Mentally Defective Children Part 13

From all these calculations we obtained a figure to remember, and also an opinion.

The figure is that the school for defectives at the Salpetriere returns to active life 12 per cent. of its pupils.

The opinion is what one might have known in advance, that in the majority of these cases the education given was a waste of effort, for none of the pupils who had acquired a calling had been affected by the worst degree of mental deficiency, idiocy, or imbecility. Moreover, none of these was epileptic as well as mentally defective. In other words, the two worst degrees of mental deficiency do not permit any hope that the child will be made capable of following any calling; and even a lesser degree of deficiency--that is to say, feeble-mindedness--is equally cut off from hope when the feeble-mindedness is complicated by epilepsy.

Before drawing from this first inquiry any practical conclusions, we should like to reach a comprehensive view of the question. We shall give our conclusions after we have synthetised all our results.

After the Salpetriere, Bicetre.

=Bicetre.=--The reader would be wrong to imagine that in these visits to the hospitals we are forgetting the school cases of mental deficiency; we are at the heart of the question. Whether we are dealing with hospital cases or school cases, there are details of organisation which are the same for all, and there are similar mistakes which we must try to avoid.

The asylum-school of Bicetre, which owes its origin, in 1892, to the General Council of the Seine, and its organisation to Dr. Bourneville, has a world-wide reputation. Dr. Bourneville has set himself to demonstrate, by every possible means, that idiots can be improved if they are treated methodically and progressively. It is thanks to his initiative that the medico-pedagogical treatment of idiocy, a treatment which has been much vaunted by the doctors, is now known everywhere. His clinique has constantly been cited as a model. This model has been imitated in France and more especially abroad. The asylums of Saint-Yon, of La Roche-sur-Yon, of Clermont, of Sainte-Gemme, and of Auxerre, have been inspired by the example of Bicetre, and have followed its methods. The State supports 440 boys in the asylum-school of Bicetre, and 230 girls at the Fondation Vallee.

We have no intention of describing here at length the organisation of these establishments. All who are interested may join in the Sat.u.r.day morning visits, when Dr. Bourneville goes round the whole of his clinique. We shall content ourselves by saying that the children in the asylum-school of Bicetre are divided into three groups:

1. The group of _invalids_--children who are idiotic, dirty, epileptic, demented. In this group are those who are regarded as incurable, and some who, although completely idiotic, are capable of some slight improvement. By means of a _swing_ or _see-saw_ their limbs are strengthened, by means of a _go-cart_ they are taught to walk, and by means of the _parallel bars_ they are taught to keep themselves upright.

2. The _healthy_ children of the _little school_, all of whom are able to walk alone. These undergo treatment for uncleanly habits. Special chairs are kept for the dirty, who are placed at stated times upon conveniences in order to regularise their functions. Then come _strengthening exercises_, which are gymnastics of a very simple kind; _toilet lessons_ to teach them to wash themselves; _table lessons_, to teach them to feed themselves, with spoon, fork, and even knife; the _training of the senses_; and, lastly, _training in speech_.

3. The third group includes children in the _big school_. These are less defective than the preceding. They are fit and healthy. But, on the other hand, there are found here a great many abnormal children (perverse and ill-balanced) who are not wanting in intelligence. The big school includes four cla.s.ses, each under the charge of a professor. The education, especially in the last cla.s.s, is carried pretty far, and many of the pupils possess their certificate of study.

For reasons upon which we will not insist, we were not so delighted with the hospital of Bicetre as we had been with the Salpetriere. We might have dispensed with this visit. The medical superintendent of the school for defectives at Bicetre has taken the trouble for a long time to publish regularly every year a volume of several hundred pages, which contains the most diverse statistical information about everything that goes on. We have studied the volumes bearing upon four years only--the years 1899, 1901, 1902, and 1903. Moreover, we profess that we have some knowledge of the school at Bicetre, having not only joined several times in the Sat.u.r.day visits, but having on several occasions carried on there researches in cephalometry; and, in the last place, we have had the pleasure of following in their inspection two members of the ministerial commission, who had had the idea of finding out how the teachers in the big school were fulfilling their functions.

It will be remembered that we made a distinction between the educational and the social return. This distinction is not recognised by everyone, and many good people take into account only the social return. There are those who would judge the school of Bicetre by one thing only--the number of patients who are made useful to society.

This is a question of great interest, but it is wrong to think that it is the only one to be considered. It would be unjust to confine oneself to it. The injustice can be understood by supposing that one is considering an inst.i.tution which receives idiots only. Would one judge such an inst.i.tution by asking how many of its patients become capable of winning their livelihood? Certainly not. It is possible to be of real service to the patients without raising them to such a level. The cure of dirty habits, for example, is not a thing to be disdained. Not only does it result in an economy of linen and washing, but it makes the patient less disgusting, less difficult to take care of. Here we have material and moral improvement which, even for those who consider expense only, cannot be considered negligible, for in the end the result is pecuniary economy. But, having stated this principle, it would be necessary to find out what is the value, what is the duration, what is the frequency of such improvements. It would be necessary to know what is their cost, and to compare the cost with the results in order to find out where one was. This kind of stock-taking, both financial and medical, has no place in the publications of the Bicetre, and cannot be replaced by isolated observations on the treatment and improvement of idiot children. There is here, therefore, a first lacuna. We note also with regret the absence of any inspection of the teachers in the schools, who are left to themselves without any supervision but that of the doctor. Now, the doctor is not usually an educationist, and it is to be regretted that he does not himself recognise his incompetency in pedagogy, but that, on the contrary, his nature, often p.r.o.ne to take offence, will not submit to any collaboration in his work. Having said this, we are going to confine ourselves to the social return of the school of Bicetre, since it is affirmed that such a return exists.

We would like to know exactly how many boys and girls have been able, after their discharge, to work at a trade and to maintain themselves.

Upon this point of capital importance the publications of Bicetre tell us nothing--absolutely nothing. It is, therefore, impossible to find out the real value of this inst.i.tution, so richly endowed, where the visitor perambulates palatial buildings, is saluted by a fanfare, and admires museums of natural history which would be the envy of many a public educational establishment. The publications give a number of particulars as to the number of dancing lessons, the walks to the Jardin d'Acclimatation, and the cost of laundry, etc.; but we are left in entire ignorance as to what all this is good for, and what is the practical tangible benefit which society receives from it.

Everyone knows, however, that the director of the school for defectives at Bicetre is an enlightened philanthropist, who has devoted himself with remarkable zeal and activity to procuring for his old pupils situations which they are capable of filling. He has understood, and was one of the first to do so, that the question of the education of defectives will never be settled until one has settled that of the social usefulness of these children.

We have even learned indirectly that he has made many endeavours to induce employers to engage his defectives as workmen; but it is likely that these suggestions have not met with the success they deserved, for the employers, threatened by the new law regarding accidents at work, hesitate to saddle themselves with workers who, being liable to attacks of epilepsy, or affected by motor inability, would lay upon them a very heavy responsibility. On the other hand, the school education has had a good deal of success since it has happened, as we have already remarked, that several of the pupils obtained their certificates of study.[14] But the only publications which we have consulted say no more about these certificates of study than about the trades followed by the defectives after leaving school. This silence is very significant. In spite of oneself, one puts a bad interpretation upon it. One has an irresistible tendency to believe, not that all the effort at Bicetre has been in vain, but that it has been disproportionate in relation to the result achieved.

We have no difficulty in admitting that idiots have been improved, but to what an extent this amelioration loses in importance if the majority of these idiots are destined to pa.s.s the rest of their life in an asylum, where they will be nourished in absolute idleness, and where, consequently, the heedless administration will gain nothing for what has been taught them at the price of such great efforts!

Let us try, however, to interpret the silence of the text. In four years 240 boys have left the school at Bicetre. In studying the school of the Salpetriere we distinguished three cla.s.ses of children--the _improved_, the _stationary_ or _doubtful_, and those who have got _worse_. We have consulted the statistical tables of Bicetre, and we have not found a single one marked _worse_, although one-third of the entire contingent are epileptic. Now, this is very surprising, since we know that epilepsy with repeated fits inexorably results in mental decadence. It is an enigma, which we explain in the following manner: Those who are really decadent have been marked _stationary_ by medical or pedagogical optimism. If our interpretation is correct, it recoils forcibly upon the expression _improved_, which is applied frequently to those discharged. To the interpretation of this word _improved_ we are, therefore, obliged to turn our attention.

What, then, must be understood by _improved_ when this word is found in the publications of Bicetre? First of all we must subtract a certain number of subjects who have been marked _transferred_. We know what is meant by this little word _transferred_ when it is applied to the children. It is lugubrious. It amounts to a sentence for life. A subject _transferred_ is one who, his time at school come to an end, is removed to an asylum for the insane, where, in all probability, he will stay to the end of his useless existence. If we eliminate the transferred, and if we keep amongst the improved only those who, having been so designated, have returned to their families, we get a proportion of 58 in 290--that is, 20 per cent. of boys.

This proportion seems to us too large, on account of the optimism which these doc.u.ments exhibit. It is to be noticed, however, that children are sometimes marked _very much improved_, or _notably improved_. If, for the sake of prudence, we consider as improved only those who are designated in this way, we have only eighteen, or 7 per cent.

This new proportion, if small in absolute value, still seems to us an exaggeration, because it is reached only by including a certain number of children affected with epilepsy. It must, therefore, be believed that their epilepsy has improved. But the amelioration or cure of epilepsy is not a matter of education; it cannot be considered as a success to be credited to active medico-pedagogical treatment. Let us therefore put the cured epileptics aside. There will then remain only seven who have undergone a notable amelioration and have returned to their families. What percentage is this? The total contingent upon which we have been making our calculations numbered 290, but it is right to exclude all the epileptics, for the reasons we have mentioned. This brings the number down to 216, and the number of children really improved, calculated upon 216, amounts, for the boys, to from 3 to 4 per cent.

By similar calculations, into the details of which we will not enter, we have shown that the improved amongst the girls are more numerous--namely, 20 per cent. But Vallee contains relatively far fewer epileptics than Bicetre. We do not know, also, how many of them have become capable of working at a trade.

We therefore conclude with the following propositions:

1. _At the school of the Salpetriere, 20 per cent. of defective girls improved, and 12 per cent. are able to work at a trade._

2. _At the Fondation Vallee, also, 20 per cent. of defective girls have improved. No return has been furnished as to their future employment._

3. _In the case of Bicetre, the number of defective boys improved is from 3 to 4 per cent. It is not known how many of these defectives are employed after leaving school._

=Some Conclusions.=--It seldom happens that one finishes an inquiry without experiencing some disappointment. One starts with great ambitions, intending to make everything plain, but on the way one is forced to lower one's flag. The truth escapes one. Sometimes it is the facts which conceal it from us, sometimes it is man who has an interest in concealing it. But the disappointment which has attended our inquiry would surpa.s.s the foresight of the most sceptical. On the other hand, if the school for defectives at the Salpetriere has enabled us to collect valuable information, we owe this good fortune entirely to the intelligent initiative of a woman. It was the directress of the school who, apart from all intervention, medical or other, had had the idea of inst.i.tuting these very complete schedules, which enabled us to discover the economic return of her school. The management deserved none of the credit. As to the school of Bicetre, we have studied it only through its annual publications, and we have managed with great difficulty to obtain only an infinitesimal amount of information of very doubtful value.

What lessons are we to draw from these examples as to the future organisation of our schools for defectives? We had hoped that the study of these inst.i.tutions would have provided us with ready-made experience as to the measures to be taken for founding schools for defectives under good conditions. The contrary has happened. The example of these inst.i.tutions has taught us one thing--the faults which we ought not to repeat.

Every impartial mind ought to be with us when we express the view that henceforth the activities of the schools and hospices should be made plain by precise information. For this it would be necessary to take the following measures:

1. That the definition of the grades of mental deficiency should not vary from one doctor to another, but that one should know what is meant by the word _idiot_, the word _imbecile_, and the word _feeble-minded_. A purely conventional but precise definition would be infinitely better than the present want of any; and we refer to the convention which we have suggested above.

2. That upon entrance and leaving, the mental condition and the state of instruction of the pupils should be precisely noted, so that by comparison of such notes, rather than by arbitrary estimates, one should be able to determine in what way the pupils have changed during their stay in school.

3. That on leaving the inst.i.tution, the children, whether they return to ordinary life or are transferred to asylums for the insane, should be followed up, and that particulars regarding their condition should be transmitted to, and centralised in, the office of the school, so that the masters may be able to judge the ulterior destiny of these children whom they have surrounded with so much solicitude during a period which often amounts to twelve or even fifteen years.

By such organisation one would at last know exactly, or at any rate approximately, what are the services rendered by such an inst.i.tution.

One would compare these services with the expenses, and one would see whether the receipts were sufficient to justify the expenditure, or whether, on the contrary, the money had been foolishly squandered, as we have reason to fear may be the case. We would also see upon what children educational effort should be directed, in order to obtain the maximum return. It would be possible to find out, for example, whether it is worth while continuing for five years, eight years, or more, to give lessons in reading to a child who, after two years, is still unable to spell. We will also consider very seriously whether a child who is unfortunately subject to repeated attacks of epilepsy, which no medical treatment has improved, and who is destined to descend progressively and inevitably through all stages of mental decadence, should be kept in his place in a cla.s.s; and whether the teachers would not be doing better to leave the child at peace than to teach him laboriously the rules of arithmetic and grammar, which will certainly be forgotten soon afterwards in the cloud which will obscure the intelligence.

One day, when we were walking through a residential school, we were struck by the spectacle of a poor epileptic. This was a little girl of about fifteen years of age. She was wearing her school ap.r.o.n, and upon her head was the little osier cap which epileptics are made to wear, to avoid the danger of falls upon the head. It was lesson-time. Pale and thin, the little patient was sitting quietly in her place, listening to the lesson of her mistress, who was explaining the rule of the agreement of the participle. Did she understand? We hope so, since she belonged to one of the higher cla.s.ses--the second, if we remember rightly. In any case, she was making a great effort to follow the grammatical explanation, and her forehead was thrown into wrinkles. All at once she gave a slight sigh, slipped down in her seat, and fell. The attendant took her in her arms and carried her into a corner of the room. The lesson continued with general indifference. The children pay little attention to such accidents, because they are so used to them. Now one, now another, has her attack of epilepsy. After a few minutes our little scholar came to herself.

She appeared quite dazed. The attendant spoke to her with kind indifference. "Come, now, that is better. It is nothing. It is all over." The child did not reply, but docilely allowed herself to be led to her seat. She took up her former position, appearing to listen vaguely; and on her pinched face, with its drawn features, the lesson in grammar continued to fall. The people, visitors and professors, who were present at that scene, and thought it quite natural, surely did not understand the heart-break of it. Some time afterwards we made inquiries about this pupil, being curious to know how she was, and what she was doing. We were told: "She is a poor little thing, who has forgotten a great deal. Formerly she was a bright child. Now she is going back every day. By-and-by she will no longer be able to read.

This is nearly always the way with our epileptics!"

This sad story, which we have just recalled, we give as a striking ill.u.s.tration of our statistical calculations regarding the ultimate fate of these inst.i.tution cases. Be it remembered, we had reached this very important conclusion: that epileptics, whether feeble-minded, or imbecile, or idiotic, never become capable of working at a trade. This somewhat vague conclusion it would be of great interest to examine more closely. Our little epileptic, who is gradually falling back, is an example. She has already reached the height of her development; she is fifteen years of age, and she is beginning to decline. We foresee the time when she will no longer know how to read. Is there, then, any use in wearying the poor thing by teaching her an abstract grammar rule?

Let us turn now to our school cases. Our conclusions may be divined.

We expressly demand that the utility of the schools shall be rigorously established, and that the teachers and inspectors shall be bound to take exact notes of the mental condition and the state of instruction of the pupils on entrance and on leaving. In this way one will act like any good shopkeeper, who considers it one of his chief duties to keep accounts of what he is doing. His system of book-keeping shows his position in a way which is indispensable if he is not to lose his money. He knows at what price he buys, at what price and under what conditions he sells, and whether, in consequence, his profits are sufficient to encourage him to continue to deal in such and such articles.

In the same way, in a well-managed school for defectives, it is necessary to know the exact details concerning the condition of the pupils on entrance and on leaving, in order that one may be able to judge the services rendered by the school; in order that one may be able to find out whether the educational methods employed are good, bad, or indifferent; whether they are better than those of another school, where different methods are followed, and so on. Such control is equally necessary in order to find out whether a particular category of children gives greater degrees of success than another; whether certain degrees of mental deficiency are capable of improvement only to an infinitesimal extent. Such things cannot be known in advance, and should not be decided lightly in credence of an _a priori_ opinion, but should be determined by accurate scientific methods, in the interest of the schools, in the interest of the pupils, and also in the interest of the tax-payers, who bear the cost.

It will not do to content oneself with admiring _in abstracto_ the goodness of the methods and the progress of the pupils, but it must ever be remembered that the aim of the schools should be to fit the defectives to take a useful place in society. The school should not aim at turning out brilliant pupils, stars in compet.i.tion, but individuals capable of looking after themselves and gaining their own livelihood. This should be the constant pre-occupation of the teachers. They should not shut themselves up within the four walls of their school, saying, "The life outside is no concern of ours." It is their imperative duty to consider the school life as a preparation for life outside. They ought, therefore, to pay attention to the needs of the immediate school environment, in order to know what are the industries which require workers, to take account of which of them are accessible to defectives, and to direct their education accordingly.

Domestic service in the country, for example, which requires but little initiative, would seem to be an excellent refuge for feeble-minded girls with good instincts. Agricultural labour supplies an excellent outlet for the boys, for in the country life is less complicated, and adaptation is more easy, than in the towns. There is a certain, practical, even easy way of finding out whether the teacher has been trying to keep in contact with real life, and whether his school for defectives is well managed. It is to find out what becomes of the defectives on leaving school, and what percentage he has been able to place in situations with a suitable salary.

Such measures of control are so logical that they only require to be formulated to obtain the immediate a.s.sent of all sensible minds. Yet one may ask whether, as a matter of fact, in the schools managed by the State, the inspectors occupy themselves sufficiently with this practical side of education, and do not even make the mistake of judging the education by itself, according to a conventional, literary, or scientific ideal. We are not speaking of public schools, colleges, and lycees. These establishments are attended by normal children, and it may be admitted that it is not, strictly speaking, the business of the State to prepare these for social life. As a matter of fact, that is not our own opinion, but that does not matter.

What is certain is that the duty of the State becomes more precise and more pressing when it is a question of a.s.suring the lot of the defectives. Has it always been kept in mind that their education should put them in the way of an occupation, and that one should teach them nothing useless, so as not to make them lose their time? We do not think so. We hope that the schools for the blind take care to know whether the Braille which they teach their pupils is a method of reading and writing which will be useful to them in life; whether the manual arts, such as caning chairs, the making of brushes and mattresses, are the best means which they can teach to the non-musicians whereby to gain their bread. We equally hope that in the schools for the deaf and dumb, which are teaching their pupils by the oral method--with what effort, what expense, and what devotion one may imagine--they have inquired what percentage of their pupils attained the ability to communicate verbally with people other than their teachers, and also what is the percentage of pupils who, ten years after leaving school, still use that method and find it advantageous.

All these questions should be asked, and conscientious minds should try to find an answer to them by impartial inquiry, in order to find out whether the methods are useful, and whether the school is directing its energies well. What is being done about this with respect to the schools for defectives?

We must do this justice to the legislation at present projected with regard to defectives, that it is not indifferent with regard to this question of control. The Ministerial Commission, in which one of us took part, heard many demands for guarantees of this kind. Its mistrust was awakened, and it made a number of suggestions which have been included in the Bill.

Thus, an elementary school inspector is trusted with the duty of taking account of the educational progress of each child. A little book must be kept recording full particulars of each individual case.

The principle of supervision by a Care Committee after leaving school has been adopted. All this is excellent. The law cannot enter into minute details. Administrative rules must be drawn up to provide against the two causes of error, prejudice and negligence.

Let us consider this question from our own point of view, and distinguish clearly between the educational and the social return.

=The Educational Return of the Special Schools and Cla.s.ses.=--In the first place, in order to gauge the advantages of special education, it is necessary to find out what becomes of defectives when they are left in the ordinary schools. It is quite clear that special education should be condemned and suppressed if it does not do more than the ordinary schools. We have seen that, in the latter, the defective is a dead weight, and the ill-balanced is a nuisance. Nevertheless, one must not jump to the conclusion that these children are in no wise modified by the school influences, and do not profit in any degree by the instruction. We have already pointed out some very touching facts: a little defective girl has learned to read, thanks to the persevering help of one of her normal companions. This proves, at least, that a.s.sociation with normal children may be good for something, but let us leave such anecdotes and attempt to reach a comprehensive view of the situation.