take, as an example of wrong management, the case of a feeble-minded woman, first seen by the CAN MENTAL DEFICIENCY BE OVERCOME? 201 present writer at the age of thirty-two years. Her history from the beginning is that of a defective. She was delayed in walking and talking, was never able to behave as other children behave, and could not learn at school. In the early childhood of this in- dividual her parents had been told by the family physician that she would outgrow her peculiarities, that she was a healthy child, only a little slow in developing, but that she would gradually " catch up," and would be all right after adolescence. The parents gladly rested there so far as professional ad- vice was concerned. They were wealthy, and in- sisted on sending their daughter to boarding school in the approved fashion. When she failed to pro- gress there, they hired special teachers of French, music, and other accomplishments to give her private lessons. The result of this unwise procedure was that the girl never learned anything that was suit- able to her intellectual status. Most of the informa- tion and skills that were presented to her for learn- ing were so far beyond her capacity that she might almost as well have remained without instruction. No one thought of such a thing as teaching her to mend stockings, to do plain sewing, to wash dishes nicely, or to weave. She has a mental level of eight years, and could have learned all these things. But French syntax has utterly escaped her, and she has not mastered even the simplest melodies on the piano. It was not until after the death of both her 202 PSYCHOLOGY OF SUBNORMAL CHILDREN parents that a sensible relative took her in charge, and secured instruction for her that was suited to her intellectual capacity, as scientifically ascertained. Being suitably occupied, she soon ceased to be de- structive and ill-tempered, as she had been. An example on a large scale of the evils of failure to identify the mentally defective during early child- hood was offered some years ago by an investigation carried out at the Municipal Lodging House in New York City. This lodging house is conducted by the Department of Public Charities, and persons who find themselves shelterless and without means are at lib- erty to apply there for supper and bed. In the win- ter of 1914 two thousand successive applicants for shelter were examined physically and mentally. One in eight of the men applying was found to be so low intellectually as to be technically designated feeble-minded. Of these practically none had ever had any training in industrial processes, or in any kind of manual work. They were all " unskilled labor," having spent, on an average, several years in the public schools trying to learn the usual school subjects which they could not grasp. Their educa- tion had thus been almost wholly neglected by the state, which at the same time had spent much money offering them a training they could not use. Ability to Learn versus Ability to Grow. From all of the foregoing discussion of this chapter it will be seen that we must make a clear distinction between CAN MENTAL DEFICIENCY BE OVERCOME? 203 ability to learn specific habits appropriate to a given intellectual level, and ability to change from that intellectual level to one higher. The former does not imply the latter, and of this fact those directing edu- cational policy are becoming increasingly cognizant, as is shown by the widespread movement for the establishment of special classes in many communi- ties. The First Recorded Experiment in the Education of a Mental Defective. Bonaterre, Professor of Nat- ural History in the Central School of the Department of Aveyron, France, reported in the year 1799 the case of a boy found in the woods, without language and behaving like a savage. Bonaterre took a philo- sophical interest in the lad, thinking that, " A phe- nomenon like this would furnish, to philosophy and natural history important notions on the original constitution of man, and on the development of his primitive faculties; provided that the state of imbe- cility we have noticed in this child does not offer an obstacle to his instruction." It eventually came about that Itard, a French physician whose professional interest was in deaf mutes, undertook the training of the boy, believing him to be simply " savage," and dissenting from the idea that he was an " idiot." His purpose was " to solve the metaphysical problem of determining what might be the degree of intelligence and the nature of the ideas in a lad, who, deprived from birth of all 204 PSYCHOLOGY OF SUBNORMAL CHILDREN education, should have lived entirely separated from the individuals of his kind." For more than a year Itard proceeded upon the as- sumption that he could educate the " savage," but later he became convinced that his diagnosis was in error, for he was unable to make a normal human be- ing out of his pupil. At last abandoning hope of developing a normal intelligence in his charge by education, he exclaimed, " Unfortunate ! Since my pains are lost, and my efforts fruitless, take yourself back to your forests and primitive tastes." It seemed to him at that moment, apparently, that all his labor had gone for naught. However, when the " savage " was brought again before The French Academy, the members of which had seen the lad in his former state, before his education had been under- taken, there was astonishment at the amount of im- provement evident. Itard had brought about cer- tain noticeable changes in the habits of the boy, es- pecially in regard to simple matters like sleeping and eating, though he had not affected his general in- telligence. Thus the first recorded experiment in the education of a mental defective was of the greatest significance for the teachers of subsequent times, though its importance was not fully realized by those who carried it out. It ended as all such undertakings end, by inculcating specific desirable habits in the child, up to the limits of his native capacity, CAN MENTAL DEFICIENCY BE OVERCOME? 205 without changing that native capacity. This is all that education can do for any child, normal, subnor- mal or supernormal. Itard never carried his work further, but his pupil, Seguin, of whom we have already spoken, based his physiological method on the beginnings that Itard had made. REFERENCES 1. Barr, M. W., The How, the Why, and the Wherefore of the Training of Feeble-Minded Children. Journal of Psycho-Asthen- ics. Sept., 1899. 2. Bonaterre, Notice Historique sur le Sauvage de 1'Avey- ron. Paris. 1799. 3. Itard, J., De 1'Education d'un Homme Sauvage. Paris. 1801. 4. Williams, G., The Problem of Restoration; A Clinical Study. University of Pennsylvania. 1918. CHAPTER XII THE CAUSES AND THE PREVENTION OF MENTAL DEFICIENCY Prevention of Mental Deficiency Must be Based Upon Knowledge of Its Causes. We study mentally defective children in order that we may improve as much as possible those whom we find among us, but we also study them in order to learn how we may re- duce their number in future generations. There has been much argument as to whether there is a place for mentally defective persons in a democratic so- ciety. It has been contended that in a democracy it is highly undesirable that there should be a con- siderable body of persons who are incapable by orig- inal nature of ever attaining economic or intellec- tual independence, even though they be well trained in the performance of automatic, routine tasks. Others argue that society needs the services of the defectives. There are and probably always will be multitudes of simple, routine tasks, which require for their performance only such abilities as the feeble-minded have. To those who take this view, it seems a veritable social blessing that there are large numbers of persons in the world who can do this es- sential monotonous work and find satisfaction in it. 206 THE PREVENTION OF MENTAL DEFICIENCY 207 As one writer says, " They are the world's hewers of wood and drawers of water," who are fitted by original nature for this routine labor, from which they free the strong and able for the progress of the majority of mankind. Whichever of these views may finally prevail, certain it is that a revision of the prevalent concept of democracy will be involved. When our fore- fathers believed that men were created free and equal, no psychological laboratories had been es- tablished. During the past century we have learned that all men are, as a matter of biological fact, created unequal. All that a democratic society can do is to equalize opportunity; it cannot equalize men. All that a democratic school can do is to equalize oppor- tunity; it cannot equalize the children. The most serious objection to the view of those who claim for the subnormal a legitimate place in the social order is that which was discussed in the chapter on instinct and emotion. It is true that all defectives above a mental level of six or seven years might well claim inclusion in the social order on the basis of sufficient usefulness. The great diffi- culty is that they are " irresponsible," incapable of participating in the moral and ethical ideals of the community. They fall prey over and over again to impulse, and this is inevitable, since they lack that intelligence which in the average person rules and guides conduct. 208 PSYCHOLOGY OF SUBNORMAL CHILDREN Psychology cannot, however, solve all of these economic, social, and political problems, which are raised by the mental defectives it has revealed. A certain writer has said reproachfully, " They (the psychologists) are responsible for the feeble-minded becoming a problem." Perhaps psychologists would hesitate to assume this responsibility. Certainly the solution of the problem rests with society as a whole, especially with educators, economists, social workers, jurists, the clergy, and organized labor. Psycholo- gists can but identify the deficient, and give infor- mation as to the causes of deficiency. Heredity and Variation. The great majority of the subnormal originate no doubt in the same way in which all grades of intellect originate, the normal and the supernormal also, namely, according to the biological law that like produces like, but not identical. The principle that like produces like we call heredity. The principle that offspring is never identical with parents we call variation. Subnormal parents tend to produce subnormal offspring just as superior parents tend to produce superior offspring, and mediocre parents tend to produce mediocre off- spring. The question is not, Why should it be thus? The astonishing thing would be if it should be other- wise. We have been long accustomed to recognize this principle in the case of plants and animals, and in physical characteristics in the case of human be- ings. Research shows that the same principle holds for mental traits as well. THE PREVENTION OF MENTAL DEFICIENCY 209 Although offspring resemble their own parents and each other much more closely than they resemble parents and offspring chosen at random, brothers and sisters are never identical with their parents nor with each other. Even twins who very closely re- semble each other will be seen to be somewhat dis- similar if scrutinized and measured, both physically and mentally. Why organisms should vary from type instead of being all identical, like bolts cast in a mold, we do not know. Much speculation has gone on in the matter, and much research has been carried out, yet the fundamental causes underlying variation remain largely unknown. We know neither how to control nor how to produce variations. Samples of Studies in the Heredity of Mental De- fect. The role played by heredity in the production of feeble-mindedness has been shown repeatedly by the students of the subject. These studies have now, indeed, become sufficiently numerous and sufficiently well known to have made a considerable impression upon people in general, who have undertaken no systematic study of the subject. Dugdale, with his report on the Jukes Family, was a pioneer in this field. Briefly, Dugdale's study embraced the mem- bers of a degenerate family, whom he called " The Jukes/' for seven generations. His description is as follows : " Between the years 1720 and 1740 was born a man who shall herein be called Max. He was a descendant of the early Dutch p 210 PSYCHOLOGY OF SUBNORMAL CHILDREN settlers, and lived much as the backwoodsmen upon our frontiers do now. He is described as a ' hunter and fisher, a hard drinker, jolly and companionable, averse to steady toil,' working hard by spurts, and idling by turns, becoming blind in his old age, and entailing his blindness upon his children and grandchildren. He had numerous progeny, some of them almost certainly illegiti- mate. Two of his sons married two out of six sisters (called Jukes in these pages) who were born between the years 1740 and 1770, but whose parentage has not been absolutely ascertained. The probability is they were not full sisters, that some, if not all of them were illegitimate. The family name, in two cases, is obscure, which accords with the supposition that at least two of the women were half sisters to the other four, the legitimate daughters bearing the family name, the illegitimate keeping the mother's name, or adopting that of the reputed father. Five of these women in the first generation were married; the sixth one it has been impossible to trace, for she moved out of the country. Of the five that are known, three have had illegitimate children before marriage. One who is called in these pages Ada Juke, but who is better known as Margaret, the mother of crim- inals, had one illegitimate son, who is the progenitor of the dis- tinctively criminal line. Another sister had two illegitimate sons, who appear to have had no children. A third sister had four, three boys and one girl, the three oldest children being mulat- toes, and the youngest white. The fourth sister is reputed chaste, while no information could be gathered respecting the fifth in this respect, but she was the mother of one of the distinctively pauperized lines, and married one of the sons of Max. The prog- eny of these five has been traced with more or less exactness through five generations, thus making total heredity which has been enrolled stretch over seven generations, if we count Max as the first. The number of descendants registered includes 540 individuals who are related by blood to the Jukes, and 169 by marriage or cohabitation; in all, 709 persons of all ages, alive and dead. The aggregate of this lineage reaches probably 1200 per- sons, but the dispersions that have occurred at different times have prevented the following up and enumeration of many of the lateral branches." THE PREVENTION OF MENTAL DEFICIENCY 211 Dugdale then proceeds to show that crime, pauper- ism, prostitution, vagrancy, illegitimacy, and all forms of social disorder arose in the descendants of these Jukes. Many of them he calls " idiotic " or " weak-minded," but the date of publication of the study tells us that Dugdale would be unlikely to have any clear ideas as to the real relationship between the behavior of the Jukes and their probable mental status. Dugdale's thesis was that forms of behavior, crim- inal tendencies and pauperism, are hereditary; that undesirable traits are " bred in the bone." His book was published in 1877. He was a member of the Executive Committee of the Prison Association of New York, and it was as a student of crime that he undertook his investigations. The influence of his work has been very far-reaching, for it was, as previously said, a pioneer in its field. It was first published as a part of the thirtieth annual report of the Prison Association of New York. We are told by one of his associates that, " Like all men who think in advance of their fellows, Mr. Dugdale suffered from want of public support and approbation." Within recent years many scientific workers have followed the path he pointed out, and we now have studies of "The Nams," "The Pineys," "The Hill Folk," " The Zero Family," " The Family of Sam Sixty," and "The Kallikaks." These studies are all more or less closely modeled on " The Jukes." The method of investigation is to send out field 212 PSYCHOLOGY OF SUBNORMAL CHILDREN workers, who trace out as many relatives of the stock being investigated as possible, and gather information as to their status and characteristics by questioning, interviewing the persons themselves, and making inquiries of neighbors, "oldest living inhabitants," and the like. In 1915 an investigator, Dr. Esta- brook, brought "The Jukes" up to date, showing their descendants in this generation to have the same characteristics as those described in their an- cestors by Dugdale in 1877. " For the past 130 years they (the Jukes) have increased from five sisters to a family which numbers 2094 people, of whom 1258 were living in 1915. One half of the Jukes were and are feeble- minded, mentally incapable of responding normally to the expec- tations of society, brought up under faulty environmental condi- tions, which they consider normal, satisfied with the fulfillment of natural passions and desires, and with no ambitions or ideals in life. The other half, perhaps normal mentally and emotionally, has become socially adequate or inadequate, depending on the chance of the individual reaching or failing to reach an environ- ment, which would mold and stimulate his inherited social traits." In a detailed estimate of crime, pauperism, disease, and debauchery, Estabrook estimates that the de- scendants of the five Juke sisters have cost the tax- payers of the communities where they have resided, about $2,516,685 in money, aside from the trouble and contamination of which they have been the source. One of the most widely known of similar studies is that of the Kallikaks, reported by Dr. Goddard. Martin Kallikak, a soldier in the Revolutionary war, THE PREVENTION OF MENTAL DEFICIENCY 213 had an illegitimate son by a feeble-minded girl, whom he met in a tavern. In 1912 there were 480 trace- able descendants of this union, 143 of whom were known as feeble-minded, and many others of whom were of questionable mentality. The anti-social con- duct of these descendants makes a long history. After his return from the war, Martin Kallikak married a girl of good family. Of the descendants of this union 496 individuals were traced. No feeble-minded person was found among them. On the contrary, lawyers, educators, traders, physicians, and landowners predominated among them, and there were no criminals. It detracts somewhat from the value of these studies that they rest upon the opinions of neighbors and field workers to so great an extent, and that mental deficiency has to be inferred from undesirable behavior. There still remains to be made a study of equal scope, in which all relatives shall actually be measured intellectually, by the psychological method. Mental Deficiency is Inherited. There is now no competent student of the heredity and transmission of mental traits who would dissent from the state- ment that feeble-mindedness is hereditary. Feeble- minded and neuropathic parents produce feeble- minded offspring. Heredity is the source of most of the mental deficiency with which the social order is burdened. This conclusion rests not only upon studies of the ancestry of subnormal children, but 214 PSYCHOLOGY OF SUBNORMAL CHILDREN also upon studies of the ancestry of average and of superior persons, both children and adults. In a re- moter sense it rests, furthermore, upon studies of the heredity of physical and motor characteristics of an- imals, and even upon the study of inheritance in plants. Throughout organic nature we find experi- mentally the operation of the law that " like pro- duces like." Subnormal children are so, because they spring from the inferior germ-plasm of an infe- rior ancestry. Usually the parents themselves show the inferior mental traits, but occasionally the infe- riority is found among grandparents, or other remote progenitors, the parents themselves being of normal ability. The Nature of Heredity. This possibility of the inheritance of mental deficiency from an ancestor more remote than the parents exists because of the nature of inheritance. Persons who have made no close study of the subject usually assume that chil- dren spring from their parents' bodies and minds. The blood has been thought to be particularly in- volved, as is shown in such expressions as " He came of bad blood," " She came of such-and-such blood," " The blood of so-and-so flows in their veins." The science of biology has revealed, however, that chil- dren spring not from their parents' bodies and minds, nor from their blood, but from the germ-plasm of which their parents are merely the carriers. This germ-plasm, in the form of ova and spermatozoa, THE PREVENTION OF MENTAL DEFICIENCY 215 - C5 C O 03 ' T3 ' 216 PSYCHOLOGY OF SUBNORMAL CHILDREN is continuous from generation to generation. The body of the adult organism does not manufacture germ cells, upon which it impresses various influences contributed by other cells, such as the nerve cells, the blood cells, the cells of the muscles, and so forth. Conklin has stated these facts with admirable clar- ity as follows : " Thus the problem which faces the student of heredity has been cut in two; he no longer inquires how the body produces the germ cells, for this does not happen, but merely how the latter produce the body and other germ cells. The germ is the unde- veloped organism which forms the bond between successive gen- erations; the body is the developed organism which arises from the germ under the influence of environmental conditions. The body develops and dies in each generation ; the germ-plasm is the continuous stream of living substance which connects all gen- erations. The body nourishes and protects the germ; it is the carrier of the germ-plasm, the mortal trustee of an immortal substance." Our knowledge of these principles is due largely to the researches of the biologist Weismann. Since children are not in a fundamental sense the product of their parents' bodies and minds, but of the germ- plasm which is continuous from generation to gener- ation, and of which their parents are merely the temporary carriers, it follows that children may re- semble remote ancestors, who were products of this same continuous germ-plasm. Which ancestors an unborn child will most resemble it is almost wholly impossible to predict in the present state of knowl- edge. THE PREVENTION OF MENTAL DEFICIENCY 217 Parents who are ill-informed concerning the prin- ciples which have just been stated, often undertake to determine the traits of unborn children by exer- cising their own minds and bodies in various ways. For example, the writer has among her acquaintances an intelligent, but uninformed woman, who read political dissertations throughout the months of pregnancy, because she and her husband desired a son who would have a political career. Another be- lieves that her child was born with a red mark on his finger because she cut her own finger previous to his birth. Such beliefs have no foundation in fact. Pre-natal influences of this character do not exist. The only possible influence which the parental body, including the nervous system, can exercise upon the germ-plasm, or upon the developing embryo, is by interfering with its nourishment, or by poisoning it with chemical toxins. There are many other complicated questions about the nature of heredity, which at present occupy much of the research time of scientific thinkers. All traits are not inherited according to the same laws. For instance, certain traits in human beings appear to be Mendelian, so called because they are inherited ac- cording to the laws which were discovered by Gregor Mendel to hold in the case of peas. Such a trait, apparently, is eye-color. If a member of a blue-eyed family mates with a member of a brown-eyed family, the descendants do not have eyes which are a mixture 218 PSYCHOLOGY OF SUBNORMAL CHILDREN of blue and brown. Their eyes are either brown or blue, according to the combinations of eye-color found in subsequent matings from generation to gen- eration, but they do not eventuate in a new blue- brown blend of eye-color. On the other hand, skin- color seems to follow a different law. If a member of a black-skinned race mates with a member of a white- skinned race, the result is the brown skin of the mu- latto. Here we have a blend of qualities, giving us an intermediate condition. Very much discussion has gone on among those best qualified to consider the question, as to whether mental deficiency is in- herited according to the Mendelian law, according to the law of blending, or according to some still differ- ent law, at present not suspected. No agreement has been reached, for research is not yet sufficiently ex- tensive. It is known that mental deficiency is trans- missible through the germ-plasm, but according to what formula we do not know. Alleged and Possible Causes of Deviation in the Direction of Subnormality. It has been stated that children are never identical with any ancestor. It is one of the marvelous facts about every human being that he is absolutely unique in the history of the race. There has never been another exactly like him, and there will never be another identical with him. It was also stated that we do not understand the laws governing these deviations, and cannot predict in what direction an unborn child will vary from the THE PREVENTION OP MENTAL DEFICIENCY 219 mental and physical status of his parents. Various theories have, however, been advanced in the at- tempt to explain mental deviations in the direction of subnormality as the result of influences external to the germ-plasm, acting either before or after the conception of the individual. Advocates of these theories believe that by removing the supposed ex- ternal causes of subnormality, we might solve the problem of mental deficiency without becoming in- volved in the troublesome ethical and social consid- erations which arise with the question of preventing procreation by the unfit. It will be profitable to ex- amine these theories at some length. Alcoholism and Other Conditions in the Parents. It is possible that chemical changes in the bodies of human beings may affect the germ-plasm of which they are the carriers. Such conditions as lead-pois- oning, alcoholism, chronic disease, partial starvation, might conceivably vitiate a potentially normal germ- plasm in such a way that mentally inferior children would be produced in consequence. That such conditions actually, do have such con- sequences has never been scientifically demonstrated. It is impossible to experiment with human beings be- cause they breed so slowly, and because there is a strong prejudice against biological experimentation on mankind. Thus, all we have that bears upon our question in the case of human beings is a collection of anecdotes, some of which show that a chronically 220 PSYCHOLOGY OF SUBNORMAL CHILDREN ill, alcoholic, badly-nourished, or over-fatigued par- ent produced a feeble-minded child ; others of which show that another parent, affected in the same man- ner, produced a superior child. No conclusions whatever can be drawn from such material. Similarly valueless are the statistics which show that many parents of feeble-minded children are al- coholic. It is not permissible to conclude that one phenomenon is the cause of the other, simply be- cause they accompany each other. Indeed, it is most reasonable to infer that feeble-mindedness causes alcoholism, and that the parents of feeble-minded children are alcoholic because they are mentally de- ficient, and unable to perceive or to appreciate the poverty, misery, and general ruin which drunkenness brings. Experiments like those which Dr. Stockard has performed in the alcoholization of guinea-pigs are very suggestive in this connection. Here adult guinea-pigs of both sexes were subjected to the fumes of alcohol, and it was found that their offspring were greatjy reduced in number, with many stillbirths, and were weak and sickly. Though it is a long leap from the physical life of guinea-pigs to the mental life of man, such experiments suggest that we may sometime find chemical properties of the parental body to be influences making for devia- tion in the direction of subnormality. Sensory Defects. It is not very unusual to read THE PREVENTION OF MENTAL DEFICIENCY 221 that mental deficiency has been overcome in some child by the simple expedient of fitting him with glasses. What is meant in these cases is that the child was able to go forward in school, and improved in conduct after being fitted with glasses. School work and conduct are dependent upon eye-strain as well as upon innate intelligence, and may be modified by relieving the former, without reference to any change whatever in the latter. An inferior intelli- gence cannot be improved by correcting a sensory de- fect. On the other hand, it is a question as to how much, if at all, a good intelligence may be hindered from developing by the lack of a means of contact with the objective world. Psychologists are gradually accumulating information about the intelligence of the blind and the deaf and dumb, but no systematic body of knowledge is as yet available. In general it appears in mental tests that children who suffer from severe sensory defects, total blindness or total deafness, are somewhat behind seeing and hearing children in their mental development; that total deprivation of a special sense is an influence making for subnormality in intelligence. Slight sensory de- fects probably have no effect, as they are found among children of all degrees of intelligence, among the very superior as well as among the very deficient. Dental Caries, and Defects of the Teeth. Bad teeth have been alleged as a possible cause of mental 222 PSYCHOLOGY OF SUBNORMAL CHILDREN subnormality. As in the case of eye defects, it has been said that intellectual deficiency may be cor- rected by proper dental treatment, the statement resting on the fact that school work and conduct have been improved thereby. Since school work and conduct may be seriously interfered with by toothache, it follows that both may improve greatly after the teeth have been repaired, without refer- ence to any modification of the intelligence. In order to determine the effects of any physical condition on mental conditions, it is necessary to carry out systematic and carefully controlled experi- ments on children whose intelligence has been ac- curately measured, including always the precaution of the " control group," (as seen in the case of Woodrow's experiments on learning). The only actual experiments which have been made in the attempt to determine the influence of dental condi- tions upon mental subnormality have, unfortunately, neglected the check of the " control group," so that the results cannot be interpreted. These were experi- ments performed on twenty-seven children, who were suffering from disorders of the teeth and gums. Be- fore treatment they were given five psychological tests. During the course of the treatment and after its termination, the same five tests were given four times, in only slightly modified form. The last trial showed very great improvement over the first trials, but we are by no means justified in concluding that THE PREVENTION OF MENTAL DEFICIENCY 223 the correction of dental disorders had an influence in bringing about this improvement. We know from the psychology of practice and learning that these children would have done much better on the last trial than on the first trial even if their teeth had never been treated. All of the improvement may well be due to practice. This investigation should be repeated, using at the same time a " control group " of children of equal ability, suffering to an equal extent from the same kind of dental disorders, who should take the tests exactly as the children who undergo treatment do, but who should not themselves be treated during the course of the experiment. If the treated group showed a reliably greater improvement than the " control group," we should be justified in concluding that the difference must be ascribed to the correction of dental conditions. It is therefore an entirely open question whether carious teeth may exert an influence making for sub- normality in intelligence, as children develop. That such is the case seems scarcely probable in view of the fact that a large percentage of children of very superior intelligence are found to be affected in this way. Tonsils and Adenoids. Some years ago the re- moval of tonsils and adenoids was advocated by cer- tain enthusiastic persons as a remedy for mental de- ficiency. Many parents of feeble-minded children 224 PSYCHOLOGY OF SUBNORMAL CHILDREN were led to believe that the removal of these portions of the anatomy would result in normal intellectual development, and the present writer has repeatedly been a witness to the bitter disappointment and re- sentment of parents, who for years had cherished the false belief that a deficient child would be " cured " by this operation. The conduct and school work of a child are fre- quently improved by the excision of tonsils and ade- noids, for a child will usually apply himself more ef- fectually to tasks demanding effort if he is physically comfortable. But no scientific evidence exists to show that this operation ever has the slightest effect on the intelligence quotient. Any statement of value would necessarily be based on experiments con- ducted by the method suggested in the case of carious teeth, and such experiments have never been per- formed. The fact that adenoids and abnormal ton- sils are found with as great frequency among average and superior children as among subnormal children gives a priori reason for supposing that experiment would reveal no connection between intelligence and tonsils and adenoids, although between school prog- ress and the latter a connection might well exist. Malnutrition. Malnutrition is frequently alleged as a cause of mental backwardness, and indeed mal- nutrition and ansemia are undoubtedly capable of producing a listlessness and inattention which con- duce to poor school work, and hence to retardation THE PREVENTION OF MENTAL DEFICIENCY 225 in school status. However, here, as in the case of other physical defects, we have no scientific experi- ments to guide our conclusions. We do not know as a scientific fact that malnutrition can affect the intelligence quotient of a child in the slightest de- gree. The proponents of the theory that such an effect will be demonstrated, point out that all tissues of the body are susceptible to starvation, and it is only rea- sonable to suppose that the nervous system, being a tissue of the body, is no exception to the rule. Noth- ing is proved, however, by this kind of thinking, for it may well be that the tissues of the body nour- ish themselves selectively upon the available food; so that the nervous system might grow and function at the expense of other tissues. Recently Dr. Blanton has made an attempt to ap- proach this question scientifically. Among school children in Trier, Germany, who had suffered severely from malnutrition during the war, a decided increase in scholastic retardation was found. Upon inquiry a large number of children were considered by rek- tors or teachers as probably subnormal intellectually. The direct examination of intelligence by psycholog- ical methods is given for thirty children, who had suffered severely from lack of food, but from whose personal and family history a normal intelligence would be expected. It is not possible to base re- liable statements upon thirty cases, in attempting to Q compare the distribution of these children with the normal curve. Nevertheless, it is of interest to know that so far as the figures go, the result showed no de- viation from normal expectation. Of the thirty chil- dren selected as described, twenty-three fell within the norm; while three showed superior intelligence, and four showed intelligence below the average, fall- ing between eighty IQ and ninety IQ. This is what we should expect among well-nourished children so selected, anywhere. The investigator concludes that malnutrition ex- tending over a period of two years causes decrease in nervous and physical energy, and changes in the atti- tude of children toward school work, but that chil- dren of superior or average intelligence can withstand malnutrition of even a serious degree, extending over more than two years, without any impairment of the intelligence. He adds that " children of poor or in- ferior intelligence suffer a general and sometimes per- manent lowering of the whole intelligence level, from even a moderate degree of malnutrition." This lat- ter statement does not, however, rest upon any ac- ceptable objective evidence presented. The results from the thirty children objectively measured do not furnish a basis for the inference, since it would be quite as logical to attribute the superior intelligence unexpectedly found among them to malnutrition, as to attribute the inferior intelligence unexpectedly found to this cause. THE PREVENTION OF MENTAL DEFICIENCY 227 Of course a great many of the subnormal children who are examined in schools and on clinics are un- der-nourished, but it would be very unscientific to conclude from this fact that malnutrition caused the mental dullness. The most reasonable interpreta- tion of such correlation as may exist between malnu- trition and mental deficiency is that mentally infe- rior parents produce mentally inferior children, and at the same time are unable, on account of their in- efficiency, to provide adequate food for them. We should expect, of course, that because of the laws of heredity stupid children will be ill-nourished more often than intelligent children. The same remarks would apply to the supposition that mental defi- ciency may be caused by poor home conditions. Institutional Life. Another cause of low intelli- gence that is alleged repeatedly in diagnoses is in- stitutional life. A child is said to be " retarded, due to institutional life." A prospective adoptive par- ent, seeking professional advice, is told that he will be doing well to take the child, for though he is one or two or three years below the norm in intelligence, this is " due to institutional life," and he will be- come " a bright child " once he is out of the insti- tution. Here obviously we have to deal with the familiar fallacy. We should expect that " institutional life " and mental subnormality will frequently occur to- gether, not because orphanages produce deficiency in 228 PSYCHOLOGY OF SUBNORMAL CHILDREN children, but because of the laws of heredity. Dull parents are unable to provide properly for their children, and they also feel less responsibility for their offspring than do intelligent parents. Hence their dull offspring are many times more likely to become the wards of charitable institutions than are the children of competent, intelligent parents. By these remarks we do not, of course, understand that there are no normal and superior children in or- phanages. There are many, for accident sometimes carries off very young parents, who have not yet had a chance to establish economic security, and whose relatives are in other lands. Sometimes illegitimate children are left at the doors of foundling asylums, whose parents are of good intelligence, but wish to avoid social disapprobation. A great disaster like a war or an epidemic operates to fill orphanages with children of good quality. Sometimes parents of good intelligence are physically weak, and for this reason are compelled to give their children over as public charges. Thus we do find children of all degrees of intelligence in institutions. The median for chil- dren in institutions is, however, distinctly below the median for children chosen at random, and the chances of finding subnormal children as dependent are very great. In order to determine scientifically the effects of institutional life as contrasted with good home con- ditions upon the intelligence quotients of children, THE PREVENTION OF MENTAL DEFICIENCY 229 it would be necessary to take a large number of young children with high intelligence quotients, and subject them to institutional life for a term of years, to see whether they became reduced below their original status. Similarly it would be necessary to take a large number of young subnormal children from in- stitutions, and subject them to the influences of good home conditions for a term of years, in order to see whether they would thus be raised toward normality. No one has ever performed this crucial experiment, although the latter half of it might easily be under- taken by a psychologist connected with a bureau of child- welfare. Hookworm and Malaria. In the case of hook- worm and malaria among the children of the South in the United States, psychologists have carried out some experimental investigation. In 1916 the In- ternational Health Commission published the report of psychological investigations by Dr. E. K. Strong, Jr., in which all the essentials of scientific method were carefully observed. Mental tests were given to four groups of school children, (A) uninfected chil- dren, (B) children infected and not treated, (C) chil- dren treated and completely cured, and (Z)) children treated but not completely cured. These children were all tested psychologically be- fore any treatment whatever was instituted, and were re-tested at the expiration of .3 of a year. The re- sults of the study are difficult to interpret, as 230 PSYCHOLOGY OF SUBNORMAL CHILDREN contradictory tendencies are shown in the various tests employed. In opposites, logical memory, mem- ory span, and handwriting the infected, but not treated, (group 5), were decidedly inferior to the treated and cured groups in the amount of improve- ment shown in .3 of a year. In calculation, form- board ability, and general intelligence the infected, but not treated, (group 5), surpassed the treated and cured groups in amount of improvement during the interval. When the percentages of gain in all the tests given are tabulated, the result is as shown in the following table: SHOWING THE GAIN IN EACH OF SEVEN MENTAL TESTS FOB THE FOUR GROUPS OF CHILDREN (Strong) A'B C'8 D'a B's Opposites 24.2% 3.0% 13.1% 29% Calculation 27.0 20.5 12.5 25.5 Logical Memory 54.5 36.6 18.1 14.4 Memory Span 5.2 3.7 2.7 -6.5 Handwriting . 1.2 1.6 -10.9 -9.8 Form-Board . 9.3 5.8 5.2 9.0 Binet-Simon . 2.0 2.3 5.4 5.6 17.6 10.5 6.6 5.9 Ratios 100 60 38 34 When the results from all the tests are combined as above, the average shows that the infected and not treated group (group B) is decidedly behind the treated and cured group (group C) in amount of im- THE PREVENTION OF MENTAL DEFICIENCY 231 provement over a period of .3 of a year. It is ques- tionable, however, whether it is legitimate to combine the results from the Binet-Simon Measuring Scale for Intelligence in this manner with the other single tests, because it is not a test, but a combination of many tests, and the results from it are much more reliable for this reason than are the results of any single test. On the Binet-Simon Measuring Scale the results were as follows : THE AVERAGE AGE, BOTH ACTUAL AND MENTAL, OP CHILDREN TREATED AND NOT TREATED FOR HOOKWORM, TOGETHER WITH THE GAIN MADE DURING A PERIOD OP .3 OP A YEAR (Strong) GROUPS A's C's D's B's Time of Exam. before after b. a. b. a. b. a. No. of Cases . . 18 18 26 26 17 17 9 9 Av. Act. Age . . 11.1 11.4 10.9 11.2 11.1 11.4 10.6 10.9 Av. Ment. Age 10.1 10.2 9.3 9.6 8.9 9.4 9.4 10.0 Gain Act. Age . . 0.3 0.3 0.3 l_ _ 0.3 Gain Ment. Age . 0.1 0.3 0.5 .... 0.6 The figures show that the infected children who were not treated made a greater gain in the develop- ment of general intelligence than did those who were treated and cured. It is true that this experiment extended over a very short time, and it is possible that the lapse of a year or of two years might show a more impressive 232 PSYCHOLOGY OF SUBNORMAL CHILDREN gain in those treated and cured. Dr. T. L. Kelley made a similar experiment with school children in the State of Texas, using educational tests instead of mental tests. His experiment extended over six months, and he investigated the effects of malaria as well as the effects of hookworm. Unfortunately no group corresponding to group B in Dr. Strong's ex- periment was used by Dr. Kelley, so that it cannot be stated in connection with his work what amount of gain would have been made in the educational tests by a group of children infected with malaria or with hookworm, but not treated. It can only be stated that children cured of disease gained in these tests slightly more than did children tested in the same manner and on the same occasions, who had not been infected at all with the diseases under investigation. From this it is suggested that hookworm and malaria are influences making for retardation in school sub- jects, since when they are removed there is a greater gain than with healthy children. The influence shown is not great, however, and not entirely consist- ent, as in the Courtis Tests in the fundamentals of arithmetic the cured-of-disease group showed less im- provement than did children who had never had the diseases, and from whom no such handicap was there- fore removed. The Experimental Literature on the Relation be- tween Physical and Mental Is Very Meager. The investigations of hookworm and malaria outlined THE PREVENTION OF MENTAL DEFICIENCY 233 above, have been considered at length because they are samples of the kind of laborious work that must be done before any body of truth can become avail- able on the subject of the influence of physical con- ditions upon the development of intelligence. In no branch of child study is research more needed and at the same time more conspicuously lacking. General discussion, both printed and oral, abounds, but gen- eral discussion is of no value except in so far as it may be the preliminary to objective and controlled experimentation. The subjective opinion of a physician who treats a physical disorder, as to the amount of mental de- velopment taking place in consequence, is not at all reliable. He is limited by the same laws which gov- ern all human psychology. He will be almost cer- tain to see improvement, where he is persuaded that it should and does exist. Nothing is reliable except objective measurements, made by trained persons, and these have been recorded in only a few instances. The lack of data does not, of course, prevent a great number of positive statements from being made. Every specialist tends to believe that the remedy for mental subnormality lies in curing the physical or social conditions which lie within his own field. What we must demand from all who speak is not their opinion, however, but objective measure- ments made by competent experts. It is necessary 234 PSYCHOLOGY OF SUBNORMAL CHILDREN for us all to bear continually in mind the nature of evidence, so that we may not be misled by anecdotes. Children of Very Superior Intelligence Also Have Physical Defects. One fact which renders doubtful the hope that we shall be able to overcome mental subnormality to any very marked extent by the cor- rection of physical defects is that we find these phys- ical defects among children of the very highest in- telligence, as well as among those who are the most inferior. Among twenty-five public school pupils chosen by mental tests to form a special class for gifted children, the following physical defects were subsequently found: Physically perfect 6 Carious teeth 9 Enlarged tonsils 5 Defective nasal breathing . . . . 2 Orthopedic defects 2 Malnutrition 9 Overweight 2 The intelligence quotients and the number of grades covered in one term by the children having these physical defects appear in the table on the fol- lowing page. The median IQ is seen to be 137. The median grade progress is 2 grades for the term. One would be laughed out of court who would undertake to prove the very superior intelligence of these children to be due to their carious teeth, THE PREVENTION OF MENTAL DEFICIENCY 235 enlarged tonsils, malnutrition, and so forth. And yet the same array of data in the case of the subnormal has sometimes led to an inference as inadmissible. The fact is that we find physical defects scattered throughout the whole range of intelligence, and the relation between the two is almost wholly unknown, except in the case of neurological disorders. AGE, IQ's, AND GRADE PROGRESS OP CHILDREN HAVING THE PHYSICAL DEFECTS LISTED ABOVE (Specht) B. AGE IQ G.P. G. AGE IQ G.P. H.S. II 8 150 2 S.F. 10* 161 3 W.H. 9 5 149 2 H.W. 10 2 154 3 A.B. 10 4 147 2 s.s. 11 s 144 2 R.P. 9 7 146 3 R.H. II 6 141 2 I.K. II 1 146 3 H.G. 10 2 130 2 S.R. 10 2 143 2 R.B. 10* 137 3 P.P. 10 138 2 E.P. 10 8 137 3 P.M. 9 8 137 3 A.S. 10 136 3 E.R. 10 133 4 D.M. 10 B 132 1 V.S. 910 131 2 R.S. 10? 133 3 H.L. 10 1 127 2 S.B. 10 2 122 2 H.R. II 2 123 2 N.W. 10 5 122 2 H.G. 10 1 " 117 2 Physical Defects Should Be Corrected for the Sake of General Health, It goes without saying that a child's teeth should be filled if any are decayed ; that his sensory defects should be corrected, if they are cor- rigible ; that any obstruction in the respiratory tract should be removed; that any and all diseases and 236 PSYCHOLOGY OF SUBNORMAL CHILDREN disorders should be detected and treated. Every child should be kept at what is for him the maximum of physical health. Physical strength is one of the most important determinants of achievement, and should be conserved on its own merits. But we must guard against the supposition that by conserving physical health, and correcting anatomical defects, we shall be able to solve the problem of mental de- ficiency. The Prevention of Mental Deficiency. The known fact that stands out most clearly in a consid- eration of the causes of mental deficiency is that it is hereditary. Feeble-mindedness is transmissible through the germ-plasm, and a large majority of the defective, variously estimated at from eighty-five to ninety-five percent, show " a bad family history," either maternal or paternal, or both. Since this is so, it follows that the prevention of mental deficiency in the population can be accomplished only by pre- venting defective persons from procreating. Since this realization has dawned upon the in- formed public many so-named eugenic movements have been organized. These organizations have for their object the formulation of plans whereby the propagation of the inferior may be prevented. Now, it is apparent that this aim will be very difficult of attainment. Such plans run counter to one of the strongest of human instincts, which, as has been said, is well developed in the feeble-minded ; namely, the THE PREVENTION OF MENTAL DEFICIENCY 237 sexual instinct. They also run counter to the firmly established principle that " all men are created equal; that they are endowed by their creator with certain inalienable rights." In a democracy no one feels fully qualified to " pass upon " the biological rights of another, even though that other may pilfer his goods, contaminate his children, and be supported at his expense in prison, almshouse, or refuge. Two general schemes have been proposed for re- ducing the number of defectives born into the world : (1) the segregation of all mentally deficient adults during the reproductive period; (2) the artificial sterilization of mental defectives by surgical means. That there are serious practical objections to both plans is evidenced by the fact that neither of them is in operation, or seems likely to be put into operation soon. The objection to the first plan is that of the great expense involved. A conservative estimate of the number of defectives at present at liberty, as compared with the facilities now provided for their detention, indicates that expenditures on an enor- mous scale would be necessitated in order to segre- gate all of a state's defectives for the reproductive period of their lives. The objections to the second plan, that of sterili- zation, are chiefly objections of sentiment. Here as elsewhere, there is a wide gap between the theory of what should be done, and actual realization in con- duct. In states where sterilization is legalized it is 238 PSYCHOLOGY OP SUBNORMAL CHILDREN carried out with relative infrequency. The law will have to make sterilization mandatory, not permissive only, before such measures will become effectual ; and the consensus of opinion seems to be that knowledge should be much more extensive than it is at present, in order to justify such mandatory legislation. REFERENCES 1. Bigelow, M. A., Contributions of Zoology to Human Wel- fare. Science. July 5, 1918. 2. Blanton, S., Mental and Nervous Changes in the Children of the Volksschulen of Trier, Germany, Caused by Malnutrition. Mental Hygiene. July, 1919. 3. Bryant, L. S., Unstable Diastolic Blood Pressure and Feeble-Mindedness. School and Society, Feb. 20, 1915. 4. Conklin, E. G., Heredity and Environment. Princeton University Press. 1917. 5. Courtis, S. A., Measurement of the Relation Between Physical and Mental Growth. American Physical Education Re- view. Nov., 1917. 6. Dawson, W. J. G., Results Obtained from the Removal of Tonsils and Adenoids in the Feeble-Minded. Journal of Psycho- Asthenics. March and June, 1918. 7. Davenport, C. B., Heredity in Relation to Eugenics. Henry Holt and Company, New York. 1911. 8. Dugdale. R. L., The Jukes. G. P. Putnam's Sons. New York. 1877. 9. Estabrook, A. H., The Jukes in 1915. Carnegie Institu- tion of Washington. Washington. 1916. 10. Estabrook, A. H., and Davenport, C. B., The Nam Family. Eugenics Record Office. Cold Spring Harbor, New York. 1912. 11. Foster, J. C., A Case of Intellectual Development Despite Enforced Seclusion. Journal of Applied Psychology. June, 1919. 12. Goddard, H. H., Feeble-Mindedness: Its Causes and Con- sequences. The Macmillan Co., New York. 1914. 13. Goddard, H. H., The Vineland Experience with Pineal Gland Extract. Journal of the American Medical Association. May 5, 1917. THE PREVENTION OF MENTAL DEFICIENCY 239 14. Haines, T. H., Wassermann Reactions of Juvenile Delin- quents. Journal of the American Medical Association. Jan. 8, 1916. 15. Kelley, T. L., The Effect of Hookworm and Malaria upon Physical and Mental Development of School Children. Element- ary School Journal. Sept., 1917. 16. Keyes, H. B.. Effect of Outdoor and Indoor School Life on the Physical and Mental Condition of Children. Fourth Inter- national Congress on School Hygiene. Buffalo. August, 1913. 17. Kite, E. S., " The Pineys." Survey. Vol. 31 : 7-14. 1913. 18. Kostir, M. S., The Family of Sam Sixty. Ohio Board of Administration. Columbus. 1916. 19. Peters, A. W., Relation of Biochemistry to the Problems of Psych opathology. Journal of Psycho-Asthenics. 1912. 20. Pintner, R., and Paterson, D. G., The Form-Board Ability of Young Deaf and Hearing Children. Psychological Clinic. Jan., 1916. 21. Pintner, R., and Paterson, D. G., Learning Tests with Deaf Children. Psychological Monographs. Vol. XX, No. 4. Jan., 1916. 22. Pintner, R., and Paterson, D. G., A Measurement of the Language Ability of Deaf Children. Psychological Review. Nov., 1916. 23. Southard, E. E., The Correlation of Brain Anatomy, Men- tal Tests and School or Hospital Records in a Series of Feeble- Minded Subjects. Journal of Nervous and Mental Disease. 1916. 24. Specht, L. F., A Terman Class in Public School No. 64, Manhattan. School and Society. March 29, 1919. 25. Strong, E. K., Effects of Hookworm Disease on the Mental and Physical Development of Children. International Health Commission. Bulletin No. 3. Rockefeller Foundation. New York. 1916. 26. Thomson, J. A., Darwinism and Human Life. Henry Holt and Company, New York. 1910. 27. Wallin, J. E. W., Experimental Oral Euthenics. Dental Cosmos. 1912. 28. Wallin, J. E. W., Experimental Oral Orthogenics. Journal of Philosophy, Psychology and Scientific Methods. 1912. 29. Weismann, A., The Germ Plasm. Walter Scott. London. 1893. CHAPTER XIII SECONDARY CASES A Small Percentage of Mental Deficiency is Due to Disease of the Nervous System. As we have al- ready stated, research points to the conclusion that approximately 90 percent of the mentally subnormal are the products of inferior germ-plasm. The re- mainder are the victims of organic causes, and are in a true sense pathological cases. In such cases the mental deficiency is said to be secondary, meaning that it depends on and is a consequence of some un- derlying misfortune to the nervous tissue, but for which the child would have been of normal intelli- gence. Since the nervous system is the physiological mechanism fundamental to the psychological life, de- struction or disease of its elements may result in psy- chological abnormalities. In the case of young chil- dren, disease of the nervous system may result in failure to develop intellectually. These are the true cases of arrested development, previously mentioned, and to be described here in some detail. Syphilis. This disease is directly responsible for a smaller proportion of mental deficiency in children than was formerly supposed. No doubt this is due 240 SECONDARY CASES 241 to the fact that syphilis causes sterility, abortion, and infant mortality, so that few offspring of syphilitic parents live to show mental deficiency. Syphilis is an organic disease, to which various tissues of the body are susceptible, the nervous tissue among them. If it attacks the nervous tissue of a young child, the typical result is mental deficiency. If it attacks the nervous tissue of an adult, the typical results are ataxia, intellectual deterioration, general paresis. Many children whose mental deficiency is due to syphilis deteriorate as they grow older, and follow the ordinary course of general paresis. They are then classified under the concept of juvenile paresis. The mental condition is not recoverable, though treat- ment ordinarily given in cases of syphilis is often ef- fective in allaying active physical symptoms. There are certain typical clinical features which characterize these children. The bridge of the nose is often lacking, there being merely a flat space be- tween the eyes. In many cases the incisors are peg- shaped, and notched on the edge, being termed " Hutchinson's teeth." The reflexes are in the ma- jority of cases disturbed. There is a positive reac- tion in the Wassermann test of the blood. Ductless Glands. It is well known that mental deficiency may result from malfunctioning of the thyroid gland. If during the years of growth this gland does not secrete its product into the system, the result is a child showing the following character- 242 PSYCHOLOGY OF SUBNORMAL CHILDREN istics: stunted physical growth, spade-shaped hands and feet, legs short and bowed, a broad nose, a thick, coarse tongue, and a sallow, parchment-colored skin, which is dry, rough, and so redundant that it wrinkles on the face and scalp. The tout ensemble gives us a gnome-like little creature, easily recognized for what he is by one who has seen many cases so af- fected. These children are called cretins. The specific medicinal treatment is thyroid extract, and if the case is diagnosed in the first year of life, and treated regularly and persistently during life, the individual may in some cases approximate normal development. In other cases no effect of the treat- ment can be noted. What the result of treatment will be in any given case is, therefore, unpredictable. The most common result seems to be that there en- sues improvement in both mental and physical con- dition, even in cases neglected beyond infancy. Treatment is sometimes conducted surgically, by the transplantation of a thyroid gland from the neck of an animal to the body of the affected child. Favor- able results have been reported from such operations, but in any given case the outcome is unpredictable. Cretins differ widely with respect to intelligence. Some never develop above a mental level of three years. Others approximate normality, both men- tally and physically. The present writer knows of one case, that of a girl of seventeen, who was suffi- SECONDARY CASES .243 ciently intelligent to hold a position at simple, routine clerical work in an office, and yet in whose case a diagnosis of cretinism was made after consultation among several competent specialists, on the basis of the clinical features presented. The symptoms were mild but typical. The physique was stunted, the extremities were blunt and spade-like, the skin was sallow, with a tendency to be redundant, there was a history of slow development, and the physiological changes normal at adolescence had not taken place. This case illustrates the range of severity in cretin- ism. The principles underlying the education of cretins are the same as in mental deficiency in general, ex- cept for the fact that they are especially character- ized by poor motor control. Their gait is ungainly, they manage their bodies poorly, and are not as near the norms as are ordinary feeble-minded children in ability to make eye-hand coordinations. Thus on the whole they will not be very well adapted to man- ual training. The discovery of the fact that cretinism is due to malfunctioning or absence of the thyroid gland has led to the expectation that other cases of mental de- ficiency may finally be traced to abnormalities of various ductless glands. There have been attempts to treat mentally subnormal children with extract from the pituitary gland, from the thymus gland, and with other endocrine substances. No convincing 244 PSYCHOLOGY OF SUBNORMAL CHILDREN results of such treatment have been reported. Such reports as have been scientifically made give the re- sult of experimentation as negative. Experimentation in the matter of the influence of the ductless glands upon anatomical and physical anomalies is, however, making progress. It is well established that malfunctioning of the pituitary gland affects physical growth. Dr. Walter H. Eddy has recently established in experiments carried out at the New York Hospital, that substances extracted from the pancreas of a sheep very clearly affect the physical development of rats when administered to them. Thus within the next century there may come about a much closer contact between endocri- nology and psychology than has existed hitherto. Abnormal Growths in the Brain. Tuberous or nodular growths in the brain tissue may cause a child to be mentally defective. If these are present, con- vulsions, headache, twitching, tremor, paralysis, and progressive deterioration, one or all, are symptom- atic. The treatment is surgical, but a favorable out- come is to be expected in rare cases only. Hydrocephalus. Hydrocephalus is a condition in which there is an accumulation of cerebro-spinal fluid within the ventricles of the brain, sometimes amounting to several pints. This fluid exerts pres- sure upon the brain tissue, and also upon the skull, the sutures of which often become quite widely spread. These children, therefore, usually have very SECONDARY CASES 245 large heads, though in rare instances where the bones of the skull have united prematurely, expansion of the cranium may not be possible, in which case con- vulsions are frequent, followed by early death. The course of hydrocephalus is unpredictable. It may progress, and end in death during childhood; it may become arrested spontaneously; or it may be amenable to periodic surgical treatment, which con- sists in drawing off the excess fluid. In nearly all cases there is some degree of mental deficiency. Mild cases are occasionally seen in school, though the majority are easily recognized as proper subjects for hospital or institutional care. Encephalitis and Meningitis. Acute inflammation affecting the nervous tissue in a growing child may be the cause of mental subnormality. Usually such infections occur in the early years of childhood, and the mortality from them is very great. Of children who do not succumb by death, a very few recover completely, but in most cases the intelligence is im- paired, and paralysis and sensory defects, especially deafness, are commonly present. A minute description of the onset, course, and pathology of these conditions is irrelevant to the purposes of a treatise on educational psychology. It is furthermore true that very few of the children so afflicted ever appear in the schools. This is so for various reasons. In the first place, there are very few of them in existence. In the second place, they 246 are usually of very low grade mentally, too low for attendance upon the public schools. In the third place, they are often physically crippled in such a way as to render attendance upon school impossible. Of the rare cases attending schools, it will often be found that they profit less by instruction than do ordinary defectives. Apparently the lesions which are produced by the disease interfere with the asso- ciation processes, in a manner which is not seen in those who have never suffered from any pathological condition, but are simply of inferior quality. Epilepsy. Frequently repeated convulsions, which are epileptic in character, have a deleterious effect upon the mental life. In persons who have reached the limits of mental growth before the onset of the seizures, deterioration in mental processes is a com- mon phenomenon. When the attacks begin in a growing child, in whom the development of the neu- rones is still incomplete, growth may be arrested by the disorder, and mental deficiency results. Here again the degree of deficiency varies from mild infe- riority to the condition of idiocy. Epileptics of whatever degree of intelligence tend always to deterioration, so that instruction is carried on in their case with a maximum amount of effort and a minimum amount of reward. The prospects of improvement by training, and the outlook in gen- eral for these cases is most unfavorable. Retention seems to be especially impaired by epilepsy, so that SECONDARY CASES 247 the child forgets what seemed to have been well learned on a previous occasion. It is much more difficult to build up a system of specific habits in them, than in children simply inferior by nature. Moreover, epileptics in general are characterized by irritability and other unfortunate traits of tempera- ment, and feeble-minded epileptics are no exception to this rule. The seizures producing the mental deficiency may be of any of the classic types. They may be of the Grand Mai type, in which the whole body is con- vulsed ; they may be of the Petit Mai type, in which there is convulsive twitching, without falling; they may be Jacksonian in character, in which case only a part of the body is involved ; or they may belong to the type called Psychic Epilepsy, in which case there are no motor phenomena, the consciousness alone be- ing interrupted. It has been found that the epileptic respond best to manual training, and to occupations which can be carried on in the open air. It has always to be borne in mind that dangerous machinery, sharp imple- ments, and hot objects like boilers and stoves, must be avoided in the occupation of the epileptic, as he may injure himself in an attack. Thus cooking, running elevators, and similar simple work for which high-grade defectives are and can be trained, are not appropriate in these cases, although clinical examin- ers constantly find epileptics so engaged. 248 PSYCHOLOGY OF SUBNORMAL CHILDREN Infantile Cerebral Degeneration. From a cause unknown it sometimes happens that cerebral degen- eration begins in an infant or young child, progress- ing through a course in which total blindness super- venes, and at the end of which the child dies. The disorder is always fatal, and the victim of it does not, of course, develop normal intelligence, as de- generation of the cortical neurones is one of the chief pathological features of the condition. These chil- dren rarely live to attain school age, and even if one so afflicted should survive to such age, he would be unfit to attend school. Thus teachers are very little concerned with such cases. Since the course of the disease is progressive deterioration to inevitable early death, the cases are subjects for nursing rather than for teaching. Because of the fact that more than one child in a family is usually affected, the disease is often called Amaurotic Family Idiocy, the word amaurotic refer- ring to the atrophy of the optic nerve, which leads to blindness. Injury to the Cranium, Involving the Brain. Se- vere injury to the head, in which the skull is frac- tured, and the brain is involved, may result in arrest of mental development, if it occurs in a young child. Even though the skull remain intact, it is possible to bring about the catastrophe if the injury is of such a nature as to produce hemorrhage within the brain. Prolonged pressure on the head during the process SECONDARY CASES 249 of birth may work such injury. Paralysis of one or more limbs is a very common feature of such cases. Motor control is poor, and not infrequently the child grows up subject to convulsions. Such condition due to pressure during birth is called Little's Disease, for the physician who originally described it. Mental deficiency may, but does not invariably, accompany the paralysis, and other manifestations. Since the child suffering from Little's Disease is a cripple, his instruction is often carried on privately, rather than as a member of a school group. Injury to the head sustained after birth, during the years of childhood, may also interfere with mental growth. Only very severe accidents are, however, to be considered here, such as are followed by hemor- rhage from nose or mouth, loss of consciousness, frac- ture, vomiting, a change in temperature, convulsions, or paralysis. Nearly all children " bump their heads," yet continue to follow out the course of nor- mal development. It is true that children who are mentally deficient by original nature fall more frequently and have more accidents than do normal children, simply because they are not so able to guard against common dan- gers. Thus " falling down," " hitting the head," and such accidents are very often alleged by parents to be the cause of their offspring's defects. In the ma- jority of cases it will be found that where a fall is the cause given, cause and effect have been confused; 250 PSYCHOLOGY OF SUBNORMAL CHILDREN that the child is not defective because he fell, but fell because he is defective. These Causes May Act on Any Degree of Native Intelligence. Accident and disease, such as we have touched upon here, may degrade to a lower level any degree of intelligence. They may degrade a genius, a mediocrity, or a moron to the status of an idiot or an imbecile. They may also attack children originally idiotic or imbecile. They occur without reference to the degree of intelligence potential in the germ-plasm. The opinion has been put forth by a few specialists in the field that children of neuropathic ancestry are more likely to suffer from organic diseases of the nervous system than are children in whose ancestry there is no neuropathic strain. This has never been established by figures scientifically collected. If true, it might mean that the number of really secondary cases is even smaller than at present estimated. Mental Deficiency Due to Accident and Disease is not Hereditary. In cases where a child of poten- tially good intelligence becomes the victim of any of the organic misfortunes which have been mentioned in this chapter, and is mentally deficient as a result, this mental deficiency is not hereditary. The nature of the germ-plasm is such that it cannot be affected by injuries to the nervous tissues, any more than it can be affected by the amputation of an arm from the body, or by dyeing the hair of the head. The chances are small that any child affected in the manner which SECONDARY CASES 251 has been described will have direct descendants, so that the question of heredity has a practical bearing only in the case of his relatives. The hereditary background is not impaired in the least by the pres- ence of a truly secondary case of feeble-mindedness in the family, since this is a matter of external in- fluences, and not a matter of the constitution of the germ-plasm. Whether a given case is secondary or not can be determined only by a competent special- ist. Parental and popular prejudice would, of course, tend to find some external cause for all men- tal defect, would tend to regard all cases as second- ary ; whereas very few cases really fall into this cate- gory. Teachers Do Not Often Find Secondary Cases in School. It is clear that accident and disease suffi- ciently severe to produce mental deficiency will, as a matter of fact, be survived by few children. The mortality among children afflicted with syphilis, ab- normal growths in the brain, hydrocephalus, enceph- alitis, meningitis, cerebral degeneration, and frac- ture of the skull is very great. Since no great pro- portion of children are ever afflicted with these mis- fortunes in the first place, and since only a few of those afflicted survive, it follows that among children of school age, few exist. Of the few who do exist, most are reduced to the status of idiocy or imbecility, and many are crippled, so that they are obviously not " physically and mentally able to attend school." 252 PSYCHOLOGY OF SUBNORMAL CHILDREN Those who are able to receive instruction, are often taught privately at home. The secondary cases of mental deficiency which are oftenest met in the elementary school, and in special classes, are the epileptics and the cretins. Teachers should, therefore, be able to recognize these condi- tions when confronted by them. In mental ability they are on the whole much more uneven than the feeble-minded, whose deficiency is primary. Second- ary cases are characterized by irregularity of per- formance in tests of intelligence. REFERENCES 1. Baldwin, B. T., A Study in Mental Retardation in Relation to Etiology. Medical Record. Jan. 27, 1917. 2. Barr, M. W., Mental Defectives. P. Blakiston's Son and Company. Philadelphia. 1913. 3. Eddy, W. H., The Isolation of a Growth-Producing Sub- stance from Sheep Pancreas. Journal of Biological "Chemistry. Oct., 1916. 4. Jelliffe, S. E., and White, W. A., Diseases of the Nervous System. Lea and Febiger. Philadelphia. Second Edition. 1917. 5. Shuttleworth, G. E., and Potts, W. A., Mentally Deficient Children. P. Blakiston's Son and Company. Philadelphia. 1916. 6. Tredgold, A. F., Mental Deficiency. William Wood and Company. New York. Second Edition. 1915. CHAPTER XIV NERVOUS AND MENTAL DISORDERS WHICH MAT COMPLICATE MENTAL DEFICIENCY The Mentally Deficient are Subject to Mental and Nervous Disorders Which may Affect Children in General. A low grade of intelligence is no insurance against mental and nervous disorders, to which chil- dren in general may be subject. Just as the feeble- minded may contract any organic disease, so they may be affected by disorders of the mind and nerves. In such cases the disease or disorder is the accompan- iment of the mental subnormality , there being no causal relation. In addition to the organic diseases and traumata of the nervous system, which have already been men- tioned, and which may affect the originally feeble- minded to reduce them further in mental status, it is necessary to consider briefly certain other nervous and mental disorders, which occasionally complicate mental deficiency in children. Speech Dejects. Speech defects are much more common among subnormal children than among chil- dren chosen at random. The power of learning to formulate words rests upon a basis of various complex 253 254 PSYCHOLOGY OF SUBNORMAL CHILDREN abilities which we have called general intelligence, Individuals below a certain mental age are incapable of using language; in the sense that they cannot learn to express their ideas or trends by the use of articulate sounds. It has already been noted that lateness in talking is characteristic of those who are subnormal in gen- eral intelligence. As speech develops in the subnor- mal it often tends to be defective in some respect, most commonly in respect to distinctness of articu- lation. Dr. Wallin found that in the classes for mentally deficient children in St. Louis about a fourth of the children were defective in speech. " In general the lower the grade of intelligence of the group, the greater the prevalence of speech defects." All forms of speech defect except stuttering were more prevalent among mentally deficient than among normal children. Other investigations have led to similar conclusions, except that all have not agreed that stuttering is more common among chil- dren of normal intelligence. As Dr. Wallin observes : " It is not at all surprising that there should be a close correlation between speech defects and mental defect, in view of the fact that the mechanism of speech is highly complicated, involving the harmonious integrative action of a number of delicate anatomical, physiological, and mental adjustments. The above facts indicate how necessary it is that teachers of feeble-minded and NERVOUS AND MENTAL DISORDERS 255 backward children should be capable of correcting at least the simpler types of faulty articulation." Two peculiarly interesting anomalies of speech met with in low-grade institutional cases are echola- lia and coprolalia. Echolalia is a curious tendency found in defectives, who are mentally at what Binet calls " the dawn of speech," to repeat or echo what is said to them or in their hearing. Individuals who have not sufficient intelligence to originate remarks of their own, may be able to " echo " quite well. They show no understanding of the question-re- sponse situation, but imitate words and inflections which they hear. Sometimes they repeat gestures as well. The same phenomena are observable in young children who are at " the dawn of speech," but are not so noticeable in them as they quickly pass beyond this mental level, may pass it in a week or a month, perhaps, whereas the defective who reaches his ultimate intellectual level just at this point shows the phenomenon all his life. Binet gives an interesting account of the imbecile, Denise, who could echo quite well, though she was forever incapable of developing the complete use of spoken language. Denise was twenty-five years old, an iiynate of an institution in Paris. Binet gives the following description of her. " She is affected with echolalia and mimicry accompanied by all kinds of comical actions. If one coughs, she coughs; if one blows his nose, she blows hers; if one laughs, she laughs. She re- peats the last word of a sentence which is said, or else says yes 256 PSYCHOLOGY OF SUBNORMAL CHILDREN in acquiescence, even when one is paying no attention to her. At the same time she imitates whatever one does. If one writes, she takes on a mischievous air and pretends to write with her finger on the table; if one scratches himself she scratches her- self; if one crosses his arms she does the same; if one twirls his moustache, she imitates the action. The imitation by gesture or voice is done quickly, accompanied by a laugh and mocking air, but the imitation does not continue long. Very quickly her attention fails; Denise thinks of other things, looks about her, then after a time comes back to us and if we continue to write she resumes her imitative gestures. . . . Before a witness whom she does not know Denise is intimidated, remains shy, and shows no evidence of echolalia or mimicry. It is, therefore, something dif- ferent from reflex echolalia, since it is under the influence of psychic causes and is exercised only under certain easily deter- mined conditions. Neither is it a voluntary echolalia, the art of imitation as practiced by a comedian who gives himself to this effort as others give themselves to any sort of work. It is an intermediate form which is at the same time partly reflex and partly voluntary, and which very clearly expresses the childish character of Denise." Coprolalia is the tendency to utter certain words or phrases spontaneously, without any appropriate ex- ternal stimulus having been applied. The individ- ual bursts forth suddenly at intervals with his ex- pression. For example one imbecile repeated at in- tervals, " I want to know," and another was accus- tomed to utter explosively, "Get out! Get out! " Both echolalia and coprolalia occur generally among defectives who are too low-grade to develop language, and who are therefore not school cases. Occasionally a subnormal child is found who has developed a language of his own. Being unable to articulate the word which he hears applied to that of NERVOUS AND MENTAL DISORDERS 257 which he wishes to speak, he approximates it with some utterance of his own, and by repetition makes the association permanent; and he continues to use these improvised words even after he reaches a higher level of intelligence, at which the correct expressions could be learned. To re-educate such a child in speech is a long and tedious task. There has been a considerable amount of discussion bearing on the relation of " handedness " to speech. It has been indicated by investigation of the relation of speech defects to " handedness " that attempts to " change over " a right-handed child to the left, or a left-handed child to the right, frequently result in stuttering. That there is some connection between the speech mechanism and the mechanisms control- ling the hands is further indicated by data bearing upon right hemiplegia and left hemiplegia (paralysis of right and of left sides, respectively), and the dis- turbances of spoken and written speech attendant thereupon. On the whole, it would seem to be the wisest policy not to try to " change over " a child who is decidedly left-handed, or decidedly right-handed. The correction of serious speech defects can be suc- cessfully undertaken only by teachers who have made a special study of the subject. In some cases the condition calls for surgical or dental treatment, as in tied-tongue, cleft palate, and malformation of the teeth. Treatment should be prescribed by a special- ist, wherever the services of a specialist are available. 258 PSYCHOLOGY OF SUBNORMAL CHILDREN Chorea (St. Vitus Dance}. This disorder is named from the Greek word which means to dance. Fio. 21. Facsimile of a letter written by a feeble-minded child with chorea. Dancing is suggested by the gait of the child affected, as in the more pronounced cases there is great diffi- culty in coordinating the movements of the grosser NERVOUS AND MENTAL DISORDERS 259 muscles. The outstanding feature is impairment of motor control, which ranges in severity from mere twitching of the finer muscles, so slight that it can be detected only by instruments of precision, to a condition in which the child is in constant motion, jerking and twitching in all his muscles. The move- ments are arhythmical in character, not like that rhythmical nodding of the head, which is sometimes seen in old people. The extreme interference with voluntary move- ment is well illustrated in Figure 21, which shows a letter written by a feeble-minded child with chorea. It is also illustrated by the motor test reproduced in Figure 22, which shows the condition of a boy of normal intelligence, suffering from chorea in severe degree. In these children often the first symptom noted is that handwriting is poor. Of course all man- ual work is a strain upon them. They " drop things," spill ink, stumble, speak indistinctly, and " cannot keep still " in school. Any child exhibiting these symptoms in noticeable degree should become an object of concern to the psychological clinic. That mental symptoms may be present in chorea is seen in the case of the child whose motor test is shown in Figure 22. Fred F - was seen in 1916, on the Psychopathic Wards at Bellevue Hospital. He was 11 years 3 months old, and had been in school up to the very day of his appearance at the hospital. Motor symptoms were very marked, speech was 260 PSYCHOLOGY OF SUBNORMAL CHILDREN indistinct, and there were delusions of grandeur. These delusions were fairly stable, remaining approx- imately the same from day to day. He said on ex- amination : " I have seven million dollars. I sold LJTJTJTJ A. FIG. 22 (A). Motor test and handwriting of a normal child. Fio. 22 (B) . Motor test and handwriting of a child suffering from chorea. diamonds and got it. I have a big house on Fifth Avenue. Big white house. When I get out of here I'm going down to Texas to be a cowboy. ... At night I see big faces on the walls. Big horns on them. In the day I see little things flyin' around me. NERVOUS AND MENTAL DISORDERS 261 They scare me. I knock 'em, like that ! I hear ladies talkin' underneath the pillow. They say, ' Catch him. Bring him down here.' They're going to eat me. When I hear them, I get up quick and try to find a book to read, so I'll fool 'em." At night this child cried out, and frequently he rose and walked out of his room in his night clothes. The mental symptoms are usually, however, not of this bizarre character, consisting rather in a gen- eral apathy and dullness of attitude. Pulse is accel- erated, and temperature may be high. A child suf- fering from well-defined chorea has no place in school, and should be removed for medical treatment until he recovers. Hysteria, and Other Functional Disorders. Among the soldiers of the recent war who showed hysterical symptoms, and who were incapacitated by functional neuroses, were many of subnormal intelligence. Hundreds of men of very low grade intellectually were inducted into the service at the beginning of the war, before the psychological methods of exam- ination had been put into use. In this way it came about that men as low in the scale of intelligence as the six-year level were found among those suffering from hysteria in the hospitals. It has thus been shown that very low orders of intelligence are capa- ble of taking refuge in hysteria, when faced by an unavoidable environment from which they shrink instinctively. 262 PSYCHOLOGY OF SUBNORMAL CHILDREN In many cases histories of these soldiers were ob- tained, showing that they had evinced hysterical symptoms in childhood and adolescence. Mental deficiency may be complicated by hysterical attacks, just as mental mediocrity, and mental superiority may be so affected. Dementia Praecox. The relation between intelli- gence level and the occurrence of various forms of in- sanity is practically unknown. No research exists to show whether there is an increase or a decrease in liability to insane states as we go downward in the scale of intelligence. It may be that a stupid man is more likely to become insane than a mediocre man or a gifted man; or there may be no relation what- ever between degree of intelligence and the liability to become mentally unbalanced ; or the relation may vary greatly with the different psychoses. It is certain that adolescents of subnormal intelli- gence may and do develop the type of psychosis called dementia praecox. On the other hand there is probably a limit to the intellectual level at which this may occur. Certainly no one has ever reported an idiot or a low-grade imbecile as having developed dementia praecox. Evidently a certain amount of mental life is necessary as a basis for the disorder, which argues in favor of the theory that dementia praecox is psychological in character, and not of organic origin. The forms of abnormal behavior subsumed under NERVOUS AND MENTAL DISORDERS 263 the concept of dementia praecox are numerous and varied, and will not be discussed in detail here. De- tailed information on the subject is to be found in the references appended. In general it may be stated that the disorder is characterized by emotional in- adequacy, pathological indifference to surroundings, and phantasy. False beliefs (delusions) and false percepts (hallucinations) are usually present. The child or adolescent expresses absurd ideas, hears voices, sees visions, and otherwise conducts himself strangely. The age of onset is most frequently be- tween fifteen and twenty-five years, though it has been reported as early as ten years. Dementia praecox is not a recoverable condition, and the indi- vidual suffering from this psychosis is a menace to himself and others, and has no place in school. Manic-Depressive Insanity. This mental disor- der occasionally occurs among children, and among subnormal children as well as among others. In the manic phase the child is abnormally elated, active, flighty, incoherent, and shows other psychological and neurological symptoms. In the depressed phase he is indifferent and inactive, often will not even make the effort to eat, or attend to other personal needs, sits with bowed head, does not answer when spoken to, or else answers very slowly, and presents in general the picture of extreme woe. Sometimes melancholy delusions are present, and the patient hears voices, sees visions, and so forth. 264 PSYCHOLOGY OF SUBNORMAL CHILDREN In these cases one phase follows the other, in va- rious combinations. There may be first a period of depression followed by a period of excitement; or a e&jLibr (^0**"*s ' Fio. 23. Facsimile of a letter written by a child in the manic phase of manic-depressive insanity. NERVOUS AND MENTAL DISORDERS 265 period of excitement followed by depression; or either may be followed by a period of normal behav- ior, which is in turn followed by the opposite mood. The chances of recovery from any single attack are FIG. 24. Drawing by a child in the manic phase of manic-depressive insanity. very good, always, however, with liability to recur- rence. Figure 23 and Figure 24 show respectively a letter and some drawings produced by a child eleven years of age, who was brought to the Psychopathic Wards of Bellevue Hospital in a typical manic state. This letter and these drawings were produced at the height 266 PSYCHOLOGY OF SUBNORMAL CHILDREN of the attack, spontaneously. The child was in the 7 A grade in school, and was slightly superior to the average in general intelligence, showing on examina- tion after recovery a mental age of thirteen years, two months. That a similar condition may occur in a child of subnormal intelligence is shown by the following case : Rachel M , a child of twelve years, was brought for mental examination at the request of a society interested in child welfare. The child had been observed performing peculiar antics in a street car, and upon being spoken to would tell neither her name nor her address, but loudly demanded a nickel. Upon examination she showed well-marked flight of ideas, as follows : " Crazy they say crazy. Mendelsohn whoop-ee ! Mendelsohn comes my mother is crazy ha! ha! blood blood in the eye blood in your eye the children where's my penny? jail gone to jail. So many children are lost go to H ! go to H ! No, I don't say you go to H , I say Mendelsohn go to H . Where is my penny? and there goes teacher " . . . This string of incoherencies was continuous. The child was placed in the hospital, where she was ex- tremely mischievous and garrulous, and where she answered hallucinatory voices. After six days the symptoms subsided, and at the end of the tenth day she was in condition to be discharged to the custody of her parents, who had located her. An intelligence NERVOUS AND MENTAL DISORDERS 267 examination, conducted after all symptoms had sub- sided, gave her a mental level of five years, two months. This was in entire agreement with the facts of her developmental history, and her school history. At the age of twelve years she was still in the first grade at school, though she had attended since the age of six years. She had never learned to write even her own name legibly, and could recognize only a few simple monosyllables when asked to read. Her family knew that she had " never been bright," but stated that this was her first attack of this nature. She had " never acted in this way before," and had never before wandered away from home. A case of depression in a feeble-minded child is the following : Walter S , a boy of fourteen years, was sent for mental examination, accompanied by the following statement from a physician, in the De- partment of Education : " The Bureau of Attendance of the Department of Education requested me to examine a boy fourteen years of age, named Walter S , who has behaved abnormally only since last Monday, at which time he left home at 7:40 A.M., for the early session at a parochial school. He re- turned at 10 A.M., and could give no account of him- self. He is afraid to leave the home premises unac- companied by his parents. He can answer only simple questions, and them with great difficulty. He has a slight contusion above the left ear. No paralysis. No history of nose-bleed. Has not been 268 PSYCHOLOGY OF SUBNORMAL CHILDREN unconscious, so far as known. He was delirious last night. I telephoned this P.M., and was directed to send him for observation." The boy was brought by his father who stated that he had always been backward in school. He knew the child was " not bright," for he had been " left back " five times, and had attained only grade 5A at the age of fourteen years. He had, however, never acted in this peculiar manner before. Upon examination the boy was very much de- pressed. There was no mobility of facial expression, and reaction time was abnormally long. He re- sponded to questions with wholly irrelevant remarks, such as, " He will go to hell," " They will sin if they eat meat on Friday," " They must pray for him." He was afflicted with self-accusatory ideas. He de- clared that the whole world hated him. This was because he was ruptured as a baby, on account of his mother holding him too much. He reiterated the statement that he would go to hell, because he had been so bad. When he wept he said it was because he had cursed at the teacher. This was a very wicked thing to do. God spoke to him. There was a band of iron about his head, and people gazed at him on account of his sins. In about a week the symptoms subsided in the case of Walter S , and he became cheerful, and normal in behavior. Intelligence examination revealed a NERVOUS AND MENTAL DISORDERS 269 mental level of eight years. This finding was en- tirely consistent with the developmental history of the boy, and with his school status. His case illus- trates very well the occurrence of a psychotic episode in a child of subnormal intelligence. Other Forms of Mental and Nervous Disorder in the Subnormal. We have now mentioned briefly the nervous and mental disorders which are most com- monly found among children, among mentally de- ficient children as well as among others. Every teacher should know of the existence of these disor- ders. Many a case regarded as disciplinary, over which the teacher wears out her energies, really be- longs to one or another of the conditions described here. Our discussion has been by no means exhaus- tive, but only such as will enable teachers to be in- telligently on the lookout for symptoms of real men- tal and nervous disturbance in children who present special problems of discipline. When such symp- toms are noted by a teacher, the child should be re- ported at once to the psychological clinic, or to whatever person is in a position to make a diagnosis of the case. In addition to the disorders specifically mentioned here, it must be stated that the adult feeble-minded may suffer from any organic disease of the nervous system which may affect persons in general ; and that they may develop any psychosis, except such psy- choses as require a well developed intellectual life as 270 PSYCHOLOGY OF SUBNORMAL CHILDREN a basis. It is possible that paranoia (sometimes for- merly called "reasoning insanity") cannot develop in feeble-minded persons, and that they may be exempt from certain other forms of insanity by virtue of their inability to formulate and entertain ethical ideals, or strenuous personal ambitions. The lower the intelli- gence, the simpler is the mental life, and hence the fewer are the mental conflicts which arise. Thus it is possible, though not known to be a fact, that low intelligence may constitute an exemption from cer- tain mental disorders which are psychological in character. 1. Gordon, A., Psychoses in Mental Defects. American Jour- nal of Insanity. April, 1919. 2. Hollingworth, L. S., Echolalia in Idiots. Journal of Edu- cational Psychology. April, 1917. 3. Richards, E. L., Psych opathological Observations in a Group of Feeble-Minded. American Journal of Insanity. March, 1919. 4. Tredgold, A. F., Insane Aments. (Mental Deficiency.) William Wood and Company. New York. Second Edition. 1915. 5. Wallin, J. E. W., Report on Speech Defectives in the St. Louis Public Schools. Board of Education. St. Louis. 1915-16. 6. Walsh, E. A., A Study of the Speech Defects of Ninety-One Ungraded Class Children. Master's Essay. Columbia University. 1917. 7. White, W., Outlines of Psychiatry. Nervous and Mental Disease Publishing Company. Washington. Sixth Edition. 1918. CHAPTER XV SPECIAL CLASSES AND SPECIAL SCHOOLS Why Have Special Classes Been Established f Be- fore the enactment of compulsory education laws, those children who did not " fit " into the system suitable for the majority failed to attend school, or were excluded by act of the school itself. Subnormal children have always existed, doubtless in about the same proportion as they now exist, but the school did not become acutely aware of them until the law de- creed that every child must receive an education, " if physically and mentally able to attend school." The state then hired truant officers to bring in those who of their own volition failed to attend, and the school was prohibited from " expelling " children. Thus the subnormal child and the school were forced into a reluctant mutual recognition of each other. The recognition on the part of the school was re- luctant because " an education " meant that which constituted the curriculum for the great average, and " education " in this sense these " misfits " were un- able to assimilate. The teachers in the elementary school labored long and diligently with them, not recognizing the true source of difficulty. It reflects 271 272 PSYCHOLOGY OP SUBNORMAL CHILDREN unfavorably upon a teacher's ability when many of her pupils are unpromotable. Thus the problem of instructing and disciplining these children has been a great drain upon the time and energies of teachers, who were conscientious in the belief that all are created equal, and that all can learn equally if a sufficient effort is made. Nor is it correct to speak of this situation in the past tense, for it still exists in the majority of our public schools to-day. The cities are taking the lead, but towns, villages, and rural dis- tricts have, in most cases, still to face the problem in the light of scientific fact. The same increasing interest in public education which led to the enactment of compulsory school laws, also led to the professional training of teachers. In the professional training of teachers psychology is of fundamental importance, and one of the chief interests of educational psychology for the past twenty years has been the study of individual differ- ences. Gradually those facts which we have sum- marized in the first chapter of this book were recog- nized by progressive educators. It was learned that children differ by original nature over a very wide range of ability ; that what constitutes education for one, may not constitute education for another; that the schools must offer a widely differentiated cur- riculum if compulsory education is to succeed. Thus special classes began to appear here and there over the country, as part of the school system. SPECIAL CLASSES AND SPECIAL SCHOOLS 273 These have been established not only for the children who are subnormal in general intelligence, but for children who for various reasons do not fit into the regular classes. In 1915 the city of Cleveland had special classes, separately conducted, for truants, for the deaf, for the blind, for the epileptic, for the crip- pled, for the tubercular, for the foreign born and re- cently immigrated, for the dull and backward (not so low in the scale as the feeble-minded), and for the mentally defective. In addition to these various kinds of special classes, provision is being made here and there for the very superior children, who can eas- ily cover two or three years' work while the average child is covering one year's work. The History of Special Classes for the Subnormal in the United States. As long ago as 1872 Dr. Wil- liam T. Harris, then United States Commissioner of Education, called attention to what he designated the " pedagogical misfits " in St. Louis, but the educa- tional world was not roused to any effective interest in the matter at that time. The idea of the actual establishment of special classes for deficient children in the public schools seems to have been first intro- duced publicly to American teachers as a professional group by August Schenck, of Detroit, in 1878, in an address before the American Teachers' Association. Acting on the suggestions there made, Dr. Andrew Rickoff, Superintendent of Schools for the city of Cleveland, established two special classes in Cleve- 274 PSYCHOLOGY OF SUBNORMAL CHILDREN land, limiting them to children who presented disci- plinary problems. The second special class was es- tablished in Chicago, in 1892. This has since been expanded into the Department of Child Study and of Special Classes, for which Chicago has long been noted. New York established its first special class in 1895, under the direction of Miss Elizabeth Farrell. Un- der Miss Farrell's direction, this work has grown un- til now there are over two hundred and fifty special classes for subnormal children in New York City. From 1895 up to the present time the movement for special classes has grown apace, so that in 1911, ac- cording to the Bulletin of the United States Bureau of Education, a total of ninety-nine cities had public classes for mentally defective pupils, and two hun- dred and twenty had classes for what was called "mentally backward" children. Since 1911 this number has greatly increased. The first city to plan for a complete organization of these classes directly under the school administra- tion was Providence, Rhode Island, which had six classes for truants and disciplinary cases, and a sep- arate class for backward children, by 1896. Spring- field, Massachusetts, followed with special classes in 1898, and Boston in 1899. At the present time school reports show that cer- tain states are very far ahead of others in provision for subnormal children. California, Illinois, New SPECIAL CLASSES AND SPECIAL SCHOOLS 275 Jersey, Wisconsin, Ohio, New York, Minnesota, Iowa, Missouri, and Massachusetts are among the leaders. Organization of Special Classes. In cities where the school population is sufficient to call for the es- tablishment of several classes for the subnormal, it is usual to consider them as a department, and to place this department under a supervisor, especially trained to administer it. The curriculum is planned by the supervisor, in consultation with the teachers, and others who may be concerned. The work is thus coordinated under a responsible head. Examples of this organization are seen in New York, St. Louis, Duluth, Richmond, and in many other large cities. For rural districts and small towns the state may provide the administration of special classes, in co- operation with the local authorities. For example, the State of New York provides a supervisor of spe- cial classes in the state department of education, in accordance with a law passed in 1918. The first re- port of the state supervisor of special classes in Wis- consin has recently been issued. Michigan has con- ducted a mental survey during the months just passed, with the object of ascertaining what provi- sions are needed, and Virginia is engaged in a similar enterprise. Special Schools. Usually the special class occu- pies a room in the building where the regular classes are held, but in certain communities the special classes of a large section are all placed in a building 276 PSYCHOLOGY OP SUBNORMAL CHILDREN by themselves, which is then called a special school This plan has the advantage of rendering possible the more exact grading of the children by mental age. On the other hand, it has the disadvantage of bring- ing the children a greater distance from home than does the special class which is maintained in the reg- ular school building. Each plan, in fact, has its ad- vantages, and hence its staunch advocates. In this connection it should be noted that the state institutions for the feeble-minded are now called schools, where laws pertaining to their maintenance have recently been re-formulated. Formerly, when intellectual subnormality was considered a mental disease, the institutions for the feeble-minded were called asylums, and were maintained as custodial in- stitutions, on a medical basis. With the passing of this concept of intellectual subnormality, and with the recognition of the fact that children sent to these institutions are continuous in ability and kind with children in general, the word " asylum " is disappear- ing, and the institutions are being placed on an edu- cational basis, under the designation school. These then become special schools, belonging under the supervision of the state department of education. Of course in these institutions there will always be a number of cases where mental development cannot rise above the level of infancy, and these will need nurses rather than teachers, as infants do. The ma- jority of inmates are improvable by education, just SPECIAL CLASSES AND SPECIAL SCHOOLS 277 as other children are, though in lesser degree. Of these state schools the most widely known are the Training School for the Feeble-minded at Waverly, Massachusetts; the Training School for the Feeble- minded and Epileptic, at Faribault, Minnesota; the Whittier State School, at Whittier, California; and the Sonoma State Home at Eldridge, California. The Training School for the Feeble-minded at Vine- land, New Jersey, which is perhaps better known here and abroad than any other special school of its kind in this country, is not strictly a state institution, be- ing supported to a great extent privately. All these schools have become famous through their edu- cational system, and through the research which they have carried on in the psychology and treatment of the mentally defective. State institutions for the feeble-minded began to be established in the United States about the middle of the nineteenth century. The first institution of the kind in the United States was built at Syracuse, New York, in 1854. It is interesting to note that it was built as a school, and has always been maintained as a school. At the present time there are only a few states which are without provision for the feeble- minded. Training of Teachers for Special Classes. In or- der to render efficient service in special classes, . a teacher must have a firm grasp on the psychological and social problems presented by her pupils. This 278 PSYCHOLOGY OF SUBNORMAL CHILDREN means special training, beyond that which is pre- scribed for teachers generally, though this special training need not be elaborate or greatly prolonged. Within the past ten years departments of psychology and education, in universities and normal schools, have organized courses for teachers of special classes. Training is given in industrial arts, methods of teaching, hygiene, correction of speech, the psychol- ogy of subnormal children, corrective gymnastics, and sociology. The demand for teachers who have had the prescribed preparation for teaching in special classes far exceeds the supply at present. An increasing number of teachers in the regular grades of the elementary school elect these courses, as they realize that they themselves have to deal with the subnormal children in communities where no special classes have been organized. To teachers of the regular grades it is especially interesting to know how the feeble-minded are distributed through the school, where no attempts at segregation have been made. Distribution of Subnormal Children in the Grades. Idiots seldom enter the public schools, so that teach- ers do not have to deal with such children very fre- quently, unless their work is in a special school, such as those maintained by the states. If an idiot en- ters public school at all, it is only for a short time in kindergarten or first grade. Idiots are institutional cases, and are nearly always recognized as such by SPECIAL CLASSES AND SPECIAL SCHOOLS 279 parents, and by administrative authorities in the school. Defectives of IQ lower than 30 seldom ap- pear at school. Defectives between 50 and 70 IQ are those who attend the public school, as distin- guished from the state institution. In addition the public school has, of course, all the degrees of sub- normality which range from 70 IQ, up to normal, but which are not technically rated as " defective." Our question is, what is the distribution of the technically defective in the grades of the public school? Investigation has shown that there are mentally defective children in all grades of the elementary school, but that the number found above the sixth grade is very small. High-grade defectives may oc- casionally reach the seventh or eighth grade in com- munities where there is a rule requiring that no child shall repeat a grade more than once. Under such a rule, promotion becomes automatic, and pres- ence in a given grade loses much of the significance it should have in relation to mental capacity. Very little study has been made of the intelligence of high school pupils, but the indication is that ado- lescents with an IQ as low as 70 practically never enter public high school. It cannot be said that ado- lescents as low in the scale as 70 IQ absolutely never enter high school, for an instance is known to the present writer where a girl of intelligence nearly as low as this actually did enter a public high school, and was retained there for several weeks. However, the 280 PSYCHOLOGY OF SUBNORMAL CHILDREN high school teacher has little concern with the techni- cally defective, though the subnormal who lie be- tween 80 and 90 IQ very often complicate high school problems. It is true, then, that the teachers of kindergarten, first grade, second grade, third grade, fourth grade, fifth grade, and sixth grade will have charge of the mentally defective, in school systems which make no provision for special classes. Teachers of kinder- garten and first grade commonly have to deal with all defective children in the community, who are above the status of idiocy. A typical example of this was seen in a Nebraska town of about four thousand in- habitants. The teacher of the first grade had two rows of pupils far beyond first-grade age, sitting in the first-grade room. The true nature of the diffi- culties experienced with these children was not well understood. The complaint was that they had not yet been able to learn to read or write a single word, and since they could not proceed to the next grade until these arts had been mastered to some extent, they were " kept back." Some of them had spent three or four years in this room, taking the time of the teacher from the other pupils, and disturbing the discipline of the class, held there to tasks which were irrelevant to their needs. Teachers of second grade also have to deal with nearly all of the defective children of a community, for they seldom pass beyond the compulsory school SPECIAL CLASSES AND SPECIAL SCHOOLS 281 age without visiting the second grade. Scarcely ever would a child be kept for eight or ten years in the first grade. He would be promoted at least once, if for no weightier reason than that a change might be thought to be beneficial. Teachers of third and fourth grade have at any given time more defectives than any others, because there is a strong tendency for those of the status of moron to collect there. It is necessary to bear in mind the fact that as the degree of defect becomes milder, the numbers become greater. There are many more morons than imbeciles, and the former practically always reach the third or fourth grade before they pass the compulsory school age, even in schools where promotion is not regulated by artificial rules. They are able to perform the work of the third or fourth grade by the time they are fifteen or sixteen years old, because their mental level is then eight or nine years, and thus they really " reach " these grades. In school systems where the rule is that a pupil may repeat a grade only once, the defective reaches the fifth or sixth grade, before the compulsory school age is passed. In many states the limit of com- pulsory attendance is sixteen years, for all who have not by that age passed successfully beyond the sixth grade. Under such circumstances, where no provision has been made for the scientific se- lection of the deficient, the defective child enters 282 PSYCHOLOGY OP SUBNORMAL CHILDREN school at about the age of six years. If he re- peats every grade once on his scholastic journey, he reaches the third grade and remains in it dur- ing the years ten to twelve, he is in the fourth grade during the years twelve to fourteen, and is in the fifth grade from fourteen to sixteen. Thereafter he is above the age of compulsory attendance, and drops out of school. This is the typical career of many a feeble-minded boy and girl, who have dragged on through the elementary grades in this fashion, a burden to their teachers, to the administrative officers, and to themselves, never being recognized for what they really are. At the end of such a course, time, money, and effort have all been spent, and the boy or girl has learned almost nothing that is useful to one of such limited capacity. A feeble- minded boy after spending several months in a grade beyond his mental age was asked to tell what he had learned during the term. All he could say was that, " An interrogative sentence begins with a capital let- ter." Asked to illustrate by giving an interrogative sentence, he was unable to respond. He had no con- ception of what he was talking about. The work of the year had been a meaningless verbal jumble to him, in no sense training him, or preparing him for social participation. The state, having the inten- tion of training him, had in reality forcibly deprived him of an education, by compelling him to attend on the work of the regular grades. SPECIAL CLASSES AND SPECIAL SCHOOLS 283 The Relation between the Special Classes and the Psychological Clinic. The first step in the proper training of the subnormal is identification. When special classes were first started, there was no tech- nique for the scientific identification of the intellec- tually subnormal. Children were entered in the special classes largely on the basis of general conduct. In this way children of all degrees of intelligence were collected, in a heterogeneous group, with nothing in common except unsatisfactory conduct, or backward- ness in school work. Educators were not slow to * see that the success of the special class is directly de- pendent upon the accurate identification of the pupils who really belong in it. As psychologists devel- oped a scientific technique for identifying the subnor- mal, educators called them into service, and the psy- chological clinic developed, as we have already seen in a previous chapter. The chief function of the psy- chological clinic is identification; the diagnosis of conduct. It therefore bears an essential relation to the special class. In follow-up work the clinic is also an important agency, as it keeps the records pertain- ing to each child, and can keep and furnish subse- quent history. Follow-up Work. It is not infrequently supposed by those who have made no systematic study of the subject, that the school will permanently solve the whole problem of mental deficiency, by administer- ing training suited to the mental level of each child. 284 PSYCHOLOGY OP SUBNORMAL CHILDREN The training plays, however, only a part (though a large part), in the solution of the problem. No training can ever provide intelligence, the ability to meet new situations adequately, to make adaptations in emergencies, to perceive the remote consequences of present acts. Thus the defective if left to his own supervision is much more likely than is the average person to fall into trouble, to " lose his job," and to become dependent in spite of the specific skills which he has acquired by training. In order to reduce these dangers to a minimum some system of follow-up work is necessary. Just what this system shall be is a question at present much discussed by social workers, educators, and cit- izens interested in the welfare of the state. We need especially to know the subsequent histories of the graduates of special classes. We need to know what their success is, socially and industrially. A few preliminary studies have been published by in- spectors of ungraded classes, and the indication is that the graduates of special classes are able to main- tain themselves industrially to a surprising degree. The findings are somewhat complicated, to be sure, by the fact that labor has been very scarce during the years of the war, and wages have been high. Whether the subnormal will make as good a show- ing in more normal times remains to be seen. As a final word, let it be said that the school alone cannot solve the problem of mental deficiency. All SPECIAL CLASSES AND SPECIAL SCHOOLS 285 the agencies and agents of social welfare must en- list in an intelligent cooperation, to the end that the subnormal may find social adjustment and cease to be a menace and a burden to the state, and to themselves. REFERENCES 1. Farrell, E. E., A Preliminary Report on the Careers of 350 Children who Have Left Ungraded Classes. Journal of Psycho- Asthenics. Sept. and Dec., 1915. 2. Fitts, A. M., Mental Defectives in Industry. Ungraded. May, 1919. 3. Maxfield, F. N., The Present Status of the Subnormal Class. State Council of Education. New Jersey. Oct., 1918. 4. Michigan, State of, Backward and Deficient Children. De- partment of Public Instruction. Lansing. 1918. 5. Mitchell, D., Schools and Classes for Exceptional Children. Cleveland Foundation. Cleveland, Ohio. 1916. 6. New York City, Reports on Special Classes. Department of Education. 1916-17. 7. Oakland, California, Annual Report of The Superintend- ent of Public Schools. Board of Education. 1917-18. 8. Richmond, Va., Report of the Work of Special Classes. City School Board. Sept., 1918. 9. St. Louis, Missouri, The Psycho-Educational Clinic and Special Schools. Annual Report of the Superintendent of Instruc- tion. 1916-17. 10. Wisconsin, State of, The Exceptional Child in the Public Schools. Biennial Report. State Department of Public Instruc- tion. Madison. 1919. INDEX Abilities, special, 125, 126 Adenoids, 223 Alcoholism, 19, 219 Arithmetic, 126, 127 Bellevue Hospital, 259, 265 Birth-rate of feeble-minded, 146 Boston, special classes of, 274 California, expenditures for crime, 21; School of Industry, 33; Juvenile Court, 33 Chicago, special classes of, 274 Chorea, 258 Classification of mental defectives, 52 Cleveland, special classes of, 273 Cranium, 135 Cretinism, 242 Crimes of feeble-minded, 155 Criteria, social-economic, 43 ; peda- gogical, 44 ; medical, 45 ; psy- chological, 48 Curriculum, differentiated, 25 ; for feeble-minded, 187 Delinquency, 18 ; among children, 32 Dementia, 49 ; prsecox, 262 Detroit, prevocational classes, 127 Development, "arrested," 94 ; phys- ical, 96 ; mental, 99 ; limits of, 98 ; in mental defectives, 100, 105 Diagnosis, how made, 70 ; early diagnosis important, 200 Disabilities, special, 125, 126 Drawings of feeble-minded, 183, 184 Echolalia, 255 Education, implications for, 90, 129, 168, 187; physical, 145; moral, 167 ; first experiment in education of a defective, 203 Emotion, 153 Encephalitis, 245 Environment, as related to feeble- mindedness, 15 Epilepsy, 246 Eugenics, 236 Experimentation, 63, 85, 86, 88, 97, 98, 101, 105, 111, 112, 113, 118, 125, 126, 127, 137, 138, 139, 161, 173, 175, 176, 177, 179, 180, 182, 183, 184, 199, 203, 220, 222, 223, 225, 229, 230, 231, 232, 235, 244, 284 Fighting, 159 Follow-up work, 283 Glands, 241 Growth, physical, 95 ; mental, 97 Habit, 167, 198 Heredity, 208 ; of mental defect, 209; nature of, 214 Hookworm, 229 Hydrocephalus, 244 Hysteria, 261 Idiots-savants, 127 Imbeciles, moral, 167 Improvement, nature of, 197 Individual differences, 5 Infantile cerebral degeneration, 248 Inferiority, constitutional, 54 Injury to the brain, 248 Instinct, general consideration of, 150; in the feeble-minded, 120, 154 Intelligence, 116, 117 Intelligence quotient, 67 287 288 INDEX Jukes Family, 209 Kallikak Family, 212 Learning process, 170; of feeble- minded, 171 ; curves, 173, 177 ; mental age in, 181 Legislation, 237, 271 Malaria, 229 Malnutrition, 224 Manic-depressive insanity, in men- tal defectives, 263 Manual arts, 115 Meningitis, 245 Mental age, 64, 181, 178 Mental defectives, classification of, 52 ; scientific study of, 17 ; iden- tification of, 55; education of, 271 Mental deficiency, definition of, 38; criteria of, 42 Mental tests, 62, 64, 66, 69, 70 Microcephalus, 145 Minnesota, State School for Feeble- Minded, 125 Mongolians, 144 Mortality among feeble-minded, 146 Mothers, unmarried, 20 Nervous system, growth of, 97 ; diseases of, 240 New Jersey, Newark, clinic of, 71 New York, expenditures for crime, 21 ; Clearing House for Mental Defectives, 34 ; Department of Ungraded Classes, 125; Munici- pal Lodging House, 202 Pennsylvania, University, clinic of, 75 Perception, 120 Practice curves, 173, 177 Prenatal influences, 217 Prevention of mental deficiency, 206, 236 Prostitutes, mental status of, 20 Providence, special classes of, 274 Psychographic methods, 69 Psychologist, 73 Psychological clinics, 74, 76 Race, as related to feeble-minded- ness, 14 Reading, 126, 127 Responsibility, legal, 165 Retardation, in the schools, 24 ; causes of, 26 Secondary cases, 240 Sensory capacity, 110; defects, 220 Sex, 9, 11, 158 Special classes, 271, 273, 277 Special schools, 271, 275 Speech, 253 Springfield, special classes of, 274 Stigmata, 133, 139 Suggestibility, 160 Superior children, 8, 234, 235 Surveys, mental, 27 Syphilis, 240 Syracuse, State School, 277 Teeth, defects of, 221 Texas, State Reformatory, 33 Tics, 114 Tonsils, 223 Training, transfer of, 179 ; indus- trial, 130 ; physical, 146 ; moral, 167 ; in specific habits, 195 Unemployment, 20 Variability, 1; physical, 3, 138; mental, 5, 6, 7 ; in school attain- ment of children with identical mental ages, 125 Variation, 208 Vineland, 136 Vital capacity, 137 Printed in the United States of America. UNIVERSITY OF CALIFORNIA LIBRARY, LOS ANGELES EDUCATION AND PSYCHOLOGY LIBRARY This book is DUE on the last date stamped below. SEP 19 1968 RECEIVED OCT 25 Id/2 DU. /PSYCH. UBfiARK 1974' Form L9-10m-9,'65(F7203b8)4939A UCLA-ED/PSYCH Library LB 1091 H72 pp. 979037 9