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UNIVERSITY OF PENNSYLVANIA
THE PROBLEM OF RESTORATION;
A CLINICAL STUDY
BY
GERTHA WILLIAMS
A THESIS
PRESENTED TO THE FACULTY OF THE GRADUATE SCHOOL IN
PARTIAL FULFILMENT OF THE REQUIREMENTS FOR
THE DEGREE OF DOCTOR OF PHILOSOPHY
QTttr (Huliegtaie Jfirrea
GEORGE BANTA PUBLISHING COMPANY
MENASHA, WISCONSIN
191.8
GIFT OF
UNIVERSITY OF PENNSYLVANIA
THE PROBLEM OF RESTORATION;
A CLINICAL STUDY
BY
GERTHA WILLIAMS
A THESIS
PRESENTED TO THE FACULTY OF THE GRADUATE SCHOOL IN
PARTIAL FULFILMENT OF THE REQUIREMENTS FOR
THE DEGREE OF DOCTOR OF PHILOSOPHY
GEORGE BANTA PUBLISHING COMPANY
MENASHA, WISCONSIN
1918
«Uv*
CONTENTS
INTRODUCTION 1
CASE HISTORIES.
1. Fannie B 11
2. James C 17
3. Charles C 20
4. JohnC 24
5. Monroe C 28
6. Robert C 31
7. Francis D 34
8. Jennie J 38
9. Gabriel K 43
10. Gladys K 46
11. Elizabeth R 49
12. Henry S 53
13. JacobS 57
14. Harry A 60
15. Bertha B 63
16. Henry B 68
17. Charles Cv 71
18. Edward D 74
19. William F 77
20. Archibald M 80
21. Harry M 82
22. AlvahM 86
23. Charles 0 89
24. Randolph? 92
25. Walter R 95
26. Harry S , 97
27. SadieS 102
28. William G 106
DISCUSSION OF CASES 109
CONCLUSION 115
381664
INTRODUCTION
A number of different meanings are possible for the word "restora-
tion. " One condition is implied by all these definitions. The present
status of the child is one of retardation, either physical, pedagogical
or social. In addition the word restoration implies that the child is to
foe restored to something. Probably in the more common use of the
word the child is to be restored to the grade in school to which he belongs
according to his chronological age. To this definition of the word I
have objections. The child's ability or inability to get along in school
I consider an excellent single test of his mentality. School life is the
normal life for a child of school age and inability to get along in that
environment is an important point against the child. But to hold the
child to the standard of completing one school grade a year makes at
least one-third of the school children, according to the investigations of
Mr. Leonard Ayres, retarded and under present school conditions not
restorable. This makes this use of the word "restoration" of no prac-
tical value. A pedagogical retardation of one or even of two years,
while it throws an interesting light on our school problems, is not neces-
sarily a serious retardation from the social standpoint. So I am not
demanding of a restoration case that it be possible to restore the child
to grade but rather that it must be possible by some kind of special
treatment to bring the child up to the level of social competency, to
prepare him to lead a useful life in society. His rate of development
may be slower than that of the average child but his development must
reach a point where it is possible for him to live a normal life in society.
The special treatment to be given the child may be physical or it may
be educational.
The question immediately arises, "What standard can be used to
determine whether the child can live a useful life in society? " I have
used the standard set by departments of compulsory education, that a
child must satisfactorily complete the sixth grade in school. I use the
word "satisfactorily" advisedly. To satisfactorily complete the sixth
grade does not mean that the child is promoted "on age," nor that he
is pushed along the educational highway, nor that he is sixth grade
level in some things and the second or third in others. To satisfac-
torily complete the sixth grade he must have attained the performance
I THE PROBLEM OF RESTORATION
level of a seventh grade pupil. Some subjects may be better than
others of course and some mental qualities better than others but his
general level must be that of a seventh grade pupil. Nor would I
consider that a child reaching the seventh grade level of proficiency
entirely under special class conditions had satisfactorily completed
the sixth grade. Environment under special class conditions is so
favorable as to constitute a kind of social segregation and so is not a
satisfactory test of a child's ability to maintain his place in the world.
So while special class is a legitimate means of restoring a child, his
residence in special class must not be permanent. With the help
given by the individual instruction in the special class he must be made
capable of making satisfactory school progress under regular grade
conditions, reaching the seventh grade level by the time he is sixteen.
To determine whether a given child can reach the general level of
a seventh grade pupil before the age of sixteen means careful study of
the child over a long period of time. The twenty-eight cases included
in this thesis are the members of the restoration classes conducted by
the Psychological Department of the University of Pennsylvania for
two successive years. Twenty-seven of these cases have been under
my direct observation for five and a half hours a day for a period of six
weeks. All of the cases have had at least one examination at the
Psychological Clinic and in most cases more than one. The Social
Service Department has investigated home and school conditions.
Even with so thorough a study, I am not able to reach a decision in
every case but have to label some of the cases still "doubtful."
I will take up briefly the class organization, selection of children,
etc. in order that the kind of pedagogic treatment given each child
may be understood.
The restoration class of the Psychology Department of the Univer-
Purpose of sity of Pennsylvania serves a twofold purpose. There is
Restoration the practical purpose of teacher training, of preparing
Class teachers who come to the summer session of the Univer-
sity to conduct classes for backward children. In this purpose of the
class I was not directly interested. The other purpose of the class is
a. scientific one, to investigate mental development in a typical case
especially with a view to correct diagnosis and prognosis. In this
sense the restoration class is a progressive psychological experiment.
It is this purpose of the restoration class which is of spec ial interest to
me in this thesis.
THE PROBLEM OF RESTORATION 3
The twenty-eight cases comprising the personnel of the restoration
Selection class were selected from the records of the cases studied by
of the Psychological Clinic, a record including over two thou-
Children sand cases. Several factors determined the selection of the
children. The most important factor was the mental status of the
child. The children selected were all children for whom from the clinical
examination, school report, family history, etc. restoration was con-
sidered possible. Of course the prognosis was not equally favorable
in all cases. We were more doubtful of the ultimate restoration in
some cases than in others. Distance from the University was also a
factor in selection. We preferred cases who were either within walking
distance of the University or who could reach the University on one car-
line without transferring. In the case of the child where the prognosis
was very favorable distance was not considered. In some cases the
University paid the car-fare of the child or even sent a social worker
for the child and to take it home. Age was also a factor. The class
was limited to preadolescent boys and girls and cases under seven were
not usually considered. The Department does not believe that the
same methods of instruction and discipline are desirable for preadolescent
and adolescent children and for this reason adolescent children were
excluded from the class. Children under seven were excluded because
it was desirable for class activities to have as homogeneous a group
as possible.
From the two thousand Clinic records about fifty cases were selected
for the class of each year, who met the qualifications as to mental status,
age and distance from the University. This list was arranged in order
of desirability. From this list of fifty cases fifteen were selected for
the restoration class. In some cases parents or guardians were unwilling
to send the children and so it became necessary to prepare a long list
in order to get the desired number. The class membership was always
limited to fifteen as it is believed by the Department that one teacher
cannot give individual instruction to more than that number.
Since all of the cases were selected from the Clinic records in every
Preliminary case a clinical examination of the child had been made.
Work It is an unbreakable rule of the department that no child
is ever to be taken into the restoration class as a regular member of the
class who has not previously been examined at the Clinic. Many of
the children in the class had had several clinical examinations. This
clinical examination includes personal and family history, mental
examination and physical examination. The physical examination
4 THE PROBLEM OF RESTORATION
includes certain anthropometric measurements such as height and weight
which indicate the stage of development of the child's growth processes,
whether normal, retarded or accelerated.
Home and school visits are made for each child by the Social Ser-
vice Department. At the school the social worker finds out the char-
acter of the child's work, whether his work is even or is better in some
subjects than in others, what his school progress has been, what kind
of teaching he has had (e.g. whether his teacher is experienced, what
her method of handling children is, whether the child has had any
manual work). The social worker also finds out the child's attitude
toward the teacher, toward the school work, toward the other children,
whether he plays normally etc. At the home the social worker finds
out the financial level of the family, the care the children receive, methods
of discipline. The home visit also gives her a chance to estimate the
mental level of other members of the family.
The clinical examinations, the school and home visits are prelim-
inary to the opening of the class. Their purpose is to give a complete
clinical picture of the child. We supplement the findings of the clinical
examination by noting the child's reaction to his natural environment,
his home and school life. This is especially important when one uses
a social definition of restoration as I am doing in this thesis. This
complete clinical picture is also valuable to the teacher. School is a
preparation for life so must concern itself with all aspects of life, not
merely with the academic side. The teacher can give the child the
educational treatment best suited to his needs if she has this complete
clinical picture of him.
Previous to the opening of the class all physical defects which can
be corrected are corrected. The University and other hospitals in
Philadelphia co-operate with the Clinic in this work. Hypertrophied
and diseased tonsils and adenoids are removed, vision is corrected,
teeth are cleaned and filled, etc. The six weeks of the summer session
are so short that it seems advisable to have this work done beforehand.
As the restoration class is a psychological experiment it is advisable
to have the children in just as good a physical condition as possible.
The group is far from being a homogeneous one. In age the children
The Children range from seven to thirteen. Physically they vary
as a Group much. Some are in excellent physical condition, others
in fair, some in very poor condition. Some are anemic, many nervous,
a few partially deaf. They come from many different kinds of homes.
The larger per cent of them come from homes of the poorer class. But
THE PROBLEM OF RESTORATION 5
even here conditions vary very much. Some children in poor homes
receive very good care and others do not. One child (Francis D.),
for instance, comes from a home where the father is dead and the mother
is keeping the family on a small mother's pension with some help from
two older children, yet the children receive very good care and are
well-fed and well-nourished. In another home financially of about
the same level (Jacob S.), care is very poor and the children under-fed,
not because of too little food but because of food unwisely chosen and
poorly cooked. Discipline varies very much. In some homes disci-
pline is adequate and intelligent; in other homes it is too strict or too
lenient, or unintelligent, that is, not the kind of discipline adapted to
the needs of that particular child. One child (Jennie J.) receives excel-
lent care but the discipline is not adapted to her particular needs and
has suppressed almost completely her initiative and individuality.
Pedagogically all the children have one point in common. They
have been unable to get along well in school. School progress has been
retarded in every case. As to the school grade, they range from the
first through the fifth grade. The nature of the school difficulty has
been different in each case. Some of the children are generally weak
in all subjects. Others have special difficulty with arithmetic or with
reading. Others have a speech defect which retards progress. Prob-
ably in no two cases is the nature of the difficulty exactly the same.
And in mental traits there is still greater diversity among the chil-
dren. Some of the children need special training in self-control. Others
need to be encouraged to express themselves. Some are pugnacious
and aggressive, others timid and easily imposed upon. Attention is
adequate in some cases; in others inadequate. This diversity of mental
traits will be brought out more fully in the discussion of the individual
children.
The class then is far from being homogeneous in its composition.
The children have really only one point in common; they are retarded
in school work. As regards age, physical condition, the environment,
nature of the difficulty with school subjects and congenital traits there
is much diversity among them.
The number of children is limited to fifteen. There are two
regular teachers besides a special teacher who comes in
Class for physical exercises. These teachers have all been
Organization especially trained for this work. The two regular
teachers, besides having had successful experience with
0 THE PROBLEM OF RESTORATION
both normal and subnormal children, have had a thorough foundation
for the work by extensive work in psychology.
The curriculum included the usual academic subjects, arithmetic,
reading, spelling, oral and written language, writing and articulation
work for the children with speech defects. In addition to the academic
subjects there were physical exercises, folk-dancing, swimming and
several kinds of handwork.
In the teaching of the academic subjects several points of difference
from the teachng in most regular grades are worthy of note. There
is no rigid course of study. The spelling words, for instance, are often
taken from words which have come up during the day in the various
activities of the classroom. They are words in which the child has
become especially interested and which he feels the need of being able
to spell. For an arithmetic lesson a boy may measure the amount of
lumber necessary to make a bench and its cost at so much a foot. The
work is very closely related to the child's experience and needs. He
learns addition not as an abstract process but as a concrete thing neces-
sary to accomplish something which he very much wants, very closely
related, then, to his needs.
The suggestion of what to do often comes from the children. The
first period in the morning, the opening exercises is conducted almost en-
tirely by the children. During that period they bring up events which
have interested them at home, on the way to school or in school. Often
something comes up in the opening exercises that furnishes a theme
for later lessons. For instance, one day a child saw a skeleton in a
shop window on the way to school. This led to a discussion on the
function of the bones, how to keep the bones straight, etc. Physiology
was not scheduled for 9 :30 that morning but a lesson in physiology was
conducted at that hour which was of far more interest to the children
than a lesson that had been planned beforehand would have been. If
a bird happens to fly into the room, a lesson on birds is almost sure to
follow. If a lesson proves to be especially interesting and profitable
it is prolonged.
The child has much freedom in the choice of work at his seat. Early
in the morning each child is given his spelling, arithmetic, etc. for the
day. The he is free to do that work whenever he wishes. His work has
to be completed at a certain time and he is responsible for completing
it within that time but is free to arrange his work in any way he wishes.
If he makes a poor arrangement it may result in his having to do arith-
THE PROBLEM OF RESTORATION 7
metic while the other children are doing bench work or he may have to
remain after school to complete his work. When that happens once he
is usually careful that it does not happen again.
Nor is there any rigid division of subjects. A child may learn to
spell a word during an arithmetic lesson or may learn to count during
a language lesson. One day in a class lesson on the flag one little boy
counted the stripes, several children learned to spell flag, red, stripe,
etc., the older children learned about Betsy Ross and the making of the
first flag, and all the children drew the flag and learned to sing the song,
"Betsy Ross. " This was a lesson then in arithmetic, history, oral and
written language, spelling, drawing and music.
It would seem that under this system some lessons might be neg-
lected. But that does not happen. Arithmetic, reading, spelling and
language are after all related to the child's needs. Under present social
conditions we, even as children, need to know how to spell, read, cipher
etc. The only difference is that under this system the subjects are more
closely connected with the child's needs and he is better able to see the
connection. Of course it means that there can be no set programme.
The child's need for arithmetic may come, not at 10:30, but at 11:25.
But there is under this system a sponteneity and interest in the work
which is not possible under a less flexible system. The work is saved
from the deadly monotony of routine. The child develops naturally;
development is not forced. Moreover, the children develop initiative
and an ability to find something to do for themselves. In addition to
its undoubted pedagogic value, the method is of scientific value in the
observation of the individual children.
In the physical exercises the aim is not only to develop muscular
control and co-ordination and to prevent fatigue but to develop mental
traits such as alertness of attention, quick obedience, distribution of
attention, etc. Instruction is by imitation and command. In the folk-
dancing the aim is to develop general co-ordination, grace of motion and
beauty of posture. Every other day there was swimming at the Univer-
sity natorium under a skilled director. A few of the children learned
to swim during the six weeks.
In addition to the formal gymnastics one period each day was
devoted either to free play or to games directed by one of the regular
teachers. This may be called a period devoted to social education
where the children become the teachers and train each other. There
was free give and take. The importance of this period in the develop-
ment of the child cannot be overemphasized. It was also a valuable
8 THE PROBLEM OF RESTORATION
period for observation as it offered an opportunity to see what the child
would do when undirected.
The handwork consisted of basketry, rug-weaving, paper construc-
tion work and bench work. In all this work the emphasis was not upon
the fineness of the finished product but upon what the work had done
in the development of the child. The value of the handwork in develop-
ing motor control and co-ordination, attention and interest was very
great. Often it was the one thing that interested the child and other
interests were developed from it. This was especially true in one of
the cases reported in the later part of the thesis, Monroe C. Monroe
hated school and all connected with it, but through his interest in making
a hammock became interested in the restoration class and never missed
a day. While in school considerable was accomplished in academic
work which would not have been possible had he not first become
interested in handwork.
At noon a hot luncheon was served to the children. This was a
well-balanced luncheon and observations were made of its effect upon
the children as measured by their weight. The children served the
luncheon themselves and table manners and methods of serving were
taught by this means. Following the lunch period, the children rested
in reclining chairs for about a half-hour. Sometimes the rest period
was omitted and for it was substituted a period in which the children
listened to music by the player-piano. School work was never resumed
immediately after luncheon.
The discipline in the class differed considerably from that of the
usual school room. In the restoration class restraint was
Discipline from within, not from without. A feeling of personal
responsibility for the conduct of the room was developed
in each child. He was made to feel that it was his room, that he was
a very real part of the whole. There were only two very simple rules,
"Keep busy" and" Work quietly." The children, even these backward
children, very readily saw the necessity for these rules and were willing
to co-operate with each other to see that they were kept. Much more
freedom is possible when this feeling of personal responsibility is
developed. The children moved quietly about the room to get materials
for their work, or even talked quietly to each other at their handwork,
just as employees in any well-ordered work-room talk with each other.
One of the means of developing this sense of responsibility was
the " store." Each day each child was given stars for work and con-
duct. He was not given a star for a perfect spelling or arithmetic paper,
THE PROBLEM OF RESTORATION 9
but for doing his best in spelling or arithmetic, however poor his "best"
might be. Stars for conduct were given to the childien who had been
able to take care of themselves for, to take care of oneself was a super-
lative virtue in this class. If Johnnie had especial difficulty in con-
trolling his temper, he was given an extra star for making an extra effort
toward self-control. If Mary was inclined to be untidy, she was given
an extra star for a neat desk. Once a week these stars were exchanged
by the children for paper money. With this money articles could be
bought at the "store," such things as baseballs, bats, hair-ribbons,
candy, pencils, etc. So the child had a concrete reward for good be-
havior and for making a satisfactory effort. In addition to its value
as an aid to discipline and to the development of a sense of personal
responsibility the store offered concrete instruction in arithmetic, in
imaking change, etc.
The instruction of course had to be largely individual, adapted to
the needs of the particular child. A child might be doing
Training third grade arithmetic and first grade reading. The child
who had physical defects such as a spinal curvature was
given corrective gymnastics under the direction of an orthopedic sur-
geon. The method of teaching was also adapted to the needs of the
child. Each child was studied individually and that method used
which was best suited to his needs. If a child were intelligent enough
to be taught spelling phonetically he was taught it in that way. To
the child with a strong visual and weak auditory memory words were
presented visually, while the reverse was true with the child possessing
a strong auditory and weak visual memory. Methods of discipline
were also adapted to individual needs. The child who needed to develop
self-control was helped to develop that control. If a child needed
instead to develop self-expression, he was encouraged in every way to
express himself.
Of course individual treatment of the children in the room demands
much of the teacher. She must study each child separately and plan
her work so that the child will be given the kind of instruction that he
needs, and that no one in the class will be neglected. It is essentially
a psychological method and requires close and trained observation.
The teacher of the restoration class, Miss L. Edna Slugg was unusual
in her ability rapidly to "size up" the children, classify them, discover
their assets and defects and the kind of instruction they needed. Even
in class lessons attention to individual needs is possible as was illustrated
10 THE PROBLEM OF RESTORATION
by the lesson on the flag quoted above, a lesson which was adapted
to the intelligence of the different members of the class.
Emphasis on individual training does not mean that group spirit
is neglected. In fact it seems to me a more real group spidt is developed
by this means than by the more formal class-room discipline. A spirit
of helpfulness develops. The older children help and feel responsible
for the younger children. The children love their work and feel pride
in the room. It is so truly their room. Even the programme depends
upon them to a large extent, so a spirit of loyalty to the room and to
each other develops.
What is the attitude of the children toward the room? At first
they are shy, self-conscious and unresponsive. They come usually
from regular rooms and, as they are the backward ones in these rooms,
they have been repressed and have lost confidence in themselves. They
have lost the power of initiative and have developed the habit of waiting
to be told what to do. But as they begin to feel the spirit of freedom
of the class-room, they become responsive, interested, busy and happy
in their work. That their interest is real is shown by their attendance
which was very good even for the hot summer season in Philadelphia.
Many of the children came early and went late so interested were they
in their work. The conditions seemed to be the ideal ones for bringing
out the child's best.
CASE HISTORIES
FANNIE B.
Fannie is a case which is classic in the history of the Clinic. She
was selected for special study because at the outset she was considered
a hopeful case for restoration. Fannie has been under the observation
of the Clinic for nine years. For a part of that time she was in the
direct care of the department and for the whole time the Clinic has
directed her care and education. Seventeen social agencies and eleven
physicians have co-operated with the Clinic in this work. Physical
care, a carefully selected environment and special training have all
been tried. I have chosen her for my thesis because it seems to me that
no factor has been neglected to being about her restoration.
Fannie was discovered by a school nurse in 1907. She was then a
sullen, unde r -nourished child of eight years with a dull and vacant
expression, irregular teeth and speech so defective as to be unintelligible.
The father, mother and seven children lived in two small rooms which
were sparsely furnished, poorly ventilated and very dirty. There were
soiled clothes in a corner and an offensive odor from the sewer drainage.
No regular meals were served but bread, tea and sometimes fish were
kept on the table and, as the nurse reported, " the flies ate all the time,
the children when hungry."
The family is Russian Jewish. They lived in southern Russia for
a time where the first four children were born. Then they moved to
Buenos Ayres and finally to North America in 1894. The father is a
religious teacher and earns less than three dollars a week. In 1907
there were nine living children in the family, all apparently normal.
The family history is meagre and, so far as reported, negative.
Fannie was brought by the nurse to the Clinic in March, 1907 for a
mental examination. She had entered school at the age of six and had
spent two years in the first grade with still no hope of promotion. It
was discovered at the Clinic that her tonsils were very seriously hyper-
trophied and that adenoids were probable. Her vision was defective
and there was an internal strabismus. There was a reduction in hearing
to about one-fourth normal. In the examination she was very stubborn,
was unwilling or unable to answer questions and refused to have her
picture taken, turning and facing the back of the chair. She seemed
almost entirely lacking in curiosity, vanity, energy and good-will. She
showed so little interest in her surroundings as to appear feeble-minded.
12 THE PROBLEM OF RESTORATION
In April her eyes were refracted and the tonsils and adenoids re-
moved. A better diet was prescribed by the school nurse. As a result
of the operation and the better diet Fannie's appearance improved,
the skin was clearer and her weight increased. She began to show
some interest in her environment and her powers of attention improved.
She still breathed through her mouth and was still very deaf especially
for words.
Because of the marked improvement in Fannie as a result of the
better physical care and because she had made intelligent answers to
questions in the mental examination it was decided that she was an
interesting case for study and hopes of her ultimate restoration were
held. In June, 1907 she was placed in Dr. Witmer's Hospital School
and during the summer attended the special class conducted by the
Psychological Department of the University.
The teacher of the Special Class discovered that Fannie could write
a number of sentences from memory but knew none of her letters. Her
articulation was very faulty. The attention was hard to hold and she
was very stubborn. For about half an hour in the morning Fannie
appeared to be in a stuporous condition, dull and uninterested. Gradu-
ally, if eft alone, she would awaken from this condit on and do fairly
rapid work. These periods of stupor shortened from day to day and
finally disappeared entirely.
Little was accomplished in the articulation work at first because of
poor attention and lack of interest combined with the deafness. But
finally Fannie became more interested, learned to imitate sounds given
her and at times seemed to hear even differences in shading without any
trouble. She was never able to hear separate words if spoken in a low
tone.
Her comprehension in number work was very slow but she learned
during the summer to add by twos to ten and subtract by twos in the
reverse order.
Her social education progressed rapidly. When she first came to
the Hospital School she took large mouthfuls, bolted her food and did
not know how to use a knife, fork or spoon. But she was very observant
and her improvement was rapid.
In July a second adenectomy was performed and in August a
third operation was necessary. The improvement after each operation
was noticeable in all her work. She was brighter, more lively, talked
and laughed and took an active interest in her environment.
THE PROBLEM OF RESTORATION 13
The improvement in Fannie as a result of the summer's care was
very great. Her character seemed completely changed. Her atten-
tion had improved, she was less sullen and stubborn, her interest in her
surroundings had been aroused, and she had become lively and talka-
tive instead of dull and apathetic. Her articulation had improved,
she had learned many words of one and two syllables and had done
fairly well in number work. She showed a good visual memory for words
and could copy nicely on paper.
After the summer session Fannie was sent to the country and in
October, 1907 was placed in a private home near the University and
attended public school. It was hoped that she would be helped by a
real home environment and special attention was given to her diet,
her articulation and the formation of correct habits of breathing. Fan-
nie became very helpful in assisting about the house. She was very
fond of younger children. She seemed contented and happy in her
new home.
In school she was entered in the first grade. By this time she could
read well in the second reader, was good in spelling and wrote very
nicely. Her number work was still poor and she had great difficulty
in expressing herself. Her hearing was quite good, at times almost
normal until December when she again became quite deaf. The deaf-
ness seemed then the only obstacle to her making normal progress.
In January, 1908 Fannie was again taken to a laryngologist, and
it was found that she had chronic catarrh of the nose, throat and middle
ear. It was thought she might improve under treatment and regular
treatments were given her three times a week. Her hearing during
the winter was very variable. At times when her nose was clear her
hearing was almost normal and she would appear bright and lively.
Again, when the catarrh was bad, she would be very deaf and conse-
quently dull and her old fits of sullenness would return. Her condition
was very dependent upon the weather.
By spring her nose and throat condition was much improved and
consequently she was bright and lively. She became very much inter-
ested in her clothes and wished to wear her best every day. Her sur-
roundings aroused her interest and she asked such questions as "How
do the flowers grow?" "Where is God?" "Why can't we see Him?"
Except for the number work she seemed to get along fairly well in
school and in June, 1908 was promoted to the lower second grade.
She was then nine years old.
14 THE PROBLEM OF RESTORATION
During the summer of 1908 Fannie again attended the summer
school. Her deafness seemed much improved and she was bright and
alert in her manner. She was very self-conscious, giggled and squirmed
on one foot when spoken to. Her nose and throat treatments were
continued during the summer.
In the fall she again attended public school and was promoted to
the upper second grade in January, 1909. In June, 1909 she failed of
promotion. In the fall of 1909 Fannie was placed in a small institution
for dependent children and attended public school. Her school record
was not so satisfactory in the new school and she was demoted to lower
second. She was very shy in school, difficult to teach and copied her
lessons from the other children. The school placed her on the back-
ward list. Housework she did very well although she needed more
supervision than the other children in the home.
In January, 1910 Fannie was placed in a small, private school for
backward children which was located in the country. She was then
about eleven years old, the exact date of her birth not being known.
The new teacher, Miss B. found Fannie helpful, quick and thorough
around the house and her disposition very pleasant. She was happy
and affectionate and very fond of caring for the younger children. In
school work she was dull but interested and earnest. Her articulation
was very poor, reading and spelling fair, language work good and num-
ber work poor.
During the winter of 1910 Fannie made fair progress. In the
spring of 1910 Miss B. succeeded in interesting her in nature study with
excellent results. Improvement in all her work and especially in num-
ber work was very noticeable. She became interested in her environ-
ment. Her progress in domestic work continued. She was very tact-
ful and trustworthy in handling younger children. She was thoughtful
and could be sent on errands, buying several articles at different stores
and bringing back the correct change. She developed a more intelli-
gent understanding of what she read. Her nose and throat condition
continued to improve.
Fannie's improvement was so encouraging that in the fall of 1911
when Fannie was twelve years old she was again entered in public school,
still living however at the private school in the country. Her work in
the school was very satisfactory. The teacher and principal were
interested in her and she made very satisfactory progress.
Fannie attended public school until the fall of 1913. She passed
into the fourth grade with a general average of 92. In the fourth grade
THE PROBLEM OF RESTORATION 15
departmental work was begun and Fannie became confused by the
number of teachers, could not always hear, and was distressed when
her marks were poor. Her comprehension seemed duller and her
marks were not nearly so high. In spite of this she passed into the
fifth grade in June, 1913 at fourteen years of age. But the strain of the
school year had been severe so in the fall of 1913 Miss B. decided to
keep Fannie in her own school for the following year.
Fannie reached puberty in December, 1911 at the age of thirteen
years. With puberty there seemed to come a change in Fannie's char-
acter. She lost her sweetness of disposition, became sullen, rude, sel-
fish and greedy. She would dictate to the other children. She grew
lazy and would scheme to get out of work. She developed the fault
of self-pity and felt abused if made to work.
Mentally she seemed to retrograde and grow dull and stupid. She
seemed lacking in imagination, did not comprehend things unless pre-
sented very concretely. She became easily confused. Miss B. at-
tempted to train Fannie to assist her in manual work in the school
but found that Fannie did not have sufficient judgment for this, and
so, instead, she trained her to be an upstairs maid. This was difficult
to do because of Fannie's self-pity and her laziness. She did not wish
to do the routine work but craved new experiences and was consequently
discontented. Yet she was unequal to meeting new situations and the
attempt to do so only caused mental confusion and sullenness.
In May, 1915 when Fannie was sixteen years old she was tried as
assistant maid in a home. She was found unsatisfactory and remained
only five days. A situation was then obtained for her where she could
earn her board and room by doing light housework. Fannie is still
working for this family and her work is satisfactory with constant
supervision. She is not competent however to earn any wages and
her clothes are provided by a charity society.
Nine years of special training and medical treatment have failed
to make Fannie self-supporting. She is to-day socially incompetent,
hence we must diagnose her as feeble-minded.
As to the cause of her mental condition I believe she is a case of
acquired feeble-mindedness due to neglect. It is probable that her
heredity has not been especially favorable. The mental level of her fam-
ily is not high. The charity organization has a constant struggle to keep
them above the poverty line. Yet I do not believe that Fannie is con-
genially feeble-minded but that by birth she is normal although low
16 THE PROBLEM OF RESTORATION
normal, somewhat below the average. For eight years she suffered
from insufficient food, poor food, bad air and lack of care generally.
This eight years of neglect has resulted in a physical condition that is
permanent. That her mentality suffered also from the same cause,
I feel certain. Her disposition, her attention, her interests all varied
with her physical condition. The same causes which produced the
general physical condition affected at the same time her nervous system,
resulting in a permanent mental retardation, an arrested development.
The retrogression at puberty seems to militate against this and indicate
an innate defect. But it seems to me that an organism weakened by
neglect as Fannie's was might succumb to the storm and stress of puberty
although not innately defective.
THE PROBLEM OF RESTORATION 17
JAMES C.
James was first sent to the Clinic in October, 1912 by a hospital
clinic because of suspected mental deficiency. He was then almost
nine years old. He seemed quite normal to the mother, played with
children of the same age and got along well with them, not allowing
them to impose upon him. But in school work he seemed unable to
make any progress. He had entered the first grade at the age of six
and was still in the first grade at the time of the examination.
James was being treated for chorea at the hospital. He had been
excessively nervous for four years; his nervousness seemed to increase
after an attack of measles at the age of six. He had nocturnal enuresis
which had not been helped by circumcision nor by medicine. Ade-
noids and tonsils had just been removed and his eyes refracted and
glasses prescribed. There was no history of any serious illness.
Birth was natural, full term and he was not partially asphyxiated.
But he was a blue baby. As a baby, he was healthy, not troublesome
and seemed like other children. He walked and talked at the usual
time and cut his first tooth before he was a year old.
James' father died at the age of forty of "stomach trouble." The
mother supports the family by working by the day. An older girl in
the family is at service and earns four dollars a week. There were
four other children in the family, all reported to be normal. There was
no history of any abnormalities in the family and no history of miscar-
riages.
James showed up very poorly in the mental examination, .was diag-
nosed as feeble-minded and an application for institutional care made.
This application was accepted by the institution but the mother never
took James to the institution.
In March, 1915 a social worker from the Clinic called upon James*
mother. His mother reported that James was getting along nicely in
school and seemed to be getting "brighter." A second examination of
James was immediately arranged for and the date set for April, 1915.
James was by this time in the lower third grade. His reading and
spelling were reported to be good, writing and arithmetic fair, geo-
graphy good and handwork good. His attendance was regular, he
had never changed schools and his conduct was good. James had
spent two years in the first grade and two years in the second grade.
His physical condition had much improved. He was still nervous
but much less so than in the previous examination. The enuresis had
18 THE PROBLEM OF RESTORATION
persisted. His age was now eleven years and four months. He was
very tall for his age, both his height and his weight being that of a
boy of fourteen. Posture was fair and gait normal. Nutrition seemed
to be good. His forehead was low and the shoulder blades prominent.
In the mental examination he did very well. He read understand-
ingly from a second and fourth reader and his reproductions of what he
read were intelligent. His number work was third grade level by the
Courtis tests. In the speed reasoning test he did not comprehend the
explanation. After the explanation was repeated he made three at-
tempts with one example correct. By the Binet-Simon scale there was
a retardation of two years.
His showing in this examination was so much better than in
the previous examination that it was felt that he was of normal men-
tality although retarded in school work. To test this diagnosis it was
decided to enter James in the 1915 restoration class for observation.
When James entered the restoration class his age was eleven years
and seven months. James was very good-natured and so docile as to
be easily imposed upon by the other children in the class. His expres-
sion was cowed and spiritless. His posture was stooping as if he had
neither the energy nor the courage to stand erect. In his movements
he was slow and uncertain like an old man. He was very slow in fol-
lowing directions and usually directions had to be repeated for him.
When his hearing was tested it was found to be normal. His slowness
in following directions was due not to defective hearing nor to lack of
obedience but to slow comprehension. He was unable to distribute
his attention so could attend to but one thing at a time. If given more
than one direction at a time, he became confused. If given definite
tasks to perform he accomplished considerable but, if left to himself,
would spend his time wondering what to do next so would accomplish
little or nothing.
Reading and spelling were good third grade level. In number work
he could add, subtract and multiply. An attempt was made to teach
him short division but his comprehension was so slow that he accom-
plished little during the session. He had a fair knowledge of third grade
geography facts but his ideas were often confused, although a few defi-
nite questions from the teacher would usually clear them up. He had
much knowledge of the world especially of robbers' devices, of people
arrested, etc. This information he probably learned from his brother
who was a truant and very troublesome.
James' eyes were tested during the session and found to be badly
in need of refraction. There was hyperopia and astigmatism. The
THE PROBLEM OF RESTORATION 19
right eye was probably amblyopic and had a tendency to deviate out-
wards. There were some old scars on the right cornea of uncertain origin.
The chief factor in James' progress has been, I think, the retentive-
ness and trainability of his memory. Learning has been slow as the
result of a limited memory span (four digits), defective comprehension
and intelligence but he has retained what he has learned. Analytic
concentration of attention is fair and his attention is very persistent
but not well-distributed. Threshold of sensitivity is high both for
vision and audition. Imageability is also defective. Control and
co-ordinatien of movement are poor and he has almost no initiative. (
Vitality is poor. His defectiveness is thus quite general, his only asset
being his retentive memory.
James is quite certainly feeble-minded. The mental level of the
family is not high. The mother's intelligence is of "a low level. The
children who are working earn low wages and do not advance in their
work. But while the heredity is not very favorable, I do not believe
James' deficiency is hereditary. I doubt whether it is even congenital.
Babyhood history was favorable. The only unfavorable point in his
birth history is the fact that he was a blue baby. I incline to the belief
that he is a choreic defective. When he first came to us he was suffering
from a severe case of chorea and his mental level seemed to be that of a
middle grade imbecile (Barr classification). The improvement he
showed in the second examination I believe to have been due to the
improvement in his nervous condition. However, I doubt whether
there will be any further improvement. The effects of the chorea still
remaining are permanent effects, so that his present mental status is a .
permanent one. Ultimately institutional care must be considered for
James as he is just intelligent enough to make a good tool for some more
intelligent "crook."
20 THE PROBLEM OF RESTORATION
CHARLES C.
Charles was first sent to the Clinic in January, 1915 by one of the
churches in Philadelphia because he did not seem to be getting along
well in school. His age was then nine years and ten months. Charles
was in the upper second grade having spent one year in each half grade.
Reading and spelling were poor, writing and arithmetic fair. He was
fond of music and able to carry a tune. There was no handwork in
the school. Although Charles had twice changed schools, his atten-
dance had been regular. He was often tardy. Conduct in school was
reported to be poor.
Charles seemed quite normal to his parents. They reported that
he played with children of the same age and got along well with them,
not allowing them to impose upon him. He played tag, hide-and-
seek, ball, etc. and was very active in play. The mother admitted
that Charles was very mischievous and preferred to play rather than
work. His father helped him with his lessons at home and said that
Charles always knew his lessons before starting to school but seemed to
forget them in school. The father scolded Charles for forgetting his
lessons but without result. The mother said that Charles could not
be driven or "hollered at."
Charles' health was reported by his mother to be good although he
he was very thin. He slept well and had a good appetite. His bowels
were regular and carefully watched by his mother. There was no
history of enuresis nor of any serious illnesses nor accidents.
His birth was instrumental, although full term. Delivery was
forced. He was a blue baby and partially asphyxiated. At birth his
whole head was reported to have been black. He weighed nine pounds.
The mother had nursed her father-in-law through a serious illness just
previous to her pregnancy so her health during her pregnancy was poor
and she was ill in bed for three months previous to Charles' birth.
After his birth she had a prolapse.
Charles was a little late in teething, walking and talking. His
first tooth he cut at the age of eleven months, he walked at fifteen
months and talked at two years. He was healthy, not troublesome
and seemed in every way like other children.
In the family there is a serious history of tuberculosis. The father
was at the time of the examination dying of tuberculosis Both his
father and mother died of tuberculosis and one sister was suspected of
THE PROBLEM OF RESTORATION 21
tuberculosis. Besides Charles, there were two other living children in
the family, a girl of seven in whom tuberculosis was suspected and a
baby of two years who later developed tubercular glands. The first-
born child had died at the age of four and a half years of tuberculosis
of the hip. There is no history of miscarriages in the family but there
had been three stillbirths. In the case of the last-born child a mis-
carriage was threatened at the fifth month.
Physically Charles was well-developed and fairly well-nourished.
His head was microcephalic and contracted in the frontal region, his
forehead sloping. The shoulder blades were protruding and the chest
very flat. The internal canthus was adherent suggesting a uterine
arrest of development.
The mental examination revealed considerable retardation in school
subjects. His reading was only a first reader level and then he missed
a number of words. He reproduced only one idea out of a possible
nine or ten. Simple problems such as "How much change would one
get if one bought two pounds of sugar at six cents a pound and gave the
storekeeper a quarter?" he only succeeded in getting after several
attempts. He succeeded no better when given the coins with which
to make change. On the Binet-Simon scale his level was that of an
eight-year-old child but he performed the tests more like a seven-year-
old. Mental processes were very slow. His memory span was only
five digits. In some of the tests he showed himself to be capable of
rather close observation. However, the results of the tests were incon-
clusive, revealing no specific mental defects. So diagnosis was deferred
and it was decided to admit Charles to the 1915 restoration class.
Charles was doing no better in school work, every subject being
unsatisfactory. He was still in the upper second grade. Attendance
was irregular and he was often tardy. He made no effort and was
disobedient, foolish and silly.
A call to the home was made and the home found to be fairly neat
but poorly ventilated. The mother seemed quite competent but
inclined to interfere too much with the school and probably too lenient
with Charles.
When Charles entered the restoration class his age was ten years
and six months. He was very restless and inclined to be disobedient,
responding slowly or not at all to class signals. He did not apply him-
self but preferred trifling to working. He improved in this respect
during the session and by the close of the session was fairly prompt in
responding to signals. His disposition was usually pleasant. He had
22 THE PROBLEM OF RESTORATION
occasional sulky spells but they were of short duration. He would
smile in spite of himself. He played quite normally with the other
children in the class and got along well with them although he would
occasionally tease them in a good-natured way.
In number work he could add with carrying, subtract with borrow-
ing and multiply by one digit. But he was very careless, would leave
out a number or forget to carry. He often confused one process with
another, adding when he should multiply. An attempt was made to
teach him short division but met with no success. He would continually
multiply instead of divide. The fundamental operations of arithmetic
seemed to have little meaning for him and he showed the need of further
drill in concrete work. He could solve simple one-step problems and
occasionally problems of two steps if one of the operations involved
were addition or subtraction.
He read very well in a first and fairly well in a second reader. His
reproductions of what he read were very scanty. Spelling was fair
second-grade level if the lesson consisted of not more than ten words,
half of which were familiar. He was confused by a longer lesson and
would accomplish nothing in it. Writing was very careless. Oral
language was good second grade level, written only fair.
He accomplished little in handwork as he was not willing to make
much effort and did not persist at any task. To avoid sawing he took
some pieces left from another boy's work and fitted them together.
Very little was accomplished in school work during the session.
He made little effort and evaded a task whenever possible. He con-
stantly said "I can't" when able to do. Attention to class lessons or
to work at his seat was poor and it required constant effort on the part
of the teacher to keep him at work. He was not at all disturbed by
failure and constantly assumed an attitude of "showing off" before the
observation class of teachers even when doing poor work.
Charles' chief defects are in attention. He is lacking in both analytic
and persistent concentration of attention. Mental processes are very
slow and he is easily fatigued. Retentiveness is poor so his memory
is not trainable. Auditory memory span is only five digits. Intel-
ligence is very poor and he has displayed no planfulness. In the mental
examination his confusion of some of the blocks of the form-board
would seem to indicate a defect in imageability. Co-ordination and
control of movement seem to be sufficient and he has plenty of initiative.
THE PROBLEM OF RESTORATION 23
Charles' defectiveness, then, is very general and makes education
for him impossible. Retardation is general as indicated by the late
walking and talking. That his condition is congenital would seem to
be indicated by the birth history. The family history of tuberculosis
makes one suspect that the cause of Charles' condition is tubercular
degeneracy. Charles has since been diagnosed by the Clinic as a middle
grade imbecile (Barr classification).
24 THE PROBLEM OF RESTORATION
JOHN C.
John was first sent to the Clinic in June, 1913 by one of the hospi-
tals in Philadelphia. He was backward in school and his mother com-
plained of his lying and stealing. His age was then nine years and
nine months. His mother gave him a very bad character. She said
he was easily influenced by bad companions and had been stealing from
her, from the teacher and from pupils in the school for several years.
He often tried to lay the blame on his younger brother. He was very
impulsive and had a violent temper yet was affectionate. He did not
seem to be able to discriminate between right and wrong and never
repented of his misdeeds. He played with boys of his own age and was
very active in play. He was able to go on errands, in fact seemed quite
intelligent. He had a paper route and was very clever about keeping
money given him by new customers. The mother and grandmother
tried to discipline him by both threats and persuasion but neither
method was at all effective.
John had entered school at the age of six years. He had spent three
terms in the lower first grade, one term in the upper first, two terms
each in the lower and upper second grade. At the time of the examina-
tion he had just been promoted to the third grade. The teacher re-
ported that John was indifferent and did not pay attention but did not
seem to be defective. There were fifty children in the room.
John's health was excellent except that he was somewhat nervous.
He slept well but was restless in his sleep. He had been circumcised
two years previously. There was no enuresis.
Birth was instrumental. Labor was long and difficult and the baby
was injured. The marks of the instruments were still visible but there
was no depression. As a baby John was very bright; he began to walk
and talk at the age of nine months and was easily trained in personal
habits.
There was one other child in the family, a boy of six years. Although
sickly and delicate this boy was bright and at the age of six years was
in the second grade. John's mother had not lived with her husband
after the birth of her second child because of his cruelty. Soon after-
ward her husband had died of tuberculosis. He had never been strong
and had had a "tobacco" heart. After his death John's mother re-
married but six months later her second husband dropped dead. Since
the death of her second husband she had lived with her mother and held
a position as a cloth mender. Her mother rented rooms to University
THE PROBLEM OF RESTORATION 25
students. The grandmother seemed intelligent and the students were
fond of. her. Nothing unfavorable was reported in the family history.
The mental level of the family as a whole seemed rather above the
average.
No serious defects were discovered in the mental examination. The
examiner felt it was a case for careful teaching and judicious discipline
and recommended that an attempt be made to break up his habit of
stealing by encouragement rather than by severe discipline. It was
suggested that the teacher make her teaching more concrete for John.
In June, 1914 John was still in the lower third grade and was not
to be promoted. The teacher reported that his writing and geography
were poor and his arithmetic impossible. In language he would write
sentences that did not make sense. He learned readily to recite poems
but could not write them. His best work was in spelling. His conduct
had improved and he was no longer troublesome.
An examination at the Clinic at this time confirmed the teacher's
report. Spelling was fair. In reading he was slow. He knew most
of the words in an Aldine first reader but was very careless. In arith-
metic he was very slow and did not know the arithmetical combinations.
His mother had less trouble with him. She had tried reasoning with
him about the lying and stealing and he had much improved.
John was admitted to the 1914 restoration class. He was very
troublesome at first and not at all interested. Finally he became
interested and developed into a good, earnest helper. He applied
himself better to his work although still not working up to his limit.
He was always popular with the children in the class and a leader in
their sports. His age was now ten years and ten months.
His school work was about high second grade level. His progress
was very slow. He was two weeks learning addition with carrying.
He seemed very slow in forming new associations. His handwork was
good.
In the fall of 1914 John was allowed to enter the upper third grade
in spite of the fact that he had failed of promotion in June. He seemed
more interested in his work and his work had very much improved.
In July, 1915 John was re-examined at the Clinic. His age was then
eleven years and ten months. His mental age by the Binet-Simon
scale was less than ten years. There was considerable retardation in
reading and spelling; his work was not higher than second or low third
grade level. In the mechanical tests he did fairly well using an intel-
ligent method on the whole although, in the Healy Construction Puzzle
26 THE PROBLEM OF RESTORATION
B., he made several attempts to force the circle into the half -circle
space. He worked slowly and deliberately. His memory span was
seven digits.
John was admitted into the 1915 restoration class. Outside of
academic work John certainly gave one the impression of being a very
normal boy. He was pleasant in the room, obedient on the whole and
very popular with the children in the class. In their sports he was a
leader and his sense of honor in the games was high; he always played
"fair." In all his social reactions he was intelligent. While inclined
to be mischievous himself, he would not tolerate the sneakiness and
deceit of William G. and decided to " settle" with him but waited until
the last day of the session so he would not lose any stars by the trans-
action.
He was interested in the physical exercises, gave good attention and
executed the movements with precision and force. When the com-
mands were given rapidly he was never confused but rather stimulated
to greater effort and seemed to thoroughly enjoy the contest. He
enjoyed swimming and was a very good swimmer.
But in academic work he was not interested. He would do nothing
if allowed to and could manage to appear very busy and at the same
time accomplish nothing. If told a task must be accomplished he
stopped his trifling and got to work. As soon as that particular task
was accomplished he took up his trifling again.
One was in danger of being deceived in John. It seemed as if he
could accomplish if he would. But if one observed him very closely
one found that, even when he made the effort, accomplishment was
slow. He worked very slowly and it took him a long time to understand
any new step. Even the addition of one more digit in an example in
multiplication was for him a new step. His reading, spelling and arith-
metic were fair third grade level. In reading he was very slow in recog-
nizing a word and seemed unable to direct his attention to the word, a
defect in analytic concentration of attention. If given time enough he
could usually recognize a word.
Although somewhat interested in woodwork John had little interest
in other handwork. He worked intermittently all summer on a very
simple mat, finishing the last day when the class were offered extra
stars for completed handwork. Several times he persuaded James C.
to work on the mat for him.
Perhaps John's most apparent defect is the limitation of his range
of interests. Were he interested in academic subjects considerably
THE PROBLEM OF RESTORATION 27
more could be accomplished. But there are other defects. Mental
processes are very slow. Analytic concentration of attention is defec-
tive and his attention is not persistent, except when he is interested.
His attention is well-distributed. His movements are well controlled
and co-ordinated and he has plenty of initiative. There seem to be no
defects in imageability but he seems unable to make associations for
himself although his memory span is seven digits. His powers of
observation are good but his intelligence is less than fair. While his
retentiveness seems normal his memory is not trainable due to his
inability to form associations for himself.
With the slowness of his mental processes, his defective under-
standing and only fair intelligence, a memory which is not sufficiently
trainable and his lack of effort and application it is impossible for John
to acquire an adequate education. The last report of him was in April,
1916 when, at the age of twelve years and seven months, he was still
in the upper third grade with a general standing of 30. Progress for
John must always be slow and he can never make up his grade retarda-
tion. He is not a restoration case.
28 THE PROBLEM OF RESTORATION
MONROE C.
Monroe was first sent to the Clinic in April, 1913 by the principal
of the school because of his pedagogical backwardness. Monroe's age
was then ten years and five months. He had been attending the one
school for four years but was not getting along well in school.
Monroe lived with his paternal grandmother. His mother had
left her husband when Monroe was a year old. Before her marriage
she had been a bare-back rider and fancy toe dancer in a circus. Her
mother and step-father had also followed the circus life but were re-
ported to have been fine people. After Monroe's mother left her hus-
band it is reported that she became a "bad woman."
Monroe's father was a trapeze performer in the circus before his
marriage, having entered the circus life at the age of fifteen. When
he married he gave up the circus life and drove an ice wagon, but re-
turned to the circus when his wife left him. As a boy he had been slow
in school work.
Monroe had lived with his grandmother since he was a year old.
The family consisted of two of Monroe's aunts, one aged twenty-three
and one of twenty-six and a little girl cousin of four and a half years
besides Monroe and his grandmother. Monroe was reported by the
grandmother to be affectionate and fairly obedient with no bad personal
habits. He was fond of out-of-door sports such as cycling and ball
and had a preference for companions older than himself. At home he
shoveled the snow and cared for the furnace. He was very fond of
sweets but would not eat meat and vegetables unless forced to do so.
Monroe was an only child and there have been no miscarriages in
the family. His birth was normal in every way. He was a healthy
baby, bright and not at all troublesome. He sat up at six months,
walked at fifteen months and talked plainly at two years.
He has been healthy except that he is subject to colds. Adenoids
and enlarged tonsils have been diagnosed but the operation has never
been performed.
At the time of the examination Monroe was an attractive looking
boy, normal in appearance, well-nourished and in excellent general
condition. His hands were moist and slightly cyanosed. He had a
protuberant abdomen and a slightly minus genital development. The
teeth were decayed and somewhat crowded. There was a slight lordosis.
Three mental examinations have been made of Monroe; one in
April, 1913; a second in March, 1915 and a third in April, 1915. The
THE PROBLEM OF RESTORATION 29
examinations revealed considerable retardation in school subjects. In
the 1915 examinations his number work was third grade level, reading
scarcely as high. Spelling was very poor. The general impression
he made was favorable; he was interested in the tests and intelligent in
those he could do. Memory span was limited to five digits. The results
of the examinations were inconclusive, diagnosis was deferred and
Monroe was entered in the 1915 restoration class for observation.
Monroe was now in the upper third grade. This was his sixth year
in school. He was unsatisfactory in reading and spelling and sometimes
in language. He was not interested in school, was bored by being with
such young children and was beginning to play truant.
When Monroe entered the restoration class his age was twelve
years and eight months. He was popular with the other children and
got along well with them. He was inclined to tease the younger chil-
dren but in a good-natured way which they did not resent. In play
he was very active and a leader among the boys. His disposition in
school was variable. He had very frequent stubborn, sullen spells
when he was inclined to be disobedient and very disagreeable. When
good-natured he was a very pleasant member of the class. With very
careful handling on the part of the teacher Monroe could be coaxed
and jollied into a good humor again. By means of encouragement and
firmness he was helped to control his moods and, by the end of the
session, the number of sullen spells had grown much less and most of
the time Monroe was a good-natured and obedient member of the class.
Monroe had little interest in academic subjects, but his interest
in handwork was very great. He became so interested in making a
hammock that he came to school early and went late and, probably for
the first time in his life, began to enjoy school. Through his interest
in handwork it was possible to accomplish something in school sub-
jects. But he never became really interested in academic subjects.
He merely tolerated them for the sake of the handwork.
In number work he knew the four fundamental operations but needed
more drill on multiplication and long division. He could solve simple
one-step problems and occasionally problems involving two steps but
his ability to apply his arithmetic was far behind his knowledge of the
fundamental operations of arithmetic.
Reading and spelling were both very poor. He could read poorly
in a third reader, well in a second reader. His reproductions of what
he read were very good. He had no conception of phonics but learned
during the session to recognize a few words in this way. He could
30 THE PROBLEM OF RESTORATION
learn daily from six to ten words of second, third and fourth grade level
but, once learned, the words were only retained for a few days.
Monroe's fund of general information was higher than his general
educational level but hardly the level of a boy of twelve and a half
years. His progress during the summer was not great.
In the fall of 1915 Monroe returned to the upper third grade. He
did not pass into the fourth grade until January, 1916 when he was
fourteen years old. The teacher felt there was some improvement in
Monroe's work but his reading was still scarcely second grade level.
Monroe has a specialized defect, an inability to retain letter com-
binations. This makes it impossible for him to learn to read and write.
Hence he is not educable, is what Dr. Witmer calls a "congenital illit-
erate. " Vitality is good; there are no defects in attention and his move-
ments are well-controlled and co-ordinated. His range of interests is
very much limited. Observation and understanding are sufficient and
his intelligence is, on the whole, normal although limited in range. His
limited memory span indicates a defect in associability.
Monroe's defect in retentiveness makes it impossible for him to
attain the general level of a seventh grade pupil. He is, therefore,
not a restoration case.
THE PROBLEM OF RESTORATION 31
ROBERT C.
Robert has had an eventful life; at least the first twelve years of it
have been eventful. He was first brought to the Clinic in April, 1911
by his mother because of a violent temper and general backwardness.
The mother had been referred to the Psychological Clinic by one of the
hospitals in Philadelphia. Robert was then seven years old. His
mother reported that for three years Robert had had violent fits
of temper. He had threatened his mother with a butcher knife and had
been cruel to his little step-sister. After the spells he was always
sorry for what he had done. Except for these spells he was obedient
and affectionate. The physician at the hospital had said that the
symptoms were those of acute mania.
Robert was in the first grade in school, having entered Kindergarten
at the age of five years. He was making practically no progress in
school.
Except for his nervous condition his health was fair. Adenoids
had been removed two years previously but had again been diagnosed.
He had had pneumonia twice. There was no history of convulsions.
Birth history was negative. He had had no infant troubles and had
teethed, walked and talked at the usual time.
Robert was an only child. The father had been epileptic and had
died insane when Robert was two years old. His father had been
reported "queer," one of his sisters had committed suicide and another
sister was "queer" and made nervous movements.
There was nothing significant in the mother's family except pos-
sibly that her mother had died of tuberculosis. She herself was very
nervous and had been in the hospital two years previously with nervous
prostration. She had married again and had had one child, Robert's
step-sister.
Robert made such a poor showing in the mental examination that
he was diagnosed as mentally defective and in need of custodial care.
An application to an institution for the care of the feeble-minded was
made for him and he was admitted to the institution in August. But
his mother felt that Robert was heartbroken at being away from her
and so removed him from the institution.
In June, 1913 Robert was again brought to the Clinic because his
mother reported that he had "gone back to his old ways." Robert,
who was now nine years old, was in the lower second grade, having spent
32 THE PROBLEM OF RESTORATION
three years in the first grade. The mother admitted that she was very
nervous, worried much over Robert's condition and that her nervousness
probably reacted upon Robert. Robert had frequent nocturnal enuresis.
His mother now had a baby eight months old.
The Clinic was doubtful of the diagnosis in Robert's case, although
still inclined to think him feeble-minded. It was felt to be necessary
to remove Robert from his mother's care and so, in July, he was placed
with a caretaker in the country. The caretaker reported Robert ner-
vous, melancholy and at first homesick. He was usually obedient and
had had no fits of temper. She felt that he had been too much restrained
at home. He had become very much interested in animals and was doing
well in school work.
In March, 1914 Robert's step-sister died of cerebrospinal meningitis.
In April, 1914 Robert was again examined at the Clinic. He was
diagnosed as a border-line case and an interesting case to continue under
observation.
Robert was admitted to the 1914 restoration class for observation.
His age was then ten years and five months. He boarded in the city
and the caretaker had no trouble with him in discipline. He never
lost his temper and was always obedient and very affectionate with
younger children. He had no enuresis but did have heavy night sweats.
Robert was found in the restoration class to be very much retarded
in school work, his work being only second and third grade level. He
worked very slowly and if hurried became excited and irritable. His
conduct was excellent. He worked best with quiet, firm encouragement.
In the fall of 1914 Robert was placed in the upper third grade of
public school, still living with the caretaker in the city. In February,
1915 he was promoted to the lower fourth grade. His work in the
fourth grade was not very satisfactory. Reading was good and spelling
fair. His arithmetic was very poor. Geography was poor at first but
later improved. He was not promoted in June.
Robert was admitted to the 1915 restoration class. His age was
now eleven years and five months. He seemed less timid than he had
been the year before but was still cowardly and sneaky, pushing the
other boys or doing things when the teacher was not watching him.
He was slow to obey commands but, if spoken to sharply, became
startled and obeyed promptly. There were nervous twitchings of the
face. He seemed incapable of making much of an effort and was quickly
fatigued. He did not care for woodwork; it required too much effort.
THE PROBLEM OF RESTORATION 33
He preferred handwork like spool knitting or simple weaving and did
little of that.
His school work was good third grade level. He was about ready
to begin fourth grade work. He never volunteered to answer a ques-
tion although, when it was insisted upon, he could often answer well.
Robert was about ready to begin fourth grade work when, at his
age, he should be doing fifth or sixth grade work. Because of his ner-
vousness, lack of vitality and slow mental processes his progress in the
future will probably be as slow as it has been in the past. His attention
is sufficient in analytic concentration but lacking in persistence. His
attention is not alert and his range of interests is considerably limited.
His movements are well-controlled and co-ordinated, but he is very-
deficient in initiative and his movements are not vivacious. Image-
ability and associability appear to be normal. Understanding is rather
slow, he is deficient in observation and very deficient in intelligence.
Retentiveness is only fair.
At his present rate of progress it is probable that Robert will reach
the level of about a fifth grade pupil. He is, then, not a restoration
case. It is probable that he is a type of choreic or epileptic defective.
34 THE PROBLEM OF RESTORATION
FRANCIS D.
Francis was first brought to the Clinic in February, 1915 because of
his backwardness in school. His age was then nine years and one month.
His mother reported that he played with children of his own age but
got along poorly with them, allowed them to impose upon him and was
constantly looking for a fight. If sent to the store on errands he would
forget what he had been sent for.
Francis presents a picture of quite general retardation. While the
birth history is negative he was late in both walking and talking, not
walking until fifteen months of age, not talking until four years of age.
He was a " nervous" baby.
At the time of the examination Francis had been in school for two
years but was still in the lower first grade. His average in that grade
was 50; he could not read, write nor spell. While he had attended, in
the two years of his school life, four different schools, his attendance
had been regular and his conduct fair.
Francis had always been healthy. He had had no serious illnesses
except pneumonia and his recovery from that seemed to have been
complete.
The father was dead. The mother had a small mother's pension
and on this supported herself and ten children with some help from two
of the older children. The family income was less than seventy dollars
a month and yet the home was comfortable, the children clean and well-
nourished. Discipline in the home seemed to be very good. Francis
was well-behaved, obedient, truthful and affectionate and gave evidence
of adequate home training.
The family history is interesting. The father died in an insane
hospital of paresis. The oldest child, a boy of eighteen, is epileptic
and mentally retarded. There is no history in the family of insanity or
epilepsy. The other children in the family appear to be normal. Two
of the older children, girls of seventeen and fourteen, are working and
earning only four dollars a week but, as they left school early, the
deficiencies in their education may account for their low wages. There
have been no miscarriages in the family.
The mental examination confirmed the school report as to Francis'
lack of proficiency in school subjects. His reading in the Primer was
poor. When asked to read the letters in some of the words, he read
"p" as "e," "g" as "a," and "t" as "n." He was unable to spell
THE PROBLEM OF RESTORATION 35
such words as "can," "rat," "on" and "the." He had learned no
number combinations but had to count up such sums as 3 plus 4 on his
fingers. In the Courtis arithmetic test he was only able to do two
additions in one minute. There was a year's mental retardation by the
Binet-Simon scale. He had a memory span of only five digits. Diag-
nosis was deferred.
At the recommendation of the Clinic Francis was transferred to a
special class. The principal of the school was very reluctant to place
Francis in a special class as by this time he was doing much better
work in the first grade and had obtained a general average of 70 in the
month of March. The special class to which Francis was transferred
was large, the teacher inexperienced and the children quite low-grade.
Because of the improvement in Francis reported by the principal
it was decided to take him into the restoration class for observation
during the summer of 1915.
At the time Francis entered the restoration class his age was nine
years and four months. He was a very normal looking boy, attractive
in appearance, quiet, well-behaved and very cheerful. He enjoyed the
class activities and was very responsive whenever the class activities
were within his abilities. He liked to answer questions and often
raised his hand when he did not know the answer to the question. As
he was not conscious of his own limitations there was almost an entire
absence of self-consciousness. He got along very well with the other
members of the class although occasionally he showed a tendency to be
quarrelsome. In the games he was very active.
In arithmetic Francis knew a few arithmetical combinations in addi-
tion and could do simple two-column addition such as 23+ 34. His
comprehension in learning any new step was slow and he easily became
confused. An attempt was made to teach him two-column addition
with carrying. He learned to add up the right-hand column and write
the result at the side, but at this point he became confused. He was
not able to complete without much help problems of this sort by the end
of the session although all effort was concentrated upon teaching him
this one thing. The addition of a new column in simple addition such
as 323+434 instead of 23+34 was for him a new step requiring labor-
ious effort to learn.
In reading also he accomplished little. His recognition of words was
very poor. It was found that he did not know the sounds of the sep-
arate letters and was unable to discriminate one sound from another.
To teach him a new word took much drill and constant effort. Moreover
36 THE PROBLEM OF RESTORATION
after it was learned, it was not remembered. Francis spent most of
his time relearning what he had learned before. His comprehension
of what he read was good and he answered intelligently questions about
what he had read. He often supplied a word he did not know from the
context. He gave fair attention during a reading lesson and seemed
interested in the lesson.
Spelling was as poor as reading. He was handicapped because he
did not know the sounds of the letters. It was useless to teach him the
sounds of the letters as it required much effort on the part of the teacher
and he was not intelligent enough to use phonics after being taught.
He seemed to remember spoken words better than written ones so was
taught new words by writing them on the board, at the same time
spelling them aloud. His retention was so poor that, as in reading, he
was constantly relearning what he had learned before.
Francis could do little in written language because of his lack of
proficiency in spelling. He was fond of stories and liked to tell stories
he had heard to the class, but often omitted important parts of the story
and did not always relate the story in its logical sequence. He was
always quite unconscious that he had omitted anything but rather
proud of his effort.
In the physical exercises he was wholly dependent upon imitation
and even then could imitate only the simple movements. In the more
complicated movements he became confused and usually executed only
a part of the movement. Energy was good and attention fair. He was
at his best in the games, interested and quick in his movements.
He was capable of doing only the simplest kind of handwork such as
stringing beads or simple paper folding. He attempted to make a
bread board but required much help and could comprehend only one
step at a time. He worked with great energy and showed no signs
of fatigue. Control and co-ordination of movement were good and he
had plenty of initiative but poor understanding and no planfulness.
Francis' progress, then, in the restoration class was very unsatis-
factory.
Francis' most serious defect is his poor retentiveness. It seems to
extend to both letter and number combinations and even to ideas.
There are indications of a defect in imageability especially in visual
imagery. The limitation in associability is only slight as indicated by
his memory span of five digits. Both comprehension and intelligence
are deficient and the intelligence is limited in range. Analytic concen-
tration of attention is fair but his attention is not persistent. His
THE PROBLEM OF RESTORATION 37
movements are well-controlled and co-ordinated and he has plenty of
initiative.
Francis presents a picture of quite general retardation, late walking
and talking and marked pedagogical retardation. He has serious
specific mental defects especially in memory, imagination and attention.
He is quite certainly feeble-minded. His condition is congenital and
the paresis in the father suggests the possibility of syphilitic degeneracy.
38 THE PROBLEM OF RESTORATION
JENNIE J.
Jennie was referred to the Clinic in April, 1915 by her mother. She
was then ten years of age. The school had reported no deficiencies in
Jennie but her mother felt that she did not fit into the school system.
Her deficiency in arithmetic was marked. The mother had also noted
that Jennie had great difficulty in expressing herself. She seemed very
backward, also, in children's games. She did not care to run, skip,
jump or climb, was very awkward with a croquet mallet and afraid of
falling in skating or swinging. She did not care to play with dolls or
play-houses but preferred books, pictures and music. She did not care
to play with other children but would stand aside and watch them play,
making no attempt to enter into their games. All this was reported
by Jennie's mother.
The family history is negative and there have been no miscarriages
in the family. Jennie is an only child. Birth was instrumental and
labor long. But she was not injured, was not a blue baby and was not
partially asphyxiated. The mother's health was good during her
pregnancy but the father was forty-two years of age at Jennie's birth
and had been under considerable mental strain for a year previous to
her birth. Jennie walked and talked at the usual time. At the age of
three months she suffered from malnutrition. She was bottle-fed and,
the food being deficient in bone-making material, she teethed late and
had weak ankles. The weak ankles were corrected with orthopedic
shoes. At three years of age she had acute indigestion accompanied
by convulsions. The convulsions have never recurred. At the age
of six years she had a serious case of typhoid followed by a relapse.
Recovery was slow and for a long time there was much muscular inco-
ordination. When she was eight years old, her vision was found to be
very defective. Objects appeared wavy, broken and double to her.
Her vision has been corrected with glasses.
Jennie had completed the third grade in school. She entered the
first grade at the age of seven and a half years and her school progress
had been normal. There is no manual training in the school she
attended.
Jennie was admitted to the restoration class of 1915. Her age was
then ten years and seven months. She was a quiet, shy and sensitive
child with almost no initiative. She was excessively neat, even finicky
about soiling her hands or her clothing. In the class she never asserted
THE PROBLEM OF RESTORATION 39
herself but waited to be told what to do. If left alone she would sit and
do nothing but, if given any task, performed it willingly. She was very
shy with the other children and did not enjoy their companionship,
allowing them to "boss" her and following their leadership without
protest. But gradually she began to respond to the freedom of the class
room. She no longer waited to be told what to do but learned to keep
busy without suggestion from the teacher. Finally she began to assert
herself. She began, rather timidly, to ask to do little things about the
room such as passing paper or helping to serve at lunch. If permission
were refused (as it sometimes was to note its effect upon her and to help
bring out her self-assertion) she would frown and actively show her
displeasure. This was a remarkable reaction, considering her passive-
ness at the beginning of the session. She began to enjoy the companion-
ship of the other children of the class and to laugh and play with them.
She would beg them to remain after school to play with her. She no
longer followed their leadership without protest but began to assert
herself and even occasionally to boss, rather timidly, the younger chil-
dren.
In the restoration class it was found that in number work she could
do addition without carrying and subtraction without borrowing and
knew her multiplication tables through the threes. But, although she
knew the number combinations well, she confused one process with
another, adding, for instance, instead of multiplying. She also had
great difficulty in solving problems in addition, subtraction and multi-
plication. She was given addition and subtraction concretely, to teach
her the meaning of the processes. It seemed probable that the arith-
metic in the school Jennie had attended had been too abstract and she
had not been made to understand the fundamental operations in arith-
metic. She was slow in comprehending arithmetic and easily confused.
Moreover, she was considered by the school to be ready for fourth grade
although her arithmetic was barely third grade. She had been allowed
to go on without conquering the fundamentals of arithmetic. As a
result, she disliked the subject. Moreover, she had had no opportunity
at home to apply the arithmetic she had learned. She had never been
sent to the store, and had difficulty in distinguishing even the more
common coins from each other. She was easily confused in class les-
sons but made better progress with individual instruction. On the
whole, her progress in arithmetic during the session was very satis-
factory.
40 THE PROBLEM OF RESTORATION
Her reading was good except for her reproductions. She was shy
about expressing herself and responded briefly to questions. But her
reproductions, although scanty, showed intelligence and thought.
Her spelling was good, her mistakes logical. In oral language she
showed the same diffidence about expressing herself. There was some
improvement in this respect during the session. Written language was
better than oral.
In handwork she was awkward and lacked energy and physical
strength. She was keenly interested in it, however, and showed good
persistence. There was a slight improvement in her co-ordination and
energy during the session. In the physical exercises her movements
were at first slow and uncertain and deficient in energy. She was
unable to raise her arms to the level of her shoulders or to lift her heels
from the floor. She was almost wholly dependent upon imitation, was
easily confused and unable to keep up with the class. As she became
more familiar with the movements she gained confidence, was less
easily confused, her movements gained in energy and strength and she
was better able to keep up with the class. She showed good concen-
tration of attention and good persistence. Her rhythm in the folk
dancing was very good. In the games she was awkward and self-
conscious.
Jennie's home is an excellent one of the upper middle class. Her
father is a retired merchant. The father and mother are devoted to
her and spend much time and thought upon her care and education.
The father has collected quite a library of books on the care of children
including both physical and mental care. She has been much with older
people and has had almost no companions of her own age. In fact
she is the product of too much care. She is merely the expression of
her father's theories as to what a child should be. She eats shredded
wheat biscuit for breakfast, not because she likes them — she does not —
but because her father likes them and thinks they are good for little
girls. She is quiet and well-behaved because that is her parents' ideal
of a little girl. In fact all of her initiative and individuality have been
suppressed by contact with stronger individualities. Everything has
been decided for her. She has had no freedom, no chance to think for
herself, no opportunity for self-development. She seemed quite a
colorless child.
Mentally there is a retardation of over a year by the Binet-Simon
scale. The errors were chiefly with tests requiring manual skill, facility
of expression or arithmetic. She showed much confusion during the
THE PROBLEM OF RESTORATION 41
examination, failing in tests which she later performed with ease. She
performed the tests slowly and deliberately but systematically and with
intelligence.
There are no serious specific defects in the three fundamental pro-
cesses of attention, imagination and memory. She has sufficient analy-
tic concentration of attention and her attention is sufficiently distri-
buted although easily distracted. Her memory is excellent both in
retentiveness and trainability. Imageability and associability are
sufficient and her imagination is complex. Her powers of observation
are good and her intelligence normal. Her understanding is generally
good, although somewhat slow in arithmetic. This has been aggra-
vated by her defective vision, poor teaching and the fact that her environ-
ment has not demanded arithmetic. Her father asserts that a woman
does not need arithmetic anyway! But the limitation in the range of her
comprehension is not sufficient to prevent her learning arithmetic if
properly taught. Her progress during the summer warrants that belief.
Jennie's lack of opportunity for self-development explains many of
her defects. It explains her lack of initiative and poise, her deficient
vivacity of movement and alertness of attention, and her difficulty in
expressing herself. Lack of companionship with other children accounts
for her deficient interest in children's games as also for her unusual inter-
est in music, books and pictures.
Her physical condition, resulting from malnutrition in infancy and
the severe attack of typhoid account for her awkwardness in anything
requiring manual skill, her inco-ordination and poor control of move-
ment. She has had little opportunity to improve her co-ordination and
control as there is no manual training in the school which she attends
and she has played little with other children. That these defects can
be considerably modified seems probable from her improvement, slight
as it was during the summer.
Jennie, then, I believe to be a restoration case. She has no serious
congenital defects and many of her defects can be explained by her
physical condition and her environment. Her general level is probably
slightly below the average. Had she been average or a little above she
might successfully have resisted the suppression of her personality.
But I feel sure that her general level is high enough so that, in the right
kind of environment she would have developed sufficient poise, initia-
tive, etc. Had her parents had less time to devote to her, had she been
thrown more upon her own resources and had the companionship of
children of her own age, she would not now be retarded.
42 THE PROBLEM OF RESTORATION
To overcome the effects of her physical condition and her environ-
ment she needs a special kind of treatment, manual work and physical
exercises to overcome her inco-ordination and lack of control of move-
ment and freedom to develop personality, initiative, poise, vivacity,
etc. This freedom she cannot get in her home. At the suggestion of
the Clinic she was placed in a private school in a city near her home.
She boarded with a friend of her mother's in the city. The home afforded
her more freedom and the companionship of another girl a little older
than herself. The school offered her further companionship with other
children and was small enough to make individual instruction possible.
Her progress during her year in this school has been favorable and seems
to justify a favorable prognosis in her case.
THE PROBLEM OF RESTORATION 43
GABRIEL K.
Gabriel was brought to the Clinic in 1914 by his mother because she
wished advice as to his training. He was an attractive little Syrian
boy with black hair and large, brown eyes. At the age of one year he
had had a severe attack of polio-myelitis, the effects of which were
still noticeable in the limp in both legs and in his slow movements.
He was flat-footed and wore anatomic shoes. Gabriel's health had
always been good with the exception of the polio-myelitis.
No specific mental defects were revealed in the mental examination
except that the mental reactions were somewhat sluggish and he seemed
unimaginative and practical. His age at this time was five years and
four months.
Gabriel attended the Montessori class conducted by the Psychology
Department in the summer of 1914. At first he seemed a very dis-
couraging case. He showed almost no initiative, lacked strength and
energy and was very obstinate. His attention was not persistent.
Comprehension was slow and he fatigued quickly. But during the six
weeks there was a marked improvement. His concentration of attention
improved, his attention became more persistent and he developed some
initiative, although still very imitative. His comprehension improved
and he developed better co-ordination of movement.
Gabriel's improvement during the six weeks was so favorable that
in 1915 he was admitted to the restoration class in spite of his age which
was only six years and five months. It was found in the restoration
class that Gabriel had no idea of obedience and was still very obstinate.
He showed the same deficiency in initiative that he had shown in the
Montessori class the year before. He seemed unable to find anything
to do for himself but waited to be amused. The emphasis in Gabriel's
case was placed on discipline rather than upon academic work. An
attempt was made to teach him obedience and to arouse him to make
some effort for himself. This attempt was fairly successful. From a
sullen, obstinate child with almost no initiative he developed into an
obedient, happy child capable of keeping himself busy.
His progress in academic work was satisfactory. He learned to
recognize the numbers 1, 2, 3, written on cards and to select the cor-
responding number of objects. He learned to fill in Montessori insets
with colored crayons. Finally, from the circle an apple was developed
by adding a stem to the circle. Then from the apple an "a" developed
44 THE PROBLEM OF RESTORATION
and this led to other letters, "d," "g," etc. By the end of the session
he could recognize and write from memory several words. While his
progress was not rapid he gave the impression of being a normal boy
slightly below the average but capable of making normal school progress.
In the fall following Gabriel's attendance upon the restoration class
he was placed by his mother in a small, private school. From the
reports of his work at the school received through his mother he seems
to have made satisfactory progress there with normal children.
Gabriel's birth was normal in every way although his mother was
very nervous during her pregnancy. He was slow in walking as a
result of the polio-myelitis. He talked at the usual time and had no
difficulty in teething. There have been no miscarriages in the family.
There is one other child in the family, a girl of four, who seems normal
in every way.
Gabriel's mother stuttered as a child. Otherwise, the family his-
tory is negative. The father deserted the family for a time but has
returned. He has never been much help in supporting the family.
The mother has supported the children by boarding and caring for other
children. The mother, while she gives the child good care, is not very
intelligent and her discipline is neither firm nor consistent.
Gabriel is deficient in energy and his mental processes are slow.
He fatigues quickly. His analytic concentration of attention is suf-
ficient but his attention is not persistent. This is probably due to
inadequate discipline as his persistent concentration of attention is
fair when he is interested. His attention is sufficiently distributed
but not very alert. His range of interests is somewhat limited.
Movements are not well-controlled nor co-ordinated, and he is very
deficient in initiative. Moreover, his responses lack complexity and
vivacity. His imageability is normal but his imagination is not as
fanciful as it should be at his age. His powers of observation- seem
normal as also his understanding. He has sufficient intelligence. His
retentiveness is normal and his memory trainable. Sensitivity is normal.
Gabriel's chief defects, then, are in vitality, persistent concentra-
tion of attention, range of interests, control and co-ordination of move-
ment, initiative and imagination. Mental processes are slow. The
deficiency in vitality is slight and is due to his physical condition. The
effects of the polio-myelitis are noticeable in his poor control and co-
ordination of movement. But that this deficient control and co-ordina-
tion of movement can be much improved by manual work and physical
exercises was indicated by the summer's observation. The remaining
THE PROBLEM OF RESTORATION 45
defects in attention, initiative and the limitation in range of interests
seem to me to be partly accounted for by the lax, inconsistent and
unintelligent discipline in the home. In the restoration class where
he was encouraged and sometimes forced to think for himself he became
interested, happy, busy and capable of applying himself to a task and of
finding something to do for himself. This favorable response to the
freedom of the restoration class makes me hopeful of Gabriel as a res-
toration case under proper environmental conditions. His satisfactory
progress in the private school in which he has been placed makes me
still more hopeful.
It is probable that Gabriel's heredity is not especially high but that
by birth he is "low normal." His mental condition has been com-
plicated by the effects of the polio-myelitis and by the wrong kind of
discipline in the home. With good care and adequate discipline he
should be able to make normal progress in school.
46 THE PROBLEM OF RESTORATION
GLADYS K.
Gladys was sent to the Clinic in April, 1915 by one of the hospitals
in the city because of her school backwardness. Her age was then
eleven years. Gladys had entered school late because of an attack of
scarlet fever at the age of five years. She began to go to school at the
age of seven, entering the first grade. During her first semester at
school, she was absent a great deal because of an attack of pleural pneu-
monia. The following term she re-entered the first grade in another
school, spending two terms and a part of a third in the lower first grade,
then the rest of the term and another term in the upper first grade. She
spent one term in the lower second grade; then, upon the mother's
request, was promoted to the upper second grade. In the upper second
she obtained as good reports, the mother said, as she had received in the
lower second grade. After spending a year and a half in the upper
second grade, she was promoted to the lower third grade. But, after
three weeks in the lower third grade, it was found that she could not
do the work and she was demoted to the second grade. Her atten-
dance at school had been regular and her conduct good except that
she was inclined to talk a good deal. Reading and spelling were good
and writing fair but in number work she was very slow, in fact seemed
quite unable to grasp it. The mother felt that the teacher neglected
Gladys, not calling upon her to recite.
Gladys played with children the same age and got along well with
them, not allowing them to impose upon her. She had an "intimate"
friend of twelve, another of seven. She had many playmates but her
mother did not allow her to play much with other children. At home
she was irritable, frequently losing her temper. She had nervous habits
like brushing back her hair, playing with her handkerchief, etc. She
seemed quite normal in her play life, playing with dolls, school, etc.
She played the piano by ear. Her mother helped her to dress although
she was able to dress herself.
Her health was good except for her nervous irritability. There
was no enuresis. She had not yet reached puberty. She had had
pleural pneumonia once and measles three times but with no serious
after-effects. After scarlet fever she had had a running ear and had
been deaf for three weeks but recovery had been complete and her
hearing was at this tune excellent.
THE PROBLEM OF RESTORATION 47
Birth was instrumental but labor was short, she was not partially
asphyxiated, was not a blue baby and cried immediately after birth.
There is a possibility that her birth was about two weeks premature.
She was a healthy baby, not troublesome and in every way like other
children. She walked and talked at the usual time and cut her first
tooth at the age of eight months.
There is one other child in the family, a baby of seven months who
appears to be normal. When Gladys was twenty months old the mother
had a miscarriage, supposedly because of her weakened condition after
typhoid malaria. The family history as reported is negative. Both
the father and the mother are stout. The father is an X-ray manu-
facturer. The home is very comfortable and is attractively furnished.
In the mental examination Gladys seemed at times to become con-
fused and not to understand what was expected of her. Her auditory
memory span was limited to four digits. She read fairly well from a
second reader, and read a simple passage in a fifth reader but her repro-
duction of what she read was very meagre. One or two new words
read in the first line of a story were forgotten by the third line. There
were other evidences of defective retentiveness. In making change she
hesitated and upon questioning it was discovered she had forgotten the
amount asked for. Her time was long in the mechanical tests but she
seemed to comprehend the idea of the test without a greal deal of dif-
ficulty. Her mental age by the Binet scale was eight years. Diagnosis
was deferred and it was decided to observe her in the 1915 restoration
class.
In June Gladys was promoted to the lower third grade although
the teacher was very doubtful as to what Gladys would be able to do
in the third grade. Gladys' mother had been drilling her on the multi-
plication tables so Gladys was able to multiply and divide but could
not add and subtract. She did not know the combinations in addition
and subtraction and had to count them up on her fingers.
When Gladys entered the restoration class her age was eleven years
and three months. She was very talkative and sociable with the other
children and got along well with them. In the class she was apparently
interested and occupied but accomplished very little. She answered
questions at random and was not at all troubled when her attention
was called to a mistake. Her mental attitude toward herself and her
work was one of complete satisfaction, whether her work were poor or
good. She seemed incapable of concentration.
48 THE PROBLEM OF RESTORATION
Her reading was fair third grade level but, if questioned as to the
meaning of a passage read she had no grasp of it and could only
reproduce it if questioned step by step. Her spelling was fair third
grade level.
Gladys' number work was only second grade level and poor. In
adding she frequently forgot to carry. She knew her multiplication
tables but had difficulty in applying them to examples in multiplication.
She was unable to apply her arithmetic to problem work. Any new
process she comprehended slowly and had to be taught but one step
at a time.
In the physical exercises the movements were energetic and forceful
and her attention and interest good. Her movements were, however,
largely imitative.
Her chief defects are in understanding and intelligence. Associa-
bility is very defective as indicated by the auditory memory span of
only four digits. Her retentiveness is only fair and her memory not
very trainable. She is quite deficient in analytic concentration of
attention. Her attention is sufficiently distributed but not very per-
sistent. Her movements are well controlled and co-ordinated and her
initiative is sufficient but her responses are not complex. Mental pro-
cesses are very slow. Vitality seems to be normal.
Gladys is not a restoration case. She is incapable of making normal
progress in school and can never reach the general level of a seventh
grade pupil.
THE PROBLEM OF RESTORATION 49
ELIZABETH R.
Elizabeth was first brought to the Clinic in September, 1914 by the
superintendent of a home for delinquent girls. She was brought for
advice and diagnosis because of her backwardness in school and because
she was reported to be stubborn and wilful. She was then about twelve
years old, there being some doubt as to the date of her birth.
Her history is an interesting one. Nothing is known of the brith
and babyhood history. In 1910 the family was reported to a charity
organization in Philadelphia by Elizabeth's grandmother because the
father was not caring properly for his family and because the children
were hungry most of the time. The relatives were unable to assist
and were distressed because of the neglect. The family was supervised
by the charity organization for a year and, as there was marked improve-
ment in the living conditions, the case was dropped. In 1912 there was
a new complaint. The neighbors reported that the mother drank,
was profane and quite incapable of caring for children. As a result of
the investigation of the home the parents were arrested. As the father
was a steady worker he was allowed to go on suspended sentence. The
mother was sent to the House of Correction and the children placed in
the custody of the charity organization. Elizabeth was placed in an
institution for the care of dependent children and, after a short time
transferred to another similar institution. Here she was reported to
be stubborn and wilful and to have a demoralizing effect upon the other
children. So in January, 1914 she was transferred to an institution for
incorrigible but not immoral girls and was still an inmate of this home
at the time of the examination at the Clinic.
There were seven other children in the family. Little is known
of them except that one boy has been reported since to swear, lie and
steal. No abnormalities have been reported in the family.
In the home Elizabeth was affectionate and gave little trouble in
discipline except that she was occasionally disobedient. She got along
well with the other girls and did not allow them to impose upon her.
She was quick and alert but inclined to be irresponsible.
Her health seemed good except for a succession of styes. During
the summer she had had a running ear.
Her school life had been so irregular that her school history did not
throw much light upon the case. The last time she had attended public
school she had been in the second grade. She was attending school in
50 THE PROBLEM OF RESTORATION
the home but, as she had been in the institution so short a time, there
had not been much time for observation. She seemed to memorize
readily but to forget quickly.
The physical examination revealed a retardation in both height and
weight of from one to two years. Measurement of her head showed
her to be both microcephalic and dolichocephalic. She was left-handed.
The superintendent of the home reported that she had not yet reached
puberty.
She read easily from a second reader but her reproduction of what
she read was scanty and meager. She was unable to accurately perform
the fundamental operations in arithmetic. Her auditory memory span
was limited to five digits. By the Binet-Simon scale there was a mental
retardation of from one to two years. It was felt as a result of the
examination that mentally Elizabeth was below standard although not
feebleminded.
In May, 1915 Elizabeth was brought to the Clinic for a second
examination. Her age was then thirteen years and four months. Her
mental age by the Binet-Simon scale was twelve years. Her auditory
memory span was only four digits. Her school work was about third
grade level. The institution reported her troublesome, hard to manage
and not affected by punishment. The previous diagnosis was confirmed
and it was decided to admit Elizabeth to the 1915 restoration class for
observation.
Elizabeth had made practically no progress in school work since
being admitted to the institution, although she attended school regularly.
She was doing only first grade work, it was reported. She seemed to
grasp things quickly but did not retain them and showed no ability
in any special line. Punishment made little impression upon her.
She did not hold resentment against those who punished her, in fact
seemed to have completely forgotten the punishment after about five
minutes. Threats were unavailing. She seemed childish in both
her play and her mischief. She was never impertinent nor saucy. She
craved attention even to the extent of occasionally hurting her finger
in order to get sympathy. She seemed to have no sense of pride or
shame. She seemed, not immoral, but unmoral.
In the restoration class Elizabeth was obedient, happy and very-
responsive. She was affectionate with the other children and enjoyed
their companionship. Her craving for affection was at times pathetic.
Her desire to attract attention often made her self-conscious. She was
easily influenced and very fond of approbation. She was inclined to
THE PROBLEM OF RESTORATION 51
be careless and irresponsible and to shirk a task, such as setting the
table. But, if given definite tasks to perform for which she alone was
responsible she did them quickly and well. She had to be forced to
depend upon herself. She needed considerable restraint and much
supervision as with too much freedom she grew more careless and
irresponsible. She tried hard at grade work and always finished it
without being watched. If allowed to choose her own work, however,
she chose the easier things to do. Her attention was easily distracted;
she seemed incapable of concentrated attention. She was fond of
talking and of answering questions but answered impulsively without
stopping to think. If forced to stop and think out her answers she was
capable of doing so. She had plenty of initiative and could always find
something to do for herself, although her choice was not always wise.
For a girl of thirteen she seemed very childish.
Her reading was good third grade level. Her reproductions were
full, even voluble and given in a very interesting way. She spelled
during the summer review words from a third grade speller, obtaining
marks always above 90. Her language work was exceptionally good for
third grade both in written and oral work. She told and wrote stories
very well, usually choosing fairy stories she had read. She often re-
peated the exact words of the story, interspersing the words of the book
with words of her own choosing.
In number work she could add but needed further drill in carrying.
She had to be taught borrowing in subtraction. In multiplication she
needed further drill. Her comprehension of any new point was slow
and she needed more drill than the average pupil.
Her handwork was good for a beginner both in weaving and in
basketry. In the physical exercises she was not especially interested,
gave poor attention and was inclined to shirk, although able to do the
exercises well when forced. Her movements lacked energy.
Her attention was deficient in both analytic and persistent concen-
tration but was well-distributed and sufficiently alert. Her range of
interests was restricted, her interests being those of a younger child.
Her movements were well-controlled and co-ordinated and she had
plenty of initiative but her choice of what to do was not always wise.
Imageability was sufficient but associability very deficient, her auditory
memory span being only four. This made learning very slow for her.
Her imagination lacked complexity. Her powers of observation seemed
to be very good. Understanding was a little slow and intelligence some-
what defective. Retentiveness seemed fair although the reports of the
52 THE PROBLEM OF RESTORATION
home were unfavorable on this point. But her most serious defect was
her irresponsibility and inability to take care of herself.
Although Elizabeth will never make up her grade retardation she
can probably be trained to earn her own living by some light industrial
work such as sewing or caring for children. But she will need close
supervision and firm though kindly discipline. She would be easy to
manage through her love of approbation and craving for affection. But
these conditions amount to partial segregation, so Elizabeth is not a
restoration case.
THE PROBLEM OF RESTORATION 53
HENRY S.
Henry first came to us in March, 1915 when he was almost fourteen
years old. He was brought to the Clinic by his father because of his
pedagogical retardation and a very serious speech defect. Articulation
was faulty and there was a very bad stammer. The father reported that
Henry was very nervous and that his speech was always worse when
excited or after strenuous exercise such as running or skating. Outside
of school Henry seemed to the father normal although not as bright as
the other children in the family. In doing little things about the house
he seemed as capable as the other children. He got along well with
other children but played with children of his own grade in school who
were of course younger than he was. He was easily imposed upon in
play.
Henry started school late because of his speech defect and attendance
had been irregular due to his nervousness. After six years of school
he was in the upper fourth grade of parochial school. Even then his
lessons were not all of fourth grade level and his father felt that he had
been advanced because of his size. Reading and spelling were very
poor and not over second grade level. Arithmetic was very much
better. Henry was able to do fractions and long division.
Other than the nervous condition which had been diagnosed as
chorea Henry's health was good. The school physician had advised
an operation for the removal of adenoids but the family physician felt
that an operation was not necessary. Henry was a mouth-breather.
Birth was normal in every way. The mother was of a nervous
temperament and was nervous during her pregnancy but was otherwise
healthy. Henry was a healthy baby until he was a year old and began
teething. After this he was delicate and did not grow well. He was
reported by the father to have walked at the age of nine months, but
with uncertainty and with his head forward. He did not talk until
four years old and then poorly.
There were three other children in the family ranging in age from
three years to ten, all apparently normal and healthy with no speech
defects. One child died in infancy of a growth underneath the tongue
of unknown character. This child was an eight-month's baby, delivery
having been brought on by an acute kidney trouble. As reported the
family history is negative. The father is a hatter and appears to be
54 THE PROBLEM OF RESTORATION
intelligent. The home is clean and comfortably furnished although
cluttered with bric-a-brac.
In the physical examination it was found that Henry had a rudimen-
tary uvula, his palate was anemic and the hands cyanosed. The lower
gums were hyertrophied. At the eye clinic it was found that there
was some hypermetropia and glasses were prescribed. The nose and
throat examination revealed a chronic catarrhal rhinitis and naso-
pharyngitis and a small adenoid mass.
The mental examination revealed considerable retardation in reading
and spelling. The articulation was so faulty that it was almost impos-
sible to understand him. His reading was poor second grade level.
He was unable to read very simple written and printed directions such
as " Get up and shut the door and then open it again and then sit down
in the other chair." "Pleasant" he spelled "plesmant," "watch"
"wached," "tan" as "tone." Arithmetic was very much better.
He made change readily and by the correct method. He was able to
solve simple problems if presented orally. By the Courtis arithmetic
tests his arithmetic was third grade level.
Henry seemed intelligent in general conversation and did very well
in some of the mechanical tests. He did the form-board test quickly
and intelligently, arranging the blocks well for rapid placement. He
made two errors in the Healy Completion Test but both were logical
ones. In the Healy Construction Puzzle B. he failed after some effort
but succeeded on the second trial after being shown the blocks in place.
His auditory memory span was six digits. By the Binet-Simon scale
there was a retardation of almost five years.
Henry was diagnosed tentatively as feeble-minded but it was decided
to observe, him in the 1915 restoration class.
When Henry entered the restoration class his age was exactly four-
teen years. In appearance he was very normal, tall and well-nourished,
very likeable and attractive. His disposition was sunny and he was
popular with the other children in the class.
In arithmetic Henry was able to perform all the fundamental opera-
tions and addition, subtraction, multiplication and division of fractions
and mixed numbers. He was quick and accurate. In problem work he
was very much handicapped by his reading difficulty but solved readily
two-step problems presented orally. He was very intelligent about
solving problems, working them in the shortest way and using illustra-
tions to help him. His explanations of his problems showed that he
really understood them.
THE PROBLEM OF RESTORATION 55
He had great difficulty with reading and spelling. His recognition
of words was very poor and his retention of letter combinations very
defective. He was able to get some of the words by the context. He was
helped somewhat by phonics but, because of his faulty articulation,
phonics often could not help him. His reproductions of what he read
were very good and showed thought. His writing was good.
Considering his grade retardation he had a good fund of general
information concerning history and geography facts and points of scien-
tific interest. His vocabulary was good.
He was not interested in the physical exercises or the folk-dancing
largely because he felt them to be "too babyish" for a boy of his size
and age. He was able to interpret the commands, however, and exe-
cuted them well when willing to make the effort. His comprehension
of the commands was good.
He was especially interested in the handwork. During the six
weeks he made a large hammock, a small basket for collar buttons and
a book-rack. He worked quietly and efficiently and with little direction
from the teacher. He planned his work beforehand, displaying indivi-
duality in his planning and intelligence, ingenuity and initiative in the
execution of his plans.
Henry is a very interesting case. Outside of his work in reading and
spelling he made a very favorable impression upon us. He was cer-
tainly intelligent. This was shown in his handwork especially but also
in his solving of problems in arithmetic. Of course his arithmetic was
very much retarded by his grade retardation and reading difficulty but
he was able to solve problems by the shortest method, to use illustra-
tions and diagrams intelligently and to explain his results clearly. Even
in his reading he was intelligent in filling in from the context when he
did not recognize the word or in substituting one word for another he
was unable to articulate. His powers of observation were very good.
He " sized up" the parent of one of the children quite accurately, we
thought. His attitude toward his work was childish. He was not
serious about it and, although self-conscious before the observation
class of teachers, not sufficiently troubled by his own shortcomings.
He seemed in fact proud of himself because of his proficiency in hand-
work and arithmetic. Of course he has lacked the opportunity to com-
pare himself with others of the same age but does not seem ashamed to
accept help in school work from a sister four years younger.
56 THE PROBLEM OF RESTORATION
His chief" defect is his inability to retain letter combinations. This
defect in retentiveness does not seem to extend to number combina-
tions.! His auditory memory span is slightly limited. There are no
defects in attention. His movements are well-controlled and co-
ordinated and he has plenty of initiative.
Because of his defect in retentiveness he cannot learn to read, hence
is uneducable and can never reach the educational level of a seventh
grade pupil. On our present plane of civilization which demands read-
ing as a tool one doubts whether Henry can become self-supporting.
He is of the type of defective which Dr. Witmer calls a ''congenital
illiterate." He is not a restoration case.
THE PROBLEM OF RESTORATION 57
JACOB S.
Jacob was first brought to the Clinic in January, 1915 by a probation
officer because of his backwardness in school. At this time Jacob's
age was eleven years and eight months. He was in the lower third
grade of public school. Jacob had entered school at the age of six
spending two years in each grade. His arithmetic and writing were
reported by the school to be very good but reading and spelling were
poor. His conduct in school was poor. He was reported to be dis-
obedient, careless and inattentive. Attendance at school was very
irregular due to his own illness and that of other members of the family.
He had twice changed schools.
In the home Jacob was giving no trouble except that he got along
poorly with his brothers and sisters. He played with children of the
same age but allowed them to impose upon him. He was very fond of
roller-skating and of riding a bicycle. The family consisted of the
father and mother and six children besides Jacob, ranging in age from
sixteen months to fifteen years. The house was a six-room house but,
as the father kept a second-hand furniture store, most of the house was
used as a storage place for old furniture. Only two rooms were used
for sleeping rooms and one additional room served as a living room in
which the family of nine cooked, ate, played, studied, etc. The house
was dirty and, of course, cluttered with furniture. The parents were
poor, ignorant Jewish people, the children poorly cared for and disci-
pline in the home inadequate.
Jacob's health was fair. Tonsils and adenoids had just been re-
moved. There was no history of enuresis. He had had an infantile
umbilical hernia which had been successfully treated. Later he had
had a scrotal hernia which was reduced by an operation. His palate
was slightly contracted and he had a mild pigeon breast.
The birth history was favorable in every way. He was a healthy
baby, not at all troublesome and walked and talked at the usual time.
The other children in the family seemed to be of normal mentality.
One child had died in infancy of pneumonia. There had been two mis-
carriages in the family. Otherwise the family history as reported was
negative.
In many of the mental tests Jacob did very well. He made change
quickly and intelligently. Associations were very ready; he gave eighty-
one words in three minutes. He solved the Healy Completion test
58 THE PROBLEM OF RESTORATION
quickly giving intelligent reasons for all his placements. His auditory
memory span was five digits ; he succeeded once with six digits and gave
six digits once with one inversion. On the Binet-Simon scale he tested
about at age.
His arithmetic was very good for third grade. H was able to per-
form the fundamental operations quickly and accurately. He was also
able to apply his arithmetic to the solving of quite complicated problems.
It seemed probable that he could have done arithmetic of a higher
grade level had he had instruction in it. Reading was very poor. His
recognition of words was so poor that he was unable to read from a
Primer. He tried to fill in from the context when he did not know a
word or to reason it out from the picture. Spelling was equally poor.
"Now" he spelled "elts," "coat" "klot," "nest" "list." His hearing
was normal. He was able to hear both sentences and separate words
with no difficulty. There was no speech difficulty. Jacob was diagnosed
as a case of congenital word blindness.
In February, 1915 at the suggestion of the Clinic Jacob was trans-
ferred to a special class. Jacob became very much interested in the
drawing and manual work of the special class and did very well in it.
His conduct was still poor. He was reported to be talkative, impudent,
sulky and subject to violent fits of temper.
It was decided to admit Jacob to the 1915 restoration class. His
age at the tune of the opening of the class was twelve years and two
months. He was a tall, thin boy with a dark, sallow complexion and
very bright, brown eyes. He was poorly dressed and often dirty. He
made few advances to the children but responded readily to their
advances. He was fond of the younger children and very kind to them.
He was always amiable and good-natured and gave no trouble in dis-
cipline. He played well with the other children of the class but allowed
them to impose upon him.
Jacob preferred handwork to academic work. If not interested in a
lesson he did not apply himself and practically nothing was accomplished
If interested he would give good attention to a lesson and accomplish
a good deal.
His fund of general information was fair but there were curious
gaps in it. His information was not well organized nor controlled.
He was very fond of weaving, basketry and woodwork and did
fairly good work. He frequently neglected other lessons to do handwork.
His work in arithmetic, spelling and reading confirmed the findings
of the Clinic. He did well in arithmetic although he was retarded
THE PROBLEM OF RESTORATION 59
through his grade retardation and consequent lack of instruction in
arithmetic of a higher grade level. With reading and spelling he could
do almost nothing. He could not retain letter combinations whether pre-
sented visually or orally, hence was unable to recognize words in read-
ing or to spell even the simplest words.
Jacob's chief defect is this specific defect in retentiveness or inability
to retain letter combinations. He seems to have no difficulty in retain-
ing number combinations. His auditory memory span is limited to
five digits but his associability in the free association test was very good
as he gave eighty-one words in three minutes. However, his associa-
tions are not well-controlled as shown by the gaps in his fund of general
information and his sometimes random responses to questioning. His
interests are limited in range; his interest in academic subjects is defi-
cient. Initiative is somewhat deficient. Analytic and persistent con-
centration of attention are normal; his attention is sufficiently distri-
buted but not very alert. His movements are well-controlled and
co-ordinated. There seems to be no defect in imageability. Voco-
motor imagery predominates. Observation and understanding are
sufficient and intelligence fair. Sensitivity is normal.
Jacob is not a restoration case. His inability to retain letter com-
binations makes it impossible for him to ever learn to read and spell,
therefore he can never acquire an education. He is of the type which
Dr. Witmer calls "congenital illiteracy."
60 THE PROBLEM OF RESTORATION
HARRY A.
Harry was first brought to the Clinic in April, 1914 by his grand-
mother because of his backwardness in school. His age at this time
was seven years and ten months. In appearance he was normal, an
attractive Scotch lad with sandy hair and blue eyes. He was a very
active child. At home Harry seemed quite normal in his reactions,
his grandmother reported. He played like other children although
he was more destructive than most children.
Harry had spent three terms in school. He had been promoted to
the second grade but had been unable to do the work, and so was demoted
to the first grade. The teacher complained that he was lazy and wasted
time. He did not like school and had to be almost driven to school.
The class was large and there were only half-day sessions in Harry's
grade.
In the mental examination given at this time no specific defects were
discovered except a red-green color blindness which would of course
not interfere with school progress. The mental retardation as measured
by the Bint-Simon scale was very slight. He read fairly well in a
first reader but mainly from memory of the story rather than by recog-
nition of the separate words. He often filled in the gaps by the context.
Spelling was poor. It was felt that Harry's backwardness in reading
and spelling might be due to lack of careful teaching owing to the size
of the room and the half-day sessions.
The physical examination revealed a slightly protuberant abdomen
and navel. No rupture was apparent. The second teeth were rather
slow in coming. His height and weight were normal for a boy of seven.
The appearance of his skin suggested anemia. The tonsils were seri-
ously hypertrophied and adenoids probable.
Nothing abnormal was revealed by the birth and babyhood history.
He walked and talked at the usual time and seemed in every way like
other children. At the age of four years he was struck by a milk bottle.
He suffered much pain at the time but there was no wound or swelling
and the accident has left no scar. He had had seriously swollen glands
on the right side of the lower neck. He slept well although with his
mouth open. There was no enuresis, but some difficulty in retaining
urine.
No abnormalities were reported in the family. Harry is an only
child. His mother died soon after Harry's birth as the result of a cold
THE PROBLEM OF RESTORATION 61
contracted after her confinement, Harry's maternal grandmother took
him when he was nine weeks old and has taken care of him ever since.
He apparently receives good care. The house is untidy and cluttered
with furniture but is not dirty. Discipline in the home is probaby inade-
quate.
Upon the advice of the Clinic, Harry's tonsils and adenoids were
removed. His grandmother also tried to help him at home with his
school work but she grew impatient with him because of his slow progress
and not much was accomplished.
In May, 1916 Harry was brought again to the Clinic for re-exami-
nation. His school progress had not improved. After spending another
year in the first grade, making five terms in all, he was promoted to
the second grade. After one year in the second grade he was promoted
to the third grade but was unable to do the work and had to be demoted
to the second grade. By this time his age was nine years and eleven
months. By the Binet-Simon scale the mental retardation amounted
to one year and nine months. His reading in the second reader was
only fair and his reproduction of what he read fair. Number work was
no better. He did not know the simplest combinations in addition and
multiplication. Spelling was very poor.
Harry was admitted to the 1916 restoration class for observation.
By this time his age was ten years and one month. His conformity
was poor and he was a very troublesome member of the class. His
lack of self-control was serious. He seemed to be incapable of inhibi-
ting any impulse and so was easily influenced by the other children
in the class. Nor was there any satisfactory response to the freedom
of the restoration class. At the end of the summer session he showed
as little ability to take care of himself and as little effort toward self-
control as he had shown in the beginning. The presense of the observa-
tion class of teachers made him self-conscious and he constantly played
to the gallery.
Writing v/as fair but very careless. Reading was about second
grade level but poor. His poor recognition of words and only fair
articulation resulted in a slow and hesitating expression. Considering
his poor recognition of words his reproduction of what he read was good.
Spelling was very poor. He was unable to retain letter combinations
and was not intelligent enough to be helped by phonics. When the
sounds of the letters were emphasized he was able to recognize a few
of them but could not discover the sounds for himself. He made little
progress in reading and spelling during the summer.
62 THE PROBLEM OF RESTORATION
His progress in number work was no greater. He showed the
same inability to retain number combinations that he had shown with
letter combinations. An attempt was made to teach him multiplica-
cation during the summer but his comprehension was so slow that he
made little progress.
In the physical exercises he was dependent largely upon imitation.
Energy and rhythm were good but attention poor.
Harry's most serious defect is his poor retentiveness which seems
to include both letter and number combinations. His memory of
ideas and events seems fair. His auditory memory span is limited to
five digits and is probably also a factor in his poor memory. From the
observation during the summer it seems probable that his memory
is not trainable. In addition to the defective memory there are serious
defects in attention. Analytic aud persistent concentration of atten-
tion are poor and his attention is not alert. Intelligence is only fair
and is limited in range. Understanding appears to be fair but is some-
what limited in range. Sensitivity is normal except for the red-green
color blindness.
With his defects in memory and attention and with only fair intel-
ligence and with a limitation in range of both intelligence and under-
standing, Harry is incapable of acquiring even the rudiments of an
education and cannot be made self-supporting. With his poor conform-
ity he is even less able to take care of himself. He is then not a restora-
tion case. His defects are probably congenital. There is no evidence
of their being hereditary. Nor is there any retardation shown in the
babyhood history but his defects are of such a nature that they would
probably not reveal themselves until he began to try to learn to read
and write. Inadequate discipline in the home possibly accounts par-
tially for Harry's poor conformity but I am inclined to think that his
poor conformity is due in large measure to his inability to control him-
self.
THE PROBLEM OF RESTORATION 63
BERTHA B.
Bertha was first brought to the Clinic in May, 1913 when she was
almost seven years old. The school reported her lazy and very trouble-
some. She was then in the first grade in school, having entered in Sep-
tember, 1912. Her school work was poor for first grade work. She
could recognize only a few simple words and in number work, although
able to work out simple sums when she applied herself, preferred to
guess at the results.
The father had diabetes and was unable to work much of the time.
The mother supported the family by washing. The house was dirty
and Bertha poorly cared for. Discipline in the home, while severe,
was unintelligent and ineffective.
Bertha showed two years of retardation in height and weight. But
she was well-proportioned in spite of her small size. She had always
been healthy. She had had diphtheria in 1911 followed by a " running
ear" but this trouble had disappeared and her hearing seemed to be
normal. The birth and babyhood history were mostly negative. Birth
was instrumental but labor was easy, she was not injured and suckled
naturally. There is a report of indigestion in infancy, otherwise the
babyhood history is negative. There had been one miscarriage in
the family. Two children died in infancy; the cause of their death
was not known by the mother. The mother was tubercular but re-
ported that her health had been good while carrying Bertha. Other-
wise the family history as reported is negative.
In the mental examination given in May, 1913 Bertha was prompt,
livery and intelligent. She seemed excitable and very talkative. Her
chief defect was her poor attention. Special class was recommended
for her by the Clinic, but the mother refused to give her consent.
In June, 1914 after two years in the first grade Bertha was promoted
to the second grade. In February, 1915 the principal of the school
reported that he had tried Bertha under five different teachers but
without result. In a mental examination given at this time Bertha
showed considerable retardation in school subjects; her school work
was not higher than first grade level. She showed the same defects
of attention she had revealed in the previous examination. It was
decided to enter Bertha as a member of the restoration class of 1915.
When she entered the 1915 restoration class Bertha's age was nine
years and one month. Bertha was a rather troublesome member of
64 THE PROBLEM OF RESTORATION
the class. She had little respect for authority, was always slow to
obey and openly disobedient when she dared. She was very intelli-
gent in figuring out just how far she dared go in defying authority.
When refused permission to do what she wished by one teacher, she
would go to another teacher. She was very responsive when the thing
the class was doing fitted in with her own inclination but, if it did not,
she responded slowly or not at all to class commands. She very much
enjoyed attention and constantly played to the gallery if visitors were
present. By the end of the first day she had established herself as
"boss" of the younger children. She bossed their games, supervised
their physical exercises or taught them to articulate correctly. She
had little respect for the rights of other children but would pull down
their houses in the sand, take their rulers or pegs and work on their
handwork. The younger children did not resent her attitude toward
them but she was very unpopular with the older children.
In academic work she made little progress. Her effort was poor,
she was not interested and her attention was deficient in both analytic
and persistent concentration. In number work she learned a few com-
binations in addition but preferred to answer at random. She learned
the combinations readily when she gave attention to the lesson but
did not give attention unless forced to. She was able to obtain an
answer in addition concretely but, even then, was careless, easily dis-
tracted and more interested in drawing nests of colored eggs on the
board than in using this device to obtain a correct answer.
Her reading was very much better than her number work. She
read easily in a second reader although she made many careless mistakes
because of her inattention. Her interest in her reading often succumbed
to her greater interest in her surroundings. Her reproductions were
good but she drew upon her fancy freely.
Spelling was only fair. This was due to her inattention and lack
of effort. Retentiveness seemed normal but she did not give sufficient
attention to the lesson to learn the words. With words that were
spelled phonetically she had little difficulty.
In oral language she showed good powers of observation and intel-
ligence in her answers to questions. But her imagination was little
controlled by her memory. Written language was poorer than the
oral.
In handwork Bertha accomplished little. She worked intermittently,
discarding her handwork for anything which appealed more to her
interest at the time. Her interest was transitory. She did not con-
THE PROBLEM OF RESTORATION 65
plete even one piece of handwork during the summer. In learning any
new handwork her comprehension was very good. She showed little
planfulness in her handwork. She preferred work which was easy for
her and quickly finished such as stringing beads.
In the physical exercises she was at first largely dependent upon
imitation but, after she had learned the commands, was able to interpret.
Her movements were well controlled and co-ordinated and very ener-
getic but she wasted much energy in superfluous movements. Her
interest soon flagged and she was easily distracted by her surroundings.
She paid little attention to signals but executed the command when it
best suited her convenience to do so. She spent much of her time
bossing the other children and her own work suffered in consequence.
Folk-dancing appealed more to her interests. She learned the steps
readily and changed quickly from one step to another. Her move-
ments were quick and graceful and her attention alert and concentrated.
In the fall following her attendance upon the restoration class,
Bertha was returned to the lower second grade. A decided improve-
ment was noticed in both her conduct and in her work. She made a
very satisfactory effort and sometimes remained after school to ask the
teacher's help. Arithmetic was her only unsatisfactory subject. She
was promoted in February to the upper second grade and in June to the
lower third.
During the year her father had died of a diabetic abscess. Bertha
and her mother were living with a cousin who paid half of the living
expenses. The cousin's wife took care of Bertha and she was much
better cared for than ever before, going to school with clean face and
dress. A baby which had been born in 1914 was living with another
cousin.
During the year Bertha had had considerable trouble with a running
ear, which was causing a slight reduction in hearing. It responded read-
ily to treatment but the family neglected the treatments. By summer
the ear was again in a good condition.
Bertha was addmitted to the 1916 restoration class. Her age was
then ten years and one month. But in spite of the favorable school
report Bertha made a very unfavorable impression upon us. In arith-
metic she was able to add with carrying and subtract with borrowing
but made so many careless mistakes that she rarely obtained the cor-
rect answer. She would add two columns in one, forget to carry, or
borrow where it was not necessary. In problems she added indis-
criminately. Her poor results were due to inattention and poor ap-
66 THE PROBLEM OF RESTORATION
plication. She was not interested in her work and made no serious
effort to accomplish anything.
The same inattention and lack of effort were noticeable in her reading.
Her reading was third grade level but poor. Recognition of words
was fair but seemed poor because of her inattention. She read more
accurately backwards than forwards. Her mistakes were never unin-
telligent ones but she depended upon her imagination to supply the
words where the recognition of the words required an effort on her part.
Her articulation was good and her expression very good, even drama-
tic. Accurate reading of the words was in fact sacrificed to dramatic
expression especially if an audience were present. Her spelling was
even poorer than her reading.
But her poor conduct was even more serious. She made no effort
to control herself. She was not affected by criticism and was immune
to disapproval. Punishments which interfered with her pleasure or
comfort had some effect upon her but the effect was not lasting. She
still craved attention and seemed not to care whether the impression
she was making were favorable or unfavorable provided she was making
an impression. She was bold and forward, played like a boy and had
no modesty.
Bertha's most serious mental defect is her poor analytic and per-
sistent concentration of attention. Attempts to train her attention
for two summers have failed. Her other mental qualities seem suffi-
cient for normal progress. Her memory is not very trainable but not
so much because of poor retentiveness but because of inattention while
learning. Her defect of attention is so serious that it interferes with
learning and makes school progress impossible.
Combined with this defect of attention is her deficient conformity.
Her ideals are low, she lacks self-control and is immune to disapproval.
Her only social instinct seems to be her desire to attract attention. Since
social restraint will be ineffective with Bertha it will make her very
dangerous. Even now she is not a fit associate for other children
especially as she shows so much ability in managing other people. She
would make a good "gang boss" whether the purpose of the gang were
regular or otherwise. Her deficient conformity may be due to poor
environment although the almost entire absence of social instincts
indicates an innate defect. Even if her condition be due to environ-
ment it is now too serious to be corrected by a change in environment.
THE PROBLEM OF RESTORATION 67
Moreover, she will never make up her grade retardation because of
her defective attention combined with her lack of effort. She is then
not a restoration case as she can be restored neither to sufficient ability
nor conformity. She should be segregated for the benefit of society.
68 THE PROBLEM OF RESTORATION
HENRY B.
Henry was first brought to the Clinic by a social worker in October,
1910 when he was three years old because of failure to talk and general
backwardness. He was able to say only a few words such as "papa,"
"mama" and "dada" and some of these were articulated in a high,
unnatural voice. He understood what was said to him and seemed
bright and intelligent in the examination. He learned readily how
to blow but would make no effort at any of the elements of articulation.
The family is English and have been in this country only two years.
During this time the charity organization has assisted the family finan-
cially and helped the father and mother to find employment. The
mother is respectable and a good mother and has tried to manage her
household on the small wages earned by her husband. The character
of the man is not so good; he drinks and is able to earn only a small wage.
The social worker reported that Harry had been "backward" from
birth. She gave no information concerning his birth or babyhood.
Mrs. B. was pregnant at the time of the examination and Harry, being
a troublesome child, made her very nervous, so she had applied for
institutional care for him during her confinement. There was an older
child, a girl of five years whom the father was willing to care for. Harry
had been placed in a small boarding home.
As Harry had seemed bright and intelligent during the examination
it was felt that speech training would be advisable for him and he was
entered in the speech clinic of the Department. The speech training
was continued until May, 1911 when his speech had unproved very
much although somewhat indistinct. He could imitate nearly every word
he heard. At this time the case was closed.
In February, 1911 soon after Harry first came to the Clinic the
charity organization found it necessary to break up the family. Mr. B.
had been drinking heavily and had stolen a sum of money. Harry
remained at the boarding home.
In November, 1913 the caretaker who still had charge of Harry
reported that he was in the first grade in school and was doing nicely
and talking well. He seemed like other children, full of life but thought-
ful. He stammered at times. It was reported that the mother had
also stammered. The father was now in prison on a six months' sentence.
Henry was not seen again by the Clinic until February, 1916 when
he was eight years and six months in age. He was then in the upper
THE PROBLEM OF RESTORATION 69
second grade. His attendance at school had been rather irregular
because his home had been frequently changed. He had spent one
year in the first grade, three terms in the lower second grade and this
was his first term in the upper second grade. His school reports had
been good until a short time previous to this visit when they had gone
down. He had been influenced by other boys to play in vacant lots
and had often been late for school. He was restless in school and the
teacher was impatient with him.
In the mental examination given in February, 1916 Henry revealed
several specific mental defects, a deficiency in comprehension and in
intelligence, a limited memory span and a possible defect in retentive-
ness. On the basis of this examination it was decided to admit him to
the 1916 restoration class.
In July when the restoration class opened, Henry's age was eight
years and eleven months. He was tall for his age, one year accelerated
in both height and weight. His hair was brown and his eyes dark. His
head was rachitic, his face narrow and his ears large and ill-shaped.
Circulation was poor as indicated by the pallor of his face, the rough
skin and cyanosis of the hands. He was very nervous, unable to stand
or sit still with constant choreiform movements. His nervous condi-
tion had been diagnosed at the Hospital as habit spasms. His eyes were
hypermetropic but had been refracted in February.
Harry was very troublesome in the restoration class. He constantly
annoyed the other children and interfered with their rights, making
himself very unpopular with them. He seemed unable to take care of
himself and quite lacking in self-control.
His writing was poor and untidy and showed poor co-ordination
and control of movement. Reading was high first grade level. Recog-
nition of words was only fair and he frequently misread words he knew
due to his poor analytic concentration of attention. Expression was
slow and halting, articulation only fair and his reproductions meagre
and scanty. Spelling was poor, partly due to his poor attention during
class lessons and partly due to his deficient retentiveness.
In number work he could add and subtract without carrying or
borrowing. But, due to his poor analytic concentration of attention,
he was very careless. He often added the digits of both columns in one
column. He comprehended a new process readily but his retention
was not so good. His work in the physical exercises was variable. It
was good when he gave his attention to the commands but it was not
70 THE PROBLEM OP RESTORATION
often that he made the effort. His energy and his rhythm were good
and he comprehended new commands readily.
His speech was careless. He could articulate the words correctly
but made no effort to do so. He omitted final consonants and made
many substitutions.
Harry's attention is very deficient both in analytic and persistent
concentration and in alertness. His memory span is limited and his
memory is not retentive. He does not lack initiative and his compre-
hension is sufficient but his intelligence is defective and his vitality
poor. He is markedly deficient in self-control. With this combina-
tion of mental defects Harry is not capable of acquiring the educational
level of a seventh grade pupil, hence is not a restoration case. He is
not qualitatively like a feeble-minded child but is probably a type of
choreic defective. His poor early environment and neglect may have
been a factor in his nervous condition and it is probable that the heredity
is not particularly favorable.
THE PROBLEM OF RESTORATION 71
CHARLES Cv.
Charles was first brought to the Clinic in July, 1915 by his father
who was worried because Charles was so retarded pedagogically and who
wished advice as to physical care for him. His age was then nine years
and eight months. Charles had been promoted in June to the lower
third grade. He had entered school at the age of six but had several
times failed of promotion. Three times he had changed schools. Read-
ing and spelling were fair, arithmetic and writing poor. Conduct in
school was reported to be fair, effort poor. The teacher reported that
Charles was lazy and seemed to be in a trance.
Charles' general physical condition was reported to be good. His
tonsils and adenoids had been removed four years previously. He
had almost died under the anaesthetic. Early in 1914 Charles had
been kicked in the back by a large boy wearing skates. As a result
of the accident the left leg was paralyzed for two weeks from the hip
down. At the time of the examination the left leg was about a half
inch shorter than the right one. He had no pain in his back except
when hit, but often had a pricking sensation in the left leg. An opera-
tion on the right side of the brain had been advised by the orthopedic
surgeon 'consulted but the father had opposed the operation. Charles
had a spinal curvature which he was said to have had from birth. No
serious illnesses were reported. He had broken his collar-bone three
years previously but no serious consequences had been noted.
Birth and babyhood had been normal in every way. There were
two other children in the family, a boy of eight and one of six, both
apparently normal. The mother had died of uterine inflammation
following a cold. In June, 1914 the children were entered in an orphan
home. In the orphanage Charles was reported to be normal in every
way. He played quite normally with children of his own age, racing and
romping. His back was easily injured.
In the physical examination at the Clinic it was found that there
was a slight spastic contracture of the left arm. His station was un-
steady but he was able to stand on either leg, although the left leg
was considerably weaker than the right. There was a slight lordosis.
The shoulder blades were stooped, the right lower than the left. There
were several slight stigmata, a protuberant obdomen, outstanding ears,
a sloping forehead and a tongue abnormally large which most of the
time hung out of his mouth giving him an unfavorable appearance.
72 THE PROBLEM OF RESTORATION
No specific mental defects were revealed in the mental examination,
and it was felt that Charles' lack of progress might be due to his physi-
cal condition and to the fact that he was attending school for only half-
time sessions. It was recommended that he be given out-door exer-
cise and possibly work in the orthopedic gymnasium if it seemed advisa-
ble.
The orthopedic dispensary advised no gymnasium work but that
his condition be left to nature.
In May, 1916 Charles was re-examined at the Clinic. His age was
then ten years and seven months. Charles was repeating the work of
the lower third grade and his work in that grade was only fair. The
teacher said he was lazy and would sit with his mouth open and tongue
hanging out as if in a trance. Spelling and reading were especially poor.
Charles' father had remarried about six months previous to this
second examination of Charles. The stepmother seemed fairly intel-
ligent and interested in the children's welfare. The house was clean,
well-furnished and attractive.
In the mental examination Charles showed considerable retarda-
tion in reading, spelling and number work. He read fairly well in a
second reader, reading the words correctly but with poor expression.
Spelling was poor. By the Courtis tests his arithmetic was second
grade level and below. He was able to solve simple problems but was
very slow in obtaining a correct answer. Although more doubt was felt
of Charles' mental status than in the previous examination no definite
conclusion was reached and it was decided to enter him in the 1916
restoration class for observation.
Charles was ten years and eight months in age when he entered the
restoration class. He had been promoted in June to upper third grade.
He was a very quiet and well-behaved boy and well-liked by the other
children. Usually he was good natured but he had occasional sullen
spells. He seemed quite deficient at first in both initiative and courage,
As a result of the freedom of the restoration class he developed some
initiative by the end of the session. His timidity we felt to be closely
related to his physical condition. Charles' work varied very much
from day to day. On some days he worked hard and accomplished much.
On other days he accomplished practically nothing. This, too, was
probably closely related to his physical condition.
His reading was good high second grade level. Recognition of words
was good, expression fair and reproduction good. His fund of general
information was that of a high second or low third grade boy. Spell-
ing also was good second grade level.
THE PROBLEM OF RESTORATION 73
In number work he was able to do addition with carrying, subtraction
v.ith borrowing and multiplication by one digit. He knew the process
of division but needed further drill to get the correct result. His com-
prehension in any new step was very slow and he very easily became
confused. He needed further drill in solving simple problems. His
understanding was slow and probably deficient and he was not intel-
ligent in interpreting problems.
In the physical exercises he gave good attention and his movements
were forceful. Understanding was slow and he was slow in learning
new commands. Rate of movement was so slow that he had difficulty
in keeping up with the class. In the swimming he accomplished little
as he was afraid to go into the water and considerable urging was nece-
sary to persuade him to go in.
Charles' chief defect is the slowness of all his mental processes.
Comprehension is very slow, probably deficient and intelligence less
than fair. Attention is sufficient and retentiveness good. The limi-
tation of his auditory memory span to five digits indicates a defect
in associability which is probably of significance in accounting for his
slow learning. Movements are sufficiently controlled and co-ordinated.
Vitality is deficient and he lacks initiative.
It is the slowness of the mental processes and consequent slow learn-
ing which account for Charles' slow progress. His work is fair in quality
for the grade he is in but at almost eleven years of age he is only in the
third grade. He is a proficient second or low third grade pupil but
at his age he should be at least a proficient fourth grade pupil. As
his slow mental processes make progress so slow it seems unlikely that
he will be able to complete the sixth grade by the time he is sixteen.
It has taken him over four years to complete two grades so it is probable
that he cannot complete the remaining three and a half grades in the
five years left to him.
His poor physical condition may account somewhat for his slow
progress but I am inclined to think his slow progress is due to a defective
nervous sytem, one not sufficiently permeable to new impressions. This
condition of the nervous system is probably innate, as indicated by
the many stigmata, although it may have been induced by the injury
noted above. I am very doubtful of Charles' ultimate restoration.
74 THE PROBLEM OF RESTORATION
EDWARD D.
Edward was referred to the Clinic by one of the hospitals in Phila-
delphia because of pedagogical backwardness and the report of i poor
memory. He had entered public school at the age of six years, spending
two years in the first grade and a year in the lower second grade. In
June, 1916 he was promoted to the upper second grade. Attendance
at school had always been regular and his conduct in school good. The
teacher reported that Edward forgot his arithmetic and spelling .
Edward's health was good except for occasional headaches. Ton-
sils and adenoids had been removed. The genital development was
slightly minus.
Edward did not walk until he was twenty months old but he was
a fat, heavy baby. He did not talk until between two and a half and
three years of age. His first tooth he cut at seven months. He was
a healthy baby, not troublesome and seemed in every way like other
children. His birth was normal.
The family history is negative. There are four other living children
in the family, all apparently normal. One child died in infancy of
summer complaint. The house is clean and well-cared for, although
sparsely furnished. The mother seems to be intelligent. Edward is
well-cared for and discipline in the home seems to be adequate.
After a clinical examination Edward was admitted to the restoration
class of 1916. His age at the opening of the class was exactly nine
years. He was a quiet and well-behaved boy, attractive and very normal
in appearance except for an infantile nose which was probably due to
the effects of the adenoids. He was small for his age and measurement
showed that there was a year's retardation in height. He was active
in play and got along well with the other children in the class. At
first he seemed to lack initiative but, as he became acquainted, his
initiative developed.
In the restoration class his writing was found to be good. His
reading was good high second grade level. Spelling was not quite
so good as the reading but was fair low second grade level. His mis-
takes in spelling were logical ones and he was able to use phonics intel-
ligently. In number work he was able to do addition with carrying,
subtraction with borrowing, short division and simple multiplication,
Although slow he was accurate. He was able to solve simple problems
in addition and subtraction.
THE PROBLEM OF RESTORATION 75
In fact Edward gave the impression in the restoration class of being
a very normal boy. Appearance and behavior were favorable. The
quality of his school work was good and he had no special difficulty
with any subject. His comprehension was quick. He was taught
addition with carrying only once and not only comprehended it readily
but retained it well. We failed to find the defect in memory reported
by the school. His mental processes were slow. One often had to
wait for his responses but, when the response came, it was good. This
slow response sometimes gave one the impression on superficial obser-
vation that he had not understood. Memory span, both auditory and
visual were limited. His auditory memory span tested by digits was
five; the visual memory span tested by letters four. This made learning
somewhat slow for Edward and was probably a factor in the slowness
of his mental processes. His intelligence was not defective. He was
intelligent enough to spell phonetically and to apply his arithmetic to
problem work. He was slightly deficient in energy, in alertness of
attention and in vivacity. Other than these defects he had no specific
mental defects. His attention was normal both in analytic and per-
sistent concentration and in distribution. His range of interests was
normal for a boy of nine years. It was not difficult to interest him in
school subjects and he was normally interested in play. His move-
ments were well-controlled and co-ordinated. Imageability was suf-
ficient and his imagination was normally complex for a boy of nine.
Initiative seemed deficient at first but improved as he became better
acquainted. Auditory sensitivity was slightly subnormal for spoken
words but normal as tested with a watch. In the mental examination
Edward tested almost at age on the Binet-Simon scale.
I am inclined to think that Edward is a restoration case. The
history of late talking and walking is against him as is also the slightly
minus genital development. But both of these are too slight to be of
much significance. The lack of school progress and the report of a
poor memory are more serious. However, during the period of obser-
vation in the restoration class, it was found that the quality of Edward's
school work was good, he comprehended new processes readily and re-
tained them well. Of course it is advisable to observe Edward for a
still longer time to test his retentiveness over a longer period. But it
seems possible that his lack of school progress may be accounted for by
his not being given sufficient time for learning in school and allowance
not being made for the slowness of his mental processes. Because
of his limited visual and auditory memory span he needs a little extra
76 THE PROBLEM OF RESTORATION
time for learning. And because his mental processes are somewhat
slower than the average, his responses are a little slow in coming but
are good when they do come. I do not believe that Edward's defects
will prevent his making normal progress in a regular grade provided
the teacher understands his limitations. Even should they retard
progress somewhat, I believe progress will still be rapid enough to make
restoration possible. However, he should be kept under observation
for a few years to test this prognosis.
THE PROBLEM OF RESTORATION 77
WILLIAM F.
William was referred to the Clinic in March, 1915 by the school
principal because of his backwardness in school. His age was then
eleven years and nine months. He was in the upper third grade, having
spent two terms in the upper second grade. This was his second term
in the lower third grade. He had never changed schools but had had
many absences from school because of poor health. His conduct in
school was reported to be poor; he was irritable and made little effort.
His marks were in general poor but he occasionally did good work.
At this time his health was poor. He had an intestinal hemorrhage
and much pain with every movement of the bowels. There were
rectal ulcers which had not responded to treatment. He slept poorly
and did not feel rested upon awaking in the morning. He slept with
his mother and with the windows closed. At the time of the examina-
tion he was on a diet prescribed by the hospital. There was no his-
tory of any serious illnesses. He had a slightly protuberant ab-
domen.
William seemed normal about the home although his mother said
he was " stupid like." He played with children the same age and
got along well with them but he was very sensitive and lost his temper
easily. He was active in play.
The birth and babyhood were normal in every way. There was
one other child in the family who appeared to be normal. One child
had burned to death a year previously. The father was a laborer and
the mother eked out the income by cleaning in the school. While the
mother was not intelligent she seemed to give William good care and
discipline in the home appeared to be adequate. The home, while
sparsely furnished, was clean and well cared for. There had been one
miscarriage in the family, between William and the next child. There
was a history of chorea and heart trouble on the mother's side. Other-
wise, the family history was negative.
In the mental examination, while there was considerable retardation
in school subjects, no serious mental defects were discovered. There
was about two years of mental retardation by the Binet-Simon scale.
It was felt that William was a normal boy, rather dull, whose pedagogi-
cal retardation was fully accounted for by the medical history. It
was recommended that the emphasis be placed in William's case upon
medical care even to the extent of removing him from school if necessary.
78 THE PROBLEM OF RESTORATION
A second examination in November, 1915 confirmed the first diag-
nosis and prognosis. By this time William's physical condition had been
diagnosed by the hospital as hemophilia and had responded considerably
to treatment.
With the improvement in William's physical condition his school
work had improved. He had not been promoted in June, 1915 but
in the fall had tried an examination and been promoted to the lower
fourth grade. He had done well in the lower fourth grade and in Febru-
ary was promoted to the upper fourth grade. He was still backward
in arithmetic but was trying hard. In June, 1916 he was promoted
to the lower fifth grade.
It was decided to admit William to the 1916 restoration class for
observation. He was an attractive boy of thirteen years and one month,
preadolescent and very normal in appearance. He was usually good-
natured but had occasional sullen spells. He was popular with the
other children both with those of the same age and with those younger.
He felt some resentment at being a member of the restoration class
probably because he was a little older than the other members of the
class and felt that he was different from the other children. This feeling
of resentment was very much in his favor, we felt. Because of this
attitude and also because it seemed desirable for his own develop-
ment, William was not often required to enter into class activities but
was left much to himself. Under this treatment he developed a sense
of responsibility and an ability to take care of himself.
Not much attention was given to academic work. His spelling and
reading were good fourth grade level. He was interested in what he
read and read with good expression. He was able to take a book to
his seat and read to himself with evident pleasure in the story. He
had a good fund of general information. In number work he was able
to perform the fundamental operations although inclined to make care-
less errors. He needed further drill on problems on his comprehension
in problem work was slow and he was slightly deficient in reasoning
ability. His handwork was good; he enjoyed it and did it intelligently.
William revealed in the class no specific mental defects except a
slight deficiency in range of intelligence and a slowness of mental pro-
cesses. The observation in the restoration class, then, confirmed the
diagnosis of the Clinic. It is probable that he is too far behind his
grade now to make up his grade retardation but, as his health is so
much improved, can probably make normal progress in the grade he
THE PROBLEM OF RESTORATION 79
is now in even under regular grade conditions. He might do a little
better under special class conditions and, in addition, would have the
greater freedom he needs and the opportunity to do manual work which
he so much enjoys.
William, then, is a dull normal boy whose grade retardation is due
largely to his former poor physical condition. While he cannot make
up his grade retardation he has the ability to take industrial training.
So he can be made self-supporting, hence is a restoration case.
80 THE PROBLEM OF RESTORATION
ARCHIBALD M.
Archibald was sent to the Clinic in March, 1915 by a physician in
Philadelphia who considered him backward and wished Dr. Witmer's
opinion and advice upon the case. Archibald's age was then ten years
and ten months. His general health was poor and he was at the time
being treated for anemia. He had nocturnal enuresis. There was no
history of any serious illness. He was two years accelerated in height
and his height and weight did not correlate, there being a discrepancy
of one year between them.
Archibald was at this time in the lower third grade. He had not
entered school until the age of eight but, except that he had spent
two terms in the lower second grade, school progress had been normal.
His work in the third grade was generally unsatisfactory although the
teacher felt that there had been some improvement since the treatment
for anemia had been begun. His conduct in school was excellent.
The family had noted nothing abnormal in Archibald. He played
with children of the same age and got along well with them although
he allowed them to impose upon him. He liked to help his father who
is a carpenter and seemed very capable.
The birth history is negative. Babyhood was normal except that
he seemed more quiet than most babies. The family history as reported
is negative. The mother's brother did not like school but is now a suc-
cessful carpenter in Australia. The family came to America from
Ireland in 1910. There were four other children in the family who
appeared to be normal in every way.
No specific mental defects were discovered in the mental examination
although Archibald was two years retarded mentally by the Binet-
Simon scale. Arithmetical associations were slow. It was felt that
his physical condition might account for his retardation. An open air
class was recommended with special attention to proper diet.
There was no open air class near Archibald's home so it was not
possible to carry out this recommendation.
Archibald's home is sparsely furnished but clean. His mother
seems to give him good care, to feed him wisely and discipline in the
home appears to be adequate.
Archibald remained in the lower third grade one year and was pro-
moted to the upper third grade in January, 1916. The teacher said
that he was very slow and nervous but that his work was better than
it had been in the fall. In June he was promoted to the lower fourth
grade.
THE PROBLEM OF RESTORATION 81
Archibald was admitted to the 1916 restoration class. His age
was then twelve years and two months. He was a quiet, well-behaved
boy but without spirit or initiative. He was good-natured and well
liked by the other children as he constantly allowed them to impose upon
him. He was very timid and never took his own part in any way. He
was not active in play but preferred to stand aside and watch the other
children play and had to be forced into the games.
His reading was good third grade level. Recognition of words was
good and expression fair. He read with some hesitation. His reading
was rather mechanical than intelligent and his reproductions meagre
and scanty. Spelling was fair.
In number work he could perform the fundamental operations but
with many errors. He was unable to apply the operations to problem
work. Arithmetical associations he formed slowly. An attempt was
made to teach him fractions but his comprehension of any new process
is very deficient. His work in arithmetic was mechanical and he de-
pended upon his memory, not upon his intelligence.
He was not interested in the physical exercises, comprehension was
slow, energy poor and attention only fair. His rate of movement was
very slow. In the swimming he was so timid that it was difficult to
get him to even go into the water.
We were quite convinced by the end of the session that Archibald
was feeble-minded. His defectiveness is quite general. Mental pro-
cesses are very slow, comprehension is deficient and his intelligence
very defective. His memory is retentive and trainable, probably
accounting for his school progress. His attention is sufficient and his
movements well controlled and co-ordinated. Imageability appears
to be normal. Energy is deficient.
The mental condition is probably complicated by his poor physical
condition. His defectiveness may be anemic in origin. There is a
possibility of his mental condition being congenital from the report of
his being an unusually quiet baby. He can probably be taught to
read, write and perform the fundamental operations in arithmetic
although one questions the use of an education to him as he is not intel-
ligent enough to use it as a tool. Ultimately institutional care must be
considered for him.
82 THE PROBLEM OF RESTORATION
HARRY M.
Harry was first brought to the Clinic in October, 1915 by a social
worker because of his pedagogical backwardness and his bad conduct
in school and Sunday-school. His age was then six years and one
month. Harry had just entered school in the fall and had so far made
no progress; every subject was unsatisfactory. His conduct was very
poor. The Kindergarten teacher reported that in her room Harry
had not seemed dull but had been very troublesome.
Harry's mother had not noticed that he was dull before starting to
school. At home he was able to care for himself at the toilet and to
dress himself but his mother usually dressed him as he took so long to
do it. He played with children of his own age and seemed normal and
active in play but did not get along well with other children as he was
quarrelsome and inclined to fight.
Harry's birth was normal in every way. His babyhood history
is favorable and he was a healthy baby except for intestinal indigestion.
His mother reported that his general health was good except that he
was very nervous. He often cried out in his sleep. His temper was
variable. Adenoids and tonsils were removed in January. He had
been circumcised. There was occasional nocturnal enuresis. At the
age of one year he had had a bad fall after which he seemed to be uncon-
scious. At the age of three years he fell again. These two falls seem
significant as now he drags the left leg slightly. He has had no serious
illnesses.
The family history as reported is negative. There have been no
miscarriages. There is one other child, a baby of eleven months who
appears to be normal. The social worker questions the mother's
mentality.
Harry is an attractive child, very normal in appearance. In the
examination he was very nervous and excitable and seemed quite undisci-
plined. The result of the examination was negative, pointing to no one
conclusion. His attention and interest were markedly deficient and
made it difficult to test other mental traits. Auditory memory span
was only three digits. On the Binet-Simon scale there was a mental
retardation of about half a year. He was unable to recognize any words
in the reader and could not count objects correctly because of his poor
attention. He recited several nursery rhymnes and his mother reported
that he learned these readily.
THE PROBLEM OF RESTORATION 83
After the examination Harry was placed in a "special help" class
in the public school. In February he was promoted to the upper first
grade, in June to the lower second grade.
In August, 1916 Harry was re-examined. His behavior during
this examination was especially interesting. He was very excitable
and nervous and made many grimaces. He would run about the room,
playing in the sand pile or with the toys but would soon lose interest
and turn to something else. When asked to put pegs in the pegboard
he said he could not do it but was able to do it when it was insisted
upon. He seemed inclined to do as he pleased but, when told he must
do a thing, was able to do it.
There was some evidence of inco-ordination. His hands trembled
as he tried to place blocks in the form-board. His station was normal.
His gait was normal in walking but showed a poor balance when he
ran about the room. He was not very intelligent in working the tests
but used a trial and error method mostly. Imageability seemed some-
what defective. In the Witmer cylinders he seemed to have little
judgment of depth. But, in the form-board, imageability seemed suf-
ficient.
Attention was still poor. When asked to watch the point of a
pencil his eyes wandered about the room and the effort apparently
fatigued him.
He seemed to have little conception of number. Speech was slo-
venly. He frequently omitted final consonants although able to pro-
nounce them if it was insisted upon.
It was decided to observe Harry for two weeks in the restoration
class. To make the observation for this period more valuable he was
removed from his home and placed in a small boarding- home. In the
boarding-home it was found that Harry was a masturbator. He had
to be watched continually and his hands tied at night. He slept well,
was obedient and played well with the other children in the home. He
dressed himself with the exception of buttoning his shoes. His appe-
tite was poor. The caretaker reported his disposition unsettled.
In the restoration class Harry was inclined to be troublesome. He
had poor self-control and no idea of obedience. He seemed to have
formed the habit of following his impulses without question. He re-
sponded slowly or not at all to signals; commands usually had to be
repeated for him. He would run about the room without permission.
He frequently said " I can't " when he was able to do. In fact he seemed
a quite undisciplined little boy. He was very nervous and excitable,
84 THE PROBLEM OF RESTORATION
paid little attention to class lessons and seemed quite unable to concen-
trate. His effort was poor.
His writing was only fair. He held his pencil in an awkward posi-
tion and his co-ordination and control of movement were poor. His
reading was first grade level. Recognition of words was slow and expres-
sion hesitating. The analytic concentration seemed to account for this
together with the fact that his attention was easily distracted by other
things. His reproduction of what he read was scanty and meagre and
only in response to questioning. He was able to use phonics to help
him in the recognition of words with some help from the teacher.
His spelling was fair high first grade level. He appeared to associate
the sound of the letter with the written letter better than with the spoken
letter. In number work he learned to add simple combinations like
four plus three, five plus two concretely. He was about ready to begin
first grade number work.
Harry's chief defects are his lack of self-control and his poor analytic
and persistent concentration of attention. In addition, his auditory
memory span is very much limited. Vitality is poor, he lacks energy
and is easily fatigued. Control and co-ordination of movement are
poor. Imageability seems to be normal, understanding and intelli-
gence are sufficient. Retentiveness seems to be normal but his memory
is slightly deficient in trainability owing to his limited memory span.
The problem in Harry's case is whether his defects of attention and
self-control are due to his nervous condition and have a physiological
cause or whether both the nervous condition and the mental defects
are due to the poor discipline in the home. The history of the two falls
in infancy together with the possibility of a slight paralysis suggested
by the tendency to drag one leg and the imperfect co-ordination and
control of movement would indicate a physiological cause. On the
other hand his environment has certainly been unfavorable. He seems
to be quite undisciplined and has acquired the habit of following his
impulses without restraint. Can he inhibit his impulses and control
his attention? The only way to decide, it seems to me, is to attempt
to train his attention and self-control. The period of observation in
the restoration class was too short to reach any conclusion. The empha-
sis in the treatment of Harry should be upon the discipline. Discipline
should be firm but kind. To develop a sense of responsibility he should
be given simple, regular tasks. As he fatigues quickly work periods
should be short but he should be held rigidly to the accomplishment of
the tasks assigned. Such a course of training cannot be undertaken
THE PROBLEM OF RESTORATION 85
in his own home as his mother is too unintelligent to direct it. This
kind of treatment, since it involves removal from home, would be
expensive and I am not at all sure that Harry is worth it. From the
scientific side it would be interesting to discover whether restoration is
possible in a case of Harry's type. I must leave Harry as a doubtful
case.
86 THE PROBLEM OF RESTORATION
ALVAH M.
Alvah first came to the Clinic in April, 1913 when his age was eight
years and eleven months. He was sent by the principal of the school
because he was not getting along well in school and was reported to be
disobedient. He was receiving help at home with his lessons but there
was still little improvement in his work.
Alvah was at this time in the lower third grade. He returned to
the Clinic for re-examination in May, 1916 when he was twelve years
old. In that three-year interval he had made just one-half year's pro-
gress in school. The teacher complained that Alvah was very trouble-
some, had a bad temper, no self-control and no powers of concentration.
Alvah was admitted to the 1916 restoration class. His age was then
twelve years and two months. We were immediately impressed with
Alvah's complete satisfaction with himself, his swaggering self-conceit.
It mattered not whether a task was performed poorly or well, Ah ah
was quite satisfied with himself. If corrected in any way he became
sullen. He was inclined to boss and bully the other children in the class
and adopted a very superior and pugnacious attitude toward them but
if his superiority were challenged, he immediately became a coward.
He displayed a bad temper poorly controlled and had frequent sullen
spells with little or no cause. He was somewhat of a hero-worshipper
and easily influenced by those whom he admired. His combination
of qualities made him particularly troublesome in the school-room.
In appearance, Alvah is average height for his age but is rather thin.
His head is so small in circumference as to make it microcephalic. The
forehead slopes backward and there is a depression in the head in the
right occipi to-parietal region. He has the typical adenoid countenance
with sloping chin, malocclusion of the teeth and high, arched palate.
The teeth are Hutchinsonian, the abdomen infantile and there is a
slight left scoliosis.
Alvah's school work in the restoration class was hardly third grade
level. He read fairly well in the third reader. Recognition of words
was only fair. He was not able to use phonics to any extent but was
dependent upon memory. His expression was good, especially con-
sidering his only fair recognition of words. His reproduction of what
he read was unusually good. Spelling was poor. He was unable to
get any help from phonics and his memory was too imperfect for satis-
factory spelling. " Anxiously" he spelled "anixanhed," " search'1
"schard."
THE PROBLEM OF RESTORATION 87
In number work he could perform the fundamental operations but
with many errors. He would often subtract the upper number from
the lower, if the lower number happened to be the larger. He confused
multiplication with division. He could do simple, one-step problems
but had no success with more complicated problems. He was able to
count change correctly although very slowly and somewhat unintelli-
gently. For instance, for twenty-eight cents he gave a dime, three
nickels and three pennies.
His physical exercises were very good compared with his other
work. He was dependent upon imitation until he had learned a com-
mand when he was able to interpret it. He gave good attention, was
interested and executed the commands with much energy. He learned
to swim during the summer due largely to the entire absence of fear
but it was a fool's courage, not intelligent courage. He was very much
interested in woodwork but his work was only fair. He was unintel-
ligent in his handwork and unable to persist in any method taught him.
His general health is good except that he is nervous. His birth
was instrumental and his head was injured. Possibly the depression
noted above was the result of this birth injury. During the first year
of his life he was subject to convulsions which have not recurred. He
was rather slow in walking; otherwise the babyhood history is normal.
The family history as reported is negative.
Alvah's chief defect is his poor intelligence. He makes remarkably
good use, however, of his limited intelligence, giving the impression of
being more intelligent than he is. He is deficient also in comprehen-
sion and his memory is not retentive. His associability is sufficient
as indicated by his auditory memory span of seven digits. His atten-
tion is also adequate except possibly for a slight deficiency in persistent
concentration. His range of interests is slightly limited. There is
no deficiency in his control and co-ordination of movement and he has
plenty of initiative but his responses are not sufficiently complex for
a boy of twelve. His imagination also lacks complexity.
There are two years of mental retardation as measured by the Binet-
Simon scale. I should say that the mental retardation is even greater
than this and there are in addition the qualitative defects noted above.
Alvah is quite certainly feeble-minded and was so diagnosed by the
Clinic after the six weeks of observation in the restoration class. The
babyhood and school history and the absence of any illness except the
convulsions in infancy would seem to indicate that his condition is
congenital. It may have resulted from the birth injury but the fact
88 THE PROBLEM OF RESTORATION
that there is no evidence of a gross injury would seem to militate against
that theory. Developmental conditions antedating birth may be
responsible for his condition and would seem to be indicated by the
mother's ill health during pregnancy. The family history as reported
is negative.
For the present Alvah would be safe in a special class. Ultimately
and, I should say, soon institutional care must be considered for him
as his tendency to hero-worship combined with his self-conceit, desire
for revenge and pugnaciousness will make him a very dangerous mem-
ber of Society, especially as a tool for some intelligent criminal.
THE PROBLEM OF RESTORATION 89
CHARLES 0.
Charles was first brought to the Clinic in March, 1914 by his parents
because of a speech difficulty. His age then was seven years exactly.
He had an infantile stammer of such a serious character that it was dif-
ficult to understand anything that he said.
Charles had at this time never attended school. He was a healthy
child. There was occasional enuresis upon being frightened but no
nocturnal enuresis. He had had diphtheria at the age of eighteen
months. Birth was normal in every way. He did not begin teething
until fourteen months of age and had spasms at the time. He was slow
in sitting up but this had not worried the mother as he was a very fat
baby. He was past two years old when he began to walk and did not
try to talk until past four years of age.
There were two other children in the family, a girl of eight and a
baby of two years. Both these children seemed normal in every way.
The family history is negative except that the father did not talk plainly
until sixteen years of age.
Physically Charles was well-formed and well-nourished. Appearance
was normal; he was an attractive looking boy. The palate was arched
and contracted and the tonsils slightly hypertrophied. The tongue
was long and mobile. No specific mental defects were discovered in
the mental examination and it was felt that his mentality was normal.
It was recommended that he be given articulation work in the speech
clinic.
In the fall of 1914 Charles was sent to school. His progress at
first was not satisfactory and he was not promoted in February. The
second semester his school work improved considerably and he was
promoted in June. Reading was still unsatisfactory. His attendance
at school had not been very regular. The boys at school had laughed
at Charles because of his speech defect. As a result he had become very
sensitive about his speech defect and was inclined to fight the boys who
teased him. He seemed quite capable of taking his own part.
Charles' work in the speech clinic at first was very promising as the
sounds were clear-cut and he was willing and amiable. But he forgot
from lesson to lesson what he had been taught. And his attention
wavered after the first few minutes of the lesson. There was no co-
operation at home. Charles' progress in the speech clinic during the
first year was not satisfactory.
90 THE PROBLEM OF RESTORATION
In May Charles' adenoids and tonsils were removed.
It was decided to enter Charles in the 1915 restoration class. He
was then eight years old. He was very good-natured and not at all
troublesome in the restoration class. In fact he seemed to almost
wholly lack initiative. He was quite satisfied to sit and do nothing.
He made little effort either in his work or in his speech and seemed to
take no interest in academic work. In play he was active and ener-
getic and full of initiative. He was especially fond of wrestling with
the other boys and liked to tease but in a good-natured way.
In number work he could add and subtract simple combinations
concretely, arriving at the correct results. Spelling was fair low first
grade level. Reading was poor first grade level. He seemed to have
difficulty in pronouncing the words after hearing them but was helped in
pronouncing new words by seeing them written on the board or by
watching the lip movements.
Special emphasis in the restoration class was placed upon Charles'
speech. He was constantly drilled in articulation, faulty speech was
corrected and correct pronunciation insisted upon. There was during
the summer a slight improvement in Charles' speech in spite of lack of
effort on his part.
We were still doubtful of Charles at the end of summer after six
weeks of observation in the restoration class. His satisfaction in doing
nothing and his lack of effort and interest seemed to indicate a mental
defect. On the other hand there was a possibility that he was only slow.
We felt that further observation was necessary in his case.
In the fall of 1915 Charles entered the upper first grade. He was
not promoted in February, every subject except writing being unsatis-
factory. In June he was promoted to the lower second grade.
Because of the doubt which we felt as to Charles' mental status he
was again entered in the restoration class of 1916. His age was then
nine years and four months. Charles was more troublesome in the
class than he had been the year before. Although his initiative had
improved his self-control was poor and he was easily influenced. More-
over, correction did not trouble him sufficiently. He was more inter-
ested in his work and made a more satisfactory effort. He was very slow
and painstaking and, it hurried, became confused. Attention to class
lessons was only fair. He was active in play but babyish if hurt.
His speech was very much improved although he still had difficulty
with a few sounds. Reading showed considerable improvement over
the previous year. Recognition of words was good and expression fair
THE PROBLEM OF RESTORATION 91
in spite of the speech defect. His reading was fair high first grade level.
Spelling was good first grade level. He knew the consonant sounds
and did not confuse them. Vowels were more difficult for him because
of his speech defect. He articulated long "i" as short "a" so spelled
"bite" "bat." Number work was fair high first grade level. He
seemed to have no difficulty in memorizing simple combinations in
addition and subtraction but was very slow in working the examples.
His comprehension in learning any new step was very slow. Attention
was only fair.
In the physical exercises his work was only fair although he was
capable of doing good work when he could be aroused to make the
effort. Attention wavered and his response to signals was slow.
I am inclined to be doubtful of Charles as a restoration case. The
speech defect itself is a serious symptom, especially as it has responded
so slowly to training. He is quite deficient in initiative and lacks self-
control. He is easily influenced and not sufficiently troubled by cor-
rection. His mental processes are very slow, understanding is slow
and his attention, while sufficient in analytic concentration, is not per-
sistent. Effort is poor and he is not interested in school work although
normally interested in play. Imageability is normal and his associa-
bility only slightly limited. Intelligence seems to be sufficient. Reten-
tiveness is normal and his memory seems to be trainable.
Charles' school progress has not been satisfactory. As a baby he
was slow in teething, walking and talking. He has had much attention
both in the speech and in the restoration class but has not responded
satisfactorily to these opportunities and his improvement has not been
sufficient to warrant calling him a restoration case. However, there
has been some improvement and I do not like to say that he is not a
restoration case. Hence I will leave him as still doubtful.
92 THE PROBLEM OF RESTORATION
RANDOLPH P.
Randolph was first examined at the Clinic in December, 1914 when
he was seven years and ten months in age. He was sent by the teacher
because he was not getting along well in school. Randolph had entered
the first grade in September, 1913 but, after two months, was taken out
of school because of illness. He re-entered the first grade in Septem-
ber, 1914. He was not at this time amenable to school discipline. He
was not vicious but very mischievous and constantly repeating the
same offenses. He talked incessantly and seemed unable to concen-
trate his attention. His reading was good.
The mother reported that Randolph did not care to play with other
children, and got along very poorly with them. This was partly due,
she thought, to the fact that the other children laughed at him because
of his "baby talk." Randolph seemed normal about the house but
very nervous. His mother had noticed the lack of concentration of
which the teacher complained. Randolph was beginning to be a little
untruthful and was inclined to pick up profanity on the street.
In the mental examination Randolph showed a deficient intelligence
and a somewhat limited memory span. He read easily a passage from
his school reader, then read it equally well with the page covered. Spell-
ing was poor and he could do no number work. His speech was very
defective. He omitted final consonants and made many substitutions.
As Randolph gave some evidence in the tests of learning readily it was
felt that his poor articulation might account for his difficulty in school
and that he would be capable of rapid improvement under training.
Birth and babyhood history were normal and so strengthened this
opinion.
In accordance with the recommendation of the Clinic Randolph
was given an examination with a view to speech training. In this
examination it was felt that his speech difficulty was probably the result
of a subnormal mentality but, as his physical condition was very poor,
it was possible that both the defective speech and the backwardness
might be due to his general physical condition.
So in September, 1915 Randolph was taken to a hospital clinic and
a general physical examination made. He was sleeping well but ate
rapidly, not masticating his food properly. He had had diphtheria
at four years and pneumonia at seven years. In the physical examina-
tion he was found to be of a neurotic type. His general physical con-
THE PROBLEM OF RESTORATION 93
dition was poor and a special diet and course of treatment were pre-
scribed for him. He had a slight lateral scoliosis and for this physical
exercises were prescribed under the direction of an orthopedic surgeon.
Circumcision was found to be necessary and the operation was performed.
In the meantime the social worker had investigated the home condi-
tions. She found the family consisting of Randolph, his father and
mother and a baby of one year living in two small rooms. The rooms
were clean and neat but very crowded. The baby had a crib but Ran-
dolph slept with his father and mother. The mother was very nervous,
in fact had symptoms of exophthalmic goiter. Randolph irritated her
and she frequently lost patience with him. Randolph was subject to
fits of temper. The father was a steady drinker and gave little money
toward the support of the family. He was often impatient with Ran-
dolph.
A school report was obtained in January, 1916. Randolph was
now in the upper first grade and his work was very much improved, so
much so that he was again promoted in February to the lower second
grade. Arithmetic was his only unsatisfactory subject. His conduct
had not improved so much but he was less nervous. Randolph was
again promoted in June, 1916.
The school report of Randolph was so favorable that it was decided
to enter him in the 1916 restoration class. The family had moved into
larger quarters and Randolph had a room to himself. In May it was
found that Randolph's nose and throat were in a bad condition and
his tonsils and adenoids were removed before the opening of the summer
session.
Randolph gave one the impression in the class of general weakness,
mental and physical. He was tall for his age of nine years and four
months but very thin and pale, partly as a result of his operation. Both
jaws were contracted and the teeth irregular although in good condition.
He did not get along well with the other children and did not care to play
with them.. He was unpopular with them as he would whine if hurt
and was inclined to " tattle" on them. He had almost no initiative
and his extreme timidity often made him untruthful. He constantly
repeated the same offenses.
He could do practically no arithmetic except read and write a few
numbers. He could not even add and subtract concretely with sticks
or blocks because, while he was able to comprehend what to do, he was
unable to count the objects correctly.
94 THE PROBLEM OF RESTORATION
Reading, although better than the number work, was poor second
grade level. Recognition of words was fair and expression fair although
slow and hesitating. Spelling was very poor. He was not intelligent
enough to use phonics and his retentiveness of letter combinations was
poor.
His physcial exercises were very poor. He was entirely dependent
upon imitation and was too slow to imitate well. Consequently he
became confused if the commands were at all complicated. His atten-
tion was good, comprehension poor and energy poor.
Randolph is certainly mentally defective. His defectiveness is
quite general. He has defects of vitality, attention, imagination and
memory. He lacks initiative and his imagination is not complex.
His intelligence is very deficient and his memory not trainable. Asso-
ciability as shown by the auditory memory span seems to be normal.
It is probable that Randolph's condition is congenital in spite of
the favorable birth and babyhood history. The mother has had six
pregnancies. The first baby died at the age of three days of hypostatic
pneumonia. The second pregnancy resulted in an abortion at the sixth
week. The third was a seven months baby and was malformed; there
was no brain development. Randolph was the next child. The fifth
child died at the age of two years of pneumonia. The sixth child is
a baby now two years old and apparently normal. The family history
as reported is negative except that Randolph's maternal grandmother
died of paresis reported to have been contracted after the birth of her
children.
Ultimately institutional care must be considered for Randobh.
THE PROBLEM OF RESTORATION 95
WALTER R.
Walter was sent to the Clinic in March, 1916 by a medical clinic
in Philadelphia, because he was reported by his mother to be incorri-
gible at home and in school. His age was then seven years and three
months. His mother reported that he played with children of the same
age but allowed them to impose upon him. At school he was often
beaten by the colored boys.
Walter had entered the first grade in the fall and was now spending
his second term in the lower first grade. He had spent eight terms in
the Kindergarten, entering at the age of three. Attendance at school
had been regular. His mother reported that his conduct in school
was poor.
Walter was in poor physical condition. He had a chronic running
ear which had been treated at the hospital. Arrangements had been
made to remove his tonsils and adenoids. He had just recovered from
a severe attack of acute bronchitis. There was occasional nocturnal
enuresis. There was no history of any serious illnesses.
The birth history is negative. As a baby he was delicate and trou-
blesome and seemed to the mother duller than the other children in
the family. He did not walk until three years of age. He did not talk
until four years of age and did not talk plainly at the time of the exami-
nation.
There were two other children in the family, a boy of nine years
who was in the first grade in school and a girl of three years who, from
the mother's report, appeared to be normal. Two children were dead.
The family history as reported is negative.
The father had died of blood poisoning and the mother supported
the family by washing. The financial level of the family was low and
they had required some outside assistance.
Walter was slightly under-height and under-weight for his age.
In his appearance there was a decided suggestion of Mongolianism.
There was the characteristic lack of development of the head in the
occipital region, the tongue was fissured, the nose depressed, and the
hands Mongoloid.
The result of the mental examination was doubtful and the diag-
nosis deferred. There was about a year's mental retardation measured
by the Binet-Simon scale. He was not intelligent in solving the tests
but used largely a trial and error method. He worked very persistently
96 THE PROBLEM OP RESTORATION
but showed some evidence of fatigue. Imageability seemed defective
as also did his comprehension. His memory span was only four digits.
It was decided to observe Walter in the 1916 restoration class. The
results of the mental examination had not been conclusive. While
he had shown evidence of specific mental defects his mental level was
certainly not as low as his appearance would suggest. The restoration
class would test his capacity to learn. In order to have him in the best
possible physical condition the hospital sent Walter to the country for
six weeks. When he returned from the country he had gained four
pounds and seemed to be in splendid physical condition.
At the time Walter entered the restoration class his age was seven
years and seven months. He was very good-natured and easily imposed
upon and did not resent being bossed by the other children. He showed
almost no initiative.
His writing at first was very poor because of his poor muscular co-
ordination. He was given Montessori insets to outline and fill in.
This improved his co-ordination so that he was able to copy quite well
by the end of the session.
He made almost no progress in reading during the session. An
attempt was made to teach him to recognize a few simple words by
having him copy them on the board. He would remember the word
for a few minutes but, after a few hours or by the next day, had forgotten
it entirely. His understanding was very defective. An attempt was
made to teach him to discriminate words ending in i-t but the attempt
was quite unsuccessful. His attention and interest were sufficient
for very short periods only.
In number work he was taught to count objects up to twenty-six
and to recognize and read numbers through five but he was not able to
add even simple combinations concretely.
In the physical exercises he was entirely dependent upon imitation.
His effort was good, his attention persistent and he did not seem to
fatigue easily but his understanding and his analytic concentration of
attention were so poor that he could execute only the very simple
movements.
We felt that Walter was not an educable case. His defectiveness
was quite general with specific mental defects in analytic concentration
of attention, retentiveness, initiative and intelligence. His condition
probably dates from birth as the late walking and talking would seem
to indicate. There may be an hereditary defect as one other child is
seriously retarded pedagogically and the intelligence of the mother is not
high. Walter has since been diagnosed by the Clinic as feebleminded.
THE PROBLEM OF RESTORATION 97
HARRYS.
Harry was first examined at the Clinic in April, 1916 when his age
was seven years and nine months. He was sent by the principal of
the school because of his inability to get along in school. The teacher
reported him very nervous and excitable and incapable of giving atten-
tion. Harry had entered the first grade at the age of six years but was
sent home because of his nervousness. When he re-entered school he
was placed in a special class where he had been up to the time of the
examination. German is spoken in the home and Harry had some
difficulty in learning English. His conduct was fair but he was very
restless. School attendance had been rather irregular because of fre-
quent illnesses. Harry had not learned to read while in the special
class. He had memorized the stories in the reader but could not recog-
nize the separate words, nor spell out the letters. He showed no interest
in the activities of the class. He would march with the class for a few
steps, then break step. He would sing with them for a few notes, then
cover his ears. The class was composed of quite low-grade children.
Harry was tall for his age and very thin. Measurement proved
him to be one year accelerated in height and one year retarded in weight
so there was a discrepancy of two years between his height and weight.
His nervousness was extreme. He was unable to keep still for any
length of time. His voice was high-pitched and, when excited, his
whole body became tense. He would cringe from a harsh voice as
from a blow. In appearance he was not attractive. His head was
small, bullet-shaped and slightly malformed. His face looked undevel-
oped.
Harry had always been nervous. He caught cold easily and had twice
had bronchial pneumonia. At one time he had dragged one leg. He
had been a masturbator but the masturbation had discontinued at
the time of the examination. There was a history of enuresis. The
father reported that his general health was somewhat improved, that
he ate better, slept better and was not as pale and thin as formerly.
Harry's personal history is interesting. His father is a talented
musician and comes of good German stock. A brother of the father is
a professor in Oxford University, and another brother is a successful
merchant. The mother is dead but from the reports of her and from
her picture one would judge her to have been a refined and sensitive
woman of good stock, German like her husband. She and her husband
98 THE PROBLEM OF RSETORATION
were first cousins. She was forty years old when Harry was born.
She had been married before and had had no children by her first hus-
band but had had one stillbirth. There was one child besides Harry
by her second marriage. This child suffered from congenital cyanosis
at birth, was always sickly and died at the age of a year and a half.
This baby required so much care that the mother was not at all well
before Harry 's birth.
Harry's birth was normal in every way except that he was a very
small baby weighing at birth only three and a half pounds. He was
late in teething and talked before he walked, talking at one year and
walking at eighteen months. He was a nervous, irritable baby but
otherwise, seemed normal and like other children.
When Harry was six years old his mother became an invalid and
remained an invalid until her death one year later. In her invalidism
she was very nervous and Harry especially seemed to make her more
nervous. As a result he was allowed to do anything he pleased so
long as he did not annoy his mother. Discipline was almost wholly
neglected for the entire year of his mother's invalidism. Moreover
it is probable that his mother made him nervous as he did her.
After his mother's death he was passed around among the relatives.
As he was by this time quite undisciplined none of the relatives were
able to endure him and, after they had all tried and failed, he was re-
turned to his father. The father next tried a series of housekeepers
but, after a short trial, each housekeeper left in disgust. Finally the
father married one of his housekeepers and she is at present Harry's
stepmother. She is of a much lower class socially than Harry's father,
is cross and disagreeable and has a harsh voice. She does not under-
stand Harry and her discipline is neither wise nor intelligent. The
house, while clean, is untidy and cluttered. She talks about Harry
before him and on one occasion read to him an account of a man "just
like him" whose "having his own way" led to his murdering another
man. She has two children of her own, a girl of thirteen and one of
eleven, who "boss" Harry and understand him no better than their
mother does. Harry feels the difference between himself and his step-
mother and resents her authority, maintaining that he is his own boss.
The parents report that Harry is very easily excited at home and
that his attention is flighty. He has a very bad temper. When
punished he is resentful and angry and punishment never seems to do
him any good.
THE PROBLEM OF RESTORATION 99
In the mental examination his persistent concentration of attention
was very poor. His comprehension and intelligence seemed somewhat
limited in range but on the whole sufficient. His imageability as shown
by the design blocks was unusually good. He could repeat quite com-
plicated designs from memory after a short exposure using an intelli-
gent method.
At the suggestion of the Clinic Harry was entered in the Kinder-
garten of a public school. The teacher became very much interested
in him and studied him individually. He did well in regular Kinder-
garten work, was in the highest of the three sections. He was quick
with blocks but did better by imitation than by oral direction. He was
slow in academic work, seemed unable to concentrate his attention upon
it. He was obedient although the teacher often had to speak twice to
him. His attention was poor but his nervousness seemed to improve.
He fatigued very quickly. In June he was promoted to the first grade
although the Kindergarten teacher was doubtful of his ability to com-
prehend the work.
Harry was admitted to the restoration class of 1916. His age was
then eight years and one month. He was present only three weeks.
In this time not very much was accomplished with academic work.
This was due to his poor attention, lack of interest and slow compre-
hension. His retentiveness seemed fair. In the physical exercises
he was dependent almost wholly upon imitation and then could only
imitate the simplest movements. His attention was very poor. He
had little energy, was easily fatigued and made little effort to do the
exercises. He was not at all troubled because he was unable to do them.
His conduct was poor. He was not amenable to school conditions even
under special class conditions. His response to commands was very
slow. He gave, one the impression of being wholly undisciplined and
seemed to lack the ability to control either his nervousness or his behavior
but was a slave to every impulse. His attitude toward the other chil-
dren was very childish.
It was felt that the chief obstacle to normal progress in Harry was
his lack of self-control and deficient attention. An attempt was made
to train his self-control and attention by careful discipline. This
meant painstaking and untiring effort on the part of the teacher. The
improvement in Harry was very slight. He learned to control him-
self for short periods. His power of self-control varied from day to
day and on the days when his control was poorest, inquiry usually
revealed some disturbance at home; he had been punished or been
100 THE PROBLEM OF RESTORATION
unduly hurried at breakfast. Unfortunately the three weeks were
too short to really make a satisfactory attempt to develop his self-
control.
Harry's imageability seemed to be good but his imagination was
not sufficiently complex. His memory appeared to be retentive and
trainable. Memory span was good. Comprehension was somewhat
slow and limited in range. His chief defects, however, were in atten-
tion, self-control and lack of vitality.
The result of the summer's observation was inconclusive in Harry's
case. He was present only three weeks and the influence of the home
counteracted any favorable effect the restoration class might have
had. Practically nothing was accomplished in academic work during
the three weeks partly because all effort was concentrated upon train-
ing Harry in self-control. The problem seemed to be whether Harry's
attention and self-control could be trained. There was very little
improvement in either during the observation period. Of course one
must consider the shortness of the time and the counter-effect of the
home. That his nervousness and lack of self-control were related
seemed probable. Was the deficient self-control due to the nervousness
and would it improve, should the nervous condition improve? Was the
nervousness the result of the poor discipline or were both the nervousness
and the lack of self-control symptoms of mental deficiency? These
were some of the problems. There was considerable evidence that his
nervous condition was congenital. His appearance suggested a uterine
arrest of development. The history of one stillbirth and one case of
congenital cyanosis in the family pointed to unfavorable developmental
conditions. Any defect in the family would be accentuated by the
fact that the father and mother were related.
On the other hand, Harry had been submitted to the wrong kind
of discipline for the last two years. The kind of environment in which
he had lived was particularly unfavorable for a nervous child. He
seemed quite undisciplined and his defects of self-control were so serious
that it was possible that, even were they due to environmental condi-
tions, they would not respond to a change of environment. So many
problems arose in Harry's case that I was unable to come to a definite
conclusion, although I was inclined to be very doubtful of his being a
restoration case.
THE PROBLEM OF RESTORATIG • '»'
In the fall of 1916 a further attempt was made to teach Harry, clinic
teachers being sent out from the Phychological Clinic for this purpose.
The emphasis was placed upon academic subjects. Harry's response
to the teaching was so unfavorable that it was decided that he was
feeble-minded, not educable and certainly not a restoration case.
1HE 'PROBLEM OF RESTORATION
SADIE S.
Sadie was first brought to the Clinic in February, 1916 by a charity
organization in Philadelphia because of her doubtful mentality and
her peculiar behavior. Her age was then seven years and one month.
Sadie had been removed from her parents by Court order because of
poor living conditions and the inability of the father to support the
family. She was placed by the Court in the care of the charity organi-
zation which had brought her to the Clinic. This charity organization
placed Sadie in a boarding home but the caretaker of the boarding-home
was unable to control her. She was placed in one home after another
where the same difficulty was encountered. Because of reported mas-
turbation she was placed under observation in a hospital for three
weeks. The hospital reported that Sadie would jump out of bed and
slap the other patients with no apparent provocation.
Sadie entered the first grade in the fall of 1915 and spent two terms
in the lower first grade. She accomplished very little in school during
this first year. The second year of school she accomplished more and,
at the time of the examination, was in the upper first grade. The
teacher reported her memory poor.
There was practically nothing known of Sadie's family except that
her father waa inefficient and shiftless. The family is Russian Jewish.
There are four other children in the family varying in age from four to
ten years. Nothing is known of them. There is no information con-
cerning Sadie's birth and babyhood.
Physically Sadie is unusually well-developed. Her height and weight
are that of a girl of nine or ten. This caused us to doubt the correct-
ness of her age but her teeth are those of a seven-year-old girl. Her
general health is good and the observation at the hospital proved the
masturbation to be less than reported. Sadie had had a double mastoid
operation. She had the enquiring, rather immobile expression of a
partially deaf child together with the tendency to day-dream. Exami-
nation proved that her hearing had been reduced to about one-fifth
normal. Strangely her deafness had not been discovered either by
the school or by the caretakers.
In the mental examination we found that Sadie was not proficient
in either reading or number work. Her recognition of words was poor,
her articulation fair but the tone monotonous. Judging from her arti-
culation her hearing had probably been normal or nearly so from two
THE PROBLEM OF RESTORATION 103
to four years of age. She had little conception of number beyond three.
Because of her deafness she had probably profited little by her school
instruction.
There was a year's mental retardation by the Binet-Simon scale.
Her auditory memory span was limited to four digits. Observation
seemed deficient and she appeared to lack initiative. Attention seemed
sufficient in analytic and persistent concentration but not sufficiently
distributed nor alert. There was evidence of a deficiency in imageability.
Her intelligence seemed normal.
It was decided that Sadie's deafness probably accounted for her
inability to get along in school. She had revealed no very serious men-
tal defects in the examination and the discipline in the boarding home
in which Sadie had been placed seemed to have been unintelligent.
It was felt, therefore, that Sadie was normal although retarded and prob-
ably slow because of her deafness and possibly inferior race extraction.
It was recommended that she be placed with some woman intelligent
enough to understand the situation and well-enough disposed to meet
her on her present plane of development. It was also decided to observe
Sadie in the 1916 restoration class.
In June, Sadie was promoted to the lower second grade. The teacher
reported that her work was improving. However, she did not seem to
be able to concentrate her attention upon anything.
When Sadie entered the restoration class her age was seven years
and five months. She was not an especially troublesome child in the
class although she would often leave her seat without permission and
come up to the teacher to ask a question. This we felt to be accounted
for by her deafness. She was an active child with much initiative and,
had she not been kept busy, would probably have been more trouble-
some. It was more difficult to keep her busy than it was to keep a
hearing child busy.
Her reading was about upper first grade level. Her recognition
of words was only fair and expression poor. Comprehension seemed
slow but this may have been due to her defective hearing. Her reten-
tiveness seemed deficient. In spelling Sadie learned new words readily
but did not seem to 're tain them. Because of her deafness she confused
certain sounds and this made spelling more difficult for her. "Bird"
she spelled "birk," confusing the "d" and "k." She was about ready
for upper first grade spelling.
104 THE PROBLEM OF RESTORATION
She was just about ready to begin number work. She could read
and write numbers through nine. An attempt was made to teach her
addition and subtraction concretely with the peg-board but her compre-
hension was very slow, she was easily confused and could learn but one
step at a time. Her understanding seemed deficient.
Writing was very good.
In the physcial exercises she was entirely dependent upon imitation
as she could not hear the commands. Her comprehension here was
slow and her attention not well distributed. Rhythm and energy were
good.
Her speech was defective because of her deafness. She omitted
final consonants and confused certain sounds as "d" and "t," "p"
and"b,""b"and"f".
Sadie revealed, then, several mental defects as a result of the obser-
vation of her during the summer. The most serious of these was her
defective retentiveness. But, as Sadie was a member of the restoration
class only three weeks and her attendance was irregular, we felt that
further observation was desirable to confirm this. Understanding
seemed deficient but may have been merely slow as a result of her
deafness. Auditory memory span was slightly limited. Analytic and
persistent concentration of attention were sufficient but her attention
was not sufficiently distributed nor alert. Imageability seemed suf-
ficient and initiative was good. Her intelligence was only fair. Energy
was good. Her responses and her imagination were not sufficiently
complex.
Many factors enter into Sadie's case. She is so handicapped by
her deafness that it is impossible for her to obtain an education under
regular grade conditions. Moreover, the environment has been un-
favorable. The conditions in the home were so poor that it was neces-
sary to remove her from her home. Since then it has been impossible
to find a caretaker able to control her. Of course the difficulty which
caretakers have had in controlling her indicates a deficiency in con-
formity on Sadie's part but one cannot be sure that the caretakers have
been intelligent and wise in their discipline, as her deafness alone has
made discipline difficult. Moreover, Sadie had not been a difficult
child to handle in the restoration class during the short time she had
been a member of the class. Certainly the constant shifting from place
to place making necessary on Sadie's part constant adjustments to new
conditions had been most unfavorable. So, in spite of the serious
mental defects which Sadie had displayed making us doubtful of her
THE PROBLEM OF RESTORATION 105
restoration, we felt it to be unfair to make a final diagnosis without
further observation, observation under more favorable environmental
and educational conditions.
In the fall of 1916 Sadie was placed in a small private school where
instruction was individual and the discipline firm, sympathetic and
intelligent. Her progress has been carefully watched. She failed to
make satisfactory progress under these conditions and so has been diag-
nosed bv the Clinic as feeble-minded.
106 THE PROBLEM OF RESTORATION
WILLIAM G.
William first came to the Clinic in January, 1915. His mother
brought him because of a serious speech defect. William's age was
then seven years and ten months. His mother reported that he played
with children of the same age but got along poorly with them as he was
inclined to be " bossy. " He seemed to her quite normal about the house.
He was especially interested in manual work and liked to make things
out of wood.
William was in the first grade of parochial school. He had spent
two years in the first grade entering at the age of six. Attendance had
been quite irregular because of frequent illnesses. The quality of his
work was poor except in drawing, handwork and music. He seemed
especially fond of music. He was reported to be inattentive in school,
very restless and mischievous.
His health was reported to be fair. He had been under treatment
for eighteen months for indigestion and nervousness but his condition
had very much improved. His appetite was good, the bowels regular
but he was still restless in his sleep. The tonsils were hypertrophied.
He formerly had had enuresis but this had disappeared since he had
been circumcised four years previously. There was no history of any
serious illness.
Birth history is negative. He walked and talked at the usual time.
His first tooth he cut at the age of twelve months but after that his
teeth came very rapidly. The stammering was not noticed until he
was three years of age. He was a healthy baby and seemed in every way
like other children.
There were three other children in the family, all girls, one of six,
one two and a baby of six weeks. These children appeared to be normal.
There had been two miscarriages, one before William's birth and one
since. The family history as reported is negative, except that the pater-
nal grandparent had a mild stammer.
The house in which the family lived was large with good air and
ventilation. It was sparsely furnished but clean. The father worked
nights in an automobile garage and all four children slept in the same
room with the mother.
In June, 1915 William was not promoted and it was decided to take
him into the 1915 restoration class for observation.
He was only present for one week in the 1915 restoration class. But
he made so lasting an impression that the next year the teacher insisted
THE PROBLEM OF RESTORATION 107
that he had been present the whole six weeks. He was obedient only
when watched; he always seemed to do what should not be done. He
acted wholly upon impulse apparently without considering the results
of his acts. He was very unpopular with the other children. Even the
mischievous boys disliked him, one of them describing him as "the
freshest kid of his size I ever seen. " He seemed quite undisciplined and
none of the methods tried during his attendance upon the restoration
class seemed effective. Nothing seemed to interest him.
The time was too short to do much with academic work but the
quality of his school work seemed very poor for first grade.
William's speech had improved under speech training. There
had been considerable improvement in articulation so that his speech
was more distinct. The stammer was as bad as ever.
In February, 1916 William was promoted to the second grade, and
in June to the upper second grade. He was reported as doing fairly
well in school except for his speech.
William was entered in the 1916 restoration class. His age was then
eight years and eight months. Although there was some improvement
in his conduct he was still very troublesome. He was meddlesome and
sneaky, seemed quite unable to take care of himself and made little
effort at self-control. He seemed very nervous and excitable and
quite unable to stand or sit still. He got along poorly with the other
children, would annoy them and, if they struck him, would cry and
run to tell the teacher.
Reading was very poor. Recognition of words was only fair and
he was unable to use phonics to help him in the recognition of new words.
Expression was hesitating and halting, due partly to his speech defect.
Spelling was also poor. His retention of letter combinations seemed
poor.
In number work he could do addition with carrying, subtraction
with borrowing and short division but had to resort to devices like marks
as the retention of number combinations was as poor as his retention of
letter combinations. He was able to do simple problems if presented
orally but had more difficulty with written problems because of his
reading difficulty. He measured the size of a bench he wished to make
and figured its cost at so much a foot.
In the physical exercises William was able to interpret quite com-
plicated commands, seemed interested in the exercises and his sense
of rhythm was good. But his movements were not very forceful and
his attention to the commands only fair.
108 THE PROBLEM OF RESTORATION
William's chief mental defects are his defective persistent concen-
tration of attention and poor retentiveness. His retentiveness seems
to be poor both for letter and number combinations. His attention
is not controlled although occasionally, when interested, his attention
is sufficiently persistent. Intelligence and understanding seem to be
normal, and he has plenty of initiative.
The lack of self-control is serious. The lack of self-control may be
partially due to his nervous condition. Another factor in the deficient
conformity and possibly also in the nervous condition is the inadequate
discipline in the home. The mother has little control over William.
She is so worn out with child-bearing and the care of the children that
she is nervous and irritable, besides being inefficient. William particu-
larly needs firm discipline to develop in him habits of obedience and
self-restraint. I see little hope of any improvement in William's con-
formity under present conditions as his mother is quite unable to cope
with him. An aunt with whom he occasionally stays has more control
over him but were he to stay with her permanently, I would be doubtful
of the outcome as I doubt whether William has the capacity for self-
control. Moreover, William's defect of retentiveness is so serious as
to make normal progress impossible. William, therefore, is not a
restoration case.
THE PROBLEM OF RESTORATION 109
DISCUSSION OF CASES
My final classification of these twenty-eight cases is as follows:
1916 1915 Fannie B. Grouped
Restoration cases 22 4
Doubtful cases 32 4*
Not restoration cases 10 11 1 20*
Total 15 15* 1 28
*Three of the 1915 class were also members of the 1916 class.
Not much can be said of these twenty-eight cases as a group. They
are distinctly individuals, differing each from the other. But a few
observations seem warranted by these few cases. The observations
must be understood to be made of these twenty-eight cases only, and
not necessarily to be of any wider significance.
With these high-grade defective children, border-line cases their
defects do not show until they are of school age. There are few stigmata.
Sixteen of the twenty-eight cases have no stigmata. Six of the remaining
twelve have only a few stigmata, probably no more than many normal
persons. The general appearance of the child was favorable in twenty-
one of the twenty-eight cases. In no case was the appearance very
unfavorable.
The family history as reported was favorable in twenty of the twenty-
eight cases. In four more cases there was no information regarding
the family history. In three more cases the family history was only
slightly unfvorable leaving only two cases with a distinctly unfavorable
family history, I mean by this a neuropathic family history. In several
of the cases there was a history of tuberculosis in the family or of heart
trouble. These cases I have not included as of unfavorable family
history. In six of the twenty-eight cases there were a number of still-
births, miscarriages or infant deaths in the immediate family. It is
difficult to get reliable family histories as most persons are very reticent
concerning these points. One cannot regard these family histories,
therefore, as of much significance.
The birth history is favorable in nineteen of the twenty-eight cases.
In four more cases there is no information as to the birth history. In
one case the birth was only slightly unfavorable leaving only four cases
of unfavorable birth history. These four cases include congenital
110 THE PROBLEM OF RESTORATION
cyanosis (two cases), long and hard labor and instrumental birth with
injury to the child.
The babyhood history is favorable in seventeen of the twenty-eight
cases. There was no information concerning the babyhood in four
cases, leaving seven cases with an unfavorable babyhood history. By
unfavorable babyhood I mean late teething, walking and talking.
I was impressed by the fact that in very few of the cases, specifically
in only three, was there any physiological retardation as measured by
height. In twelve of the cases there was neither retardation nor accel-
eration. In thirteen of the cases or almost half there was acceleration.
I do not know how to interpret this. It certainly indicates that the
growth processes have not been normal. In a few of these thirteen
cases both height and weight have been accelerated but more often the
height alone, resulting in a discrepancy between height and weight.
This is especially true of the nervous cases.
Nervousness is very frequent in these twenty-eight cases. Eight
are very nervous, five slightly so. There are neurological signs such
as a paralysis in three of the cases. The nervousness seems signifi-
cant as it is a symptom other than the mental deficiency of a defective
nervous system. One of the cases with neurological symptoms is Gabriel
whom I have classified as a restoration case. In his case the neuro-
logical symptoms are the result of polio-myelitis, hence indicate a
nervous system that has been injured through disease, not one that is
innately defective.
In all of the cases there is some pedagogical retardation varying in
amount from one-half year to four years. In most of the cases it was
this pedagogical retardation that first brought the child to the Clinic.
But, while the pedagogical retardation is always significant, indicating
as it does the child's inability to get along in his normal environment,
his inability to progress with children of his own age, it alone is likely
to prove misleading. A few cases will make this clear. Randolph P.,
one of the lowest-grade children in the group, has failed of promotion
only once. At the age of nine years and four months he is in the upper
second grade, revealing considerable pedagogical retardation but he
entered school a year late because of illness and his health has been so
poor that school attendance has been irregular.
Henry B. has only failed of promotion twice and he again is a low-
grade case. At the age of eight years and eleven months he is in the
upper second grade. Moreover, his attendance has been very irregular
THE PROBLEM OF RESTORATION 111
and he has frequently changed schools. Upon the advice of the hospital
he has even been taken out of school because of his nervous condition.
Archibald M. is another low-grade case compared with the group.
Yet, although he is twelve years old, he has only failed of promotion
twice. And again, his health has been poor and he has been under
treatment at the hospital for anemia. Certainly in none of these cases
can the pedagogical retardation taken by itself be regarded as serious.
Compare Henry B. and Edward D. They are within one month
of the same age and are in the same grade in school. Edward I have
classified as a restoration case, Henry as not restorable. Yet Henry
spent one year in the first grade, while Edward spent two years in the
first grade. While of course I may be mistaken in regarding Edward as
a restoration case, at least he is much more nearly normal than Henry
while from the pedagogical history one would expect the exact reverse.
Often the school grading is not an indication of the child's real
educational level. Harry A. was ranked by the school as upper second
grade level yet his work is only first grade level. Charles C.'s school
grading was upper third, yet most of his work was not higher than second
or low third grade level. In scarcely any case was the school grading
found to be correct. Yet the teacher of the restoration class who did
the grading was trained in the Philadelphia schools and taught there
for many years, so was quite familiar with the course of study of the
different grades.
Compare Edward D. and Randolph P. Both are graded by the
schools as upper second grade. Yet Randolph can do no arithmetic
except read and write a few numbers. He cannot even add concretely
with blocks or sticks. Edward can add with carrying, subtract with
borrowing and can do short division and some simple multiplication.
Hearing them read one might think they were of the same level but
Edward can intelligently reproduce what he has read while Randolph's
reproductions are scanty and meagre.
Randolph is reported by the school to be good in reading. He has
mastered the mechanics of reading of the second grade level but his
reading is like a parrot's talking, a mere trick. One can tell by his
reproductions that reading can never be for him a tool which he can use.
He can never be taught to read in the real sense of the word.
I was often misled in my selection of children by the school report
of the child's progress. Take the case of Archibald M. After the
hospital began treating him for anemia the school reported a very
favorable improvement in his work. It looked like a clear case of
112 THE PROBLEM OF RESTORATION
retardation due to physical condition. Yet, after one week's observa-
tion in the restoration class, we were sure that Archibald was feeble-
minded. Randolph P. was a similar case. The report of the examiner
in the speech clinic was very unfavorable. But, after Randolph's
treatments at the hospital began, there was so favorable an improve-
ment in his school work that I decided to take him into the restoration
class. Francis D. is another case. When he first came to the Clinic he
was, from the school report, accomplishing nothing in school. But when
the Clinic recommended special class for him the principal was reluctant
to send him because his school work had improved so much since the
examination at the Clinic. Because of this reported improvement I took
him into the restoration class and he proved to be a low-grade case.
So while inability to get along in school is an important factor,
worthy of much consideration it needs to be interpreted. When a
child's pedagogical retardation amounts to several years, he is usually
a hopeless case for restoration. But even in cases where the pedagogical
retardation is slight, the case may be hopeless also. Two of the cases
which I have classified as not restorable are retarded pedagogically
only one-half year. Of course they are the younger children of the
group varying in age from seven to nine years. In interpreting the
pedagogical retardation one must consider whether the school grade
represents the child's real educational level. The tendency is to push
the backward child on because of his over-size, crowded conditions of
the school, etc. One must consider why the child is retarded, such
factors as late entrance, irregular attendance, the kind of teaching the
child has had etc.
The home environment of these cases is interesting. In nine of
the twenty-eight cases the financial level of the family was considerably
below the average, in seven other cases somewhat below the average.
Yet care of the children was adequate in nineteen of the cases and
only very inadequate in five cases. By adequate care I mean that the
child had enough to eat and was kept clean and comfortable. In these
five cases the child had to be removed from the home because of inade-
quate care.
But discipline in the home I have classified as inadequate in four-
teen of the cases, as only fair in six more. And it is not always in the
homes of low financial level where the discipline is poor. Francis D.'s
mother is supporting herself and ten children on an income of less than
seventy dollars a month, yet care is adequate and the children well-
disciplined. In the case of Jennie J., on the other hand, while the finan-
THE PROBLEM OF RESTORATION 113
cial level of the family is very high and the care excellent discipline
is very unfavorable.
Of course these children are as a whole very difficult to handle.
Discipline that might be adequate for the average child is inadequate
for these children. Many of them are nervous; they are lacking in self-
control. A deficiency in conformity is often a symptom of their de-
fectiveness.
It is probable that it is to the child slightly below par mentally
that proper discipline and also physical care are of the greatest impor-
tance. The average or bright child will probably make progress in
spite of poor discipline or even in spite of poor health if the discipline
and the poor health are not of too serious a nature. The child very
much below par mentally will be retarded with the best of physical
care and discipline. But the child slightly backward most needs good
care and adequate discipline.
The intricacy of the causes of the retardation is very evident in
these cases. Probably in all of the twenty-eight cases the mental level
is somewhat below the average, very much below the average in some
of the cases. This subnormal mentality is due to poor heredity, develop-
mental conditions, disease, neglect. Combined with the subnormal
mentality there is often a poor physical condition, nervousness, inade-
quate discipline and poor care or neglect. The causes of retardation
are so intricate, the combination of causes differs so much in the different
cases that it is impossible to generalize and of little value were it possible.
In nine of the cases the speech was defective. In fact a speech defect
if at all pronounced may be regarded as a serious symptom. Speech
training is not effective for these cases. In several of the cases there
has been speech training extending over a number of years. But,
while the cases apparently respond to training, learn to articulate well
in the speech clinic these backward cases do not carry the training over
into their conversation or reading but remain practically unhelped by
the training. Henry B. was a good illustration of this. He was given
speech training during the summer. The teacher of the restoration
class complained to the speech teacher of Henry's defective speech and
was told that Henry articulated well in the speech lesson. But his
daily speech improved not at all as a result of the training.
Three of the twenty-eight cases are partially deaf. In the case
of Bertha B. the reduction in hearing is only slight and only temporary
and has probably interfered not at all with school progress. In the
114 THE PROBLEM OF RESTORATION
cases of Fannie B. and Sadie S. the deafness was a real factor and made
the diagnosis especially difficult, making necessary, especially in the
case of Fannie, observation over a long period of time.
THE PROBLEM OF RESTORATION 115
CONCLUSION
Of the twenty-eight cases studied in this thesis, then, twenty cannot
be restored, four are doubtful and four only can be restored. These
results seem very discouraging. And yet, at the time these children
were selected for study, the prognosis in each case seemed favorable.
But although they were chosen only after a clinical examination and
after careful study, the observation in the restoration class has not
supported this prognosis in most cases. The prognosis was too favor-
able and restoration is not possible for most of them.
Retardation then is a far more serious problem than we have as
yet realized. We have been too hopeful. The children we have been
calling restoration cases are not restoration cases at all. We have
been striking too low and attempting to restore those for whom restora-
tion is impossible. When institutions for the feeble-minded were first
established the aim was to restore the inmates, to make it possible by
special educational methods for the inmates to be prepared to live a
normal life in society. This attempt has been given up, and we realize
now that these cases are custodial cases and cannot be restored by any
kind of educational treatment. Special classes in the public schools [
were started with a similar aim. An attempt to teach these special '
class children has convinced us that restoration for these cases also is
impossible. But we still believe that in schools where the feeble-
minded have been weeded out and placed in special classes, that for the
pedagogically retarded pupils left in the regular grades restoration is
possible. Public school systems are just beginning to become interested
in these so-called backward cases. One is quite safe in saying, I think,
that in the near future classes for these backward children are going ?
to be organized, organized for the same purpose which actuated the
establishment of special classes in the beginning, the restoration of the
children. And that the outcome of this new attempt at restoration
will be similar to the outcome of the special class experiment, I feel
certain.
In Detroit last fall a few teachers were assigned to a few schools in
the city to coach these so-called backward pupils and bring them up to
grade. I had the privilege of examining some of these children in one
of the schools. The school already had a special class so one would be
justified in assuming that the feeble-minded children had already been
pretty well weeded out of that school. And yet, in a brief, superficial
116 THE PROBLEM OF RESTORATION
examination, of a few of these children, I was able to diagnose over
half of them as either feeble-minded or border-line. I have no doubt
that the result of attempting to restore the other half of these children
to grade will prove that for many of them also restoration is impossible.
We have as yet then scarcely touched upon the problem of restora-
tion. For further study of the problem a careful and prolonged study
of possible restoration cases is necessary. The amount of pedagogical
retardation alone is not a sufficient basis for the selection of these cases.
These few cases tend to show that the correlation between a child's
school progress and his innate mental ability is not always close. While
the child's inability to make normal progress in school is always sig-
nificant, the pedagogical retardation must be interpreted. We must
discover what the obstacle to normal progress has been.
Nor is a clinical examination alone sufficient to diagnose these
cases even when this clinical examination includes family history,
medical history, physical examination, etc. These are the difficult cases.
It is necessary in addition to the clinical examination to attempt their
restoration, to try a course of treatment upon the child, either educa-
tional or medical or both, and note its effect. We must try a practical
test, an attempt to teach. The observation of the regular grade teacher
is not sufficient in most cases. Most regular grade teachers ae not suf-
ficiently trained for this kind of observation, and have too many children
in the room to study each one individually.
This kind of study, then, means the observation of the child over
a long period of time. It may often be necessary to change the kind
of treatment and try the effects of other kinds of treatment. Several
studies of this kind have been made by the Psychological Department
of the University of Pennsylvania. Fannie B. is an example of such
a study. The Restoration Class was organized largely for the purpose
of studying this type of case.
I believe the schools can very advantageously make these kind of
studies. They have the material for it. If restoration cases are to be
found anywhere they are to be found in the public schools where the
children range from the very bright to the feeble-minded. For this
work a clinical psychologist and an experienced and well-trained teacher
should work together with the aid of a school nurse or social worker,
physicians, clinics etc. If, after a careful clinical examination including
the child's whole personal and family history, restoration seemed pos-
sible for the child an educational prescription could be made for that
child. This prescription could be carried out by the teacher under
THE PROBLEM OF RESTORATION 117
the psychologist's direction. Then the course of treatment educa-
tional, medical and social could be noted and the kind of treatment
altered if it seemed advisable. Ultimately it should be possible to reach
a conclusion as to whether the individual children were restoration
cases.
After a sufficient number of cases have been studied in this way it
ought to be possible to tell how many defects and what kind of defects
a child may have and restoration still be possible. The case of Edward
D. seems to indicate that a limited memory span provided the limitation
be slight does not make normal progress impossible. Can defective
attention be trained? The case of Bertha B. seems to indicate that it
cannot. If we could control her whole environment, the result might
be different but I am doubtful even then of the ultimate outcome of
the experiment. This and similar problems should be settled by studies
of this kind.
To reiterate, these twenty-eight cases are too few to draw from them
any far-reaching conclusions. The study indicates however that the
problem of retardation is more serious than we at present realize and
that we have scarcely touched the problem of restoration yet. To
discover the restoration cases in the school requires a more serious,
thorough study than is being made at present and means close co-
operation between psychologists, teachers, physicians and social workers.
It means careful study of the cases over an extended period of time,
constantly checking up one's prognoses and revising them. By this
means it ought to be possible to discover in the individual cases whether
or not they are restorable and ultimately it ought to lead to the dis-
covery as to what combination of assets and defects make restoration
possible, and what the remedial treatment should be, social, medical
and educational.
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