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 I 
 
EXPERIMENTAL STUDIES IN PSYCHOLOGY AND PEDAGOGY 
 
 Editor : 
 LIGHTNER WITMER 
 
 Univehsitt of Pennsylvania 
 
 V. A CLmiCAL STUDY OF ONE THOUSAND RE- 
 TARDED CHILDREN IN THE PUBLIC SCHOOLS 
 OE CAMDEN, NEW JERSEY 
 
A CLINICAL STUDY OF ONE THOUSAND RETARDED CHILDREN 
 IN THE PUBLIC SCHOOLS OF CAMDEN, NEW JERSEY 
 
 JACOB DANIEL HEILMAN, Ph. D., 
 
 PROFESSOR OF PSYCHOLOGY, STATE NORMAL SCHOOL, GREELEY, COLO 
 
 PHILADELPHIA 
 
 THE PSYCHOLOGICAL CLINIC PRESS 
 
 1910 
 

 
A THESIS 
 
 SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL 
 
 OF THE UNIVERSITY OF PENNSYLVANIA IN PARTIAL 
 
 FULFILMENT OF THE REQUIREMENTS FOR 
 
 THE DEGREE OF DOCTOR 
 
 OF PHILOSOPHY 
 
A CLINICAL STUDY OF ONE THOUSAND EETARDED 
 
 CHILDEEN IN THE PUBLIC SCHOOLS 
 
 OF CAMDEN, NEW JERSEY. 
 
 Intboduction. 
 
 It was found by means of a statistical investigation made at 
 the close of the school year 1905-06, that there were more than 
 two thousand retarded children in the public schools of the city of 
 Camden. A year after the statistical investigation, an attempt 
 was made to subject each one of the two thousand cases to an 
 individual clinical examination. For causes which will be 
 described in the main body of this thesis, it was possible, however, 
 to re-examine only one-half of the original number of cases. 
 
 The motive for the clinical investigation is to be found in the 
 failure of the public school to realize one of its ideal's. This 
 failure constitutes a just cause for the criticism that there is a 
 deformation in the social institution for the education of our chil- 
 dren. Deformation Eaving been pointed out, this investigation 
 was undertaken with the hope of reform by inquiring into the 
 causes of tlie existing conditions. The object of this study is there- 
 fore twofold: first, to make a criticism of the public schools — to 
 show in what respect they fail of reaching their aims; and sec- 
 ondly, to set forth some of the causes to which the schools' failure 
 may be ascribed. The causes having been discovered, it is hoped 
 that an effort to remove them will result in the improvement of 
 the schools. As the second object constitutes almost the whole of 
 this monograph, the first Avill be disposed of in the introduction. 
 
 Children begin their public school life at different ages, some 
 as early as five, others not until eight or older. Even where edu- 
 cation is compulsory, the age of entrance will frequently be above 
 that prescribed by law. This is due in part to an evasion of the 
 law and in part to ill health, and the influx of a foreign popula- 
 tion. Nevertheless, the majority of children are under seven years 
 of age when first entered upon the enrolment records of the public 
 schools. 
 
 (5) 
 
6 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 It is the aim of the school to have each child do the work of 
 one grade in a single year, so that if a child enters the first grade 
 at the age of six years, he should, if the school succeeds in its 
 purpose, begin the work of, the second grade at the age of seven 
 years ; of the third grade at the age of eight and so on through 
 the grades. The school, however, does not succeed in realizing this 
 ideal scheme of progress. A very cursory examination of school 
 reports or enrolment records will reveal the fact that there is a 
 large number of children in the public schools who must often 
 have failed to make the necessary promotions. 
 
 From an analysis of the total enrolment figures of the Camden 
 schools for 1905-06, it appears that about 3372 public school 
 children or 26 1-3 per cent of the entire number were retarded, 
 meaning by "^retarded" those children of the first grade who were 
 nine years old or more, of the second grade those who were ten or 
 more and so on. A realization of the extent of the retardation of 
 public school children led Mr. Bryan, the city superintendent, to 
 study by means of a statistical inquiry, the conditions under which 
 it existed, and also to consent to a clinical examination of the 
 children whom his inquiry showed to be retarded. This examina- 
 tion was carried on by me during the second half of the school 
 year 1906-07. Its object was to discover the social, educational, 
 and other factors which delayed the normal progress of the child. 
 What was accomplished in the effort to realize this object, will be 
 set forth in the main body of this monograph. 
 
 In order to facilitate the investigation and to secure data that 
 were relatively uniform and of scientific value, the first task was 
 the preparation of a suitable blank. The description and analysis 
 of this blank will constitute the subject matter of the first chapter. 
 Other steps preliminary to the investigation and certain miscel- 
 laneous problems connected wdth it, like the withdrawal of chil- 
 dren from school, will be considered in the second chapter. The 
 third chapter will be a treatment of the results of the clinical 
 investigation. 
 
CHAPTER I. 
 
 Desckiptiojst and Analysis of the Blank. 
 
 The analysis of the blank is made because it is indispensable 
 to a proper comprehension of the chapter on results. It is hoped, 
 moreover, that it may prove of service to others who may contem- 
 plate the preparation of a blank for similar investigation. The 
 blank is of such a character that it may also serve as a model to 
 teachers who are persuaded of the utility of keeping a permanent 
 record of each child. Such a record, revised each year and sent 
 with the child as it is promoted or transferred from one school to 
 another, would more than repay the teacher for the time devoted to 
 making the records. To do this work properly, presupposes on the 
 part of the teacher, a knowledge of the individual child which is 
 really indispensable to its proper discipline and instruction — a 
 knowledge, however, which many teachers lack. The required use 
 of this blank will go far towards compelling the teacher to gain this 
 necessary knowledge. A case presents itself to my mind which 
 forcibly illustrates how children may be made to suffer on account 
 of the ignorance of the teacher. This was a girl, nine years old and 
 in the first grade. She did very poor work and had little promise 
 of being promoted. The mother was very urgent in demanding 
 that her child should be promoted at the close of the term. Partly 
 owing to the parent's insistence and partly in consequence of a 
 school regulation, this poor child, who was a microcephalic im- 
 becile, was detained an Jiour or more almost every day after the 
 regular school session in order that she might study her lessons. 
 On further inquiry, I discovered that no matter how much time 
 the child devoted to her lessons, she learned nothing. 
 
 The keeping of such a record would do more than benefit 
 the teacher and the pupil. Properly made and preserved, these 
 records would constitute a repository of data, upon which to build 
 generalizations of the utmost significance to the school system 
 and all connected with it, whether in the capacity of patron or 
 pupil, teacher or supervisor. 
 
 All the items of the blank, which is reproduced in actual 
 size on the following page, may be classified somewhat roughly 
 into three groups ; one group pertains to the child in the home, 
 
 (7) 
 
8 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 No. 
 
 Name 
 
 
 
 
 Grade 
 
 Class 
 
 190 
 
 Address 
 
 
 Grade 
 
 Class 
 
 190 
 
 Address 
 
 
 School 
 
 
 190 
 
 Teacher 
 
 
 School 
 
 
 190 
 
 Teacher 
 
 
 Progress 
 
 B G F 
 
 D vD Date of birth 
 
 Age 
 
 Conduct 
 
 E G F 
 
 D vD Age on entering school 
 
 No. years in school 
 
 Attendance 
 
 vR R I 
 
 vl A School 
 
 history (Rel) 
 
 
 Most deficient In 
 
 
 
 
 Best in 
 
 
 
 
 
 Habits 
 
 
 
 
 
 Father living dead Normal 
 
 Mother living dead 
 Step-father, Step-mother 
 Nationality F. 
 " M. 
 
 Birthplace 
 Lives with 
 Home Lang. 
 Older brothers living dead Arms 
 
 5 4 3 2 1 
 
 vG G M SI D Deficient 
 
 5 4 3 2 1 
 BkwIHIM II Id 
 
 Health vG G F 
 
 P 
 
 vP 
 
 Nutrition F G M 
 
 P 
 
 St 
 
 Support R W M 
 
 P 
 
 vP 
 
 vG G F P vP 
 
 Culture vG G F P vP 
 Discipline vG G F P vP 
 
 Occupation of provider 
 
 Child works at 
 
 Anormality 
 
 Asymmetry 
 
 Trunk 
 
 " sisters 
 Younger brothers 
 
 " sisters 
 Eye, R. ] 
 Eye, L. 1 
 Defects 
 Disease 
 
 Ear, R. | 
 Ear, L. j 
 Defects 
 Disease 
 
 Co-ordination 5 
 vB Bold Norm 
 Am Resp Pass 
 Sto In Al 
 vR Refl Norm 
 Stu Wilf Firm 
 Stammer (inf) 5 
 Stutter 5 
 
 Filled in by .. 
 
 <i 
 
 4 3 
 
 Shy 
 
 Sull 
 
 Nerv 
 
 Imp 
 
 Flex 
 
 4 3 
 
 4 3 
 
 Lab 
 
 " Legs 
 
 
 " Hands 
 
 
 " Feet 
 
 
 Cranium 
 
 
 Forehead 
 
 
 Face 
 
 
 Ears 
 
 
 Eyes 
 
 
 Nose 
 
 
 Lips 
 
 
 Palate 
 
 
 2 1 Tonsils 
 
 
 vS Naso-ph'nx 
 
 
 Sur Mth Breathg 
 
 
 vN Teeth 
 
 
 vl Tongue 
 
 
 "Vac Voice 
 
 2 1 Speech 
 
 2 1 Diseases 
 
 Date 
 
 oratory of Psychology, University of Pennsylvania. 
 The J. Lewis Crozer Fund. 
 
 
THE EXAMINATION BLANK. 9 
 
 another to the child in the school, and the third to the child as a 
 mental and physical entity. Just as there are three main groups 
 of facts, so there are three main sources from which to gain 
 our information : the home, the teacher and the child himself. 
 When large numbers of children are to be examined within a 
 limited period, it is impossible to undertake to see the parents 
 of every child and the necessary information must be obtained 
 from other sources. Frequently the child's teacher will have 
 some knowledge of the home conditions. In my experience, how- 
 ever, the principal is more likely to know the home, especially 
 if she has held her position long enough to become acquainted 
 with the district. It is also a practical expedient to use the child's 
 appearance as an index of the home conditions. In my work, 
 I attempted to obtain facts about the home from the teacher, 
 principal and child. 
 
 The blank makes no provision for obtaining certain data 
 of value, such, for example, as the circumstances of the child's 
 birth. A number of considerations entered into the determina- 
 tion of the number and kind of data, for the collection of which 
 provision was made. To prepare a blank four times the size 
 of this one would have been a comparatively easy task. Our 
 blank limits the data to those considered most essential for an 
 understanding of the child's status in the school, i. e. his back- 
 wardness in grade for his years. The blank must be as convenient 
 as possible to handle and must be filled out with the least possible 
 expenditure of time. Not an item appears on this blank without 
 having had its purpose and relative value subjected to critical 
 scrutiny. In certain cases, however, important facts may come 
 to light which ought not to be passed by; these should be care- 
 fully entered on the back of the blank. The blank was only put 
 into its present form after several days' trial. This resulted 
 in a few alterations, but for the most part it was left as originally 
 conceived by Professor Witmer. 
 
 There are a number of preliminary data at the head of the 
 blank which may usually be obtained from the ordinary school 
 records. These are name, address, grade, class, school, teacJier, 
 date of birth, and age; sometimes even age on entering school and 
 number of years in school can be obtained from the records. In 
 the Camden schools it was possible to obtain all but the two last 
 named items from the regular registration books. It will be 
 noticed that grade, class, school, address, and teacher are duplicated. 
 This is explained in the following way. When I began my work 
 
10 CLINICAL STUDY OF BETABDED CHILDBEN. 
 
 I examined the blanks Mr. Bryan had used in his inquiry during 
 the year 1905-06. From these records I obtained the name, grade, 
 class, address and teacher for each one of the two thousand re- 
 tarded children. These facts are required to identify and locate 
 the child, therefore I entered them upon my blanlc before be- 
 ginning the actual examination. But when I began the exami- 
 nations, I found that the location of the child had changed in a 
 large percentage of cases, due to promotion, transfer or change 
 of residence; hence the duplication. If the facts which serve 
 to identify and locate the child are obtained from the school rec- 
 ords for the year in which the investigation is carried on, some of 
 the items on the blank need not be duplicated, but this does not 
 apply to grade and class. The grade and class of the year previ- 
 ous to that of the examination should be entered for every child 
 upon the blank, so that when a child's progress is reported by the 
 teacher as good, the investigator can at once compare this judgment 
 with the number of classes or grades the child made during the pre- 
 vious year. Frequently teachers will report progress "good" simply 
 because the child in question is then doing well. They do not 
 take into consideration the length of time involved. When their 
 attention is called to the fact that the child made no promotion 
 during the previous year, they frequently reverse their judgment. 
 
 After we have obtained the name, grade, class, school, address, 
 and teacher of the child, he may be said to be located. We now 
 know where to go to find him, whether at school or at home, in 
 order to obtain the other data called for by the blank. Moreover, 
 age, grade, and class give the child's intellectual status, enabling 
 us to measure the extent of his retardation. Date of hirth and 
 age are both called for, in order that one may serve as a check 
 upon the other. If there is any inconsistency, the information 
 must be regarded as unreliable. The same may be said about 
 age on entering school and number of years in school. 
 
 Closely associated with all the data mentioned above are 
 progress, conduct, and attendance. After progress appear the 
 letters E, G, F, D and vD ; these are abbreviations for the words 
 excellent, good, fair, deficient and very deficient. The letters used 
 in connection with conduct are the same as those used with pro- 
 gress, and stand for the same words. The letters following 
 attendance are vR, R, I, vl, and A; they are symbols for the 
 words very regular, regular, irregular, very irregular, and absent. 
 These letters, standing for words, are used because they are likely 
 to mean more to the person doing the grading, than mere figures 
 
THE EXAMINATION BLANK. H 
 
 standing for so many grades. However, figures may be employed. 
 In connection with normal, which for the sake of compactness is 
 used for normal mentality, both figures and letters appear. The 
 same arrangement is employed in connection with deficient, stand- 
 ing for deficient mentality. To indicate the grades of co-ordina- 
 tion, stammer, and stutter, only figures are employed, because 
 no significant words suggest themselves. Below the item co- 
 ordination are five groups of letters and words which are used 
 to grade five different mental or moral qualities, whose purpose 
 will be considered later. The other qualities which it was thought 
 profitable to grade are liealtli, nutrition, support, home care, home ^ 
 culture, and home discipline. 
 
 I have now made mention of all the data involvmg the 
 gradation of qualities, conditions and functions; I shall next 
 consider the system of grading. It will be noticed that a five- 
 point system is adhered to throughout, and there are some reasons 
 why a five point, rather than a four or six point, or some other 
 system, should have been chosen. It appears to be the most 
 natural system. In our every-day judgments we are apt to 
 classify with respect to a system of five grades. When asked 
 to grade the mentality of a child, it does not seem difficult to 
 say that he is either good or poor, or neither. But we constantly 
 meet with exceptional cases which we feel should be classed as 
 very good or very poor, and therefore one more grade appears 
 necessary at each end of the three already given. In asking 
 teachers to grade the mentality of their pupils, I frequently asked 
 them whether the mentality was good or poor, without telling them 
 how many grades of mentality I used. In very many cases they 
 responded, "neither," meaning medium, or, "He is very good, 
 or, "He is very poor." . . 
 
 Another reason for preferring the five-point system is its 
 easy adaptation to other systems. In translating this system 
 into the percentile system, or the reverse, the lowest grade would 
 include all the points from 1-20 per cent; the second from 21-40; 
 the third from 41-60 ; the fourth from 61-80 ; and the fifth from 
 81-100. Although somewhat imperfectly, it may be articulated 
 with a three-point system by combining the two points at each 
 extremity of the five-point system. Again, some four-point systems 
 are simply five-point systems in disguise. Such, for example, is the 
 one used in the college of the University of Pennsylvania. Here 
 the symbols D, G, P, and N, stand for the words distinguished, 
 good, passed, and not passed, respectively. The group marked 
 
12 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 N has really not been analyzed and graded because the college 
 has no interest in grading students who fall below the passing 
 mark; but if the IST group were graded according to relative 
 ability, it would be found that the students in it would distribute 
 themselves into two groups which would be related to each other 
 like the D and G groups. 
 
 In connection with normal mentality, for which normcd 
 appears on the blank, I wish to explain in what way the figures 
 are used to indicate gradation. Directly after normal are placed 
 the symbols vG, G, M, SI and D, standing for the words very good, 
 good, medium, slow, and dull. Where such words or their symbols 
 are used there can be no doubt as to the grade for which they 
 stand, but this is different where figures are employed. Here 
 it will be observed that D is placed below the figure 1 ; therefore 
 the figure 1 indicates the lowest grade of normal mentality. 
 The highest grade of mentality is indicated by the figure 5, 
 placed above vG; and medium mentality by the figure 3 above 
 M. Consequently, the higher the figure, the higher is the grade 
 of mentality which it denotes. This use of the highest figure for 
 the highest, and the lowest figure for the lowest degree of the 
 quality after which it appears, is followed wherever figures are 
 used for grading. In general, this is contrary to custom, but it 
 is adhered to in this blank for the sake of being consistent with 
 the percentile system of marking grades. Just as in the percentile 
 system, so in this system the lower numbers stand for the lower 
 grades. 
 
 After this general treatment of the graded items, I wish to 
 consider these items individually, and first mentality. The imme- 
 diate purpose of the preparation and employment of this blank 
 was the collection of data for an investigation of the causes of 
 retardation. Much of the retardation may be accounted for by a 
 low degree of mentality; and to determine the number whose 
 mental capacity is low, gradation was not avoidable. The grades 
 of normal mentality appear on the blank after the word normal. 
 The symbols employed are vG, G, M, SI, and D, and they stand 
 for the words very good, good, medium, slow, and dull. These 
 words were not used to grade the class standing of the children, 
 but their mental capacity or ability. The use of the words very 
 good, good, and medium for grades 5, 4, and 3, will be accepted 
 without comment. It may seem that perhaps we should have 
 chosen the words poor, and very poor for grades 2 and 1 re- 
 spectively. These words indeed are often applied, but the endeavor 
 
TEE EXAMINATION BLANK. 13 
 
 was made to use on the blank, words which would appeal most 
 to the natural judgments of the teacher. It was thought that many 
 teachers speak of their children as being "slow" and that this 
 means more as a grading of mental capacity than the term poor. 
 A "dull" child the teacher also understands readily, and this 
 seemed to be a more striking term for children who are in the 
 lowest grade of normal mentality than the rather indefinite term 
 very 'poor. Whatever catchwords may be employed, they serve 
 only to assist the investigator to assign the child his proper posi- 
 tion in one of the five grades represented by 5, 4, 3, 2 and 1. 
 
 It is commonly assumed that all children in the public schools 
 are of normal mentality. If this were true, it would be possible 
 to distribute all our cases over the five grades of normal mentality 
 which have just been discussed. However, it does not take a very 
 extensive investigation of the mental capacity of children who 
 are retarded in school progress to discover that many of them are 
 subnormal in mental capacity. Indeed, for every thousand chil- 
 dren examined we find one or more children who are properly 
 cases for an institution for feebleminded children. We must 
 provide for a large number of children to be distributed over 
 classes or grades that are recog-nizably deficient in mentality. To 
 preserve the five-point system, children who are discovered to be 
 mentally deficient are distributed over five grades. The highest 
 grade of these deficient children is called backward; the lowest 
 grade would be the idiot. The middle grade is occupied by what 
 is generally characterized as an imbecile of medium grade. Be- 
 tween him and the backward child we place the imbecile of high 
 grade. Between him and the idiot we place the idio-imbecile. 
 In this scheme of classification we omit the imbecile of low grade, 
 whom we should classify either as an imbecile of medium grade 
 or as an idio-imbecile; and we fail to recognize more than one 
 grade of idiot. The mentally deficient are therefore represented 
 on the blank by grades 5, 4, 3, 2, and 1, for which the following 
 symbols are employed, Bkw, IH, IM, II, and Id. 
 
 A different point of view might have given rise to a different 
 system of classification. Thus, Ireland and Shuttleworth both 
 make use of a pathological classification. This must necessarily 
 be as incomplete as is our knowledge of the pathological conditions 
 of the feebleminded. It is undoubtedly of value, however, to 
 the physician, for U looks to the pathology of the idiot to throw 
 light upon its etiology, diagnosis, and prognosis. But these patho- 
 logical conditions are usually not the causes of idiocy, but mere 
 
14 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 concomitants. Tlie essential fact of idiocy is mental deficiency. 
 In the British Medical Journal for 1902 Dr. Eichholz says : "Fee- 
 blemindedness or mental deficiency is not so much a symptomatic 
 condition to which a medical man can apply his art with hope of 
 success, as a social and educational grouping which has gradually 
 arisen in connection with the development of elementary education 
 in this and other countries." Moreover, it is recognized that the 
 hope for the greatest improvement of the feebleminded lies in 
 their instruction and training, — that the problem is an educational 
 problem, and not a medical one. Even the physician becomes a 
 trainer when he undertakes the daily care of the feebleminded 
 child. This has been recognized from the time of Itard through 
 SegTiin to Sollier and Barr. In Die KinderfeMer, Vol. VII, p. 97, 
 J. Triiper quotes the following passage by Dr. Pelman, the 
 psychiatrist at Bonn, from the introduction to the German edition 
 of Sollier' s, "Psychologic de I'idiot et de I'imbecile" : "What we 
 meet as the pathological foundation of idiocy are the sequelae 
 of diseased processes that have long since run their course. These 
 one can no longer obviate through any known medical art. The 
 feeblemindedness which has its basis in a congenital brain disease, 
 or in one acquired in the first years of life, is no longer susceptible 
 of cure. The task of the physician can therefore receive but a 
 small reward." 
 
 It appears to be generally admitted that the most satisfactory 
 classification of the feebleminded is psychological or educational. 
 A psychological classification, however, does not appear to me 
 as practical as an educational one. Even so fundamental a psy- 
 chical process as the attention, upon which Sollier bases his psycho- 
 logical classification, is not such a measure of general capacity 
 as to be of much service in determining the place of these children 
 in schools and institutions. Of all the schemes of classification 
 which have been offered, the most practical, in my judgment, is 
 that of Dr. Martin W. Barr. It is based upon educability. 
 Omitting the moral imbecile, it is as follows: I. Asylum Cake: 
 1. Idiot, (a) Profound, unimprovable; (b) Superficial, improva- 
 ble in self help only. 2. Idio-imbecile, improvable in self help 
 and helpfulness. II. Long appeenticeship and colony life 
 UNDEK protection: Imbecile, (a)Low grade, trainable in indus- 
 trial and simplest manual occupations; (b) Middle grade, train- 
 able in manual arts and simplest mental requirements ; (c) High 
 grade, trainable in manual and intellectual arts. III. Trained 
 FOE A PLACE IN THE WORLD : Bachwavd or mentally feeble, mental 
 
TEE EXAMINATION BLANK. 15 
 
 processes normal but slow and requiring special training and 
 environment to prevent deterioration. 
 
 The five grades of mental deficiency that are used on the 
 blank are practically the same as those which have been presented 
 by Dr. Barr. The three highest grades of the mentally deficient 
 are in complete agreement. The low grade imbecile, however, 
 is not given a separate classification on the blank, nor is the class 
 of idiots subdivided into the profound and the superficial. 
 
 To assist in the further presentation of the items of this blank, 
 I have reproduced an actual blank partially filled out, which will 
 be found on the next page. 
 
 At the top of the blank is the name of the child, in this case 
 an assumed one. On the same line with this, is a space provided 
 for the purpose, is the number 12. This number indicates the 
 order of the blank in a series. The serial classification of the 
 cards will be determined by convenience. In mj investigation, 
 the cards of the boys and girls were placed in separate series for 
 each school. 
 
 The significance of the items which give the child's residence 
 and serve to locate him in a particular class and school and under 
 a particular teacher in the year when the examination was made, 
 needs no explanation. If these items are not sufficiently intelli- 
 gible from an examination of the reproduced blank on the next 
 page, a satisfactory explanation will be found in the preceding 
 article. 
 
 Directly below the recorded data locating the child, are 
 found the data which indicate why this child has attracted special 
 nttention. 
 
 Progress and conduct are followed by E, G, T, D, and vD, 
 the initial letters for excellent, good, fair, deficient, and very 
 deficient. Gradation of progress should be made from the 
 standpoint of the rapidity with which the child passes through 
 the grades. Many teachers feel inclined to call a child's progress 
 good because it does well in its grade, regardless of the fact that 
 the work has been repeated one or more times. The grade and class 
 of the previous year will enable the investigator to see how often 
 or how much of the work was repeated. Progress should be 
 marked with reference to the rapidity with which the child passes 
 through the grades, without regard to his attendance. 
 
 If a retarded child's progress be good at the time of the ex- 
 amination, then special effort should be made to find the cause 
 of retardation in his past school life. A space is provided for a 
 brief synopsis of the "school history." 
 
16 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 "^jSvvu 
 
 No. W Name 
 Grade Class 
 
 Grade \ Class 4* 
 School -. y^ 
 
 School WOJt/VUAA^ 
 
 ^STJvDf^o" 
 
 190 
 190 *] 
 190 
 ,190 'X 
 
 Address 
 Address 
 Teacher 
 Teacher 
 
 b'OOs 
 
 ?suf^yX 
 
 %juU (XdLo/vM^ 
 
 E G P D W Date of birth <b|oO Age *] 
 
 Progress i • i 
 
 Conduct E G P D ^ Age on entering school fe No. years In school | 
 
 Attendance vR j/ I vl A School history (Rel) (OjtOCUvO oV^oSmjuV 
 Most deficient in A 
 
 Nornlal 
 
 Father living dead 
 Mother living dead 
 Step-father, Step-mother 
 Nationality F. 
 « M. 
 
 Birthplace 
 Lives with 
 Home Lang. 
 Older brothers living dead Arms 
 
 " sisters ' 
 
 Younger brothers " 
 
 " sisters " 
 
 5 4 3 2 1 
 
 vG G M^Sl /D Deficient 
 
 5 4 3 2 1 
 BlJky IH IM II Id 
 vG G P t'^vP 
 
 Health. vG G y P vP Home Care _ , 
 Nutrition P G M l/ St " Culture vG G P P "vtt* 
 R W M y vP 
 
 Support 
 
 OccupatiorK of provider 
 
 " Culture 
 
 " Discipline vG G P P ^ 
 
 '?U UAtK/ 
 
 Child works at 
 
 jYliX 
 
 Anormality 
 
 Asymmetry 
 
 Trunk 
 
 Legs 
 
 Hands 
 
 Feet 
 
 Cranium 
 
 Forehead 
 
 Face 
 
 Ears 
 
 Eyes 
 
 Nose 
 
 Lips 
 
 4y' 
 
 Palate 
 
 Eye, R. ^ 
 
 Eye, L. ) 
 
 Defects 
 
 Disease 
 
 Ear, R. I 
 
 Ear, L. ) 
 
 Defects 
 
 Disease 
 
 Co-ordination 5 
 
 vB BAW Norm Shy vS Naso-ph'nx 
 
 Am Resp P^s Sull Sur Mth Breathg 
 
 Sto In Al N^v vN Teeth 
 
 vR Refl NcVm Imp vl Tongue 
 
 Stu Wilf Finn Flex vJfc Voice 
 
 Stammer (inf) 5 4 3 2 1 Speech 
 
 Stutter 5 4 3 2 1 Diseases 
 
 2 1 Tonsils 
 
 Filled in by . .. .fl^.tO. j4ui/VYVCW?J Date . . nLvaAI-U.^. ^. l!^ P.^ 
 
 IJ/aboratory of Psychology, University of Pennsylvaniil 
 The J. Lewis Crozer P\ind. v 
 
THE EXAMINATION BLANK. 17 
 
 As a basis for rating conduct, I chose the agreement between 
 the child's actions and school regulations. In addition to inter- 
 fering with a child's progress, poor conduct may have a diagnostic 
 value of its own. For example, deficient conduct may be a conse- 
 quence of low mental capacity. When a child is unable to take 
 part in school exercises, his conduct is invariably of such a nature 
 as to conflict with the order of the school. Deficient conduct may 
 be indicative of defective home discipline. When conduct is very 
 deficient at school, delinquency is often associated with it. When 
 conduct was reported deficient, I always inquired into the child's 
 moral history, and often obtained a stoiy of thefts, gambling and 
 sexual indecency. I recall at least two cases of horse stealing, 
 quite a number of gambling and no less than six who had been 
 guilty of sexual offences. I do not for an instant believe that the 
 teachers knew of most of the cases, or that they reported all the 
 cases which they did know. Care should be taken not to mark as 
 deficient the conduct of a restless child, who may simply be unable 
 to control his body on account of ill-health. 
 
 The symbols vR, R, I, vl and A are used to record attend- 
 ance. These symbols are the initial letters of very ^regular, 
 regular, irregular, very irregular, and absent. The choice of the 
 words used in connection with this item, as with all the other 
 items, resulted from an attempt to employ words which were 
 already used by the school for the same purpose, or which would 
 assist the investigator and teacher in making the rating. If the 
 five point system of grading be strictly followed, a child who is 
 present from 17 to 20 days in a month will be considered very 
 regular; from 13 to 16 regular; 9 to 12 irregular; 5 to 8 very 
 irregular, and 1 to 4 absent. As truancy is closely related to 
 attendance, this fact should always be investigated in connection 
 with it, and recorded on the back of the blank. On the face of 
 the blank no space was allowed for truancy and a number of 
 other important facts, because they are of relatively infrequent 
 occurrence, and a note on the back of the blank involves very 
 little time and effort. 
 
 The card of John Smith, reproduced on page 16, records 
 his progress and conduct as very deficient; attendance, however, 
 is regular. He entered school at six years of age, and at the time 
 when this blank was filled out, June 4, 1907, which may be seen 
 from the bottom of the card, he had been in school one year and 
 was at that time seven years of age. His school history shows 
 that the work of the year was done in the school in which he was 
 found at the end of the year. 
 
18 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 We therefore see that we have a record of deficient progress 
 which is not explained by irregularity of attendance, nor by 
 entering school late, and which is either associated with or caused 
 by deficient conduct. When next we look at the grading of 
 mentality, we find that he has been placed in the group of those 
 having deficient mentality and that he is classed as a backward 
 child. 
 
 The ratings of progress, conduct, attendance and mentality, 
 which have been considered, are indicated by a check mark over 
 the symbol of the reported grade of the respective quality. This 
 is an easy symbol to make, and the saving of time is an important 
 desideratum. If I dissented from the teacher's judgment with 
 respect to any item of the blank after having examined the child, 
 I noted the fact by drawing a horizontal line through the symbol 
 of the grade in which I placed him. Thus, if I had considered 
 this boy a high grade imbecile, the blank, in addition to the 
 check mark through Bkw, would have had a horizontal line 
 through IH. The marks employed are immaterial, but it is im- 
 portant that they should be made as quickly as possible and should 
 be easily distinguished in the subsequent collation of the data of 
 the blanks. 
 
 We now see that we have to do with a backward child of 
 normal age in the first school year, who has been regular in at- 
 tendance throughout the year, but whose conduct is reported as 
 very deficient. Is his backwardness the consequence of deficiency 
 of conduct? Is it the result of school conditions? Has it fol- 
 lowed upon the home environment? Or is it based upon struc- 
 tural defects, or inheritance ? 
 
 Directly below the entry of the child's mental grade is found 
 a group of items relating to the child's environment. His health 
 is reported as fair, nutrition poor, support 'poor, home care poor, 
 home culture very poor, and home discipline very poor. There 
 can be very little doubt that the progress of a child in school, 
 independent of any physiological backwardness, is the result of 
 these various factors. Even physiological backwardness may be 
 augumented, and probably caused, by the associated activity of a 
 number of unfavorable environmental conditioils. The extent to 
 which these factors are associated with different dearees of men- 
 tality as revealed through school work, is one of the subjects of 
 my investigation. 
 
 In employing this blank the general health of the child is 
 to be recorded as very good, good, fair, poor, or very poor. The 
 
THE EXAMINATION BLANK. 19 
 
 record is based upon such judgment as a teacher or parent would 
 give. It is not a report such as a medical examiner would make. 
 The object is to find to what extent the child's health interfered 
 with his attendance at school or with his performing daily tasks. 
 even if he were in actual attendance. It does not propose to 
 record the existence of actual disease. If the child is found to be 
 suffering from some special disease, this is to be reported in the 
 space provided at the bottom of the blank after the word diseases. 
 Here also are to be recorded such children's diseases as the child 
 may have suffered from in the past. When facts worthy of 
 special note are discovered in this connection, they are to be 
 recorded on the back of the blank. 
 
 Poor health may not only cause prolonged or repeated 
 absences, and so indirectly retard the child: it often interferes 
 with vigorous mental action, and is a predisposing cause of 
 fatigue. When fatigue is readily produced, sustained attention, 
 which is so essential for mental acquisition, becomes practically 
 impossible. Many physical ailments are a continual source of 
 irritation to the nervous system,' not only because they produce a 
 condition of malaise, but because they withdraw attention from 
 the lesson to the source of excitation. The connection between 
 good health and the attainment of the objects of school instruc- 
 tion is so close that school systems are awakening to the need of 
 physical directors and medical inspectors to look after the phys- 
 ical welfare of the children. Mental, and often moral, deteriora- 
 tion may result from prolonged ill-health. 
 
 The nutrition of the child is also to be recorded on the basis 
 of general observation, rather than a physician's examination. 
 The five classes, in one of which the child's nutrition may be 
 recorded, are indicated by the letters F, G, M, P, and St, which' 
 stand for the words fai, good, medium, poor, and starved, respect- 
 ively. Faulty nutrition retards the child's progress, whether it 
 is due to disease or to improper and insufficient diet. If no posi- 
 tive knowledge of the diet can be obtained, the rating of nutrition 
 may be based upon certain signs to be observed in the child. 
 After the item habits, in the blank, I usually recorded such facts 
 as I could obtain concerning the child's diet. Thus, John Smith's 
 nutrition is recorded as poor, and after the word habits occurs 
 the formula, "1. Coffee + bread & cake ; 2. Beer, 3. Tea." This 
 means that the child's usual breakfast is coffee, bread and cake; 
 that he drinks beer at dinner and tea at supper. In this case 
 it would appear that the poor nutrition was probably due to 
 
20 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 insufficient and improper diet. This condition is one which. I 
 have found in a very large number of the backward children 
 whom I have examined. 
 
 The child's color may be employed to assist in determining 
 his nutritional status, for paleness is an effect of either an insuffi- 
 cient supply or an impoverished state of the blood, due to a lack 
 of oxygen or the proper kind and amount of food materials ; but 
 lack of color must not be mistaken for a light complexion as 
 shown by the color of the eyes and hair, nor must a dark com- 
 plexion be interpreted as an absence of paleness. 
 
 Paleness may be due to a blood disease called ansemia, and 
 when this is the case, the skin will remain permanently pale with- 
 out change of color. The color of the lips, and changes of color 
 in the finger nails when subjected to pressure, may also be 
 observed. If this change of color upon pressure is not very 
 decided, it may be taken as a sign of poor nutrition. If the 
 return of color upon removal of the pressure is slow in appearing, 
 it indicates vaso-motor disturbance. 
 
 Other important signs of poor nutrition are emaciation, and 
 deficient weight in comparison with height. Disproportion among 
 the several members of the body may indicate defective nutrition 
 at some period previous to the time of examination. Signs of 
 defective' nutrition during the early period of rapid development 
 previous to the second year, may be observed in teeth, ears and in 
 other developmental defects. These, however, are not to be taken 
 into account in this connection, excepting in a general way. They 
 will be entered under anormalities and asymmetries of the bodily 
 members. 
 
 If the financial support of the child in the home is poor, it is 
 likely that poor nutrition is the result of insufficient diet. If 
 the support is ample, poor nutrition is more likely to be due to 
 physiological conditions, and to be associated with ill-health. The 
 support which the child receives at home is entered as rich, well- 
 to-do, medium, poor, or very poor. The financial condition of 
 the family not only militates against the child's health and nutri- 
 tion, and so causes retardation : it becomes a direct cause of 
 retardation owing to the fact that many children are kept from 
 school to assist in eking out a livelihood for the family. Many 
 children in Camden leave school about the middle of May to 
 engage in some kind of occupation. This is especially true of the 
 Italian children, who leave school about a month and a half before 
 the close of the term to obtain employment as berry-pickers. 
 
TEE EXAMINATION BLANK. 21 
 
 Moreover, in my investigation there appeared to be some families 
 60 afflicted with ill-health and poverty that they would have to 
 depend upon charity for their subsistence if they sent their chil- 
 dren regularly to school. Poverty becomes a direct cause of 
 retardation when it is so extreme as to prevent the family from 
 supplying proper and sufficient food, clothing and housing. The 
 nurture of thousands of children in our large cities is the direct 
 cause of adult inefficiency. 
 
 Home care, home culture, and home discipline are usually 
 directly correlated with the financial status of the family, though 
 there are many exceptions to this rule. Home care is rated as 
 very good, good, fair, poor, or very poor. The cleanliness of the 
 child's person and clothing is the best indication of home care. 
 The vitiated air in which many of our teachers and children are 
 immersed day after day, has its origin not only in the poisonous 
 products of the breath, but also in the children's clothing, which 
 is often soaked with filth. It would surprise any' investigator to 
 learn how many parents adopt the convenient custom of "sewing 
 up" their children for the winter. As the cold weather increases, 
 the number of garments increases, and as the weather moderates 
 the garments diminish. During this entire period the clothing 
 worn next the skin is unchanged, and may be neither washed nor 
 aired for months. This filthy condition not only militates against 
 the child's well-being, but interferes with his progress in school, 
 because these children are repulsive to most teachers. 
 
 Insufficient clothing makes it difficult for many children to 
 maintain health and keep in daily attendance. I was informed 
 by the principal of one of the Camden schools that there had been 
 a marked improvement in attendance upon supplying the poorest 
 children with the cast-off clothing of those in more fortunate cir- 
 cumstances. 
 
 The overcrowding of a family into one or two rooms, 
 the result of insufficient financial support, is also a frequent 
 factor in reducing home care and home discipline to a minimum. 
 
 By home culture is meant the degree of mental development 
 and refinement attained by the family. If the child has an intel- 
 lectual, moral, and emotional environment of high grade, his 
 school progress is favored by it. The conception of culture is 
 not very definite, nor is it easy to estimate the different grades 
 of home culture. I asked the teachers to base their judgments 
 on the kind of literature read in the home, on the parents' occu- 
 pation, and the content and modes of conversation. In the deter- 
 
22 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 mination of the culture level, as well as of other facts about the 
 home, the child himself very often serves as a satisfactory index. 
 
 The relation of home culture to school progress is not to be 
 settled off-hand without a careful inquiry. Children from the 
 homes of very ignorant parents often stand high in their school 
 work, but intellectual standing is not the whole of culture. Where 
 the moral element is prominent, the members of a family live a 
 life of duty and self-restraint and effort, whether at home or in 
 school. This, of course, means application and discipline that 
 develop habits of work and attention so necessary for school prog- 
 ress. Lack of moral training in the sense of absence of proper 
 home discipline is a frequent cause of lack of industry, applica- 
 tion, and concentration of attention. I consider the item of home 
 discipline one of the most important determining factors of school 
 progress. A well disciplined child will always be amenable te 
 the directions of his teacher and the regulations of the school. On 
 the other hand, a child may manifest good moral conduct, may 
 give no trouble in school, and yet may lack the essentials of dis- 
 cipline. In explanation of the deficient progress of John Smith, 
 I consider the rating of home discipline, very poor, as significant. 
 In his case, it also resulted in deficient conduct. 
 
 We now know something of this boy's environment. He is 
 the offspring of parents who are living in poverty (his father is a 
 presser, a tailor's assistant), unable to supply his body with 
 sufficient food, though not requiring him to work as yet, unintelli- 
 gent enough to furnish him with beer, tea and coffee, un- 
 willing or unable to accord him satisfactory care of body and 
 clothing, low in the scale of culture, and incapable of supplying 
 the mental and moral discipline, the lack of which is probably 
 evidenced in his retarded progress and deficient conduct. 
 
 In the lower left-hand corner of the blank are a number of 
 items of great interest in determining the general physical apti- 
 tude of the boy, as well as certain traits of character which stand 
 in close correlation to the manifestation of intelligence. Does 
 the boy show good motorial co-ordination'? The check mark 
 stands over the number 3, which gives his co-ordination a rating 
 of medium. We learn little from this that throws light on the 
 association of motor with intellectual deficiency, but from a large 
 number of cases we may see whether boys deficient in intelligence 
 more often manifest good co-ordination, poor co-ordination, or 
 medium. 
 
 It is impossible to give in this place an extended discussion 
 
THE EXAMINATION BLANK. 23 
 
 of the factor of co-ordination. A few words in regard to it will 
 have to suffice. Co-ordination may be defined as the ability to 
 accomplish by means of muscular contractions and with the least 
 possible expenditure of energy, a definite purpose or assigned 
 task. It means more than the simultaneous or successive synergy 
 of two or more muscles or groups of muscles. It requires a deli- 
 cate adjustment of the muscular innervation necessary to move 
 a member of the body at a given rate through a given distance. 
 There is reason to believe that control of this muscular innerva- 
 tion is dependent upon the will, and that volitional activity is 
 closely associated with mentality. 
 
 Several criteria may be employed to pass judgment upon the 
 degree of co-ordination. One is the accuracy with which the task 
 is accomplished. Thus, if a child be asked to move his arm a 
 given distance in a given direction, his co-ordination may be re- 
 garded as good if his movement corresponds very exactly to the 
 one required. Judgment of the degree of co-ordination may also 
 be based upon the facility displayed in the accomplishment of 
 an assigned task. In my investigation I employed the following 
 method to rate co-ordination: I threw a number of pegs, about 
 two inches long and one-eighth of an inch in diameter, upon the 
 table and asked the child to pick them up as rapidly as possible, 
 using for the purpose but one hand and holding the pegs in the 
 same hand while he continued to pick them up. 
 
 Below the word co-ordination are five groups of symbols and 
 words descriptive of mental and emotional character. Their ap- 
 pearance on the blank was to some extent in the nature of an 
 after-thought. It was not my purpose to determine whether the 
 child was shy or bold, amiable or sullen, stolid or nervous, reflec- 
 tive or impulsive, stubborn or vacillating in will ; but it became 
 apparent that shy children are often misjudged. They are apt 
 to be under-rated in intelligence and bold children over-rated. Shy 
 and timid children will not do so well in their recitations as the 
 bold and forward. Some children approximating the condition of 
 moral imbecility are extremely forward and bold, and give the 
 appearance of great intelligence, and are therefore apt to be rated 
 high. Teachers are apt to underestimate the capacities of a 
 sullen or surly child, and give too favorable a rating to an amiable 
 one. The child whose thought is characterized by reflection is 
 oftentimes under-rated in comparison with the impulsive child. 
 Moreover, many of these characters have a diagnostic value. Shy- 
 ness is often associated with deafness, for the semi-deaf child 
 
24 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 often knows tliat something is required of him, the exact nature 
 of which he is unable to comprehend. Sullenness is associated 
 with adenoids, as is also stolidity. ISTervousness and impulsive- 
 ness and vacillating will are symptomatic of impoverished nervous 
 systems. It is also true that these characters exercise a facili- 
 tating or retarding effect upon school progress and general mental 
 development. The shy child is not likely to get so much out of 
 the school work as the bold child. The amiable child receives 
 more attention from its teacher than the sullen or surly child. 
 The child who is alert in mentality is more apt to profit by the 
 school environment than one who is stolid or nervous. The child 
 whose will is firm, will do better work than one whose vacillating 
 will produces want of application, or one in whom wilfulness or 
 stubbornness awakens antagonism and negativism. 
 
 The choice of words with which to describe mental and 
 emotional character is not an easy one. The words that have 
 been selected for this purpose were chosen after careful consid- 
 eration. It is possible that different words may recommend them'- 
 selves to others as being more suitable. The words selected were 
 picked out primarily because they were thought to give an ade- 
 quate description of a mental character, that is, for the purpose 
 of providing an exact psychological designation, but also to fur- 
 nish terms familiar to the everyday judgment of the teacher. The 
 terms describe the following five traits of character : — 
 
 (1) Social reaction: — ^boldness or shyness. 
 
 (2) Feeling and its expression: — amiability, responsiveness, 
 sullenness or surliness. 
 
 (3) General mental and physical activity: — stolidity, inert- 
 ness, alertness, or nervousness. 
 
 (4) Intellectual character: — rreflectivity or impulsiveness. 
 
 (5) Will or volitional character: — stubbornness, wilfulness, 
 firmness, flexibility, or vacillation. 
 
 I give below various words that may be employed to describe 
 each of the five groups used in connection wdth each of these five 
 traits of character. The one which is employed upon the blank 
 stands at the top in each case, printed in italics. 
 
 Social reaction: 
 
 
 
 
 
 very "bold 
 
 hold 
 
 normal 
 
 shy 
 
 very shy 
 
 insolent 
 
 courageous 
 
 indifferent 
 
 reserved 
 
 afraid 
 
 impudent 
 
 forward 
 
 unconcerned 
 
 coy 
 
 cowardly 
 
 impertinent 
 
 pert 
 saucy 
 
 
 timid 
 
 bashful 
 
 diffident 
 
 
THE EXAMINATION BLANK. 
 
 25 
 
 Expression of feeling: 
 
 amiable 
 
 responsive 
 
 passive 
 
 sullen 
 
 surly 
 
 sweet 
 
 impressionable 
 
 indifferent 
 
 sulky 
 
 rude 
 
 genial 
 
 sympathetic 
 
 apathetic 
 
 cross 
 
 gruff 
 
 gentle 
 
 
 phlegmatic 
 
 peevish 
 morose 
 
 
 General activity: 
 
 
 
 
 
 stolid 
 
 inert 
 
 alert 
 
 nervous 
 
 ver-y nervous 
 
 apathetic 
 
 inactive 
 
 active 
 
 eager 
 
 excitable 
 
 impassive 
 
 sluggish 
 
 bright 
 
 restless 
 
 
 wooden 
 
 
 
 
 
 Intellectual character: 
 
 
 
 
 very reflective 
 
 reflective 
 
 Normal 
 
 impulsive 
 
 very impulsii 
 
 meditative 
 
 thoughtful 
 cautious 
 
 indifferent 
 
 thoughtless 
 
 rash 
 
 Will: 
 
 
 
 
 
 stubborn 
 
 icilful 
 
 firm 
 
 flexible 
 
 vacillating 
 
 intractable 
 
 determined 
 
 normal 
 
 submissive 
 
 wavering 
 
 obstinate 
 
 headstrong ■ 
 
 
 yielding 
 
 unstable 
 
 obdurate 
 
 refractory 
 
 
 pliant 
 
 
 unyielding 
 
 
 
 
 
 It will be seen from the above that the child's social reactions 
 are distingTiished as presenting opposite characters of boldness 
 and shyness. Children who present neither character in marked 
 degree are called normal. Perhaps it would have been better to 
 describe them as indifferent. Children with an excess of either 
 character are described as very hold, or as very shy. 
 
 Feeling, or more accurately the expression of feeling in the 
 child's reaction to the teacher and other persons of his environ- 
 ment, is characterized as amiable, responsive, passive, sullen, or 
 surly, for which the symbols Am, Resp, Pass, SuU, and Sur are 
 employed in the blank. The amiable child is characterized by a 
 sweetness of disposition which is bound to make friends. Thus, 
 amiability wins a teacher's regard and leads to efficient effort on 
 her part, but amiability in some cases leads to an excess of feeling 
 which is detrimental to the best intellectual work. The child who 
 is classed as amiable possesses a character which is therefore of 
 doubtful value for school progress. On the other hand, the child 
 who is characterized as responsive is easy to work with, sympa- 
 thetic, and is the most favorably situated child so far as feeling 
 is concerned. The sullen child scowls and pouts, showing ill 
 temper in facial expression but remaining silent. The surly child 
 is more active in the expression of his ill humor, using voice and 
 
26 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 bodily action to demonstrate its presence. These children are 
 difficult to treat in large classes. Their feelings, unless they are 
 won over by a skilful and good-tempered teacher, are a serious 
 bar to mental progress. The child who is indifferent in the ex- 
 pression of a state of feeling, and in his reaction to the iteacher, 
 is characterized on the blank as passive. Passivity may give free 
 play to intellectual effort, and the passive child may furnish a 
 more favorable soil for the teacher's efforts than the excessively 
 amiable child, but feeling is a great stimulus to effort and it is 
 probable that in most cases passivity is a relatively unfavorable 
 soil. 
 
 A child's activity, whether of mind or body, may be such that 
 we may characterize him as alert. When present in excess it 
 becomes nervousness. At the opposite extreme is stolidity. For 
 an intermediate grade between the stolid and the alert child, the 
 blank employs the term inert, or inactive- The five grades are 
 therefore stolid, inert, alert, nervous, and very nervous, repre- 
 sented respectively by the symbols Sto, In, Al, ]!^erv, and v^N". 
 
 With respect to intellectual activity, all children may be 
 divided into three classes, — the sensory or reflective, the motor or 
 impulsive, and those who are neither. The latter group the blank 
 designates as normal, though probably the term indifferent or 
 mixed is to be preferred. The impulsive type is distinguished 
 by the" rapidity with which it responds to a question or other 
 mental stimulus. This type of child does not stop to think. As 
 soon as an appeal is made to it, there is an immediate response, 
 which is frequently ridiculous on account of immature thought. 
 The reflective type is characterized by relatively slow but intelli- 
 gent responses. The blank subdivides the reflective and impulsive 
 groups into two sub-groups, in which each quality appears in 
 either a moderate or excessive degree. The blank, therefore, dis- 
 tinguishes children as very reflective, reflective, normal, impulsive, 
 and very impulsive. The symbols for these words are vR, Refl, 
 Norm, Imp, and vT. 
 
 For the classification of the will the blank distinguishes the 
 stubborn, wilful, firm, flexible, and vacillating, using for the pur- 
 pose the symbols Stu, Wilf, Firm, Flex, and Vac. These terms are 
 self-explanatory. There may be some confusion, however, of. 
 stubbornness with sullenness and surliness. It is true that a 
 defect of will is often associated with a defect of feeling, but I 
 have examined many cases that did not show any ill humor, who 
 yet sitaply refused to obey all commands. 
 
THE EXAMINATION BLANK. 27 
 
 One other character is of sufficiently general significance to 
 be treated in connection with the items that form the subject of 
 this chapter. The most superficial examination of a child 
 will bring from him some utterance. In voice and speech, the 
 examiner or teacher may quickly infer the presence of phys- 
 ical or mental defects. On the physical side the utterance of a 
 single word in answer to a question may awaken the suspicion 
 of naso-pharyngeal obstruction. The treatment of purely phys- 
 ical defects will be discussed later. In this place, I wish to 
 consider defects of articulation, which are also active factors in 
 causing retardation. Children with defective speech receive low 
 grades in reading, and their intelligence is usually underesti- 
 mated by the teacher, who attributes much of the speech defect to 
 a lack of knowledge. These defects hinder progress in still 
 another way. Such children are frequently ridiculed by their 
 schoolmates on account of their impediments of speech. In this 
 way they learn to dislike school, lose interest in their work, and 
 become absentees. But more important than this is the effect of 
 defective modes of articulation and phrasing upon written lan- 
 guage. Some children with an infantile stammer write school 
 compositions which mirror with great fidelity their habits of oral 
 speech. 
 
 Defects of articulation are frequently associated with de- 
 fective hearing, for a child who is unable to hear words distinctly 
 will be unable to reproduce them properly. Observation has also 
 shown that defects of articulation cause defective hearing of lan- 
 guage. Children that appear to be deaf to words, improve when 
 their defects of articulation are cured. 
 
 The words stammer, and stutter, are loosely employed by 
 English writers to designate nearly every defect of speech. A 
 definite meaning should be attached to each. In this blank the 
 word stammer is employed to cover any defect of articulation, 
 as, for example, the inability to produce certain sounds, or the 
 substitution of one sound for another like ih for s in lisping. A 
 stammer may indicate defective organs of articulation, like a 
 cleft palate, displaced teeth, or a partial paralysis of the tongue. 
 A stammer, however, may simply be the persistence of an in- 
 fantile speech ' habit, "baby talk." This retardation in speech 
 may be due to an undeveloped mind, or may be the result 
 of adenoids or other obstruction in the resonance cavity, which 
 may or may not have been removed. If the stammer is an 
 infantile stammer, a check mark is made over the symbol inf. 
 
28 CLINICAL STUDY OF BETABDED CHILDBEN. 
 
 The degree of the stammer is indicated by a check mark over one 
 of the five numbers appearing to the right of the word stammer. 
 
 A stutter is characterized by a series of spasmodic hesita- 
 tions and the frequent repetition of some of the spoken elements. 
 This defect may be acquired by imitation. It may be the result 
 of nervousness, or it may be due to an inability to co-ordinate 
 the movements of breathing v^ith those which control the articu- 
 lation. Stuttering does not seem to have the same causal rela- 
 tionship to intellectual retardation as does stammering. The 
 blank provides, as with other items, five grades for an estimation 
 of the degree of stuttering. 
 
 From the record card on page 16, a blank partially filled 
 in, we ascertain the following facts about the boy John Smith, 
 which cause him to stand out as a distinct personality. He is 
 seven years of age, has been one year at school, where he attended 
 regularly, but where his conduct and progress were both very 
 deficient. He is classified as a backward case, subnormal in intel- 
 ligence. His co-ordination is only medium. He is bold in his 
 association with his teachers, passive or indifferent in feeling 
 towards them. He shows signs of nervousness. He is neither 
 reflective nor impulsive, and is vacillating in will. We have also 
 learned that while his health is fair, his nutrition is poor, and 
 that he is trying to do his school work on a breakfast of coffee, 
 bread and cake ; that he also drinks beer and tea. This insufficient 
 and improper diet, which probably is responsible in large measure 
 for his nervousness, his vacillating will, and his deficient conduct 
 and progress in school, is itself the result of the poverty of his 
 parents, which enables them to give him but poor support in a 
 home that is characterized as of very inferior culture, providing 
 very deficient mental and moral discipline, and inadequate care 
 of his person and clothing. 
 
 I tuni now to school history (Bel). A large number of chil- 
 dren are retarded because of frequent changes from one school 
 system to another. This usually involves an initiation into a new 
 course of study and the use of unfamiliar text books, with a conse- 
 quent loss of time. Even the transfer from one school to another 
 of the same system is frequently productive of the loss of a grade 
 in the child's progress. The families of some of the children 
 whom I examined had changed their residence at least half a dozen 
 times during the school life of the children. In some cases this 
 change of residence is made by the family, and even by the chil- 
 dren alone, to escape the enforcement of compulsory school at- 
 
THE EXAMINATION BLANK. 29 
 
 tendance. A brief summary of the school history of the child is 
 therefore of importance if we are to estimate the influence of this 
 factor in producing retardation. The symbol {Rel) is introduced 
 chiefly to remind the investigator to enter a record of attendance 
 in the parochial schools in the case of boys who are members of the 
 Eoman Catholic Church. The curriculum of parochial schools, 
 as well as of other church schools, is very poorly articulated with 
 that of the public schools. For this reason children who have 
 attended parochial schools in the early years are apt to be retarded 
 when they subsequently enter the public schools. Moreover, many 
 children spend a year in the parochial school, at about the age of 
 twelve, in order to receive religious instruction. These children 
 lose a whole year of the public school work, and in some cases have 
 lost step with their fellow pupils of the public schools to such an 
 extent that they are scarcely able to begin again where they had 
 left off. 
 
 A child may be deficient in all his school branches, or he may 
 show himself deficient in but one. If in certain grades this one 
 subject happens to be arithmetic, it may prevent his making normal 
 progress ; in other grades it is language that is a great obstacle to 
 progress. For this reason the items most deficient in and hest in' 
 are recorded. Statistics obtained from large numbers of children 
 will also throw some light on the question whether mentally de- 
 ficient children commonly manifest ability and memory for some 
 single line of thought or activity like music, drawing or manual 
 work. It is a common belief, although not supported by suf- 
 ficient evidence, that the public school system does not appeal to 
 the capabilities of children who are exceptionally gifted in one 
 line and possessed of counterbalancing deficiencies in other lines. 
 
 The child whose blank we have taken as an illustration had 
 been only one year in school, and the absence of any record in the 
 appropriate space leads us to believe that his deficiency in progress 
 was manifested in all the work of the school. 
 
 Certain habits of life are found to exist among school chil- 
 dren, which seriously interfere with their progress. Among these 
 are the use of tobacco and injurious beverages, like tea and coffee 
 and even beer and whiskey. Under habits I also recorded the 
 amount and kind of food eaten at one or more meals, but especially 
 at breakfast. Immoral practices are also to be recorded in this 
 connection, but these should not be inquired into in every case. 
 It seemed the better part of discretion to record facts of this kind 
 only when brought to my attention by teacher or principal in those 
 cases where such practices were notorious. 
 
30 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 The family life may retard the progress of a child in school, 
 in so far as it affects his health, nutrition, support, his care and 
 discipline. The relation of these factors to retardation has 
 already been discussed. In addition to these, a few other items 
 concerning the family appear of sufficient importance to warrant 
 the making of a record. If the child has lost one or both of his 
 parents, the probability is that there has been a reduction in care, 
 nutrition and health, for parents must be presumed to take a 
 deeper interest in the welfare of their children than do relatives 
 or friends. In the case of the father's death the children are 
 often neglected because the mother is unable to bear the burden of 
 support. Many mothers leave home early in the morning to go 
 to work and return late in the evening ; the children are left all day 
 with no one to provide for their wants or to oversee them except- 
 ing when at school. The children of raany mothers, who are the 
 support of the family, find it difficult to obtain even one good meal 
 a day. Wlien such children are questioned they usually report tea 
 and bread for breakfast and the same for dinner; some children 
 go to school without breakfast. The loss of the mother is also very 
 unfavorable to good home conditions. Her place may be taken by 
 a step-mother, but the phrase "a step-mother's care" has lived long 
 enough in the language of the race to persuade us of its significance. 
 The loss of either father or mother is also an indication of the 
 severity of the struggle for existence on the part of the immediate 
 •progenitors of the child, or it may point out a possible lowered 
 resistance to disease. 
 
 The blank, therefore, provides for recording whether the 
 child's father and mother are living or dead and whether the child 
 has a step-father or step-mother. There is also a space provided in 
 which to record with whom the child lives. A child may be living 
 with relatives, guardians or acquaintances, who provide it with a 
 home life distinct from that of its own father and mother. Abnor- 
 mal home conditions are sometimes brought to light which are sig- 
 nificant. If the child is asked whether he lives with his parents 
 he will invariably respond in the affirmative, even though he may 
 be living with only one of them. If he is asked, "Do you live with 
 your father and mother?" he will invariably answer, "With my 
 father," or "With my mother," if he is living with but one of them. 
 A record which shows a living father must not be taken to demon- 
 strate the fact that the father is the support of the child or even 
 that the child is living with the father. The blood relations of 
 the child are often in no wise responsible for the child's support 
 and home care. 
 
THE EXAMINATION BLANK. 
 
 31 
 
 190 Address « 
 
 190 1 Address ^0% (^JLO/Ju 
 190 Teacher 
 
 No. \X 
 
 Grade 
 Grade \ 
 School 
 School 
 Progress 
 
 ^JKa^I 
 
 Name 
 Class 
 Class 4 
 
 y' 190 Teacner 
 
 uT/OJLvuaJl) 190 T Teacher ^'VUaA/^ (XcXoJ'/Wii 
 
 D T«) Date of birth <o I OO Age 1 
 
 E G F 
 
 Conduct 
 
 Attendance 
 
 Most deficieht In 
 
 Best in 
 
 Habits \,\yMJxSL> 
 
 E G F D \^ Age on entering school G No. years in school f 
 vR i^ I VI A School history (Rel) (i) ^cj^aM> /a> *\)0 .oJUaaA- 
 
 ^^jutj "r %\jjoA. ^ ^jcXx) 'X.Q) 
 
 5 4 3 2 1 
 
 vGGM SI D Deficient 
 
 vG G F P ^vP Home Care 
 
 5 4 3 2 1 
 BlA^IHIM n Id 
 vG G F l/vP 
 
 vG G F P vVP 
 Discipline vG G F P vfp 
 
 Culture 
 
 Occupation of provider 
 
 E 
 
 hJZAAJ^) 
 
 _m^ 
 
 Father li\mg dead Normal 
 
 IVIother liVmg dead Health ,^ * 
 
 Step-father, Step-mother Nutrition F G M y St 
 Nationality F.|v\aaAMO.m3 Support R W M ^^vP 
 
 " M.I <l«AA>t> 
 
 Birthplace 9AuJloL- Child works at 
 Lives with P/OXX'VlM Anormality Asymmetry 
 
 Home Lang. W<AA.ao T«-unK (O^ g/^y (^JVA^^.UA^ 
 
 Older bfothers UvingOdeadp Arms 
 
 " sisters " " OLegs 
 Youhger brothers " ^ " O Hands 
 
 « sisters " O " Feet 
 
 Eye, R. 
 Eye, L. 
 Defects 
 Disease 
 Ear, R. 
 Ear, L. 
 Defects 
 Disease 
 
 J|o 
 
 Cranium 
 
 i^_ 
 
 Forehead 
 
 1- 
 
 Face 
 
 Ears 
 
 10 
 
 :-h 
 
 Eyes 
 Nose 
 
 ^janjcxv ^ cn^Ai^At\Avc^uvv\j(:v-- 
 
 Lips 
 
 /: 
 
 Palate 
 1 Tonsils 
 
 Co-ordination 5 4 ¥ 2 
 
 vB BMd Norm Shy vS Naso-ph'nx 
 
 Am Resp PsIks Sull Sur Mth Breathg 
 Sto In Al NeVV vN Teeth 
 vR Refl N(Vm Imp vl Tongue 
 Stu Wilf Firm Flex V4(<f Voice 
 Stammer (inf) 5 4 3 2 1 Speech 
 Stutter -, 5.4321 Diseases 
 
 V. ^J^AAXkU/CL 
 
 
 Filled in by ..K.O jiuAAAA^QuVb. Date . AWAyyuJ.*). ,.\f\ OT. 
 
 M Laboratory of Psychology, University of PennsylvaniaJl 
 The J. Lewis Crozer Fund. ^ 
 
32 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 The language of the child's home may be an important factor 
 in producing retardation in school progress. Some children of for- 
 eign parentage are retarded for several years because they are not 
 equipped with a knowledge of the language of the school and many 
 school systems fail to provide for proper instruction in the English 
 vocabulary. Every large city has some sections where the chil- 
 dren, even at play, speak a foreign language. The necessary in- 
 formation to estimate the importance of this factor in an individual 
 case is given in connection with the items nationality F and 
 nationality M, which provide for the record of the nationality of 
 the father and mother, and with birthplace and home language. 
 When a child is foreign born I found it convenient to inquire as to 
 its age at the time of immigration and I sometimes recorded this 
 in connection with the item birthplace. Even English-speaking 
 children who come to this country at eleven or more years of age 
 lose at least a year on account of the difference in the curriculum. 
 
 The remaining items with which we have to deal are concerned 
 with the child's physical condition. We obtain some indication of 
 the child's physical vigor, vitality and viability when we know the 
 number of brothers and sisters living and dead. It is very diffi- 
 cult to ask a child or even an adult the necessary questions in such 
 a manner as to elicit exact information of the character we desire. 
 The blank records data in a way that appears to present the ques- 
 tion in the best possible form for answer. A numeral records the 
 number of older brothers livvng and deadj, the number of older sis- 
 ters living and dead^ the number of younger brothers living ^and 
 dead and the number of younger sisters living and dead. The boy 
 whose blank we have taken as an illustration has two younger 
 brothers, both of whom are living. The information obtained from 
 these items is very meagre. We know only that he is the first 
 child. According to some authorities, the first child is more apt to 
 suffer from accidents of birth than later children. A physician 
 interested primarily in the child's physical history would want to 
 know very much more in this connection than is provided for by 
 the blank. Eor example, he would require a history of mis- 
 carriages. 'No matter how valuable such data may be, it would 
 be undesirable to make an effort to obtain them. It is only when 
 children are brought for examination to a clinic by father or 
 mother that such facts can be ascertained. Discretion as well as 
 the limitation of time render it necessary to omit many other items, 
 for example, the birthplace and condition of the grandparents. 
 The blank probably provides for as many items in this connection 
 as it is wise and convenient to endeavor to obtain. 
 
THE EXAMINATION BLANK. 33 
 
 The purposes of the blank must be borne in mind when we 
 examine the remaining items which deal with the physical con- 
 dition of the child. Space is provided for an entry of the results 
 of a brief examination of eyesight and hearing and for the record 
 of marked anormalities or asymmetries of the trunk, arms, legs, 
 hands, feet, cranium, forehead, face, ears, eyes, nose and lips. 
 Space is also provided for a record of anormalities that are often 
 associated with naso-pharyngeal obstruction, — leading in some cases 
 to a diagnosis of adenoids. Thus, the condition of the palate is to 
 be observed, the tonsils, the naso-pharynx, the teeth, the tongue. 
 If mouth breathing exists, it is to be recorded ; the voice is to be 
 observed for symptoms of adenoids and the quality of speech is 
 to be recorded for the same purpose. Finally, a brief record is to 
 be made of the diseases from which the child has suffered during 
 infancy and childhood. The examination from which this record 
 will be filled out is superficial and is directed only to the ascer- 
 tainment of striking defects. Time is wanting, nor is it practica- 
 ble to subject a child to an extensive physical examination. A. 
 child ought not to be touched nor can many instruments be used 
 to facilitate the work of the examination. A medical inspector 
 may perhaps use a tongue depresser, but experience in some cities 
 has shown that even they had better employ some such common 
 article as a spoon for the purpose. The tests which I employed 
 excited no criticism, excepting in the case of one child who refused 
 to take part in the test of hearing, for which I employed an instru- 
 ment. I feel that I went as far as it is wise for any one, except- 
 ing a medical man, to go, and that even the medical inspector could 
 not take much more advanced measures without awakening a storm 
 of criticism. From the standpoint of medical inspection, such re- 
 sults as I obtained with this blank must necessarily be unsatis- 
 factory, but this same criticism holds good also of much of the 
 medical inspection that is made in the schools to-day, excepting in 
 so far as it relates to the discovery of contagious diseases and para- 
 sites. 
 
 From the nature of my investigation it was impossible to 
 make anything like a thorough examination of sight and hearing. 
 The limitations of time and the lack of proper rooms and instru- 
 ments practically confined my work to a hasty test of the child's 
 ability to see and hear. To examine eyesight, I employed Snellen's 
 test cards, both the alphabet and illiterate types, the latter for 
 children who did not know the alphabet. Where the child's famil- 
 iarity with the alphabet was in doubt, a brief preliminary drill 
 
34 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 was employed to determine whether the inability to read the line 
 was due to ignorance or defective vision. ISTone of the children 
 examined by me were under ten years of age, and I seldom was 
 compelled to resort to the illiterate card. 
 
 On account of the dimensions of most of the rooms in which 
 I tested the eyesight of the children, I was obliged to make use of 
 the ten-foot line. In making my tests, I placed the cards so that 
 the ten-foot line was about level with the eyes and squarely in 
 front of the child. I placed it so as to be in a good light and to 
 avoid strong reflections. If the child wore glasses, I tested him 
 with and without them. Both eyes were tested together and each 
 separately. During the test I always looked at the child to be 
 certain that when one eye was tested the other was covered and to 
 observe excessive hesitation and signs of eye-strain. In cases of 
 strain and marked hesitation, the child was asked to move toward 
 the cards until the letters on the line were read easily. Before 
 beginning the test, I laid off a ten-foot range, which I subdivided 
 into feet. When, therefore, the child moved from a distance of 
 ten feet to a shorter distance I was able at once to note the dis- 
 tance in feet at which he read the line. The blank on page 31 
 shows that John Smith read the ten-foot line at a distance of seven 
 feet with both eyes, and the ditto marks opposite eye R and eye L 
 show that with each eye separately he read the line at the same 
 distance. His sight is therefore sufficiently defective to justify 
 the recommendation that his eyes be examined by an oculist. 
 
 Various tests are employed to measure the acuity of hearing. 
 All of these fall into one or the other of two classes ; the first is a 
 speech test, and the second is a test with mechanical sounds. The 
 speech may be either whispered or conversational. Undoubtedly 
 the test which employs conversational speech is of the greatest 
 value, for it tests the child's ability to hear conversation, upon 
 which depends his apprehension of oral instruction in the school 
 room. A conversation test, however, is objectionable because it 
 requires a very large room. To avoid this difficulty the whisper 
 test is usually employed as a substitute. Both speech tests are 
 open to the practical objection that the intensity of the sound 
 cannot be kept constant. Moreover, much time is required to 
 carry out the tests satisfactorily, and the results vary with the 
 acoustic properties of different rooms, depending upon their size 
 aud shape and upon convection currents due to the unequal heat- 
 ing of the air. Similar objections may be offered to the employ- 
 ment of mechanical sounds for testing hearing. The watch, the 
 
THE EXAMINATION BLANK. 35 
 
 Politzer acoumeter, tuning forks, and specially constructed audi- 
 ometers, are the instruments usually employed, '^o instrument 
 has yet been devised which furnishes a constant and accurately 
 measured standard of sound intensity. In my tests I employed an 
 audiometer which is to be recommended, not as an instrument 
 of precision, but as a convenience for rapid testing. 
 
 This audiometer consists of a box, six inches by seven inches 
 by eleven inches, divided by a partition into two parts. In one 
 compartment of the box is placed a small clock as the source of 
 sound. The other compartment contains a specially contrived 
 stop-cock connected with a metal tube, which at one end divides 
 into two branches for conducting the sound impulses to each of 
 the two ears. These two branches project about an inch beyond the 
 box. To these, when the instrument is to be used, rubber tubes 
 are attached, which connect with the ear-piece of a binaural 
 stethoscope. The stop-cock which regulates the size of the open- 
 ing through which the sound is allowed to pass, is connected with 
 an index finger moving over a graduated disk, arbitrarily divided 
 into one hundred divisions. When the index finger points to the 
 zero mark, the tube is open to its fullest extent. When it points 
 to one hundred, it is entirely closed. The least audible sound for 
 most normal ears is obtained with the index finger at the mark 92. 
 The instrument is provided with two other stop-cocks, one on each 
 of the two branches of the tube. These are to shut off the sound 
 instantaneously from one of the two ears and without the subject's 
 knowledge. The advantages of this audiometer are found in the 
 convenient variation of the intensity of the sound and its measure- 
 ment with some accuracy on an arbitrary scale, and in the ease with 
 which the sound can be shut off from one or both ears so as to test 
 the reliability of the subject's responses. With this instrument the 
 child whose hearing capacity is measured by TO for the right ear 
 and by 65 for the left ear (see blank on page 31) has subnormal 
 hearing in both ears, the left being slightly more defective than 
 the right. This record, especially when taken in connection with 
 facts which give rise to the suspicion of adenoids, is sufficient to 
 warrant his being referred to the medical inspector or to a medical 
 clinic for the nose, ear and throat, for examination and treatment. 
 Spaces are provided for the record of disease and defects of 
 the organs of sight and hearing. It is intended that only those 
 diseases and defects shall be recorded which attract attention on 
 superficial examination. These include sore and inflamed eyes, 
 strabismus, nystagmus, certain readily observed defects of pupil 
 and iris, a running ear or a perforated ear drum. 
 
36 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 Ample space is provided to record marked anormalities and 
 asymmetries of bodily members and their functions. It is impos- 
 sible in this article to attempt a statement of the various 
 physical anormalities and asymmetries that may be reported under 
 this heading. Defects may be recorded for their own sake, or 
 because they have diagnostic value as symptoms or stigmata of 
 degeneration and arrested development. The reader must be re- 
 ferred to the copious literature on this subject for information 
 as to the particular defects which may be considered worthy of 
 being recorded. What will be recorded will depend very largely 
 upon the extent of the information possessed by the investigator, 
 on the purposes of the investigation, and on the interest which the 
 investigator may take in the association of physical defects with 
 retardation. I made no attempt at a thorough examination or 
 record of minute deviations of different parts of the body from the 
 normal type, whether in structure or functioni. My record of the 
 boy whose card I have taken for an illustration shows the cranium 
 and forehead to be smaller on the right side than on the left. It 
 is also reported that the ears are large and outstanding. All the 
 other items recorded have a significance in connection with the 
 diagnosis of naso-pharyngeal obstruction. The chest is reported 
 to be contracted, the tonsils enlarged, the voice muffled, and the 
 speech nasal. He is also reported to have badly decayed teeth, 
 which are frequently found associated with enlarged tonsils and 
 adenoids. 
 
 The last item on the blank to be considered is diseases. These 
 include measles, chicken pox, mumps, sca;rlet fever, diphtheria, 
 whooping cough, meningitis, and convulsions. On the card re- 
 ported above, no diseases are recorded. ■ This was the case with 
 very many cards. It does not mean, necessarily, freedom from 
 disease during infancy, but perhaps only lack of information. It 
 is difficult, if not impossible, to extract satisfactory information 
 from the child, and I believe that physicians encounter the same 
 difficulty in obtaining accurate information even from the parents. 
 It must be borne in mind that an investigation such as I conducted 
 can only endeavor to obtain the fullest and most exact informa- 
 tion possible imder the circumstances. 
 
 We are now prepared from examination of the record of 
 Jonh Smith to make a tentative statement of the causes of his 
 very deficient progress in school work. He is seven years of age 
 and has been in attendance at school one year. There is no evi- 
 dence to be had from the blank that deficient progress is due to 
 
THE EXAMINATION BLANK. 37 
 
 inefficient instruction, nor can it be ascribed to delay in entering 
 school, or to irregularity in attendance. He is the child of Russian 
 Jews who speak Yiddish at home. This may be responsible to 
 some extent for his inability to progress at school, but it must be 
 remembered that the child was born in this country, and other 
 Russian Jewish children under similar circumstances are pro- 
 gressing normally in school work. It is rather to the naso-pharyn- 
 geal obstruction, the result of poor nutrition, due to insufficient 
 support at home and deficient home care, that I would attribute 
 his retardation in school work. The nasal speech, the muffled 
 voice, the enlarged tonsils, the contracted chest, the subnormal 
 acuity of hearing, his nervousness, and even his vacillating will, 
 are a group of phenomena which suggest adenoids. Adenoids are 
 merely an enlargement or hypertrophy of lymphatic tissue in the 
 naso-pharynx. They may be due to the very decayed teeth, which 
 act as a source of infection to the tonsils and adenoid tissues. 
 The naso-pharyngeal obstruction and the decayed teeth may both 
 result from the insufficient nutrition, the presence of which is 
 attested by the customary breakfast of coffee, bread and cake. 
 
 The remedies to be suggested in this case are partly medical 
 and partly social. He should be referred to the medical inspector 
 and taken by his parents or a school nurse to a clinic for nose and 
 throat diseases for examination and treatment. The insufficient 
 nutrition may be due to the impoverished condition of his parents, 
 or to ignorance. The solution and treatment of this problem must 
 be left to the various social and philanthropic agencies, which in 
 our large cities are beginning to attack the problem with determina- 
 tion and scientific insight. 
 
CHAPTEE II. 
 
 Pbeliminaey Steps and Miscellaneous Problems. 
 
 During tlie school year 1905-06, there were enrolled in the 
 elementary schools of Camden, IST. J., 12,801 children. If only 
 those children of the first grade whose ages were below seven and 
 those of the second grade whose ages were below eight, and so on 
 for the rest of the grades, were taken to be of normal age for their 
 respective grades, then only 28 per cent of all the children were 
 of normal age for their grades. If the upper age limit of the 
 normal child were raised one year for each grade, the percentage 
 of normal children rose to 53. If still another year were added, 
 making all children in the first grade below nine of normal age 
 for the grade, and all those of the second grade below ten normal, 
 then T4 per cent, or 9500 children composed the normal group. 
 This left 3372 for the abnormal or retarded group. 
 
 During the latter half of the school year 1905-06, this retarded 
 group of children was made an object of special investigation by 
 Mr. James E. Bryan, the city superintendent, in order to deter- 
 mine the conditions favoring retardation. He was assisted in 
 his efforts by the public school teachers of the city to whom were 
 sent special forms calling for the following data : name., residence, 
 age in years and months, number of years in school, length of time 
 in present class, present progress, attendance, sight, hearing, gen- 
 eral health, and special data which referred to inattention, mental 
 deficiency, and bad conduct. After the teachers had received 
 instruction in the method of procedure they obtained the ■ above 
 data for 2033 retarded children and recorded them upon the 
 special forms or blanks. To all of this material I had access, and 
 after having obtained permission from the Camden school authori- 
 ties to make my clinical study of the 2033 cases, I transcribed 
 it on blanks prepared for the purpose, so that I could refer to it 
 at any time during the course of my inquiry. 
 
 At this stage of the investigation my efforts had been con- 
 centrated upon four objects. The first was to study the extent 
 of retardation for different school years and various school systems. 
 I found that retardation was not a local condition, but was wide- 
 spread and chronic. The second step was to obtain permission 
 
 (38) 
 
PBELIMINABY STEPS. 39 
 
 from the school authorities of Camden to make the investigation. 
 Here there was some cause for apprehension. It was feared that 
 patrons of the schools would not take kindly to such an innova- 
 tion, especially since Mr. Bryan had conducted his investigation 
 the previous year. Children might object to an examination, and 
 even to such questions as required them to state of what their 
 breakfasts consisted. Additional teachers would be required to 
 substitute for the regiilar teachers while they were being inter- 
 viewed in reference to the retarded children in their rooms, and 
 thus additional expense would be incurred. In spite of these 
 misgivings it may be said that the whole investigation met with 
 practically no opposition. There was an occasional teacher who 
 seemed to have no sympathy with the work; an occasional parent 
 who declared that his child should not be examined; yet of all 
 the children asked only two refused, one in obedience to her 
 mother's command, and another out of sympathy for her school 
 mate who had already refused. There was practically no resistance 
 on the part of the children; some, indeed, felt very much dis- 
 appointed upon learning that they would not be examined. The 
 third object was the preparation of the blank described m the 
 first chapter, and the fourth the transcription of the data referred 
 to in the preceding paragraph. 
 
 The next step was to undertake the actual examination of the 
 children. It was begun in the latter part of February, 1907, 
 and concluded the last week in May of the same year. To this 
 part of the work I devoted about sixty days. One half of the 
 time was given to collecting data from the teachers and the other 
 half to examining about one thousand children. Usually I was 
 able to devote between five and six hours a day to the work m 
 the schools. Consequently, I could give only about ten minutes 
 to the examination of one child. Had it been possible to devote 
 more time to this phase of the investigation its merit, no doubt, 
 would have been much enhanced. A number of factors co-operat«d 
 to make this impossible. In the first place the total amount of 
 time was limited, because I was not prepared to begin the work 
 earlier in the year, and because the city superintendent requested 
 me to finish it before June so as not to disturb the schools during 
 the time for examinations and promotions. On account of numer- 
 ous withdrawals it would have been unwise to attempt to carry 
 the investigation into another year. I was unwilling to decrease 
 the number of children on account of the ill effects of errors with 
 small numbers. Unless the number of children were reasonably 
 
4:0 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 large it would also be impossible to make symptomatic correla- 
 tions. Moreover, to exclude any of the retarded children from 
 my investigation would have compelled me to abandon my original 
 purpose of making some statement relative to each one of the 
 2033 retarded cases. 
 
 Before visiting a school, blanks like the one described in the 
 first chapter were prepared for all the retarded children belonging 
 to that school. Upon every blank were entered the facts neces- 
 sary to locate a child, viz, : the name of the school and teacher, 
 and the name of the child with its grade, class, and home address. 
 
 The work at the school was carried on in the principal's ofiice and 
 was begun by getting all possible information f rotm the principal an,d 
 the teachers of the gTades in which the children happened to be, or 
 had been the previous . year. It is very important that some 
 knowledge of the child be obtained before meeting it, in order that 
 special attention may be given to defects and adverse conditions 
 Avhich others have observed. Moreover, confidence in my own 
 observations made upon children was increased or diminished 
 according to the confirmation or negation of the teachers. 
 
 After the teachers had been interviewed the work of examin- 
 ing and questioning the children was begun. That they should 
 not be influenced by each other's answers, no more than two chil- 
 dren were allowed in the room at one time. This was found to 
 be a very desirable number. Very few children showed signs 
 of fear or confusion. The child who was the first to be examined, 
 showed most timidity and awkwardness in responding to the tests 
 and questions. Having been allowed to look on, the second child 
 had acqviired some familiarity Avith the method of procedure, 
 some knowledge of what was expected of him; he also took note 
 of the harmlessness of the instruments and tests employed, and 
 acquired a certain degree of willingness to answer questions which 
 were similar to those he had heard others answer. In this way 
 the reactions of the children were very much facilitated and the 
 element of fear practically eliminated. For the nature of the 
 tests and the character of the questions the reader is referred to 
 the description of the blank in the first chapter. 
 
 It was impossible for me to examine even a majority of the 
 2033 cases whose names I had received. Tor this a variety of 
 causes were responsible. From an inspection of the data which I 
 had received from the city superintendent, it appeared that errors 
 had been made in entering as retarded the names of twenty-nine 
 girls who in reality belonged to the group of children of normal 
 
PRELIMINARY STEP8. 41 
 
 age. Moreover, the name of one boy appeared twice. He had 
 evidently been transferred during the period of Mr.. Bryan's 
 investigation. Consequently, it became evident from the material 
 in my possession before beginning the investigation, that 2033 
 constituted the whole number of retarded children, of whom 1075 
 were boys and 928 girls. 
 
 Upon beginning my "work with the children I discovered at 
 once that the original number would be still further considerably 
 reduced. Second in importance in bringing about this state of 
 affairs were absentees on the days I visited the several schools. 
 To make another attempt to see these children was out of the ques- 
 tion on account of a lack of time. Moreover, three efforts which 
 had been made to see all the retarded children of a few schools, 
 proved unsuccessful. The number of absentees for the boys was 
 123 or 11.4 per cent; for the girls 102 or 11 per cent. Among 
 the girls there were also two who refused to be examined. 
 
 On account of overcrowding, promotions, and changes of resi- 
 dence, a number of children had been transferred to other schools 
 in Camden. Of these children I was able to see only those who 
 had been transferred prior to my visiting the schools where they 
 were finally entered. It Avas not even possible to see all of these, 
 for many had not entered the schools to which they had been 
 transferred. Children will resort to everj^ possible means to evade 
 the compulsory attendance law. Their schemes sometimes com- 
 pletely baffle the attendance officers. I know of a case who had 
 two addresses, one in the city with his parents and the other in an 
 adjoining township with his grandparents. The attendance officer 
 of the city was told that the boy lived with his grandparents in 
 the countr}'', and the officer of the country district was informed 
 that the boy lived Avith his parents in the city. Of the 155 chil- 
 dren reported to have been transferred I could locate only 42, 
 leaving 113 unexamined, 65 boys and 48 girls. 
 
 A certain number of boys and girls were reported to have 
 left the Camden schools. This indeed Avas the most dominant 
 factor in preventing a re-examination of the entire group. There 
 were 368 boys and 313 girls, a total of 681, who withdrew from 
 school in a little less than one year's time ; for Mr. Bryan's inves- 
 tigation, during Avhich these children's records were first made 
 out, was carried on during the months of May and June, 1906, 
 while I began to re-examine them in the latter part of February, 
 1907, and concluded my work in the latter part of May in the 
 same year. In less than a year, therefore, 34 per cent of the 2003 
 
42 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 cases whom I attempted to re-examine had. left school ; 34 per 
 cent being boys and 33 per cent girls. 
 
 These percentages would no doubt have been increased had it 
 been possible to locate all the transferred children. It is very 
 likely that many of them had left school. 
 
 It is interesting to note that the percentage of children who 
 withdrew from the retarded group exceeds the percentage of those 
 who withdrew from the group of so-called normal age. From the 
 available data it appears impossible to obtain accurate results, 
 but an attempt can be made. The number of children enrolled in 
 the Camden schools at the end of September, 1905, was 11,117. 
 There were, however, 1684 accessions during the year. Most of 
 these occurred shortly after the schools opened, so that of the 
 1684 children entering during the year about 1000 were enrolled 
 near the beginning of the school year. We may therefore say that 
 12,117 children entered the Camden schools in September, 1905. 
 During the year there were 3072 withdrawals; i. e. 3072 children 
 withdrew from 12,117 during the course of one school year. This 
 gives a percentage of 25.4; as the percentage of withdrawals from 
 the retarded group was 34, it exceeds the percentage of total with- 
 drawals by 8.6. The excess of withdrawals from the retarded 
 group over those from the normal group must consequently be still 
 greater. It is, however, to be observed that the elimination for 
 the total number occurred between September and June, inclusive, 
 and for the retarded group approximately between the beginning 
 of June and the early part of April. Therefore the retarded group 
 had the advantage of the Avithdrawals during the long summer 
 vacation. It is quite likely that after this period a large number 
 of children do not return to school. On the other hand it must 
 not be overlooked that the elimination for the non-retarded group 
 only would be less than 25.4 per cent and that it would be higher 
 for the retarded group, if information of all the transferred chil- 
 dren were to be had. In view of these considerations it is 
 justifiable to claim that the retarded children, the very ones who 
 have profited least by public education, are the first to leave school. 
 The children who are the most poorly equipped to fight the battles 
 of life, are the first to abandon their school training. The whole 
 number of children whom it was impossible to reach on account of 
 refusals, absences, transfers, and withdrawals was 1021. Of these 
 556 were boys and 465 girls. For the boys the percentages of 
 absentees, transfers, and withdrawals were 11.4, 6, and 34.2 
 respectively. For the girls these figures given in the same order 
 
PRELIMINARY 8TEP8. ^3 
 
 were 11, 5.3 and 33.7. In every case the percentages for the 
 o-irls are slightly lower than those for the boys, but they are so 
 nearly the same as to indicate practically no sex differences The 
 percentages of children who conld not be reached is 50.9 for the 
 boys and 50.1 for the girls. Consequently, I was unable to re- 
 examine one-half of the original number. I began to make out 
 records for 2003 cases but succeeded in completing only 98i. 
 In order that I might have the data of at least 1000 cases, I ex- 
 amined 30 retarded children whose names I had not received from 
 the statistical investigation. By using 18 of these extra cases m 
 connection with the 982, I obtained the 1000 cases, 533 boys and 
 467 girls, upon which the results of this study are based. Ihe 
 facts enumerated above are summarized in table I m the 
 
 ""^^^ Although the withdrawal of children from school is of suffi- 
 cient importance and extent to be a problem for a separate i^^^i^J' 
 I thouo-ht it might be interesting and of value, to collect such data 
 upon this subject as would enable me to make some statement 
 about each one of the 681 retarded children who withdrew from 
 school From the nature of my investigation I could gather only 
 such information as was easy of access, and therefore I am pre- 
 pared to speak in definite terms about no more than 420 ot the 
 withdrawn children. Of the remaining 261 children there were 
 119 cases, 63 boys and 56 girls, who were reported to have left 
 the city of Camden. I possess no information whatever about 
 59 boys and 83 girls, the remainder of the 261 cases. 
 
 I shall now turn to the 420 cases, 246 boys and 174 girls 
 •concerning whose life after they had left the Camden schools I 
 can make more definite statements. There were 8 boys and 3 
 girls who entered business college, 14 boys and 7 girls ^elonging 
 to parochial schools, and 3 boys and 1 girl who attended other 
 schools. Consequently, there were 36 cases, who, althougli having 
 left the Camden public schools, had not abandoned their efforts 
 to secure an education,-they were still attending some school. 
 From the Camden school records, however, it appeared that they 
 had withdrawn. The school records, therefore, are a poor source 
 of data for investigating the problem of elimination from schoo . 
 From these records it appeared that 420 children had left^ehool, 
 but 8.6 per cent of them had merely left the public schools. More- 
 over the school records reported the 119 children who left Camden 
 as having withdrawn, but it is more than likely that a large per- 
 * This percentage is evidently higher for the group of children of normal age. 
 
44 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 centage of these were attending other public schools. In fact, in 
 a few cases I received positive information that they were attend- 
 ing school at other places. It is also likely that a large number 
 of the 142 cases, concerning whom I was unable to obtain data, 
 were still in school at some place; but these, too, from a mere 
 study of the records, appeared to have been eliminated. It is 
 the shifting character of our population which is responsible for 
 much apparent elimination. Of the 420 cases who are now under 
 consideration I was informed that 192 boys and 91 girls were at 
 work. The number of boys who were at work, therefore, far 
 exceeds the number of girls; but if those who were reported to be 
 at home be added to the number engaged in some kind of work, 
 the sum for the boys will be 194 or 82.2 per cent of the total 
 2003, and for the girls 138, or 79.3 per cent. In many cases it 
 appeared that the kind and permanency of a boy's position were 
 rather closely associated with the quality of his work at school. 
 In many cases I attempted to find out what kind of work the boys 
 were doing, ISTot infrequently I received the reply that they 
 changed so often that it was impossible to keep track of them. 
 Upon inquiring into their school history I learned that they had 
 been rather shiftless pupils. 
 
 Usually poverty is regarded as one of the important factors 
 in causing children to leave school, but from my investigation it 
 does not appear to be very significant. Out of the 420 children 
 there were only 3 whose homes were in such want that their 
 assistance was required. There were 27 cases who were unable 
 to attend school the whole or greater part of the year on account 
 of ill health. Only 8 of these were boys. They are 3.3 per cent 
 of the whole number of withdrawn boys of whom I was able to 
 collect any data. The percentage for the girls is 10.9. This 
 is more than three times that for the boys. Of the 2003 original 
 cases, some definite knowledge was furnished about 1742. Of this 
 number 5 had died, 3 of them boys ; 1 boy and 1 girl had been sent 
 to prison. From the fact that 12 of the children, all of them boys, 
 were out of school on account of bad conduct, we may have some 
 indication of the ability of woman to discipline the boy. Most of 
 these cases it was impossible to keep at school on acconnt of their 
 demoralizing influence. Hence it appears that the school system 
 was not adequate to offer instruction to all the children whom the 
 law required to attend school. 
 
 From the whole retarded group only 9 entered the high school 
 in September, 1906, These 9 cases were in reality not furnished 
 
PBELIMINABY STEPS. 45 
 
 by the whole retarded group, for there are 261 cases of whom I 
 have no information, and as some of these may have entered the 
 high school of another city the 261 should therefore he deducted 
 from the 2003, leaving 1742 as the number from which the J 
 high school pupils came. In June, 1906, there were 9729 chil- 
 dren enrolled in the Camden schools. This was only a short time 
 after Mr Bryan's statistical investigation, during which a record 
 was made of the 2003 retarded cases. As the investigation was 
 made somewhat before the end of June, we may say that at this 
 time there were about 10,000 children on the rolls. If the retarded 
 o-roup be deducted from this number about 8000 will remain; 
 from these all but 9 of the children who entered the high school 
 were drawn. If the normal group of 8000 children furnished 
 pupils for the high school in the same ratio as the retarded group, 
 then only 50 children would have entered the high school m Sep- 
 tember 1906, whereas this number was 129. We may therefore 
 conclude that less than two-fifths as many children from the re- 
 tarded as from the normal group entered the high school, ihe 
 foregoing figures are set forth in table II, in the appendix. 
 
CHAPTEE III. 
 
 Results and tpieie Treatment. 
 
 The collation of data was begun by establishing for each case 
 the amount of retardation in years and half years. The statistical 
 data received from Mr. Bryan represented each child of the first 
 grade as being at least nine years of age.' Several factors, how- 
 ever, co-operated to reduce this lower limit of retardation for many 
 cases. One of these was a recognition of classes in calculating the 
 amount of retardation. In each grade of the Camden schools 
 there are two classes, one of which is more advanced than the 
 other. According to the data which I received from Mr. Bryan a 
 child was retarded the same amount regardless of class, but in my 
 computations, I took the child in the higher class to be retarded one 
 half year less than the one in the lower, and this reduced the 
 amount of retardation for many cases by one half year. 
 
 There were also surprising discrepancies in age. In some 
 cases these amounted to two years, thus making a child who had 
 been retarded two years according to the statistical investigation, 
 of normal age according to the clinical. From a comparison of the 
 data which I received, and the data which I collected, it appeared 
 that there was a lack of uniformity among the Camden teachers in 
 recording the children's ages, some taking the register age and 
 others the age of the children in May or June, 1906, the time of 
 the statistical investigation. According to my method of calculat- 
 ing the amount of retardation it was increased for those children 
 whose register age was given but reduced for some of the others. 
 I determined the age for all the children up to the first of 
 February, 1907,* about the time of the mid-year examinations, 
 and took the grade and class in which they were directly after the 
 examinations, for this was the time of my inquiry. An example 
 may serve to illustrate in what way the amount of retardation was 
 reduced for some of the children. A boy in the first grade whose 
 birthday was on May 30, 189Y, was examined and had his age re- 
 
 *Evidently it would have been more accurate to calculate the ages up to a 
 time midway between two examination periods. 
 
 (46) 
 
RESULTS AND THEIR TREATMENT. 47 
 
 corded bj the teachers ou June 10, 1906. Consequently this boy 
 was nine years of age and in the first grade. He therefore properly 
 belonged to the retarded group. He made the June promotions 
 for 1906 and the February promotions for 1907. He must then 
 have been in the second grade, and in order to be retarded, his age 
 should at least have been ten years. But according to my v^ay of 
 calculating age, he was only nine years and six months by the first 
 of February, and consequently did not belong to the retarded 
 group. 
 
 The co-operation of two or more of the above-named factors 
 in a single case lowered the retardation of 129 of the 1000 children 
 sufficiently to exclude them from the retarded group. By assuming 
 seven years to be the normal age for the lowest class of the first 
 grade, seven and a half years the normal age for the highest class of 
 the first grade, eight years as the normal age for the lowest class of 
 the second grade, etc., and calculating upon this basis the amount 
 of retardation for each child in years and half years, — taking the 
 time for calculating the age simultaneous with the time for pro- 
 motions, — I found that the amount of retardation for the boys 
 varied from one year and less to seven years, and for the girls 
 from one year and less to seven and a half years. The exact 
 character of the retardation is given in table III, in the appendix. 
 
 From what has just been said and from what was stated on 
 earlier pages of this monogTaph, it appears that unless great care 
 is taken in compiling and analyzing enrolment figures the results 
 obtained from them in calculating the extent of retardation are apt 
 to be very misleading. From an analysis of the total enrolment 
 figures for 1905-06 Mr. Bryan found that 3372, or 26 1-3 per cent 
 of the children were retarded, but when he made his statistical 
 investigation at the close of tlie school year he found only 2033, 
 or more accurately 2003. How is this difference to be explained ? 
 Some of it may be accounted for by a reduction in the school 
 population. The total enrolment was 12,801. This is the number 
 analyzed to determine the extent of retardation; but at the time 
 of the investigation there were only about 9729 children on the roll. 
 Some of it may be accounted for by absentees, but this factor does 
 not seem sufficient to explain the reduction from 3372 to 2003. 
 Hence we must look for an additional cause. The total enrolment 
 showed the ages and grades of the children as they were when they 
 entered school. When the teachers made special records for the 
 retarded children in May and June, some of them took the register 
 age of September, or the time when the children entered school, but 
 
48 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 their grade for May and June. As there was a mid-year promo- 
 tion, the grade of the children was raised but their age remained 
 the same as that of the enrohnent figures. According to the enrol- 
 ment figures, therefore, from which it appeared that 3372 children 
 were retarded, a child may have been nine years old and in the first 
 grade in September, thus being retarded; but according to the 
 statistical investigation this same child was taken as nine years old 
 the following May, even though it had in the meantime been 
 promoted to the second grade, in consequence of which it was not 
 retarded. In this another cause appears for the discrepancy in the 
 number of retarded children as found by the analysis of the enrol- 
 ment figures and the statistical investigation. I have already 
 shown how the number of retarded children as found by the statis- 
 tical investigation was further reduced by the clinical investiga- 
 tion. 
 
 In determining the amount of retardation for the 1000 chil- 
 dren who are the subjects of this studj^, I assumed that seven years 
 was the normal age for the first grade, eight years the normal age 
 for the second and so on for the other grades. But how is this to be 
 justified, for it is evident that some children enter the first grade 
 at the age of five or six, or even when they are older ? In fact, I 
 found that the age of entrance varied from five to twelve years. 
 This is shown more in detail in table IV. Should not the age of 
 entrance of each child be taken as its normal age in the first grade ? 
 I should say yes, provided the curriculum were adapted to the stage 
 of the child's development when he entered. For this group of 
 children I thinlc the normal age can best be determined by com- 
 puting the average amount of retardation for each age of entrance. 
 The age for which the average amount of retardation is least should 
 then be taken as the normal age for the first grade. 
 
 There were sixty-one boys who entered school at the age of 
 five years. Of these, four were retarded one year or less if seven 
 years be taken as the normal age of the first grade, lowest class ; 
 seven and a half years for the first grade, highest class ; eight years 
 for the second grade, lowest class, and so on. Under the same 
 conditions nine were retarded 1^/2 years ; six, 2 years ; seventeen, 
 2^ years ; eleven, 3 years ; ten, 3^4 years ; three, 4 years, and one, 
 4% years. The average amount of retardation in years for the 
 sixty-one cases may thus be shown to be 2.57 years. By calculat- 
 ing in the same manner the average amount of retardation for 
 the groups of children who entered at 6, 7, 8, 9, 10, 11 and 12 
 years of age, we obtain respectively 2.58,. 2.56, 2.98, 3.37, 3.91, 
 
RESULTS AND THEIB. TUEATMENf. 49 
 
 4.00, 4.50 years. The average retardation therefore for the three 
 lowest ages of entrance is practically the same, and it is not until 
 entrance has been postponed to the eighth year that there is a 
 notable increase in the amount of retardation. The series for the 
 girls corresponds closely to that of the boys. Writing them one 
 below the other, they are as follows : 
 
 Age of entrance — 
 
 5 6 T 8 9 10 11 12 
 
 Boys . . . 2.57 2.58 2.56 2.98 3.37 3.91 4.00 4.50 
 
 Girls .. . 2.71 2.64 2.66 2.88 2.98 3.88 4.25 4.50 
 
 Had six years been chosen as the normal age for the first 
 grade, for the purpose of finding the above averages, each average 
 would have been increased one year and the first three would still 
 be the lowest. Had eight years been taken, each average would 
 have reduced one year and the first and the third would have 
 remained the smallest. Taking the series as given above, the aver- 
 ages for entrance at five and six years are the same as those for 
 entrance at the age of seven. But in this connection it must be 
 remembered that the children who entered at five attended school 
 two years longer than those who entered at seven, and those who 
 entered at six one year longer. But for this increased attendance 
 they made no progress. They were an expense and burden to the 
 school system which cared for them one and two years before 
 they began to develop. Had they entered at the age of seven 
 years they would have made the same progress in the course of 
 their school history, would have cost the school system nothing, and 
 would not have interfered with the progress of those who were older, 
 by overcrowding the lower grades. It is true that those who 
 entered at the age of seven years attended one year longer than 
 those who entered at eight, but they were benefited by it because 
 their retardation is shown to be less. Hence we may conclude 
 that seven years was the most favorable age for the children of 
 this group to enter the Camden schools. This is most probably 
 true of other retarded groups, who are attending school where the 
 curriculum is similar to that of the Camden schools. It would 
 seem worth while to determine the most favorable age of entrance 
 for children who are of normal age for their respective grades. 
 (See table V). 
 
 Where shall we look for the cause of the excessive retardation 
 of children who enter school before the age of seven ? Evidently 
 we must begin with their age, because this is the only respect in 
 
50 CLINICAL STUDY OF BETABDED CHILDBEN. 
 
 which they differ from those retarded children who enter at seven. 
 It is contrary to experience to say that children between five and 
 seven years of age are in a stage of non-development. They may, 
 however, be too immature to profit by what the school has to offer. 
 If this be the case, the school curriculnm should be so modified as 
 to be adapted to the capacity of these children, or there should be a 
 revision of school laws regulating more precisely the age when 
 children should enter school. To attempt to feed a child's mind 
 with pabulum upon Avhich it does not thrive may not only mean a 
 financial waste to the school system, a hindrance to the growth of 
 other children, and a needless expenditure of energy and time on 
 the part of the teacher, but it may mean life-long harm to the child 
 itself. 
 
 The amount of retardation having been determined, I 
 attempted to account for it in each individual case, by collating 
 such of the data on the clinical examination blanks as I had 
 assumed to be the causes of retardation. Most of the causes 
 recorded on the blanks I subsumed under three general heads, viz., 
 physical, social, and mental or psychical. Under the physical I 
 classed health, nutrition, adenoids, speech, sight, hearing, tonsils, 
 and smoking; under the social, entrance, attendance, school history, 
 home life, and language ; and under the mental, mental deficiency 
 and conduct. Home life embraces "suppbrt," ^'home care," "home 
 culture," and "home discipline". These and other items men- 
 tioned under the headings of physical, social, and psychical causes 
 are fully described in Chapter I. 
 
 Depending somewhat upon the kind and intensity of the 
 cause, I was frequently in doubt as to its activity in producing 
 retardation. This gave rise to a division of causes into those 
 whose activity was doubtful and those concerning whose influence 
 no doubt was entertained. The latter were called real causes and 
 the former doubtful causes. With the exception of smoking all 
 the causes appear as real. From the list of doubtful causes, 
 adenoids, entrance, attendance, and mental deficiency were 
 excluded. Therefore, health, tonsils, nutrition, speech, sight, 
 hearing, conduct, home life, language, and school history are com- 
 mon to both groups of causes, a certain degree of intensity being 
 adapted as distingTiishing one group from the other. The system 
 of grading found upon the blank was followed in classifying the 
 causes. 
 
 The distinction between a real and a doubtful cause was 
 perhaps chosen in an arbitrary way, but it was not employed 
 
BE8ULTS AND THEIR TREATMENT. 51 
 
 capriciously. An attempt was made to apply it uniformly 
 throughout. Health was always taken as a real cause when rated 
 below the medium, or when there was a past history of ill health. 
 It was always classed as a doubtful cause when it appeared on the 
 blank simply as of medium grade. All, ratings of health which 
 were above the medium were considered normal, unless there was 
 sufficient evidence on the back of the blank to make out a case of 
 previous ill health. 
 
 The classes for nutrition were determined in the same way 
 as those for health. When of medium grade it was taken as a 
 doubtful cause ; for all lower grades as a real cause ; and for all 
 higher it was neglected. This method of classifying nutrition 
 was modified by signs of rickets or other indications of former 
 poor nutrition. 
 
 Adenoids were always taken as a real cause. 
 
 Enlarged tonsils were taken as a doubtful cause unless medical 
 opinion had judged them to be a source of considerable injury to 
 the health of the child. Except in a very few cases they con- 
 stituted one of the symptoms for the diagnosis of adenoids. 
 
 Speech defects were of two kinds, stammering and stuttering. 
 A stammer rated as medium or above and a stutter rated above 
 medium, or a combination of the two defects in a single case, were 
 real causes. For all other ratings speech became a doubtful cause. 
 
 Sight was treated as a doubtful cause when it was either 2/3 
 or 7/10 normal for both eyes ; when it was 2/3 or Y/10 for one eye 
 and less than normal for the other; or when one eye was normal 
 and the other less than 2/3. If it was more defective than 2/3 for 
 both eyeS;, it was a real cause ; also if it was less than 2/3 for one 
 eye and below normal for tlie other. Less defective vision than 
 7/10 for both eyes and 2/3 or 7/10 for one eye, in case the other 
 eye was normal, was neglected. 
 
 Hearing was normal when its acuity was above 70 for both 
 ears or when it averaged above 70 in case it did not fall below 61 
 for either ear. All degrees of acuity between 61 and 70 
 inclusive for both ears, or all degrees that averaged between 61 and 
 70, unless it was less than 30 for one ear, were taken as doubtful 
 causes. Hearing was cla:ssed among the real causes when it was 
 less than 30 for one ear or averaged less than 61 for both. 
 
 Entrance and attendance appear only as real causes. A child 
 who entered after seven years of age was thought to have a real 
 cause of retardation. Similarly a child who missed one-fourth or 
 more of the school time was recorded as having a real cause. 
 
52 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 "Home care," "home culture/' "home discij)line," and "home 
 support" are all involved in determining the class of causes for 
 home life. As there are four different items with five grades 
 each, it would be very tedious to set forth in each case the criteria 
 which determined the class of causes for home life. A general 
 idea may be given by stating that when the ratings were equivalent 
 to three P's or less, home life was taken as a real cause. It became 
 a doubtful cause when the ratings were above those required to 
 make it a real cause and equivalent to or below four F's. 
 
 The school history of a child was thought to be a real cause of 
 its retardation, when it involved attendance at either a rural, 
 foreign, or parochial school, or no less than four different city 
 systems. If there were less than three changes of city systems 
 they were regarded as comprising a doubtful cause under the 
 heading of school history. 
 
 If the birth-place of a child was foreign, and a foreign 
 language was spoken exclusively in the home, language was con- 
 sidered a real hindrance to the child's progress. Most of the 
 records, however, were accompanied by the teacher's statement 
 that unfamiliarity with the English tongue was a real difficulty 
 with these children. The age of immigration was another factor 
 which was taken into account in this connection. If the child 
 immigrated before it had acquired speech, it was treated as though 
 born in this country. Language was counted as a doubtful cause 
 for a child who immigrated before the development of speech and 
 in whose home only a foreign language was used. Language was 
 not considered, when English in connection with some foreign 
 tongue was spoken in the home. 
 
 A "very deficient" grade of conduct was always put into the 
 class of real causes, and a grade that was only "deficient" into the 
 class of doubtful causes, unless its classification among the real 
 causes was warranted by additional information on the back of the 
 blank. All grades of conduct above deficient were not considered. 
 
 I have set forth the principal facts which guided me in the 
 classification of causes into real and doubtful. In some cases, 
 however, information which appeared on the back of the blank 
 justified a departure from the rules as laid down above. In the 
 choice of these rules I can not claim to have exercised good judg- 
 ment before having subjected my results to criticism. Preparatory 
 to this criticism and the presentation of my results, I shall con- 
 tinue my discussion of causes. 
 
 As there are fourteen kinds of real causes, like health, conduct. 
 
RESULTS AND THEIB TREATMENT. 53 
 
 home life, etc., one or all of which are possible in a single case, it 
 happens that their number for different cases varied. For some 
 only one real cause could be found, and for others two, three, or 
 even more. Similarly the intensity of causes varied. For 
 example, vision might be 1/4 normal for one child and only 1/10 
 normal for another. In addition to this it has been shown that 
 the amount of retardation varies from one year to six and one- 
 half years. When, therefore, the number and intensity of the 
 factors was in my opinion sufficient to account for the -whole 
 amount of retardation I called them an adequate cause of the 
 retardation. The number of factors operative to produce an 
 adequate cause for the boys varied from 1 to 9 and for the girls 
 from 1 to 6. The whole number of boys for whom an adequate 
 cause was found, for whose whole amount of retardation the factors 
 found are believed to have been responsible, is 335. The boys for 
 whom 1, 2, 3, 4, 5, 6, 7, 8, and 9 factors were found, are 43, 119, 
 106, 46, 13, 6, 1, and 1, respectively. The whole number of girls 
 with adequate causes is 321. Given for the different number of 
 factors from 1 to 6, following the same order, they are 42, 140, 
 80, 42, 15, and 2. The percentage of girls for whose retardation 
 sufficient cause has been found is 68.Y and the percentage for the 
 boys is 62.9. That the percentage for the boys is lower than that 
 for the girls may be wholly or in part accounted for by the fact 
 that the investigation was begun with a large boys' school, where 
 blanks were filled out for 75 cases. The difference, however, is 
 only 5.8 per cent. There is, moreover, a close correspondence 
 between the numbers in the series for the two sexes. The whole 
 number of children for whom there appears to be an adequate 
 cause is 656. This is 65.6 per cent of the number examined. 
 
 The whole number of factors for the boys is 900. This gives 
 an average of 2.7 factors for each boy. The numbers for the girls 
 are 817 and 2,6. The average number of factors for the sexes 
 is therefore practically the same. 
 
 For the different kinds of causes, however, sex differences 
 appear. It was previously pointed out that the number of girls 
 who were out of school on account of ill health was much larger 
 than the number of boys who were out for the same cause. In 
 confirmation of what was said, the cause of ill health appears 102 
 times for the girls and only 80 times for a larger group of boys. 
 IsTutrition appears 69 times as a cause for the boys and only 42 
 times for the girls. There are 38 cases of adenoids among the 
 boys and 26 among the girls. Speech defects are almost twice 
 
54 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 as numerous among the boys as among the girls, the numbers 
 being 32 and 16 respectively. The intensity of visual defect rep- 
 resented under adequate causes occurs 88 times v^^ith the girls and 
 only 50 times with the boys, being almost twice as frequent among 
 the girls as among the boys. Hearing defects are practically of 
 equal frequency for the sexes. The number of boys is 25 and for 
 the girls 20. 
 
 Of the social causes, entrance, attendance, and lang-uage show 
 practically no sex differences. Given in the above order the figures 
 for the boys are 117, 178, and 22 respectively j and for the girls, 
 117, 188, and 17. 
 
 School history, according to the principles guiding me in 
 choosing this as a cause, affects only 69 boys as opposed to 85 
 girls. This difference can possibly be explained by assuming 
 that the girls remembered their own history better than the boys. 
 According to my results the number of boys coming from poor 
 homes exceeds the number of girls ; for the former the number is 
 138 and for the latter 84. It appears to me most unlikely that 
 the number of poor homes among the boys should exceed the number 
 among the girls. It seems reasonable to suppose that the girls are 
 better cared for by the home than the boys. As the girl is more 
 intimately connected with the home than the boy, she is doubtless 
 more influenced by its discipline. Boys are more apt to be out 
 upon the street where they are under the surveillance of no one. 
 Many public playgrounds, where the boy could spend his leisure 
 hours under the observation of his parents or some officer especially 
 appointed for the purpose, might make him more amenable to 
 home and school discipline. 
 
 It has been pointed out that conduct was worse among the 
 boys than among the girls. This is confirmed by the results 
 which were here obtained, there being 41 boys with deficient con- 
 duct as opposed to 12 girls. There are 38 boys and 18 girls who 
 are rated as mentally deficient. They include all grades of mental 
 deficiency, from the backward child, or the borderland case, to the 
 idiot. For the groups under consideration the mentally deficient 
 boys are about twice as numerous as the mentally deficient girls. 
 This proportion of deficients is not confirmed by a study of grades 
 of mentality below backwardness, among children not belonging to 
 the thousand retarded cases who were the object of this investiga- 
 tion. ITineteen cases of mental deficiency were found among 
 practically^ six thousand children. Out of these nineteen cases, 
 only eight were boys and eleven were girls. 
 
RESULTS AND THEIR TREATMENT. 55 
 
 It is of interest to observe that, in spite of compulsion by law, 
 attendance is the most frequent cause of retardation. Those of 
 next greatest frequency are late entrance and home life. If all 
 the adequate causes be given in the order of their frequency of 
 occurrence,, they are as follows: Attendance 366, entrance 234, 
 home life 222, health 182, school history 154, sight 138, nutrition 
 111, adenoids 64, deficiency 56, conduct 53, speech 48, hearing 
 45, lang-uage 39, tonsils 5. The total number of social causes is 
 1015. They appear almost twice as often as the physical causes, 
 which occur only 593 times. It appears to be probable that the 
 social causes are not only most frequent, but also most far-reaching 
 in their consequences. Many of the physical causes would doubt- 
 less disappear with the improvement of some of the social causes. 
 (See table VI, appendix). The order also might change for a 
 different group of children or for a different investigator, who 
 might require one or more of the defects or social conditions to be 
 more or less intense in order to rank as a real cause.' 
 
 In many cases the number and activity of the real causes 
 were, in my opinion, not sufficient to account for the whole amount 
 of retardation. In this event, the real causes, instead of being 
 called adequate, were called contributory factors, i.e. they con- 
 tributed toward a complete or adequate statement of the causes of 
 retardation. A contributory factor might be of the same conse- 
 quence as an adequate cause. Two cases might have the same 
 number, kind and intensity of real cause, but because they were 
 associated in the one case with one year's and in the other with six 
 years' retardation, they might be an adequate cause in the former 
 and only contributory factors in the latter. 
 
 The whole number of cases for whom contributory factors 
 were found is 195, of these 104 or 9.5 per cent are boys and 91 or 
 19.5 per cent were girls. The relative frequency for each item of 
 the contributory factors is the same as that for the adequate causes. 
 The boys show better health, more speech defects, more acute 
 vision, and poorer conduct and home life than the girls. For the 
 boys, the total number of contributory factors is 119, an average of 
 1.14; for the girls, 106, an average of 1.16. . The social causes 
 again are more numerous than the physical, there being 157 of the 
 former to 58 of the latter. For a detailed distribution of con- 
 tributory factors the reader is referred to table VI. 
 
 Doubtful causes were defined as those of doubtful influence in 
 producing retardation. For the sake of discussion the doubtful 
 causes are sub-divided. When thev occur in connection with 
 
56 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 adequate or contributory factors they are called associated factors ; 
 but when they are the only causes possible to discover in one or 
 more cases, they are termed unassociated factors. There are 70 
 boys and 40 girls with 130 and 75 unassociated factors of retard- 
 ation respectively. The whole number of doubtful causes is 746 
 for 509 boys, and 537 for 452 girls. The sex differences pointed 
 out for the real causes are the same for the doubtful causes except- 
 ing health, nutrition, hearing, and school history. Hearing, how- 
 ever, will be the only exception if the doubtful and real causes be 
 combined, and for this defect no sex difference was claimed under 
 the real causes because it appeared to be practically equally preva- 
 lent for the sexes, affecting 6.8 per cent bf the boys and 5.8 per 
 cent of the girls. 
 
 The order of frequency of occurrence of the doubtful causes 
 differs considerably from that of the adequate. Given in the 
 order of frequency, they are: Enlarged tonsils 264, home life 
 190, smoking 87, health 143, nutrition 133, conduct 125, school 
 history 95, sight 83, speech 63, language 59, and hearing 41. 
 The position of smoking in the series was determined upon the 
 basis of the average, because this condition refers only to the boys. 
 
 For the adequate causes it was found that the number of social 
 causes w-as almost twice as large as the number of physical causes, 
 but this relation is more than reversed for the doubtful causes. 
 There are only 344 social as opposed to 814 physical causes. This 
 change is to be explained by the fact that entrance and attendance 
 were excluded from the doubtful social causes and enlarged tonsils 
 and smoking added to the doubtful physical causes. 
 
 The total number of doubtful causes found is 1283, and the 
 total number of real causes 1942. As it is less my purpose to point 
 out the number of causes, their relative frequency and sex differ- 
 ences, than to prove that they are real causes of retardation, I 
 shall take up the treatment of the latter and refer to table VI 
 for a more detailed account of the former. At this place, how- 
 ever, the description of a number of cases to illustrate the different 
 kinds of causes may be of service. To this purpose I shall there- 
 fore devote the next few pages. 
 
 No Causes. 
 
 Case I. According to my scheme for the determination of 
 real and nominal causes, none appeared on the record of this boy. 
 He entered school at the age of five years. His present age is 12 
 years and 11 months; this in connection with the fact that he is in 
 
RESULTS AND THEtR TREATMENT. 57 
 
 the advanced or A class of tlie fourth grade fixes the amount of his 
 retardation at two and one-half years. He attends school regularly 
 and makes a fair grade in conduct and progress. Having always 
 attended the same school, he has suffered no loss through transfers. 
 He was reported to have medium mentality ; he is healthy and well 
 nourished. His home life is above the average. His parents are 
 of American descent. They speak the English language in the 
 home. Both sight and hearing are normal. There are no physi- 
 cal stig-mata, with the exception of a somewhat high palate. The 
 only children's diseases were whooping cough and scarlet fever. 
 
 Case II. A girl 17 years and 6 months old. She entered 
 school at the age of five and is now in the advanced class of the 
 eighth grade. The amount of her retardation is three years. At 
 the time her record was filled in, her progress was reported to be 
 good, conduct excellent, and attendance regidar. She had attended 
 three different schools, all of which were in the city of Camden. 
 Her mentality is good. She is neither bold nor shy, of an amiable 
 disposition, and alert in her general reactions. Her health, nutri- 
 tion, and home life are very good. Her parentage is American 
 and the English language is spoken in the home. There are no 
 physical stigmata, but her hand balance is slightly nervous. In her 
 early school years she suffered from measles, chicken-pox, and 
 mumps. Her teacher assigned slow development as the cause of 
 her retardation. I did not succeed in discovering any causes for 
 this case. 
 
 Doubtful Causes. 
 
 Case III. This is a boy who is 13 years old. He is in the 
 lower or B class of the fifth grade and the amount of his retarda- 
 tion is two years. He entered school at the age of six. His 
 attendance is regular, conduct good, and progress deficient. He 
 has never belonged to other than the Camden schools, and has been 
 transferred only once. His mentality is medium. Health, nutri- 
 tion, and home life are good. His parentage is English, but he 
 was born in Philadelphia. His father is dead. He has an older 
 sister and one younger brother. Vision in the right eye is normal, 
 but in the left only 1/5. Hearing is normal. The palate is nar- 
 row and tonsils are enlarged. Mouth breathing is associated with 
 these defects. In this case sight and enlarged tonsils were taken as 
 doubtful cau-ses. 
 
 Case IV. A boy aged 14 years and 8 months. He is re- 
 tarded two and a half years, being in the A class of the sixth grade. 
 
58 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 He entered school at the age of six. His ratings for progress, 
 conduct, and attendance are fair, good, and regular respectively. 
 There is nothing in his school history to account for his retardation. 
 His mentality is of medium grade. His health is fair, and both 
 nutrition and home life are good. The English language is spoken 
 by the parents, who are of American descent. Sight and hearing 
 are normal. There is a slight stutter in his speech. The hand 
 balance is somewhat nervous and the palate is high and narrow. 
 Health and defective speech are classed among the doubtful causes. 
 
 Case V. This girl is in the B class of the fifth grade and is 
 12 years and 4 months old. The amount of her retardation is 
 therefore one and a half years. She is reported to make excellent 
 progress, attends school regularly, but her conduct is only fair. 
 She began her school life in Philadelphia at the age of six. Her 
 mentality is very good, health fair, nutrition good, and home life 
 above medium. Her parentage is German, and the German lan- 
 guage is spoken in the home. Vision is 10/15; hearing normal; 
 the palate is high. Measles and mumps were the only children's 
 diseases. School history, health, language, and sight appear as 
 doubtful causes on the record of this case. 
 
 Case VI. This girl, who is 13 years and 10 months old and 
 is in the B class of the fifth grade, is retarded three years. She 
 entered school at the age of seven. Her progress is fair, conduct 
 good, and attendance regular. She began school in Philadelphia, 
 her native city, and has attended two different schools in the city 
 of Camden. Her grade of mentality is slow, and her health and 
 home life fair. She is well nourished. Her parents are Italians, 
 but they speak the English as w^ell as the Italian language in the 
 home. Vision in the right eye is normal, in the left 8/10. Hear- 
 ing is normal, there are no physical defects and no diseases except- 
 ing measles. She is shy, pleasing in her manner, inert in activity, 
 and appears to be of a reflective type of mind with a firm will. 
 School history, health, and home life are the doubtful causes in 
 this case. 
 
 CONTEIBUTOEY FaCTORS. 
 
 Case VII. The age of this boy is 13 years and 6 months and 
 he is in class B of the fifth grade. The amoimt of his retardation 
 is therefore two and a. half years. He makes fair progress and 
 attends school regularly, but is deficient in conduct. He' entered 
 school at the age of eight, which is one year older than the normal 
 age of entrance for this group. He has never attended any but 
 
BE8ULT8 AND THEIE TREATMENT. -59 
 
 the Camden schools. His mentality, health, and nutrition are 
 good. His home life is above medium grade. Parentage is 
 American, home language English. Both sight and hearing are 
 normal. The palate is high and the tonsils are enlarged. Diph- 
 theria was the only disease. Late entrance was taken as a con- 
 tributory factor, and conduct and tonsils as associated doubtful 
 causes. 
 
 Case VIII. A boy whose age is 12 years and 9 months. 
 He is in grade two, class A. The amount of his retardation is four 
 and one-half years. He entered school at the age of eight. His 
 progress and conduct are deficient, but his attendance is regular. 
 He has always attended the same school. He is a dull child with 
 medium nutrition, a fair home life and good health. His parents 
 are German, but the English language is spoken in the home. 
 Sight and hearing are normal. His hand balance is slightly ner- 
 vous and there is a stutter in his speech which was rated worse 
 than medium. The children's diseases are measles and whooping 
 cough. In this case late entrance and stuttering were regarded as 
 contributory factors, and home life, nutrition, and conduct as asso- 
 ciated doubtful causes. 
 
 Case IX. This is a girl 13 years and Y months old. She 
 is in grade four, class A, and is retarded three years. Her 
 progress and conduct are deficient, but her attendance is very 
 regular. She entered school at the age of six. Mentally she is 
 slow. Health and nutrition are good, home life medium, parentage 
 is English. She lives with her mother, her father being dead. 
 Her mother keeps a store, in which the girl^vorks before and after 
 school. Vision is normal ; hearing is normal in the right ear, but 
 so defective in the left ear that she could not be tested with the 
 audiometer. Her palate is very high and her speech is defective. 
 The speech defect is a stammer, one grade better than medium ; 
 children's diseases are measles and mumps. Hearing is a con- 
 tributory factor and home life, conduct, and stammering asso- 
 ciated doubtful causes. 
 
 CaseX. A girl aged 12 years and 6 months. She is in grade 
 three, class A. Her retardation is three years. She has made 
 very deficient progress, having missed the last two promotions. 
 Her conduct is rated as deficient, hut as she is a moral case, conduct 
 was regarded as a real cause. She entered school at the age of 
 seven and attends very regularly. Her mentality is dull, health 
 good, nutrition fair, and home life poor. Home life is therefore 
 another real cause. Her parents are German and they speak the 
 
60 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 German language exclusively. The birtliplace of the child is 
 Camden. Her sight and hearing are normal. The tonsils are 
 enlarged and the voice is nasal. The children's diseases are 
 measles, mumps, chicken-pox, diphtheria, and scarlet fever. Con- 
 duct and home life appear as contributory causes in this case ; the 
 associated doubtful causes are nutrition, enlarged tonsils and 
 language. 
 
 Adequate Causes. 
 
 Case XL This is a boy who is retarded one year, being 9 
 years and T months old and in the A class of the second grade. He 
 entered school at the age of seven. His progress is fair, conduct 
 good, and attendance regular. He attended only tvi^o different 
 schools, both of which were in the city of Camden. His mentality, 
 health, and nutrition are good; home life is medium, parentage 
 German. The parents speak the German language exclusively. 
 This boy was born in Germany. In this case the principal of the 
 school reported that unfamiliarity with the English language had 
 been a bar to his progress. Vision 8/10 R; 10/10 L; hearing 
 normal. There are no physical defects and no diseases. As this 
 case was retarded only one year it was thought that language might 
 reasonably be considered as the sole cause of his retardation. Home 
 life was taken as an associated doubtful cause. 
 
 Case XII. The amount of this boy's retardation is one and 
 one-half years. He is 13 years and 6 months old and is in grade 
 six, class B. He entered the Camden schools at the age' of six. He 
 also attended the schools of a rural district for a period of 
 two years. His progress is fair, conduct deficient, and attendance 
 irregular. His mentality is of medium grade. Health and nutri- 
 tion are good and home life is above the average. Parentage is 
 American. Sight and hearing are normal. The tonsils are en- 
 larged and the voice is obstructed. The diseases are measles, 
 chicken-pox, whooping cough, and mumps. This boy confessed 
 that he smoked the pipe. He is bold, surly and stubborn. Attend- 
 ance and school history were considered adequate causes, and con- 
 duct, smoking and enlarged tonsils doubtful causes. 
 
 Case XIIL A boy aged 11 years and 8 months. He is in 
 grade three, class B, and is retarded two and a half years. He 
 entered school at the age of eight and attends very regularly. His 
 conduct is good and progress fair. There has been nothing in 
 his school history to retard his progress. He has medium men- 
 tality. His health is poor and his nutrition medium. He is a 
 
RESULTS AND THEIR TREATMENT. 61 
 
 smoker. Home life is poor; parentage American; language Eng- 
 lish. Sight and hearing are normal. Stammering is below 
 medium. His diseases are measles, mumps, whooping cough, and 
 pneumonia. Health, home life, stammering, and entrance are 
 taken as adequate causes ; smoking as an associated doubtful cause. 
 
 Case XIV. The age of this boy is 13 years and 6 months. 
 He entered school at the age of nine years and is now in grade four, 
 Class A. The amount of his retardation is three years. His 
 progress is very deficient. He is, no doubt, a case of promotion on 
 the merit of age. His conduct is good and his attendance regular. 
 He has always attended the same school. He is a mentally deficient 
 case of the backward grade. His health, nutrition, and home life 
 are good. He lives with his parents, who are of American descent. 
 His sight and hearing are normal. The hand balance is nervous 
 and the palate is high. He has suffered from mumps, pneumonia, 
 and spinal meningitis. He still complains of headache and vomit- 
 ing. Mentality and age of entrance were taken as adequate causes 
 of his retardation. His deficient mentality is doubtless due to 
 physiological conditions produced by spinal meningitis. A sister 
 of this boy died of the disease. 
 
 Case XV. A boy aged 13 years and 7 months, is in the third 
 grade, class A. He is, therefore, retarded four years. He entered 
 school at the age of seven. His progress is deficient, conduct good, 
 and attendance regular. He was never transferred to other schools ; 
 his mentality, health, and nutrition are good. Home life is poor; 
 the parents are Italians who speak their native tongue exclusively. 
 Vision is 8/10 ; hearing normal. There are no physical defects 
 and no diseases. Late entrance and home life are the adequate 
 causes. As the birthplace of this boy was Philadelphia, and there 
 was no positive evidence that langTiage retarded him, language 
 was taken as a doubtful cause. The teacher assigned lack of appli- 
 cation as one of the causes. 
 
 Case XVI. A boy 14 years and 6 months old. He is in 
 grade one, class A. The amount of his retardation is seven years. 
 He entered school at the age of nine and has never been transferred. 
 His progress is very deficient, conduct is excellent and attendance 
 irregular. He is mentally deficient, belonging to the class of 
 idiots. His muscular co-ordination is very bad, — ^he is unable to 
 write legibly; he walks with difficulty, and stutters and stammers 
 badly. He has a poor memory and is unable to tell a connected 
 story. He can do practically no school work. His health is poor, 
 nutrition fair, home life poor. He was born of American parents 
 
62 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 and lias one older sister, who attends to the household duties, the 
 mother being dead. It was difficult to test his sight and hearing, 
 but both appeared very deficient. He showed mouth breathing, a 
 V-shaped palate, enlarged tonsils, and a number of other signs 
 usually associated with adenoids. His cranium is small and there 
 are marked stigmata of degeneration. I was unable to obtain any 
 history of diseases. In this case the following nine real causes 
 were found : attendance, entrance, mentality, health, sight, hear- 
 ing, adenoids, speech, and home life. In connection with these 
 nutrition appears as a doubtful cause. 
 
 Case XVII. This is a girl 12 years and 6 months old and in 
 the B class of the fourth grade, her retardation being two and a half 
 years. Her progress is fair, conduct good, and attendance very 
 poor ; she is absent about one-half of the time. I was unable to 
 obtain her age of entrance. She attended a parochial Catholic 
 school for a period of four years. She also belonged to the Phila- 
 delphia public schools. Mentality is good ; health and nutrition 
 fair ; home life above medium. Parentage is mixed, the father 
 being of American and the mother of Irish extraction. Sight and 
 hearing are normal. The enlarged tonsils are associated with a 
 sullen disposition. The diseases are measles and whooping cough. 
 Attendance and school history are taken as the adequate causes, 
 health, nutrition, and tonsils being associated factors. 
 
 Case XVIII. This is another girl whose retardation is two 
 and a half years. She is in the second grade, class B, and is 10 
 years and 7 months old. She entered school at the age of nine and 
 attends very regularly, but her conduct is deficient and her prog- 
 ress very deficient. Her school history is free from retarding 
 causes. Her mentality is slow, health good, and nutrition very 
 good. Her home life is fair. She was born in Italy of Italian 
 parents who speak only their native tongue. The teacher assured 
 me that language was a retarding cause. Vision is 10/20 ; hearing 
 82 R ; 60 L. A very narrow palate, enlarged tonsils, mouth breath- 
 ing, reduced hearing, abnormal sight, a dull expression, and a short 
 upper lip led to the diagnosis of adenoids. The children's dis- 
 eases are measles, mumps, chicken-pox, and scarlet fever. Adequate 
 causes are late entrance, language, sight and adenoids. Doubtful 
 causes are home life, conduct, and hearing. 
 
 Case XIX. A colored girl 15 years and 7 months old. She 
 is in grade five, class B ; hence is retarded four and one-half years. 
 She entered school at the age of seven, but her attendance is very 
 irregular, only about four-fifths of the time. Her conduct is good, 
 
RESULTS AND THEIR TREATMENT. 63 
 
 but lier progress is very deficient. She attended school in four 
 different cities. Her mentality is niedinni. Her health, nutrition, 
 and home life are good. As her father is dead, she lives with her 
 mother, who works out. Vision is 10/20 with glasses, 1/20 with- 
 out glasses; hearing normal, tonsils enlarged. The diseases are 
 whooping cough and measles. Attendance, school history, and 
 sight are adequate causes and enlarged tonsils an associated factor. 
 Factors like deprivation of parents are treated under the head of 
 miscellaneous. 
 
 Case XX. This is a girl 16 years and 1 month old, who is 
 retarded seven and a half years,, being in grade 2, class A. She 
 entered school at the age of eight. There is nothing in her school 
 history to retard her progTess, which, nevertheless, is very deficient. 
 Her conduct is excellent and her attendance very regular. She is 
 mentally deficient, of the idio-imbecile grade. Her health is fair, 
 but on account of physical stigmata, like excessive nervousness, 
 deformed palate, low forehead, small cranial circumference (nine- 
 teen inches), and external strabismus, health was regarded as a real 
 cause. Her nutrition is medium, and home life above the average. 
 Her only brother is also mentally deficient. She was born of 
 Jewish parents. The home language is Yiddish. Vision was 
 tested with the illiterate card and was found to be 16/30, Hearing 
 normal. She speaks with difficulty, and has a pronounced stam- 
 mer. The adequate causes for this case are entrance, mentality, 
 health, sight, and speech. Langiiage is an associated doubtful 
 cause. The number of cases with decided physical stigmata was 
 small ; hence I made no separate class for them. 
 
 After having gone over the 1000 records and marked upon 
 each one all the real causes to be found, according to the rules 
 which I had laid down as the distingiiishing marks of such causes, 
 I found that real causes were noted in 851 of the 1000 cases. I 
 further found that there were 110 cases with unassociated factors, 
 %. e. doubtful causes not associated with real causes. There 
 remained, therefore, 39 cases for which no causes appeared. Con- 
 sequently it follows, if the assumed causes of retardation are real, 
 if there is any connection whatever between causes and retardation, 
 that the children for whom no causes could be found will decrease 
 in number with an increase in the years of retardation. It will 
 further be true if the unassociated factors have no connection with 
 retardation, that the number of children for whom unassociated 
 factors were found will not increase as the years of retardation 
 increase. If the two principles just set forth can be proved, it 
 
64 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 must follow that the number of children for whom, real causes 
 were found (among the 851 cases) must increase with the amount 
 of retardation. I made my calculations for the boys and girls 
 separately, but as the numbers are small, I combined the figures 
 for the two in the final result. Similarly I first computed for 
 years and half years, but for the final result I combined the years 
 with the half years, for the same reason that I combined the sexes. 
 To this method I adhered for computing all the tables that follow. 
 In the text I shall make mention of the final results only, but in 
 the tables the calculations will be given in full. In order to avoid 
 needless repetition, the number of years of retardation will not be 
 mentioned in connection with every series of figures. The first 
 figure in the series will always correspond to one year's retarda- 
 tion, the second figure to twO' years' retardation, the third to three 
 years, and so on to the fifth year, which was taken as the maximum 
 amount of retardation for the final series. 
 
 Distributed among the different periods of retardation, 1, 2, 
 3, 4, and 5 years, it appeared that 11, 15, 11, 2, and were the 
 number of children for whom no causes were found. By distribut- 
 ing the whole number of cases in the same way the series 129, 385, 
 323, 123, and 40 was obtained. Dividing the figures in the first 
 series by their corresponding figures in the second the results will 
 be 8.5, 3.9, 3.4, 1.6, and 00. These figures represent the percent- 
 age of cases for whom no causes were discovered, for each of the 
 periods of retardation. It will be observed that they decrease with 
 the increase in the years of retardation, and therefore that our 
 first supposition has been proved. 
 
 For each of the several periods of retardation, from the short- 
 est to the longest, the number of cases with unassociated factors is 
 21, 55, 27, 7, 0. By treating them in the same way as the number 
 of cases for which no causes were found, the following series of 
 percentages will result: 16.3, 14.3, 8.4, 5.7, and 0. They stand 
 for the percentage of cases with unassociated factors and form a 
 descending series with the ascending series of years. Hence the 
 second supposition is true. The first and second assumptions 
 having been shown to be true, the third follows without calculation. 
 It will be given below. 
 
 The number of cases with real causes for each of the different 
 periods of retardation is 97, 315, 285, 114, and 40. By finding 
 their percentage of the whole number of children for each of the 
 several periods of retardation, the following series will be formed : 
 75.2, 81.8, 88.2, 92.7, and 100.0. This series increases with the 
 
RESULTS AND THEIR TREATMENT. 65 
 
 amount of retardatiou according to tlie supposition, (See table 
 VII.) Practically the same proof of the relation between real 
 causes and retardation may be cast into a somewhat different form. 
 It may be assumed that the average retardation for the cases with 
 no causes and unassociated factors should be less than the average 
 retardation of the cases with real causes, if retardation is a function 
 of the real causes. 
 
 Calculated in years and half years, the total retardation of the 
 39 cases for whom no causes were found is 91.5 years. The aver- 
 age will therefore be 2.35 years. The total retardation of the 110 
 cases with unassociated factors is 262.5 years, and the average 2.39. 
 For the 851 cases with real causes the total retardation in years is 
 2453, and tlie average 2.88. The average amount of retardation 
 of the cases with unassociated causes exceeds that of the cases with 
 no causes by .04 of a year, and the average amount of retardation 
 of the cases with real causes is .49 of a year more than that of the 
 cases with unassociated causes, thus offering proof of the reality of 
 the real causes. Perhaps it will be thought that these differences 
 are small, but it must be remembered that this is partly due to 
 the fact that the number of children with a high retardation is 
 much smaller than the number of children with a low retardation, 
 and this reduces the averag'es. If the number of children were 
 evenly distributed among the several years of retardation the differ- 
 ences would be greater. (Table XII.) The above proof may be 
 worked out more in detail by supposing the average retardation 
 to increase with the number of causes. It will be remembered 
 that all the real causes that could be discovered in each of the 
 records, — this choice being made with strict uniformity according 
 to rules already discussed, — were noted, whether the degree of 
 retardation was one or five years. If now there is a connection 
 between the number of causes noted and retardation, then Ave should 
 expect that for the cases for whom only one or two causes of retarda- 
 tion could be found (with certain obvious exceptions), the average 
 amount of retardation would be less than for the cases for whom 
 more causes were found. If this be true then retardation is a 
 function of the number of causes noted. In collecting the data, 
 the cases with contributory factors were not distributed among the 
 several years of retardation in series composed of the different 
 numbers of causes, and therefore they will have to be excluded from 
 the real causes in this computation. Because the numbers were 
 small this distribution was not made. Could they have been 
 treated, however, with the other real causes, the adequate causes. 
 
66 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 in this connection they would simply add to the proof, as will 
 appear from table VIII. 
 
 The supposition is that if the average number of years of 
 retardation increases with the number of causes found, retardation 
 is a function of these causes. The highest number of causes found 
 in any one case was nine,, but as the number of cases with 5, 6, 7, 8, 
 and 9 causes is very small, they will all be included in the groups 
 with five causes. The series representing the total amount of 
 retardation in years, corresponding to the order of causes from one 
 to five, is 190, 687.5, 571, 299, and 146 ; and the number of cases 
 for each period of retardation is 85, 259, 186, 88, and 38 respec- 
 tively. Calculating the average amount of retardation in years, 
 the following will be obtained: 2.24, 2.65, 3.07, 3.40, and 3.84. 
 The series increases with the number of causes, and thus retarda- 
 tion is a function of them. (Table XII.) 
 
 The relative and absolute value of the real and doubtful 
 causes may be tested by still other suppositions. I shall begin 
 with unassociated factors. If unassociated factors are connected 
 with retardation their number should increase with the increased 
 retardation. The unassociated factors corresponding to each of 
 the different years of retardation are 48, 100, 45, 12 and ; the 
 cases with unassociated causes are 21, '55, 27, 7 and 0. Dividing 
 the number of causes by the corresponding number of children in 
 each case, the following series of average number of causes will be 
 produced: 2.28, 1,82, 1.67, 1.71, and 0.00. The series is descend- 
 ing while the amount of retardation is ascending. Hence the 
 supposition is not warranted. (Table VIII c.) 
 
 By making the same supposition as above in reference to the 
 combined associated and unassociated factors, the value of all the 
 doubtful causes may be shown. Three series of causes, cases, and 
 averages may be given at once. Following the order indicated 
 they are 192, 493, 386, 164 and 48; 118, 370, 312, 121, and 40; 
 1.63, 1.33, 1.24, 1.36, and 1.20. The nature of the series justifies 
 the same conclusion as for unassociated factors. (Table VIII c.) 
 
 A treatment of the contributory factors according to the last 
 supposition and method will yield the following series: !F actors, 
 17, 87, 82, 32, and 7 ; cases, 16, 80, 70, 24, and 5 ; averages, 1.06, 
 1.09, 1.17, 1.33, 1.40. As the series of the average number of 
 factors increases regularly with the amount of retardation, the 
 assumption that the contributory factors are real causes of retarda- 
 tion is justified. (Table VIII c.) 
 
 For the adequate causes the series are: Causes, 153, 548, 
 
RESULTS AND THEIR TREATMENT. 67 
 
 606, 280, and 130 ; cases, 81, 235, 215, 90, and 35 ; averages, 1.89, 
 2.33, 2.82, 3.11, and 3.71. The series of averages for the adequate 
 causes is a better series than the one for the contributory factors. 
 This may show that they are more efficient in producing retarda- 
 tion than the contributory, but it must be observed that the numbers 
 are much larger for the adequate than for the contributory factors, 
 and on this account a better series is to be expected. (Table 
 VIII c.) 
 
 I have also calculated series for various combinations of 
 causes. In the text only the series representing the average num- 
 ber of causes will be given. By a combination of contributory 
 and adequate causes, a series of averages for all the real causes will 
 be obtained. The series is as follows: 1.75, 2.02, 2.41, 2.70, and 
 3.43. (Table VIII c.) 
 
 The next series will show how the average number of con- 
 tributory and associated factors increases with the amount of 
 retardation. All the causes, both real and doubtful, found in the 
 cases under consideration are represented in this computation. 
 The series is 2.44, 2.29, 2.40, 2.96, and 3.20. (Table VIII c.) 
 
 By combining the adequate causes with all their associated 
 factors in the same manner as explained for contributory factors, 
 the following series will be obtained: 3.40, 3.59, 4.00, 4.37, and 
 4.83. (Table VIII g.) 
 
 The next set of averages is obtained by a combination of real 
 causes and associated factors. All the cases except those with 
 unassociated factors and those for whom no causes were found are 
 involved in the calculation of this series. It is as follows: 3.24, 
 3.26, 3.61, 4.08, and 4.60. It appears, therefore, that in spite of 
 the unfavorable influence of doubtful causes, the series remains 
 unbroken and stands as evidence of the fact that the causes 
 which at first were assumed may now be regarded as real. (Table 
 VIII c.) 
 
 The objection may be made that the series given above do not 
 ascend as rapidly as one would expect. To this it may be replied 
 that the work is of a statistical nature, and that the number of 
 cases is not sufficiently large to eliminate the disturbing effect of 
 errors. Moreover, it has been found that the average age of the 
 children increased with retardation. The average age of the boys 
 who are retarded 5.5 years is 3.7 years more than the average age 
 of those who are retarded one year. Tor the girls the difference 
 between the average for 1 and 5.5 years retardation is still larger, 
 being 5,3 years. The average age increases regularly with retarda- 
 tion for both the boys and the girls. It may be seen from the fol- 
 
68 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 lowing series that althougli several of the consecutive numbers are 
 alike, not a single break occurs : 
 
 Years of 
 Retardation 
 
 1.5 2 2.5 3 3.5 4 4.5 5 5.5 
 
 Boys'Average Age, 11.0 11.9 12.2 12.9 13.2 13.6 13.7 14.1 14.1 14.7 
 Girls' Average Age, 10.8 11.9 12.4 13.1 13.5 14.1 14.1 14.1 14.8 15.6 
 
 On account of the increase of age with retardation, it seems 
 fair to assume that the larger the amount of retardation the longer 
 time the causes had to produce it, and that therefore it is not 
 necessary that their number and average should multiply rapidly 
 with increased retardation. (Table IX.) 
 
 As the number of cases is small and the kinds of causes nu- 
 merous, it is not to be expected that series with any degree of regu- 
 larity can be obtained from a separate treatment of the causes. 
 Especially is this true because the cases distribute themselves 
 so unevenly among the different years of retardation. For two 
 years' retardation there are 315 cases with real causes and for five 
 years only 40 cases. In spite of these difficulties I have been able 
 to compute fairly symptomatic series for the three groups of social, 
 physical, and psychical causes. Doubtful causes were excluded from 
 the calculations. The social causes are most numerous and conse- 
 quently give the most regular series. The number of causes for 
 each of the different years of retardation is 102, 398, 408, 185, and 
 79, and the corresponding cases are 97, 315, 285, 114, and 40 ; the 
 series of average number of social causes is-1.05, 1.26, 1.43, 1.62, 
 and 1.98. The total number- of real social causes is 1172. The 
 real physical causes are 651, only about one-half as many as the 
 social causes. In spite of the small number, the series of averages 
 for the physical causes, with a single exception, ascends quite 
 regularly with the amount of retardation. The series is .65, .65, 
 .82, .89, and 1.20. The series for the psychical causes, conduct and 
 mental deficiency, is .05, .10, .16, .23, and .25. (Table X.) 
 This progression is surprisingly regular in view of the small num- 
 ber of cases. It may be attributed to the mentally deficient cases. 
 If a series be computed for them only, an unbroken progression will 
 result. The total number of mentally deficient cases of all grades 
 from backwardness to idiocy is 56. These distribute themselves as 
 follows among the several years of retardation : 1, 11, 23, 15, 6. 
 If all the cases with real causes, yielding the series, 97, 315, 285, 
 114, and 40, be used for the purpose of converting the series into 
 one of percentages, the following regular progression will be 
 obtained: 1.0, 3.5, 8.1, 13.2, 15.0. (Table XIY c.) 
 
RESULTS AND THEIR TREATMENT. 69 
 
 Making use of the symbols described in the blank, the table 
 below will show the grade distribution of the 56 mentally 
 deficient cases. All cases which it was thought belonged more 
 pro^jerly to a class of borderland cases between the mentally normal 
 and the mentally deficient were grouped among the best grade of 
 mentally deficient. 
 
 Bkw IH IM II Id Totals 
 
 Boys 34 2 1 1 38 
 
 Girls 16 1 1 18 
 
 Totals 50 3 1 1 1 56 
 
 From this table it will appear that the number of imbeciles 
 found among the one thousand children is 6 or .6 of 1 per cent. 
 I examined about three-fifths (6000) of the children attending 
 the Camden schools for mentally deficient cases in addition to my 
 list of retarded children. Among them I found 19 imbeciles. To 
 these three-fifths of the 6 belonging to the retarded group should 
 be added, making about 23, or almost A of 1 per cent. The per- 
 centage of imbeciles for the retarded group is therefore higher 
 than for a group of children taken at random. Perhaps some of 
 the 19 imbecile children would more properly have been classed 
 as backward cases, but in my opinion all of them would have fared 
 far better had they been at an institution for mentally deficient 
 children. The grading of the 19 cases appears in the accompany- 
 ing table : 
 
 III IM II Totals 
 
 Boys 4 3 1 8 
 
 Girls 6 3 2 11 
 
 Totals ; 10 6 3 19 
 
 In treating mentality as a cause of retardation, I did not 
 consider the cases which were reported by the teachers as slow and 
 dull, to show a lack of capacity for school work. This was done 
 because it was thought that the degree of mentality which is 
 usually termed dull or slow might simply be a result of other 
 causes. As there are only 334 dull and slow children in the whole 
 retarded gi^oup, it is evident that not only slow and dull children 
 are retarded. The percentage of such children, however, appears 
 to increase with the amount of retardation. If they be distributed 
 among the different years of retardation, the series 24, 123, 119, 
 
70 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 49, and 19 will be obtained. The series for the whole number of 
 children is 129, 385, 323, 123, and 40. The percentage, there- 
 fore, of the whole number of children for each of the several years 
 of retardation will form the following sequence: 18.6, 31.9, 36.8, 
 39.8, and 48.0. From this series it appears that the number of 
 slow and dull children increases rapidly and regularly with the 
 amount of retardation. (Table XL) A further study of the 
 cases the teachers called slow and dull showed that their physical 
 causes were practically as numerous as for those of better grade of 
 mentality (leaving out of account the mentally deficient). For 
 the slow and dull group the average number of physical causes is 
 .67, and for the other gTOup .64. For the boys and girls sep- 
 arately the figures are .63 and .61, .72 and ,69 respectively. If 
 all the real causes be considered, they will average 1.94 for the 
 slow and dull group and 1.94 for the other group. The two 
 groups, however, show a decided difference in the amount of 
 retardation, that of the former being 3.00 years and of the latter 
 2.71 years. The figures for the different sexes are practically the 
 same. A still further study of slow and dull cases showed that the 
 percentage of first-born among them was 19.8, while the percentage 
 of first-born among the other cases, excluding the mentally defi- 
 cient, was only 16.7 ; also that the percentage of first-born among 
 the mentally deficient was 28.6. This fact was shown by both 
 sexes. Further light was thrown upon slow and dull children, 
 including mentally deficient, by finding that 52.3 per cent of them 
 were also called stolid or inert, while only 21.5 per cent of the 
 other children were called inert. This striking difference appears 
 for both sexes. Many children might lose their apparent dulness 
 if quickened by proper physical exercises. Teachers frequently 
 complain that some days children are exceptionally dull. At such 
 times it appears to me they should indulge in physical exercises 
 until they show some capacity for acquiring the three R's. 
 
 In order to obtain additional evidence of the relation between 
 social causes and retardation, I correlated the extent of retardation 
 of school districts differing in social grade, with the average enrol- 
 ment for the districts. They were graded into five classes, in addi- 
 tion to the negroes. The 2003 retarded children when distributed 
 among the different grades from the highest to the lowest (includ- 
 ing negroes as the lowest grade) formed the series 116, 357, 515, 
 612, 163, and 240. The average enrolment distributed in the 
 same way gave the following series: 708, 1846, 2780, 3063, 710, 
 and 645. Therefore, the percentage of children retarded in each 
 
RESULTS AND THEIR TREATMENT. 11 
 
 one of the districts from the best to the poorest grade is, 16.3, 19.3, 
 18.6, 19.3, 22.9, and 37.2. The fourth, third, and second grades 
 show practically no difference in the number of retarded children. 
 But the fifth and first show a difference of 3 and 3.6 per cent 
 respectively; while the colored schools average almost twice as 
 many retarded children as the other schools. The results might 
 have proved to be more symptomatic had the several school districts 
 been composed of more homogeneous groups in respect to social 
 standing. (Table XIII.) 
 
 Having treated the real causes in groups of social, physical, 
 and psychical, we may now turn to a consideration of the individual 
 causes in these groups. In this connection I wish to repeat that 
 the number of cases for which real causes were found is small, 
 being only 851, and the kinds of causes are many; therefore it 
 must not be expected that the percentage of cases with one kind of 
 cause increasesi as retardation with any degree of regularity. 
 Especially is this true because the 851 cases distribute themselves 
 very unevenly among the several years of retardation. 
 
 The method of treating the individual causes is precisely the 
 same as that employed for the different groups. As, however, only 
 one kind of cause is considered in a single table, the final series 
 will not be one of average number of causes, but of the percentage 
 of children for whom the cause was found. Thus as there were 
 97 children retarded one year for whom real causes were found 
 and only 13 of these had poor nutrition, the percentage of children 
 who were retarded one year and had nutrition as a real cause is 
 13.4. Eeal causes were found for 315 children whose retardation 
 was two years. There were 28 of these who had poor nutrition. 
 Therefore, of the children who were retarded two years 8.9 per 
 cent had faulty nutrition as a real cause of retardation. The per- 
 centage for the children who were retarded three, four, and five 
 years was calculated by the same method. The method set forth 
 for nutrition is the one employed for the treatment of all the other 
 individual causes. The complete calculations appear in table XIV. 
 At this place I shall give only the contrasted series in the order of 
 frequency of the causes, the most frequent first. 
 
 From a glance at table XIV it will appear that the series of 
 percentages is regularly ascending with the amount of retardation 
 for only entrance, attendance, home life, and mental deficiency. 
 It follows, therefore, that the series for all the causes, except 
 mental deficiency, is broken when their number falls to 200 or 
 less. The absolute and relative importance of the individual 
 
72 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 causes of retardation could be tested in a way by the above method, 
 if the number of cases investigated were 10,000 instead of 1000. 
 Were the number of cases suiEciently large, a test could be made, 
 not onlj of the value of individual causes but even of the different 
 grades of these causes. 
 
 There are a number of causes which it was thought well to 
 treat individually, either because no attempt had been made to 
 collect from all the children data pertaining to these causes, or 
 because the data were sufficiently numerous to warrant a separate 
 consideration. In some cases, moreover, there was such inde- 
 cision as to the real value of the data that separate treatment seemed 
 preferable. On account of their variety of character they may be 
 subsumed under the heading of miscellaneous causes. 
 
 I shall first turn to the relation between smoking and the 
 amount of retardation. The method of correlation is the same as 
 that used in the preceding tables. The cases who smoke were 
 first distributed according to their occurrence among the several 
 years of retardation. Similarly were all the boys of whom the 
 information was sought. The next step was to find for each year 
 of retardation the ratio of the number of cases smoking to the 
 number of cases asked for these data. In this way a series of 
 ratios or percentages was obtained which showed whether or not the 
 number of boys smoking increased with the amount of retardation. 
 The determinations were first made for years and half years, but 
 che half years were then combined with the years to make the 
 series of percentages more regular. I shall give here only the 
 series for which the years and half years were combined, the first 
 number in a series corresponding to one year's retardation and the 
 second number to two years' retardation, and so on. The series 
 for the number of cases smoking is 7, 24, 31, 17, and 8 ; for the 
 whole number of boys asked the series is 74, 183, 164, 70, and 23. 
 By means of these series the percentage of boys who smoke may be 
 calculated for each year of retardation. These percentages will 
 produce the following progression: 9.5, 13.1, 18.9, 24.3, and 
 34.8. The series is highly symptomatic of the injurious effects of 
 smoking upon the boy's school progress. If this series really stands 
 for what it seems to indicate, the assumption that smoking was 
 merely a doubtful cause is false. By asking the boys whether 
 they smoked cigars, cigarettes, or a pipe, I learned that only a 
 very few smoked cigars, and that those who smoked a pipe were 
 almost as many as those Avho smoked cigarettes. As nearly as I 
 could determine, the boys who smoked cigarettes smoked more 
 
RESULTS AND THEIR TREATMENT. 73 
 
 constantly than those who smoked a pipe. It is quite likely that 
 the boy can stand the smoking of bleached cigarette tobacco much 
 better than the relatively stronger pipe tobacco. If the cigarette 
 injures the boy more than the pipe or cigar, it is because he 
 indulges more excessively in smoking the cigarette. (Table 
 XV.) 
 
 The next series of percentages is intended to show the cor- 
 relation of the number of cases drinking tea and coffee, with the 
 amount of retardation. The calculations were made in the same 
 way as those for smoking. As the cases for this cause were boys 
 and girls, the series were first determined for the different sexes, 
 but the series given in the text represent the combination of the 
 sexes. The series of cases is 49, 196, 167, 61, and 12 ; of all the 
 children asked 76, 275, 227, 82, and 26 ; of percentages 64.4, 71.3, 
 73.6, 74.4, and 46.1. This series is slightly symptomatic of the in- 
 jurious effects of tea and coffee drinking before the fifth year is 
 reached ; here there is a sudden drop which it is difficult to explain. 
 Perhaps the number is too small to eliminate the bad effects of 
 errors. Or it may be that many of these children were forbidden 
 the use of tea and coffee on account of ill health, the percentage of 
 ill health for this group being much higher than that of any other 
 group. (Table XVI.) 
 
 By correlating the amount of retardation with the cases who 
 reported that they ate poor breakfasts, a negative result was 
 obtained. The three series given in the order of cases, whole 
 number of children, and percentage are as follows: 22, 75, 70, 22, 
 and 7; 76, 275, 227, 82, and 26; 28.9, 27.2, 30.9, 26.8, and 27. 
 Three numbers of the last series are nearly alike and there is a 
 difference of only 4 per cent between the highest and lowest. 
 (Table XVI.) 
 
 Of the one thousand cases there were 234, 23.4 per cent, who 
 were deprived of one or both parents either by death or separation. 
 This percentage seems to be excessive, but on account of insufficient 
 data no comparison can' be made Avith the children of normal age 
 for their grade. The relation of deprivation of parents to the 
 amount of the child's retardation can however be tested as above, 
 by a correlation of the number of cases deprived, Avith the 
 amount of their retardation. The series for the cases deprived is 
 23, 89, 79, 32, and 11 ; for the whole number of children 129, 385, 
 323, 123, and 40 ; and the series of percentages is 17.8, 23.1, 
 24.4, 26.0, and 27.5. This succession of percentages shows a 
 regular increase of cases deprived of parents in proportion with the 
 
74: CLINICAL STUDY OF RETARDED CHILDREN. 
 
 amount of retardation. As adequate cause for the retardation of 
 670 cases has already been found, it would appear that the finding 
 of additional causes is a denial of the adequacy of the causes 
 assumed to be so. In this there may be some truth, for it was 
 wholly a matter of judgment whether the causes were adequate to 
 produce a given amount of retardation. In this connection, how- 
 ever, it must be remembered that some of the causes here treated, 
 like deprivation of parents, lie back of some of the causes already 
 considered. Thus deprivation) of parents lies back of home life. 
 Of the 234 cases deprived of one or both parents, 86, or 37 per 
 cent, were reported to have a poor home life, of the grade described 
 in the preceding pages. Many of these causes may also refer more 
 especially to the cases for whom no adequate causes had in my 
 opinion been found. (Table XVII.) 
 
 It has already been shown (table IX) that the average age 
 of the children increases with the amount of retardation. The 
 above series shows that the number of cases deprived of parents 
 increases with the amount of retardation. Consequently it follows 
 that both age and the cases deprived of parents increase with the 
 amount of retardation. It appears, therefore, to be a logical neces- 
 sity to have the number of cases deprived of parents increase with 
 age, and if this be so then it is only reasonable to suppose that 
 deprivation of parents is a function of age and has no connection 
 whatever with the amount of retardation. As it is only the average 
 age which increases with the amount of retardation, it is not a 
 necessity for all the oldest children to be most retarded nor for all 
 the youngest to be least retarded. From table IX it appears that 
 there are some children 14, 15, 16, and 17 years of age who are 
 retarded only 1, 1.5, 2 and 2.5 years respectively, while there are 
 children only 10, 12, and 13 years of age who are retarded 3.5, 5, 
 and 5.5 years. From anything that has thus far been said it is 
 therefore not necessary for the number of cases deprived of parents 
 to increase with age ; and upon making a correlation of age with 
 the number of cases deprived of parents, a series is obtained Avhich 
 shows that the number of cases deprived does not increase with 
 age. There are 17 cases who are 9 and 10 years of age ; 61, 11 and 
 12; 110, 13 and 14; 42, 15 and 16; and 4 cases who are 17 and 
 18. The whole number of children corresponding to each of the 
 several ages from the lowest to the highest is 67, 305, 426, 169, 
 and 33. Giving the former series in terms of the latter, we obtain 
 the following series of percentages: 25.4, 20, 25.8, 24.9, and 12.1. 
 This series indicates that the number of cases deprived of one or 
 
RESULTS AND THEIR TREATMENT. 75 
 
 both parents decreases rather than increases with age, consequently 
 the series showing an increase of the number of cases deprived with 
 the amount of retardation, is symptomatic of a relation between 
 the two. (Table XVIIL) 
 
 From calculations given below, it appears that first-born chil- 
 dren are more apt to be retarded than others. The number of boys 
 examined in this investigation is 533. We may assume that they 
 represent so many families, although the number is somewhat less. 
 The whole number of children both living and dead, for the 
 assumed 533 families is 2856. Among these therefore we may 
 expect 533 first-born children. If we can expect 533 first-born 
 among 2856 children, then among 533 the number to be expected 
 is 100. In reality the number is less than 100 because the number 
 of families is less than 533. Sometimes two or more children 
 came from the same family. In the same way it was found for 
 the girls that 84 first-born may be expected among 467 families 
 with 2603 children. By actually counting the number of first- 
 born among the 533 boys and 467 girls, they were found to be 
 124 and 122 respectively. This is an excess of 24 with the boys 
 and 28 with the girls. The excess would have been exaggerated 
 had the thousand boys and girls actually represented so many 
 families. 
 
 In this connection it is interesting to observe that the per- 
 centage of first-born is higher among the mentally deficient than 
 among the mentally normal. Of 38 mentally deficient boys 11 or 
 28.4 per cent are first-boni, but of 495 normal boys there were 
 only 113 or 22.8 per cent who were first-born. In the same way 
 it was found that 27.8 per cent of the mentaljy deficient girls but 
 only 23.8 per cent of the mentally normal girls were first-born. 
 The number of first-born among the whole number of mentally 
 deficient cases exceeds the number among the mentally normal by 
 5.3 per cent, and the number of first-born among this retarded 
 group exceeds the number to be expected by 52. 
 
 From the results obtained in reference to first-born children 
 one might be inclined to suppose that their number would increase 
 \vith the amount of retardation, but the final series showing this 
 relation does not confirm this presupposition. The series is 32.8, 
 23.4, 22.0, 19.5, and 22.5. This is somewhat indicative of a de- 
 crease in the number of first-born with the amount of retardation. 
 
 An attempt was made to study the effect of large families 
 upon the amount of retardation by correlating it Avith the number 
 of living brothers and sisters. It was found that the 129 cases 
 
T6 CLINICAL 8TUDY OF RETARDED CHILDREN. 
 
 who were retarded one year had 387 sisters and brothers, and that 
 the 385, 323, 123, and 40 cases who were retarded 2, 3, 4, and 5 
 years respectively had each 1244, 1057,, 441, and 139 sisters and 
 brothers. The average number of sisters and brothers from one to 
 five years of retardation forms the following series, 3.00, 3.23, 
 3.27, 3.58, and 3.48. Here, therefore, there is some indication 
 that large families favor retardation. It may be, however, that 
 large families are associated with some other cause, like home life, 
 which might be responsible for the retardation. Where one event 
 may be dependent upon a large number of events it is difficult to 
 determine which is the real cause or to determine their relative 
 value should there be more than one. (Table XVII.) 
 
 The number of cases for the different years of retardation had 
 also a number of dead sisters and brothers. Distributed among the 
 years of retardation from 1 to 5 they form the following series: 
 99, 442, 411, 175, and 73. The series of averages is 77, 1.15, 
 1.27, 1.42, and 1.83. This series indicates an increase in the 
 jiumber of dead sisters and brothers as the amount of retardation 
 increases. In making this correlation it was thought that the 
 ntimber of dead children in different families was a measure of 
 their relative viability. The larger the number dead the less 
 would be the viability. It was further assumed that the less the 
 viability the greater would be the amount of retardation. If the 
 number of dead children in a family is a measure of its viability, 
 then it has been shown by the above series that viability decreases 
 as the amount of retardation increases. (Table XVII.) 
 
 Several objections may be made to the above series of aver- 
 ages. It may be said that as the size of families increases with 
 the amount of retardation, one may expect the number of dead to 
 increase in the same way. B'ut the increase of the former is 
 broken in regularity while the latter is not. Moreover, by taking 
 the difference between the lowest and the highest average for the 
 living sisters and brothers, and averaging it for the five years, the 
 result will be only .116, but for the dead sisters and brothers the 
 average difference is .212, almost twice as large. Again, as the 
 numbers in the latter series are only half the size of those in the 
 former we should expect the reverse to be true. 
 
 Against both series the same objection may be made as was 
 urged against the series showing the relation of deprivation of 
 parents to the amount of retardation. It is likely that the older 
 the children the larger the number of dead sisters and brothers. 
 As the average age increases with retardation, the increase of dead 
 
EESULTS AND THE IB TREATMENT. 77 
 
 sisters and brothers may be simultaneous with the amount of 
 retardation and age, but in reality be a function of the latter. To 
 determine whether this was true,, a correlation was made between 
 the age of the cases and the number of their dead sisters and 
 brothers. The number of cases 9 and 10 years old is 67 ; 11 and 
 12 years 305; 13 and 14, 426; 15 and 16, 169; and 17 and 18, 
 33. The number of dead sisters and brothers for each of the num- 
 ber of cases is 71, 382, 515, 190, and 42 respectively. From these 
 series the following series of averages is obtained: 1.06, 1.25, 1.21, 
 1.12, 1.27. Perhaps this series shows a slight increase of the 
 average number of dead witli the increase of age. But it by no 
 means accounts for the far more rapid and regularly ascending 
 series, which shows the relation of the number of dead sisters and 
 brothers to the amount of retardation. (Table XVIII.) 
 
 Usually much of the retardation in the public schools is 
 ascribed to the attendance of a foreign population. I have there- 
 fore made an accurate calculation of the average amount of retarda- 
 tion for each of the several races represented in this investigation. 
 The calculation was made by multiplying the amount of retarda- 
 tion in years and half years by the number so retarded. The sum 
 of these products was divided by the whole number of the race for 
 which the computation was made, to obtain its average amount of 
 retardation. 
 
 The races whose representation was sufficiently large for indi- 
 vidual treatment will be given in the order of the amount of their 
 average retardation, beginning with the one having the highest 
 average. Italian, 3,15 years; negro, 2.96; mixed parentage, 2.86; 
 total non- American, 2.84; all races not treated individually, 
 2.82; American, 2.79; German, 2.62; English, 2.36. The num- 
 ber of children for each of the different races given in the above 
 order is, Italian, 39 ; Il^egro, 112 ; mixed, 73 ; total non- American, 
 367; all races not treated individually, 44; American, 633; 
 German, 78 ; English, 21. These numbers may be too small to 
 base any conclusions upon them, but if the results obtained be con- 
 sidered reliable^ then it follows that the foreign population on the 
 whole increases the average amount of retardation by only .05 of 
 a year. The facts would be stated more accurately, if it were said 
 that some foreigii races had a tendency to raise the average amount 
 of retardation, while others reduced it. The Italian and the ITegro 
 are most retarded, and the German and English the least. (Table 
 XIX.) 
 
 Much retardation is undoubtedly due to a curriculum which 
 
78 CLINICAL STUDY OF RETARDED CHILDREN. 
 
 aims at making a man out of the boy before lie is ready to be a 
 man. The school in its methods and course of study must recog- 
 nize the interest of the boy as a boy, if it would keep him for the 
 sake of instruction. The school has certainly failed to interest the 
 subjects of its endeavor, and therefore it has become necessary for 
 the state to legislate upon this problem, and pass compulsory 
 attendance acts. In the state of New Jersey the child is unable 
 to leave school before its fourteenth birthday. From this it fol- 
 lows that there is a continual increase in the number of retarded 
 children until the fourteenth birthday, when there is a sudden drop 
 and the series for retarded children decreases to the eighteenth 
 birthday. By taking all children as 9, 10, 11, etc., who are in 
 their ninth, tenth and eleventh years respectively, and distributing 
 the thousand cases of retarded children according to their several 
 ages, the following ascending series is obtained from 9 to 13 
 inclusive: 35, 97, 133, 200, and 253; then when the thirteenth 
 year has been completed there is a drop from 253 to 149, the num- 
 ber 14 years of age, and the series is decreased. The whole series 
 after the thirteenth year is 149, 81, 33, 15, and 4, 
 
 In the chapter on elimination or withdrawals, it was pointed 
 out that by far the largest number of boys and girls leave school 
 to work or stay at home. Eeal poverty plays a very small part in 
 elimination, tl^ere being only 3 out of 420 cases. I think it fair 
 to say that most of the children who leave the elementary grades 
 do so because they are not interested in the work of the school. 
 Parents do not compel, thev permit them to go to Avork. (Table 
 XX.) 
 
 The average amount of retardation increases with the age, 
 having practically reached its maximum at the age of 14, when it 
 is 3.2 years for the boys and 2.9 years for the girls. These would 
 no doubt be the points of maximum retardation had not the nearest 
 birthday been taken to make the computations. The series of 
 average retardation for the boys and girls from the 9 to the 18 
 years inclusive are as follows : 
 
 Age 9 10 11 12 13 14 1^ 16 17 18 
 
 Boys 1.4 1.6 2.3 2.7 2.9 3.2 3.4 3.2 3.6 4.7 
 
 Girls 1.6 1.8 2.1 2.7 2.9 2.9 3.3 3.2 3.4 3.4 
 
 (See Table XXI.) 
 
 By calculating the average amount of retardation for the 
 several grades, it is found that instead of increasing with the grade 
 as we might expect, it decreases. For the first and second grades 
 the average retardation is 2.93 years; for the third and fourth 
 
RESULTS AND THEIR TREATMENT. 79 
 
 2.86; for the fifth and sixth. 2.67, and for the seventh and eighth 
 2.64. (Table XXII.) As the amount of retardation does not 
 increase, even with the lower grades where its reduction by with- 
 drawal is practically impossible, it appears that if the curriculum 
 is to be considered a cause of retardation, it can be a cause only 
 in the first grade. Probably the work of the first grade is not 
 articulated properly with the life of the child before he enters 
 school. 
 
 I offered as a proof of the reality of my causes of retardation 
 the fact that their number increased regularly with the amount of 
 retardation. To this the objection was made that as children of 
 different grades belonged to a group who were retarded to the same 
 extent, and as some of their retardation was to be ascribed to a 
 curriculum which was less properly adapted to the child in the 
 higher than in the lower grades, the groups might be altered if this 
 factor of the curriculum were considered and thus the symptomatic 
 series disturbed. It was claimed that the amount of retardation 
 due to the curriculum should be deducted from the given amount 
 of retardation. From the above table it appears that the assump- 
 tion that the work of the higher grades is not so well adapted to 
 the child as the work of the lower grades is not true. Moreover, 
 if the assumption were true, the chances that it would make the 
 series more rather than less symptomatic are at least equally great. 
 Therefore it is not to be considered. In the fact that average re- 
 tardation increases with age but not with the grade, we have a 
 statement of the fact that retardation principally affects the lower 
 grades. Here children must be considerably retarded before they 
 are permitted to leave school. We have, therefore, an overcrowd- 
 ing in the lower grades which in itself is a cause of retardation. 
 Retardation, therefore, becomes a cause of retardation by putting 
 children on half time or so overcrowding the rooms that they 
 become unfit for children and render the work of the teacher 
 inefficient. 
 
 In this monograph have been set forth a method and a blank 
 for the examination of retarded school children, as well as a method 
 for the treatment of results. The problem of retardation itself has 
 been considered. It was found that the thousand children repre- 
 sented in this investigation had an average retardation of 2.81 
 years and that it ranged from 1 to 7.5 years. Certain miscel- 
 laneous problems, like the withdrawal of children from school and 
 the time devoted to the examination of a thousand cases, are also 
 
80 CLINICAL STUDY OF BETABDED CHILDBEN. 
 
 discussed. The records of a number of cases are given. From 
 these it appears how certain facts were taken as causes of retarda- 
 tion. These causes are classed under the headings, physical, social, 
 and psychical. It is thought that adequate causes have been found 
 for the total retardation of 656 cases. For these cases the average 
 number of physical, social, and psychical causes is 3.62. To these 
 might be added a certain number of miscellaneous causes of an 
 hereditary nature. In fact many of the other causes may be mere 
 manifestations of the single cause, heredity. An attempt is 
 made to show the reality of the causes by pointing out that their 
 number increases with the amount of retardation. Several other 
 proofs are also offered. The value of this inquiry would doubtless 
 be much enhanced by a similar investigation of several thousand 
 additional retarded cases, as well as by the examination of a 
 thousand normal children for the sake of making a comparative 
 study. 
 
APPENDIX 
 
TABLE I 
 
 Retarded according to Superintendent's 
 
 statistics (1905-06) 
 
 Reported retarded by mistake 
 
 Names appearing twice 
 
 Actually retarded (1905-06) 
 
 Absent at time of examination( 1906-07). 
 
 Refused to be examined 
 
 Transferred to other schools in Camden 
 Withdrawn from Camden public schools 
 
 Not examined 
 
 Examined 
 
 Extra cases examined 
 
 Extra cases used in this study 
 
 Whole number of cases in this study. . . . 
 
 Boys 
 
 No. 
 
 1076 
 
 1 
 
 1075 
 123 
 
 65 
 368 
 556 
 519 
 21 
 14 
 633 
 
 Per 
 
 Cent. 
 
 11.4 
 
 6. 
 34.2 
 51.7 
 48.3 
 
 Girls 
 
 No. 
 
 957 
 29 
 
 928 
 
 102 
 
 2 
 
 48 
 
 313 
 
 465 
 
 463 
 
 9 
 
 4 
 
 467 
 
 Per 
 Cent. 
 
 11. 
 
 5.3 
 33.7 
 50.1 
 
 Totals 
 
 No. 
 
 2033 
 
 29 
 
 1 
 
 2003 
 
 225 
 
 2 
 
 113 
 
 681 
 
 1021 
 
 982 
 
 30 
 
 18 
 
 1000 
 
 Per 
 Cent. 
 
 11.2 
 
 6.6 
 34. 
 60.9 
 49.1 
 
 TABLE II 
 
 Number withdrawn for reasons ascertained ... 
 
 Attending some other school 
 
 Normal school 
 
 Business college 
 
 Mihtary academy 
 
 Private school 
 
 Parochial school 
 
 Working 
 
 Living at home and not working 
 
 In children's home 
 
 Withdrawn because of poverty 
 
 sickness 
 
 death 
 
 bad conduct , 
 
 imprisonment 
 
 Number withdrawn for reasons not ascertained 
 
 Left Camden 
 
 No information 
 
 Total number withdrawn 
 
 Boys 
 
 GlKLS 
 
 Totals 
 
 246 
 
 174 
 
 420 
 
 25 
 
 11 
 
 36 
 
 
 1 
 
 1 
 
 8 
 
 3 
 
 11 
 
 1 
 
 
 1 
 
 2 
 
 
 2 
 
 14 
 
 7 
 
 21 
 
 192 
 
 91 
 
 283 
 
 2 
 
 47 
 
 49 
 
 2 
 
 1 
 
 3 
 
 1 
 
 2 
 
 3 
 
 8 
 
 19 
 
 27 
 
 3 
 
 2 
 
 5 
 
 12 
 
 
 12 
 
 1 
 
 1 
 
 2 
 
 122 
 
 139 
 
 261 
 
 63 
 
 56 
 
 119 
 
 59 
 
 83 
 
 142 
 
 368 
 
 313 
 
 681 
 
 TABLE III 
 Analysis of Retarded Children by Half Years of Retardation 
 
 Years 
 
 1 
 
 1.5 
 
 2 
 
 2.5 
 
 3 
 
 3.5 
 
 4 
 
 4.5 
 
 5 
 
 5.5 
 
 Totals 
 
 
 38 
 15 
 
 43 
 33 
 
 61 
 
 85 
 
 132 
 107 
 
 91 
 104 
 
 74 
 54 
 
 52 
 32 
 
 19 
 20 
 
 16 
 12 
 
 7 
 5 
 
 533 
 467 
 
 Girls 
 
 Totals 
 
 53 
 
 76 
 
 146 
 
 239 
 
 195 
 
 128 
 
 84 
 
 39 
 
 28 
 
 12 
 
 1000 
 
 83 
 
TABLE IV 
 
 Analysis of Retarded Children by Ages op Entrance 
 
 Age 
 
 5 
 
 6 
 
 7 
 
 8 
 
 9 
 
 10 
 
 11 
 
 12 
 
 Totals 
 
 Boys 
 
 Girls 
 
 61 
 53 
 
 134 
 113 
 
 149 
 .136 
 
 86 
 84 
 
 33 
 29 
 
 11 
 12 
 
 4 
 4 
 
 3 
 2 
 
 481 
 433 
 
 
 Totals 
 
 114 
 
 247 
 
 285 
 
 170 
 
 62 
 
 23 
 
 8 
 
 5 
 
 914 
 
 TABLE V 
 
 Seven Years the Most Favorable Age for Entering School. 
 
 
 g 
 
 «-, a 
 
 Years op Retardation 
 
 o 
 
 Average 
 Retard. 
 
 Average 
 Retard. 
 Boys and 
 Girls 
 
 1 
 
 1.5 
 
 2 
 
 2.5 
 
 3 
 
 3.5 
 
 4 
 
 4.5 
 
 5 
 
 5.5 
 
 6 
 
 6.5 
 
 5 
 
 4 
 
 9 
 
 6 
 
 17 
 
 11 
 
 10 
 
 3 
 
 1 
 
 
 
 
 
 61 
 
 2.57 
 
 2.63 
 
 o 
 
 6 
 
 14 
 
 13 
 
 16 
 
 40 
 
 20 
 
 16 
 
 9 
 
 4 
 
 1 
 
 1 
 
 
 
 134 
 
 2.58 
 
 2.61 
 
 7 
 
 16 
 
 9 
 
 21 
 
 43 
 
 30 
 
 16 
 
 10 
 
 3 
 
 1 
 
 
 
 
 149 
 
 2.56 
 
 2.62 
 
 
 8 
 
 3 
 
 7 
 
 8 
 
 22 
 
 14 
 
 15 
 
 9 
 
 2 
 
 4 
 
 1 
 
 
 1 
 
 86 
 
 2.98 
 
 2.93 
 
 
 9 
 
 
 1 
 
 3 
 
 5 
 
 6 
 
 7 
 
 5 
 
 3 
 
 2 
 
 1 
 
 
 
 33 
 
 3,37 
 
 3.05 
 
 
 10 
 
 
 
 1 
 
 
 2 
 
 1 
 
 3 
 
 2 
 
 1 
 
 1 
 
 
 
 11 
 
 3.91 
 
 3.90 
 
 
 11 
 
 
 
 
 
 
 1 
 
 2 
 
 1 
 
 
 
 
 
 4 
 
 4.00 
 
 4.13 
 
 
 12 
 
 
 
 
 
 
 
 1 
 
 1 
 
 1 
 
 
 
 
 3 
 
 4.50 
 
 4.50 
 
 
 5 
 
 
 4 
 
 12 
 
 12 
 
 13 
 
 7 
 
 5 
 
 
 
 
 
 
 53 
 
 2.71 
 
 S.6S 
 
 
 6 
 
 5 
 
 14 
 
 23 
 
 25 
 
 21 
 
 11 
 
 7 
 
 4 
 
 2 
 
 
 1 
 
 
 113 
 
 2.64 
 
 2.61 
 
 OD 
 
 7 
 
 7 
 
 12 
 
 26 
 
 35 
 
 28 
 
 13 
 
 5 
 
 5 
 
 4 
 
 
 1 
 
 
 136 
 
 2.66 
 
 2.62 
 
 (S 
 
 8 
 
 1 
 
 2 
 
 18 
 
 17 
 
 23 
 
 13 
 
 5 
 
 2 
 
 1 
 
 2 
 
 
 
 84 
 
 2.88 
 
 2.93 
 
 O 
 
 9 
 
 
 
 5 
 
 7 
 
 7 
 
 6 
 
 2 
 
 2 
 
 
 
 
 
 29 
 
 2.98 
 
 3.05 
 
 
 10 
 
 
 
 1 
 
 1 
 
 2 
 
 1 
 
 1 
 
 3 
 
 3 
 
 
 
 
 12 
 
 3.88 
 
 3.90 
 
 
 11 
 
 
 
 
 
 
 1 
 
 1 
 
 1 
 
 1 
 
 
 
 
 4 
 
 4.25 
 
 4.13 
 
 
 12 
 
 
 
 
 
 
 
 
 2 
 
 
 
 
 
 2 
 
 4.50 
 
 4. SO 
 
 S4 
 
TABLE VI A. 
 Distribution of Real Causes — Boys 
 
 s 
 
 p 
 
 ai 
 O 
 
 2 
 
 03 
 C 
 
 2 
 
 o 
 
 a 
 
 a 
 
 3 
 
 T3 
 
 •a 
 
 Physical 
 
 Social 
 
 Psychi- 
 cal 
 
 Total 
 
 JS 
 
 "3 
 
 O 
 
 3 
 
 20 
 28 
 16 
 5 
 6 
 1 
 1 
 
 "so 
 
 7 
 2 
 9 
 
 89 
 111 
 200 
 
 a 
 
 Q 
 
 "3 
 
 5 
 25 
 24 
 10 
 
 5 
 
 3 
 2 
 5 
 
 74 
 
 46 
 
 120 
 
 '3 
 a 
 
 4 
 
 13 
 
 9 
 
 7 
 2 
 1 
 1 
 1 
 ~38 
 
 1 
 1 
 2 
 
 40 
 26 
 66 
 
 45 
 « 
 
 V 
 
 <u 
 
 0. 
 
 cc 
 
 5 
 12 
 8 
 4 
 2 
 
 1 
 
 2 
 
 1 
 
 35 
 18 
 53 
 
 4 
 
 .16 
 
 11 
 
 13 
 
 4 
 
 1 
 
 1 
 
 1 
 
 50 
 
 4 
 
 4 
 
 54 
 
 98 
 
 152 
 
 B 
 
 ■E 
 
 cS 
 D 
 
 2 
 
 5 
 
 12 
 
 4 
 
 1 
 
 1 
 ~25 
 
 3 
 2 
 5 
 
 30 
 24 
 
 54 
 
 C3 
 O 
 
 H 
 3 
 
 ~3~ 
 
 1 
 1 
 
 4 
 2 
 6 
 
 S 
 
 13 
 03 
 
 C 
 
 w 
 
 6 
 
 38 
 
 40 
 
 23 
 
 7 
 
 2 
 
 1 
 
 m 
 
 16 
 5 
 
 138 
 135 
 273 
 
 g 
 
 a 
 
 OS 
 T3 
 
 
 a) 
 < 
 
 18 
 
 54 
 
 62 
 
 27 
 
 9 
 
 6 
 
 1 
 
 1 
 
 178 
 
 14 
 
 3 
 
 17 
 
 195 
 208 
 403 
 
 1 
 
 s 
 
 "o 
 o 
 
 A 
 o 
 
 m 
 
 3 
 23 
 25 
 13 
 
 4 
 
 1 
 
 ~69 
 
 18 
 3 
 
 90 
 107 
 197 
 
 3 
 
 S 
 o 
 
 W 
 
 1 
 
 39 
 
 49 
 
 29 
 
 12 
 
 6 
 
 1 
 
 1 
 
 138 
 
 15 
 
 6 
 21 
 
 159 
 97 
 
 256 
 
 0) 
 
 bo 
 c3 
 D 
 be 
 
 a 
 
 C3 
 
 , 1-1 
 
 1 
 7 
 9 
 4 
 1 
 
 3 
 1 
 3 
 
 25 
 18 
 43 
 
 8 
 
 11 
 
 11 
 
 3 
 
 3 
 
 1 
 
 1 
 
 "38 
 
 38 
 18 
 56 
 
 u 
 
 3 
 
 ■a 
 a 
 o 
 o 
 
 1 
 2 
 25 
 5 
 4 
 3 
 1 
 
 41 
 
 3 
 
 4 
 
 7 
 
 48 
 15 
 63 
 
 1 
 
 2 
 3 
 4 
 5 
 6 
 7 
 9 
 
 43 
 
 119 
 
 106 
 
 46 
 
 13 
 
 6 
 
 1 
 
 1 
 
 43 
 
 238 
 
 318 
 
 184 
 
 65 
 
 36 
 
 7 
 
 9 
 
 900 
 
 Totals 
 
 335 
 
 if 
 
 "2 
 
 1 
 2 
 
 89 
 15 
 
 89 
 30 
 
 Totals 
 
 104 
 
 119 
 
 Grand Totals 
 Boys 
 
 439 
 
 412 
 
 1019 
 
 Girls 
 
 923 
 
 Totals 
 Boys & Girls 
 
 851 
 
 1942 
 
 85 
 
TABLE VIb 
 
 Distribution of Real Causes— Girls 
 
 03 
 
 '5 
 < 
 
 2 
 
 o 
 
 (U 
 
 Q. 
 
 a 
 £ 
 ■a 
 
 2 
 
 Physical 
 
 Social 
 
 Psychi- 
 cal 
 
 Total 
 
 J3 
 
 w 
 
 2 
 34 
 29 
 22 
 13 
 
 2 
 102 
 
 8 
 
 1 
 
 ~9 
 
 111 
 
 89 
 
 200 
 
 d 
 1 
 
 3 
 
 14 
 
 12 
 
 11 
 
 2 
 
 ~42 
 
 3 
 
 1 
 4 
 
 46 
 
 74 
 
 120 
 
 •S 
 
 '3 
 
 c 
 
 ■a 
 
 3 
 3 
 9 
 
 7 
 4 
 
 26 
 40 
 66 
 
 J3 
 
 i 
 
 Q 
 
 w 
 
 5 
 6 
 4 
 1 
 
 1 
 1 
 2 
 
 18 
 35 
 53 
 
 M 
 
 9 
 
 29 
 
 23 
 
 17 
 
 8 
 
 2 
 
 ~88 
 
 6 
 
 4 
 ~10 
 
 98 
 
 64 
 
 152 
 
 c 
 'C 
 
 (3 
 
 tS 
 
 5 
 5 
 
 7 
 3 
 
 20 
 
 4 
 
 4 
 
 24 
 
 30 
 
 54 
 
 a 
 o 
 H 
 
 1 
 1 
 
 2 
 
 2 
 4 
 6 
 
 1 
 
 "S 
 w 
 
 4 
 
 51 
 
 34 
 
 20 
 
 6 
 
 2 
 
 117 
 
 15 
 3 
 
 18 
 
 135 
 
 138 
 273 
 
 o 
 o 
 
 a 
 
 53 
 
 a 
 < 
 
 16 
 73 
 54 
 32 
 11 
 2 
 188 
 
 15 
 
 5 
 
 20 
 
 208 
 195 
 403 
 
 >> 
 
 o 
 
 s 
 
 "o 
 o 
 ja 
 
 ig 
 
 7 
 37 
 19 
 15 
 
 7 
 
 85 
 
 16 
 
 6 
 
 22 
 
 107 
 
 90 
 
 197 
 
 B 
 o 
 
 K 
 
 25 
 26 
 22 
 9 
 2 
 84 
 
 7 
 6 
 
 97 
 159 
 
 256 
 
 
 
 3 
 
 5 
 9 
 3 
 
 17 
 
 1 
 1 
 
 18 
 25 
 43 
 
 1 
 
 "S 
 
 1 
 
 1 
 
 5 
 6 
 4 
 2 
 
 18 
 38 
 56 
 
 1 
 
 T3 
 
 a 
 o 
 O 
 
 4 
 5 
 3 
 
 I2 
 
 1 
 2 
 3 
 
 15 
 48 
 63 
 
 1 
 
 2 
 3 
 4 
 5 
 6 
 
 42 
 140 
 80 
 42 
 15 
 2 
 
 42 
 280 
 240 
 168 
 75 
 12 
 817 
 
 Totals 
 
 321 
 
 . S 
 II 
 
 "2 
 
 1 
 2 
 
 16 
 15 
 
 76 
 
 30 
 
 106 
 
 Totals 
 
 91 
 
 Grand Totals 
 Girls 
 
 412 
 
 923 
 
 Boys 
 
 439 
 
 1019 
 
 Totals 
 Boys & Girls 
 
 851 
 
 1942 
 
 86 
 
TABLE Vic. 
 Distribution of Doubtful Causes — Boys. 
 
 
 
 
 
 
 Physical, 
 
 
 
 Social 
 
 
 
 
 O t. 
 
 V 
 
 o 
 
 53 
 
 
 
 
 
 
 
 
 
 Pi 
 
 o 
 H 
 
 
 o 
 
 
 
 5P ■ 
 
 
 M 
 
 o 
 
 3 
 
 ^ 
 
 
 
 J3 
 
 £ 
 2 
 3 
 o 
 
 
 
 02 
 
 M 
 
 in 
 
 CIS 
 
 c 
 o 
 
 o 
 
 a 
 
 CO 
 
 o 
 
 o 
 02 
 
 1 
 
 3 
 
 i 
 
 G 
 O 
 
 o 
 
 
 
 1 
 
 43 
 
 7 
 
 7 
 
 3 
 
 3 
 
 2 
 
 8 
 
 2 
 
 9 
 
 17 
 
 5 
 
 5 
 
 68 
 
 m 
 
 2 
 
 119 
 
 19 
 
 20 
 
 9 
 
 9 
 
 1 
 
 28 
 
 19 
 
 14 
 
 27 
 
 11 
 
 25 
 
 182 
 
 
 3 
 
 106 
 
 13 
 
 10 
 
 5 
 
 10 
 
 3 
 
 25 
 
 18 
 
 5 
 
 27 
 
 4 
 
 18 
 
 138 
 
 « 
 P^ 
 
 4 
 
 46 
 
 9 
 
 1 
 
 4 
 
 4 
 
 1 
 
 15 
 
 9 
 
 - 
 
 3 
 
 1 
 
 8 
 
 55 
 
 V. 
 
 5 
 
 13 
 
 4 
 
 _ 
 
 1 
 
 1 
 
 - 
 
 3 
 
 3 
 
 1 
 
 - 
 
 1 
 
 - 
 
 14 
 
 
 6 
 
 6 
 
 - 
 
 - 
 
 - 
 
 - 
 
 1 
 
 1 
 
 1 
 
 - 
 
 - 
 
 - 
 
 - 
 
 3 
 
 o 
 
 7 
 
 1 
 
 - 
 
 - 
 
 - 
 
 - 
 
 - 
 
 - 
 
 1 
 
 - 
 
 - 
 
 - 
 
 - 
 
 1 
 
 
 9 
 
 1 
 
 - 
 
 1 
 
 - 
 
 - 
 
 - 
 
 - 
 
 - 
 
 - 
 
 ~ 
 
 - 
 
 "" 
 
 1 
 
 < 
 
 Totals 
 
 335 
 
 52 
 
 39 
 
 22 
 
 27 
 
 8 
 
 80 
 
 53 
 
 29 
 6 
 
 74 
 19 
 
 22 
 
 7 
 
 56 
 
 462 
 
 . 2 
 
 El O 
 
 1 
 
 89 
 
 17 
 
 12 
 
 7 
 
 2 
 
 3 
 
 20 
 
 .16 
 
 21 
 
 130 
 
 
 2 
 
 15 
 
 1 
 
 3 
 
 2 
 
 2 
 
 1 
 
 3 
 
 4 
 
 3 
 9 
 
 2 
 ~21 
 
 1 
 
 2 
 23 
 
 24 
 
 Totals 
 
 104 
 
 18 
 
 15 
 
 9 
 
 4 
 
 4 
 
 23 
 
 20 
 
 154 
 
 Totals 
 
 439 
 
 70 
 
 54 
 
 31 
 
 31 
 
 12 
 
 103 
 
 73 
 
 38 
 6 
 
 95 
 1 
 
 30 
 
 79 
 
 616 
 
 
 1 
 
 31 
 
 
 2 
 
 2 
 
 2 
 
 _ 
 
 11 
 
 4 
 
 3 
 
 31 
 
 0) 
 
 ■S2 
 
 2 
 
 26 
 
 5 
 
 1 
 
 5 
 
 3 
 
 2 
 
 12 
 
 4 
 
 7 
 
 8 
 
 3 
 
 2 
 
 52 
 
 3 
 
 6 
 
 
 2 
 
 - 
 
 - 
 
 - 
 
 3 
 
 3 
 
 2 
 
 3 
 
 1 
 
 4 
 
 18 
 
 S£ 
 
 4 
 
 6 
 
 3 
 
 5 
 
 - 
 
 1 
 
 - 
 
 5 
 
 2 
 
 1 
 
 4 
 
 1 
 
 2 
 
 24 
 
 a 
 
 5 
 
 1 
 
 1 
 
 1 
 
 - 
 
 1 
 
 - 
 
 - 
 
 1 
 
 1 
 17 
 
 5t 
 
 16 
 111 
 
 5 
 35 
 
 - 
 
 5 
 
 Totals 
 
 70 
 
 9 
 
 11 
 
 7 
 
 7 
 
 2 
 
 31 
 
 14 
 
 11 
 
 130 
 
 Grand Totals 
 
 509 
 
 79 
 
 65 
 
 38 
 
 38 
 
 14 
 
 134 
 
 87 
 
 90 
 
 746 
 
 Boys 
 
 
 
 
 
 
 
 
 
 4( 
 
 ) 7£ 
 
 24 
 ) 5S 
 
 
 
 Girls 
 
 452 
 
 64 
 
 68 
 
 25 
 
 45 
 
 27 
 
 130 
 
 - 
 
 35 
 
 537 
 
 Totals 
 
 961 
 
 143 
 
 133 
 
 63 
 
 83 
 
 41 
 
 264 
 
 87 
 
 95 19( 
 
 125 
 
 1283 
 
 Boys & Girls 
 
 
 
 
 
 
 
 
 
 1 
 
 ' 
 
 
 87 
 
TABLE VId. 
 
 Distribution of Doubtful Causes — Girls. 
 
 o 
 
 o 
 
 d 
 fa 
 
 T3 
 
 2 
 'S 
 o 
 
 < 
 
 i 
 
 u 
 
 g ^ 
 o n 
 
 g 
 i5 
 
 1 
 
 a 
 £ 
 
 o 
 
 Phtsicai, 
 
 Social 
 
 ■< 
 
 i 
 1 
 
 
 
 Ci 
 
 •| 
 
 3 ■ 
 
 J3 
 o 
 
 m 
 
 5 
 
 a 
 
 c 
 o 
 
 • S 
 
 s 
 
 >. 
 
 u 
 
 
 
 a 
 
 "o 
 o 
 
 » 
 02 
 
 5 
 
 13 
 
 9 
 
 1 
 
 28 
 3 
 
 3 
 31 
 
 1 
 2 
 5 
 1 
 9 
 
 40 
 55 
 95 
 
 01 
 
 3 
 
 a) 
 
 E 
 o 
 
 W 
 
 9 
 24 
 10 
 
 5 
 
 1 
 
 ~49 
 
 16 
 1 
 
 66 
 
 3 
 5 
 5 
 
 13 
 
 79 
 
 111 
 190 
 
 5 
 
 6 
 3 
 2 
 
 1 
 
 4 
 
 4 
 21 
 
 1 
 2 
 3 
 
 24 
 35 
 59 
 
 o 
 
 3 
 -0 
 
 13 
 
 6 
 
 1 
 2 
 3 
 4 
 5 
 6 
 
 42 
 140 
 80 
 42 
 15 
 2 
 
 6 
 20 
 13 
 
 4 
 
 2 
 23 
 11 
 
 8 
 
 4 
 6 
 4 
 
 1 
 
 15 
 
 8 
 
 4 
 
 1 
 
 2 
 
 13 
 
 3 
 
 3 
 
 1 
 1 
 
 11 
 43 
 20 
 10 
 6 
 1 
 
 - 
 
 2 
 8 
 10 
 4 
 2 
 
 43 
 169 
 93 
 45 
 12 
 2 
 
 Totals 
 
 321 
 
 43 
 
 44 
 
 14 
 
 29 
 
 23 
 
 91 
 
 - 
 
 26 
 
 364 
 
 n 
 
 "^2 
 
 1 
 2 
 
 76 
 15 
 
 9 
 2 
 
 12 
 • 4 
 
 6 
 
 7 
 
 1 
 
 4 
 
 18 
 5 
 
 - 
 
 4 
 1 
 
 83 
 15 
 
 Totals 
 
 91 
 
 11 
 
 16 
 
 
 8 
 
 4 
 
 23 
 
 - 
 
 6 
 
 98 
 
 Totals 
 
 412 
 
 54 
 
 60 
 
 21 
 
 37 
 
 27 
 
 114 
 
 - 
 
 31 
 
 462 
 
 •a 
 11 
 
 S a! 
 
 a 
 
 1 
 2 
 3 
 
 4 
 
 18 
 
 11 
 
 9 
 
 2 
 
 1 
 2 
 5 
 2 
 
 1 
 
 1 
 5 
 
 1 
 
 2 
 
 5 
 2 
 
 1 
 
 - 
 
 8 
 5 
 2 
 
 1 
 
 - 
 
 3 
 
 1 
 
 18 
 22 
 
 27 
 8 
 
 Totals 
 
 40 
 
 10 
 
 8 
 
 4 
 
 8 
 
 - 
 
 16 
 
 - 
 
 4 
 
 75 
 
 Grand Totals 
 Girls 
 
 452 
 
 64 
 
 68 
 
 25 
 
 45 
 
 27 
 
 130 
 
 - 
 
 35 
 
 537 
 
 Boys 
 
 509 
 
 79 
 
 65 
 
 38 
 
 38 
 
 14 
 
 134 
 
 87 
 
 90 
 
 746 
 
 Totals i 
 Boys & Girls' 
 
 143 
 
 133 
 
 63 
 
 83 
 
 41 
 
 264 
 
 87 
 
 125 
 
 1283 
 
S o 
 
 s 
 
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 93 
 
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 >H 
 
 00 -* 
 
 
 ■* 
 
 a> d 
 
 >o' 
 
 
 d d 
 
 d 
 
 B[Jio JO jaqum^ 
 
 IN CO 
 
 «5 
 
 O CO 
 
 93 
 
 10 ■* 
 
 03 
 
 CO 
 
 93 
 
 
 
 
 
 a3Bju90Ja<i 
 
 IN O 
 
 CO 
 
 oi 
 
 lO to 
 03 d 
 
 IN r-l 
 
 to 
 to' 
 
 >H 
 
 IN 03 
 
 03 
 
 
 00 CO 
 U3 10 
 
 to_ 
 
 
 d d 
 
 d 
 
 gXog JO jaqiunN 
 
 CO CO 
 
 to 
 
 00 •* 
 
 15 
 
 rH t^ 
 
 00 
 
 CO rH 
 
 ^ 
 
 
 
 
 
 o 
 
 aSBiaaojag 
 
 lO (N 
 l> 03 
 
 00 
 
 00 CO 
 •*' CO 
 
 03 
 9o' 
 
 rH CO 
 
 •* IN 
 
 93 
 
 (N eo 
 
 rH IN 
 
 to 
 
 
 d d 
 
 
 d 
 
 cptr) puB sXog 
 
 ■* t- 
 
 - 
 
 t^ 00 
 
 «J5 
 
 00 CO 
 
 ::; 
 
 -H rH 
 
 ©i 
 
 
 
 
 
 a3'B:(na3ja(} 
 
 O ^ 
 O IM 
 
 90 
 OO 
 
 •* 00 
 M IN 
 
 to_ 
 
 03 to 
 rH ui 
 
 93 
 
 
 
 >c' 
 
 03 
 
 
 d d 
 
 d 
 
 sp'O JO JaquiTiN 
 
 o ■* 
 
 ^ 
 
 IN CO 
 
 X5 
 
 IN CO 
 
 >C! 
 
 rH 
 
 '^ 
 
 
 
 
 
 aSfi^^naojaj 
 
 lO o 
 
 to 
 
 00 
 
 (N 00 
 
 00 co' 
 
 ©J 
 
 to 
 
 to d 
 
 to_ 
 oo' 
 
 OS 
 
 rH d 
 
 
 q (3 
 d d 
 
 
 d 
 
 sAog JO jaquin^ 
 
 ■* CO 
 
 t^ 
 
 UO U5 
 
 o 
 
 to 
 
 to 
 
 rH 
 
 •^ 
 
 
 
 
 
 nOT5BpJB:>aiJ }o ^unoray 
 
 U5 
 
 tH i-I 
 
 Mi 
 
 U5 
 N (N 
 
 
 10 
 
 eo' co' 
 
 e 93' 
 93 
 
 ■*■ ■*' 
 
 
 10 >fl 
 
 X3 
 
 89 
 
« Q 
 
 m 
 
 « "^ 
 
 8 ^ 
 
 aSBjaAv 
 
 MOOIOM050(NOOO 
 C0t>l>-*(N0000OOO 
 
 NNC^IMIMCvllN-^tOCO 
 
 sjo^OB^ JO jaqran^ 
 
 t-lOr-llOOOIM'-lNtOtO 
 <N .-1 00 ■* ■* c<5 tH 
 
 pa^oagv Jaqrati^ 
 
 CO (M -1 r-l 
 
 ^ 1 
 
 sSviBAy 
 
 i-HO-^i-HCOINCOOCOO 
 
 nmmn-^-^-^rji-^iD 
 
 Bio^o'B^ JO jaqran^ 
 
 lOoot^ioiomocD'-io 
 
 tDairHO^C<5ffl®I>C0 
 
 ^ CO (N (M ^ 
 
 pa^oagV -laqtnn^ 
 
 ooooTjioocoiNt^mioio 
 
 i-HNCOt-lOlOCOrH,-! 
 
 ►J 3 
 
 ■<! O 
 
 oS-ei^Ay 
 
 C0C<lt-.lO(NC0Mai>O'9< 
 Tj(c0CO-*00i-lOSCOt^rt 
 
 cococoeoco>*icOTt<Tt<u5 
 
 sio^DB^j JO jaqran^i 
 
 (NC000OC0t^r-ia>®CD 
 l>(N(Mai00t>O5l>t>CO 
 
 th ^ CO cq (N ^ 
 
 pa^oajgv -laqnin^ 
 
 .-lt^00C0'*lt~00Q0CO(> 
 <N CO CO >H t^ to •* iH i-H 
 
 a 
 3 2 
 
 83BJ9Ay 
 
 I00<0-*l0l^t~000 
 
 rHooto>oincDooo 
 
 (N(NINrHrtr-lr-IC0OO 
 
 sjo^oB^j JO i3qum{\[ 
 
 oocoi>cot~.-iu5eooo 
 
 (N CO (N rt rt 
 
 pa^joagv jaqran^ 
 
 COCOQOTjIr-lt^COiHOO 
 
 
 a 
 
 5 o 
 
 n H 
 
 
 
 o 
 
 83BJ8AV 
 
 Ot-lK505OC0!DC0OO 
 OrHIMO'-l'-ICOCOOO 
 
 sjo:jO'B^ JO jaqran^j rn co <n r^ ^ 
 
 pa'joagV -laq^^N c<5 cq r^ ,-h 
 
 
 ►J 
 
 ^ K 
 H to 
 B p 
 P <! 
 
 a" 
 
 aSBjaAv 
 
 000'0-*(N-*COt>(N>0 
 
 sjo^oB^ JO jaquin^ 
 
 Ttt-^-^OilCiOrtCOO^H 
 CDCDOOOOOOl>CO(M.-l 
 
 pa:joagv jaquin^ 
 
 CO'*lC<M00t^lCI'-Hr-l 
 
 
 p no 
 or p 
 H -5 
 
 < 
 
 aSBjaAy 
 
 CO«D->#OOI>05t^COt^O 
 «O)INCO00rHO>O5®«D 
 
 rHrH(M(M(MCOIM(NCO'*< 
 
 ejo^OBj JO jcaqran^ 
 
 C0m(OCD(M©O'*>CC0 
 COUSt^OOmcOi-iTjtlOC^) 
 
 papagV jaquiriN 
 
 0000>*lC»CO(Mt^iOlOU5 
 rH(MC0t^l0lOC0i-(i-l 
 
 
 aSBjaAV 
 
 •HtflcOOOCOCOOt^Ot^ 
 
 i>i>i-iojcoi>(oco":)>o 
 
 i-lr-l(NT-l(MlNIM(NCOCO 
 
 SJO'JO'BJ JO Jaqmn^i 
 
 ffliOi-lTjliOCOiOOOt^iO 
 
 COCOC30(Nt^00(M'*>OC<l 
 
 (M rt rH r-( 
 
 pa'joaj^V jaqtnn^ 
 
 -Ht^OdCO-*t^00005Dt~ 
 (NCOCOTHl>®-^r-li-( 
 
 NOiivaaviaw jo inqokv 
 
 >0 lO U5 lO lO 
 
 
 
 '-lrH(M(NC0C0n<'*»OlO 
 
 90 
 
o 
 
 ^1 
 
 Contributory 
 
 AND 
 
 Associated 
 
 : ; 
 
 aSBjaAv 
 
 OtOO(M'-<'OT»HCOOO 
 
 (MiH(N(M(M<M(M05<NO 
 
 Bjo^OBj JO Jaquiti^ 
 
 CO ITS IC (N r-l ^ 
 
 p^:^09J}V JaqniTiN 
 
 tHC0t^'*C0^l>C0NO 
 .-H IN tM ■-< 
 
 Adequate 
 
 AND 
 
 Associated 
 
 eS^JOAv 
 
 cqioioooMiot^oo 
 
 0SC<3(N««0C0O00iC(O 
 
 CqcOCOCOCOCO'*'*-*-* 
 
 BJO^OB^ JO jaqnnm 
 
 iot^<M'-icoooaioo'ne<5 
 
 ^ (N (N -1 
 
 pa^oagv -laqninjN: 
 
 (NCCCOt^-^'tOlNCOO'O 
 i-i(NlOfflt~M(N»Hrt 
 
 Real and 
 Associated 
 
 aSBiaAV 
 
 OOi-lOJIMMlOOeDOeO 
 
 (NCSINMCOCOCOM-*-* 
 
 sjo:jOB^j JO JaquinN 
 
 t-(N<ri-*<coco<D05aico 
 
 CCiOO'-iOllNtOOOO'^M 
 C) N CO --H tH 
 
 pa^oajJV -laqtanf^ 
 
 
 o 
 m 
 
 o o 
 
 O H 
 < ta 
 
 aS'BjaAV 
 
 Ot^ONOOCOOOO 
 lOtOOJCONlOCOOOO 
 
 -HCOrH^IN-HrHOOO 
 
 sJo:jO'Bj[ JO JtaquinN 
 
 CO^OS-Ht-hSO-^OOO 
 
 T-l 1-H (N i-H 
 
 pa^oaj^V Jaqam^ 
 
 <NCOOCOiO'*COOOO 
 
 u 
 
 o 
 
 aS^jaAy 
 
 OOO'-llNC^lrtCDlOO 
 rt' ^ ^' rt t-i rt' rt' ^ rt' C5 
 
 siojOB^ jo jaqum^i 
 
 .-IC01>l>00-*00iOC0O 
 tH IN IN .-H 
 
 pa^oagV .laqranN 
 
 rHCOt^-^CO^t^COINO 
 rH IN IN rH 
 
 H 00 
 
 n p 
 
 aSBiaAv 
 
 COMCO^IN^COCOOO 
 
 rtO'-HIN^INrHCOOO 
 
 sJO^0Bi[ JO aaqum^ 
 
 l^t^TjitO"*(NCO-*INlO 
 
 I rtTt<05lNrHCDC0lNrt 
 
 pa^oajjv Jaqran^ 
 
 lOl35C0-*INrHC<IO5(NiO 
 i-llNOOOO>OCO.-lrt 
 
 H in 
 
 aSBJaAV 
 
 CCt^lNINOI^OiOOO 
 0000(N-*«0iOOt^'*<0 
 ,-<rH(NlN'(N(NCOC<5COCO 
 
 sio^OBj JO jaquinN 
 
 INC0-*(NINCD«5OS;c0 
 IN-*IN!OOsOi«0®<^'-' 
 
 pa:>oaav •laqnmN 
 
 (NCOtDt^'*COINCDO"5 
 rHC<l'0«OI>W<M'-l'~' 
 
 ID 
 
 aSBJaA-y 
 
 i>t^cooot^-*>niNooo 
 t^t^aioiNcoio-*o«o 
 
 rH r-i r-< (N 0^ IN IN CO CO Co' 
 
 ejo^OB J jo laqranfj 
 
 C0C0r-(05OO'*'Ot^00 
 lN-*-*O0IN'-<t^«OC0r-( 
 
 r-l rH (N rH 
 
 pacioagv jaqtnnjs[ 
 
 COCDCO^-it^t^CSOSOllO 
 .-l(Nt>020S-*INrH'-l 
 
 NOixvaavxa'jj ao xnqotcv 
 
 in lo >n "C "5 
 
 ^' r-i (N (N CO Co' Tjl Tjl U5 lO 
 
 91 
 

 H ^ 
 
 Contributory 
 
 AND 
 
 Associated 
 
 aKBjaAy 
 
 (N <N 
 
 
 ^ CO 
 C^ IN 
 
 
 CO OS 
 IM to 
 
 Im' IM 
 
 
 ^' 
 
 t^ CO 
 
 to 00 
 IM co" 
 
 
 CO 
 CO 
 
 CO CO 
 
 93" 
 
 SJO^OBJ JO jaqumj^ 
 
 05 O 
 CO 
 
 05 
 SO 
 
 >o 00 
 •* CO 
 
 1 
 
 00 
 OS 
 
 to 
 
 00 CO 
 ■* (M 
 
 s 
 
 to 
 
 to 
 
 pa^oajgy jaqmn^ 
 
 ■* IM 
 
 to 
 
 IM "O 
 
 § 
 
 ■* to 
 
 ■* IM 
 
 
 
 00 to 
 
 •-* 
 
 CO IM 
 
 "3 
 
 
 Adequate 
 
 and 
 Associated 
 
 a3'BJ8AV 
 
 CO (M 
 
 CO CO 
 
 93 
 
 IM t^ 
 CO t^ 
 
 CO CO 
 
 03 
 93' 
 
 00 IM 
 
 CO •*' 
 
 8 
 
 IM 10 
 
 IM to 
 
 ■*' ■*' 
 
 
 ■* 
 to CO 
 
 ■*' "3' 
 
 23 
 00 
 
 sJO'jDBj JO jaquini^ 
 
 O lO 
 o t~ 
 
 2 
 
 a> to 
 
 <35 •* 
 IM lO 
 
 
 00 CO 
 00 t~ 
 ■* CO 
 
 i 
 
 OS 'H* 
 
 IM r-< 
 
 
 to CO 
 tH U3 
 
 1 
 
 pa^oagV jaqmn^i 
 
 eo ta 
 
 S 
 
 O «3 
 OS •* 
 
 § 
 
 ©* 
 
 t^ 00 
 IM 00 
 
 X3 
 
 OS rt 
 10 CO 
 
 § 
 
 lO 
 IM tH 
 
 ^ 
 
 
 aSBjaAy 
 
 (N IM 
 
 Co" CO 
 
 93 
 
 O "O 
 t-( CO 
 
 CO CO 
 
 to 
 ©J 
 
 93' 
 
 CO OS 
 •* 00 
 
 CO co' 
 
 to 
 93 
 
 to •* 
 00 "3 
 
 CO •* 
 
 00 
 
 
 to IM 
 
 ■* OS 
 
 Tt< ^" 
 
 <to 
 
 SJO^OB^ jo jaqninjfi 
 
 OS "5 
 
 2§ 
 
 93 
 
 ■* 00 
 
 CO to 
 
 2= 
 
 to CO 
 
 00 ■* 
 10 ■* 
 
 01 
 
 » 00 
 
 OS to 
 
 IM r-l 
 
 
 10 OS 
 IM U3 
 
 ^ 
 
 pa^oajjv -laqnin^ 
 
 ■* 00 
 CO «D 
 
 01 
 
 ,-1 ■* 
 
 »«3 
 93 
 
 .-1 Tjl 
 
 
 1> CO 
 
 -* 
 
 00 IM 
 IM rt 
 
 
 
 
 a 
 z; 
 
 aS^jaAy 
 
 O 00 
 
 00 
 
 O CO 
 O to 
 
 IM r-I 
 
 00 
 
 U3 r)i 
 
 to 
 
 -H co' 
 
 f^ 
 
 d 
 
 d 
 
 sio^oB^ JO jsquin^i 
 
 CO rH 
 
 00 
 
 to ■* 
 
 
 
 
 00 t^ 
 IM tH 
 
 >« 
 ^ 
 
 OS CO 
 
 e< 
 
 
 
 
 
 pa^oajjV JaquinN: 
 
 LO CO 
 
 S 
 
 00 t- 
 
 t§ 
 
 to r^ 
 
 
 CO •-! 
 
 e^ 
 
 
 
 
 
 s 
 
 S " 
 o 
 
 aSBJaAV 
 
 O 00 
 
 o o 
 
 T-4 »-( 
 
 ^. 
 
 >o o 
 
 O --I 
 
 § 
 
 to OS 
 
 f^ 
 
 00 
 (M U3 
 
 93 
 >-i 
 
 i^ 
 
 to 
 
 
 
 sjo:^0'B^ jo jaqumj^ 
 
 Tjl CO 
 
 fv 
 
 IM "3 
 IM to 
 
 ^ 
 
 U3 CO 
 
 00 
 
 CO OS 
 IM 
 
 15 
 
 "3 IM 
 
 K 
 
 pa^oagv Jaqranj^ 
 
 rj< (M 
 
 to 
 
 <-i OS 
 
 C^ 1(3 
 
 § 
 
 Ttl to 
 ■* (M 
 
 
 
 00 to 
 
 ^ 
 
 CO IM 
 
 X3 
 
 
 i4 
 P » 
 
 93BJ3AV 
 
 <o to 
 
 to 
 
 00 to 
 IM CO 
 
 1? 
 
 .-< CO 
 
 ^ 
 
 OS 
 <M in 
 
 n 
 
 ■* CO 
 -H CO 
 
 
 sjo^oBj jo J9qUIIl|iI 
 
 00 ^ 
 
 Oi 
 
 00 lO 
 
 § 
 ^ 
 
 OS t^ 
 
 ^ to 
 
 IM i-H 
 
 1 
 93 
 
 1^ 
 
 "3 
 
 
 IM to 
 
 CO r-l 
 
 00 
 
 p8:>08jjv jaquin^i 
 
 Ol OS 
 
 ■* to 
 
 oo 
 
 OS ^ 
 CO CO 
 r-l IM 
 
 93 
 
 00 IM 
 
 93 
 
 CO 00 
 
 00 CO 
 
 
 00 IM 
 IM ^ 
 
 
 
 s 
 
 y m 
 < H 
 
 a P 
 w ■>! 
 o 
 
 93VMA.Y 
 
 CO IM 
 
 00 05 
 
 ^. 
 
 IM O 
 IM •* 
 
 IM IM 
 
 93 
 
 -^ 00 
 1> OS 
 
 im" (M 
 
 00 
 
 00 to 
 OS CO 
 
 (m' CO 
 
 93 
 
 to 
 CO ■*' 
 
 93 
 
 sjo^oBj JO jaquin^ 
 
 IC 00 
 
 § 
 
 O 00 
 O -^l 
 (M CO 
 
 00 
 
 ■* IM 
 
 T)< to 
 CO IM 
 
 to 
 
 to ■* 
 t^ 
 >-( .-1 
 
 
 OS ,-< 
 
 § 
 
 paioagv Jaqmn^ 
 
 o ^ 
 CO lO 
 
 00 
 
 O "3 
 OS ■* 
 
 
 t^ 00 
 IM 00 
 
 »<3 
 
 05 --1 
 U3 CO 
 
 § 
 
 10 
 
 IM ^ 
 
 ^ 
 
 
 la P 
 
 eS'BjaAy 
 
 ,J( to 
 
 Hi 
 
 8§ 
 
 N (m' 
 
 
 CO in 
 im' (m' 
 
 si 
 
 00 10 
 10 
 
 ci CO 
 
 ^' 
 
 to 00 
 
 CO 10 
 co" CO 
 
 93 
 93" 
 
 Bjo-^o^^ jo jaqtatiN 
 
 05 ^ 
 
 
 IM CO 
 <M .-( 
 IM Tfl 
 
 to 
 
 U3 CO 
 
 a> OS 
 
 CO IM 
 
 1 
 
 OS CO 
 OS ^ 
 
 
 ■* CO 
 
 OS •* 
 
 93 
 
 pa^oagv -laqtimij 
 
 ■* eo 
 CO to 
 
 
 1-1 IM 
 
 93 
 
 
 00 
 
 t^ 
 
 t^. CO 
 
 vt- 
 
 00 IM 
 
 
 
 NOixvaj 
 
 ivxay Ao xNaoivv 
 
 
 Ki 
 
 IN IM 
 
 
 «3 
 
 CO CO 
 
 3 93' 
 
 Tt<' •*' 
 
 
 U3 
 
 
 92 
 
o 
 
 o 
 PS 
 
 ffl 
 
 P 
 
 o 
 
 
 
 
 
 i._ 
 
 Mean of 
 Av. Age 
 Boys & 
 
 CO 
 
 iJ 1 
 
 OSOJCOO'^OSOS'-""^ 
 
 C<1 
 
 
 OrH(NCOCOCOW-*^ 
 
 in 
 
 
 
 Average 
 Age 
 
 COOi'^'HlOiHrHi-lOO 
 
 to 
 
 
 OrHINCOCO-*-*-*-* 
 
 in 
 
 ■ I 
 
 a to 
 
 ^5 
 
 i-ICOooOOiO«IN'-< 
 
 m 
 
 Girls 
 Age at Nearest Birthday 
 
 00 
 
 rH CO 
 
 
 O iO C<1 rH ^ rH 
 
 C<l 
 
 00 
 
 «0 
 
 ■* t> o 00 e<i IN CO 
 
 -> 
 
 CO 
 
 lO 
 
 >c 
 
 CO'OOO'-HT^NCO-* 
 
 '^ 
 
 r-l 
 
 co-*ioc<ioofflr-'H 
 
 rt O) (M rH 
 
 
 03 
 
 CO 
 
 I-l 
 
 (MiOU3'-lO«0«0«DCO 
 
 i-H C^ CO rH 
 
 "< 
 
 1 "^ 
 o 
 
 r-l 
 
 1 C0>Ot-rHI>CDU5>-l 
 1 rH (M rH 
 
 
 1 "5 
 1 "^ 
 
 rH 
 
 ■* <N N •* 00 IM 
 
 r^ (N rH 
 
 
 1 N 
 
 I to 
 
 O 
 
 CO •* t^ •* 
 
 00 
 
 OS 
 
 1 CO tH 1-1 i-H 
 
 1 * 
 
 o 
 
 e O 
 
 oaic<i05CitDi>>-i'-it^ 
 
 rH 1-i IN C<i CO CO cc ■* •* •* 
 
 CD -IS 
 
 5 f^ 
 
 
 (N CO r-l rH 
 
 r-li-HO5tDIN-*'-l00 
 
 (NIN'^OINOO'^COC^ 
 
 iNt^-^^tO-HinoOINCO 
 
 IN IN <N rH 
 
 t>iO00^1Nr-IOilNC0 
 
 t* rH to CO CO t* 
 
 to 05 00 "5 r-l I-( 
 
 rHlHlNINC0C0'*'*'nU5 
 
sptO pu-B sAog 'iB'^ox 
 
 ■* CO 
 CO <D 
 
 05 
 
 ^ •* 
 
 ;^§ 
 
 s5 
 
 r^ rH 
 
 X3 
 
 00 
 
 t^ CO 
 
 ~* 
 
 00 (N 
 IN rH 
 
 1 
 
 O 
 
 SPIO JO jaqranu ibc^ox 
 
 CO CO 
 
 § 
 
 CO rH 
 
 
 OS ■* 
 
 ^ 
 
 ^ 
 
 os'os 
 
 IM rH 
 
 00 
 
 IM >C 
 
 6. 
 
 Sitog JO J3quinn 1'b:jox 
 
 ,-1 t> 
 
 (N CO 
 
 5 
 
 00 CO 
 CO rt 
 
 >o 
 
 t- CO 
 
 ~^ 
 
 00 00 
 
 ■* rH 
 
 to 
 to 
 
 CO t^ 
 
 ^ 
 
 
 <! 
 o 
 
 s 
 
 o 
 
 IS 
 
 
 
 pjtqO J8d -ojsi aSBJaAy 
 
 OS CO 
 
 o o 
 
 ^ 
 
 §q 
 
 o 
 
 CO (N 
 rH IM 
 
 to 
 
 •C OS 
 IM rH 
 
 1? 
 
 lO U3 
 IM IN 
 
 ^ 
 
 sasnBQ JO jgqmn^ 
 
 CO (M 
 
 "5 
 
 «?3 
 
 e5 
 
 IN IN 
 
 «> 
 
 ■^ 
 
 OS b- 
 
 ^ 
 
 t^ CO 
 
 o 
 
 OS 
 
 s 
 
 piQ J8(J -ojsj 93BiaAy 
 
 00 •* 
 o o 
 
 ^ 
 
 CO OS 
 
 o o 
 
 §. 
 
 s§ 
 
 
 2c^_ 
 
 ■^ 
 
 ^^ 
 
 CO 
 
 sasn'BO JO jaqum^j 
 
 
 ©J 
 
 IM 00 
 
 O 
 
 t^ ■* 
 
 - 
 
 CO ■* 
 
 »^ 
 
 IM <-l 
 
 93 
 
 >1 
 
 c 
 
 m 
 
 itog aad -o^ aSBjaAy 
 
 O CO 
 tH o 
 
 
 00 C^ 
 
 S3 
 
 O rH 
 
 (N CO 
 
 Si 
 
 CO t^ 
 
 CO r-< 
 
 05 
 
 CO (N 
 
 §. 
 
 sasri'BQ JO jaqum^ 
 
 IM rH 
 
 95 
 
 I> ■* 
 
 e3 
 
 lO rH 
 rH C^ 
 
 93 
 
 CO CO 
 
 01 
 
 >o N 
 
 *» 
 
 h3 
 O 
 
 
 p|iqO 13d -oiii aS'BjaAy 
 
 OS 1-1 
 
 ^ 
 
 (N IN 
 
 to 
 
 CO OS 
 CO US 
 
 93 
 
 >H 
 
 U3 00 
 lO l> 
 
 rH ,-1 
 
 to 
 
 ■* CO 
 O 00 
 
 (N rH 
 
 >H 
 
 sasn^Q JO jaqran^^ 
 
 <M O 
 CO t~ 
 
 1 
 
 •* OS 
 CO lO 
 ^ C<1 
 
 2? 
 
 93 
 
 ^2 
 
 § 
 
 ^ 
 
 05 CD 
 rH U; 
 
 1 
 
 t^ IN 
 
 "3 IM 
 
 g 
 
 CO 
 
 -1 
 a 
 
 6 
 
 IJTQ jad -o^i aSBJaAy 
 
 t~ rH 
 
 
 03 1-1 
 rH ■* 
 
 93 
 
 CO CO 
 
 ■5- 
 
 
 ^. 
 
 00 o 
 O 00 
 
 IN r-i 
 
 6» 
 
 sagnBO JO jaqran^ 
 
 2S 
 
 ^ 
 
 r^ 00 
 
 00 IN 
 
 >C5 
 5 
 
 IM t^ 
 
 § 
 
 ^ 
 
 IN CO 
 
 ■* CO 
 
 g 
 
 lO 01 
 IN 
 
 ^ 
 
 05 
 
 ;« 
 
 
 
 m 
 
 iCog Jad •ojs[ aSBjaAy 
 
 O .-H 
 
 §. 
 
 t^ CO 
 
 CO rH 
 
 s3 
 
 lO 00 
 CO lO 
 
 to 
 
 §s 
 
 to_ 
 
 O CO 
 O 00 
 
 IN -< 
 
 ^ 
 
 sasnBQ JO jaqian^ 
 
 (N 1-H 
 
 to 
 
 C<1 rH 
 
 lO CO 
 
 2? 
 
 00 
 
 O CO 
 
 o o 
 
 § 
 
 t^ CO 
 
 t^ CO 
 
 >H 
 
 IN « 
 
 CO rH 
 
 MS 
 
 1 
 
 « E 
 go 
 « 
 
 pijqO -lad 'ON aS^iaAy 
 
 r- CD 
 
 «5 
 
 to 
 
 CD CO 
 
 to 
 
 lO CO 
 00 t^ 
 
 00 
 
 OS 00 
 
 2? 
 
 00 
 
 O "3 
 
 §. 
 
 sasniBO JO jaqran^ 
 
 (M CO 
 
 S 
 
 ■* C<1 
 t^ CO 
 
 
 CO i^ 
 
 ^ 00 
 
 93 
 
 CO ■* 
 
 >H 
 
 g2 
 
 
 
 pjo Jad -Oil aSBjaAy 
 
 (N IM 
 
 05 CO 
 
 ^ 
 
 i> lO 
 
 ^ 
 
 01 CO 
 OO CO 
 
 3 
 
 o w 
 
 Ol 
 
 >H 
 
 CO o 
 00 CO 
 
 § 
 
 sasnBQ JO jaqranj^ 
 
 <M CO 
 
 00 
 
 (N CO 
 US lO 
 
 § 
 
 »< 
 
 CO rH 
 00 CO 
 
 *^ 
 
 01 00 
 IM N 
 
 ^ 
 
 O 00 
 
 00 
 
 a! 
 
 s 
 
 05 
 
 jtog jad •oj^ aSBjaAy 
 
 t> IN 
 
 ■O CO 
 
 § 
 
 00 o 
 
 to_ 
 
 rH T)< 
 OO 00 
 
 00 
 
 O CO 
 
 to_ 
 
 "3 CO 
 IM 1* 
 
 § 
 
 sasnBO JO Jaqum^ 
 
 (N CO 
 
 ^ 
 
 IN OS 
 (N t^ 
 
 S 
 
 §§ 
 
 to 
 
 N IN 
 
 CO rH 
 
 ^ 
 ^ 
 
 S2 
 
 § 
 
 NoiivaaviaH ^o aNnorey 
 
 lO 
 
 
 IN IN 
 
 
 U3 
 
 co' co" 
 
 !§ 93' 
 93 
 
 
 M3 
 
 U5* "3" 
 
 >0 
 
 94 
 
TABLE XI 
 
 Correlation of Amount of Retardation with the ^Number of Cases 
 
 Reported to be " Slow and Dull ' 
 
 ion. 
 
 o 
 
 "S 
 
 « 
 
 '0 
 
 
 
 
 
 
 
 Is 
 
 1. 
 
 1.5 
 
 Total 
 
 1 & 1.6 
 
 3. 
 
 2.5 
 
 Total 
 
 Z &2.5 
 
 3. 
 
 3.5 
 
 Total 
 
 3 &S.5 
 
 4. 
 
 4.5 
 
 Total 
 
 A & 4.5 
 
 5. 
 
 5.5 
 
 Total 
 
 6 & 5.5 
 
 38 
 43 
 
 81 
 
 61 
 132 
 
 91 
 
 74 
 
 165 
 
 52 
 19 
 
 71 
 
 16 
 
 7 
 
 9 
 5 
 
 U 
 
 16 
 46 
 
 62 
 
 31 
 26 
 
 20 
 10 
 
 23.7 
 11.6 
 
 17. S 
 
 26.2 
 34.8 
 
 34.1 
 35.1 
 
 34 5 
 
 38.5 
 52.6 
 
 31.3 
 
 57.1 
 
 39.1 
 
 15 
 33 
 
 85 
 107 
 
 104 
 54 
 
 158 
 
 32 
 
 20 
 
 12 
 5 
 
 17 
 
 10 
 
 26 
 35 
 
 61 
 
 39 
 23 
 
 13 
 6 
 
 2 
 
 10 
 
 6.7 
 27.3 
 
 '.3 
 
 30.6 
 32.7 
 
 31.8 
 
 37.5 
 42.6 
 
 40.6 
 30.0 
 
 36.3 
 
 66.7 
 40.0 
 
 68.8 
 
 53 
 76 
 
 129 
 
 146 
 239 
 
 386 
 
 195 
 
 128 
 
 84 
 39 
 
 28 
 12 
 
 40 
 
 10 
 14 
 
 42 
 81 
 
 70 
 49 
 
 119 
 
 33 
 16 
 
 49 
 
 13 
 6 
 
 19 
 
 18.9 
 18.4 
 
 iS.e 
 
 28.8 
 33.9 
 
 31.9 
 
 35.9 
 38.3 
 
 39.3 
 41.0 
 
 39.8 
 
 46.4 
 50.0 
 
 .45.0 
 
 95 
 
TABLE XII 
 
 XJORRELATION OF CaUSES WITH AVERAGE AMOUNT OF RETARDATION IN YeARS* 
 
 
 BOTB 
 
 Girls 
 
 Bote 
 
 AND Girls 
 
 m 
 
 
 
 S 
 
 
 
 a 
 o 
 
 
 c 
 
 a 
 
 O 
 
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 a 
 
 
 
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 o 
 
 
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 XI 
 
 OS 
 
 
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 3 
 
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 o 
 
 3 
 
 >■ 
 
 
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 2; 
 
 <1 
 
 1 Adequate 
 
 97 
 
 43 
 
 2.26 
 
 93 
 
 42 
 
 2.21 
 
 190 
 
 85 
 
 2.24 
 
 2 
 
 317.6 
 
 119 
 
 2.67 
 
 370 
 
 140 
 
 2.64 
 
 687.5 
 
 259 
 
 2.65 
 
 3 
 
 327 
 
 106 
 
 3.08 
 
 244 
 
 80 
 
 3.05 
 
 571 
 
 186 
 
 3.07 
 
 4 
 
 158 
 
 46 
 
 3.43 
 
 141 
 
 42 
 
 3.36 
 
 299 
 
 88 
 
 3.40 
 
 5 
 
 Totals 
 
 82.5 
 
 21 
 
 3.93 
 
 63.5 
 
 17 
 
 3.74 
 
 146 
 
 38 
 
 3.84 
 
 982 
 
 335 
 
 2.93 
 
 911.5 
 
 321 
 
 2.84 
 
 1893.5 
 
 656 
 
 2.89 
 
 No Causes 
 
 53 
 
 24 
 
 2.21 
 
 38.5 
 
 15 
 
 2.57 
 
 91.5 
 
 39 
 
 2.35 
 
 
 
 
 
 
 
 
 
 
 
 Factors 
 
 162.5 
 
 70 
 
 2.32 
 
 100 
 
 40 
 
 2.50 
 
 262.5 
 
 110 
 
 2.39 
 
 Real Causes 
 
 1283 
 
 439 
 
 2.92 
 
 1170 
 
 412 
 
 2.84 
 
 2453. 
 
 851 
 
 2.88 
 
 Grand 
 
 
 
 
 
 
 
 
 
 
 Totals 
 
 1498.5 
 
 533 
 
 2.81 
 
 1308.5 
 
 467 
 
 2.80 
 
 2807 
 
 1000 
 
 2.81 
 
 *When the amount of retardation was more than 5.5 years, it was taken a? 5.5 in thi 
 table. 
 
 TABLE XIII 
 Correlation of Social Level of the School Districts with Number 
 
 Retarded 
 
 Social Level 
 
 Number 
 Retarded 
 
 Average Enrol- 
 ment 1905-06 
 
 Percentage 
 Retarded 
 
 5 
 
 116 
 
 708 
 
 16.3 
 
 4 
 
 357 
 
 1846 
 
 19.3 
 
 3 
 
 515 
 
 2780 
 
 18.6 
 
 2 
 
 612 
 
 3063 
 
 19.3 
 
 1 
 
 163 
 
 710 
 
 22.9 
 
 Negroes 
 
 240 
 
 645 
 
 37.2 
 
 90 
 

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 IN rH 
 
 10 IN 
 
 93 
 
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 90 
 
 CO IN 
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 >o 
 
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 93 
 
 10 
 
 IN IN 
 
 Si 
 
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 (M 
 
 130 
 
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 O rH 
 
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 90 
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 CO CO 
 
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 JO sjaq^oja paB sjajsig 
 
 (N lO 
 
 lO CO 
 .-1 (N 
 
 90 
 
 >0 05 
 
 
 05 00 
 rH CO 
 
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 CO 00 
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 CO rH 
 
 
 t- IN 
 
 01 -* 
 
 01 
 
 93 
 
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 CO co' 
 
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 CO co' 
 
 
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 Bl-iiO JO JaqrariN ibc(OX 
 
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 P 
 
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 m 
 
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 M 
 
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 m 
 
 
 
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 Co 
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 JO sjaq^ojg puB sjacjsig 
 
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 t^ CO 
 
 IM (M 
 
 00 
 
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 00 lO 
 
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 K 
 
 IM CO 
 
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 Mi 
 
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 00 CD 
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 Id' 
 
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 !N lO 
 
 K 
 
 CO IM 
 
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 CD O 
 (M IM 
 
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 93 
 
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1^ 
 
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 K 
 
 
 
 
 
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 00 
 
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 00 
 
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 i-l CO CD CO 
 
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 cc 
 
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 t^ CD (N 10 
 IN I> 00 1-1 
 
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 :=: 
 
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 CO 1> (N 
 
 CO 
 
 CO 
 
 
 
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 CO, CO C» CO 
 1-1 >0 IN 
 
 05 
 
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 lO 
 
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 ,-l>Orti-i00Tt<IN^ 
 
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 1-1 1-1 rH -^JH C5 CO 
 
 
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 IN ^ 10 CO 
 
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 CO 
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 1-1 i> a. 10 00 lo 
 
 1-1 CO rt 
 
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 00 
 
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 1-1 (N lO ■* 1-1 
 
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 (M 
 
 10 CD 00 -* ^ 
 
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 ^ 
 
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 i-l(NCO-*lOCDI>00 
 
 1 
 § 
 
 104 
 
l-l < 
 
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 i-li-l(N(M(MCOCOWCOCC 
 
 
 lOlMt^(NOOCO(N 
 rH ^ (N <N -H 
 
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 SPJO JO -ojsj 
 
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 a 
 
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 a 
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 rH ^ 
 
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 CO tH ■* CO i-H 
 
 
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 10 (© to (M (M T-H 1 
 
 
 iMcOtOCO^OOINCO ' 
 
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 COt^O(N>-lO'Oi-l 
 
 r-l CO (M --< ^ ; 
 
 
 .-( IM <N (M 
 
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 cq .-H rt >-i 
 
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 - 
 
 (N CO ■* CO (M 
 
 o 
 
 m 
 
 uoi^BpjBc^a^ 
 aSBjaAy 
 
 ■*ir>COl^©IM-*IMtDt^ 
 r-irHIMNINCOCOCOCO'* 
 
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 .2 
 ■a 
 
 d 
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 b- 
 
 "^ 
 
 lO 
 
 ® 
 
 '^ 
 
 ffl 
 
 -^ 
 
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 lO 
 
 CO Th IN CO CO "-I 
 
 
 IN CO 00 ■* >-< 'H 
 
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 05 ^ lO CO ■* >-l i-H 
 
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 rHt^rHtC-HININCO'-l 
 rt rH (N rt 
 
 m 
 
 tH CO IN •* CO » CD 
 rt tH IN IN 
 
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 incoTt<Tj(ijH.HaiiN 
 
 IN CO !N IN >-< 
 
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 i-H IN 
 
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 i-IO>'-l"5t>t~(N'H 
 
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 savax Ni aov 
 
 030'-iiNcoTHu:icot^oo 
 
 105 
 
TABLE XXII 
 Correlation of Grade with Average Retardation 
 
 
 Boys 
 
 Girls 
 
 BoTS AND Girls 
 
 
 
 c ■ 
 
 
 
 a 
 
 
 m 
 
 a 
 
 
 
 
 ^o 
 
 
 
 _o 
 
 
 1h 
 
 o 
 
 
 a 
 
 
 '+3 
 
 a 
 
 
 
 R 
 
 5 
 
 "43 
 
 
 o 
 
 
 c3 
 
 o 
 
 
 03 
 
 _o 
 
 
 c^ 
 
 
 d 
 
 T) 
 
 >> 
 o 
 
 m 
 
 -3 
 
 
 3 
 
 ■a 
 
 -3 
 
 c 
 
 03 
 
 03 
 
 
 b 
 
 
 OJ 
 
 '^ 
 
 
 9 
 
 
 CQ 
 
 "S 
 
 
 ri 
 
 "o" 
 
 « 
 
 53 
 
 tt-i 
 o 
 
 P^ 
 
 03 
 
 >. 
 
 P^ 
 
 
 
 < 
 
 
 
 
 
 
 
 P^ 
 
 M 
 
 
 
 .^2 
 
 oj 
 
 , 
 
 J2 
 
 03 
 
 , 
 
 * 
 
 03 
 
 c 
 
 s 
 
 3 
 
 
 c3 
 O 
 
 S 
 3 
 
 
 03 
 O 
 
 03 
 O 
 
 5i 
 
 o 
 
 e 
 
 Z 
 
 <t) 
 
 H 
 
 ^ 
 
 < 
 
 H 
 
 H 
 
 <1 
 
 1 
 
 79.0 
 
 23 
 
 3.43 
 
 40.0 
 
 14 
 
 2.86 
 
 119.0 
 
 37 
 
 3.22 
 
 2 
 
 274.0 
 
 97 
 
 2.83 
 
 154.5 
 
 53 
 
 2.92 
 
 428.5 
 
 150 
 
 2.86 
 
 1 &S 
 
 363.0 
 
 120 
 
 2.9i 
 
 194.5 
 
 67 
 
 2.90 
 
 547.5 
 
 187 
 
 2.93 
 
 3 
 
 314.0 
 
 108 
 
 2.91 
 
 305.0 
 
 111 
 
 2.75 
 
 619.0 
 
 219 
 
 2.82 
 
 4 
 
 387.5 
 
 135 
 
 2.87 
 
 327.0 
 
 112 
 
 2.92 
 
 714.5 
 
 247 
 
 2.89 
 
 3 & 4 
 
 70^.5 
 
 S4S 
 
 2.88 
 
 65^.0 
 
 223 
 
 ;g.SS 
 
 1333.5 
 
 466 
 
 2.86 
 
 5 
 
 285.5 
 
 103 
 
 2.77 
 
 237.5 
 
 86 
 
 2.76 
 
 523.0 
 
 189 
 
 2.77 
 
 6 
 
 80.5 
 
 37 
 
 2.18 
 
 131.0 
 
 49 
 
 2.67 
 
 211.5 
 
 86 
 
 2.46 
 
 6 & 6 
 
 366.0 
 
 140 
 
 2.61 
 
 36 8. S 
 
 135 
 
 2.73 
 
 734.5 
 
 275 
 
 2.67 
 
 7 
 
 59.5 
 
 23 
 
 2.58 
 
 67.0 
 
 26 
 
 2.58 
 
 126.5 
 
 49 
 
 2.58 
 
 8 
 
 18.5 
 
 7 
 
 2.64 
 
 45.0 
 
 16 
 
 2.81 
 
 63.5 
 
 23 
 
 2.76 
 
 7 & 8 
 
 75.0 
 
 SO 
 
 2.60 
 
 112.0 
 
 42 
 
 2.67 
 
 iSO.O 
 
 72 
 
 2.64 
 
 p 
 
 ; 
 
 106 
 
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