THE RELATION OF PHYSICAL TO MENTAL DEFECT IN SCHOOL CHILDREN. By Walter S.
Cornell, M.D.,
University of Pennsylvania. our race between six and fifteen years is a disthe fact that the problem of diet, so important from tinctive one, in infancy, decreases with the corresponding increase in bodily activity. So, also, the prevalence and effect of contagious disFor these reasons the mortality rate eases suffer a reduction. and the probability of survival becomes decreases
The age of
progressively,
steadily brighter. The age of development, however,
is one in which the subseis welfare mental largely predetermined. quent physical and still lies largely fortune his Though the child's life be fairly safe, his teacher, and his in the hands of his parents, his environment, of the burdens heredity, producing physician. First must be met children. A perneurotic and of deformed, thousands sickly, life-long) acting force is here to be com-
petually (or rather,
bated and reckoned with. Second to heredity is a poor city air and its improper diet of environment, with its lack of fresh these to influences, healthy infants succanned foods. Exposed those of already suffering from rickets, cumb and join the ranks obstruction. Finally, the ignorance anfflmia, and adenoid nasal to the damage already done, and of parents causes indifference to the existing list of evident teeth the of decay adds
premature
physical imperfections.
also harmful to Are these injuries to the health of the child their pale of influhis mind ? Will he ultimately pass through
less scarred, but possessing the same knowledge and his more vigorous mental faculty that make for power, as neighbor ? Backward and subnormal children approach so nearly the between physical defect and ordinary child that the connection in individual cases. brain defect is often not demonstrable at all (231) ence more or
?
THE PSYCHOLOGICAL CLINIC.
232 In these the
acting influences are of minor degree, being principally poor eyesight, deafness, and poor nutrition (adenoid growths are included in the latter two). We may either assume that the rule of a sound mind in a sound body is a natural law, and so reason by analogy that it operates in these cases, or by a study of a large series of cases draw positive original conclusions from this very class itself. The latter is well worth proving, if it be possible to do so. In the special classes for backward children conducted by our large cities, the reports show that almost every backward child exhibits physical defect of some sort. In these classes the proportion of defective children is given by one authority as 95 per cent of the whole number. That the physically defective among ordinary school-children show subnormal mentality is the converse of this proposition
capable of demonstration. following investigation I have endeavored to clearly establish this relationship. The children studied were those of three Philadelphia public schools, whom I had previously physically examined in prosecution of the official work of medical school inspection. The first step was the recording, in each school, of the name, physical record, and scholarship of each child. The last mentioned datum was obtained by using the previous term-marks iii three of the school studies, from which an average mark was easily calculated. and should be In the
The average term-mark of the whole school
was
first obtained
by the simple process of adding the term-marks of all dren together, and dividing by the number of children. ample, in the Claghorn School this was 73.1.
the chilFor
ex-
The record-cards of the children were then divided into two collections: one of the healthy or normal children, the other of the general group showing some noteworthy physical defect. The average term-mark (the scholarship index) was then calculated for each group separately, and the two compared, first with each other, and then with the term-mark of all the children previously calculated. The results showed that in each school, and in each individual branch of study in each school, the healthy or normal children stood higher in their classes than the average children, and the physical defectives, taken as a class, stood lower than the average children.
DEFECTS IN SCHOOL CHILDREN. Allison School?219 Normal child
Children, Both Sexes,
233
G to 12 Years Old.
Average
:
75
Average child General defectives Adenoids and
enlarged
74 72^ tonsils
72
Deaf
67.2 Ninth Street Primary School?84 Children, Both Sexes, G to 10 Years Old. Language 72.9 70.5 G3.3 GO
64 cases normal children 84 cases average children 21 cases
8
cases
No
cases
general defectives adenoids
Arithmetic
Spelling 75.4 72.8 64.8
75.5 74 70
G6.7
65
deaf.
Claghorn School?252 Children, Both Sexes, 12
Language 179
cases
252
cases
73
cases
normal children average children
general defectives
An sible
by
Average 74.6 72.4 6G 63.9
investigation
on
Arithmetic
74.4
72
72.7 71.4
70 65.1
to
15 Years Old.
Geographyand
History 76.6 76.5 76.2
Average 74.3 73.1 70.8
slightly different lines was made posClaghorn School of four classes of
the existence in the
which had been so made up at the beginning of the year that the brighter children constituted two classes, and the duller children the other two classes. The latter were smaller, so as to afford more opportunity for individual instruction. A comparison of the physical condition of the children is instructive: the
same
grammar
grade,
Class 1
Class 15
Bright Children Number of children Normal
50
Defective Percentage of normal children
14
36
72%
Class 9
Class 11
Dull Children
Chil^-en
39 32
32
?
12
16
62.5%
44.8%
82%
20
29 13
In June, 190G, the school medical inspection corps of Philadelphia was directed by its chief, Dr. Thomas J. Beatty, to make a comparative study of those bright children exempted from their annual examinations, and those children whose lower scholastic standard necessitated their examination for promotion. The proportion of physical defects recorded in the two groups was made the basis of comparison. I am indebted to Dr. Beatty for per-
THE PSYCHOLOGICAL CLINIC.
2U mission to
publish
the
figures
It will be observed
time.
which I submitted to him at that
that,
on
averaging
the five
children showed the lower percentage of
brighter
physical
87
35
75
34
128
65
81
49
Camac School
183
71
103
75
Claghorn School
193
61
127
66
647
260
425
262
Ilutledge
School
School
Allison
Percentage defective
An effort ence
was
to
nose
38.1 per cent.
28.8 per cent.
.
made
of defects of the
the
defect.
Exempt Children Non-Exempt Children Normal Defective Normal Defective 5G 28 39 38
Primary School
Ninth Street
schools,
determine the exact degree of influand throat. The harmful results of
recognized in recent years. In the Claghorn School the four classes of bright and dull children were examined again. Their eyesight proved to be about the same (averaging 5-~y and nasal ~). Enlarged tonsils, adenoids, deafness, catarrh occurred much more frequently, however, among the two these have been
classes of duller children. written shows
only too plainly the findings:
In many the adenoid their faces. The
on
Class 1
Class 15
Bright Children Number of children
expression
was
following table Class 9
Class 11
Dull Children
cwitlre^i
50
39
32
29
6
4
9
9
Nose and throat conditions: Number
defective
With single Tonsils
or
combined defects, viz: 3
4
3
3
Adenoids
2
1
5
6
Deaf
2
Catarrh
Percentage
..
5
1
..
2
3
of children with nose and throat
defects
12%
The conclusions to be drawn from the
10.2%
28.1%
31%
foregoing facts
are
very evident. The educational result in our public schools suffers a discount of about G per cent in the case of the physically de-
fective
ing
well as a waste of the time rightfully belongchildren. The drain on the teacher's energies is than proportionately increased by the presence of such chilbecause of their associated nervousness or stupidity.
children,
as
to the normal
more
dren,
Note.?This article is from a chapter of a book in course of preparation, entitled "Medical Inspection of School Children."
Cornell, M.D.,
University of Pennsylvania. our race between six and fifteen years is a disthe fact that the problem of diet, so important from tinctive one, in infancy, decreases with the corresponding increase in bodily activity. So, also, the prevalence and effect of contagious disFor these reasons the mortality rate eases suffer a reduction. and the probability of survival becomes decreases
The age of
progressively,
steadily brighter. The age of development, however,
is one in which the subseis welfare mental largely predetermined. quent physical and still lies largely fortune his Though the child's life be fairly safe, his teacher, and his in the hands of his parents, his environment, of the burdens heredity, producing physician. First must be met children. A perneurotic and of deformed, thousands sickly, life-long) acting force is here to be com-
petually (or rather,
bated and reckoned with. Second to heredity is a poor city air and its improper diet of environment, with its lack of fresh these to influences, healthy infants succanned foods. Exposed those of already suffering from rickets, cumb and join the ranks obstruction. Finally, the ignorance anfflmia, and adenoid nasal to the damage already done, and of parents causes indifference to the existing list of evident teeth the of decay adds
premature
physical imperfections.
also harmful to Are these injuries to the health of the child their pale of influhis mind ? Will he ultimately pass through
less scarred, but possessing the same knowledge and his more vigorous mental faculty that make for power, as neighbor ? Backward and subnormal children approach so nearly the between physical defect and ordinary child that the connection in individual cases. brain defect is often not demonstrable at all (231) ence more or
?
THE PSYCHOLOGICAL CLINIC.
232 In these the
acting influences are of minor degree, being principally poor eyesight, deafness, and poor nutrition (adenoid growths are included in the latter two). We may either assume that the rule of a sound mind in a sound body is a natural law, and so reason by analogy that it operates in these cases, or by a study of a large series of cases draw positive original conclusions from this very class itself. The latter is well worth proving, if it be possible to do so. In the special classes for backward children conducted by our large cities, the reports show that almost every backward child exhibits physical defect of some sort. In these classes the proportion of defective children is given by one authority as 95 per cent of the whole number. That the physically defective among ordinary school-children show subnormal mentality is the converse of this proposition
capable of demonstration. following investigation I have endeavored to clearly establish this relationship. The children studied were those of three Philadelphia public schools, whom I had previously physically examined in prosecution of the official work of medical school inspection. The first step was the recording, in each school, of the name, physical record, and scholarship of each child. The last mentioned datum was obtained by using the previous term-marks iii three of the school studies, from which an average mark was easily calculated. and should be In the
The average term-mark of the whole school
was
first obtained
by the simple process of adding the term-marks of all dren together, and dividing by the number of children. ample, in the Claghorn School this was 73.1.
the chilFor
ex-
The record-cards of the children were then divided into two collections: one of the healthy or normal children, the other of the general group showing some noteworthy physical defect. The average term-mark (the scholarship index) was then calculated for each group separately, and the two compared, first with each other, and then with the term-mark of all the children previously calculated. The results showed that in each school, and in each individual branch of study in each school, the healthy or normal children stood higher in their classes than the average children, and the physical defectives, taken as a class, stood lower than the average children.
DEFECTS IN SCHOOL CHILDREN. Allison School?219 Normal child
Children, Both Sexes,
233
G to 12 Years Old.
Average
:
75
Average child General defectives Adenoids and
enlarged
74 72^ tonsils
72
Deaf
67.2 Ninth Street Primary School?84 Children, Both Sexes, G to 10 Years Old. Language 72.9 70.5 G3.3 GO
64 cases normal children 84 cases average children 21 cases
8
cases
No
cases
general defectives adenoids
Arithmetic
Spelling 75.4 72.8 64.8
75.5 74 70
G6.7
65
deaf.
Claghorn School?252 Children, Both Sexes, 12
Language 179
cases
252
cases
73
cases
normal children average children
general defectives
An sible
by
Average 74.6 72.4 6G 63.9
investigation
on
Arithmetic
74.4
72
72.7 71.4
70 65.1
to
15 Years Old.
Geographyand
History 76.6 76.5 76.2
Average 74.3 73.1 70.8
slightly different lines was made posClaghorn School of four classes of
the existence in the
which had been so made up at the beginning of the year that the brighter children constituted two classes, and the duller children the other two classes. The latter were smaller, so as to afford more opportunity for individual instruction. A comparison of the physical condition of the children is instructive: the
same
grammar
grade,
Class 1
Class 15
Bright Children Number of children Normal
50
Defective Percentage of normal children
14
36
72%
Class 9
Class 11
Dull Children
Chil^-en
39 32
32
?
12
16
62.5%
44.8%
82%
20
29 13
In June, 190G, the school medical inspection corps of Philadelphia was directed by its chief, Dr. Thomas J. Beatty, to make a comparative study of those bright children exempted from their annual examinations, and those children whose lower scholastic standard necessitated their examination for promotion. The proportion of physical defects recorded in the two groups was made the basis of comparison. I am indebted to Dr. Beatty for per-
THE PSYCHOLOGICAL CLINIC.
2U mission to
publish
the
figures
It will be observed
time.
which I submitted to him at that
that,
on
averaging
the five
children showed the lower percentage of
brighter
physical
87
35
75
34
128
65
81
49
Camac School
183
71
103
75
Claghorn School
193
61
127
66
647
260
425
262
Ilutledge
School
School
Allison
Percentage defective
An effort ence
was
to
nose
38.1 per cent.
28.8 per cent.
.
made
of defects of the
the
defect.
Exempt Children Non-Exempt Children Normal Defective Normal Defective 5G 28 39 38
Primary School
Ninth Street
schools,
determine the exact degree of influand throat. The harmful results of
recognized in recent years. In the Claghorn School the four classes of bright and dull children were examined again. Their eyesight proved to be about the same (averaging 5-~y and nasal ~). Enlarged tonsils, adenoids, deafness, catarrh occurred much more frequently, however, among the two these have been
classes of duller children. written shows
only too plainly the findings:
In many the adenoid their faces. The
on
Class 1
Class 15
Bright Children Number of children
expression
was
following table Class 9
Class 11
Dull Children
cwitlre^i
50
39
32
29
6
4
9
9
Nose and throat conditions: Number
defective
With single Tonsils
or
combined defects, viz: 3
4
3
3
Adenoids
2
1
5
6
Deaf
2
Catarrh
Percentage
..
5
1
..
2
3
of children with nose and throat
defects
12%
The conclusions to be drawn from the
10.2%
28.1%
31%
foregoing facts
are
very evident. The educational result in our public schools suffers a discount of about G per cent in the case of the physically de-
fective
ing
well as a waste of the time rightfully belongchildren. The drain on the teacher's energies is than proportionately increased by the presence of such chilbecause of their associated nervousness or stupidity.
children,
as
to the normal
more
dren,
Note.?This article is from a chapter of a book in course of preparation, entitled "Medical Inspection of School Children."
