Clinical Reports The
Post-Meningitic
Imbecile.
patience with a fretful baby turns to alarm as a fever becomes apparent even to her unpractised eye. The rising doctor's face is very grave as he listens to that sharp, peculiar little cry which heralds a dread disease. As the days drag by, as the weeks succeed the days, the mother and the doctor watch the raging conflict between the forces of life and death?the delicate surface of a A mother's
baby's brain their battle-ground. The heat of battle burns and scars and destroys soft tissues, which, once gone, will never grow again. At last, death apparently relents and calls his forces off, but as he vanishes he wears a grin which the mother does not see. The doctor gazes after him with suspicion. *
*
*
A delicate child of three years, a child often under the doctor's just beginning to talk. His mother is delighted. He has already learned to walk. care, is
*
*
*
It is the first day of school for a little boy of six. As his mother dresses him?he is unable to dress himself?she ponders over his unresponsiveness to discipline, his disobedience, his inability to perform and hopes that school will solve the problem. A few months later, an anxious mother, who realizes that her child is not as other children, a troubled teacher whose precious energy is spent in vain on a little pupil who cannot do the work, and
errands,
a
pitying
nurse, hold
a
consultation. *
*
*
A shy, tired, tow-headed little fellow of six years and eight months, drapes himself across the formboard in the clinic room of a psychological laboratory, his head on his arm. He looks like any ordinary, every-day little boy, whom you might meet in a friend's home, or your own. He plays with the blocks, loses interest, gives up the job, and gazes around the room. Aroused and encouraged by the examiner, he makes a better effort, and fits the forms correctly as sudden flashes of mental light illuminate the fumbling and indicate the right move. In six minutes and fifty seconds the blocks are placed. A memory span of six does little to offset an Intelligence Quotient of 63. *
*
(123)
*
124
THE PSYCHOLOGICAL CLINIC.
A reluctant examiner turns his steps toward his private office a little boy's mother awaits him. He has no words of hope to cheer her. He must tell her that death was the victor, when, six years ago, he made the battlefield barren and went off with a grin. where
Louise
Hubbard, M.A., Student, University of Pennsylvania.
Graduate
The Imbecile in School. Russell is a tall boy of 15 years and 7 months who has been in a sixth grade room at school, head and shoulders above his His short trousers help somewhat to camouflage the classmates. disparity in size, which would be cruelly emphasized by the long trousers to which his age and height would entitle him. Only in
sitting
physical stature, though, does Russell surpass his classmates, and there is no pitiful subterfuge to soften the evidence of his pygmy size in the midst of his fellows who tower above him in mental stature. To the meaningless strings of words and shapeless piles of figures which confront his eyes and bombard his ears, they give easy comprehension. They walk along with careless unconcern where he The sun flounders befogged and bewildered in a pathless marsh. shines clearly for them while a gray, obstructing mist wreathes itself slowly in and out around the efforts of his brain. When Russell finds himself thrown into the maelstrom of rough and ready boys' play, he is almost equally at a disadvantage, because he does not understand the laws of give and take. So, because he has been a misfit through all his school career, because his promotions depend upon his outgrowing the seats he leaves behind, because of unruliness and temper in the class-room, and babyishness, with tearful flights to the teacher for protection on the playground, this slender boy sits in a psychological clinic with his closely-cropped, bullet head winged by large out-standing ears, The and his squinty, skewed eyes peering through spectacles. examiner is kind. She helps him with the puzzles he cannot solve, She also helps him and praises him for learning them so easily. cannot with the colored patterns which he reproduce?and he is allowed to depart in peace. Russell would not have understood, had he heard them, the heavy-sounding terms and phrases used in a discussion of him after his departure: "chronologically fifteen years, mentally six"; "trainable, but not educable"; ""MGI"; "Spring City would be ideal";
CLINICAL REPORTS. "has practically reached the limit of his development".
125 Russell's
explained. It is the reaction of the human organism against mal-adjustment, against an environment from which it gains
bad behavior is no
benefit and to which it makes
no
contribution.
Louise Hubbard, M.A., Graduate Student,
University of Pennsylvania..
General
Physical
and Mental
Deficiency.
Poor Miss
Mary was a pathetic little creature. Although seven of she had the physical development of a child of four. years age, Her face was narrow, pinched and colorless. Her thin light hair unruly, and stuck out at unexpected angles all over her head. She breathed continually through her mouth, which did not add in any way to her attractiveness. Her shoulder blades protruded noticewas
and there
was an accompanying lack of chest development. under-nourished and under-developed. She was an amiable little thing, extremely amenable to the wishes of the examiner. The presence of the class did not affect her in any way?she showed no
ably
She
was
signs of self-consciousness and retained her calm, quiet manner throughout the testing. Mary is not able to get along in school. She spent two years in kindergarten and is now in the first grade. During the last three or four years, she has had a series of falls without apparent cause. While playing, she suddenly falls and loses consciousness. She has had no very severe illness which might account for these mysterious
attacks,
herself, her
ity.
and there is no history of convulsions. She cannot dress but is clean in her personal habits and extremely fastidious in
eating. She solved the formboard slowly and showed deficient trainabilShe met her Waterloo in the cylinders. She made four consecu-
tive trials and failed all. Even with instruction, she failed the Healy A puzzle twice. She showed an irregularity in performance and Her Her attention fluctuated constantly. great distractability. She had was normal. three?below very poor imagememory span ability and low trainability. She was persistent, but in an undirected planless way. She experienced great difficulty in learning a few marked deficiency in retentiveness and associability. watching her performance on the various tests, there was little doubt that Mary was feebleminded, as well as physically defective. Her little body was starved for air, receiving just about half
letters, showing After
THE PSYCHOLOGICAL CLINIC.
126
the amount it needed. It may be that her reported fainting spells can be traced to this cause. Any over-exertion taxes her strength It endurance. be that along with her other physical beyond may she has a weak heart. A thorough medical examination would not be out of place and might help a little. It may be that through correction of her physical defects, her mental status At present, the only possible diagnosis is Middle Grade can be raised.
imperfections,
Imbecile with
general physical
and mental defect and
deficiency.
Helen Wilson Brown, Graduate Student,
B.S.,
University of Pennsylvania.
Post-Infantile Paralysis. of
Francis had that most desirable and much sought after quality personal magnetism. His serious and highly intelligent appear-
attracted everyone. His chestnut hair was brushed slickly back from his forehead and his quiet hazel eyes missed no detail in his new surroundings. Unlike the usual boy of twelve years of age, he conveyed no impression of out-of-doors and ruddy healthiness. His was rather the frail, delicate, indefinable charm of the hot-house plant. His serious thoughtful gaze spoke of intellectual pleasures rather ance
than
physical.
At seventeen months of age, Francis had infantile paralysis. He had no In his case, it was fortunately confined to the spine. But a serious general paralysis mental disturbances whatever. resulted. At four years of age, he was pronounced a hopeless case. At seven years of age, his left arm, which was utterly useless, was Since then, however, he has been gradually improving. removed. At the present time, his gait is practically normal, although he has had great difficulty in the past with locomotion. The upper part of his right arm is still defective. He can raise it or move it forward from the shoulder. This makes a fall a serious matter for him, not
being able to catch himself or to break his fall with his arm. But in spite of all these handicaps, he is an excellent swimmer and horseman! Surely this in itself shows a remarkable strength of character to overIn addition, his school work is excellent. Due come such difficulties. to ill health, he did not enter school till seven years of age, and for the first year he attended about three months out of the usual ten. But he accomplished all the work required, nevertheless, and was promoted. He was able to pass examinations to skip the sixth grade and is now in the seventh. His conduct in school has always been
CLINICAL REPORTS.
127
His teachers say that he has an abnormally logical mind with real devotion to the natural sciences. He did splendidly with the tests given him in clinic, even solving an adult Maze test in less time than many graduate students. Francis is undoubtedly a very superior boy. His physical handi-
irreproachable.
probably resulted in more stress being laid on his mental development. In spite of this he is naturally a highly intelligent and intellectual type of boy. He is certainly in the best 10 per cent of children of his age, and probably in the best 1 per cent. cap has
Helen Wilson
Beown, B.S., Student, University of Pennsylvania.
Graduate
An Institutional Case.
Stella, aged ten years, nine months, is a little German Jewish Judging from her sister who accompanied her to the clinic it would appear that the family was one of the small merchant class typical of their race. The family is not willing to recognize that anything is wrong with the girl. To them she is just a little bit backward. However, to the teacher of the special class of which she is a member there is apparent a very real deficiency, and to any one accustomed to seeing deficient children she gives a typical picture of mental deficiency. Her expressionless face, without a glimmer of intelligence or interest in the world about her, showed a very low mental order. She has a low limit of physical power. She is anemic and easily fatigued. Her fatigue is so great that on simple tasks such as repeating numbers in the memory span test when she reaches her limit, such mental fatigue sets in that she goes to pieces completely and can not remember even the simplest combinations. Her span of associability seems to be very definitely four or five ideas and no more. Her fatigue is so great that her teacher cannot tell her to do anything in school and ever have her do it, for she fatigues girl.
before she
can
be told.
On
an
alertness test she could not follow
direction, showing, as she showed in practically every test that was given in a clinical examination a low order of attention, which means poor alertness, no retention and consequently no reflection and no reasoning. Her language is infantile, motor co-ordination poor, senses dull, discrimination of form almost totally lacking. In all clinical tests calling for a display of intelligence her method is always that of a very low trial and error, wholly planless. Her I. Q.
more
is 45.
than
one
128
THE PSYCHOLOGICAL CLINIC.
The above paragraph is a picture of Stella as she appeared in the clinical examination. She is lacking in every mental ability which would go toward success in even the lowest type of labor. She is non-educable and non-trainable. Consequently she becomes a case
for institutional care, a purely custodial case. stigmata of degeneracy nor of physical
While she does
not show any
inability, except her anemia and great fatigueability one might reasonably expect that she is organically as inferior as she is mentally. It is reported that a distant relative was like Stella, and while the relationship is distant it would bear investigation. The general level of the family is not high, and it may be that other members more closely related are somewhat deficient also, although not as bad as Stella. Stella is a typical low grade imbecile on the Barr classification, and at the same time typical of so-called hereditary feeble-mindedness. There is no proo/ that the case is an hereditary one; it may be the result of accident or disease in utero. The hereditary factor, however, is one worth investigation if the cause is to be determined. Leigh C.
Douglass, Student, University of Pennsylvania.
Graduate
Post-Meningitic
Imbecile.
patience with a fretful baby turns to alarm as a fever becomes apparent even to her unpractised eye. The rising doctor's face is very grave as he listens to that sharp, peculiar little cry which heralds a dread disease. As the days drag by, as the weeks succeed the days, the mother and the doctor watch the raging conflict between the forces of life and death?the delicate surface of a A mother's
baby's brain their battle-ground. The heat of battle burns and scars and destroys soft tissues, which, once gone, will never grow again. At last, death apparently relents and calls his forces off, but as he vanishes he wears a grin which the mother does not see. The doctor gazes after him with suspicion. *
*
*
A delicate child of three years, a child often under the doctor's just beginning to talk. His mother is delighted. He has already learned to walk. care, is
*
*
*
It is the first day of school for a little boy of six. As his mother dresses him?he is unable to dress himself?she ponders over his unresponsiveness to discipline, his disobedience, his inability to perform and hopes that school will solve the problem. A few months later, an anxious mother, who realizes that her child is not as other children, a troubled teacher whose precious energy is spent in vain on a little pupil who cannot do the work, and
errands,
a
pitying
nurse, hold
a
consultation. *
*
*
A shy, tired, tow-headed little fellow of six years and eight months, drapes himself across the formboard in the clinic room of a psychological laboratory, his head on his arm. He looks like any ordinary, every-day little boy, whom you might meet in a friend's home, or your own. He plays with the blocks, loses interest, gives up the job, and gazes around the room. Aroused and encouraged by the examiner, he makes a better effort, and fits the forms correctly as sudden flashes of mental light illuminate the fumbling and indicate the right move. In six minutes and fifty seconds the blocks are placed. A memory span of six does little to offset an Intelligence Quotient of 63. *
*
(123)
*
124
THE PSYCHOLOGICAL CLINIC.
A reluctant examiner turns his steps toward his private office a little boy's mother awaits him. He has no words of hope to cheer her. He must tell her that death was the victor, when, six years ago, he made the battlefield barren and went off with a grin. where
Louise
Hubbard, M.A., Student, University of Pennsylvania.
Graduate
The Imbecile in School. Russell is a tall boy of 15 years and 7 months who has been in a sixth grade room at school, head and shoulders above his His short trousers help somewhat to camouflage the classmates. disparity in size, which would be cruelly emphasized by the long trousers to which his age and height would entitle him. Only in
sitting
physical stature, though, does Russell surpass his classmates, and there is no pitiful subterfuge to soften the evidence of his pygmy size in the midst of his fellows who tower above him in mental stature. To the meaningless strings of words and shapeless piles of figures which confront his eyes and bombard his ears, they give easy comprehension. They walk along with careless unconcern where he The sun flounders befogged and bewildered in a pathless marsh. shines clearly for them while a gray, obstructing mist wreathes itself slowly in and out around the efforts of his brain. When Russell finds himself thrown into the maelstrom of rough and ready boys' play, he is almost equally at a disadvantage, because he does not understand the laws of give and take. So, because he has been a misfit through all his school career, because his promotions depend upon his outgrowing the seats he leaves behind, because of unruliness and temper in the class-room, and babyishness, with tearful flights to the teacher for protection on the playground, this slender boy sits in a psychological clinic with his closely-cropped, bullet head winged by large out-standing ears, The and his squinty, skewed eyes peering through spectacles. examiner is kind. She helps him with the puzzles he cannot solve, She also helps him and praises him for learning them so easily. cannot with the colored patterns which he reproduce?and he is allowed to depart in peace. Russell would not have understood, had he heard them, the heavy-sounding terms and phrases used in a discussion of him after his departure: "chronologically fifteen years, mentally six"; "trainable, but not educable"; ""MGI"; "Spring City would be ideal";
CLINICAL REPORTS. "has practically reached the limit of his development".
125 Russell's
explained. It is the reaction of the human organism against mal-adjustment, against an environment from which it gains
bad behavior is no
benefit and to which it makes
no
contribution.
Louise Hubbard, M.A., Graduate Student,
University of Pennsylvania..
General
Physical
and Mental
Deficiency.
Poor Miss
Mary was a pathetic little creature. Although seven of she had the physical development of a child of four. years age, Her face was narrow, pinched and colorless. Her thin light hair unruly, and stuck out at unexpected angles all over her head. She breathed continually through her mouth, which did not add in any way to her attractiveness. Her shoulder blades protruded noticewas
and there
was an accompanying lack of chest development. under-nourished and under-developed. She was an amiable little thing, extremely amenable to the wishes of the examiner. The presence of the class did not affect her in any way?she showed no
ably
She
was
signs of self-consciousness and retained her calm, quiet manner throughout the testing. Mary is not able to get along in school. She spent two years in kindergarten and is now in the first grade. During the last three or four years, she has had a series of falls without apparent cause. While playing, she suddenly falls and loses consciousness. She has had no very severe illness which might account for these mysterious
attacks,
herself, her
ity.
and there is no history of convulsions. She cannot dress but is clean in her personal habits and extremely fastidious in
eating. She solved the formboard slowly and showed deficient trainabilShe met her Waterloo in the cylinders. She made four consecu-
tive trials and failed all. Even with instruction, she failed the Healy A puzzle twice. She showed an irregularity in performance and Her Her attention fluctuated constantly. great distractability. She had was normal. three?below very poor imagememory span ability and low trainability. She was persistent, but in an undirected planless way. She experienced great difficulty in learning a few marked deficiency in retentiveness and associability. watching her performance on the various tests, there was little doubt that Mary was feebleminded, as well as physically defective. Her little body was starved for air, receiving just about half
letters, showing After
THE PSYCHOLOGICAL CLINIC.
126
the amount it needed. It may be that her reported fainting spells can be traced to this cause. Any over-exertion taxes her strength It endurance. be that along with her other physical beyond may she has a weak heart. A thorough medical examination would not be out of place and might help a little. It may be that through correction of her physical defects, her mental status At present, the only possible diagnosis is Middle Grade can be raised.
imperfections,
Imbecile with
general physical
and mental defect and
deficiency.
Helen Wilson Brown, Graduate Student,
B.S.,
University of Pennsylvania.
Post-Infantile Paralysis. of
Francis had that most desirable and much sought after quality personal magnetism. His serious and highly intelligent appear-
attracted everyone. His chestnut hair was brushed slickly back from his forehead and his quiet hazel eyes missed no detail in his new surroundings. Unlike the usual boy of twelve years of age, he conveyed no impression of out-of-doors and ruddy healthiness. His was rather the frail, delicate, indefinable charm of the hot-house plant. His serious thoughtful gaze spoke of intellectual pleasures rather ance
than
physical.
At seventeen months of age, Francis had infantile paralysis. He had no In his case, it was fortunately confined to the spine. But a serious general paralysis mental disturbances whatever. resulted. At four years of age, he was pronounced a hopeless case. At seven years of age, his left arm, which was utterly useless, was Since then, however, he has been gradually improving. removed. At the present time, his gait is practically normal, although he has had great difficulty in the past with locomotion. The upper part of his right arm is still defective. He can raise it or move it forward from the shoulder. This makes a fall a serious matter for him, not
being able to catch himself or to break his fall with his arm. But in spite of all these handicaps, he is an excellent swimmer and horseman! Surely this in itself shows a remarkable strength of character to overIn addition, his school work is excellent. Due come such difficulties. to ill health, he did not enter school till seven years of age, and for the first year he attended about three months out of the usual ten. But he accomplished all the work required, nevertheless, and was promoted. He was able to pass examinations to skip the sixth grade and is now in the seventh. His conduct in school has always been
CLINICAL REPORTS.
127
His teachers say that he has an abnormally logical mind with real devotion to the natural sciences. He did splendidly with the tests given him in clinic, even solving an adult Maze test in less time than many graduate students. Francis is undoubtedly a very superior boy. His physical handi-
irreproachable.
probably resulted in more stress being laid on his mental development. In spite of this he is naturally a highly intelligent and intellectual type of boy. He is certainly in the best 10 per cent of children of his age, and probably in the best 1 per cent. cap has
Helen Wilson
Beown, B.S., Student, University of Pennsylvania.
Graduate
An Institutional Case.
Stella, aged ten years, nine months, is a little German Jewish Judging from her sister who accompanied her to the clinic it would appear that the family was one of the small merchant class typical of their race. The family is not willing to recognize that anything is wrong with the girl. To them she is just a little bit backward. However, to the teacher of the special class of which she is a member there is apparent a very real deficiency, and to any one accustomed to seeing deficient children she gives a typical picture of mental deficiency. Her expressionless face, without a glimmer of intelligence or interest in the world about her, showed a very low mental order. She has a low limit of physical power. She is anemic and easily fatigued. Her fatigue is so great that on simple tasks such as repeating numbers in the memory span test when she reaches her limit, such mental fatigue sets in that she goes to pieces completely and can not remember even the simplest combinations. Her span of associability seems to be very definitely four or five ideas and no more. Her fatigue is so great that her teacher cannot tell her to do anything in school and ever have her do it, for she fatigues girl.
before she
can
be told.
On
an
alertness test she could not follow
direction, showing, as she showed in practically every test that was given in a clinical examination a low order of attention, which means poor alertness, no retention and consequently no reflection and no reasoning. Her language is infantile, motor co-ordination poor, senses dull, discrimination of form almost totally lacking. In all clinical tests calling for a display of intelligence her method is always that of a very low trial and error, wholly planless. Her I. Q.
more
is 45.
than
one
128
THE PSYCHOLOGICAL CLINIC.
The above paragraph is a picture of Stella as she appeared in the clinical examination. She is lacking in every mental ability which would go toward success in even the lowest type of labor. She is non-educable and non-trainable. Consequently she becomes a case
for institutional care, a purely custodial case. stigmata of degeneracy nor of physical
While she does
not show any
inability, except her anemia and great fatigueability one might reasonably expect that she is organically as inferior as she is mentally. It is reported that a distant relative was like Stella, and while the relationship is distant it would bear investigation. The general level of the family is not high, and it may be that other members more closely related are somewhat deficient also, although not as bad as Stella. Stella is a typical low grade imbecile on the Barr classification, and at the same time typical of so-called hereditary feeble-mindedness. There is no proo/ that the case is an hereditary one; it may be the result of accident or disease in utero. The hereditary factor, however, is one worth investigation if the cause is to be determined. Leigh C.
Douglass, Student, University of Pennsylvania.
Graduate
