Part 1. Obligatory.

(i.) Has the child any mental symptoms other than mental deficiency? Signs of alcoholism, etc.?

(ii.) Is there reason to think the child has any weakness, congenital or acquired? Cretinism?

(iii.) Are there any (_a_) Sensory defects--sight?

hearing?

(_b_) Motor defects--paralysis?

tremor, etc.?

(iv.) Is the child epileptic? What symptoms are present--convulsions, vertigo, loss of consciousness? Their frequency, etc.?

(v.) Has the child adenoids?

(vi.) Is the child hysterical?

(vii.) Any other ailments?

(viii.) What directions are to be given to the schoolmaster?

Part II. Optional.

A. Cephalometry and stigmata of degeneration.

B. History: Birth.

Convulsions.

Age at commencement of dent.i.tion.

Age at commencement of control of bladder Age at commencement of and bowel.

Age at commencement of walking.

Age at commencement of speech.

Infantile diseases.

C. Heredity.

Father-- Name: Date of birth: Place of birth: { syphilis.

Illnesses { alcoholism.

{ insanity.

Mother: _Ibid._ Brothers and Sisters-- Number: Age: Mortality: Health of survivors: Etc.

To sum up, we do not think that the doctor will often have to reject a child, but he will often furnish indications which will help to direct the efforts of the teacher. He will proclaim the opinion, at once so just and so humane, that the symptoms of mental deficiency and want of balance in abnormal children do not arise from laziness or naughtiness, but require no methods of treatment except such as are likely to relieve them. And this conviction which animates him he will impress little by little on the teacher. He will accustom the latter not to regard a defective child at fault like a normal, responsible child, whom he is sometimes tempted to punish in anger, but rather as a patient whose faults should be overcome by persevering patience.

FOOTNOTES:

[13] For the sake of greater completeness, let us refer to a type of imbecile with very characteristic features--namely, the _Mongol_. A little round head, chubby cheeks, rosy as if painted with rouge, oblique eyes, a nose broad at the base and with a tip like a little ball, skin slightly yellow--the whole appearance of the child is such that one doubts his European origin, and thinks of a Chinese doll, with limbs of india-rubber, so great is the looseness of the joints.

During his first year the Mongol is rather drowsy and quiet--too "old-fashioned," as the mothers say. In the second or third year he becomes lively. His countenance acquires a comic and jolly expression, and his imitative instincts become curiously developed, and as a general rule he is very sweet-tempered. They all resemble one another, and all "promise much and achieve little," for they never cease to be imbeciles.

CHAPTER V

THE EDUCATIONAL AND SOCIAL RETURN OF SCHOOLS AND CLa.s.sES FOR DEFECTIVES

=An Inquiry in the Hospitals.=--Two years ago one of us betook himself to M. X., an important official in one of our ministries, in order to ask him to join a Ministerial Commission which was going to pay a visit to one of our asylum-schools. M. X. shrugged his shoulders, and replied energetically: "No, no, no! I have had enough of such visits.

I will go neither to the Salpetriere nor to Bicetre. What would I see there? An idiot who allows his saliva to collect in his open mouth; another who has epileptic fits; a third who can say nothing but 'Ba, ba!' What would that prove? The only way in which one can find out whether a school for bad cases of mental deficiency is good for anything, is to find out the mental condition of those who leave. How many defective subjects are there who, after having been treated at the Salpetriere or at Bicetre, are able to gain their own livelihood?

That is what one would like to know, and that is what no one ever tells us!"

The listener to these incisive and sensible remarks replied, after a moment's reflection: "I entirely agree with you. The information which you desire is of the greatest importance for judging the value of a school. I imagine that such information would be difficult to obtain.

But one can try. I am willing to make the attempt."

A few days later the two authors of the present work took the field.

The long preliminary conversations which they had had together about this subject had convinced them that they would encounter opposition.

But they decided to treat the question as one treats a scientific matter--with perseverance, with courage, and without _parti pris_ of any kind.

Let us subdivide the question to make it more plain. We proposed to discover the value of a school. To make such an inquiry really complete, it would be necessary to consider the question from two points of view--the one educational, the other social.

The educational return consists in the degree of instruction which the inst.i.tution succeeds in giving to its pupils, after so much time, and with so much expense. In the case of an inst.i.tution for the sick, the return will take the medical form of a cure or improvement of health.

In order to estimate such various returns, it would evidently be necessary to be in possession of various data: (1) A knowledge of the state of instruction or the state of health of the subjects on their admission to the school; (2) a knowledge of their state of instruction or of health on leaving, so that one would be able to estimate by comparison what they owe to the school; (3) a knowledge of the cost for each pupil, whether for instruction or for medical expenses.

The social return consists in the place taken by the pupils in society. This depends in part, it is clear, upon the educational return, but only in part. One could imagine a school, and there are some of the kind, which only cares about producing graduates, without thinking of what will become of them in life, even if they go to the dogs. Every cla.s.s, every school, for defectives ought to aim at rendering its pupils socially useful. It is not a question of enriching their minds, but of giving them the means of working for their living. This is an important question. Upon this depends our complete and final judgment of the utility of special education.

And be it understood this is not a simple question. Nothing is simple in the sphere of sociological phenomena, and one cannot get hold of an atom of truth except by inquiries bristling with difficulties of all kinds--inquiries whose rules, moreover, are not yet known, but which will certainly be known some day. It is quite necessary.

In order to discover the social return of an inst.i.tution, school, or hospital, there are many data to be brought together. Here are some of them. What is the number of those who are ultimately able to look after themselves? For how long a time are they able to do so? To what extent have they been a.s.sisted by what they acquired at school? And, lastly, what becomes of the failures?

But whatever the social or educational return may be, it would be most important to know what would have become of similar cases who had received no such instruction, or, rather, who had been instructed or treated by different methods.

A single example will show the importance of these reservations.

Recently an alienist wanted to prove that all the idiots, without exception, who had been treated in his asylum had been improved. He published copious notes upon these children, which had been taken during several years by different people--the physician, resident doctor, attendant, teacher, etc. On reading these observations one learned that one child, who on admission was unable to walk, by-and-by began to do so. He had grown; he had also begun to speak, etc. In all this there was nothing surprising, and we imagine that, in spite of his optimism, the doctor, who is the author of these observations, would not pretend to credit an increase in size to his medico-pedagogical treatment. As to the rest of the development of the faculties we know nothing. It is possible that an idiot who has ceased to be dirty, or who has learned to dress himself, would have done so in any case without object-lessons. It would be necessary to understand the natural development of idiocy in order to estimate exactly the service which had been rendered by the medico-pedagogical treatment. Otherwise sceptics will suspect that three-quarters of what is claimed to be the result of treatment is really due to nature.

After these preliminaries, let us now turn to our inquiry.

=At the Salpetriere.=--Here we were received most kindly. The superintendent of the hospital introduced us to a most excellent woman, Mme. Meusy, who was at that time head-mistress of the school for defectives at the Salpetriere. This is a little school with about 140 girl pupils. It is part of the clinique of Dr. Voisin. The school is divided into four cla.s.ses, each of which is under a lady teacher.

It is a modest school, and, we think, little known. Elementary education is given there, and, be it understood, the teachers make a point of object-lessons and the training of the senses. But this education has no original feature. It simply follows what is done elsewhere. There is a workshop where the patients skilfully manufacture artificial flowers. Dr. Voisin has for a long time been asking for a laundry, for the sake of the patients who require physical exercise, but he has not been able to get it.

Mme. Meusy had prepared us to some extent for the work which she had done in the school by intelligent organisation. It was a pleasure to us to see with our own eyes the notes she had kept regarding each of her pupils. All the schedules were in perfect order, regularly filled up to the day. They contained all the medical information, as to diagnosis and treatment, which Mme. Meusy had been able to procure from the doctor by reiterated requests. They contained also full particulars as to the state of instruction of the child, her character, her apt.i.tudes, and the amount of her school attendance.

Such notes were repeated periodically, so that it was easy to find out approximately whether or not the child had progressed during her stay in the school. Finally, her history after discharge was noted. It is only just that we should here express once more to Mme. Meusy how much we admired the care, the order, and the intelligence with which she had kept these individual histories. It is an example to be followed.

Mme. Meusy readily placed before us one after another all these doc.u.ments, and allowed us to extract from them the notes which seemed of most value for our work. While one of us was taking the notes, she contributed much valuable information in a lively voice; for she knew her pupils admirably, she followed them after they left school, and often received visits from them. But, although she clearly understood the importance of our inquiry, she could not keep to herself a distressing thought, which was that a large number of these unfortunate girls had obtained no benefit from the instruction received at the school during a long series of years. The majority, on leaving school, had been transferred to asylums for adults. It saddened her to acknowledge such impotence officially. However, neither she nor her devoted staff of teachers was responsible, for if their educational success was restricted, that was due to the fact that the administration had for some time been sending her the epileptic defectives, while reserving for the Fondation Vallee the privilege of having the non-epileptic defectives. Now, everyone knows that when epilepsy, with repeated fits, is present, it produces a mental decadence against which the best teacher is powerless.

The information which we have collected about the work of the school of the Salpetriere bears upon 117 children, who had left the school during the period of four years. Now, this is how these children are distributed, if they are cla.s.sified according to their condition on leaving:

1. Children who had _improved_. Some of these had returned to their families; they lived at home, and were employed, more or less, and the directress states that they had improved in their mental condition.

These numbered eight. Others had become capable of following a calling, either in the asylum as attendants, or outside as seamstresses, ironers, laundresses, domestic servants, etc. These numbered twelve. (None was employed in making artificial flowers, for which there was a workshop in the school.) The total number who had improved, therefore, was twenty.

2. _Doubtful_ cases--children who had returned to their families, but concerning whose mental state and employment precise information was lacking. These numbered twenty.

3. Those who had got _worse_. These are the cases who had been marked "transferred." They are to be found in the lunatic asylums, where they are destined to pa.s.s the rest of their existence. Of these there is a formidable number--namely, sixty.

4. Those who had _died_, of whom there were seventeen.