Arthur Holmes.

The conservation of the child; a manual of clinical psychology, presenting the examination and treatment of backward children online

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Southern Branch
of the

University of California

Los Angeles

Form L 1


cop . 1

This book is DUE on the last date stamped below

NOV i I9?8

MAY 3 1933


OCT 2^'
( -8 192.

MAR* 7 j.



JUL 2 6 1929 4**0^




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'APR 193D AUG 2 0*^

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Z 35-B8







Copyright, 1912
By J. B. Lippinoott Company

Published September, 1912

Printed by J. B. Lippincott Company
The Washington Square Press, Philadelphia, U.S.A.

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The rapid growth of the new clinical psychology and
the inauguration of Psychological Clinics in connection
with various institutions have made the need of a book
on this subject peculiarly felt by students and workers.
The Psychological Clinic at the University of Pennsyl-
vania was the pioneer in this country. Its sixteen years'
existence, its accumulation of records and the present
high state of organization to which it has been brought,
make an account of its history and functions especially

This monograph aims to give a practical description of
the inauguration and operation of a psychological clinic.
Being practical, it docs not attempt to go deeply into the
abstract principles underlying clinic methods. While
giving several systems of mental tests it do?s not, for
example, offer any extended discussion of their psycho-
logical bases, nor does it enter into an exhaustive criti-
cism of the definition and classification of mental defec-
tives, but contents itself with pointing out how the more
common criteria have been applied in practice.

Nevertheless the work is a unit in itself. It covers the
field of clinic operations. It offers a practical guide to
the psycho-clinicist, and at the same time extends its
discussions of retarded children far enough to make it
valuable and interesting to the teacher, to the medical



man, or any one else interested in child-welfare. It in-
cludes, therefore, tests and measurements gathered from
different sources and compacted into a form readily
applicable to the diagnosis of special children.

To my own clinic experience, covering a number of
years, the aid and advice of many workers in cognate
fields have been added. To Dr. Clara Harrison Town,
Director of the Laboratory of Clinical Psychology,
Lincoln State School and Colony at Lincoln, Illinois, I am
especially indebted for the elaboration of the psycholog-
ical analysis in Chapter VII; and to Dr. Frieda Lippert,
Psychological Clinic Assistant at the University of
Pennsylvania, for help with the physical examination

Primarily for inspiration to this work and constant

guidance in it, my greatest debt is due to Dr. Lightner

Witmer, with whom I have been associated, and who

most generously placed at my disposal the invaluable

results of his sixteen years' experience. In making this

acknowledgment, I express but a very small fraction of

my debt to him. What science and society at large owe

to him as the inaugurator of this beneficent application

of psychology to the mental ills of children, only the

coming years will reveal.


University of Pennsylvania, January, 1912.


The people of this nation have been prodigal of all
their resources. It was evident long ago to the thoughtful
mind that the time was speedily approaching when we
should both repent our extravagance and endeavor to
institute such change in our procedure as to conserve
what we formerly wasted. Whence arose in the past
decade the nation-wide movement for the conservation
of our natural resources. Economic stress led to this
reform. It is well, even if it is confessedly late. In our
greed to make easily a large sum of wealth we have
wasted beyond recovery a much larger sum. Wisdom is
becoming our heritage, but it has come with a limping gait.
The same general truth applies to the conservation
of our greatest and noblest asset — our children. We
have given the child whose native endowments made
easy its education a fairly creditable training. Those
that did not readily lend themselves to the system of
education as it was were cast aside as waste products of
our civilization. We are now reaping the crop in shame.
Our land is filled with all sorts of institutions, maintained
at enormous cost, in which is crowded our army of mis-
fits. We cannot by legislative and philanthropic endeavor
meet the rapidly growing demand. We have neglected
the ounce of prevention and are feebly providing the
pound of cure.

To charge this situation to the public school is most
unfair. The conditions governing these could not result



in any other issue. These conditions the school was forced
to accept. It did not create them, nor did it feel content
under them. The people have applauded this great
institution of democracy, and neglected to make it the
agency their platitudes would have it to be.

With a fiscal provision that is unworthy a great people;
with partly trained, inexperienced but thoroughly well-
meaning teachers; with overcrowded classes; with inade-
quate and at times incompetent supervision; with ignoble
interference by school directors whose business is legis-
lative, but who made it their business to be executives
as well; with equipment confessedly poor; with buildings
that were a menace, not an aid, to right education; with
the absence of uniformity even in ideals, due to inadequate
supervision; and with substantially no provision for
enforced attendance, for the prevention of the exploita-
tion of child-labor, and for professional medical care of
the child, the marvel is that the school has done so well.
The saving influence in it all has been, and is, the unselfish
and beneficent force of teachers who have faced a critical
situation with great fortitude, tact and devotion. They
have sensed the conditions. They have appealed for
remedies. They have gone vastly beyond their legal
duties in a heroic effort to reach the last child and aid
him to his best estate in the Republic.

The conservation of the child, by all odds the most vital
conservation with which we can have to do, has thus
been allowed to await the action of some modern Pesta-
lozzi; — some great-hearted and sanely-visioned teacher
who would turn to the waste products of our schools and
in the spirit of science and humanity ascertain their true
state and formulate such guidance as to give to these
their maximum value to society. We are now doing this.


The Psychological Clinic at the University of Pennsyl-
vania was a pioneer in this cause. Here the latest and
best scientific research has been applied to the child whose
mentality precluded its ability to proceed normally with
its education. Much has already been done of educa-
tional moment. It is important now to generalize this
work, and particularly to give teachers everywhere an
insight into these cases, that they may be promptly and
properly cared for. Theoretically there should be no
waste product in our schools. As tools of democracy the
schools should universalize their activities. Practically,
for causes patent to all, there will always be subnormal
children. They cannot be educated with normal children.
Both groups suffer by the contact. To detect the sub-
normal children and subject them to scientific diagnosis
is the first step in their proper education. This much we
may now confidently claim is possible.

To classify the subnormals into such groups as are
essential to their right treatment is a vastly more complex
and difficult matter. We lack as yet absolute criteria
for such classification. Science must give us these stand-
ards, and science will. It is my opinion, after years of
observation, that too many so-called scientific diagnoses
are crudity itself, — that many a child is classed as sub-
normal whose only limitation is an unfortunate environ-
ment. The temptation to find sensational data as to the
number of "misfits" in the school is too strong for some
to resist. The apparent willingness of an impatient. or
overwrought teacher may also work injustice to some.
But with due allowance for all this, there remains a large
group for whom special classes or some other remedial
agency must be secured. The really subnormal child
appeals in compelling ways to one's sympathy. More-


over, the true ends of our social democracy are vitally
concerned in securing to those the most careful and com-
plete training.

Many children need a care and culture vastly more
specific in character than they now receive. The failure
to make suitable provision for these results in great loss
to them and to society. They are indisputably entitled
to the best they can receive, and society is the loser as
well when any unit of it acts below his best. Moreover,
the school is by unreflecting critics made to appear a
failure when it is notoriously true that the school alone
so nurses these cases along as to gloss over what would
be a social disaster were the school rigidly to define its
scope and technically fulfill the letter of its law.

Back of Dr. Holmes's discriminating study lies a great
educational and social need. If we are wise we shall heed
it and turn seriously to the business of caring for the most
hopeless unit in the social order. We shall do this all the
better by giving heed to the facts here presented and
by following the scientific method here so graphically


M. G. B.

August 22, 1912.




Historical Sketch 15

The lot of the idiot in ancient times; in the early Christian
period; in the Middle Ages; during the Renaissance; in
modern times.

The impulse for the modern movement; Periere, the predecessor
of Rousseau; "Emile" and the lines of modern pedagogical
development; regular education in the schools; Pestalozzi;
the Kindergarten; Froebel; the modern physical education
through Basedow.

The physiological education of mental defectives; the wild boy
of Aveyron; Dr. Itard, who was actuated by an epistemo-
logical motive but used the physiological method; his work
continued by Seguin in France, Saegert in Germany,
( rUggenbuhl amongst the Cretins in Switzerland; the expan-
sion of the work; the movement conducted by medical men.

The psychological movement ; the new physiological psychology;
clinical psychology; the Psychological Clinic established;
directed by a psychologist ; individual study ami treatment
of exceptional children.


Constitution of the Clinic 32

Material equipment; rooms, apparatus for tests, toys, instru-
ments, photographic apparatus, records, blanks, questions,
The Clinic workers; the psychologist as head; reasons for such
an arrangement; the medical examiner and his work; the
social worker: her qualifications, equipment and duties; the
recorder: her duties and qualifications.



The Function and Field of the Psychological Clinic. . . 45

The popular notion of a psychological clinic; what it does not
do; what it does do.

It has a two-fold function divided into several tasks; for the
purpose of description, all these are grouped about diag-
nosis of mental cases; its scientific tasks, — collecting and
filing data; discovering and proving tests or mental measure-
ments; its philanthropic task, — connecting children with
the best means of treatment at clinics, institutions and
homes; advising teachers and parents, supervising training
and treatment.

The need for such an institution found in the large numbers of
both backward and mentally defective children; statistics


Operation of the Clinic 76

The child received; placed at ease by the social worker; the
examiner and his duties.

The oral examination or history; begins with questions of
present import; proceeds to the less known; mother and
teacher examined separately.

The physical examination; is extensive, but not intensive; sepa-
rate rooms; woman for girls.

Mental examination; observation of every movement of child;
examiner must be alert to overcome stubbornness; make
allowances for fatigue, excitement, novelty; the mother
must be included in the examination; parents are nearly
always ignorant or inefficient; the inefficient are weak or
over-hard; statements of play, music and memory.

The child must be then sent to a medical clinic, doctor, special-
ist; possibly returned for further mental tests; then sent
to regular school; or special class.


Classification of Clinic Cases 92

Those who come are already partially classified into (a) mental
deviates; (6) moral deviates.


Most of the mental deviates treated are arrested, backward or

retarded in their mental development; all can be classified

as (a) curably backward; (!>) incurably backward.
The standards of normality; individual, social, pedagogical.
Some children arc temporarily backward because of removable

defects; others incurably backward, and must be classified

as aments.
The temporarily backward are (a) immediately recoverable,

(b) rapidfy recoverable, (r) slowly recoverable.
The incurably backward are further subclassified different 1}'

by different authors; definitions of Seguin, Tredgold;

classification of Tredgold, Goddard, Barr, Binet.


Method of Classifying Clinic Cases 133

Theoretical method of direct observation upon some cerebral

defect; the cases of Helen Keller and Kaspar Hauser.
Indirect methods of distinguishing permanent from temporary
mental retardation; oral questioning to discover factors in
personal and family history ; a physical examination made to
discover the presence of removable physical defects and


Method of Classifying Clinic Cases (Concluded) 179

The mental test proper; the place and importance of mental

Tests used in the Clinic for measuring general retardation; the

pedagogical, their significance, formulation, use and results;

tests for four school grades; Binet tests; their use and

significance; latest formulation. Psycho-physical analysis;

two-fold purpose: (a) to locate the causes of retardation in

some mental defect, (6) to determine the kind of training;

the tests themselves as formulated by the Clinic.


Classification of Moral Deviates 250

Does moral imbecility exist without mental defect? An exami-
nation of authorities; their testimony docs not agree.


A study of normal morality; Sidgwick's three methods of ethics*;
reduced to two psychological types: (a) rational, (b) in-

Possible varieties of moral imbecility; many degrees of moral
imbecility; moral responsibility; Dr. Tredgold's theory.

Diagnosis of moral imbecility; no peculiar symptom-complex;
the nature and persistence of evil acts; the effect of disease;
the effect of heredity; the presence of mental defect; its
nature; its discovery by psycho-analysis.


The Sociological Relations of the Clinic 299

Whence come the children and whither do they go?

Scientific relations; with abnormal psychology; Dr. Witmer's
outline of clinical psychology presented before the American
Psychological Association.

Relation of the Clinic to the Hospital School; one supplements
the other; Hospital School as a temporary school or place
of observation; a necessity under present social conditions.

Children come from high and low society, illustrative cases;
homes, cases; public and parochial schools, cases; physicians
and medical clinics, cases; charitable organizations, cases.

Cases according to their disposal may be divided into three
classes: (a) those cured by medical or surgical relief, cases
described; (b) those relieved by medical or surgical treat-
ment, but requiring special training to restore them to their
normal places in school and society, cases; (c) those found
to be incurably retarded and hence candidates for institu-
tions for feeble-minded, cases.



Group of atypical pre-adolescent children at dinner in special

class-room 26

Usual type of form-board used in clinic examinations 34

Modification of form-board 35

No further tests necessary to show child suffering from myopia 66
Adenoid case. Four-months-old baby from which adenoids were

removed 66

Profile and side view of adenoid case 66

Typical adenoid case 66

Making head measurements in a mental examination 82

Child being tested for individual capacities 88

Steadiness test 90

Test of child's ability to form picture of, or to recognize a shape

by touch op

Mentally retarded on account of tubercular inheritance, malnu-
trition, and useless teeth 116

Mentally retarded on account of malnutrition and other physical

defects 116

Mentally retarded on account of neglect, malnutrition, defective

eyes, and speech defect 1 16

On the borderland 116

High-grade moron. Very deaf 132

Twelve-year-old high-grade imbecile suffering from malnutrition 132
High-grade imbecile. Much more capable than her appearance

indicates 132

High-grade imbecile. Ten years old. Less capable than her

apperance indicates 132

Cast of child's jaw malformed so that front teeth do not come

together 154

V-shaped upper jaw which so often accompanies adenoid growths 154

A hydrocephalic imbecile. Low grade 168

Middle-grade imbecile 168

Hands and webbed fingers of Mongoloid idiot boy 172

Hands of imbecile boy, typical in his physical appearance 172



Materials for Binet tests (Fig. 1) 213

.Esthetic comparison. Used for 6-year-old Binet test (Fig. 2) . . 215

Unfinished pictures. Used for 7-year-old Binet test (Fig. 3) . . 217

Testing color zones of eye with perimeter 230

Child tested by ergograph 230

Record made by plethysmograph and pneumograph on roll of

smoked paper 244

Plethysmograph, for recording fine variations in emotions 246

Cretin girl. Typical position of tongue 294

Case of extreme moral delinquency. Age 10 years 294

Middle-grade moron-Mongoloid 294

High-grade moron. Negroid type of profile 294

Group of atypical adolescent boys 340

The Conservation of
The Child

2. 3 S 9 &



The Treatment of Idiots among the Ancients. — The

lot of the idiot has varied with the tides of history. Among
the ancients feeble-minded children were objects of de-
rision, reproach and persecution, were without rights or
privileges, accursed by the gods. Some nations, like the
Spartans, got rid of them by exposure or violence. Traces
of this practice are found in the laws of Lycurgus, and
intimations of it exist in Cicero's writings. Until recently
the same custom prevailed among some South Sea Island-
ers and some North American Indians, though not
universally with the latter, as the well-known instance in
Cooper's "Deerslayer" would indicate. Even in the
ancient times all idiots did not share the same fate, for
we read of Patua, the blind imbecile slave of Seneca's
wife; and of Nero, Commodus, Elagabalus, three wearers
of the imperial purple.

Early Christian Care of Idiots. — The relentless cru-
elty of the ancients changed to kindness among the early
Christians for whom Christ's ministry to the demon-
possessed became a divine example. Notable leaders of
the early Church like the Bishop of Myra (the St. Nicholas
of to-day), in the reign of the Emperor Constantine in



the west about 300 a.d., devoted themselves to the care
of these unfortunates, and Euphrasia, closely related to
the royal household of Theodosius, retired at the age of
twelve to the convent of Thebiad for the same purpose.
Examples of the same consideration for the mentally
afflicted are found in other religions. Confucius and
Zoroaster commended imbeciles as objects of mercy, and
the Koran enjoins all true believers to have charity for
the feeble-minded.

The Mediaeval Attitude. — The early Christian zeal,
sincere but unskilled, changed to the lighter and more
frivolous attitude of the mediaeval period. Imbeciles
now became the fools and jesters of the royal courts.
They had the freedom of palaces; they wandered unmo-
lested over Europe^ and were regarded by the French
especially as "enfants du bon Dieu." They were viewed
by most people with superstitious reverence, as those
who walked on earth but had their conversation in heaven.
For this reason Tycho Brahe, the great Scandinavian
astronomer, retained always in his observatory a fool
companion to whose babblings he listened as to revela-
tions from heaven. Probably a remnant of that super-
stition still remains in the word "cretin," from the French
"Chretien" or Christian, which is yet applied to a certain
class of defectives.

The Renaissance Reaction. — Such friendliness, how-
ever, based only upon fancy and superstition, could not
be other than fitful and uncertain. In the Renaissance
the pendulum swung back again toward the ancient cru-
elty. Luther and Calvin both denounced imbeciles as
"filled with Satan." As a cure for their condition, beat-
ings, scourgings, and other forms of inhuman treatment
were resorted to in order to drive out the possessing


demon. Even to-day among the ignorant and supersti-
tious in America such beliefs are still current, and instances
of savage cruelty practised upon the weak-minded are
not unknown.

Modern Physiological Education the Source of
Training of Idiots. — Fortunately, however, the founda-
tions of the modern understanding of imbecility were
being laid in the emphasis upon physiological education.
From many workers, responsible for the beginnings of the
modern movement, there emerges distinctly one leader in
Jacob Rodrigues Pereire. Seizing upon the physiological
studies of other original investigators, his active sympathy
and powers as a linguist and philosopher led him to apply
the physiological method to the education of deaf mutes.

Whether the streams of pedagogical treatment of the
feeble-minded can be traced back to Pereire or not, cer-
tainly they can be easily followed to the marvellous
suggestor of so many modern methods, Jean

t. / • • Rousseau

Jacques Rousseau (1712-1778), and his original
and impractical "Emile." Through that book, Pesta-
lozzi was directly inspired in 1767 to purchase a hundred
acres of ground in the country, to build his cottage, and
there to undertake the rearing of his own son like the ideal
"Emile." Of his seven years' experience in this attempt
he kept a note book called ''The Father's Journal," per-
haps the first piece of child psychology on record. When
his experiment with his own son failed, he enlarged the
enterprise in 1775 by turning his farm into a manual
training school where the children of poor neighbors might
come to study and pay their tuition by the products of
their toil. While his doctrine was " reform by environ-
ment," it practically amounted to education by physical
training. This enterprise gained for him the professor,


ship in the orphan asylum in Stanz in 1787, and later led
him to found his institute at Yverdun in 1805 from which
have emanated all modern methods and theories of educa-
tion. It was at the latter institute that Froebel spent his
time from 1782 to 1852 and received the impetus to that
great work for children originated and carried on in the

Directly traceable to the wonderfully suggestive Rous-
seau comes another line of pedagogical development closely
allied to physiological training, and developing into the
modern movement of physical education. In 1774, Base-
dow, directly influenced by the "Emile," founded his
other Lines of Philanthroporium at Dessau, which in turn in-
Deveiopment S pi re( j Salzmann to begin a similar work near
Gotha in 1784, where Gutsmuths labored from 1785 to
his death. Father Jahn (1778-1852) first met Freizen at
Planann's Pestalozzian Institute at Berlin, and together in

Online LibraryArthur HolmesThe conservation of the child; a manual of clinical psychology, presenting the examination and treatment of backward children → online text (page 1 of 24)