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Full text of "A clinical study of one thousand retarded children in the public schools of Camden, New Jersey"

SBSS^s^Mvtfi^^-^i^^^Ji^* 










EXPERIMENTAL STUDIES IN PSYCHOLOGY AND PEDAGOGY 


KuiTou: 


LIGHTNER WITHER 


UNrVBKBlTT OF Pf.KNBTI.VAI«A 


A CLINICAL STUDY OF RETARDED CHILDREN 

1 


1 

JACOB DANIEL lUL^lLMAN. Pn D 


PHOFESeOR OF P8TrH01X)0Y, HTATK ' 


ORKBLEY, COLO. 




PHIIAnFrPITTA 


THF f^YCI! 



Psychological 
Monographs 



A SERIES OF EXPERIMENTAL 

STUDIES IN PSYCHOLOGY 

AND PEDAGOGY 



EDITED BY 

LIGHTNER WITMER 
University of Pennsylvania 



1. Spelling in the Elementary School. An Experimental and Statistical In- 

v-estigation. 1902. 98 pp. 16 figures in the text and an appendix of 
26 tables. Price: cloth, $1.25; paper, $1.00. 

By Oliveh p. Cornman, Ph. D., District Superintendent of vSchools, 
Philadelphia. 

" Dr. Cornman has made an extensive investigation of the ability of school children 
in Philadelphia schools in the subject of spelling, and studied his results with such 
care that liis work deserves special attention." Professor W. H. Burnhsm. The 
Pedagogical Semiir'ary. Vol." VIII. No. 4, Dec, 1906, p. 491. 

2. The Sensation of Pain and the Theorj^ of the Specific Sense Energies. 

1902. viii, 87 pp., with one table and two figures in the text.^ Price: 
paper, $1.00. 

By Anxa J. McKeag, Ph. D., Protassor of Pedagogy, Wellesley 
College. 

As the result of an experimental iavestigation of the reaction of a number of sub- 
jects to painful stimuli, the author first presents an analysis of the pain judg- 
ment, which is presented either as a general or unforced judgment, or as a judgment 
in which the subject is rerjuired to give expression to the perceived qualitative 
distinctness and discreteness-of the sensation. The relation of pain and. touch to- 
various stimuli is given consideration. Irian important chapter h, resume of the 
history of the theory of the specific .sense energie.s is given, with special reference 
to the sensation of pain, and an examination is made of tifae pKj^idlogical basis 
of pain in the periphery and nerve centres. . t - 

3. The Application of Statistical Methods to the Problem of Psychophysics, 

1908. 221 pp., including 91 tables. , Price: paper, $2.50. r 

By F. M. Urban, Ph. D., University of Pennsylvania, Philadelphia. 

4. Two Experimental Studies of the Insane. I. The Train of Thought. 

II. Some Physiological Conditions acconipanyintg States of Depres- 
sion. 191.9. 84 ppv;, 3 inserted tables. Pricfe: papet, $1.00. 

By Clara Harrison Town, Ph. D., Resident. Psychologist at Friends' 
Asylum for the IiLsane, Ffankford, Philadelphia, Pa. 

5. A. Clinical Study of One Thousand Ret:irded Children in Camden, N. J. 

By J. D. Heilman, Ph. D., Professor of Psychology, State Normal 
School, Greeley, Colorado. — pp., hxcluding 22 tables. Price: paper, 

SI. 00. ■ ' ■'■ 

THE PSYCHOLOGICAL CLINIC PRESS 

WOODLAND AVE. & 36TH ST. 
WEST PHILADELPHIA, PA. 



EXPERIMENTAL STUDIES IN PSYCHOLOGY AND PEDAGOGY 



Editor : 
LIGHTNER WITHER 

University op Pennsylvania 



V. A CLINICAL STUDY OF ONE THOUSAND RE- 
TARDED CHILDREN IN THE PUBLIC SCHOOLS 
OF CAMDEN, NEW JERSEY 



A CLINICAL STUDY OF ONL THOUSAND RLTARDLD CHILDRLN 
IN THE PUBLIC SCHOOLS OF CAMDLN, NFW JFRSFY 



BY 

JACOB DANIEL HEILMAX, Ph. D.. 

PROFESSOR OF PSYCHOLOGY, STATE NORMAL SCHOOL, GREELKY, COLO 



PHILADKLPHIA 

THE P8YCHOLOOICAL CLINIC PRESS 
1910 






^-h 



A THESIS 



SUBMIT 1 ED TO THE FACULIY OF THE GRADUATE SCHOOL 

OF THE UNIVERSITY OF PENNSYLVANIA IN PARTIAL 

FULFILMENT OF THE REQUIREMENTS FOR 

THE DEGREE OF DOCTOR 

OF PHILOSOPHY 



239394 



A CLIMCAI. STIDV OF ONE THOUSAND RETARDED 

rillLDKKN L\ THE PUBLIC SCHOOLS 

OF CAMDEN, NEW JERSEY. 



Introduction. 



It was fouiul by means of a statistical investigation made at 
the close of the school year 1905-06, that there were more than 
two thousand retarded children in the public schools of the city of 
Camden. A year after the statistical investigation, an attempt 
was made to subject each one of the two thousand cases to an 
individual clinic^il examination. For causes which will be 
descriJK'd in the main body <»f this thesis, it was possible, however, 
to re-examine only <»ne-half of the original number of cases. 

The motive for the clinical investigation is to be found in the 
failure of the piddic school to realize one of its ideals. This 
failure constitutes a just cause for the criticism that there is a 
deformation in the social institution for the education of our chil- 
dren. Defonnation Raving Ix^m pointed out, this investigation 
was undertaken with the hope of reform by inquiring into the 
causes of tlie existing conditions. The object of this study is there- 
fore twofold: first, to make a criticism of the public schools — to 
show in what respect they fail of reaching their aims; and sec- 
ondly, to set forth some of the cAuses to which the schools' failure 
may i>e ascribed. The causes having l)een discovered, it is hoped 
that an effort to remove them will residt in the improvement of 
the schools. As the second object constitutes almost the Avhole of 
this monograph, the first will l>e disposed of in the introduction. 

Children JK'gin their public school life at different ages, some 
as early as five, others not until eight or older. Even where edu- 
cation is conij)ulsorv, tlie age of entrance will frequently be above 
that pivscribed by law. This is due in ]»art to an evasion of the 
law and in ]tart to ill lu-alth, and the influx of a foreign popula- 
tion. Nevertheless, the majority of children are under seven years 
of age when tirst entered upon the enrolment records of the public 
schools. 

(fi) 



6 'CllNWA^B'SXVDY OF RETARDED CHILDREN. 

It is {tie 'al ill' of' tile school to have each child do the work of 
one grade in a single year, so that if a child enters the first grade 
at the age of six years, he should, if the school succeeds in its 
l)urpose, l)egin the work of the second grade at the age of seven 
years; of the third grade at the age of eight and so on through 
the gTades. The school, however, does not succeed in realizing this 
ideal scheme of progress. A very cursory exaniination of school 
reports or enrolment records will reveal the fact that there is a 
large numher of cliildren in the ])ul)lic schools who must often 
have failed to make the necessary promotions. 

From an analysis of the total enrolment figures of the Camden 
schools for 1905-06, it appears that about 3372 public school 
children or 26 1-3 per cent of the entire number were retarded, 
meaning by "retarded" those children of the first grade who w^ere 
nine years old or more, of the second grade those who were ten or 
more and so on. A realization of the extent of the retardation of 
public school children led Mr. Bryan, the city superintendent, to 
study by means of a statistical inquiry, the conditions under which 
it existed, and also to consent to a clinical examination of the 
children whom his inquiry showed to be retarded. This examina- 
tion was carried on by me during the second half of the school 
year 1006-07. Its object was to discover the social, educational, 
and other factors which delayed the normal progress of the child. 
What was accomplished in the effort to realize this object, w-ill be 
set forth in the main body of this monograph. 

In order to facilitate the investigation and to secure data that 
were relatively uniform and of scientific value, the first task was 
the ]>reparation of a suitable blank. The description and analysis 
of this blank will constitute the subject matter of the first chapter. 
Other steps preliminary to the investigation and certain miscel- 
laneous problems connected with it, like the withdrawal of chil- 
dren from school, will be considered in the second chapter. The 
third chapter will be a treatment of the results of the clinical 
invcstic'ation. 



CIIAPTEU I. 
Description and Analysis ok riii: Ijlank. 

Tilt' analysis of the blank is inado because it is indispensable 
to a proper coinprebension of the chapter on results. It is hoped, 
moreover, that it may prove of service to others who may contem- 
plate the preparation of a blank for similar investigation. The 
blank is of such a character that it may also serve as a model to 
teachers who are i)ersuaded of the utility of keeping a permanent 
record of each child. Such a record, revised each year and sent 
with the child as it is promoted or transferred from one vSchool to 
another, W()uld more than repay the teacher for the time devoted to 
making the records. To do this work properly, ])resupposes on the 
part of the teacher, a knowledge of the individual child which is 
really indispensable to its proper discipline and instruction — a 
knowledge, however, which many teachers lack. The HMpiircd use 
of this blank will go far towards compelling the teacher to gain this 
necessary knowledge. A case presents itself to my mind which 
forcibly illustrates how children may be uuide to suffi'r on account 
of the ignorance of the teacher. This was a girl, nine years old and 
in the first grade. She did very poor work and had little promise 
of being promoted. The mother was very urgent in demanding 
that her child should be promoted at the close of the term. Partly 
owing to the parent's insistence and ]iartly in consequence of a 
school regulation, this poor child, who was a micnx^ephalic im- 
becile, was detained an hour or more almost every day after the 
regidar school session in order that she might study her lessons. 
On further inquiry, I discovered that no matter how much time 
the child devoted to her lessons, she learned nothing. 

The keeping of such a record would do more than benefit 
the teacher and the j)upil. Properly nuule and preserved, these 
records would constitute a repository of data, upon which to build 
generalizations of the utmost significance to the school system 
and all conuecteil with it, whether in the capacily of patron or 
pupil, teacher or supen'i.sor. 

.Ml the items of the blank, whii'h is reprod\ieed in actual 
size on the following page, UM\y l)e classified somewhat roughly 
into three groups: one group i)ertains to the child in the home, 

(7) 



8 CLINICAL STUDY OF RETARDED CHILDREN. 



No. Name 










Grade Class 




190 


Address 




Grade Class 




190 


Address 




School 




190 


Teacher 




School 




190 


Teacher 




Progress E G F 


D \ 


D Date of birth Age 




Conduct E G F 


D V 


D Age on 


entering school No. years in school j 


Attendance vR R I 


vl 


A School 


history (Rel) 




Most deficient in 










Best in 










Habits 






54321 543 


2 1 


Father living dead 
Mother living dead 
Step-father, Step-moth 
Nationality F. 
M. 
Birthplace 
Lives with 


er 


Normal 


vG G M SI D Deficient Bkw IH IM 


II Id 


Health 


vG G P P vP Home Care vG G P 


P vP 
P vP 


Nutrition 


P G M P St " Culture vG G F 


Support 


R W M P vP " Discipline vG G F 


P vP 


Occupation of provider 




Child wo 


rks at 






Anormality Asymmetry 




Home Lang. 

Older brothers living dead 

" sisters " 
Younger brothers " " 

" sisters " " 
Eye, R. ] 
Eye, L. j 
Defects 
Disease 

Ear, R. | 
Ear, L. j 
Defects 
Disease 

Co-ordination 5 4 3 2 1 
vB Bold Norm Shy vS 
Am Resp Pass Sull Sur 
Sto In Al Nerv vN 
vR Refl Norm Imp vl 
Stu Wilf Firm Flex Vac 


Trunk 






Arms 






Legs 






Hands 






Feet 






Cranium 
Forehead 






■ 




Face 






Ears 






Eyes 






Nose 






Lips 






Palate 






Tonsils 






Naso-ph'r 
Mth Brec 
Teeth 


IX 




ithg 








Tongue 






Voice 






Stammer (inf) 5 4 3 


2 1 


Speech 






Stutter 5 4 3 


2 1 


Diseases 






Filled in by 






Datft 




Laboratory of Psychology, University of Pennsylvania. 
The J. Lewis Crozer Fund. 





THE KXAMlSATloy: liLASK. 9 

another to the child in the school, and the third to the child as a 
mental and pliysieal entity. Just as there are throe main groups 
of facts, so there are three main sources from which U> gain 
our information: the home, the teacher and the child himself. 
When large numbers of children arc to ho examined within a 
limited j>eriod, it is impossible to undertake to see the parents 
of ever}' child and the necessary information must be obtained 
from other sources. Frequently the child's teacher will have 
some knowledge of the home conditions. In my experience, how- 
ever, the principal is more likely to know the home, especially 
if she has held her jiosition long cno\igh to become acqmiinted 
with the district. It is also a practical expedient to use the child's 
appearance as an index of the home conditions. In my work, 
I attempted to obtain facts about the home fmin the teacher, 
principal and child. 

The blank makes no provision for obtaining certain data 
of value, such, for example, as the circumstances of the child's 
i)irth. A number of considerations entered into the determina- 
tion of the number and kind of data, for the collection of which 
provision was made. To prepare a blank four times the size 
of this one would have been a comparatively easy task. Our 
blank limits the data to those considered most essential for an 
understanding of the child's status in the school, i. e. his back- 
wardness in grade for his years. The blank must be as convenient 
as possil)le to handle antl must be filled <>ut with the least ]X")Ssible 
expenditure of time. Not an item appears on this blank without 
having had its purpose and relative value subjected to critical 
scrutiny. In certain cases, however, important facts may come 
to light which ought not to be passed by; these should be care- 
fully entered on the back of the blank. The blank was only put 
into its present form after several days' trial. This resulted 
in a few alterations, but for the most part it was left as originally 
conceived by Professor Witmer. 

There are a number of proliniiiiarv data at the head (»f the 
blank which may usually bo obtaiiKMJ from the ordinary school 
records. Those are name, address, fjradr, r^a.w. srhnoJ. frnrhrr, 
date of hirfh. and nrfr : sometimes even arje on rnfrrintj s^rlwol and 
numhrr of yrar.9 in ftrhool can be obtained from the records. In 
the Camden schools it was possible to obtain all but the two last 
named item'' from the regular regi>ilration books. It will bo 
noticed that grade, class, school, address, and fracJicr are duplicated. 
This is explained in the following way. When I began my work 



10 CLINICAL STUDY OF RETARDED CHILDREN. 

I examined the blanks Mr. Bryan had used in his inquiry during 
the year 1905-OG. From these records I obtained the name, grade, 
dass, address and teacher for each one of the two thousand re- 
tarded children. These facts are required to identify and locate 
the child, therefore I entered them upon my blank before be- 
ginning the actual examination. But M-hen I began the exami- 
nations, I found that the location of the child had changed in a 
large percentage of cases, due to promotion, transfer or change 
of residence ; hence the duplication. If the facts which serve 
to identify and locate the child are obtained from the school rec- 
ords for the year in which the investigation is carried on, some of 
the items on the blank need not be duplicated, but this does not 
ajoply to grade and class. The grade and class of the year previ- 
ous to that of the examination should be entered for every child 
upon the blank, so that when a child's progress is reported by the 
teacher as good, the investigator can at once compare this judgment 
with the number of classes or grades the child made during the pre- 
vious year. Frequently teachers will report progress "good" simply 
because the child in question is then doing well. They do not 
take into consideration the length of time involved. When their 
attention is called to the fact that the child made no promotion 
during the previous year, they frequently reverse their judgment. 

After we have obtained the name, grade, class, school, address, 
and teaclier of the child, he may be said to be located. We now 
know where to go to find him, whether at school or at home, in 
order to obtain the other data called for by the blank. Moreover, 
age, grade, and class give the child's intellectual status, enabling 
us to measure the extent of his retardation. Date of birth and 
age are both called for, in order that one may serve as a check 
upon the other. If there is any inconsistency, the information 
must be regarded as unreliable. The same may be said about 
age on entering school and ninnher of years in school. 

Closely associated with all the data mentioned above are 
progress, conduct, and attendance. After progress appear the 
letters E, G, F, D and vD ; these are abbreviations for the words 
excellent, good, fair, deficient and very deficient. The letters used 
in connection with comhict are the same as those used with pro- 
gress, and stand for the same w'ords. The letters following 
attendance are vR, R, I, vl, and A ; they are symbols for the 
words very regular, regular, irregular, very irregular, and ahsent. 
These letters, standing for words, are used because they are likely 
to mean more to the person doing the grading, than mere figures 



TLIK KXAML\AIU),\ ULAMv. H 

standing for so many grades. ITowevcr, figures may be employed. 
In connection with tturmal, which for tlic sake of compactness is 
used for normal mentality, both figures and letters appear. The 
same arrangement is employed in connection with deficient, stand- 
ing for deticient mentality. To indicate the grades of co-ordina- 
tion, stammer, and stutter, only figures are employed, because 
no significant words suggest themselves. l>clow the item co- 
ordination are five groiips of letters and words which are used 
to grade five diiferent mental or moral qualities, whose purpose 
will be considered later. The other qualities which it was thought 
profitable to. grade are health, nutrilion, support, home care, home 
culture, and home discipline. 

I have now made mention of all the data involving the 
gradation of qualities, conditions and functions; I shall next 
consider the system of grading. It will be noticed that a five- 
point system is adhered to throughout, and there are some reasons 
why a five point, rather than a four or six point, or some other 
system, should have been chosen. It appears to be the most 
natural system. In our every-day judgments we are apt to 
classify Avith respect to a system of five grades. When asked 
to grade the mentality of a child, it does not seem difficult to 
say that he is either good or poor, or neither. But we constantly 
meet with exceptional cases which we feel should be classed as 
very good or very poor, and therefore one more grade appears 
necessary at each end of the three already given. In asking 
teachers to grade the mentality of tluir i)upils, I frequently asked 
them whether the mentality was good or poor, without telling them 
how many grades of mentality 1 used." In very many cases they 
responded, ''neither," meaning medium, or, ''He is very good," 
or, ''He is very poor." 

Another reason for jjreferriiig the five-jioiiit system is its 
easy adaptation to other systems. In translating this system 
into the percentile system, or the reverse, the lowest grade would 
include all the points from 1-20 per cent; the second from 21-40; 
the third from 41-00; the fourth from 01-80; and the fifth from 
SI -100. Although somewhat imperfectly, it may be articulated 
with a three-point system l)y cond)ining the two ])oints at each 
extremity of the five-point system. ;\gain, some four-point systems 
are simply five-point systems in disguise. Such, for example, is the 
one used in the college of the University of Pennsylvania. Here 
the symbols I). G, P, and X, stan<l for the words distinguished, 
good, pa.9sed, and not passed, respectively. The group marked 



12 CLINICAL STUDT OF RETARDED CHILDREN. 

N has really not been analyzed and graded because the college 
has no interest in grading students who fall below the passing 
mark; but if the IST group were graded according to relative 
ability, it would be found that the students in it would distribute 
themselves into two groups which would be related to each other 
like the D and G groups. 

In connection with normal mentality, for w^hich nonnal 
appears on the blank, I wish to explain in what way the figures 
are used to indicate gradation. Directly after normal are placed 
the symbols vG, G, M, SI and D, standing for the words very good, 
good, medium, slow, and dull. ^\Tiere such words or their symbols 
are used there can be no doubt as to the grade for which they 
stand, but this is different where figures are employed. Here 
it will be observed that D is placed below the figure 1 ; therefore 
the figure 1 indicates the lowest grade of normal mentality. 
The highest grade of mentality is indicated by the figure 5, 
placed above vG; and medium mentality by the figure 3 above 
M. Consequently, the higher the figure, the higher is the grade 
of mentality which it denotes. This use of the highest figure for 
the highest, and the lowest figure for the lowest degree of the 
quality after which it appears, is followed wherever figures are 
used for grading. In general, this is contrary to custom, but it 
is adhered to in this blank for the sake of being consistent with 
the percentile system of marking grades. Just as in the percentile 
system, so in this system the lower numbers stand for the lower 
grades. 

After this general treatment of the graded items, I wish to 
consider these items individually, and first mentality. The imme- 
diate purpose of the preparation and employment of this blank 
was the collection of data for an investigation of the causes of 
retardation. Much of the retardation may be accounted for by a 
low degree of mentality ; and to determine the number whose 
mental capacity is low, gradation was not avoidable. The grades 
of normal mentality appear on the blank after the word normal. 
The symbols employed are vG, G, M, SI, and D, and they stand 
for the words very good, good, medium, slow, and dull. These 
words were not used to grade the class standing of the children, 
but their mental capacity or ability. The use of the words very 
good, good, and medium for grades 5, 4, and 3, will be accepted 
without comment. It may seem that perhaps we should have 
chosen the words poor, and very poor for grades 2 and 1 re- 
spectively. These words indeed are often applied, but the endeavor 



THE EXAMINATIOX BLANK. 13 

was made to use on the blank, words which would appeal most 
to the natural judgments of the teacher. It was tlionght that many 
teachers speak of their children as being "slow" and that this 
means more as a grading of mental capacity than the term pour. 
A "dull" child the teacher also understands readily, and this 
seemed to be a more striking term for children who are in the 
lowest grade of normal mentality than the rather indefinite term 
very poor. Whatever catchwords may be emj)loyed, they serve 
only to assist the investigator to assign the child his proper posi- 
tion in one of the five grades represented by 5, 4, 3, 2 and 1. 

It is commonly assumed that all children in the public schools 
are of normal mentality. If this were true, it would be possible 
to distribute all our cases over the five grades of normal mentality 
which have just been discussed. However, it does not take a very 
extensive investigation of the mental capacity of children who 
are retarded in school progress to discover that many of them are 
subnormal in mental capacity. Indeed, for every thousand chil- 
dren examined we find one or more children who are properly 
cases for an institution for feebleminded children. We must 
provide for a large number of children to be distributed over 
classes or grades that are recognizably deficient in mentality. To 
preserve the five-point system, children who are discovered to be 
mentally deficient are distributed over five grades. The highest 
grade of these deficient children is called backward; the lowest 
grade would be the idiot. The middle grade is occupied by what 
is generally characterized as an imbecile of medium grade. Be- 
tween him and the backward child we place the imbecile of high 
grade. Between him and the idiot we place the idio-imhrcile. 
In this scheme of classification we omit the imbecile of low grade, 
whom we should classify either as an imbecile of medium grade 
or as an idio-imbecile ; and we fail to recognize more than one 
grade of idiot. The mentally deficient are tlierefore represented 
on the blank by grades 5, 4, 3, 2, and 1, for which the following 
symbols are employed, Bkw, IH, IM, IF, and Id. 

A different point of view might have given rise to a different 
system of classification. Thus, Ireland and Shuttlcworth both 
make use of a pathological classification. This must necessarily 
be as incomplete as is our knowledge of the pathological conditions 
of the feebleminded. It is undoubtedly of value, however, to 
the physician, for h<' looks to the pathology of the idiot to throw 
light upon its etiology-, diagnosis, and prognosis. But these patho' 
logical conditions are usually not the causes of idiocy, Imt mere 



14 CLINICAL STUDY OF BETABDED CHILDBEN. 

concomitants. The essential fact of idiocy is mental deficiency. 
In the British Medical Journal for 1902 Dr. Eichholz says: "Fee- 
blemindedness or mental deficiency is not so mnch a symptomatic 
condition to which a medical man can apply his art with hope of 
success, as a social and educational grouping which has gradually 
arisen in connection with the development of elementary education 
in this and other countries." Moreover, it is recognized that the 
hope for the greatest improvement of the feebleminded lies in 
their instruction and training, — that the problem is an educational 
problem, and not a medical one. Even the physician becomes a 
trainer when he undertakes the daily care of the feebleminded 
child. This has been recognized from the time of Itard through 
Seguin to Sollier and Barr. In Die Kinderfeliler, Vol. VII, p. 97, 
J. Triiper quotes the following passage by Dr. Pelman, the 
psychiatrist at Bonn, from the introduction to the German edition 
of Sollier's, "Psychologic de I'idiot et de I'imbecile" : "What we 
meet as the pathological foundation of idiocy are the sequelae 
of diseased processes that have long since run their course. These 
one can no longer obviate through any known medical art. The 
feeblemindedness which has its basis in a congenital brain disease, 
or in one acquired in the first years of life, is no longer susceptible 
of cure. The task of the physician can therefore receive but a 
small reward." 

It appears to be generally admitted that the most satisfactory 
classification of the feebleminded is psychological or educational. 
A psychological classification, however, does not appear to me 
as practical as an educational one. Even so fundamental a psy- 
chical process as the attention, upon which Sollier bases his psycho- 
logical classification, is not such a measure of general capacity 
as to be of much service in determining the place of these children 
in schools and institutions. Of all the schemes of classification 
which have been offered, the most practical, in my judgment, is. 
that of Dr. Martin W. Barr. It is based upon educability. 
Omitting the moral imbecile, it is as follows: I. Asylum Cake: 
1. Idiot, (a) Profound, unimprovable; (b) Superficial, improva- 
ble in self help only. 2. Idio-imhecile, improvable in self help 
and helpfulness. II. Long apprenticeship and colony life 
UNDER protection: Imbecile, (a) Low grade, trainable in indus- 
trial and simplest manual occupations; (b) Middle grade, train- 
able in manual arts and simplest mental requirements ; (c) High 
grade, trainable in manual and intellectual arts. III. Trained 
FOR A place in THE WORLD: BacJcivavd or mentally feeble, mental 



rrii-: KXAMix.\ri<>.\ i:i..\.\h-. 15 

processes luirnial hut slow and requiring special traiiiiii«; and 
enviroinneut to prevent deterioration. 

The live grades of mental delicicncv that are used on the 
hhmk are practically the same as those which have been presented 
by Dr. Barr, The three highest grades of the mentally deficient 
are in complete agreement. The low grade imbecile, however, 
is not given a separate classification on the blank, nor is the class 
of idiots subdivided into the profound and the superficial. 

To assist in the further ])resentation of the items of this blank, 
I have reproduced an actual blank partially filled out, which will 
be found on tlie next page. 

At the top of the blank is the name of the child, in this case 
an assunu'd one. On the same linc^ with this, is a space provided 
for the purpose, is the number 1:1. This nund)er indicates the 
order of the blank in a series. The serial classification of the 
cards will be determined by convenience. In my investigation, 
the cards of the boys and girls were placed in separate series for 
each school. 

The significance of the items which give the child's residence 
and serve to locate him in a particular class and school and under 
a particular teacher in the year when the examination was made, 
needs no explanation. If these items are not sufiiciently intelli- 
gible from an examination of the reproduced blank on the next 
page, a satisfactory explanation will be found in the preceding 
article. 

Directly below the recorded data locating the child, are 
found the data which indicate why this child has attracted special 
.attention. 

Progress and conduct are followed by E, G, F, D, and vD, 
the initial letters for excellent, good, fair, deficient, and vrrj/ 
deficient. Gradation of pr(»gress should be made from the 
standpoint of the rapidity with which the child passes through 
the grades, ^fany teachers feel inclined to call a child's progress 
good because it does well in its grade, regardless of the fact that 
the work has been repeated one or more times. Tiie grade and class 
of the previous year will enable the investigator to see how often 
or how much of the work was repeated. Progress should Ik? 
marked with reference to the rapidity with which the child jia<«es 
through the grades, without regard to his attendance. 

If a retarded child's progress be good at the time of the ex- 
amination, then special effort should \)C made to find the cause 
of ret^ardation in his past school life. A space is provided for a 
brief synopsis of the "school history." 



16 CLINICAL STUDY OF RETARDED CHILDREN. 



"^So?vvu 



No. W Name 

Grade Class 

Grade \ Class 4* 
School _ -^ V^ 



190 
190 1 



School 



V 



Address 
Address 
190 Teacher 
190 '\ Teacher 



b'Ck 



P^okX' 



TVuj^ CAxUxaa^V 



EOF D >W Date of birth <bjoO Age *] 



Progress _ _ _ _- _ , 

Conduct E G F D w Age on entering school (o No. years In school | 

Attendance vR It I vl A School history (Rel) (^juiOaO oA* U?<3utv\JuV 
Most deficient In A 

HVblts^.^]|4Ju+JUi/xAt•^c>a5^ ^.R>AJuu ^.Sxa 



Normal 



Father living dead 
Mother living dead 
Step-father, Step-mother 
Nationality F. 
" M. 

Birthplace 
Lives with 

Home Lang. 

Older brothers living dead Arms 

" sisters ' 

Younger brothers " 

" sisters " 



5 4 3 2 1 

vG G M^ SI ^D Deficient 

vG G F P vP Home Care 



Health 

Nutrition F G M J^ St 
Support R W M *^vP 
Occupation, of provider 



5 4 3 2 1 
Bkk?IHIM II Id 

■FVp 



vG G F _ 
" Culture vG G F P vtt* 



Child works at 



Discipline vG G F 



JXXSi- 



Anormality 



Asymmetry 



Trunk 



Legs 



Hands 



Feet 



Cranium 



) 



Forehead 



Face 



Ears 



Eyes 



Nose 



Lips 



Eye, R. 

Eye. L. 

Defects 

Disease 

Ear, R. 

Ear, L. 

Defects 

Disease 

Co-ordination 5 4 5 2 1 Tonsils 

vB Bmd Norm Shy vS Naso-ph'nx 

Am Resp Pd/s Sull Sur Mth Breathg 

Sto In Al N^v vN Teeth 

vR Refl NcVm Imp vl Tongue 

Stu Wilf Firm Flex vJfc Voice 

Stammer (inf) 5 4 3 2 1 Speech 



Palate 



Stutter 



5 4 3 2 1 Diseases 



Filled in by ....fl^.tO. J4ui/VYVCW^J Date . . .vLaMJU.^J". ^. 1 !^ P.l 

ijjiboratory of Psychology, University of Pennsylvania! 
The J. Lewis Crozer Fund. M 



THE EXAML\ATH).\ llLASK. 17 

A3 a basis for rating conduct, I chose the agreement between 
tlie child's actions and school regulations. In addition t<» inter- 
fering with a child's progress, poor conduct may have a diagnostic 
value of its own. For example, deficient conduct may be a conso- 
(juence of low mental capacity. When a child is unable to take 
l)art in school exercises, his conduct is invariably of such a nature 
as to conflict with the order of the school. Deficient conduct may 
be indicative of defective home discipline. \Vhen conduct is very 
deficient at school, delinquency is often associated with it. When 
conduct was reported deficient, I always inquired into the child's 
moral history, and often obtained a story of thefts, gambling and 
sexual indecency. I recall at least two cases of horse stealing, 
quite a number of gambling and no less than six who had been 
guilty of sexual offences. I do not for an instant believe that the 
teachers knew of most of the cases, or that they reported all the 
cases which they did know. Care should be taken not to mark as 
deficient the conduct of a restless child, who may simply be unable 
to control his body on account of ill-health. 

The symbols vR, R, I, vl and A are used to record attend- 
ance. These symbols are the initial letters of very regular, 
regular, irregular, very irregular, and absent. The choice of the 
words used in connection with this item, as witii all the other 
items, resulted from an att(Ma]»t to employ words which were 
already used by the school for tlic same purjiosc, or which would 
assist the investigator and teacher in making the rating. If the 
five })oint system of lirading be strictly folldwed. a child who is 
present from IT to 20 days in a month will be considered very 
regular; from 1*> to 10 reuidar; !> to 12 irregular; '> to 8 very 
irn-gidar. and 1 to 4 absent. .\s tnuincy is closely related to 
attendance, this fact should always Ik* investigated in connection 
with it, and recorded on the back of the blank. On the face i)f 
the blank no space was alK>wed for truancy and a nundier of 
other im])ortant facts, because they an' of relatively infre(]nent 
occurrence, and a note on the back of the blank involves very 
little time and effort 

The card of John Smith, repro<luced on page 1<'», records 
his progress and conduct as very deficient; attendance, however, 
is regular. He entered school at six years of age, and at the time 
when this blank was filled out, June 4, 1007, which nniy be seen 
from the lK>ttom of the card, he had been in school one year and 
was at that time seven years of age. Tlis school history shows 
that the work of the year was done in the <cho..l in which he was 
found at the end of the vear. 



18 CLINICAL STUDY OF BETARDED CHILDREN. 

We therefore see that we have a record of deficient progress 
which is not explained by irregularity of attendance, nor bj 
entering school late, and which is either associated witli or caused 
by deficient conduct. When next we look at the grading of 
mentality, we find that he has been placed in the group of those 
having deficient mentality and that he is classed as a backward 
child. 

The ratings of progress, conduct, attendance and mentality, 
which have been considered, are indicated by a check mark over 
the symbol of the reported grade of the respective quality. This 
is an easy symbol to make, and the saving of time is an important 
desideratum. If I dissented from the teacher's judgment with 
respect to any item of the blank after having examined the child, 
I noted the fact by drawing a horizontal line through the symbol 
of the grade in which I placed him. Thus, if I had considered 
this boy a high grade imbecile, the blank, in addition to the 
check mark through Bkw, would have had a horizontal line 
through IH. The marks employed are immaterial, but it is im- 
portant that they should be made as quickly as possible and should 
be easily distinguished in the subsequent collation of the data of 
the blanks. 

We now see that we have to do with a backward child of 
normal age in the first school year, who has been regular in at- 
tendance throughout the year, but whose conduct is reported as 
very deficient. Is his backwardness the consequence of deficiency 
of conduct ? Is it the result of school conditions ? Has it fol- 
lowed upon the home environment? Of is it based upon struc- 
tural defects, or inheritance ? 

Directly below the entry of the child's mental grade is found 
a group of items relating to the child's environment. His health 
is reported as fair, nutrition poor, support poor, home care poor, 
home culture very poor, and home discipline very poor. There- 
can be very little doubt that the progress of a child in school, 
independent of any physiological backwardness, is the result of 
these various factors. Even physiological backwardness may be 
augumented, and probably caused, by the associated activity of a 
number of unfavorable environmental conditions. The extent to 
which these factors are associated with difi"erent degrees of men- 
tality as revealed through school work, is one of the subjects of 
my investigation. 

In employing this blank the general health of the child is 
to be recorded as very good, good, fair, poor, or very poor. The 



TTJE EXAMlSMiny BLAXK. 19 

rccnnl is hasod upon .such juil^iueiit as a tcafbt-r i<v paicut wduld 
jiivi'. It is uot a r(.'|)ort sucli as a medical cxauiiucr would make 
Tlio ulyji'c't is to Hml tu what extent tlii" child's health interfered 
with his attendanei' at school or with his performing; daily tasks, 
even if he were in actual attendance. It does not propose to 
record the existence of actual disease. If the child is found to he 
suifering from some special disease, this is to bo reported in the 
space provided at the l)ottom of the blank after tbe word dinra.srs. 
Here also an' to be recordeil such children's diseases as the child 
may have sutTered from in the pa>i. When facts worthy of 
special note are discovered in this connection, they arc to be. 
recorded on tbe back of tbe blank. 

Poor health may not only cause prolonged or repeated 
absences, and so indirectly retard the child : it often interferes 
with vigorous mental action, and is a predisposing cause of 
fatigue, \\1ien fatigue is readily produced, sustained attention, 
which is so essential for mental acquisition, becomes practically 
impossible. ^lany physical ailments are a continual sfuirce of 
irritation to the nervous system, not oidy because they produce a 
condition t»f malaise, but because they withdraw attention from 
the lesson to the source of excitation. The connection between 
good health and the attainment of the objects of school instruc- 
tion is so close that school systems are awakening to the need of 
physical directors and medical inspectors to look after the phys- 
ical welfare of the children. ^lental, and often moral, deteriora- 
tion may result from prolonged ill-health. 

The nutrition of the child is also to be recorded on the basis 
of general observation, rather than a physician's examination. 
The five classes, in one of which the child's nutrition may be 
recorded, are indicated by the letters F, G, M, P, and St, which 
stand for the words fat, good, medium, poor, and starved, respect- 
ively. Faulty nutrition retards the child's progress, whether it 
is due to disease or to imi)ro])er and insufficient diet. If no posi- 
tive knowledge of the diet can be obtained, the rating of nutritioii 
may be based upon certain signs to be observed in th«' child. 
.\fter the item lnt/iHs. in the blank, T usually nvorded such facts 
as I could obtain <'oncerning the child's diet. Thus, John Smith's 
nutrition is recorded as ])oor, and after the wor<l Inihlfs occurs 
tlic formula, "1. Coffee -4- bread »S: cake; 2. l>eer. .".. Tea." This 
means that the child's usmil breakfast is coffee, bread and cake; 
that he drinks beer at dinner and tea at supper. In this case 
it woidd appear that the jx)or nutrition was probably due to 



20 CLINICAL STUDY OF RETARDED CHILDREN. 

insufficient and improper diet. This condition is one wliich I 
have found in a very large number of the backward children 
whom I have examined. 

The child's color may be employed to assist in determining 
his nutritional status, for paleness is an effect of either an insuffi- 
cient supply or an impoverished state of the blood, due to a lack 
of oxygen or the proper kind and amount of food materials ; but 
lack of color must not be mistaken for a light complexion as 
shown by the color of the eyes and hair, nor must a dark com- 
plexion be interpreted as an absence of paleness. 

Paleness may be due to a blood disease called ansemia, and 
when this is the case, the skin will remain permanently pale with- 
out change of color. The color of the lips, and changes of color 
in the finger nails when subjected to pressure, may also be 
observed. If this change of color upon pressure is not very 
decided, it may be taken as a sign of poor nutrition. If the 
return of color upon removal of the pressure is slow in appearing, 
it indicates vaso-motor disturbance. 

Other important signs of poor nutrition are emaciation, and 
deficient weight in comparison with height. Disproportion among 
the several members of the body may indicate defective nutrition 
at some period previous to the time of examination. Signs of 
defective nutrition during the early period of rapid development 
previous to the second year, may be observed in teeth, ears and in 
other developmental de'fects. These, however, are not to be taken 
into account in this connection, excepting in a general way. They 
will be entered under anormaliUes and asymmetries of the bodily 
members. 

If the financial support of the child in the home is poor, it is 
likel^^ that poor nutrition is the result of insufficient diet. If 
the support is ample, poor nutrition is more likely to be due to 
physiological conditions, and to be associated with ill-health. The 
support which the child receives at home is entered as rich, well- 
to-do, medium,, poor, or very poor. The financial condition of 
the family not only militates against the child's health and nutri- 
tion, and so causes retardation : it becomes a direct cause of 
retardation owing to the fact that many children are kept from 
school to assist in eking out a livelihood for the family. Many 
children in Camden leave school about the middle of May to 
engage in some kind of occupation. This is especially true of the 
Italian children, who leave school about a month and a half before 
the close of the term to obtain employment as berry-pickers. 



Till-: i:.\.\ML\.\rn).\ nL.wK. 21 

Moreover, in my investigation there appeared to be some families 
60 afflicted with ill-health and poverty that they would have to 
depend upon charity for their subsistence if they sent their chil- 
dren regularly to school. Poverty becomes a direct cause of 
retardation when it is so extreme as to prevent the family from 
supplying proper and sufficient food, clothing and housing. The 
nurture of thousands of children in our large cities is the direct 
cause of adult inefficiency. 

Home care, home culture, and home discipline are usually 
directly correlated with the financial status of the family, though 
there are many exceptions to this rule. Home care is rated as 
very good, good, fair, poor, or very poor. The cleanliness of the 
child's person and clothing is the best indication of home care. 
Tiie vitiatccl air in which many of our teachers and children are 
immersed day after day, has its origin not only in the poisonous 
products of the breath, but also in the children's clothing, which 
is often soaked with filth. It would surprise any investigator to 
learn how many parents adopt the convenient custom of "sewing 
up" their children for the winter. As the cold weather increases, 
the number of garments increases, and as the weather moderate-? 
the garments diminish. During this entire period the clothing 
worn next the skin is unchanged, and may be neither washed nor 
aired for months. This filthy condition not only militates against 
the child's well-being, but interferes with his progress in school, 
because these children are repulsive to most teachers. 

Insufficient clothing makes it difficult for many children to 
nniintain health and keep in daily attendance. I was informed 
by the principal of one of the Camden schools that there had been 
a marked improvement in attendance upon supplying the poorest 
children with the cast-off clothing of those in more fortunate cir- 
cumstances. 

The overcrowding of a family into one or two rooms, 
the result of insufficient financial suj)port. is also a frequent 
factor in reducing home care and home discipline to a minimum. 

By home culture is meant the degree of mental development 
and refinement attained by the family. If the child has an intel- 
lectual, moral, and emotional environment of high grade, his 
school progress is favored In* it. The conception of culture 18 
not verv definite, nor is it easy to estimate the different grade** 
of home culture. I asked the teachers t<i base their judgment? 
on the kind of literature read in the home, on the parent-s' occu- 
pation, and the content and modes of conversation. In the deter- 



22 CLINICAL STUDY OF RETARDED CHILDREN. 

mination of the culture level, as well as of other facts about the 
home, the child himself very often serves as a satisfactory index. 

The relation of home culture to school progress is not to he 
settled off-hand without a careful inquiry. Children from the 
homes of very ignorant parents often stand high in their school 
work, but intellectual standing is not the whole of culture. Where 
the moral element is prominent, the members of a family live a 
life of duty and self-restraint and effort, w^hether at home or in 
school. This, of course, means application and discipline that 
develop habits of work and attention so necessary for school prog- 
ress. Lack of moral training in the sense of absence of proper 
home discipline is a frequent cause of lack of industry, applica- 
tion, and concentration of attention. I consider the item of home 
discipline one of the most important determining factors of school 
progress. A well disciplined child will always be amenable te 
the directions of his teacher and the regulations of the school. On 
the other hand, a child may manifest good moral conduct, may 
give no trouble in school, and yet may lack the essentials of dis- 
cipline. In explanation of the deficient progress of John Smith, 
I consider the rating of home discipline, very poor, as significant. 
In his case, it also resulted in deficient conduct. 

We now know something of this boy's environment. He is 
the offspring of parents who are living in poverty (his father is a 
presser, a tailor's assistant), unable to supply his body with 
sufficient food, though not requiring him to work as yet, unintelli- 
gent enough to furnish him with beer, tea and coffee, un- 
willing or unable to accord him satisfactory care of body and 
clothing, low in the scale of culture, and incapable of supplying 
the mental and moral discipline, the lack of which is probably 
evidenced in his retarded progress and deficient conduct. 

In the lower left-hand corner of the blank are a number of 
items of great interest in determining the general physical apti- 
tude of the boy, as well as certain traits of character which stand 
in close correlation to the manifestation of intelligence. Does 
the boy show good motorial co-ordination f The cheek mark 
stands over the number 3, which gives his co-ordination a rating 
of medium. We learn little from this that throws light on the 
association of motor with intellectual deficiency, but from a large 
number of cases we may see whether boys deficient in intelligence 
more often manifest good co-ordination, poor co-ordination, or 
medium. 

It is impossible to give in this place an extended discussion 



• rill-: h\\'AML\ATli)\ liLAyK. j;] 

of the factor of co-ordiiiatinii. A few words in regard to it will 
have to suthce. Co-ordination may he detined as the ahility to 
accomplish hy means of muscular contractions and with the least 
possible expenditure of ener<ry, a definite purpose or assifj^ned 
task. It means more than the simultaneous or successive synergy 
of two or more muscles or groups of muscles. It requires a deli- 
cate adjustment of the muscular innervation necessary to move 
a mend)er of the body at a given rate through a given distance. 
There is reason to believe that control of this muscular innerva- 
tion is dependent upon the will, and that volitional activity is 
closely associated with mentality. 

Several criteria may be employed to pass judgment upon the 
degree of co-ordination. One is the accuracy with which the task- 
is accomplished. Thus, if a child be asked to move his arm a 
given distance in a given direction, his co-ordination may be re- 
garded as good if his movement corresponds very exactly to the 
one required. Judgment of the degree of co-ordination may also 
be based upon the facility displayt'd in the ac('<»nij)lishnicnt of 
an assigned task. Tn my investigation I employed the following 
method to rate co-ordination: I threw a number of pegs, about 
two inches long and one-eighth of an inch in diameter, upon the 
table and askc^l the child to ])ick them up as rapidly as possible, 
using for the purjioso but one hand and holding the pegs in the 
same hand while he continued to pick them up. 

Below the word co-ordination are five groups of symbols and 
words descriptive of mental and emotional character. Their ap- 
pearance on the blank was to some extent in the nature of an 
after-thought. It was not my purpose to determine whether the 
child was shy or bold, amiable or sullen, stolid or nervous, reflec- 
tive or impulsive, stubborn or vacillating in will ; but it became 
apparent that shy children are often misjudged. They are apt 
to 1)C under-rated in intelligence and bold children over-rated. Shy 
and timid children will n(»t do so well in their recitations as the 
bold and forward. Souje children api)roxinuUing the condition of 
moral imbecility are extremely forward and bold, and give the 
appearance of great intelligence, and are therefore apt to be rated 
high. Teachers are apt to underestiimite the capacities of a 
sullen or surly child, and give too favorable a rating to an amiable 
one. The child whose thought is characterized by reflection is 
oftentimes under-rated in comparison with the ijupidsive child, 
^foreover, many of these characters have a diagnostic value. Shy- 
ness is often associated with deafnes-s, for the semi-deaf child 



24 CLINICAL STUDY OF RETARDED CHILDREN. 

often knows that something is required of him, the exact nature 
of which he is unable to comprehend. Sullenness is associated 
with adenoids, as is also stolidity. Nervousness and impulsive- 
ness and vacillating will are symptomatic of impoverished nei'vous 
systems. It is also true that these characters exercise a facili- 
tating or retarding effect upon sch(X)l i)r()gress and general mental 
development. The shy child is not likely to get so much out of 
the school work as the bold child. The amiable child receives 
more attention from its teacher than the sullen or surly child. 
The child who is alert in mentality is more apt to profit by the 
school environment than one who is stolid or nervous. The child 
whose will is firm, will do better work than one whose vacillating 
will produces want of application, or one in whom wilfulness or 
stubbornness awakens antagonism and negativism. 

The choice of words with which to describe mental and 
emotional character is not an easy one. The words that have 
been selected for this purpose were chosen after careful consid- 
eration. It is possible that different w^ords may recommend them- 
selves to others as being more suitable. The words selected were 
picked out primarily because they were thought to give an ade- 
quate description of a mental character, that is, for the purpose 
of providing an exact psychological designation, but also to fur- 
nish tenns familiar to the everyday judgment of the teacher. The 
terms describe the following five traits of character: — 

(1) Social reaction: — boldness or shyness. 

(2) Feeling and its expression: — amiability, responsiveness, 
sullenness or surliness. 

(3) General mental and physical activity: — stolidity, inert- 
ness, alertness, or nervousness. 

(4) Intellectual character: — reflectivity or impulsiveness. 

(5) Will or volitional character: — stubbornness, wilfulness, 
firmness, flexibility, or vacillation. 

I give below various words that may be employed to describe 
each of the five groups used in connection with each of these five 
traits of character. The one which is employed upon the blank 
stands at the top in each case, printed in italics. 

Social reaction: 

very hold hold normal shy very shy 

insolent courageous indiflferent reserved afraid 

impudent forward unconcerned coy cowardly 

impertinent pert timid 

saucy bashful 

diffident 



■/■///•; h'\AML\Ari<L\ j:LA.\h' 



Expression of feeling: 

iiniiiililr icaponsivc passive 

swt't't iiiipn'ssidiiiililc iiidinVreiit 

genial syuiiiatlii'tir apatliotlc 

gpiitlo phlegmatic 

General activity: 

stolid inert alert 

apathetif inactive active 

impassive slug;;i«li l»ri;:lit 



25 



sullen 


surly 


sull<y 


rntle 


<TUSS 


gruff 


peevisli 




morose 




iterious 


rrry nerrnus 


eager 


excitable 


restless 





\voo<len 










Intellectual character: 








very reflrctiic 


rrfh i-tivc 


Xormal 


iiniiidsivc 


very impulsive 


meditative 


thoughtful 
cautious 


inditTerent 


thoughtless 


rash 


Will: 










stubborn 


irilful 


firm 


^ttwible 


vaeillatiny 


intrai-talile 


determined 


normal 


submissive 


wavering 


obstinate 


headstrong 




yielding 


unstable 


obdurate 


refractory 




pliant 




unyielding 











It will be seen from the above that the child's social reactions 
are distingtiished as presenting opposite characters of boldness 
and shyness. Children who present neither character in marked 
degree are called normal. Perhaps it would have been bettor to 
describe them as indifferent. Children witli an excess of eiflier 
character are described as venj hold, or as vcrii shy. 

Feeling, or more accurately the expression of feelini;' in the 
child's reaction to the teaclier and nther persons of his environ- 
ment, is characteriz(Hl as amiahle, rrspoiu^fivr, passirc, sullcti, or 
siirJt/, for wliich the symbols Am, Resp, Pass, Snll, and Snr are 
employed in the blank. The amiable child is characterized by a 
sweetness of dis|)osition which is bound to make friends. Thus, 
amiability wins a teacher's regard and leads to efficient effort oi\ 
her part, but amiai>ilily in some cases leads to an excess of feeling 
which is detrimental to the best intellectual wr^rk. Th(^ child who 
is classed as amiable |)ossesses a character which is thereftue of 
doubtful value for school prepress. On the other haml, the child 
who is characterized as responsive is easy to work with, sympa- 
thetic, and is the most favorably situated child so far as feeling 
is concerned. The sullen child scowls and ]>outs, showing ill 
temper in facial expression but remaining silent. The surly child 
is more active in the expression of his ill humor, using voice and 



26 CLINICAL STUDY OF RETARDED CHILDREN. 

bodily action to demonstrate its presence. These children are 
diflicult to treat in large classes. Their feelings, nnless they are 
won over by a skilful and good-tempered teacher, are a serious 
bar to mental progress. The child who is indifferent in the ex- 
pression of a state of feeling, and in his reaction to the iteacher, 
is characterized on the blank as passive. Passivity may give free 
play to intellectual effort, and the passive child may furnish a 
more favorable soil for the teacher's efforts than the excessively 
amiable child, but feeling is a great stimulus to effort and it is 
probable that in most cases passivity is a relatively unfavorable 
soil. 

A child's activity, whether of mind or body, may be such that 
we may characterize him as alert. When present in excess it 
becomes nervousness. At the opposite extreme is stolidity. Foi- 
an intermediate grade between the stolid and the alert child, the 
blank employs the term inert, or inactive- The five grades are 
therefore stolid, inert, alert, nervous, and very nervous, repre- 
sented respectively by the symbols Sto, In, Al, Kerv, and vl^J". 

With respect to intellectual activity, all children may be 
divided into three classes, — the sensory or reflective, the motor or 
impulsive, and those Avho are neither. The latter group the blank 
designates as normal, though probably the term indifferent or 
mixed is to be preferred. The impulsive type is distinguished 
by the rapidity with which it responds to a question or other 
mental stimulus. This type of child does not stop to think. As 
soon as an appeal is made to it, there is an immediate response, 
which is frequently ridiculous on account of immature thought. 
The reflective type is characterized by relatively slow but intelli- 
gent responses. The blank subdivides the reflective and impulsive 
groups into two sub-groups, in which each quality appears in 
either a moderate or excessive degree. The blank, therefore, dis- 
ting-uishes children as very reflective, reflective, normal, impulsive, 
and very impulsive. The symbols for these words are vR, Refl, 
Norm, Tni]), and vT. 

For the classification of the will the blank distinguishes the 
stubborn, wilful, firm, flexible, and vacillating, using for the pur- 
pose the symbols Stu, Wilf, Firm, Flex, and Vac. These terms are 
self-explanatory. There may be some confusion, however, of 
stubbornness wnth sullenness and surliness. It is true that a 
defect of will is often associated with a defect of feeling, but I 
have examined many cases that did not show any ill humor, who 
yet simply refused to obey all commands. 



• Till': I'JXAMiyATlnX IlLASK. 27 

One other eharacter is of sutlieicMlly j^eiieral si^niHeanee to 
be treated in connection with the item?; that form the suhject of 
this chapter. The most snperticial examination of a chihl 
will hring from him some utterance. In voice and speech, the 
cxamimr or teacher may (piickly infer the presence (»f ]>hys- 
ical 111- mental defects. On the physical side the nlteraiicc uf a 
single word in answer to a question nuiy awaken the suspicion 
of naso-{)harvnf;eal obstruction. The treatment of jiurely phys- 
ical defcvts will he discussed later. In this place, I wish to 
consider deftvts of articulation, which are also active factors in 
causing retardation. ChildrcMi with defective speech receive low 
grades in reading, and their intelligence is nsiudly underesti- 
nuited by the teacher, who attributes much of the speech defect to 
a lack of knowledge. These defects hinder progress in still 
another way. Such children are frecpiently ridiculed by their 
schoolmates on account of their impediments of speech. In thifl 
way they learn to dislike school, lose interest in their work, and 
become absentees. But more important than this is the effect of 
defective modes of articulation and phrasing u\m>]\ written lan- 
guage. Some children with an infantile stammer write school 
compositions which mirror with great fidelity their habit-; of (.v;)l 
speech. 

Defects of articulation are frequently associated with de- 
fective hearing, for a child who is unable to hear words distinctly 
will be unable to reproduce them properly. Observation has also 
sho\vn that defects of articulation cause defective hearing of lan- 
guage. Children that appear to be deaf to words, improve when 
their defects of articulation are cured. 

The words stammer, and stutler, are loosely emplove<l by 
English writers to designate nearly every defect of speech. A 
drtinite meaning shoidd be attached \o each. hi ilii-; blank flic 
word sfaiinncr \< ('m|)loyrd to (•(•xcr any defect of art iciilation, 
as, for exani])le, the inability to produce certain sounds, i>y the 
substitution of one sound for another like /// for s in li>^ping. A 
stammer may indicate defective organs of articulation, like a 
cleft palate,, displaced teeth, or a partial paralysis of the t<»ngue. 
A stammer, however, nuiy simply be the persistence of an in- 
fantile speech habit, "baby talk." This retardation in <|)eecli 
may be due to an undeveloped mind, or may be tlie result 
of adiMM»ids or other obstrtiction in the resonance cavity, which 
may or nuiy not have been removed. Tf the stammer is an 
infantile stammer, a check mark is nnide over the ~yinb<il inf. 



28 CLINICAL STUDY OF RETARDED CHILDREN. 

The degree of the stammer is indicated by a check mark over one 
of the five numbers appearing to the right of the word stammer. 

A stutter is characterized by a series of spasmodic hesita- 
tions and the frequent repetition of some of the spoken elements. 
This defect may be acquired by imitation. It may be the result 
of nervousness, or it may be due to an inability to co-ordinate 
the movements of breathing with those which control the articu- 
lation. Stuttering does not seem to have the same causal rela- 
tionship to intellectual retardation as does stammering. The 
blank provides, as with other items, five grades for an estimation 
of the degree of stuttering. 

From the record card on page 16, a blank partially filled 
in, we ascertain the following facts about the boy John Smitli, 
which cause him to stand out as a distinct personality. He is 
seven years of age, has been one year at school, where he attended 
regularly, but where his conduct and progress were both very- 
deficient. He is classified as a backward case, subnormal in intel- 
ligence. His co-ordination is only medium. He is bold in his 
association with his teachers, passive or indifferent in feeling 
towards them. He shows signs of ners'ousness. He is neither 
reflective nor impulsive, and is vacillating in will. We have also 
learned that while his health is fair, his nutrition is poor, and 
that he is trying to do his school work on a breakfast of coffee, 
bread and cake ; that he also drinks beer and tea. This insufficient 
and improper diet, which probably is responsible in large measure 
for his nervousness, his vacillating will, and his deficient conduct 
and progress in school, is itself the result of the poverty of his 
^larents, which enables them to give him but poor support in a 
home that is characterized as of very inferior culture, providing 
very deficient mental and moral discipline, and inadequate care 
3f his person and clothing. 

I turn now to school historij (Rcl). A largo number of chil- 
dren are retarded because of frequent changes from one school 
system, to another. This usually involves an initiation into a new 
course of study and the use of unfamiliar text books, with a conse- 
quent loss of time. Even the transfer from one school to another 
of the same system is frequently productive of the loss of a grade 
in the child's progress. The families of some of the children 
whom I examined had changed their residence at least half a dozen 
times during the school life of the children. In some cases this 
change of residence is made by the family, and even by the chil- 
dren alone, to escape the enforcement of compulsory school at- 



THE EXAMlSATIoS i;LA.\K. 29 

tendance. A brief smiiniarv of the scluxd history of the cliihl is 
therefore of importaiieo if we nrc to estiuialc tlie inthience of this 
factor in prochuMiii!; retardation. The symhol {Rd) is introduced 
cliielly lo remind the investigator to enter a record of attendance 
in the j)aruchial schcx)ls in the case of l)oys who are members of the 
Roman Catholic Church. The curriculum of parochial schools, 
as well as of other church schools, is very poorly articulated with 
that of the public schools. For this reason children who have 
attended parochial schools in the early years are aj)t to be retarded 
when they subsequently enter the public schools. Moreover, many 
children spend a year in the parochial school, at about the age of 
twelve, in order to receive religioiis instruction. These children 
lose a whole year of the public school work, and in some cases have 
lost step with their fellow pupils of the public schools to such an 
extent that they are scarcely able to begin again where they had 
left off. 

A child may be deficient in all his school branches, or he may 
show himself deficient in but one. If in certain grades this one 
subject happens to be arithmetic, it may prevent his making normal 
progress ; in other grades it is language that is a great obstacle to 
progress. For this reason the items most deficient in and hest in 
are recorded. Statistics obtained from large numbers of children 
will also throw some light on the question whether mentally de- 
ficient children commonly manifest ability and memory for some 
single line of thought or activity like music, drawing or manual 
work. It is a common belief, although not supported by suf- 
ficient evidence, that the public school system does not a]ij)eal to 
the capabilities of children who are exceptionally gifted in one 
line and possessed of counterbalancing deficiencies in other lines. 

The child whose blank we have taken as an illustration had 
been only one year in school, and the absence of any record in the 
appropriate space leads us to believe that his deficiency in progress 
was manifested in all the work of the school. 

Certain habits of life are found to exist among school- chil- 
dren, which seriously interfere with their progress. Among these 
arc the use of tobacco and injurious beverages, like tea and coffee 
and even beer and whiskey. Under habits I also recorded the 
amount and kind of food eaten at one or more meals, but especially 
at breakfast. Immoral practices are also to bo recorded in this 
connection, but these should not be inquired into in everv case. 
It seemed the better part of discretion to record facts of this kind 
only when brought to my attention by teacher or principal in those 
cases where such practices were notorious. 



30 CLIXTCAL STUDY OF BETARDED CHILDREN. 

The family life may retard tlie progress of a child in school, 
in so far as it affects his health, nutrition, support, his care and 
discipline. The relation of these factors to retardation "has 
already been discussed. In addition to these, a few other items 
concerning the family appear of sufficient importance to warrant 
the making of a record. If the child has lost one or both of his 
parents, the probability is that there has been a reduction in care, 
nutrition and health, for parents must be presumed to take a 
deeper interest in the welfare of their children than do relatives 
or friends. In the case of the father's death the children are 
often neglected because the mother is unable to bear the burden of 
support. Many mothers leave home early in the morning to go 
to work and return late in the evening ; the children are left all day 
with no one to provide for their wants or to oversee them except- 
ing when at school. The children of many mothers, w^ho are the 
support of the family, find it difficult to obtain even one good meal 
a day. Wlien such children are questioned they usually report tea 
and bread for breakfast and the same for dinner ; some children 
go to school without breakfast. The loss of the mother is also very 
unfavorable to good home conditions. Her place may be taken by 
a step-mother, but the phrase "a step-mother's care" has lived long 
enough in the language of the race to persuade us of its significance. 
The loss of either father or mother is also an indication of the 
severity of the struggle for existence on the part of the iminediate 
progenitors of the child, or it may point out a possible lowered 
resistance to disease. 

The blank, therefore, provides for recording whether the 
child's father and mother are living or dead and whether the child 
has a step-father or step-mother. There is also a space provided in 
which to record with whom the child lives. A child may be living 
with relatives, guardians or acquaintances, who provide it with a 
home life distinct from that of its own father and mother. Abnor- 
mal home conditions are sometimes brought to light which are sig- 
nificant. If the child is asked whether he lives with his parents 
he will invariably respond in the affirmative, even though he may 
be living with only one of them. If he is asked, "Do you live with 
your father and mother?" he will invariably answer, "With, my 
father," or "With my mother," if he is living with but one of them. 
A record which shows a living father must not be taken to demon- 
strate the fact that the father is the support of the child or even 
that the child is living with the father. The blood relations of 
the child are often in no wise responsible for the child's support 
and home care. 



THE KXAMIXATfOX BLAXK 



ai 



S/wu-V^ 



No. \X 

Grade 

Grade 1 

School 

School 

Progress 

Conduct EOF 

Attendance vR E I 

Most deficient In 

Beet In 

Habits \.\yJO:XJJUL> 



^3Saij 



Name 

Class 'JV^ . r^vjuit«» r. 

Class \\ 1901 Address b"O0^ TjLcvnX 
y 190 Teacher 

'\}S lOJjvvjJo 190 n Teacher ^VkJoiA (Xc^^cxAryUs 

EOF D ^\D Date of birth blOO Age 1 



D v\5 Age on entering school G 
vl A School history (Rel) \o 



No. years In school i 



(^Jfjuo-t- Jl\j>3udL £;OcJU 'X.Q) 



iVn( 



Normal 



Health 



6 4 3 2 1 

vG G MSID Deficient 

vG G Ir P ^vP Home Care 



V-: 



Father liVng dead 
Mother liMng ' dead 

Step-father, Step-mother Nutrition F G M ^ St 
Nationality F.I VUaAAajCVvO Support R W M V^vP 
M.I WxK) 

9J&Jla- Child works at 



Occupation of provider 



5 4 3 2 1 
Bri/lHIM n Id 
vG G P ^^vP 
Culture vG G F P v\/ 
Discipline vG G F P vl? 



Birthplace 
Lives with 



r/ vo 



Anormaiity Asymmetry 
Home Lang. V^jLd^JtQ T'-unK (% gj ^V CtnAJ^ym/JreyrJlj 



Older brothers livingQdeadQ Arms 
"^ sisters '• O " OLegs 



Younger brothers "^^ " Hands 
« sisters " " ^Feet 



Eye, R. 




Eye, L. 




Defects 




Disease 




Ear. R. 


10 


Ear, L. 


Gb" 


Defects 




Disease 





'^0 



Cranium 



X--. 



Forehead 



1^ 



Face 



:h 



Ears 
Eyes 
Nose 



.AOJ^V ^ (nAjc:l;Jlg:^AVlJuwvUV.- 



Lips 



,/ 



Palate 



Co-ordination 5 4 V 2 1 Tonsils 

vB sMd Norm Shy vS Naso-ph'nx 
Am Resp Palw Sull Sur Mth Breathg 

Sto In AJ NeVV vN Teeth 

vR Refl Ndra Imp ▼! Tongue 
Stu Wllf Firm Flex Vi(f Voice 
Stammer (inf) 6 4 3 2 1 Speech 
Stutter 1 5 4 3 2 1 Diseases 
Filled In 



^tX/CLAifyfi- 






by .yQ"lAuJUvv.a/VU Date . .L^AXXJ >^. ,.\^ 07. 

U Lnhnratory of Psvcholnjty, University of PennsylvnniAl I 
Thp J Lrwis Croxpr Fund^ ^| | 



32 CLINICAL STUDY OF RETARDED CHILDREN. 

The language of the child's home may he an important factor 
in producing retardation in school progress. Some children of for- 
eign parentage are retarded for several years because they are not 
equipped with a knowledge of the language of the school and many 
school systems fail to provide for proper instruction in the English 
vocabulary. Every large city has some sections where the chil- 
dren, even at play, speak a foreign language. The necessary in- 
formation to estimate the importance of this factor in an individual 
case is given in connection with the items nationality P and 
nationality M, which provide for the record of the nationality of 
the father and mother, and with birthpluce and home language. 
When a child is foreign born I found it convenient to inquire as to 
its age at the time of immigration and I sometimes recorded this 
in connection with the item birthplace. Even English-speaking 
children who come to this country at eleven or more years of age 
lose at least a year on account of the difference in the curriculum. 

The remaining items with which we have to deal are concerned 
with the child's physical condition. We obtain some indication of 
the child's physical vigor, vitality and viability when we know the 
number of brothers and sisters living and dead. It is very diffi- 
cult to ask a child or even an adult the necessary questions in such 
a manner as to elicit exact information of the character we desire. 
The blank records data in a way that appears to present the ques- 
tion in the best possible form for answer. A numeral records the 
number of older brothers living and dead, the number of older sis- 
ters living and dead, the number of younger brothers living and 
dead and the number of younger sisters living and dead. The boy 
whose blank we have taken as an illustration has two younger 
brothers, both of whom are living. The information obtained from 
these items is very meagre. We know only that he is the first 
child. According to some authorities, the first child is more apt to 
suffer from accidents of birth than later children. A physician 
interested primarily in the child's physical history would want to 
know very much more in this connection than is provided for by 
the blank. For example, he would require a history of mis- 
carriages. No matter how valuable such data may be, it would 
be undesirable to make an effort to obtain them. It is only when 
children are brought for examination to a clinic by father or 
mother that such facts can be ascertained. Discretion as well as 
the limitation of time render it necessary to omit many other items, 
for example, the birthplace and condition of the grandparents. 
The blank probably provides for as many items in tliis connection 
as it is wise and convenient to endeavor to obtain. 



THE EXAMINATION BLANK. 33 

The purposes of the blank must be borne in niiiul when we 
examine the remaining items which deal with tlie physical con- 
dition of the child. Space is provided for an entry of the results 
of a brief examination of eyesight and hearing and for the record 
of marked anomialities or asymmetries of the trunk, anns, legs, 
haiuls, feet, cranium, forehead, face, cars, eyes, nose and lips. 
Space is also provided for a record of anormalities that are often 
associated with naso-pharyngeal obstruction, — leading in some cases 
to a diagnosis of adenoids. Thus, the condition of the palate is to 
be observed, the tonsils, the naso-pliarynx, the teeth, the tongue. 
If mouth breathing exists, it is to be recorded ; the voice is to be 
observed for symptoms of adenoids and the quality of speech is 
to be recorded for the same purpose. Finally, a brief record is to 
be made of the diseases from which the child has suffered during 
infancy and childhood. The examination from which this record 
will be filled out is superficial and is directed only to the ascer- 
tainment of striking defects. Time is wanting, nor is it practica- 
ble to subject a child to an extensive physical examination. \ 
child ought not to be touched nor can many instruments be used 
to facilitate the work of the examination. A medical inspector 
may perhaps use a tongue depresser, but experience in some cities 
has shown that even they had better employ some such common 
article as a spoon for the purpose. The tests which I employed 
excited no criticism, excepting in the case of one child who refused 
to take part in the \o<t of hearing, for which T employed an instru- 
ment. I fool that I went as far as it is wise for any one, except- 
ing a medical man, to go, and that even the medical inspector could 
not take much more advanced measures without awakening a stonn 
of criticism. From the standpoint of medical inspection, such re- 
sults as I obtained with this blank must necessarily be unsatis- 
factory, but this same criticism holds good also of much of the 
medical inspection that is made in the schools to-day, excejjting in 
so far as it relate.s to the discovers' of contagious diseases and para- 
sites. 

From the nature of my investigation it was impossible to 
make anything like a thorough examination of sight and hearing. 
The limitations of time and the lack of proper rooms and instru- 
ments practically confined my work to a hasty test of the child's 
ability to see and hear. To examine eyesight, T employed Snellen's 
test cards, both the alphabet and illiterate types, the latter for 
children who did not know the alphal^t. \Vliere the child's famil- 
iarity with the alphabet was in doubt, a brief preliminary drill 



34 CLINICAL STUDY OF RETARDED CHILDREN. 

was employed to determine whether the inability to read the line 
was due to ignorance or defective vision. None of the children 
examined by me were under ten years of age, and I seldom was 
compelled to resort to the illiterate card. 

On account of the dimensions of most of the rooms in which 
I tested the eyesight of the children, I was obliged to make use of 
the ten-foot line. In making my tests, I placed the cards so that 
the ten-foot line was about level with the eyes and squarely iu 
front of the child. I placed it so as to be in a good light and to 
avoid strong reflections. If the child wore glasses, I tested him 
with and without them. Both eyes were tested together and each 
separately. During the test I always looked at the child to be 
certain that when one eye was tested the other was covered and to 
observe excessive hesitation and signs of eye-strain. In cases of 
strain and marked hesitation, the child was asked to move toward 
the cards until the letters on the line were read easily. Before 
beginning the test, I laid off a ten-foot range, which I subdivided 
into feet. When, therefore, the child moved from a distance of 
ten feet to a shorter distance I was able at once to note the dis- 
tance in feet at which he read the line. The blank on page 31 
shows that John Smith read the ten-foot line at a distance of seven 
feet with both eyes, and the ditto marks opposite eye R and eye L 
show that with each eye separately he read the line at the same 
distance. His sight is therefore sufficiently defective to justify 
the recommendation that his eyes be examined by an oculist. 

Various tests are employed to measure the acuity of hearing. 
All of these fall into one or the other of two classes ; the first is a 
speech test, and the second is a test with mechanical sounds. The 
speech may be either whispered or conversational. Undoubtedly 
the test which employs conversational speech is of the gTeatest 
value, for it tests the child's ability to hear conversation, upon 
which depends his apprehension of oral instruction in the school 
room. A conversation test, however, is objectionable because it 
requires a very large room. To avoid this difficulty the whisper 
test is usually employed as a substitute. Both speech tests are 
open to the practical objection that the intensity of the sound 
cannot be kept constant. Moreover, much time is required to 
carry out the tests satisfactorily, and the results vary with the 
acoustic properties of different rooms, depending upon their size 
and shape and upon convection currents due to the unequal heat- 
ing of the air. Similar objections may be offered to the employ- 
ment of mechanical sounds for testing hearing. The watch, the 



THE EXAMINATION BLANK. 35 

Politzer acoumeter, tuning forks, and specially constructed audi- 
ometers, are the instruments usually employed. No instrument 
has yet been devised which furnishes a constant and accurately 
measured standard of sound int<.'nsily. In my tests I employed an 
audiometer which is to be recommended, not as an instrument 
of precision, but as a convenience for rapid testing. 

This audiometer consists of a box, six inches by seven inches 
by eleven inches, divided by a partition into two parts. In one 
CDmpartment of the box is placed a small clock as the source of 
sound. The other compartment contains a specially contrived 
stop-cock connected with a metal tube, which at one end divides 
into two branches for conducting the sound impulses to each »»f 
the two ears. These two branches project about an inch beyond the 
box. To these, when the instrument is to be used, rubber tubes 
are attached, which connect with the ear-piece of a binaural 
stethoscope. The stop-cock which regulates the size of the open- 
ing through which the sound is allowed to pass, is connected with 
an index linger moving over a graduated disk, arbitrarily divided 
into one hundred divisions. WTien the index finger points to the 
zero mark, the tube is open to its fullest extent. When it points 
to one hundred, it is entirely closed. The least audible sound for 
most normal ears is obtained with the index finger at the mark 92. 
The instrimient is provided with two other st<)p-cocks, one on each 
of the two branches of the tube. These are to shut off the sound 
instantaneously from one of the two ears and without the subject's 
knowledge. The advantages of this audiometer are found in the 
convenient variation of the intensity of the sound and its measure- 
ment with some accuracy on an arbitrary scale, and in the ease with 
which the sound can be shut off from one or l)oth cars so as to test 
the reliability of the subject's responses. With this instrument the 
child whose hearing capacity is measured by 70 for the right ear 
and by 05 for the left ear (see blank o>i page .■>!) has subnornud 
hearing in both ears, the left being slightly more defective than 
the right. This record, especially when taken in connection with 
facts which give rise to the suspicion of adenoids, is sufficient to 
warrant his being referred to the medical inspector or to a medical 
clinic for the nose, ear and throat, for examination and treatment. 

Spaces are provided for the record of disca.'ir and defects of 
the organs of sight and hearing. It is intended that only those 
diseases and defects shall be recorded which attract attention on 
superficial examination. These include sore and inflnmed eyes, 
strabismus, nystagmus, certain readily ol^^j^cd defect,s of pupil 
and iris, a running ear or a perforated ear Wuni. 



30 CLINICAL STUDY OF RETARDED CHILDREN. 

Ample space is provided to record marked anormalities and 
asymmetries of l)odily members and their functions. It is impos- 
sible in this article to attempt a statement of the various 
physical anormalities and asymmetries that may be reported mider 
this heading. Defects may be recorded for their own sake, or 
because they have diagnostic value as symptoms or stigmata of 
degeneration and arrested development. The reader must be re- 
ferred to the copious literature on this subject for information 
as to the particular defects which may be considered worthy of 
being recorded. What will be recorded will depend very largely 
upon th-e extent of the information possessed by the investigator, 
on the purposes of the investigation, and on the interest which the 
investigator may take in the association of physical defects with 
retardation, I made no attempt at a thorough examination or 
record of minute deviations of different parts of the body from the 
normal type, whether in structure or function. My record of the 
boy whose card I have taken for an illustration shows the cranium 
and forehead to be smaller on the right side than on the left. It 
is also reported that the ears are large and outstanding. All the 
other items recorded have a significance in connection with the 
diagnosis of naso-pharyngeal obstruction. The chest is reported 
to be contracted, the tonsils enlarged, the voice muffled, and the 
speech nasal. He is also reported to have badly decayed teeth, 
which are frequently found associated with enlarged tonsils and 
adenoids. 

The last item on the blank to be considered is diseases. These 
include measles, chicken pox, mumps, scarlet fever, diphtheria, 
whooping cough, meningitis, and convulsions. On the card re- 
ported above, no diseases are recorded. This was the case with 
very many cards. It does not mean, necessarily, freedom from 
disease during infancy, but perhaps only lack of information. It 
is difficult, if not impossible, to extract satisfactory information 
from the child, and I believe that physicians encounter the same 
difficulty in obtaining accurate information even from the parents. 
It must be borne in mind that an investigation such as I conducted 
can only endeavor to obtain the fullest and most exact informa- 
tion possible under the circumstances. 

We are now prepared from examination of the record of 
Jonh Smith to make a tentative statement of the causes of his 
very deficient progress in school work. He is seven years of age 
and has been in attendance at school one year. There is no evi- 
dence to be had fronatthe blank that deficient progress is due to 



THE EXAML\ATW.\ ULANK. 37 

inefficient instruction, nor can it be ascribed to delay in entering 
school, or to irregularity in attendance. lie is the child of Russian 
Jews who speak Yiddish at home. This may ])c responsible to 
some extent for his inability to progress at school, but it must be 
remembered that the child was born in this country, and other 
Russian Jewish children under similar circuuistanccs arc pro- 
gressing normally in school work. It is rather to the naso-pharyn- 
geal obstruction, the resiilt of poor nutrition, due to insufficient 
support at home and deficient homo care, that I would attribute 
his rctarchil inn in scliotil work. The nasal sjtcrch, tlic niutllc*! 
voice, the cnhiriiccl tonsils, the contractcMl chest, the suhnornial 
acuity of hearing, his nervousness, and even his vacillating will, 
are a group of phenomena which suggest adenoids. Adenoids are 
merely an enhirgement or hypertrophy of lymphatic tissue in the 
naso-pharynx. They may be due to the very decayed teeth, which 
act as a source of infection to the tonsils and adenoid tissues. 
The naso-pharvngcal obstruction and the decayed teeth may both 
result from the insutficient nutrition, the presence of which is 
attested by the customary breakfast of coffee, bread and cake. 

The remedies to be suggested in this case are partly medical 
and partly social. lie should be referred to the medical inspector 
and taken by his parents or a school nurse to a clinic for nose and 
throat diseases for examination and treatment. The insufficient 
nutrition may be due to the impoverished condition of his parents, 
or to ignorance. The solution and treatment of this problem must 
be left to the various social and philanthropic agencies, which in 
our large cities are beginning to attack tlie problem with determina- 
tion and scientific insight. 



CHAPTEK II. 

Peeliminaky Steps and Miscellaneous Problems. 

During the school year 1905-06, there were enrolled in the 
elementary schools of Camden, N. J., 12,801 children. If only 
those children of the first grade whose ages were below seven and 
those of the second grade whose ages were below eight, and so on 
for the rest of the grades, were taken to be of normal age for their 
respective grades, then only 28 per cent of all the children were 
of normal age for their grades. If the upper age limit of the 
normal child were raised one year for each grade, the percentage 
of normal children rose to 53. If still another year were added, 
making all children in the first grade below nine of normal age 
for the grade, and all those of the second grade below ten normal, 
tlien 74 per cent, or 9500 children composed the nonnal group. 
This left 3372 for the abnormal or retarded group. 

During the latter half of the school year 1905-00, this retarded 
gTOup of children was made an object of special investigation by 
Mr. James E. Bryan, the city superintendent, in order to deter- 
mine the conditions favoring retardation. He was assisted in 
his efforts by the public school teachers of the city to whom were 
sent special forms calling for the following data : name, residence, 
age in years and months, number of years in school, length of time 
in present class, present progTess, attendance, sight, hearing, gen- 
eral health, and special data which referred to inattention, mental 
deficiency, and bad conduct. After the teachers had received 
instruction in the method of procedure they obtained the above 
data for 2033 retarded children and recorded them upon the 
special forms or blanks. To all of this material I had access, and 
after having obtained permission from the Camden school authori- 
ties to make my clinical study of the 2033 cases, I transcribed 
it on blanks prepared for the purpose, so that I could refer to it 
at any time during the course of my inquiry. 

At this stage of the investigation my efforts had been con- 
centrated upon four objects. The first was to study the extent 
of retardation for different school years and various school systems. 
I found that retardation was not a local condition, but was wide- 
spread and chronic. The second step was to obtain permission 

(38) 



PRELIMINARY STEPS. 39 

frum the school anthoritios of ("anidcii to nuiki' tlir iiiVL'stii>init>n. 
Here there was some cause for jipprchcnsiou. It was feared that 
patrons of the schools would uot take kindlv to such an innova- 
tion, especially since ^Ir. IJryan had conducted his investigation 
the previous year. Thildren might object to an examination, and 
even to such questions as required them to state of what their 
breakfasts consiste*!. Ad<litional teachers would l>e required to 
substitute for the regular teachers while they were being inter- 
viewed in reference to the retarded children in their rooms, and 
thus additional expense would he incurred, in spite of these 
misgivings it may be said that the whole investigation met with 
practically no opposition. There was an occasional teacher who 
seemed to have no sympathy with the work ; an occasional parent 
who declared that his child should not be examined ; yet of all 
the children asked only two refused, one in obedience to her 
mother's c<imnuind, and another out of sympathy for her school 
mate who had already refused. There was practically no resistance 
on the part of the children; some, indeed, felt very much dis- 
appointed upon learning that they \vould not be examined. The 
third object was the preparation of the blank described in the 
tii*st chapter, and the fourth the transcription of the data referred 
to in the preceding paragraph. 

The next step was to undertake the actual examination of the 
children. It was begun in the latter part of February, liM")", 
and concluded the last week in May of the same year. Ti> this 
])art of the work T devoted about sixty days. One half of the 
time was given to culjecting data from the teachers and the other 
half to (>\aniining about one thousand children. Fsiially T was 
able ti> (hnote between five and six hours a day to the work in 
the schools. Consequently, T c«^uld give only about ten minutes 
to the examination of one child. Had it been ])ossible to devote 
more time to this phase of the investigation its merit, no doubt, 
would have been much enhanced. A number of factors cooperated 
to make this impossible. Tn the fii*st place the total amount of 
time was limited, because I was not pre]iared to l)ogin the work 
earlier in the year, and bec4iuse the city superintendent requested 
me to finish it before June so as not to disturb the schools during 
the time for examinations and promotions. On account of numer- 
ous withdrawals it would have been unwise to attempt to carry 
the investigation into another year. T was unwilling to decrease 
the numl)er of children on accf)unt of the ill effects of errors with 
small numbers. T^nless the number of children were reasonably 



40 CLINICAL STUDY OF RETARDED CHILDREN. 

large it would also be impossible to make symptomatic correla- 
tions. Moreover, to exclude any of the retarded children from 
my investigation would have compelled me to abandon my original 
purpose of making some statement relative to each one of the 
2033 retarded cases. 

Before visiting a school, blanks like the one described in the 
first chapter were prepared for all the retarded children belonging 
to that school. Upon every blank were entered the facts neces- 
sary to locate a child, viz. : the name of the school and teacher, 
and the name of the child with its gTade, class, and home address. 
The work at the school was carried on in the principal's office and 
was begun by getting all possible information f rotm the principal an,d 
the teachers of the grades in which the children happened to be, or 
had been the previous year. It is very important that some 
knowledge of the child be obtained before meeting it, in order that 
special attention may be given to defects and adverse conditions 
which others have observed. Moreover, confidence in my own 
observations made upon children was increased or diminished 
according to the confinnation or negation of the teachers. 

After the teachers had been interviewed the work of examin- 
ing and questioning the children was begun. That they should 
not be influenced by each other's answers, no more than two chil- 
dren were allowed in the room at one time. This was found to 
be a very desirable number. Very few children showed signs 
of fear or confusion. The child who was the first to be examined, 
showed most timidity and awkwardness in res])onding to the tests 
and questions. Having been allowed to look on, the second child 
had acquired some familiarity with the method of procedure, 
some knowledge of what was expected of him; he also took note 
of the harmlessness of the instruments and tests employed, and 
acquired a certain degree of willingness to answer questions which 
were similar to those he had heard others answer. In this way 
the reactions of the children were very much facilitated and the 
element of fear practically eliminated. For the nature of the 
tests and the character of the questions the reader is referred to 
the description of the blank in the first chapter. 

It was impossible for me to examine even a majority of the 
2033 cases whose names I had received. For this a variety of 
causes were responsible. From an inspection of the data which I 
had received from the city superintendent, it appeared that errors 
had been made in entering as retarded the names of twenty-nine 
girls who in reality belonged to the group of children of normal 



ago. Moreover, the name of one boy appeared twiceNslIfl hrfd 
evidently been transferred during the period of Mr. 
investigation. Consequently, it became evident from the material 
in my possession l)efore beginning the investigation, that 2033 
constituted the whole number of retarded children, of whom 1075 
were boys and 928 girls. 

Upon beginning- my work with iho childn-n I discovered at 
once tiuit the c»riginal number woidd be still further considerably 
reduced. Second in importance in bringing about this state of 
affairs were absente»-s on the days I visited the several schools. 
'J'o mak(.' another attempt to sec these children was out of the ques- 
tion on account of a lack of time. Moreover, three efforts which 
had Ikh'U made to see all the retarded children of a few schools, 
l)roved unsuccessful. The number of absentees for the boys was 
123 or 11.4 per cent; for the girls 102 or 11 per cent. Among 
the girls there were also two who refused to be examined. 

On account of overcrowding, promotions, and changes of resi- 
dence, a number of children had been transferred to other schools 
in Camden. Of these children I was able to see only those who 
had Ix^en transferred prior to my visiting the schools where they 
were finally entered. It was not eVen possible to see all of these, 
for many had not entered the schools to which they had been 
transferred. Children will resort to every possible means to evade 
the compulsory attendance law. Their schemes sometimes com- 
pletely baffle the attendance officers. T know of a case wlio liad 
two ad<lresses, one in the city with his j^arents and the other in an 
adjoining township with his gran(l])arcnts. The attendance officer 
of the city was told that the boy lived with his grandparents in 
the country, and the officer of the country district was informed 
that the boy lived with his jiarents in the city. Of the 155 chil- 
dren reported to have been transferred I could locate only 42, 
leaving 113 unexamined, (>5 boys and 4S girls. 

A certain numl)er of boys and girls were reported to have 
left the Camden schools. This indeed was the most dominant 
factor in preventing a re-examination of the entire group. There 
were 308 boys and 313 girls, a total of 081, who withdrew from 
school in a little less than one year's time; for ^fr. Bryan's inves- 
tigation, during which these children's records were first made 
out, was carried on during the months of May and Tune, 1000, 
while T began to re-examine them in the latter ]iart of February, 
1007, and concluded my work in the latter ])art of ^fay in the 
same year. In le>< than a year, therefore, 34 per cent of the 2003 



42 CLINICAL STUDY OF BETARDED CHILDREN. 

cases whom I attemiDted to re-examine had left school; 34 per 
cent being bojs and 33 per cent girls. 

These percentages would no doubt have been increased had it 
been possible to locate all the transferred children. It is very 
likely that many of them had left school. 

It is interesting to note that the percentage of children who 
withdrew from the retarded group exceeds the percentage of those 
who withdrew from the group of so-called normal age. From the 
available data it appears impossible to obtain accurate results, 
but an attempt can be made. The number of children enrolled in 
the Camden schools at the end of September, 1905, was 11,117. 
There were, however, 1684 accessions during the year. Most of 
these occurred shortly after the schools opened, so that of the 
1684 children entering during the year about 1000 were enrolled 
near the beginning of the school year. We may therefore say that 
12,117 children entered the Camden schools in September, 1905. 
During the year there were 3072 withdrawals; i. e. 3072 children 
withdrew from 12,117 during the course of one school year. This 
gives a percentage of 25.4; as the percentage of withdrawals from 
the retarded group was 34, it exceeds the percentage of total with- 
drawals by 8.6. The excess of withdrawals from the retarded 
group over those from the normal gTOup must consequently be still 
greater. It is, however, to be observed that the elimination for 
the total number occurred between September and June, inclusive, 
and for the retarded group approximately between the l>eginning 
of June and the early part of April. Therefore the retarded group 
had the advantage of the withdrawals during the long summer 
vacation. It is quite likely that after this period a large number 
of children do not return to school. On the other hand it must 
not be overlooked that the elimination for the non-retarded group 
only would be less than 25.4 per cent and that it Avould be higher 
for the retarded group, if information of all the transferred chil- 
dren were to be had. In view of these considerations it is 
justifiable to claim that the retarded children, the very ones who 
have profited least by public education, are the first to leave school. 
The children who are the most poorly equipped to fight the battles 
of life, are the first to abandon their school training. The whole 
number of children whom it was impossible to reach on account of 
refusals, absences, transfers, and withdrawals was 1021. Of these 
556 were boys and 465 girls. For the boys the percentages of 
absentees, transfers, and withdrawals were 11.4, 6, and 34.2 
respectively. For the girls these figures given in the same order 



VllELlMlSAUy STEi'S. 43 

were 11, 5.3 and 3-'). 7. In every case the percentages for the 
girls are slightly lower than those for the lx)ys, but they are so 
nearly the same as to indicate practicjUly no sex diiferences. The 
percentages of children who could not be reached is 50.9 for the 
boys and 50.1 for the girls. C'ons(^qnently, I was unable to re- 
examine one-half of the original number. I l)egan to make out 
records for 2003 cases but succeeded in completing only 982. 
In order that I might have the data of at least 1000 cases, I ex- 
amined 30 retarded children whose names I had not received from 
the statistical investigation. By using 18 of these extra cases in 
connection with the 982, I obtained the 1000 cases, 533 boys and 
4(57 girls, upon which the results of this study are based. The 
facts enumerated above are sumnuirizcd in tabic 1 in ihc 
appendix. 

Although the withdrawal of children from school is of suffi- 
cient importance and extent to be a problem for a separate inquiry, 
I thought it might 1k^ interesting and of value, to collect such data 
upon this subject as would enable me to make some statement 
about each one of the G81 retarded children who withdrew from 
school. From the nature of my investigation I could gather only 
such information as was easy of access, and therefore 1 am pre- 
pared to speak in definite terms alx)ut no more than 420 of the 
withdrawn children. Of the remaining 261 children there were 
119 cases, 63 boys and 56 girls, who were reported to have left 
the city of Camden. I possess no information whatever alx)ut 
."lit Imivs and 83 girls, the remainder of the 261 cases. 

I shall now turn to the 420 cases, 246 boys and 174 girls, 
'concerning whose life after they had left the Camden schools I 
can make more definite statements. There -vverc 8 bovs and 3 
girls who entered business college, 14 boys and 7 girls belonging 
to parochial schools, and 3 Im's and 1 girl who attended other 
schools. Consequently, there were 36 cases, who, althouirh having 
left the Camden public schools, had not abandoned their efforts 
to secure an education, — they were still attending some school. 
From the Camden school records, however, it appeared that they 
had witlulrawn. The school records, therefore, are a p<x>r source 
of data for investigating the ]in»blcm of elimination from school. 
From these records it appeared that 420 children had left school, 
but 8.6 per cent of them had merely l(>ft the ]^ublic schools.* ^fore- 
over, the school records reported the 119 children who left Camden 
as having withdrawn, but it is more than likely that a large per- 
♦ This percentage is evidently highrr for tho Kroup of children of normal age 



44 CLINICAL STUDY OF RETARDED CHILDREN. 

centage of these were attending other public schools. In fact, in 
a few cases I received positive information that they were attend- 
ing school at other places. It is also likely that a large number 
of the 142 cases, concerning whom I was imable to obtain data, 
were still in school at some place; but these, too, from a mere 
study of the records, appeared to have been eliminated. It is 
the shifting character of our population which is responsible for 
much apparent elimination. Of the 420 cases who are now under 
consideration I was informed that 192 boys and 91 girls were at 
work. The number of boys who were at work, therefore, far 
exceeds the number of girls ; but if those who were reported to be 
at home be added to the number engaged in some kind of work, 
the sum for the boys will be 194 or 82.2 per cent of the total 
2003, and for the girls 138, or 79.3 per cent-. In many cases it 
ap}3eared that the kind and permanency of a boy's position were 
rather closely associated with the quality of his work at school. 
In many cases I attempted to find out what kind of work the boys 
were doing. Xot infrequently I received the reply that they 
changed so often that it was impossible to keep track of them. 
Upon inquiring into their school history I learned that they had 
been rather shiftless pupils. 

Usually poverty is regarded as one of the important factors 
in causing children to leave school, but from my investigation it 
does not appear to be very significant. Out of the 420 children 
there were only 3 whose homes were in such want that their 
assistance was required. There were 27 cases who were unable 
to attend school the whole or gi-eater part of the year on account 
of ill health. Only 8 of these were boys. They are 3.3 per cent 
of the whole number of Avithdra"\vn boys of whom I was able to 
collect any data. The percentage for the g'irls is 10.9. This 
is more than three times that for the boys. Of the 2003 original 
cases, some definite knowledge was furnished about 1742. Of this 
number 5 had died, 3 of them boys ; 1 boy and 1 girl had been sent 
to prison. From the fact that 12 of the children, all of them boys, 
were out of school on account of bad conduct, we may have some 
indication of the ability of woman to discipline the boy. Most of 
these cases it was impossible to keep at school on account of their 
demoralizing influence. Hence it appears that the school system 
was not adequate to offer instruction to all the children whom the 
law required to attend school. 

From the whole retarded group only 9 entered the high school 
in September, 1906. These 9 cases were in reality not furnished 



PRELIMINAEY STEPS. 45 

bj the whole retar(K'<l :;roii|i, \\>r there are '2Ctl cases of whom I 
have 110 information, and as some of tliese may have entered the 
hiii,h sehool of another eitv the l'(»1 shonhl therel'nre 1h' dednete"! 
from tlie 200:5, leavini;' 1742 as the nnndier from which the ".> 
high school j)npils came. In dniic, IJMXi, there were !>7l".> chil- 
dren enroUeil in the Camden scliools. This was only a short time 
after Air. Jiryan's statistical investigation, during which a record 
was made of the 200.') n-tarded cases. As the investigation was 
made somewhat In'fore the end of June, we nuiy say tliat at this 
time there were alxmt 10,000 children on tlu^ rolls. If the retarded 
group be deducted from this numlu'r about 8000 will remain; 
from these all but 9 (»f the children wh(» entered the high school 
were drawn. If the normal group of 8000 children furnished 
})upils for the high school in the same ratio as the retarded group, 
then only 50 children would have entered the high school in Sep- 
tember, 1906, whereas tliis number was 129. We may therefore 
conclude that less than two-fifths as many children from the re- 
tarded as from the normal group entered the high school. The 
foregoing figures nro set forth in table TT, in the ajijiendiN. 



CIIAPTEE III. 

Results akd tiieik Treatment. 

The collation of data was begun by establishing for each case 
the amount of retardation in years and half years. The statistical 
data received from Mr. Bryan represented each child of the first 
grade as being at least nine years of age. Several factors, how- 
ever, co-operated to reduce this lower limit of retardation for many 
cases. One of these was a recognition of classes in calculating the 
amount of retardation. In each grade of the Camden schools 
there are two classes, one of which is more advanced than the 
other. According to the data which I received from Mr. Bryan a 
child was retarded the same amount regardless of class, but in my 
computations, I took the child in the higher class to be retarded one 
half year less than the one in the lower, and this reduced the 
amount of retardation for many cases by one half year. 

There were also surprising discrepancies in age. In some 
cases these amounted to two years, thus making a child who had 
been retarded two years according to the statistical investigation, 
of normal age according to the clinical. From a comparison of the 
data which I received, and the data which I collected, it appeared 
that there was a lack of uniformity among the Camden teachers in 
recording the children's ages, some taking the register age and 
others the age of the children in May or June, 1906, the time of 
the statistical investigation. According to my method of calculat- 
ing the amount of retardation it was increased for those children 
whose register age was given but reduced for some of the others. 
I determined the age for all the children up to the first of 
February, 1907,* about the time of the mid-year examinations, 
and took the grade and class in which they were directly after the 
examinations, for this was the time of my inquiry. An example 
may serve to illustrate in what way the amount of retardation was 
reduced for some of the children. A boy in the first grade whose 
))irthday w^as on May 30, 1897, was examined and had his age re- 

*Evidently it would have been more accurate to calculate the ages up to a 
time midway between two examination periods. 

(46) 



'results asd tih:ii: iin-ArMEsr. . 47 

c-oraed bv tlie teaelu-rs oii .1 uuc 10, V.iOi;. Cou:ie4uently this boy 
was iiineVears uf age and iu the lirst grade-, llr theivloiv i.roiH-rly 
belonged to the retarded group, lie made the June promotions 
for lUOG and the February promotions for lUOT. lb- nmst then 
have been iu the second grade, and in or.ler to be retarded, his age 
should at least have been ten years, liut according to my way of 
calcidating age, he Mas only nine years and six months by the farst 
of February, and consequently did not belong to the retarded 

group. , , r ^ 

The co-operation of two or more of the above-named factors 
in a single case lowered the retardation of 129 of the 1000 children 
sufficiently to exclude tliem from the retarded group. By assuming 
.even vears to be the normal age for the lowest class of the tirst 
.n-ade/seven and a half years the normal age for the highest class of 
die tirst grade, eiuht vears as the normal age for the lowest class of 
,he second grade,\-tc., and calcuhiting upon this basis the amount 
of retardation for each child in years and half years,— taking Uie 
time for calculating the age simultaneous with the time for pro- 
niotions,-l found that the amount of retardation for the boys 
varied from one year and less to seven years, and for the girls 
from one year and less to seven and a half years. The exact 
character of the ivtardation is given in table III, in the apiK-ndix. 
From what has just been said and from what was stated on 
earlier pages of this monogi-aph, it appears that unless great care 
is taken in compiling and analyzing enrolment ligures the results 
obtained from them iu calculating the extent of retardation are ap 
to be very misleading. From an analysis of the tota c^nrolmen 
ficnires for 1005-OG Mr. Bryan found that X)r2, or 2b l-:5 i>er cen 
of the chiblren were retarded, but when he made his statistical 
investigation at the close of the school year he found only 2033 
or more accurately 2003. How is this difforencx; to Ih^ explained 
Some of it may l»o accounted for by a reduction in the schoo 
population. The total enrolment was 12,801. This is the nunilK^r 
uialvzed to determine the extent of retardation ; hut at the tune 
the investigation there were only aknit ..)T20 c-h-ldren on the roll. 
Some of it nfay 1. accounted for by absentees but t>^^ac.or fi- 
llet seem sufficient to explain the re<luction from 33.2 to 200J 
Hencr ve must look for an additional cause. The total enroln«.nt 
lowed the ages and grades of the childnm as they were when the, 
entere<l .chool. When the tea.-hers made special record, for th. 
etrcTd children in May and June, some of them took the regis er 
age of Septemlx-r, or the time when the children entered .'hcA, but 



48 CLINICAL STUDY OF BETAEDED CHILDREN. 

their grade for May and June. As there was a mid-year promo- 
tion, the grade of the children was raised but their age remained 
the same as that of the enrolment figures. According to the enrol- 
ment figiires, therefore, from which it appeared that 3372 children 
were retarded, a child may have been nine years old and in the first 
grade in September, thus being retarded ; but according to the 
statistical investigation this same child was taken as nine years old 
the following May, even though it had in the meantime been 
promoted to the second grade, in consequence of which it was not 
retarded. In this another cause appears for the discrepancy in the 
number of retarded children as found by the analysis of the enrol- 
ment figures and the statistical investigation. I have alreadv 
shown how the number of retarded children as found by the statis- 
tical investigation was further reduced by the clinical investiga- 
tion. 

In determining the amount of retardation for the 1000 chil- 
dren who are the subjects of this study, I assumed that seven years 
was the normal age for the first grade, eight years the normal age 
for the second and so on for the other grades. But how is this to be 
justified, for it is evident that some children enter the first grade 
at the age of five or six, or even when they are older ? In fact, I 
found that the age of entrance varied from five to twelve years. 
This is shown more in detail in table IV. Should not the age of 
entrance of each child be taken as its normal age in the first grade ? 
I should say yes, provided the curriculum were ada})ted to the stage 
of the child's development Avhen he entered. For this group of 
children I think the normal age can best be determined by com- 
puting the average amount of retardation for each age of entrance. 
The age for which the average amount of retardation is least should 
then be taken as the normal age for the first grade. 

There were sixty-one bo^'S who entered school at the age of 
five years. Of these, four were retarded one year or less if seven 
years be taken as the normal age of the first grade, lowest class ; 
seven and a half years for the first grade, highest class ; eight years 
for the second grade, lowest class, and so on. Under the same 
conditions nine were retarded IV2 yeai's ; six, 2 years ; seventeen, 
2^ years ; eleven, 3 years ; ten, 3^/2 years ; three, 4 years, and one, 
41/^ years. The average amount of retardation in years for the 
sixty-one cases may thus be shown to be 2.57 years. By calculat- 
ing in the same manner the average amount of retardation for 
the groups of children who entered at 6, 7, 8, 9, 10, 11 and 12 
years of age, we obtain respectively 2.58, 2.56, 2.98, 3.37, 3.91, 





s 


;» 


10 


11 


12 


2.50 


2.98 


.'j..'J i 


;i.9i 


4. 00 


4. .50 


'1.W^ 


2.88 


2.98 


:'..88 


4.25 


4.50 



RESULTS AM) rilEli: inEATMIlSr. 49 

4.00, 4.50 years. The avcrngo n'tardaiiuu tlicrcfoiv for the tlirco 
lowest, ages of entrance is praetically the same, and it is not nnlil 
entrance has heen postponed to the eighth year that thcr*- is a 
notable increase in the anionnt of retarchition. The series for the 
girls corresponds closely to that of the hoys. W'ritini;- ihcni one 
below the other, they are as follows: 

.\gi' of cntiMiice — 

5 G 

r.oys ... 2.57 2.58 
(Jirls ,. . 2.71 2. ('.4 

Had six years been chosen as the normal age for the first 
grade, for the }nu'pose of finding the above averages, each average 
wonld have been increased one year and the first three wonid still 
be the lowest. Had eight years l)een taken, each average wonld 
have reduced one year and the first and the third would have 
renuiined the smallest. Taking the series as given above, the aver- 
ages for entrance at five and six years are the same as those for 
entrance at the age of seven. But in this connection it must be 
remembered that the children who entered at five attended school 
two years longer than those who entered at seven, and those who 
entered at six one year longer. But for this increased attendance 
they made no j)rogress. They were an expense and burden to the 
school system which cared for them one and two years before 
they began to develop. Had they entered at the age of seven 
years they wiMild have made the same progress in the course of 
their school history, would have cost the school system nothing, and 
would not have interfered with the progi'ess of those who were older, 
by overcrowding the lower grades. It is true that those who 
entered at the age of seven years attended one year longer than 
those who entered at eight, but they were benefited l)v it because 
their retardation is shown to be less. Hence we may conchide 
that seven years was the most favorable age for the children of 
this group to enter the Camden .schools. This is most probably 
true of other retarded groups, who are attending school where th<* 
curriculum is similar to that of the Camden schools. Tt would 
seem worth while to determine the most favorable age of entrance 
for children who are of normal age for their respective grades. 
(See table V). 

Where shall we look for tho cau.se of the excessive retardation 
of children whtt enter school before the age of seven? Evidently 
we must begin with their age, because this is the only respect in 



50 CLINICAL STUDY OF RETARDED CHILDREN. 

which they differ from those retarded children who enter at seven. 
It is contrary to experience to say that children between five and 
seven years of age are in a stage of non-development. They may, 
however, be too immature to profit by what the school has to offer. 
If this be the case, the school curriculum should be so modified as 
to be adapted to the capacity of these children, or there should be a 
revision of school laws regulating more precisely the age when 
children should enter school. To attempt to feed a child's mind 
with pabulum upon which it does not thrive may not only mean a 
financial waste to the school system, a hindrance to the groAvth of 
other children, and a needless expenditure of energy and time on 
the part of the teacher, but it may mean life-long harm to the child 
itself. 

The amount of retardation having been determined, I 
attemj^ted to account for it in each individual case, by collating 
such of the data on the clinical examination blanks as I had 
assumed to be the causes of ' retardation. Most of the causes 
recorded on the blanks I subsumed under three general heads, viz., 
physical, social, and mental or psychical. Under the physical I 
classed health, nutrition, adenoids, speech, sight, hearing, tonsils, 
and smoking ; under the social, entrance, attendance, school history, 
home life, and language ; and under the mental, mental deficiency 
and conduct. Home life embraces "support," "home care," "home 
culture," and "home discipline". These and other items men- 
tioned under the headings of physical, social, and psychical causes 
are fully described in Chapter I. 

Depending somewhat upon the kind and intensity of the 
cause, I w'as frequently in doubt as to its activity in producing 
retardation. This gave rise to a division of causes into those 
whose activity was doubtful and those concerning whose influence 
no doubt was entertained. The latter were called real causes and 
the former doubtful causes. With the exception of smoking all 
the causes appear as real. From the list of doubtful causes, 
adenoids, entrance, attendance, and mental deficiency were 
excluded. Therefore, health, tonsils, nutrition, speech, sight, 
hearing, conduct, home life, language, and school history are com- 
mon to both groups of causes, a certain degree of intensity being 
adapted as distinguishing one group from the other. The system 
of grading found upon the blank was follow^ed in classifying the 
causes. 

The distinction between a real and a doubtful cause was 
perhaps chosen in an arbitrary way, but it was not employed 



JiESlLTS AM) rilEli: rUllATMEST. .M 

I'iipririoiislv. \n allcuipL was iiuulu to a[)i>ly iL uiutunwlv 
tliruughuiil. JJcalth was always taken as a real cause when rated 
below the iiiedium, or when there was a past history of ill health. 
It was always classed as a douhtful cause when it appeared on the 
blank simply as of medium grade. All ratings of health which 
were above the medium were considered normal, unless there was 
sufficient evidence on the back t»f the blaid'C to make out a case of 
previous ill health. 

The classes for nutrition were det<rmined in the same way 
as those for h^th. When of medium grade it was taken as a 
doubtful cause; for all lower grades as a real cause; and for all 
higher it was neglected. This method of classifying nutrition 
was modified by signs of rickets or other indications of former 
poor nutrition. 

Adenoids were always taken as a real cause. 

Enlarged tonsils were taken as a doubtful cause unless medical 
opinion had judged them to be a source of considerable injury to 
the health of the child. Except in a very few cases they con- 
stituted one of the symptoms for the diagnosis of adenoids. 

Speech defects were of two kinds, stammering and stuttering. 
A stammer rated as medium or above and a stutter rated above 
medium, or a combination of the two defects in a single case, were 
real causes. For all other ratings speech became a doubtfiil cause. 

Sight was treated as a doubtful cause when it was either 2/3 
or 7/10 normal for both eyes ; when it was 2/3 or 7/10 for one eye 
and less than noniud for the other; or when one eye was normal 
and the other less than 2/3. If it was more defective than 2/3 for 
both eyes, it was a real cause ; also if it was less than 2/3 for one 
eye and below normal for the other. Less defective vision than 
7/10 for both eyes and 2/3 or 7/10 for one eye, in case the other 
eye was normal, was neglecU-d. 

Hearing was normal when its acuity was above 70 for both 
ears or when it averaged al)ove 70 in case it did not fall below 01 
for either ear. .Ml degrees of acuity betwe<'n 01 and 70 
inclusive for both ears, or all degrees that averaged between 01 and 
70, unless it was less than 30 for one ear, were taken as doubtful 
causes. Hearing was classed among the real causes when it was 
less than 30 for one ear or averaged less than 61 for l>oth. 

Entrance and attendance appear only as real causes. .\ child 
who entered after seven years of age was thought to have a real 
cause of retardation. Similarly a child who missed one-fourth or 
more of the school time was recorded as having a real cause. 



52 CLINICAL STUDY OF BETABDED CHILDBEX. 

"Home care," ''home culture/' "home discipline/' and "home 
support" are all involved in determining the class of causes for 
home life. As there are four different items with five grades 
each, it would be very tedious to set forth in each case the criteria 
which determined the class of causes for home life, A general 
idea may be given by stating that when the ratings were equivalent 
to three P's or less, home life was taken as a real cause. It became 
a doubtful cause when the ratings were above those required to 
make it a real cause and equivalent to or below four F's. 

The school history of a child was thought to be a real cause of 
its retardation, when it involved attendance at either a rural, 
foreign, or parochial school, or no less than four different city 
systems. If there were less than three changes of city systems 
they were regarded as comprising a doubtful cause under the 
heading of school history. 

If the birth-place of a child was foreigTi, and a foreign 
language was spoken exclusively in the home, language was con- 
sidered a real hindrance to the child's progTess. Most of the 
records, however, were accompanied by the teacher's statement 
that unfamiliarity wdth the English tongue was a real difficulty 
with these children. The age of immigration Avas another factor 
which was taken into account in this connection. If the child 
immigrated before it had acquired speech, it was treated as though 
born in this country. Language was counted as a doubtful cause 
for a child who immigrated before the development of speech and 
in whose home only a foreign language was used. Lang-uage was 
not considered, when English in connection with some foreign 
tongue was spoken in the home. 

A "very deficient" grade of conduct was always put into tlio 
class of real causes, and a grade that was only "deficient" into the 
class of doubtful causes, unless its classification among the real 
causes was warranted by additional information on the back of the 
blank. All grades of conduct above deficient were not considered. 

I have set forth the principal facts which guided me in the 
classification of causes into real and doubtful. In some cases, 
however, information which appeared on the back of the blank 
justified a departure from the rules as laid do^ni above. In the 
choice of these rules I can not claim to have exercised good judg- 
ment before having subjected my results to criticism. Preparatoiy 
to this criticism and the presentation of my results, I shall con- 
tinue my discussion of causes. 

As there are fourteen kinds of real causes, like health, conduct, 



liESL'LT.^' .\\/> rnh/i: i L'/'ATMENT. 53 

liuuiL' lifi', etc., one or all of wliii-li aiv possible in a single ease, it 
happens tiuit their number for different cases varied. For some 
only one real cause could lie found, and for others two, three, or 
even more. Similarly the intensity of causes varied. For 
example, vision might be 1/4 normal for onct child and only 1 Hi 
normal for another. In addition to this it has been shown that 
the amount of retardation varies from one year to six and one- 
half years. When, therefore, the number and intensity of the 
factors was in my opinion suliicient to account for the whole; 
amount of retardation 1 called theni an adetpuite cause of the 
retardation. Tim number of factors operative to produce an 
adequate cause for the boys varied from 1 to 9 and for the girls 
from 1 to (). The whole number of boys for whom an adequate 
cause was found, for whose whole amount of retardation the factors 
found are believed to have been responsible, is 335. The boys for 
whom 1, 2, 3, 4, a, 0, 7, 8, and 9 factors were found, are 43, 119, 
lOd, 40, 13, G, 1, and 1, respectively. The whole number of girls 
with adequate causes is 321. Given for the different number of 
factors from 1 to 0, following the same order, they are 42, 140, 
SO, 42, 15, and 2. The percentage of girls for whose retardation 
sufficient cause has been found is 68.7 and the percentage for the 
boys is 02.9. That the percentage for the boys is lower than that 
f<jr the girls may be wholly or in part accounted for by the fact 
that the investigation was Ix^gun with a large boys' school, where 
blanks were filled out for 75 cases. The difference, however, is 
only 5.8 |X'r cent. There is, moreover, a close correspondence 
between the numbers in the series for the two sexes. The Avhole 
number of children for whom there appears to he an adequate 
cause is ()5(). This is 05.0 per cent of the number examined. 

The whole nund)er of factors for the Ixiys is 900. This gives 
an average of 2.7 factors for each boy. The nund)ers for the girls 
are 817 and 2.0. The average nundier (d' factctrs for the sexes 
is therefore practically the same. 

For the different kinds of causes, however, sex differences 
appear. It was previously pointed out that the numl^er of girls 
who were out of school on account of ill health was much larger 
than llie nundier <d' boys who were out for the same cause. In 
contirnuition of what was said, the cause (»f ill health appears 102 
times for the girls ajid only 80 times for a larger group of l)oys. 
Xutrition api)ears 09 times as a cause for the boys and only 42 
times for the girls. Theiv are 38 cases of adenoids among the 
boys and 20 among the <rirls. Speech defects are almost twice 



54 CLINICAL STUDY OF RETARDED CHILDREN. 

as numerous among the bojs as among the girls, the numbers 
being 32 and 16 respectively. The intensity of visual defect rep- 
resented under adequate causes occurs 88 times with the girls and 
only 50 times with the boys, being almost tv\'ice as frequent among 
the girls as among the boys. Hearing defects are practically of 
equal frequency for the sexes. The number of boys is 25 and for 
the girls 20. 

Of the social causes, entrance, attendance, and language show 
practically no sex differences. Given in the above order the figures 
for the boys are 117, 178, and 22 respectively; and for the girls, 
117, 188, and 17. 

School history, according to the principles guiding me in 
choosing this as a cause, affects only 69 boys as opposed to 85 
girls. This difference can possibly be explained by assuming 
that the girls remembered their own history better than the boys. 
According to my results the number of boys coming from poor 
homes exceeds the number of girls ; for the former the number is 
138 and for the latter 84. It appears to me most unlikely that 
the number of poor homes among the boys should exceed the number 
among the girls. It seems reasonable to suppose that the girls are 
better cared for by the home than the boys. As the girl is more 
intimately connected with the home than the boy, she is doubtless 
more influenced by its discipline. Boys are more apt to be out 
upon the street where they are under the surveillance of no one. 
Many public playgrounds, where the boy could spend his leisure 
hours under the observation of his parents or some officer especially 
appointed for the purpose, might make him more amenable to 
home and school discipline. 

It has been pointed out that conduct Avas worse among the 
boys than among the girls. This is confirmed by the results 
which were here obtained, there being 41 boys with deficient con- 
duct as opposed to 12 girls. There are 38 boys and 18 girls who 
are rated as mentally deficient. They include all grades of mental 
deficiency, from the backward child, or the borderland case, to the 
idiot. For the groups under consideration the mentally deficient 
boys are about tA\dce as numerous as the mentally deficient girls. 
This proportion of deficients is not confirmed by a study of grades 
of mentality below backwardness, among children not belonging to 
the thousand retarded cases w^ho were the object of this investiga- 
tion. Nineteen cases of mental deficiency were found among 
practically six thousand children. Out of these nineteen cases, 
only eight were boys and eleven were girls. 



BESULTS ASV TIlKli: TllEATMENT. 55 

It is of interest to observe that, iu spite of compulsion by law, 
attendance is the most frequent cause of retardation. Those of 
next greatest frequency are late eiitram-c and home life. If all 
the adequate causes be given in the order of their frequency of 
occurrence, they are as follows: Attendance 366, entrance 234, 
lioHic life 'l-l-l, health 182, school history \')\, sight lo8, nutrition 
111, adenoids 64, deficiency 56, conduct 53, speech 48, hearing 
4."), language 30, tonsils 5. The total number of social causes is 
1015. They appear almost twice as often as the physical causes, 
which occur only 593 times. It appears to Ui [)robablc that the 
social causes are not only most frequent, but also most far-reaching 
in their consequences. Many of the physical causes would doubt- 
less disappear with the improvement of some of the social causes. 
(See table VI, ai)pen(lix). The order also might change for a 
different gi'oup of children or for a different investigator, who 
might require one or more of the defects or social conditions to ho 
more or less intense in order to rank as a real cause. 

In many cases the number and activity of the real causes 
were, in my opinion, not sufficient to account for the whole amount 
of retardation. In this event, the real causes, instead of being 
(•alh^l adequate, were called contributory factors, i.e. they con- 
tributed toward a complete or adequate statement of the causes of 
retardation. A contributory factor might be of the same conse- 
quence as an adequate cause. Two cases might have the same 
number, kind and intensity of real cause, Init because they were 
associated in the one case with one year's and in the other with six 
years' retardation, they might l>e an adequate^ cause in the former 
and only contributory factors in the latter. 

The whole number of cases for whom contributory factors 
wore found is lOT), of these 104 or !).."> ])ei- cent are l>oys and 01 or 
10.5 per cent were girls. The n'lative frequency for each item of 
the contributory factors is the same as that for tlie adequate causes. 
The boys show better health, more speech defects, more acute 
vision, and pftorer conduct and home life than tlie girls. For the 
l>oyfl, the total number of contributory factors is 110, an average of 
1.14; for the girls, 106, an average of 1.16. The social causes 
again are more numerous than the physical, there being 157 of the 
former to 58 of the latter. For a detailed distribution of con- 
tributory factors the reader is referred to table VI. 

Doubtful causes were defined as those of doubtful infliienee in 
producinir retardation. For the sake of discussion the doulitfnl 
causes are sub-divided. When thev occur in connection with 



56 CLINICAL STUDY OF RETARDED CHILDREN. 

adequate or contributory factors they are called associated factors ; 
but when they are the only causes possible to discover in one or 
more cases, they are termed unassociated factors. There are 70 
boys and 40 girls with loO and 75 unassociated factors of retard- 
ation respectively. The whole number of doubtful causes is 740 
for 509 boys, and 5o7 for 452 girls. The sex differences pointed 
out for the real causes are the same iov the doubtful causes except- 
ing health, nutrition, hearing, and school history. Hearing, how- 
ever, will be the only exception if the doubtful and real causes be 
combined, and for this defect no sex difference was claimed under 
the real causes because it appeared to be practically equally preva- 
lent for the sexes, affecting 6.8 per cent of the boys and 5.8 per 
cent of the girls. 

The order of frequency of occurrenct> of the doubtful causes 
differs considerably from that of the adequate. Given in the 
order of frequency, they are: Enlarged tonsils 264, home life 
190, smoking 87, health 143, nutrition 133, conduct 125, school 
history 95, sight 83, speech 63, language 59, and hearing 41. 
The position of smoking in the series was determined ' upon the 
basis of the average, because this condition refers only to the boys- 

For the adequate causes it was found that the number of social ' 
causes was almost twice as large as the number of physical causes, 
but this relation is more than reversed for the doubtful causes. 
There are only 344 social as opposed to 814 physical causes. This 
change is to be explained by the fact that entrance and attendance 
were excluded from the doubtful social causes and enlarged tonsils 
and smoking added to the doubtful physical causes. 

The total number of doubtful causes found is 1283, and the 
total number of real causes 1942. As it is less my purpose to point 
out the number of causes, their relative frequency and sex differ- 
ences, than to prove that they are real causes of retardation, I 
shall take up the treatment of the latter and refer to table VI 
for a more detailed account of the former. At this ]dace. how- 
ever, the descri})tion of a number of cases to illustrate the different 
kinds of causes may be of service. To this purpose I shall there- 
fore devote the next few pages. 

ISTo Causes. 

Case I. According to my scheme for the determination of 
real and nominal causes, none a])pearcd on the record (tf this boy. 
He entered school at the age of live years. His present age is "12 
years and 11 months: this in connection with the fact that he is in 



BESCi/i\'-< Ayo ill i:i i: ri: /•;. i / m i:.\ r. 5 7 

the advanced or A I'lass of the fourth grade tixos the amount of hiti 
reiardatiun at. two and uiie-half years. He attends school regidarly 
and makes a fair grade in conduct and progress. Having always 
attended the same school, he has suffered no loss through transfers 
tie was rei)orted to have medium mentality; he is healthy and well 
nourished. His home life is above the average. His parents are 
of .Vmerican descent. They sjjeak tlu; English langmige in the 
home. Txith sight and hearing are normal. There; are no physi- 
cal siigmata, with the exception of a somewhat high j»alate. The 
only children's diseases were whooj)ing cough and scarlet fever. 

Ciiy 11. A girl IT years and (> moiitiis old. She entered 
school at the age of tivi' and is now in the advanced class of the 
eighth grade. The amount of her retardation is three years. At 
the time her record was tille(l in. Iicr progress was reported to he 
good, condiu-t excellent, and attendance regular. 8he ha<l attended 
tJiree different schools, all of which were in the city oi Camden. 
Her iiienlaliiy is <i<»o<l. She is neiilicr hold nor shy, of an amiable 
disposition, and alert in her general reactions. Her health, nutri- 
tion, and home life are very good. 'Her parentagu^ is American 
and the Knglish langiiage is spoken in the home. There are no 
jthysical stigmata, but her hand balance is slightly nervous. Tn her 
early school years she suffered from measles, chicken-pox, and 
nmmps. Her teacher assigned slow development as the cause of 
her retardation. I did not succeed in discovering any causes for 
this case. 

DornTFUL Causes. 

Case ill. This is a boy who is i;3 years old. He is in the 
lower or 13 class of the fifth grade and the amount of his retarda- 
tion is two years. He entered school at the age of six. His 
attendance is regular, conduct good, and progress deficient. He 
has never belonged to other than the Camden schools, and has been 
transferriMl oidy once. His mentality is medium. Health, nutri- 
tion, an«l home life are gocwl. His parentage is Knglish, but he 
was lx»rn in Phihulelphia. His father is dead. He has an older 
sister and one younger brother. Vision in the right eye is normal, 
but in the left only 1 .">. Hearing is normal. The palate is nar- 
row and t^»nsils are enlarged. Mouth breathing is asso<*iated with 
these defects. In this case sight and enlarged tonsils were taken as 
doubtful causes. 

Case IV. A boy aged 14 years and 8 months. He is re- 
tarded two and a half years, being in the A class of the sixth grade. 



58 CLINICAL STUDY OF RETABDED CHILDREN. 

He entered school at the age of six. His ratings for progress, 
conduct, and attendance are fair, good, and regular respectively. 
There is nothing in his school history to account for his retardation. 
His mentality is of medium grade. His health is fair, and both 
nutrition and home life are good. The English language is spoken 
by the parents, who are of American descent. Sight and hearing 
are normal. There is a slight stutter in his speech. The hand 
balance is somewhat nervous and the palate is high and narrow. 
Health and defective speech are classed among the doubtful causes. 

Case V. This girl is in the B class of the fifth grade and is 
12 years and 4 months old. The amount of her retardation is 
therefore one and a half years. She is reported to make excellent 
progress, attends school regularly, but her conduct is only fair. 
She began her school life in Philadelphia at the age of six. Her 
mentality is very good, health fair, nutrition good, and home life 
above medium. Her parentage is German, and the German lan- 
guage is spoken in the home. Vision is 10/15; hearing normal; 
the palate is high. Measles and mumps were the only children's 
diseases. School history, health, language, and sight appear as 
doubtful causes on the record of this case. 

Case VI. This girl, who is 13 years and 10 months old and 
is in the B class of the fifth grade, is retarded three years. She 
entered school at the age of seven. Her progress is fair, conduct 
good, and attendance regular. She l^egan school in Philadelphia, 
her native city, and has attended two different schools in the city 
of Camden. Her grade of mentality is slow, and her health and 
home life fair. She is well nourished. Her parents are Italians, 
but they speak the English as well as the Italian language in the 
home. Vision in the right eye is normal, in the left 8/10. Hear- 
ing is normal, there are no physical defects and no diseases except- 
ing measles. She is shy, pleasing in her manner, inert in activity, 
and appears to be of a reflective type of mind Avith a firm will. 
School history, health, and home life arc the doubtful causes in 
this case. 

COXTKIBTJTORY FaCTORS. 

Case VII. The age of this boy is 13 years and G months and 
he is in class B of the fifth grade. The amount of his retardation 
is therefore two and a half years. He makes fair progress and 
attends school regularly, but is deficient in conduct. He entered 
school at the age of eight, which is one year older than the normal 
age of entrance for this gi-oup. He has never attended any but 



RESULTS AM) Till: III THE ATM EST. 50 

the Camden schools. His mentality, health, and nuiiition arc 
good. His home life is al)»tVL' luediuiii i>radc', Piin-nia^c is 
American, home lan^iiaj;u English, notli sight and hearing are 
normal. The palate is high and the tonsils are enlarged. Dipii- 
thcria was the only disease. Late entrance was taken as a con- 
tril)ut()ry factor, and conduct and tonsils as associated dunhlfid 
causes. 

Case VI 11. A boy whose age is 12 years and U niunllus. 
lie is in grade two, class A. The amount of ids retardation is f»mr 
and one-half years. He entered school at the age of eight. His 
progress and conduct are doticiont, l)\it his attendance is regular. 
He has always attended the same scliool. He is a dull child with 
medium nntrition, a fair home life and good health. His parents 
are German, bnt the English language is spoken in the home. 
Sight and hearing are normal. His hand balance is slightly ner- 
vous and there is a stutter in his speech which was rated worse 
than medium. The children's diseases are measles and whooping 
cough. In this case late entrance and stuttering were regarded as 
contribntory factors, and home lif<', nutrition, and coiuluct as asso- 
ciated doubtful causes. 

Case IX. This is a girl lo years and 7 months old. She 
is in grade four, class A, and is retarded three years. Her 
progress and conduct are deficient, but her attendance is very 
regidar. She entered school at the age of si.\. Mentally she is 
slow. Healtli and nutrition are good, home life medium, jiarentage 
is English. She lives with her mother, her father being dead. 
Her mother keeps a store, in which the girl works Ix^fore and after 
school. Vision is normal ; hearing is normal in the right ear, but 
so defective in the left ear that she could not he tested with the 
audiometer. Her palate is very high and her speech is defective. 
The speech defect is a stammer, one grade better than inedium ; 
children's di.seases are measles and mumps. Hearing is a con- 
tributory factor and home life, crin<luct, and stammering asso- 
ciated doubtful causes. 

Ca.'ie X. A girl aged 12 years and ('> months. She is in grade 
three, class A. Her retardation is three years. She has made 
very deficient progress, having missed the last two promotions. 
Her conduct is rated as deficient, but as she is a moral case, conduct 
was regarded as a nal cause. Slie entered school at the age of 
seven and attends very regidarly. Her mentality is didl, health 
good, nutrition fair, and home life poor. Home life is therefore 
another real cause. Her parents are German and they speak the 



60 CLINICAL STUDY OF IlETABDED CHILDREN. 

German language exehisively. The birthplace of the child is 
Camden. Her sight and hearing are normal. The tonsils are 
enlarged and the voice is nasal. The children's diseases are 
measles, mmnps, chicken-pox, diphtheria, and scarlet fever. Con- 
duct and home life appear as contributory causes in this case ; the 
associated doubtful causes are nutrition, enlarged tonsils and 
language. 

Adequa,te Causes. 

Case XI. This is a boy who is retarded one year, being 9 
years and 7 months old and in the A class of the second grade. He 
entered school at the age of seven. His progress is fair, conduct 
good, and attendance regiilar. He attended only two different 
schools, both of which were in the city of Camden. His mentality, 
health, and nutrition are good ; home life is medium, parentage 
German. The parents speak the German language exclusively. 
This boy was born in Germany. In this case the principal of the 
school reported that unfamiliarity with the English language had 
been a bar to his progress. Vision 8/10 R ; 10/10 L ; hearing- 
normal. There are no physical defects and no diseases. As this 
case was retarded only one year it was thought that language might 
reasonably be considered as the sole cause of his retardation. Home 
life was taken as an associated doubtful cause. 

Case XII. The amount of this boy's retardation is one and 
<me-half years. He is 13 years and 6 months old and is in grade 
six, class B. He entered the Camden schools at the age of six. He 
also attended the schools of a rural district for a period of 
two years. His progress is fair, conduct deficient, and attendance 
irregular. His mentality is of medium grade. Health and nutri- 
tion are good and home life is above the average. Parentage is 
American. Sight and hearing are normal. The tonsils are en- 
larged and the voice is obstiiicted. The diseases are measles, 
chicken-pox, whooping cough, and mumps. This boy confessed 
that he smoked the pipe. He is bold, surly and stubborn. Attend- 
ance and school history were considered adequate causes, and con- 
duct, smoking and enlarged tonsils doubtful causes. 

Case XIII. A boy aged 11 years and 8 months. He is in 
grade three, class B, and is retarded two and a half years. He 
entered school at the age of eight and attends very regularly. His 
conduct is good and progress fair. There has been nothing in 
his school history to retard his progress. He has medium men- 
tality. His health is poor and his nutrition medium. He is a 



nESFLTS AXf) Til EI U Tin: ATM EST. r.i 

smoker, iroiuc lilV- is pour; paronta.ur Aim rii-an ; laii^iiaj^e Va\'^- 
lish. Sight and hearing- an- normal. Stamnuring is In.'hjw 
nuHlium. His diseases are measles, mumps, whooping eongh, and 
pneumonia. Health, homo life, stanmiering, and entrance aru 
taken as adeijuate causes; smoking as an as-uciated douhtt'ul cause. 

('(iHc XLV. The age of this boy is 1:5 years and f. mdulhs. 
1 le entered school at the age of nine years and is now in grade; four, 
Class A. The amount of his retardation is three yeare. His 
])rogress is very deficient, lie is, no (l(nd»t, a ease of ])roniotion on 
theinerit of age. His conduct is good and his attendance regidar. 
He has always attended the same school, lie is a mentally delicient 
case of the backward grade. His health, nutrition, and home life 
are good. He lives Avith his parents, who are of American descent. 
His sight and hearing are normal. The hand balance is nervous 
and the palate is high. He has suffered from mumps, pneumonia, 
and spinal meningitis. He still conqilains of headache and vomit- 
ing. [Mentality and age of entrance were taken as adequate causes 
of his retardation. His deficient mentality is doubtless due to 
]diysiological conditions produced by s|iinal meningitis. A sister 
of this boy died of the disease. 

Case XV. A lK)y aged 13 years and 7 months, is in the third 
grade, class A. He is, therefore, retarded four years. He entered 
school at the age of seven. His progress is defici<'nf, con<luct gooil, 
and attendance regidar. He was never transferred to other sch<K)ls; 

his mentality, health, and nutrition are g 1. Home life is poor; 

the parents are Italians who sj»eak their native tongue exclusively. 
\'i-;ion is H/10; hearing normal. There are no j>hy«;ical defects 
and no diseases. Late entrance and home life are the adequate 
caus<'S. As the birthplace of this boy was IMiiladelphia, and there 
was no positive evidence that langiuige retard(>d him, language 
was taken as a doubtful cause. Tiie teacher assigned lack of appli- 
cation as one of the causes. 

Case XVI. A boy 11 years and (I months old. He is in 
grade one, class A. The amount of his retardation is .^even year-;. 
He entered school at the age of nine and has never been transferre<l. 
His pntgress is very deficient, conduct is excellent and atU>ndance 
irregular. He is mentally deficient, l>elonging to the class of 
idiots. His muscular co-ordination is very bad, — he is unable to 
write legibly; he walks with difHculty. and stutters and stjimniers 
badly. He has a poor memory and is unable to tell a cimnecte<l 
story. He can do practically no school W(u-k. His health is poor, 
nutrition fair, home life por>r. He was l)orn of American parents 



62 CLINICAL STUDY OF RETARDED CHILDREN. 

and Las one older sister, who attends to the household duties, the 
mother being dead. It was difficult to test his sight and hearing, 
but both appeared very deficient, lie showed mouth breathing, a 
V-shaped palate, enlarged tonsils, and a number of other signs 
usually associated with adenoids. His cranium is small and there 
are marked stigmata of degeneration. I was unable to obtain any 
history of diseases. In this case the following nine real causes 
were found : attendance, entrance, mentality, health, sight, hear- 
ing, adenoids, speech, and home life. In connection with these 
nutrition appears as a doubtful cause. 

Case XYII. This is a girl 12 years and 6 months old and in 
the B class of the fourth grade, her retardation being two and a half 
years. Her progress is fair, conduct good, and attendance very 
poor; she is absent about one-half of the time. I was unable to 
obtain her age of entrance. She attended a parochial Catholic 
school for a period of four years. She also belonged to the Phila- 
delphia public schools. Mentality is good ; health and nutrition 
fair ; home life above medium. Parentage is mixed, the father 
being of American and the mother of Irish extraction. Sight and 
hearing are normal. The enlarged tonsils are associated with a 
sullen disposition. The diseases are measles and whooping cough. 
Attendance and school history are taken as the adequate causes, 
health, nutrition, and tonsils being associated factors. 

Case XVIII. This is another girl whose retardation is two 
and a half years. She is in the second grade, class B, and is 10 
years and 7 months old. She entered school at the age of nine and 
attends very regularly, but her conduct is deficient and her prog- 
ress very deficient. Her school history is free from retarding 
causes. Her mentality is slow, health good, and nutrition very 
good. Her home life is fair. She was born in Italy of Italian 
parents who speak only their native tongue. The teacher assured 
me that language was a retarding cause. Vision is 10/20 ; hearing 
82 E, ; 60 L. A very narrow palate, enlarged tonsils, mouth breath- 
ing, reduced hearing, abnormal sight, a dull expression, and a short 
upper lip led to the diagnosis of adenoids. The children's dis- 
eases are measles, mumps, chicken-pox, and scarlet fever. Adequate 
causes are late entrance, language, sight and adenoids. Doubtful 
causes are home life, conduct, and hearing. 

Case XIX. A colored girl 15 years and 7 months old. She 
is in grade five, class B ; hence is retarded four and one-half years. 
She entered school at the age of seven, but her attendance is very 
irregular, only about four-fifths of the time. Her conduct is good, 



RESULTS AM) rilElll l IH-ATMKyr. G3 

but ber progress is very deticiont. Hha aiU'iided scbuul in four 
diU'ercnt cities. Jler mentality is niediiini. Jler bealtb, nutrition, 
and bonie life are good. As ber fatber is dead, sbe lives with ber 
uiotber, wbo works out. Vision is 10/20 with glasses, 1/20 witli- 
out glasses; bearing normal, tonsils eidargetl. 'J'be diseases are 
wbooping eougb and measles. Attendance, scbool bistory, and 
sigbt are adequate causes ami enlarged tonsils an associated factor. 
Factors like dcjtrivMtiou uf i)iir('iils arc 1r<';iti(I iiinlt'r ijir head <.t* 
miscellaneous. 

Case XX. Tbis is a girl IG years and 1 month old, wbo is 
retarded .seven and a half years, being in grade 2, class A. Sbe 
entered school at the age of eight. There is nothing in her school 
history to retard ber progress, which, nevertheless, is very deficient. 
Iler conduct is excellent and her attendance very regular. Sbe is 
mentally deficient, of the idio-imbecile grade, ller health is fair, 
but on account of physical stigmata, like excessive nervousness, 
deformed palate, low forehead, small cranial circumference (nine- 
teen inches), and external strabismus, bealtb was regarded as a real 
cause, ller nutrition is medium, and home life above the average. 
Jler only brother is also mentally deficient. Sbe was born of 
Jewish parents. The home language is Yiddish. Vision was 
tested with the illiterate card and was f(»un<l t(» be 1<> '-'AK Hearing 
normal. She speaks' with difficulty, and has a pronounced stam- 
mer. The ade(|uate causes for tbis case are entrance, mentality, 
health, sight, and speech. Language is an associated doubtful 
cause. The number of cases with deci<led physical stigmata was 
small ; hence I made no separate class for them. 

After having gone over the 1000 records and marked ui)ou 
each one all the real causes to l)e found, according to the rules 
which T had laid down as the distinguishing marks of such causes, 
I found that real causes were noted in 851 of the 1000 cases. T 
further found that there were 110 cases with unassociated factors, 
/. ('. doubtful causes not associated Avith real causes. Tbere 
remained, therefore, 39 cases for which no causes appeared. Con- 
sequently it follows, if the assimied causes of retardation are real, 
if there is any connection whatever In'tween causes and retardation, 
tbat the children for whom no causes could be found will decrease 
in numlx'r with an increase in the years of retardation. Tt will 
further l)e true if the imassociated factors have no connection with 
retardation, tbat the num]>er of children for whom unassociated 
factors were found will not increase as the years of retardation 
increase. Tf tbe tw(t principles just set forth can be prove<l, it 



6-1 CLINICAL STUDY OF BETARDED CIIILDEEN. 

must follow that the number of children for whom real causes 
were found (among the 851 cases) must increase with the amount 
of retardation. 1 made my calculations for the lioys and girls 
separat<^lj, but as the numbers are small, I combined the fignires 
for the two in the final result. Similarly I first computed for 
years and half years, but for the final result I combined the years 
with the half years, for the same reason that I combined the sexes. 
To this method I adhered for computing all the tallies that follow. 
In the text I shall make mention of the final results only, but in 
the tables the calculations will be given in full. In order to avoid 
needless rej)etition, the number of years of retardation will not be 
mentioned in connection with every series of figiires. The first 
figure in the series will always correspond to one year's retarda- 
tion, the second fig-ure to two years' retardation, the third to three 
years, and so on to the fifth year, which was taken as the maximum 
amount of retardation for the final series. 

Distributed among the different periods of retardation, 1, 2, 
3, 4, and 5 years, it appeared that 11, 15, 11, 2, and were the 
number of children for whom no causes were found. By distribut- 
ing the whole number of cases in the same way the series 129, 385, 
323, 123, and 40 was obtained. Dividing the figures in the first 
series by their corresponding figures in the second the results will 
be 8.5, 3.9, 3.4, 1.6, and 00, These figures represent the percent- 
age of cases for whom no causes were discovered, for each of the 
periods of retardation. It will be observed that they decrease with 
the increase in the years of retardation, and therefore that our 
first supposition has been proved. 

For each of the several periods of retardation, from the short- 
est to the longest, the number of cases with unassociated factors is 
21, 55, 27, 7, 0. By treating them in the same way as the number 
of cases for which no causes were found, the following series of 
percentages will result: 16.3, 14.3, 8.4, 5.7, and 0. They stand 
for the percentage of cases with unassociated factors and form a 
descending series with the ascending series of years. Hence the 
second supposition is true. The first and second assumptions 
having been sho^^^l to be true, the third follows ^vithout calculation. 
It will be given below. 

The number of cases with real causes for each of the different 
periods of retardation is 97, 315, 285, 114, and 40. By finding 
their percentage of the whole number of children for each of the 
several periods of retardation, the following series will be formed : 
75.2, 81.8, 88.2, 92.7, and 100.0. This series increases with the 



nESULT:> AM) Tlll-li: THI-ATM i:.\T. «;:. 

ainouul (if rctardat inii act-nrdinj;- in tlic siipiinsii ion. (^JStH.' table 
VII.) Practicallv the same proof »>f tlie relation lu'twceii real 
causes and retardation may be cast into a somewhat different form. 
It may be assumi'd that the averai;e retardation for the cases with 
no causes and unassoeiated faetiu's should be less than the average 
retardation of tlu' cases with real causes, if retardation is a function 
of the real causes. 

Calculated in years and half years, the total retardation of the 
.■)0 cases for whom no causes were found is 1)1.5 years. 'J'he av(,'r- 
age will therefore be 2.35 years. The total retardation of the 110 
i*ases with unassoeiated factors is 202.5 years, and the average 2.;Ji). 
For the 851 cases with real causes the total retardation in years is 
2453, and the average 2.88. The average amount of retardatiou 
of the cases with unassoeiated causes exceeds that of the cases with 
no causes by .04 of a year, and the average amount of retardation 
of the cases with real causes is .49 of a year more than that of the 
eases with unassoeiated causes, thus offering proof of the reality of 
the real causes. Perhaps it will be thought that these differences 
are snudl, but it nmst be renu'mbered that this is partly due to 
the fact that the number of children with a high retardation is 
much smaller tluin the number of children with a low retardation, 
and this reduces the averages. If the number of children were 
evenly distributed among the several years of retardation the differ- 
ences would be greater. (Table XII.) The above ])roof nuiy be 
workeil out more in detail by suj)])osing the average retardation 
to increase with the numbi-r of causes. It will be rcmeiultered 
that all the real causes that could be discovered in each of the 
ro<'ords, — this choice Udng nuide with strict uniformity according 
to rules already discussed, — were noted, whetlier the degree of 
retardation was one or five years. If now there is a connection 
between the number of causes noted and retardation, then we shoidd 
expect that for the cases for whom oidy one or two causes of retarda- 
tion could be found (with certain olivious exceptions), the average 
amount of retardation would Ix? less than for the cases for whom 
more causes were found. If this Ik* true then retardation is a 
function of the numlK-r of causes noted. In collecting tlie data, 
the cases with contributory factors were not distril)uted among the 
several years of retardation in series composed of tlie different 
numbers of causes, and therefore they will have to bo excluded from 
the real causes in this computation. Because tlie numlx'rs were 
small this distribution was not made. Coidd they have lx>en 
treated, however, with the other real causes, the adequate causes, 



66 CLINICAL STUDY OF RETARDED CHILDREN. 

in this connection they would simply add to the proof, as will 
appear from table VIII. 

The supposition is that if the average number of years of 
retardation increases with the number of causes found, retardation 
is a function of these causes. The highest number of causes found 
in any one case was nine, but as the number of cases with 5, 6, 7, 8, 
and 9 causes is very small, they will all be included in the groups 
with five causes. The series representing the total amount of 
retardation in years, corresponding to the order of causes from one 
to five, is 190, 687.5, 571, 299, and 146; and the number of cases 
for each period of retardation is 85, 259, 186, 88, and 38 respec- 
tively. Calculating the average amount of retardation in years, 
the following will be obtained: 2.24, 2.65, 3.07, 3.40, and 3.84. 
The series increases with the number of causes, and thus retarda- 
tion is a function of them. (Table XII.) 

The relative and absolute value of the real and doubtful 
causes may be tested by still other suppositions. I shall begin 
with Tinassociated factors. If unassociated factors are connected 
with retardation their number should increase with the increased 
retardation. The unassociated factors corresponding to each of 
the different years of retardation are 48, 100, 45, 12 and ; the 
cases with unassociated causes are 21, 55, 27, 7 and 0. Dividing 
the number of causes by the corresponding number of children in 
each case, the following series of average number of causes will be 
produced: 2.28, 1,82, 1.67, 1.71, and 0.00. The series is descend- 
ing while the amount of retardation is ascending. Hence the 
supposition is not warranted. (Table VIII c.) 

By making the same supposition as above in reference to the 
combined associated and unassociated factors, the value of all the 
doubtful causes may be shown. Three series of causes, cases, and 
averages may be given at once. Following the order indicated 
they are 192, 493, 386, 164 and 48; 118, 370, 312, 121, and 40; 
1.63, 1.33, 1.24, 1.36, and 1.20. The nature of the series justifies 
the same conclusion as for unassociated factors. (Table VIII c.) 

A treatment of the contributory factors according to the last 
supposition and method will yield the following series: Factors, 
17, 87, 82, 32, and 7 ; cases, 16, 80, 70, 24, and 5 ; averages, 1.06, 
1.09, 1.17, 1.33, 1.40. As the series of the average number of 
factors increases regularly with the amount of retardation, the 
assumption that the contributory factors are real causes of retarda- 
tion is justified. (Table VIII c.) 

For the adequate causes the series are: Causes, 153, 548, 



RESULTS AND TJIEIU TUKATMKST. G7 

GOG, -*t>0, aud 130; cases, bl, l'u5, 215, IM), ami 155 ; averages, 1.81), 
2.o;i, 2.8:i, o.ll, aiul ."5. 71. The series of averaji;es for the adequate 
causes is a better st-rics than the one for the coutrihutory factors. 
This may show that they are more etiicienl in i)roducing retarda- 
tion than the contributory, but it nuist be observed that the numbers 
are much larger for the adequate than for tlie contributory factors, 
and on tJiis account a better series is to be expected. (Table 
VI 11 c.) 

I have also calculated series for various combinations of 
causes. In the text only the series representing the average num- 
ber of causes will be given. By a combination of contributory 
and adequate causes, a series of averages for all the real causes will 
be obtained. The series is as follows: 1.75, 2.02, 2.41, 2.70, and 
'6A'6. (Table VIII c.) 

The next series will show how the average number of con- 
tributory and associated factors increases with the amount of 
retardation. All the causes, both real and doubtful, found in the 
cases under consideration are represented in this computation. 
The series is 2.44, 2.20, 2.40, 2.90, and 3.20. (Table VIII c.) 

By combining the adequate causes with all their associated 
factors in the same manner as ex])lained for contributory factors, 
the following series will be obtained: 3.40, 3,59, 4.00, 4.37, and 
4.83. (Table VIII c.) 

The next set of averages is obtained by a combination of real 
causes and associated factors. All the cases except thi»se with 
unassociated factors and those for whom no causes were found are 
involved in the calculation of this series. It is as follows: 3.24, 
3.2G, 3.G1, 4.08, and 4.G0. It appears, therefore, that in spite of 
the unfavorable influence of doubtful causes, the series remains 
unl»roken and stands as evidence of the fact that the causes 
which at tirst were jissumed may now Ixi regarded as real. (Table 
VIII c.) 

The objection may l)e made that the series given above do not 
ascend as rapidly as one would expect. To this it may be replied 
that the work is of a statistical nature, and that tlie number of 
- is not sufficiently large to eliminate the disturbing effect of 
errors. Moreover, it has been found that the average age of the 
children increased with retardation. The average age of the boys 
who are retarded 5.5 years is 3.7 years more than the average age 
of those who are retarded one year. For the girls the difference 
Intween the average for 1 and 5.5 years retardation is still larger, 
being 5.3 years. The average age increases regularly with retarda- 
tion for both the Ixjys and the girls. It may \m seen from the fol- 



68 CLINICAL STUDY OF RETARDED CHILDREN. 

lowing series tliat although several of the consecutive numbers are 
alike, not a single break occurs : 

RlrarTtion ^ l^ 2 2.5 3 3.5 4 4.5 5 5.5 

Boys' Average Age, 11.0 11.9 12.2 12.9 13.2 13.6 13.7 14.1 14.1 14.7 
Girls' Average Age, 10.8 11.9 12.4 13.1 13.5 14.1 14.1 14.1 14.8 15.6 

On account of the increase of age with retardation, it seems 
fair to assume that the larger the amount of retardation the longer 
time the causes had to produce it, and that therefore it is not 
necessary that their number and average should multiply rapidly 
with increased retardation. (Table IX.) 

As the number of cases is small and the kinds of causes nu- 
merous, it is not to be expected that series with any degree of regu- 
larity can be obtained from a separate treatment of the causes. 
Especially is this true because the cases distribute themselves 
so unevenly among the different years of retardation. For two 
years' retardation there are 315 cases with real cau-ses and for five 
years only 40 cases. In spite of these difficulties I have been able 
to compute fairly symptomatic series for the three groups of social, 
physical, and psychical causes. Doubtful causes were excluded from 
the calculations. The social causes are most numerous and conse- 
quently give the most regular series. The number of causes for 
each of the different years of retardation is 102, 398, 408, 185, and 
79, and the corresponding cases are 97, 315, 285, 114, and 40 ; the 
series of average number of social causes is 1.05, 1.26, 1.43, 1.62, 
and 1.98. The total number of real social causes is 1172. The 
real physical causes are 651, only about one-half as many as the 
social causes. In spite of the small number, the series of averages 
for the physical causes, with a single exception, ascends quite 
regularly with the amount of retardation. The series is .65, .65, 
.82, .89, and 1.20. The series for the psychical causes, conduct and 
mental deficiency, is .05, .10, .16, .23, and .25. (Table X.) 
This progression is surprisingly regular in view of the small num- 
ber of cases. It may be attributed to the mentally deficient cases. 
If a series be computed for them only, an unbroken progression will 
result. The total number of mentally deficient cases of all grades 
from backwardness to idiocy is 56. These distribute themselves as 
follows among the several years of retardation: 1, 11, 23, 15, 6. 
If all the cases with real causes, yielding the series, 97, 315, 285, 
114, and 40, be used for the purpose of converting the series into 
one of percentages, the following regular progression will be 
obtained: 1.0, 3.5, 8.1, 13.2, 15.0. (Table XIV c.) 



RESULTS AM) TllKlll TliKATMEST. C!) 

flaking; use of the symbols descrilH'd in the blank, the talde 
below will show the ovade distribntinn of the 5G mentally 
deficient cases. All cases which it was thought belonged more 
])ro|)erly to a class of borderland cases between the mentally normal 
and the mentally deticient were grouped among the best grade of 
mentally deficient. 

15kw 111 IM 11 1.1 Totals 

Boys :U •> 1 1 :5s 

Girls 1(] 1 1 18 

Totals :.() :5 1 1 1 :.<) 

From this table it will a])]»cai' that the number ot" inibrcih-s 
found among the one thousand children is (J or .('» of 1 per cent. 
T examined alM)Ut three-fifths ((lOOO) of the children attending 
the Camden schools for mentally deficient cases in addition to my 
list of retarded childnMi. Among them I found 10 ind)eciles. To 
thes<» three-fifths of the <» belonging to the retarded grou]) should 
be added, making about 23, or almost .4 c»f 1 per cent. The per- 
centage of ind)eciles for the retarded group is therefore higher 
than for a grouj) of children takcTi at random. Perha])s some of 
the 10 imbecile children would more ])ro])erly have l)een classed 
as backward cases, but in my o])inion all of them would have fared 
far l>etter had they been at an institution for mentally deficient 
children. The grading of the 11) cases appears in the accompany- 
ing table: 

III IM II T<»tals 

Boy.s 4 :; I « 

Girls r. :5 2 11 

Totals 1() n .T 10 

Iti treating mentality as a cause of retardation, I did not 
crmsider the cases which were reported by the teachers as slow and 
dull, to show a lack of ca])acity f<»r school work. This was done 
iK'i'ause it was thought that the degree of mentality which is 
usiudly termed dull or slow might sim])ly be a result of other 
causes. As there are oidy '{.'54 dull and slow children in the whole 
retarded group, it is evident that not oidy slow iin<l dull children 
are retarded. The jiercentage of such children, however, apjiears 
to increa.se with the amount of retardati(»n. If they l»e distributed 
among the different years of retanlation, the series 24, 12:{, 110. 



70 CLINICAL STUDY OF BETABDED CHILDBEN. 

49, and 19 will be obtained. The series for the whole number of 
children is 129, 385, 323, 123, and 40. The percentage, there- 
fore, of the whole number of children for each of the several years 
of retardation will form the following sequence: 18.6, 31.9, 36.8, 
39.8, and 48.0. From this series it appears that the number of 
slow and dull children increases rapidly and regularly with the 
amount of retardation. (Table XI.) A further study of the 
cases the teachers called slow and dull showed that their physical 
causes were practically as numerous as for those of better grade of 
mentality (leaving out of account the mentally deficient). For 
the slow and dull group the average number of physical causes is 
.67, and for the other gi'oup .64. For the boys and girls sep- 
arately the figures are .63 and .61, .72 and .69 respectively. If 
all the real causes be considered, they will average 1.94 for the 
slow and dull group and 1.94 for the other group. The two 
groups, however, show a decided difference in the amount of 
retardation, that of the former being 3.00 years and of the latter 
2.71 years. The figures for the different sexes are practically the 
same. A still further study of slow and dull cases showed that the 
percentage of first-born among them was 19.8, while the percentage 
of first-born among the other cases, excluding the mentally defi- 
cient, was only 16.7 ; also that the percentage of first-born among 
the mentally deficient was 28.6. This fact was shown by both 
sexes. Further light was thrown upon slow and dull children, 
including mentally deficient, by finding that 52.3 per cent of them 
Avere also called stolid or inert, while only 21.5 per cent of the 
other children were called inert. This striking difference appears 
for both sexes. Many children might lose their apparent dulness 
if quickened by proper physical exercises. Teachers frequently 
complain that some days children are exceptionally dull. At such 
times it appears to me they should indulge in physical exercises 
until they show some capacity for acquiring the three R's. 

In order to obtain additional evidence of the relation between 
social causes and retardation, I correlated the extent of retardation 
of school districts differing in social grade, with the average enrol- 
ment for the districts. They were graded into five classes, in addi- 
tion to the negroes. The 2003 retarded children when distributed 
among the different grades from the highest to the lowest (includ- 
ing negroes as the lowest grade) formed the series 116, 357, 515, 
612, 163, and 240. The average enrolment distributed in the 
same Avay gave the following series: 708, 1846, 2780, 3063, 710, 
and 645. Therefore, the percentage of children retarded in each 



RESULTS AND TllJJIK TREATMENT. 71 

one of the districts from the best to the jioorest grade is IG..*], 19.3, 
18.6, 19.3, 22.9, and 37.2. The fourth, third, and second grades 
show practically no diiferencc in the nuuiher of retarded children. 
But the fifth and first show a difference of 3 and 3.6 per cent 
respectively ; while the colored schools average almost t\\'ice as 
many retarded children as the other schools. The results might 
have proved to be more symptomatic had the several school districts 
been composed of more homogeneous gi'onps in respect to social 
standing. (Table XIII.) 

Having treated the real causes in groups of social, physical, 
and psychical, we may now turn to a consideration of the individual 
causes in these groups. In this connection I wish to repeat that 
the number of cases for which real causes were found is small, 
being only 851, and the kinds of causes are many; therefore it 
must not be exix-cted that the percentage of cases with one kind of 
cause increases as retardation with any degree of regularity. 
Especially is this true lx>cause the 851 cases distribute themselves 
very unevenly among the several years of retardation. 

The method of treating the individual causes is precisely the 
same as that employed for the different groups. As, however, only 
one kind of cause is considered in a single table, the final series 
will not be one of average number of causes, but of the percentage 
of children for whom the cause was found. Thus as there were 
97 children retarded one year for whom real causes were foimd 
and only 13 of these had poor nutrition, the percentage of children 
who were retarded one year and had nutrition as a real cause is 
13.4. Real causes were found for 315 children whose retardation 
was two years. There were 28 of these who had poor nutrition. 
Therefore, of the children who were retarded two years 8.9 per 
cent had faulty nutrition as a real cause of retardation. The per- 
centage for the children who were retarded three, four, and five 
years was calculated by the same method. The method set forth 
for nutrition is the one employed for the treatment of all the other 
individual causes. The complete calculations appear in table XIV. 
At this place I shall give only the contrasted series in the order of 
frequency of the causes, the most frequent first. 

From a glance at table XIV it will apiK»ar that the series of 
percentages is regularly ascending with the amount of retardation 
for only entrance, attendance, home life, and mental deficiency. 
It follows, therefore, that the series for all tlio eau-ses, except 
mental deficiency, is broken when their numlK'r falls to 200 or 
less. The absolute and relative importance of the individual 



72 CLINICAL STUDY OF RETARDED CHILDREN. 

causes of retardation could be tested in a way by the above method, 
if the number of cases investigated were 10,000 instead of 1000. 
Were the number of cases sufficiently large, a test could be made, 
not only of the value of individual causes but even of the different 
gTades of these causes. 

There are a number of causes which it was thought well to 
treat individually, either because no attempt had been made to 
collect from all the children data pertaining to these causes, or 
because the data were sufficiently numerous to warrant a separate 
consideration. In some cases, moreover, there was such inde- 
cision as to the real value of the data that separate treatment seemed 
preferable. On account of their variety of character they may be 
subsumed under the heading of miscellaneous causes. 

I shall first turn to the relation between smoking and the 
amount of retardation. The method of correlation is the same as 
that used in the preceding tables. The cases who smoke were 
first distributed according to their occurrence among the several 
years of retardation. Similarly were all the boys of wdiom the 
information was sought. The next step was to find for each year 
of retardation the ratio of the number of cases smoking to the 
number of cases asked for these data. In this way a series of 
ratios or percentages was obtained which showed whether or not the 
number of boys smoking increased with the amount of retardation. 
The determinations were first made for years and half years, but 
rhe half years were then combined with the years to make the 
series of percentages more regular. I shall give here only the 
series for which the years and half years were combined, the first 
number in a series corresponding to one year's retardation and the 
second number to two years' retardation, and so on. The series 
for the number of cases smoking is 7, 24, 31, 17, and 8 ; for the 
whole number of boys asked the series is 74, 183, 164, 70, and 23. 
By means of these series the percentage of boys who smoke may be 
calculated for each year of retardation. These percentages will 
produce the following progTession: 9.5, 13.1, 18.9, 24.3, and 
34.8, The series is highly symptomatic of the injurious effects of 
smoking upon the boy's school progress. If this series really stands 
for what it seems to indicate, the assumption that smoking was 
merely a doubtful cause is false. By asking the boys whether 
they smoked cigars, cigarettes, or a pipe, T learned that only a 
very few smoked cigars, and that those who smoked a pipe were 
almost as many as those who smoked cigarettes. As nearly as I 
could determine, the boys who smoked cigarettes smoked more 



RESULTS AM) TUElll TUEATMEyT. 7:3 

constantly than those who smoked a j)ipe. It is quite likely that 
the boy can stand the smoking of hleached eipirette tobaceo iiuieh 
better than the relatively stronger j)ipo tobaeeo. If the cigarette 
injures the boy mon^ than the pipe or cigar, it is because he 
indulges more excessivelv in smoking the cigarette. (Table 
XV. f 

The next series of percentages is intendi-il to show the cor- 
relation of the number of cases drinking tea and cotfec, with the 
amount of retardation. The calculations were made in the same 
way as those for smoking. As the cases for this ea\ise were lx)ys 
and girls, the series were first detennined for the different sexes, 
but the series given in the text represent the combination of the 
sexes. The series of cases is 40, 10(5, 107, (51, and 12; of all the 
children asked 7(5, 275, 227, 82, and 20 ; of percentages 04.4, 71.3, 
73.0, 74.4, and 40.1. This series is slightly symptomatic of the in- 
jurious effects of tea and coffee drinking Ix^fore the fifth year is 
reached ; here there is a sudden dro]) which it is difficult to explain. 
Perhaps the number is too small to eliminate the bad effects of 
errors. Or it may be that many of these children wei*e forbidden 
the nse of tea and coffee on account of ill health, the percentage of 
ill health for this group being much higher than that of any other 
group. (Table XVT.) 

By correlating the amount of retardation with the cases who 
reported that they ate poor breakfasts, a negative residt was 
obtained. The three series given in the order of cases, whole 
ninnber of chihlren, and ])ercentage are as follows: 22, 75, 70, 22, 
and 7; 70, 275, 227, S2, and 2tS ; 28.0, 27.2, 30.0, 20.8, and 27. 
Three nundiers of the last series are nearly alike and there is a 
difference of only 4 per cent Ix'tween the highest and lowest. 
(Tabic XVI.) 

Of the one thousand cases there were I'-W, -'■'>. 1 pel' cent, who 
were deyirived of one or both parents either by death or separation. 
This percentage seems to be excessive, Imt on account of insufficient 
• lata no comparison can Iw made with the cliildren <d normal ago 
for their grade. The relation of deprivation of j)arents to the 
amount of the child's retardation can however Ik- tested as al>ove, 
bv a correlation of the nmnber of cases deprived, with the 
amount of their retardation. The series for the cases dej)rived is 
23, 80, 70, 32, and 11 ; f<»r the whole numU'r of children 120, 385, 
323, 123, and 40; an«l the series of ]x>rcentages is 17.8, 23.1, 
24.4, 20.0, and 27.5. This succession of percentages shows a 
regidar increase of cases deprived of parents in proportion with the 



74 CLINICAL STUDY OF RETARDED CHILDREN. 

amount of retardation. As adequate cause for the retardation of 
670 cases has already been found, it would appear that the finding 
of additional causes is a denial of the adequacy of the causes 
assumed to be so. In this there may be some truth, for it was 
wholly a matter of judgment whether the causes were adequate to 
produce a given amount of retardation. In this connection, how- 
ever, it must be remembered that some of the causes here treated, 
like deprivation of parents, lie back of some of the causes already 
considered. Thus deprivation of parents lies back of home life. 
Of the 234 cases deprived of one or both parents, 86, or 37 per 
cent, were reported to have a poor home life, of the grade described 
in the preceding pages. Many of these causes may also refer more 
especially to the cases for whom no adequate causes had in my 
opinion been found. (Table XVII.) 

It has already been shown (table IX) that the average age 
of the children increases with the amount of retardation. The 
above series shows that the number of cases deprived of parents 
increases with the amount of retardation. Consequently it follows 
that both age and the cases deprived of parents increase with the 
amount of retardation. It appears, therefore, to be a logical neces- 
sity to have the number of cases deprived of parents increase with 
age, and if this be so then it is only reasonable to suppose that 
deprivation of parents ia a function of age and has no connection 
whatever with the amount of retardation. As it is only the average 
age which increases with the amount of retardation, it is not a 
necessity for all the oldest children to be most retarded nor for all 
the youngest to be least retarded. From table IX it appears that 
there are some children 14, 15, 16, and 17 years of age who are 
retarded only 1, 1.5, 2 and 2.5 years respectively, while there are 
children only 10, 12, and 13 years of age who are retarded 3.5, 5, 
and 5.5 years. From anything that has thus far been said it is 
therefore not necessary for the number of cases deprived of parents 
to increase with age; and upon making a correlation of age with 
the number of cases deprived of parents, a series is obtained which 
shows that the number of cases deprived does not increase with 
age. There are 17 cases who are 9 and 10 years of age ; 61, 11 and 
12; 110, 13 and 14; 42, 15 and 16; and, 4 cases who are 17 and 
18. The whole number of children corresponding to each of the 
several ages from the lowest to the highest is 67, 305, 426, 169, 
and 33. Giving the fonner series in terms of the latter, we obtain 
the following series of i^ercentages : 25.4, 20, 25.8, 24.9, and 12.1. 
This series indicates that the number of cases deprived of one or 



RESULTS AND TllFAi: TL'JJATMI'JNT. 75 

both parents decreases rather than incivases with age, eonseqnently 
the series showing an increase of tlie number of cases deprived with 
the amount of retardation, is svmptonnitic of a relation between 
the two. (Table XVIII.) 

From calculations given below, it appears that tirst-born i-hil- 
dren are more apt to be retarded than others. The number of boys 
examined in this investigation is 533. We may assume that they 
represent so many families, although the nundx^r is somewhat less. 
The whole nund)er of children lx>th living and dead, for the 
assumed 533 families is 2856. Among these therefore we may 
expect 533 first-born children. If wje can expect 533 first-bom 
among 2856 children, then among 533 the number to be expected 
is 100. In reality the number is less than 100 because the number 
of families is less than 533. Sometimes two or more children 
came from the same family. In the same way it was found for 
the girls that 84 first-l)orn may be expected among 467 families 
with 2603 children. By actually counting the number of first- 
born among the 533 boys and 467 girls, they were found to be 
124 and 122 respectively. This is an excess of 24 with the boys 
and 28 with the girls. The excess would have been exaggerated 
had the thousand boys and girls actually represented so many 
families. 

In this connection it is intx^resting to obsen'c that the per- 
centage of first-born is higher among the mentally deficient than 
among the mentally normal. Of 38 mentally deficient boys 11 or 
28.4 per cent are first-born, but of 405 normal boys there were 
only 113 or 22.8 per cent who were first-born. In the same way 
it was found that 27.8 per cent of the mentally deficient girls but 
only 23.8 per cent of the mentally normal girls were first-l>oni. 
The nmnber of first-bom among the whole number of mentally 
deficient cases exceeds the number among the mentally normal by 
5.3 per cent, and the numl>er of first-l>om among this retarded 
group exceeds the number to be expected by 52. 

From the results obtained in reference to first-bom children 
one might be inclined to suppose that their numl>er would inorease 
Nvith the amount of retardation, but the final series showing this 
relation does not confirm this presupposition. The series is 32.8, 
23.4, 22.0, 10.5, and 22.5. This is somewhat indicative of a de- 
crease in the number of fii-st-lx>rn with the amount of retardation. 

An attempt was made to study the effect of large families 
upon the amount of retardation by correlating it with thr numlvr 
of living brothers and sisters. It was found that the 120 cases 



76 CLINICAL STUDY OF BETARDED CHILDREN. 

wlio were retarded one year had 387 sisters and brothers, and that 
the 385, 323, 123, and 40 cases who were retarded 2, 3, 4, and 5 
years respectively had each 1244, 1057, 441, and 139 sisters and 
brothers. The average number of sisters and brothers from one to 
five years of retardation forms the following series, 3.00, 3.23, 
3.27, 3.58, and 3.48. Here, therefore, there is some indication 
that large families favor retardation. It may be, however, that 
large families are associated with some other cause, like home life, 
which might be responsible for the retardation. ^Yhere one event 
may be dependent upon a large number of events it is difficult to 
determine which is the real cause or to detenuine their relative 
value should there be more than one. (Table XVII.) 

The number of cases for the different years of retardation had 
also a number of dead sisters and brothers. Distributed among the 
years of retardation from 1 to 5 they form the follo"\\dng series : 
99, 442, 411, 175, and 73. The series of averages is 77, 1.15, 
1.27, 1.42, and 1.83. This series indicates an increase in the 
number of dead sisters and brothers as the amount of retardation 
increases. In making this coiTelation it was thought that the 
number of dead children in different families was a measure of 
their relative viability. The larger the number dead the less 
would be the viability. It was further assumed that the less the 
viability the greater would be the amount of retardation. If the 
number of dead children in a family is a measure of its viability, 
then it has been sho%\Ti by the above series that viability decreases 
as the amount of retardation increases.- (Table XVII.) 

Several objections may Ix^ made to the above series of aver- 
ages. It may be said that as the size of families increases with 
the amount of retardation, one may expect the number of dead to 
increase in the same way. But the increase of the former is 
broken in regularity while the latter is not. Moreover, by taking 
the difference between the lowest and the highest average for the 
living sisters and brothers, and averaging it for the five years, the 
result will be only .116, but for the dead sisters and brothers the 
average difference is .212, almost t\\ace as large. Again, as the 
numbers in the latter series are only half the size of those in the 
former we should expect the reverse to be true. 

Against both series the same objection may be made as was 
urged against the series showing the relation of deprivation of 
])arents to the amount of retardation. It is likely that the older 
the children the larger the number of dead sisters and brothers. 
As the average age increases with retardation, the increase of dead 



RESULTS AXD Til hi i: TL'h'ATM hXT. 77 

sisters aiid brothers may be siimiltaneous with the amount of 
retardation and ago, but in reality bo a function of the hitter. To 
determine whetlier tliis was true, a eorrehition was made between 
the age of the cases and the nmnber of their dead sisters and 
brothers. The number of cases 9 and 10 years old is G7 ; 11 and 
12 years 305; 13 and 14, 420; 15 and IG, Hj\) ; and 17 and L^, 
33. The nmnber of dead sisters and brothers for each of the num- 
ber of cases is 71, 382, 515, IDO, and 42 respectively. From these 
series the following series of averages is olitained: 1.00, 1.25, 1.21, 
1,12, 1.27. Perha])s this series shows a slight increase of the 
average number of dead ^vith the increase of age. lint it by no 
means accounts for the far more rapid and regularly ascending 
series, which shows the relation of the nund)er of dead sisters an<l 
brothers to the amount of retardation. (Table XVIIT.) 

Usually much of the retardation in the ])ublic sch(X>ls is 
ascribed to the attendance of a foreign population. 1 have there- 
fore made an accurate calcidation of the average amount of retarda- 
tion for each of the several races represented in this investigation. 
The calculation was made by midtiplying the amount of retarda- 
tion in years and half y<>ars by the nundKM- so retarded. The sum 
of these products was divided by the whole number of the race for 
which the computation was made, to obtain its average amount of 
retardation. 

The races whose reiiresentation was suthciently large for imli- 
vidual treatment will be given in the order of the amount of their 
average retardation, beginning with the one having the highest 
average. Italian, 3.15 years; negro, 2.96; mixed parentage, 2. SO; 
total non-American, 2.84; all races not treated individually, 
2.82 ; American, 2.79 ; Gennan, 2.02 ; English, 2.30. The num- 
ber of children for each of the different races given in the above 
order is, Italian, 39; Xegro, 112; mixed, 73; total non-American, 
3G7 ; all races not treated individually, 44 ; American, G33 ; 
German, 78; English, 21. These numbers may be too small to 
base any conclusions upon them, but if the n-sults obtained be con- 
sidered reliable, then it follows that the foreign iK)pulati(»n on the 
whole incr<>ases the average amount of retardation by (»idy .05 of 
a year. The facts would be stated more accurately, if it w<'re said 
that some foreign races had a tendency to raise the average amount 
of retardation, while others reduced it. The Italian and the Xegro 
are most retarded, and the Gennan and English the least. (Table 
XIX.) 

^Fuch retardation i- uiid<iul)tedlv due to a enrrieubim whieh 



78 CLINICAL STUDY OF RETARDED CHILDREN. 

aims at making a man out of the boy l>efore he is ready to be a 
man. The school in its methods and course of study must recog- 
nize the interest of the boy as a boy, if it ^vould keep him for the 
sake of instruction. The school has certainly failed to interest the 
subjects of its endeavor, and therefore it has become necessary for 
the state to legislate upon this problem, and pass compulsory 
attendance acts. In the state of New Jersey the child is unable 
to leave school before its fourteenth birthday. From this it fol- 
lows that there is a continual increase in the number of retarded 
children until the fourteenth birthday, when there is a sudden drop 
and the series for retarded children decreases to the eighteenth 
birthday. By taking- all children as 9, 10, 11, etc., who are in 
their ninth, tenth and eleventh years respectively, and distributing 
the thousand cases of retarded children according to their several 
ages, the following ascending series is obtained from 9 to 13 
inclusive: 35, 97, 133, 200, and 253; then when the thirteenth 
year has been completed there is a drop from 253 to 149, the num- 
ber 14 years of age, and the series is decreased. The whole series 
after the thirteenth year is 149, 81, 33, 15, and 4. 

In the chapter on elimination or withdrawals, it was pointed 
out that by far the largest number of boys and girls leave school 
to work or stay at home. Real poverty plays a very small part in 
elimination, there being only 3 out of 420 cases. I think it fair 
to say that most of the children who leave the elementary grades 
do so because they are not interested in the work of the school. 
Parents do not compel, they permit them to go to work. (Table 
XX.) 

The average amount of retardation increases with the age, 
having practically reached its maximum at the age of 14, when it 
is 3.2 years for the boys and 2.9 years for the girls. These would 
no doubt be the points of maximum retardation had not the nearest 
birthday been taken to make the computations. The series of 
average retardation for the boys and girls from the 9 to the 18 
years inclusive are as follows : 

Age 9 10 11 12 13 14 1^ 16 17 18 

Boys 1.4 1.6 2.3 2.7 2.9 3.2 3.4 3.2 3.6 4.7 

Girls 1.6 1.8 2.1 2.7 2.9 2.9 3.3 3.2 3.4 3.4 

(See Table XXI.) 

By calculating the average amount of retardation for the 
several grades, it is found that instead of increasing with the grade 
as we might expect, it decreases. For the first and second grades 
the average retardation is 2.93 years; for the third and fourth 



RESULTS AND TlU-lJl TREATMENT. TO 

2.i>G; lor the tiftli and sixth l'.GT, ami for tho suvciitli ami eighth 
2.04. (^Table XXll.) As the amount of retardation docs uot 
increase, eveu with the lower grades where its reduction by with- 
drawal is practically impossible, it appears that if the curriculum 
is to be considered a cause of retardation, it cau be a cause only 
in the first gi'ade. Probably the work of the first grade is uot 
articulated properly with the life of the child before he enters 
school. 

1 oifered as a proof of the reality of my causes of retardation 
the fact that their uumber increased regularly with the amount of 
retardation. To this the objection was made that as children of 
difierent grades belonged to a group w^ho were retarded to tlie same 
extent, and as some of their retardation was to be ascribed to a 
curriculum which was less properly adapted to the child in the 
higher than in tlie lower grades, the groups might be altered if this 
factor of the curriculum were considered and thus the symptomatic 
series disturbed. It was claimed that the amount of retardation 
due to the curriculum should be deducted from the given amount 
of retardation. From the above table it appears that the assump- 
tion that the work of the higher grades is not so well adapted to 
the child as the work of tho lower grades is not true. Moreover, 
if the assumption were true, the chances that it would make the 
series more rather than less s_\anptomatic are at least equally great. 
Therefore it is not to be considered. In the fact that average re- 
tardation increases with age but not with the grade, we have a 
statement of the fact that retardation principally aflfects the lower 
grades. Here children must be considerably retarded before they 
are permitted to leave school. We have, therefore, an overcrowd- 
ing in the lower grades which in itself is a cause of retardation. 
Retardation, therefore, becomes a cause of retardation by putting 
children on half time or so overcrowding the rooms that they 
become unfit for children and render the work of the teacher 
inefficient. 

In this monogrn]>h liave l)een set forth a method and a blank 
for the examination of retarded school children, as well as a method 
for the treatment of results. The problem of retardation itself has 
been considered. It was found that the thousand children repre- 
sented in this investigation had an average retardation of 2.81 
years and that it ranged from 1 to 7.5 years. Certain miscel- 
laneous problems, like the withdrawal of children from school and 
the time devoted to the examination of a thousand pii'ses, are also 



so CLINICAL STUDY OF BETABDED CHILDBEN. 

discussed. The records oi a number of cases are given. From 
these it appears how certain facts were taken as causes of retarda- 
tion. These causes are classed under the headings, physical, social, 
and ps^'chical. It is thought that adequate causes have been found 
for the total retardation of 656 cases. For these cases the average, 
number of physical, social, and psychical causes is 2.62. To these 
might be added a certain numl^r of miscellaneous causes of an 
hereditary nature. In fact many of the other causes may be mere 
manifestations of the single cause, lieredity. An attempt is 
made to show the reality of the causes by pointing out that their 
number increases with the amount of retardation. Several other 
proofs are also offered. The value of this inquiiy would doubtless 
be much enhanced by a similar investigation of several thousand 
additional retarded cases, as well as by the examination of a 
thousand normal children for the sake of making a comparative 
study. 



APPENDIX 



TABLE T 



Retarded according to Superintendent 'b 

statistics (1905-06) 

Reported retarded by mistake 

Names appearing twice 

Actually retarded (1905-06) 

Absent at time of examination( 1906-07). 

Kefuaed to be examined 

Transferred to other schools in Camden 
Withdrawn from Camden public schools 

Not examined 

Elxamined 

Extra cases examined 

Kxtra ca.ses used in this study 

Whole number of cases in this study ... 



BOTB 



No. 



1076 

1 

1075 

123 

65. 
368 
556 
519 
21 
14 
533 



Per 
Cent. 



11.4 

6. 
34.2 
51.7 
48.3 



No. 



957 
29 

928 

102 

2 

48 

313 

465 

463 

9 

4 

467 



Per 
Cent. 



11. 

5.3 
33.7 
50.1 



Tot A I 



No. 



2033 

29 

1 

2003 

225 

2 

113 

681 

1021 

982 

30 

18 

1000 



Per 
Cent. 



11.2 

6.0 
34. 
50.9 
49.1 



TABLE II 



Number withdrawn for reasons ascertained . . . . 

Attending some other school 

Normal school 

Business college 

-Military academy 

Private school 

Parochial school 

Working 

Living at home and not working 

In children's home 

Withdrawn because of poverty , 

sickness 

death 

bad conduct 

imprisonment 

Number withdrawn for reoaons not ascertained. 

Left Camden 

No information 

Total nuinl>er withdrawn 



i Boys 


G1RI.S 


246 


174 


25 


11 




1 


8 


3 


1 




2 




14 


7 


192 


91 


2 


47 


2 


1 


1 


2 


8 


19 


3 


2 


, 12 




I 


1 


1 122 


139 


63 


56 


1 " 


83 


' 368 


313 



Totals 

420 

36 

1 

11 

1 

2 

21 

283 

49 

3 

3 

27 

S 

12 

2 

261 

119 

142 

681 



TABLE III 
.\naly.sis of Retarded Childhen uy Half Year.s op Retardation 



Ybabs 


1 


1.6 


2 


2.6 


3 


3.6 


4 


4.6 


6 


6.6 


TOTALa 


Boys 


38 
16 


43 
33 


61 

85 

146 


132 

107 

^39 


91 
104 


74 
64 


62 
32 


19 
20 
39 


16 
12 

28~ 


7 

5 

12 


533 

467 

1000 


Cirls 


ToTALe 


63 


76 


196 


128 


84 



Xi 



TABLE IV 
Analysis of Retarded Children by Ages of Entrance 



Age 


5 


6 


7 


8 


9 


10 


11 


12 


Totals 


Boys 

Girls 


61 
53 


134 
113 


149 
136 


86 

84 


33 
29 


11 
12 


4 
4 


3 
2 


481 
433 




Totals 


114 


247 


285 


170 


62 


23 


8 


5 


914 



TABLE V 
Seven Years the Most Favorable Age for Entering School. 





•» a 
og 


Years of Retardation 


05 
1 


1^- 


Average 
Retard. 
Boys and 
Girls 


1 


1.5 


2 


2.5 


3 


3.5 


4 


4.5 


5 


5.5 


6 


6.5 


5 


4 


9 


6 


17 


11 


10 


3 


1 










61 


2.57 


2.63 


H 


6 


14 


13 


16 


40 


20 


16 


9 


4 


1 


1 






134 


2.58 


2.61 


PQ 


7 


16 


9 


21 


43 


30 


16 


10 


3 


1 








149 


2.56 


2.62 




8 


3 


7 


8 


22 


14 


15 


9 


2 


4 


1 




1 


86 


2.98 


2.93 




9 




1 


3 


5 


6 


7 


5 


3 


2 


1 






33 


3.37 


3.05 




10 






1 




2 


1 


3 


2 


1 


1 






11 


3.91 


3.90 




11 












1 


2 


1 










4 


4.00 


4.13 




12 














1 


1 


1 








3 


4.50 


4.50 




5 




4 


12 


12 


13 


7 


5 












53 


2.71 


S.63 




6 


5 


14 


23 


25 


21 


11 


7 


4 


2 




1 




113 


2.64 


2.61 


S 


7 


7 


12 


26 


35 


28 


13 


5 


5 


4 




1 




136 


2.66 


g.62 


8 


1 


2 


18 


17 


23 


13 


5 


2 


1 


2 






84 


2.88 


$.93 


a 


9 






6 


7 


7 


6 


2 


2 










29 


2.98 


S.05 




10 






1 


1 


2 


1 


1 


3 


3 








12 


3.88 


3.90 




11 












1 


1 


1 


1 








4 


4.25 


4.13 




12 
















2 










2 


4.50 


4.60 



84 



TABLE VIa. 
Distribution of Hkai- Causes — Roys 













I'HYSirAI. 






SoriAl, 




I'SYCHI 






13 


•o 
























CAL 


1 
1 
































i 






















b 










1 






£ 




















o 














a 


in 



















a 


X 

■© 
o 

J3 


«£ 


£ 


>> 




Total 




^ 


£ 

•a 


1 i 




a 


■V 

3 

e 

•a 


o 




B 


'5 

B 



u 

a 

B 


B 


1-1 

a 




9 

1 


a 


1 






2 


u 


3 


z; 


< 

4 


CO 


03 

4 


X 
2 


3 


6 


< 

18 


3 


X 

1 


S 


o 

1 




1 


43 


43 


IS 


2 


119 


20 


5 


13 


5 


16 


5 


- 


38 


54 


23 


39 


7 


8 


2 


238 


3 


3 


106 


28 


25 


9 


12 


11 


12 


- 


40 


62 


25 


49 


9 


11 


25 


318 


-3 


4 


46 


16 


24 


7 


8 


13 


4 


- 


23 


27 


13 


29 


4 


11 


fi 


184 


^ 


5 


13 


5 


10 


2 


4 


4 




- 


7 


9 


4 


12 


1 


3 


4 


65 


3 


6 


6 


6 


5 


1 


2 


1 


1 


- 


2 


6 


1 


6 


- 


3 


3 


36 


7 


1 


1 


- 


1 


- 


1 


- 


- 


- 


1 


- 


1 


- 


1 


1 


7 


< 





1 


1 

"so 

7 


~69 
3 


1 
~38 

1 


1 
~32 


1 
4 


1 
~25 

3 


~r 


1 
117 

16 


1 
178 

14 


69 

18 


1 
138 

15 


22 
3 


1 


- 


9 


Totals 


335 


38 


41 
3 


900 


s o 

az 


I 


89 


89 


^2 


2 


15 


2 
9 


2 
~6 


1 

~2 


1 
3 


4 


2 
5 


1 


5 

21 


_3 

17 


3 
21 


6 
21 


1 
3 


-^ 


4 
~7 


80 


Totals 


104 


119 


Gran 


(f Totals 


































Boys 


439 


89 


74 


40 


35 


54 


30 


4 


138 195 


90 


159 


25 


38 


48 


1019 




/ 






r.irh. 


412 


111 


46 


26 


18 


98 


24 


2 


135 208 


107 


97 


18 


18 


15 


923 


1 


..tals 






Boy. 


A Girls 


851; 


200 


120 


66 


53 


1.52 


54 


t) 


273 403 


197 256 


43 


56 


63 


1942 



bo 



TABLE VIb 
Distribution of Real Causes— Girls 



a; 
1 

£ 

3 
& 

0) 

< 


2 

a 


1 

Si 


42 
140 
80 
42 
15 
2 


Physical 


Social 


Psychi- 
cal 


Total 


K 

2 
34 
29 
22 
13 

2 
102 

8 

1 
~9 

111 

89 

200 


a 

_o 

•| 
3 
12; 

3 
14 
12 
11 

2 
42 

3 

1 
4 

46 

74 

120 


■S 

'0 
a 
a> 

< 

3 
3 
9 

7 
4 

~26 

26 
40 
66 


J3 


0) 
(U 

0. 
CO 

I 

4 
1 

^16 

1 

1 

18 
35 
53 


1 

9 
29 
23 
17 

8 
2 

88 

6 
4 

98 

54 

152 


_c 
'C 

a 

5 
5 
7 
3 

4 
4 

24 
30 

54 


a 


1 

1 

2 

2 
4 
6 




G 

a 
W 

4 

51 

34 

20 

6 

2 

1T7 

15 
3 

18 

135 
138 
273 



u 

a 

< 

• 16 
73 
54 
32 
11 
2 

188 

15 

5 

20 

208 
195 
403 


1 

w 




M 

7 
37 

19 
15 

7 

85 

16 

6 

22 

107 

90 

197 


e 


K 

25 

26 

22 

9 

2 

~84 

7 

6 

13 

97 
159 

256 


^ 

3 

tc 
a 

03 

5 
9 
3 

17 

1 

1 

18 
25 
43 


a 

1 
5 
6 
4 
2 

18 
38 
56 




3 

a 



4 
5 
3 

I2 

1 
2 

3 
15 

48 

63 


1 
2 
3 
4 
5 

6 


42 

280 

240 

168 

75 

12 


Totals 


321 


817 


«2 


1 
2 


16 
15 


76 

30 

106 


Totals 


91 


Grand Totals 
Girls 


412 


923 
1019 


Boys 


439 


Totals 
Boys & Girls 


851 


1942 



86 



TAIU.K Vic. 

DlSTRnU'TION OK DfHIBTKUI. ('Af'SES BOYS. 





o 






P 


HYSICAL 






Social 

1 


8 




3 




















1 


ruber of real c 
per child 


1 

IB 

2 




a 

.0 


1 


2 


4 


J2 


a 



1 5 

Is 


« 


1 

1 
5 


£ 


1 


3 




3 


J3 


X 


3 

z 


c. 
00 






o 
H 


J 


S n 

9 17 


a 






1 


43 


7 


7 


3 


3 


2 


8 


2 


5 


68 


S 2 


119 


19 


20 


9 


9 


1 


28 


19 


14 27 


"i 


25 


182 


U 3 


106 


13 


10 


5 


10 


3 


25 


18 


6| 27 


4 


18 


138 


b 4 


46 


9 


1 


4 


4 


1 


15 


9 


- 3 


1 


8 


55 


-g i 5 


13 


4 


• - 


1 


1 


- 


3 


3 


1 




1 


- 


14 


•i 6 


6 


- 


- 


- 


- 


1 


1 


1 


- 


- 


_ 


_ 


3 


g 1 7 


1 


- 


- 


- 


- 


- 


- 


1 


. 


- 


_ 


_ 


1 


l' « 


1 


- 


I 


- 


- 


- 


- 


- 


- 


- 


- 


~ 1 


1 


i Totals 


335 


52 


39 


22 


27 


8 


80 


53 


29 


74 


22 

r 


56 


462 


If ^ 


89 


17 


12 


7 


2 


3 


20 


16 


6 19 


21 


130 


1? 


2 


15 


1 


3 


2 


2 


1 
4 


3 


4 


3 2 
9 21 


4 


2 


24 


"2 


Totals 


104 


18 


15 


9 


4 


23 


20 


23 


154 


Totals 


439 


70 


54 


31 


31 


12 


103 


73 


38 
6 


95 30 


79 ! 


616 


h 


1 


31 


_ 


2 


2 


2 


_ 


« 
11 


4 


1 


_ 


3 


31 


2 


26 


5 


1 


5 


3 


2 


12 


4 


7 


8 


3 


2 


52 


Is 


3 


6 


- 


2 


- 


- 


- 


3 


3 


2 


3 


1 


4 


18 


irS 


4 


6 


3 


5 


- 


1 


- 


6 


2 


1 


4 


1 


2 


24 


D 


5 


1 


1 


1 


- 


1 


- 


- 


1 


1 


- 


5 


- 


5 


Totals 


70 


9 


11 7 


7 


-' 


31 


14 


17 If. 


" 


130 


Grand Totals 


1 


















Boya 


509 
452 

961 


79 
64 


65 


38 


38 


14 


134 


87 


55 
40 


Ill 
79 


35 

24 

59 


90 


746 


Girls 


25 


45 


27 


130 


- 


35 


537 


Totals 
Roys * Girls 


143 


133 


63 


«3 


41 


264 


87 


95 


190 


125 1 


1283 



87 



TABLE VId. 

Distribution of Doubtful Causes — Girls. 



£ 

o 

u 
a 

1 

o 



< 


Number of real causes 
per child 


T3 

u 

o 

a 
IS 


Physical 


Social 


J 
■< 


g 

(2 


i 

i 

1 

1 

1 


J3 

01 


e 

•c 

"S 


JS 


u 

V 

a 


S 

u 

S 


60 

B 

K 


c 





S 

CO 


>. 

u 



s 

"o 



■ j3 
03 

; 5 

13 

9 

' 1 

j - 

I 28 

! 31 

1 

2 
5 
1 
9 

40 
55 

95 


§ 

9 

24 

10 

5 

1 

49 

16 

1 

66 

3 

5 
5 

13 

79 

111 

190 


1 

3 
M 

B 

5 
6 
3 
2 

1 

17 
4 

4 

21 

1 
2 
3 

24 
35 
59 


1 

-a 

B 




1 
2 
3 
4 
5 
6 


42 
140 
80 
42 
15 
2 


6 
20 
13 

4 


2 

23 
11 

8 


4 
6 
4 


1 
15 

8 
4 

1 

- 


2 

13 

3 

3 

1 
1 


11 
43 
20 
10 
6 
1 


- 


2 
8 
10 
4 
2 


: 43 

169 

93 

45 

12 

2 


Totals 321 


43 I 44 


14 29 1 23 

1 


91 


- 


26 


364 




1 76 

2 15 


9 ! 12 
2 1 4 


6, 7I 4 

1 i 1 i - 


18 
5 




4 

1 


83 
15 

1 98 


Totals j 91 ' 


11 16 


7 i 8 


4 


23 


- 


1 . 


Totals j 412 


54 


60 


21 1 37 


27 


114 


_ 


31 


462 


% 

u 

a 


1 18 

2 1 11 

3 9 

4 2| 


1 
2 
5 
2 


1 

1 
5 
1 


1 
1 ] - 

1 1 5 

2 2 
1 


_ 


8 
5 
2 

1 


- 


1 
3 

1 

_ 


18 

! 22 

27 

8 


Totals 1 40 1 


10 


8 


4 j 8 j - 


16 


- 


4 


75 


Grand Totals ,^„ 
_. , 452 
Girls 1 


64 


68 


25 45 27 


130 


- 


35 


537 


Boys 509 

i 


79 65 38 t 38 1 14 

' ' ' ' 


134 


87 


90 


746 


Totals 
Boys & Girls ^ 


1 1 1 
143 133 63 83 41 

1 1 


264 ' 87 


125 


1283 



c * 



C r. 

u 

a < 

S w 



a 



O 





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10 M 

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00 


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2^ 


2 


U^ 


5 


« US 


h-.fog JO jsquinu '|B)ux 


S5 


5 


(0 CO 0) 




1 


32 


«» 
K 


« t« 


s 


u 

■< 
■< 


a:9B)U93jaj 


1 * 

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d >n -.' 

1-00 30 


t. q 

90 00 






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w q 

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oS 


q q 


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eiJiQ JO jaqoiniij 




§ 






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g2 


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M US 


N. 


a;Sc)Uiijja({ 


eo q 

Ui 00 


to 


CO <o «» 

M U5 00 
« ts. 


CO m 




CO h- 

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8 


8.(og JO J3quin|i{ 


M CO 


5 


go ^^ ~» 




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00 00 


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s^JiQ purs eXog 


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q 
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s|jio JO jaqumK 


M CO 


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aSv (Udojaj 


M 


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US CO to 

g2 S 




d 


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to 
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sAog JO jaqain(j 


CO CO 


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23 8 


"- t>. 


00 


CO -< 


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s 

s 

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2 

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aSsiuaoiaj 


us M 


00' 


00 C4 Ok 

■*' CO «0 






M (0 


to 


q q 

d d 


q 

d 


aa»ijuaoj.\i 
BjjiQ JO jaqiun\ 


q -< 


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1- » «5 


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q q 


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q q 
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q q 
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q 
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M W •« 


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aSi:)u»3J3(i 


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06 


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(D 

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q q 
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q 
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BXog jojaqtonN 


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nonwpJ«l»)I 1" I'lnotny 


•o 


1: 


•0 
») 


MS 

rt CO 


•0 
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MS 




us 
1/; 1.0 





80 



< 



Contributory 

AND 

Associated 


a3BJ3Av 


wooidcocioe-jooo 

COt^t~T}<(MQOOOOOO 


Ne<llNIN<M(N(N-*OeO 


ejcjOBj JO jaqtnriN 


N ^ 00 ■* f CO — 


pa'^agj^y Jaqnm^ 


CO <N ^ rH 


1 ^ 


aSBiaAV 


^OTji-HONeooeoo 
oiO'*aio«5eoTiit^o 


COCOCOCOTjtTJ<-^.<tTjl«l 


BJOjoBj JO Jaqnm^ 


lOoot^inioiooco-HO 

00>-^0-<CO?0(Ot^CO 
— 1 CO (N M — 1 


pa^oayv Jaqum^ 


OOOO'^OOCOMt^iOiClO 

iHNeot^u5ioco»H.-( 




a3BJ8AV 


COC<lt^iOlMrOOO<3»lO'<l< 
^COCOrl<00*-<OCOt^^H 


COC0COCOCO-<).C0'<»"'^U5 


sao^OBj JO Jaqnm^ 


NCOOOOCOt^-HOSfflCO 

t»e^ci03oot^»t-.t»co 

rt ^ CO IN CQ ^ 


pa^oajgv JsqaniN 


•^r^oocoTnt^ooooiSir^ 

NCOCO-Ht^^D-^rtrt 


Ed 

" 2 


aSBJaAV 


I00«0'*i0l^t,000 
— lOOOUOiOOOOO 


N(N(N^--irt-HC0OO 


sjojoB^ jo laqaxtiN 


W«(^COt^^iOCOOO 
(M CO N -H rt 


pa^oajgv -laqnmN 


COCOOO'^^t^CO^OO 


2 » 


aSBjaAy 


0-HU500C050COOO 
O^NO^-^COCOOO 


sjojDB^ jo jaqnm^ 


eOOUDOOCOb-iO'SiWM 
1-1 CO N ^ rt 


pa^oagv -taqnin^ 


e<soi'»j<iOi-cuStHeOr-iN 

CO W 1-1 1-1 


>3 

6. K 
f- 00 

P ■<! 


aSBjaAv 


00tO»OitNT)<COt~iMU5 


sjoiOBj jo jaqmn^ 


Tti-*"ro5inin-HCooi-i 

CD!OOOOOOOI>CO<N^ 


pa^oagv jaquitiN 




H to 

■< a 

S to 
Of D 

Id 


aSBJaAV 


C0C0Tt<Mt»05t^C0t^O 
00O>NC000i-"O>a><DcD 


iHi-IC<INIMCONNCOtJI 


ejo'joBj jo Jaqumf^ 


COlflCDO(MOOT!<incO 
COiOt-CO>00— iijiiOM 


1 papajgy jaqum^ 


OOOOiJloOCOINt^iniOO 
i-llNCOt^lOl-OCOr-r^ 


on 


aSBJdAy 


iHfflcoooocoor-tot- 

t-t^i-lOseOt~.<OOU5«3 


i-I^N»HMN(NeQCOCO 


sjo-jCMSj JO jaqnm^^ 


(Ouj^'^iceoiooot^'O 

COtOOONt^QONTltinc^ 

(M ^ ^ ^ 


papacy -laqnm^ 


— "t^OOCO-^t^OOOOtflt^ 

INC0e0rHt^O'*---H 


NOLL 


raaviaa ao iNaoiry 


■o >o lo la lo 


^^e<INC<5C0-<J<'*lOlO 



yo 



6 



o 

< 

OD 

P 

o 

a 

> 






o 



CONTBIBDTORT 
AND 

Associated 


.laiaoA V 


P 1- O — 1- lO M 1- = o 

O ■£> 5 C( — «.0 -r -o 5 6 

e^ -H M e-j ci c^ c-t CO e-j o 


sjo^ovj JO Jaqumjj 


^"'SSSSl^S^® 


pa^aajgy xoqainf^ 


-Hcor^'^w-^t.psNo 


Adequate 

AND 

Associated 


oSwaAy 


o>e4ci3(OaooaouSS 
ei w" «' « CO w ■>«' ■^ -^ f' 


sju)OBj JO jaqmniti 


-H e^ (N ^ 


pa^oa^y xaqoin^ 




a (> 

•< o 
H m 


0»uaAy 


ei w ci ei « w eo «' V i< 


SJOionj JO J3qujn[>{ 


COW — o)^4<oo»1<^^ 

M M CO -« -H 


paiaajyy jaqumij 


P3<O£0«t~r~0J0iW'O 


Q 
U 

u o 


9»uaAy 


1.50 
3.67 
1.90 
1.62 
2.20 
1.50 
1.33 
0.00 
0.00 
0.00 


SJOIDBJ JO jaquinx 


n^C>^^-^:C-^000 


p9)03uy jaqam|ii 


Neoocouj^eoooo 


O 
O 


aSTuaAy 


OOQCOC^I^'Tt- OO 


ato^ov^ JO JsqumK 


•-<Wt|»h.002J«'OCOO 


paioajjy jaqamjii 


'H«t^^coJHr»^^e^o 




sSuaAy 


eoNco — N-Hcotooo 

— CO — N-HNrHPiSS 


8JO)a«j JO jsquini^ 


•H^ao — cocoM — 


papajBV JaqtunN 


— flWOOiflCO— — 


u ,•< 

a O 


aavJsAy 


-H — cj e>i ci ei co' co' co n 


sjo^auj JO jaqtuni^ 


MW'J'MMOWQ'J'OO 

C4'<re^(oa>aao3eo — 


p«V»fly xaqtimN 


C«COtOt>.'TtOMtOO>« 
— NOOt^COC^ — — 


-1 

-a 


99waAy 


{: J: 2 § R S S 5! § S 

— ■ — — ■ PI ei CI M co' eo' eo' 


U0191IJ JO joqam^ 


««— 0>pOfU5t-00 
P«<«''«'»M-«h.<OC0 — 


pa^Msy jaqumti 


eo<sco-«t^t>-9a>C40 


NOIXVOHVXaH 'O XKflOWV 


M» lo M) m >o 


— — c<NWP5-r'<rir;io 



91 





Contributory 

AND 

Associated 


a^BJaAv 


'O o 
IN lO 

<N M 




^ CO 

IN M 


05 


CO OS 

IN CO 
(N ci 





t^ CO 

CO 00 
IN CO 


Co 
05 


CO 
CO 

CO co' 


93' 




&IOJ0BJ JO J9quin>i 


a> o 

CO 


§ 


lO 00 
•^ CO 


1 


00 
OS t^ 


1 


00 CO 
■<)< CM 


i^ 


CO 


to 




pajDajgV -laqnin^j 


■<* (N 


«> 


-< 05 

(N tr> 


§ 




g 


00 CO 


^ 


eo CM 


Ki 




" s 

S ° ;< 

or 5 o 

w ■< 


aSBJaAv 


CO (M 
CO "S" 

CO eo' 


o 

80 


IN t- 

CO w 

eo' co' 


93 


00 (N 

eo' ■>ii<' 




IN U3 

M CO 

■*' •*' 


93 


CO eo 

•* U3 




O 


8JO)3«j JO jaqnm^ 


o w 
o r^ 


9» 


OS CO 

OS -v 

(N lO 


«3 
=0 


00 CO 
00 t- 

•^ CO 


00 


OS •* 

IN "H 


i 


CO eo 


05 

to 


a 

2 


pa^oajfv Jaqnin^ij 


CO lO 


5 


O lO 

OS Tt< 




t^ 00 
C>1 00 


X3 

5 


OS ^ 
>0 CO 


S 


U3 
CM ^ 


s 


m 

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9aBJ3AV 


CO co' 


93 


2 ^ 

1-4 CO 

CO co' 


93' 


CO 05 
■* 00 

CO co' 


to 
93' 


CO •* 
00 lO 

CO •*' 


00 



CO CM 
■<!< OS 

•*' Tj<' 



to 


23 


sjojoBj JO jaqmn^ 


OS lO 

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5 


■* oo 
CO CO 


i 


CO eo 
00 ■* 
10 ■* 


©J 




t- 00 
OS CD 
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U5 

to 


in 05 

CM lO 


00 


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papajjV Jaqmn^ 


•* CO 
CO «D 


05 




>« 
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S 
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t^ CO 


■^ 


§52 





< 

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a 

t3 


aS^jaAv 


O 00 
IN IN 




O CO 
O CO 

C>i t-i 


§ 


10 ■* 

t^ "3 


to 




m 

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K 


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s 

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sjoiOBj[ JO jaqumf^ 


s;^ 


00 


CO rl^ 


I 






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pa^oajgV Jaquin^ 


lO CO 


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10 


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lO o 


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sjo^oB^ JO jaqumjii 


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CO OS 

CM 


n 


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pa^oa^v -laqKin^ 


■* IN 


CO 


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O 

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93 

to 


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sjop'B j; JO jaqum^ 


00 >-< 


OS 


00 U3 

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93 


OS t^ 

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to 


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CO r- 


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paioajjV Jaqum^ 




00 


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rl (N 


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CO 00 

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cq — 





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CO IN 

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^ 


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si 


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OS CO 

cm' CO 


93" 




U3 rM 

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93 


2: 

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lO 05 


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00 


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CO IN 


to 


to 


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(N a 


^ 
^ 


CO "3 
IN IN 




00 W3 
U3 

CM CO 




CD 00 

CO 10 
CO CO 


93 

93 




sjojoBj jo jaqamN 


05 ^ 
U5 -^ 


>-< 


IN CO 
(N -H 
(N ■* 


i 


U3 CO 

OS 05 

eo N 


1 


OS CO 

05 ^ 


5 


•* CO 

OS rr 


93 




pa^oagV JaqnmN 


rjl CO 

CO CO 


^ 


^ o 






8 


r^ CO 


-* 


« CM 
CM ^ 







NOiivai 


vxay do xKaony 


in "e >,* 


US 

IN (N j^ «y 


"^ 3 93' 

co' co' ^ ^i 
93 


"3 "0 ^ 
^' ^' 1 ^ 


■c' «3' g *J 



92 



< 



1 3 ;t "« 


"* 


C1»«O1'i510>-hU5M 




Mean 

Av. A 

Boys 

Gin 


0«MMCOCOCO'»f"5 




S 1 

OS O O -« PI C3 fO •«»• I- t- 1< lO 

r 1 


i3 

r2 5 


1 
-<COoOOOiOCOM-< l« 


Age at Nearest Birthday 


« 1 ^ CO 


^ 


•H 1 


00 


«l -^t^owNNeo-^ 


s; 


us] eo'OoO'^'i'Nco*'^ 


>0 


"H 1 -H PI e^ -H 


a> 


CO 


dlOM^QtSCOCOeO'H 
1^ C< CO ^^ 


•ti 

o 


mI coiot^'^r^oiorH 




r-l •<»< N N ■* 00 W 


3 


O 1 CO ■* 1^ •* 


2 


03 1 CO -H 1-1 ^ 


« 


Average 
Age 


— -"MMCOCOC^'T'^'r 






OOeO«N-H'*NO>Ot^ 

eO'*oeoo»t*«0'<-H 


CO 


« 

r 
ia 

1 ^ 

< 


00 


--^ 


eo 


r-l M CO »* -< -< 


00 


«| «-<0»«N'*'^« 


K 


>o| MM^atcjw^coci 


s 


CO 


M M M « 1 M 


^'-SSSSI""- |2 


nI KiQoose^-^actm IS 

« 1 « CO « « 1 „ 




'^ 1 '^ 1 


« 1 « i-i «4 -r 


t; t < 2 - . • ■ 
< — - 



m 



o 

K 

o 

O 

K 
< 
> 



^ 

X ^ 



H < 



spto puB sXog 'iB^ox 


'J' CO 
CO ® 


^ 


-1 ■* 
-1 o 


S5 


rt ■!)< 

t^ ^ 


i 


t^ CO 




N rH 



~<1- 


BiJto JO jaqumu \^-\oj^ 


CO to 


§ 


CO ^ 








S2 


00 


N 10 


t^ 


Sitog JO jaqtann l^^jox 


(N CO 


00 
«3 


00 CO 
CO 1-1 


iS 


1^ CO 


-<f 


^2 


to 
to 


CO t- 


93 




S 

o 
fin 


o 
< >i 

a, (S 

go 


Pino ^^^ 'ON a3B-i8Av 


Oi CO 
C5 O 


§ 


00 rt 
O r-t 


o 


CO <N 
11 N 


to 


S2 


15 




^ 


sasn^o JO jaqoin^ 


CO <N 


•Cl 


«?! 


55 


M IN 




t^ 


to 
<>< 


t^ CO 





►J 

K 

a 


\I\ry J3d -OVJ^ a3BJ8AY 


00 't 
O O 


«1 


§§ 


^. 


B§ 


o 


2fJ_ 


^ 


!^§ 


00 


sasnisQ JO jaquin^j^ 




©i 


<N 0(0 


o 


i> •* 


:3 


CO ■* 


«^ 


e<l rH 


93 


c' 

n 


Xog jad -0^ a3BJ8Ay 


O CO 
1-1 O 




00 IN 


95 


O rH 

CT CO 




CO t^ 
CO l-H 


©1 


rH a> 
CO N 


^ 


s8sni3Q JO joqiun^f 


C^ .-1 


^ 


t^ ■* 


53 


rH IN 


03 


CO CO 


C33 


lO PI 


*» 




























O 





pjiqO J8d -o^ 93BJ3AV 


05 rt 


^ 


U5 l^ 


to 


CO OS 
CO "5 


93 


10 w 

U3 t^ 


§ 


•* CO 

00 

ci r^ 


^ 


easnBQ jo jaqraniij 


IN O 
CO t^ 


1 


CO lO 
rt IN 


93 


Oi 00 
IN rt 




2g 


5 


10 <N 


03 


m 
l-l 

K 

o 


\i\Q J8d -o^j aSBJaAy 


t^ IM 


>H 


2 5 


9? 


CO CD 


■^ 
^ 


"3 •<1< 


^ 


(N rH 


8 


sasnBQ JO jaquin^^ 


o o» 

rt IN 


^ 


t^ 00 

00 IN 


«5 

s5 


<N t^ 




IN CO 

Tf CO 


8 


>0 O) 
IN 


5? 


00 

o 

m 


jCog J8d -o^i aS'BjaAy 




§ 


CO rH 


^ 


CO lO 


to 


CO 
CO 00 


^ 


CO 
00 

IN rH 


^ 


sasnBO JO laqran^i 




to 


IN -H 

U5 CO 




22 


1 


t^ CO 
t^ CO 





IN CO 

CO rH 




n 

Ph 


Q 
Z oo 

» E 

P3 


pitqOJacI -o^ aSBJaAy 


rt IN 

t^ to 


to 


CO CO 


^ 


lO CO 
00 1^ 


^! 


0; 00 

w 


^ 


"3 


§ 


sasnBO JO Jaqnin^j 


IN CO 


S 


■* IN 
I-- CO 


1 


CO t^ 

f 00 


i 


•-H 

CO •* 


S 


00 
CO rt 


00 


3 
£ 


\i\r) J3d -ON aSBjaAV 


<N IN 

o> «o 


g 


t- U5 


^ 


§g 


5 


t^ 

■* 


05 


ss 


^ 


sastiBQ JO jtaqiunN 


0\ CD 


00 


(N CO 


I 


CO rt 
00 CO 


»1 


» 00 


IS 


w 


00 


O 

m 


itog jad -o^ aSBjaAy 


t^ IN 

lO CD 


to_ 


00 o 


to_ 


00 00 


^. 


CO CO 


to_ 


10 CO 

(N Tf 


^ 


sasn^o JO jaqmnN 


IN CO 
rt IN 


95 


(N 05 


s 


§s 


to 


<N (N 

CO rH 


^ 
■^ 



N rH 


§ 


NOIJ.VaUVXH'JJ SLO XNaOKV 


>o 


^2 


m" in 


i2 


Co' CO 


"e 93' 
93 


"3 




U3 
10 U3 


X3 



94 



TABLE XI 

Correlation ok Amount of Retardation with the Number of Cases 

1{eported to be "Slow and Dull" 

















, 




















~iZ 














' 






i 3 




















•o 




















s 










I 




5 


.3 




at 

pq 


3 






"o 






o 








la 






u 

1 


n 






5 






u 




,^ 


E 


Q 


e 


a 


(5 


« 


§ 


(5 




1 Amount o 


1 

o 


§ 

o 

00 


Percentag 


9 

1 


o 


1 


1 


s 

o 
So 


C 
U 


1. 


3S 


9 


23.7 


15 


1 


6.7 


53 


10 


18.9 


1.5 


43 


5 


11.6 


33 


9 


27.3 


76 


14 


18.4 


Total 
1 A 1.6 


SI 


U 


17.S 


5« 


/O 


ee.s 


119 


*4 


18.e 


2. 


Ul 


16 


26.2 ] 


85 


26 


30.6 


146 


42 


28.8 


2.5 


132 


46 


34.8 


107 


35 


32.7 


239 


81 


33.9 


Total 
S A 2.5 


193 


OS 


33.1 


192 


ei 


SI. 8 


S8B 


IBS 


5/. 9 


3. 


91 


31 


.34.1 


104 


39 


37.5 


195 


70 


35.9 


3.5 


74 


20 


.35.1 


54 


23 


42.6 


128 


49 


38.3 


Total 
S A 9.6 


166 


67 


34 6 


168 


«« 


39. e 


SMS 


119 


5e.S 


4. 


52 


20 


.38.5 


32 


13 


40.6 


84 


33 


39.3 


4.5 


19 


lU 


52.6 


20 


6 


30.0 


39 


16 


41.0 


Total 

4 A 4.6 


71 


50 


4».B 


B» 


19 


4ff.5 


Its 


^fi 


39.8 


5. 


lU 


6 


31.3 


12 


8 


66.7 


28 


13 


4(5.4 


5.5 


7 


4 


67.1 


5 


2 


40.0 


12 


6 


50.0 


Tottil 


es 


« 


S9.t 1 


17 


to 


58.8 


40 


19 


48.0 



yr. 



TABLE XII 

Correlation of Causes with Average Amount of Retardation in Years* 





Boys 


Girls 


Boys and Girls 


m 






a 






a 






s 


m 






o 










s 


o 


^ 


c 






s 




'.^ 


a 


£ 




O 




o 
CQ 




•a 

03 


3 

"o 


_=3 
"E 

OS 
0) 

« 


o 


2 

IS 
o 

"o 


OS 

1 




« 


t> 


^ 


« 


(U 


g^ 


« 


w 


a 




_i 




OS 


^^ 




^ 




XI 


S 




eS 


B 


a 


cS 


s 




c4 


B 






o 


s 


> 


O 


3 


> 


C 


3 


> 




H 


Z 


< 


H 


2: 


<! 


H 


^ 


< 


1 Adequate 


97 


43 


2.26 


93 


42 


2.21 


190 


85 


2.24 


2 


317.5 


119 


2.67 


370 


140 


2.64 


687.5 


259 


2.65 


3 


327 


106 


3.08 


244 


80 


3.05 j 


571 


186 


3.07 


4 


158 


46 


3.43 


141 


42 


3.36 ! 


299 


88 


3.40 


5 

Totals 


82.5 


21 


3.93 


63.5 


17 


3.74 


146 


38 


3.84 


982 


335 


2.93 


911.5 


321 


2.84 


1893.5 


656 


2.89 


No Causea 


53 


24 


2.21 


38.5 


15 


2.57 


91.5 


39 


2.35 


Unassociated 




















Factors 


162.5 


70 


2.32 


100 


40 


2.50 


262.5 


110 


2.39 


Real Causes 


1283 


439 


2.92 


1170 


412 


2.84 


2453. 


851 


2.88 


Grand 


' 










1 








Totals 


1498.5 


533 


2.81 


1308.5 


467 


2.80 


2807 


1000 


2.81 



♦When the amount of retardation was more than 5.5 years, it was taken as 5.5 in thi 
table. 



TABLE XIII 

Correlation of Social Level of the School Districts with Number 

Retarded 



Social Level 


Number 
Retarded 


Average Enrol- 
ment 1905-06 


Percentage 
Retarded 


5 


116 


708 


16.3 


4 


357 


1846 


19.3 


3 


515 


2780 


18.6 


2 


612 


3063 


19.3 


1 


163 


710 


22.9 


Negroes 


240 


645 


37.2 



no 



is 





aSciuojjaj 


s s i» M « T '.r — 30 "«■ 


saevQ JO joquinji 


OOW^t>.O00N«-H 


u 
o 

•< 
s 
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38l!)U33J3J 


0IN.®0U50W-H«0 


ae>iNoa>a>«>Ntoo 


BasBO JO jaqiunjij 


^rtrtOt»«eoN-<o 


ii 
o 


oat:)uoojdj 


COh*^^^HQ0CO00O>C*3^^ 


sacBQ JO jaquinj^ 


« « M w M e< 


o 

l\ 

COS 


a^BMi^^M 


U5 'J' M ri O f X N o o 




sasBQ JO J3quin>i 


N2*'''''j2'«*"*«^o 


< 


a8«)uo3J3j 


«W'*«000t>.N'<O>-< 




B36«3 JO jaqoinj^ 


-< ■«»' N « M rt -< 


•A 
U 

< 

1 


3S«)U3aJ9J 


c<3e(00'Hao>QOO'<t* 




sasBQ JO jaquin>i 


«»M»w<eooosoo>o 

« W N W — 




z 

■< 


3i(t:)uajjoj 


o >o c 00 f) w -.r c; m' •*' 


saesQ JO jaqiun^ 


^c«^ao4Neo>HC4-' 


a 
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a8ii)U03Jdj 


OOWiftfOCOJ'^ — WCO 


TCOMCt^O — aO'J< 


sassQ JO jaquintj 


M'^^^COOiAMeOoi 


'J3 


a8«}u33Jaj 


u5^«»-'VOce«eo« 




89SVQ JO jaqurn^ 


Nd-HOO^ft^-H^N 


a 
a 

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a>«)a8iU9j 


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ros»0 JO jaquinN 


^N'j'«acao>o-«ON 


z 

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a>« )aaoJ» J 


oetCOfOOSt^NOM 


" ?i " :.' ?i g 2 ?j « 2 


tamo JO jaquntN 


^ « «' fi •« M oc ® r^ M 


1 


9>«lUM4»d 


■srao JO JsqinitN 




•Xog JO jsqamiii »(oqj^ 


UO 


)n{iitnia>i JO innomv 


'* *o »o ut *o 
— — 71 n :-: re T -^ t.*: *o 



o 

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t-i ■< 
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m ffi 



83B)U33J3(J 



63833 P laqiniiiij 



aSBiaaojaj 



sasBQ JO jaquin^ 



aSB^uaojaj; 



S3SBQ JO jaqran^ 



3S«')a30J[3(J 



sasBQ JO jaquin^ 



t-00'i"'HC5l^iOCOO 



■-hOO'*-*NC<5<N'-''-i 



OOO'OCO.-COOOOOOO 
OMiOCDWOOOOOO 



O'-<'*C0C<5OOM>-lo 



t^(Nrt.-lOOO>000000 



lOCOt^W'-i'-lOOCO'-iO 



>-< U5 lO (N 



aSBjuaoaaj 



lO iM CD O 
lO lO O O 



sasBQ JO jaqain^ 



<0 O 00 M 



aSBjaaoiaj 



t^ t^ Oi i> o t^ 



» ■-I to o 

l> (N -H o 

M •* -^ (O 



sasBQ JO jaqmn^ 



>-i oo »ra CO 






a3'B:)uaoia(j 



t» 00 "O •* CO >-l 
t^ CO lO •* 05 (N 



05 CO O O 
to lO o o 



sasBQ JO jaqiiin>i 



i-li-liJ<-*Oii-l(N^O>-l 



aSBiaaojaj; 



O0'-l«3t>.t>0»0'*t^0 



sasBQ JO jaqniti^ 



aSB^naojaj 



OOOt^'Oi-li-icOCOCOO 
OCOCliOCOClOiOOOO 



sasBQ JO jaqmnf^ 



O'-l(N>'3C0i-(C0'-lrHi-l 



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■*00»OtO.-lTf<Oi«COO 

m" CO lO to ■*" «3 ffl lo 00 o 



sasBQ JO jaqnin^ 



(Ni-l-^(STj<C0(NC0r-lO 



aSB^uaoiaj 



t^iOtO'*-*iOXOOt^O 



saSBO JO jaqain|ij 



rHC0t>Tt<'*'^'<J<t^e<lO 



aSB^uaojaj 



oo-*Trt»ooocooocoo 



sasBQ JO jaqian^sj 



(M rt CO -H 



siJio JO jaquin^ sioqAi. 



COOCOi-it^t^OSOlNO 



uot^BpjB^ajj JO 'junouiv 



— i-HiNiNeocoTftL'Jin 



98 



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,» • V I 







lor. 



TABLE XXII 
Correlation of Grade with Average Retardation 





Boys 


Girls 


Boys and Girls 






c 






c 




_m 


a 








o 






c 






o 




c 




*^ 


a 




•^ 


c 


5 


•^ 




o 




rt 


O 




_cj 


o 


OJ 




"5 


o 

m 


■H 
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o 


(h 
d 




s 


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t- 




« 


tH 




1> 






q; 




cj 


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« 


<A 





« 


_g 


>> 


tf 


t2 








O 

« 




a 




o 

m 




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J3 
1 


> 


o 


s 

3 


2 


o 


3 

o 


> 


O 


c-i 


Z 


< 


H 


Z 


< • 


H 


H 


< 


1 


79.0 


23 


3.43 


40.0 


14 


2.86 


: 119.0 


37 


3.22 


2 


274.0 


97 


2.83 


154.5 


53 


2.92 


428.5 


150 


2.86 


1 &2 


S5S.0 


ISO 


S.9A 


i94.5 


67 


2.90 


647.5 


187 


2.93 


3 


314.0 


108 


2.91 


305.0 


111 


2.75 


619.0 


219 


2.82 


4 


387.5 


135 


2.87 


327.0 


112 


2.92 


714.5 


247 


2.89 


S &' i 


707.5 


243 


2.88 


632.0 


^^3 


;2.5S 


i333.5 


466 


2.86 


5 


285.5 


103 


2.77 


237.5 


86 


2.76 


523.0 


189 


2.77 


6 


80.5 


37 


2.18 


131.0 


49 


2.67 


211.5 


86 


2.46 


5 & 6 


S66.0 


t>,0 


2.61 


365.5 


135 


2.73 


7 34. 5 


275 


2.67 


7 


59.5 


23 


2.58 


67.0 


26 


2.58 


126.5 


49 


2.58 


8 


18.5 


7 


2.64 


45.0 


16 


2.81 


63.5 


23 


2.76 


7 & 8 


78.0 


SO 


2.60 


112.0 


4^ 


2.67 


/90.0 


72 


2.64 



106 






; 



I 



UMVEI-. 



-^HIS BOOK IS DUE ON THE L.i 
STAMPED EELO-^ 



'i'^ 



=^6 Suhiz^~ - • 




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