EEPOKT 
 
 ON THE 
 
 SCIENTIFIC STUDY 
 
 OF THE 
 
 MENTAL AND PHYSICAL CONDITIONS 
 OF CHILDHOOD. 
 
 WITH PARTICULAR REFERENCE TO CHILDREN OF DEFECTIVE 
 
 CONSTITUTION; AND WITH RECOMMENDATIONS 
 
 AS TO EDUCATION AND TRAINING, 
 
 (The Report is based upon the Examination of 50,000 Children 
 seen in 1888-91, and of another 50,000 seen in 1892-94.) 
 
 LONDON : 
 
 PUBLISHED BY THE COMMITTEE, TARKES MUSEUM, MARGARET 
 
 STREET, W. 
 
 1895. 
 
 PRICE HALF-A-CROWN. 
 
C-OVN^JU ^5 O^- 5-dL^L^^ ,, 
 
 EEPOET 
 
 ON THE 
 
 SCIENTIFIC STUDY 
 
 OF THE 
 
 MENTAL AND PHYSICAL CONDITIONS 
 OF CHILDHOOD. 
 
 WITH PARTICULAR REFERENCE TO CHILDREN OF DEFECTIVE 
 
 CONSTITUTION; AND WITH RECOMMENDATIONS 
 
 AS TO EDUCATION AND TRAINING, 
 
 (The Report is based upon the Examination of 50,000 Children 
 seen in 1888-91, and of another 50,000 seen in 1892-94.) 
 
 
 LONDON : 
 
 PUBLISHED BY THE COMMITTEE, PARKES MUSEUM, MARGARET 
 
 STREET, W. 
 
 1895. 
 

MEMBERS OF THE COMMITTEE ON THE MENTAL, AND 
 PHYSICAL CONDITION OF CHILDREN, 
 
 President. 
 
 LORD EGERTOX OF TATTON, Late Chairman of the Royal Commission on the 
 Blind, Dumb, &c. 
 
 Chairman. 
 Sir DOUGLAS GALTON, K.C.B., D.C.L., LL.D., F.R.S. 
 
 Treasurer. 
 4 ROWLAND HAMILTON, F.S.S. 
 
 X H. ASHBY, M.D., F.R.C.P. 
 FLETCHER BEACH, M.B., F.R.C.P. 
 Rev. GEO. BELL, Head Master Marl- 
 borough College. 
 G. W. BLOXAM, M.A. 
 2 E. W. BRABROOK, F.S.A. 
 : T. BRIDGWATER, M.B., LL.D. 
 tj Dr. BURGERSTEIN, Vienna. 
 Surgeon-General CORNISH, C.I.E., 
 
 F.R.C.S. 
 5 Sir THOS. CRAWFORD, K.C.B., Q.H.S., 
 
 M.D., LL.D. (deceased). 
 JOSEPH R. DIGGLE, M.A., J.P. 
 y. L. H. LANGDON DOWN, M.D., 
 
 F.R.C.P. 
 R. FARQUHARSON, M.D., LL.D., 
 
 M.P. 
 
 J. G. GARSON, M.D. 
 TIMOTHY HOLMES, M.A., F.R.C.S. 
 1 W. W. IRELAND, M.D. 
 6 Dr. JACOBI, New York. 
 DOLMAN, C., M.D., M.R.C.S. 
 x Sir GEO. HUMPHRY, M.D., F.R.S. 
 c Dr. KOTELMAN, Hamburg. 
 6 Dr. KUBORN, Seraing-Liege. 
 Sir PHILIP MAGNUS, B.Sc., B.A. 
 General MOBERLY. 
 SHIRLEY MURPHY, M.R.C.S., M.O.H., 
 London County Council. 
 
 1 F. NEEDHAM, M.D., M.R.C.P., Com- 
 missioner in Lunacy. 
 J. W. PALMER. 
 
 Miss POOLE. 
 
 G. V. I'OORE, M.D., F.R.C.P. 
 
 Sir RICHARD QUAIN, Bart., F.R.S. 
 
 HENRY RAYNER, M.D.,"M.R.C.P. 
 
 T. L. ROGERS, M.D., M.R.C.P. 
 G Dr. ROUSSEL, Paris. 
 a G. H. SAVAGE, M.D., F.R.C.P. 
 
 J. HOLT SCHOOLING, F.S.S. 
 
 Rev. T. W. SHARpE,C.B.,'Sen/Chief 
 Inspector, Education Department. 
 1 G. E. SHUTTLEWORTH, B.A.. M.D., 
 M.R.C.S. 
 
 W. WlLBERFORCE SMITH, M.D., 
 
 M.R.C.P. 
 
 T. A. SPALDING, LL.D. 
 Hon. E. LYULPH STANLEY, M.A. 
 5 J. C. STEELE, M.D. (deceased). 
 Dr. OCTAVIUS STURGES (deceased). 
 1 D. H. TUKE, M.D. (deceased). 
 CARDINAL VAUGHAN,} Archbishop of 
 
 Westminster. 
 
 2 E. WHITE WALLIS, F.S.S. 
 i 2 FRANCis WARNER, M.D., F.R.C.P. 
 Rev. J. C. WELLDON, Head Master 
 
 of Harrow School. 
 T D. YELLOWLEES, M.D., LL.D. 
 
 Hon. Secretary. 
 E. WHITE WALLIS, F.S.S. 
 
 Offices. 
 PARKES MUSEUM, Margaret Street, London, W. 
 
 The following bodies are represented on the Committee: 
 
 1 The British Medical Association. 4 The Royal Statistical Society. 
 
 2 British Association. 5 The Sanitary Institute. 
 
 8 The Charity Organisation Society. 6 Foreign Representatives. 
 
 342492 
 
EXECUTIVE COMMITTEE. 
 
 SIR DOUGLAS GALTON, K.C.B., F.R.S., Chairman. 
 
 FLETCHER BEACH, M.B., F.R.C.P. 
 
 T. BRIDGEWATER, M.B., LL.D. 
 
 J. LANGDON DOWN, M.D., F.R.C.P. 
 
 ROWLAND HAMILTON, F.S.S. 
 
 C. HOLMAN, M.D., M.R.C.S. 
 
 J. W. PALMEE. 
 
 Miss POOLE. 
 
 G-. H. SAYAGE, M.D., F.R.C.P. 
 
 J. HOLT SCHOOLING, r.s.s. 
 
 G. E. SHUTTLEWORTH, B.A., M.D., M.R.C.S. 
 
 E. WARNER, M.D., F.R.C.P. 
 
 E. WHITE WALLIS, F.S.S.. Secretary. 
 
 STATISTICAL COMMITTEE. 
 
 J. HOLT SCHOOLING, r.s.s. 
 
 J. W. PALMER. 
 
 J. LANGDON DOWN, M.D., F.R.C.P. 
 
 FRANCIS WARNER, M.D., F.R.C.P. 
 
 E. WHITE WALLIS, F.S.S. 
 
PREFACE. 
 
 The object of the Committee in undertaking this investigation of 
 the mental and physical condition of childhood was to furnish a 
 reliable statement of existing conditions found among the pupils 
 attending public elementary and other schools, and thus to establish 
 a scientific basis for the study of the requirements of child-life, 
 providing also information for the guidance of the State, educa- 
 tional authorities, and philanthropic bodies. 
 
 The scientific field of study opened up in the Beport is in many 
 respects entirely new; the Committee have endeavoured so to 
 arrange their voluminous records that they may be available for the 
 purposes of research in many important directions. 
 
 By the co-operation of the Charity Organisation Society, and 
 British Medical Association, it has been possible to include in the 
 present report certain statistics relative to 50,000 children seen 
 during the earlier enquiry, in addition to the 50,000 seen under 
 the auspices of this Committee, thereby affording in main principles a 
 wider basis of evidence. The Committee also recognise their in- 
 debtedness to the British Medical Association for continued money 
 grants, and to The Sanitary Institute for the use of offices. Their 
 thanks are also due to the British Association for money grants, 
 and to the London School Board for facilities afforded them for the 
 examination of children. 
 
 Among the efforts made to secure public attention to this important 
 subject may be mentioned Letters by Sir Douglas Galton and other 
 members of the Committee, published in the Times ; Papers read by 
 Dr. Francis Warner before the Royal Statistical Society, the British 
 Association and other societies ; and a meeting held in June 1894 
 at the residence of Lord Egerton of Tatton, the President of the 
 Committee, when proceedings were inaugurated for approaching the 
 House of Lords, with the object of obtaining an official enquiry into 
 the conditions of child-life. 
 
 In placing this report, the result of much arduous work, before 
 the public, the Committee hope that their efforts may induce the 
 State authorities to establish some permanent means of ensuring 
 that the several matters therein alluded to may receive due attention, 
 in the interests alike of the child-population, and of the community 
 at large. 
 
LIST OF CONTENTS. 
 
 PAGE: 
 PREFACE v, 
 
 CHAPTER I. 
 
 Organisation and Work of the Committee ... ... ... ... 4 
 
 List of Schools Examined 5- 
 
 CHAPTER, II. 
 
 Explanation of the Methods used in this Enquiry, and Comments on 
 theEeport 10 
 
 Facsimile of Recording Card IT 
 
 CHAPTER III. 
 
 Methods of Studying the Results of Observations Recorded with 
 reference to Tables ... 18 
 
 CHAPTER IV. 
 
 The Signs observed in Describing Children 20 
 
 CHAPTER V. 
 
 Note by Dr. Francis Warner on the Scientific Value and Significance 
 of the Signs Employed 30 
 
 CHAPTER VI. 
 
 Groups of Children and Groups of Cases 38 
 
 CHAPTER VII. 
 
 The Bearing of this Enquiry on the Education and Care of Children.. 50 
 
 Co-relation or the Relations of Physical and Nerve-signs to Low 
 Nutrition and Mental Duluess 53 
 
 The Child Material in a School 57 
 
 Assessment of Results of Intellectual and Physical Training in a 
 School, making allowance for the Physical Condition of the 
 Children 59 
 
 CHAPTER VIII. 
 
 Recommendations 65 
 
 CHAPTER IX. 
 
 Suggestions as to the Conduct and Administration of the Education 
 of Feeble-minded Children 67 
 
VII 
 TABLES. 
 
 PAGE 
 
 NOMENCLATURE OF SIGNS ADOPTED AS THE BASIS OF THIS ENQUIRY, 
 WITH TABULATION OF CASES 72 
 
 CATALOGUE OF GROUPS OF CHILDREN AND GROUPS OF CASES ... 82 
 
 TABLE I. (cases seen 1888-91). Showing Number of Children ivith each 
 Main Class of defect, and the percentage of each class respectively 
 that presented conditions of defect co-related thereto ... 13 
 
 TABLE II. (cases seen 1888-91). Showing Number of Children with 
 Defects in Development in Resident and Day Schools, and the per- 
 centage of these cases that presented co-related conditions taken upon 
 the cases with Defects in Development ... 14 
 
 TABLE III. (cases seen 1888-91). Showing Number of Children luith 
 Low Nutrition in Resident and Day Schools, and the percentage of 
 these cases that presented co-related conditions taken upon the cases of 
 Low Nutrition 43 
 
 TABLE IV. (cases seen 1888-91). Children "Feeble-minded," or Excep- 
 tional in Mental Status, their co-incident defects ... ... ... 45 
 
 TABLE V. (cases seen 1888-1891). Deaf and Dumb Children 49 
 
 TABLE VI. 100 Boys and 100 Girls with Defects in Development in the 
 
 Day School 55 
 
 TABLE VII. 100 Boys and 100 Girls with Defects in Development in the 
 
 Resident School 55 
 
 TABLE VIII. (cases seen 1892-94). School Organization 63 
 
 TABLE IX. (cases seen 1888-91). Distribution of Signs or Defects under 
 Divisions of Schools '. 94 
 
 TABLE X. (cases seen 1888-91). Distribution of Groups of Children 
 
 under Divisions of Schools ... ... 96 
 
 TABLE XI. (cases seen 1888-91). Conditions of Defective Development 
 in Relation to Low Nutrition Mental Dulness, and Nerve Defects ... 98 
 
 TABLE XII. (cases seen 1888-91). The Binary Combinations of Defects 
 in Development of the Body .' 99 
 
 TABLE XIII. (cases seen 1888-91). Number of Children with each Nerve- 
 sif/n respectively; the numbers with each Combination of these Signs 
 respectively; the number of Children in whom each Sign occurred 
 alone ; and the number of times each Sign respectively occurred in 
 Combination ... ... ... 100 
 
 TABLE XIV. (cases seen 1888-91). Cases that appear to require Special 
 Training and Care on grounds of Physical or Mental Conditions ... 101 
 
 TABLE XV. (cases seen 1888-91). Defects as observed in co-relation with 
 Development Defects, Abnormal Nerve-signs^ Low Nutrition, and 
 Mental Dulness, in Divisions of Schools respectively 102 
 
 TABLE XVI. (cases seen 1888-91). Co-relation of Defects in Development 
 
 ivith Nerve-signs, Low Nutrition, and Mental Dulness . . . 103 
 
 TABLE XVII. (cases seen 1888-91). Co-relation of Abnormal Nerve-signs 
 
 with Defect in Development, Low Nutrition, and Mental Dulness ... 104 
 
Till 
 
 PAGE 
 
 TABLE XVIII. (cases seen 1888-91). Co-relation of Binary Defects in 
 
 Development ivith Nerve-signs, Low Nutrition, and Menial Dulness ... 105 
 
 TABLE XIX. (cases seen 1888-91). Proportionate Distribution of Groups 
 of cases, and certain Defects in the Divisio?is of Schools, showing the 
 relative condition of the Children in the Resident and Day Schools, the 
 Social Classes, and Nationalities 10(> 
 
 TABLE XX. (cases seen 1883-91). Proportional Distribution of Groups 
 of Cases among the Nationalities, showing the Numbers of Children of 
 of various Nationalities in Divisions of Schools, and their relative 
 condition 107 
 
 TABLE XXI. (cases seen 1892-94). Distribution of Cases noted into 
 
 Primary Groups, arranged according to Standards ... ... ... 108 
 
 TABLE XXII. (cases seen 1892-94). Distribution of Cases noted into 
 
 Primary Groups, arranged according to Ages ... ... 109 
 
 TABLE XX til. (cases seen 1892-94). Showing the Proportion of the 
 
 Primary Groups of cases to the Compound Groups respectively ... 110 
 
 TABLE XXIV. (cases seen 1892-94). Co-relation of Compound Groups with 
 
 other defects, alone or in combination ... ... ... ... ...Ill 
 
 TABLE XXV. (cases seen 1892-94). Shoiuing the relation of Aye-groups 
 to Standard-groups among the cases noted ... ... 112 
 
 TABLE XXVI. (cases seen 1892-94). Distribution of Cases in Divisions of 
 Schools arranged according to Nationality, 'Social Classes, London 
 Board Schools, #<?., under Standards, giving number of Children seen 
 and numbers noted ... ... ... ... ... 113 
 
 TABLE XXVII. (cases seen 1892-94). Distribution of Cases in Divisions of 
 Schools, arranged according to Nationality, Social Classes, London 
 Board Schools', fyc. , under Primary Groups of Defects 114 
 
 TABLE XXVIII. (cases seen 1892-94). Proportional Distribution of Groups 
 of cases in Divisions of Schools arranged according to Nationality, 
 Social Classes, London Board Schools, fyc., showing the numbers of 
 Children and their relative condition 115 
 
 TABLE XXIX. (cases seen 1892-94). Exceptional Children distributed into 
 Standards under Defects and under Primary Groups, showing also 
 Total number of Children loho appear to require special care and 
 training ... ... ... ... ... ... 116 
 
 TABLE XXX. (cases seen 1892-94). Exceptional Children, Distributed into 
 Age Groups under Defects and under Primary Groups, showing also 
 Total number of Children who appear to require special care and 
 training 117 
 
SCIENTIFIC STUDY 
 
 OF THE 
 
 MENTAL AND PHYSICAL CONDITIONS 
 OF CHILDHOOD. 
 
 CHAPTER I. 
 
 In 1888, at the Annual Meeting of the British Medical Association 
 in Glasgow, a Committee was appointed to conduct an investigation 
 as to the average development and condition of brain power among 
 the children in primary schools. The first action taken was to 
 decide upon a mode of procedure. A form of schedule was drawn 
 up for use in reporting, and a paper of " suggestions " was prepared 
 by Dr. Warner and others, containing a list of points worthy of note 
 in making observations. 
 
 In 1889, a report was published on 5,444 children seen in fourteen 
 schools, as drawn up by Dr. Francis Warner, who for over ten years 
 had previously studied the scientific methods of observing and de- 
 scribing indications of mental status in children. 
 
 The Council of the British Medical Association have warmly 
 supported the investigation and continues to do so, and have made 
 grants of money each year. 
 
 In the same year, 1889, evidence was given by members of the 
 Committee before the Eoyal Commission on the blind, dumb, etc., 
 and for the first time it was officially recognised that there was a 
 class of children who, while not imbecile, present a certain amount of 
 mental deficiency. 
 
 The Commission reported : 
 
 "That with regard to 'feeble-minded' children, they should be 
 separated from ordinary scholars in public elementary schools, in 
 order that they may receive special instruction, and that the 
 attention of school authorities be particularly directed towards this 
 object." 
 
 In 1890, a Committee was appointed by the Charity Organisation 
 Society, including members of the former Committee "To promote a 
 
scientific inquiry with regard to the number and condition of feeble- 
 minded children or adults." 
 
 The Committee writes as follows : 
 
 "There is a large class of persons which the word 'feeble-minded' 
 may well describe, who are often in distress and often lapse into 
 destitution and degradation, and for whom at present it is usually 
 extremely difficult to make any charitable or other proper provision. 
 They cannot be termed 'imbecile/ nor can they be dealt with under 
 the Idiots Act of 1886. Bather are they in childhood the 'backward' 
 or * men tally dull' pupils of the school, whose backwardness or dull- 
 ness is the result of physical causes ; and later in life they become, if 
 they are fortunate, the dependents of kind-hearted people, or more 
 frequently the habitual inmates of workhouses, from which they po 
 out from time to time, often to their lasting harm and mischief, and 
 in the case of girls and young women not infrequently to their 
 disgrace and ruin." 
 
 " The question of trying to prevent this ' feeble-mindedness ' by 
 a better care of children, and of making for feeble-minded and desti- 
 tute adults some provision that may at least preserve them from 
 mischief, has been considered by several societies. The Metropolitan 
 Association for Befriending Young Servants has frequently had to 
 cope with the difficulty in cases of district school and other girls 
 under their charge. The National Vigilance Society has through if s 
 Preventive Committee made inquiry of the number of 'feeble-minded' 
 girls and women in workhouses and infirmaries. Their returns, 
 which, though incomplete, are useful, show that they received replies 
 from 203 Boards of Guardians ; that during the year 1889, 715 
 4 weak-minded ' women passed through 105 workhouses, and that at 
 56 workhouses it was stated that the approximate number of such 
 women who were leading immoral lives was 366. The Reformatory 
 and Refuge Union has had the question brought specially before it 
 by resolutions passed at the recent Conference of Managers ef 
 Eeformatory and Industrial Schools at Glasgow ; and the Council of 
 the Charity Organisation Society has also more than once in the 
 course of the past year or two considered the difficulty of dealing 
 with cases of this kind, as well as with cases of epileptics, crippled 
 and deformed persons." 
 
 The report of this Committee showed (1) the large number of 
 children below the average physical and mental development; (2) the 
 importance of grouping main classes of defects for the purposes of 
 research ; (3) the importance of ascertaining the co-relations of main 
 
3 
 
 classes of defectiveness, and also the co-relations of the individual 
 defects ; (4) the greater proportion of children with mental defect 
 among those with several conditions of physical defect ; (5) the 
 unequal distribution of defectiveness among groups of schools, the 
 high proportion among the pauper class, also differences in the 
 nationalities. 
 
 An interim report was presented by the Charity Organisation 
 Society to the Congress of Hygiene and Demography, 1891, and 
 their full report has since been published.* 
 
 Papers were read at the Congress on the work done up to that 
 date, and the present Committee was formed under a resolution 
 passed at the meeting. 
 
 In 1892 a full report on 50,000 children, seen in 106 schools by 
 Dr. Francis Warner, in conjunction with other medical members of 
 the Committee, was presented to the Local Government Board. 
 
 Since 1892 the work has been in the hands of the present Com- 
 mittee, and another 50,000 children have been examined for this 
 Committee by Dr. Francis Warner, in conjunction with Dr. Shuttle- 
 worth, Dr. Fletcher Beach, and others ; the methods of observation 
 have been essentially the same as those used since 1888, and their 
 value has been amply proven by experience. The methods of com- 
 pilation of facts have been much improved, and are fully explained 
 in the report. 
 
 The Milroy Lectures of the Eoyal College of Physicians were 
 delivered by Dr. Francis Warner in 1892, upon the results of 
 enquiry in 106 schools, seen in 1888-91. 
 
 In the year 1892 a Committee was appointed by the British 
 Association for the Advancement of Science, for similar enquiries, 
 and the members have worked with the present Committee ; three 
 short reports have been issued by the Committee of the British 
 Association, and it has each year been re-appointed. 
 
 At the meeting of the International Congress of Hygiene and 
 Demography at Budapest in 1894, Dr. Francis Warner and Dr. 
 Shuttleworth attended as delegates, and presented a short report 
 on the work done ; papers on the same subject were read before the 
 Sections, and a demonstration of the methods of examination was 
 given before the Congress, some children having been assembled for 
 the purpose. 
 
 * "The Feeble-minded, Epileptic, Deformed, and Crippled," and "The 
 Feeble Child and Adult ; " and " Report on Feeble-minded, Epileptic, and 
 Cripples," 1892. C. 0. S. Series. 15 Buckingham, Street, Strand, London, W.C. 
 
In November, 1894, evidence was given by Dr. Francis Warner 
 before a Departmental Committee on Poor Law Schools, showing 
 in detail the conditions of the Poor Law children in contrast with 
 those in day schools, and making certain recommendations. 
 
 Articles have been contributed to journals ; press correspondence 
 and notices have from time to time appeared, and although the 
 Committee have hitherto devoted very little attention to this branch 
 of the work, it is evident that the investigation is favourably viewed 
 by the various sections of the public interested in the welfare of the 
 children. 
 
 ORGANISATION AND WORK OF THE COMMITTEE. 
 
 The Committee now consists of representatives in Hamburg, Paris, 
 New York, Vienna, Seraing-Liege, with representatives from the 
 British Medical Association, the Charity Organisation Society, The 
 Sanitary Institute, and the Royal Statistical Society, together with a 
 number of professional men skilled in education and in the compila- 
 tion of statistical facts. 
 
 Committees appointed by the British Medical Association and by 
 the British Association for the Advancement of Science have joined 
 this Committee, and both these Associations have contributed towards 
 its funds. 
 
 The Executive Committee and Sub-Committees were appointed to 
 deal with certain details of the work, and they have supervised the 
 enquiry in all its stages. The Committee has endeavoured to spread 
 a knowledge of the objects and work, but have been hampered for 
 want of necessary funds. Applications have been made to the Local 
 Government Board, the London County Council, most of the City 
 Companies and other public bodies, and also to the Prussian Govern- 
 ment, for grants in aid of the work of the Committee, but their 
 applications have been so far without result. 
 
 The Statistical Sub-Committee have held a number of meetings to 
 discuss and direct the modes of arrangement and tabulation, and 
 have carefully examined and checked the statistical work and tables. 
 
 Following a suggestion made by the Committee to the Education 
 Department, the Rev. T. W. Sharpe, Senior Chief Inspector of the 
 Department, was, at their request, present at the inspection of some 
 of the Schools, and expressed his favourable opinion as to the 
 usefulness of the investigation, and a wish that teachers might learn 
 something of the methods of observing children for the purpose of 
 classifying them. 
 
The Committee supported a memorial of the Council of the British 
 Medical Association concerning the appointment of a Commission 
 for the scientific inquiry as to the condition of the school-population, 
 which was forwarded to the Education Department and Local 
 Government Board, and although so far without result, will be again 
 pressed as opportunity may occur. 
 
 Information concerning Irish children as seen in England was 
 forwarded to Dublin Castle at the request of the Inspectors in 
 Lunacy. 
 
 Statistics concerning feeble-minded children have been supplied at 
 the request of the London School Board, who have experienced 
 difficulties in connection with such children. A report on 35,361 
 children seen in 35 Board Schools, by permission of the Board, has 
 been forwarded to the Board. 
 
 A letter was addressed to the Universities, Colleges, and other 
 Educational Bodies, suggesting the desirability of establishing 
 lectures on the study of children. One County Council has offered 
 to meet half the expenses of such lectures as a branch of Technical 
 Education, and it is hoped that the London County Council may do 
 the same. 
 
 In December, 1893, the Committee issued an Interim Keport on 
 the work being done, copies of which were circulated. 
 
 A very valuable addendum to vital statistics might be obtained by 
 following up the history of certain cases recorded, by subsequent 
 periodical inspections, but as this is beyond the power of the present 
 Committee, it can only be suggested as one among many other 
 directions in which enquiry may be pushed in the hands of official 
 Commissions. 
 
 LIST OF SCHOOLS EXAMINED. 
 
 The 106 schools examined in the first enquiry, 1888-91, containing 
 50,027 children are divided into the following ten Divisions. 
 
 DIVISION 1 Poor Law Schools. 
 
 This includes 19 Poor Law (district and separate) schools, being 
 nearly all of those situated within the London district. 
 
 They are under the medical and educational supervision of the 
 Local Government Board. The Eoman Catholic children were 
 mostly Irish. 
 
 Numbers seen Boys 5884. Girls 3947. 
 
 Numbers noted .... 1332. 685. 
 
DIVISION 2 Certified Industrial Schools. 
 
 This includes 9 schools, they mostly receive children sent by tbe 
 magistrates as having some connection with crime, either through 
 their own acts, or those of their parents or others. 
 
 These schools were mostly near London, they are under the super- 
 vision of the Government Home Office. 
 
 Some of these were Koman Catholic schools containing mostly 
 Irish children. 
 
 Numbers seen Boys 1588. Girls 407. 
 
 Numbers noted 500. 91. 
 
 DIVISION 3 Homes and Orphanages. 
 
 This includes 6 schools or philanthropic institutions for the 
 boarding, clothing, and training of orphan children. 
 
 They are voluntary and independent of the Government. 
 
 Numbers seen Boys 774. Girls 1049. 
 
 Numbers noted 172. 186. 
 
 DIVISION 4 All Resident Schools. 
 
 This includes the 34 schools in the preceding groups combined. 
 In these schools the children receive board, clothing and education. 
 
 They are institutions, some under the Government, others volun- 
 tary for the care of children more or less destitute. 
 
 Numbers seen Boys 8246. Girls 5403. 
 
 Numbers noted 1994. 962. 
 
 DIVISION 5 Public Elementary (and other) Day Schools. 
 
 This includes 72 day schools almost all public elementary schools ; 
 a few of rather higher grade are included, 10 were under the London 
 School Board, most were voluntary. 
 
 Numbers seen Boys 18,638. Girls 17,740. 
 
 Numbers noted . . 3,575. 2,645. 
 
 DIVISION 6 20 Day Schools of the Upper Social Class. 
 
 Numbers seen Boys 5281. Girls 4934. 
 
 Numbers noted .. 1122. 
 
 DIVISION 7 52 Day Schools of Poorer Social Class. 
 
 Numbers seen .... Boys 13,357. Girls 12,806. 
 
 Numbers noted .. 2,435. 1,849. 
 
 N.B. Groups 6 and 7 combined make up Group 5. 
 
DIVISION 8 English Day Schools. 
 
 This includes all day schools containing mostly English children, 
 not Irish or Jews ; resident schools with English children are not 
 included in this group. 
 
 Numbers seen Boys 16,932. Girls 15,875. 
 
 Numbers noted .. 3,252. 2,379. 
 
 DIVISION 9 Schools containing Irish Children. 
 This includes 3 Poor Law resident schools, 4 certificated industrial 
 resident schools, and 1 public elementary day school. 
 
 Numbers seen Boys 1 694. Girls 595. 
 
 Numbers noted ,, 585. 115. 
 
 DIVISION 10 Jewish Day Schools. 
 
 The Jeivisli Schools, Whitecha/pel. 
 
 Mostly very poor, and children of foreign immigrants ; a portion 
 only of the children was seen. 
 
 Numbers seen Boys 1389. Girls 1572. 
 
 Numbers noted 247. 218. 
 
 N.B. A further analysis of the children of these Nationalities is 
 given in Tables XIX., XX. 
 
 The distribution of the children presenting the "defects" described 
 in the nomenclature (see page 72) among the Divisions of schools is 
 given in Table XIII., and the distribution of " Groups of children " 
 described in the catalogue (see page 82), is presented in Table XIV. 
 
 In the enquiry made by this Committee 1892-94, 63 schools were 
 examined containing 50,000 children ; these schools are arranged in 
 12 Divisions. 
 
 DIVISION I. 7 London Board Schools, Upper Social Class, 
 
 English Children. 
 These schools represent English children, not Irish or Jews. 
 
 Numbers seen Boys 4800. Girls 4316. 
 
 Numbers noted ... 838. 679. 
 
 DIVISION II. 11 London Board Schools, Average Social Class, 
 
 English. 
 
 The children in these schools were not characterised as distinctly 
 
8 
 
 belonging to either upper or poorer social class. They represent 
 English children. 
 
 Numbers seen Boys 6113. Girls 5628. 
 
 Numbers noted 1159. 944. 
 
 DIVISION III. 14 London Board Schools, Poorer Social Class, English. 
 The children in these schools were of poorer families than those 
 in the preceding group, they consisted mainly of English children. 
 
 Numbers seen Boys 6342. Girls 5213. 
 
 Numbers noted 1155. 863. 
 
 DIVISION IV. 3 London Board Schools, Jewish children of the Poorer 
 
 Social Class. 
 In these schools almost all the children were Jews. 
 
 Numbers seen Boys 1368. Girls 1581. 
 
 Numbers noted 249. 223. 
 
 DIVISION V. 2 Country Board Schools, English. 
 Board Schools of Seaford, Sussex, and at Harrow. English country 
 children of average social class. 
 
 Numbers seen Boys 528. Girls 482. 
 
 Numbers noted 105. 70. 
 
 DIVISION VI. 1 Edinburgh Board School, Scotland. 
 Scottish children of Upper Social Class. 
 
 Numbers seen Boys 803. Girls 807. 
 
 Numbers noted ,,163. 128. 
 
 DIVISION VII. 4 Voluntary Schools, Upper Social Class, English. 
 Two schools were in the country, one was a high-class boarding 
 school for boys, and the other two were elementary schools in town. 
 
 Numbers seen Boys 1232. Girls 939. 
 
 Numbers noted 250. 162. 
 
 
 
 DIVISION VIII. 5 Voluntary Schools, Average Social Class, English. 
 All were London elementary schools. 
 
 Numbers seen ........ Boys 968. Girls 988. 
 
 Numbers noted ...... 228. 158. 
 
 DIVISION IX. 2 Voluntary Schools, Poorer Social Class, English. 
 National schools in London. 
 
 Numbers seen ........ Boys 697. Girls 720. 
 
 Numbers noted ...... 137. 96. 
 
DIVISION X. 10 Voluntary Schools, Irish Children, Poorer 
 
 Social Class. 
 Irish children seen in London. 
 
 Numbers seen Boys 2171. Girls 1952. 
 
 Numbers noted 535. 324. 
 
 DIVISION XI. 3 Voluntary Schools, Jewish Children, Average 
 
 Social Class. 
 London Jewish children. 
 
 Numbers seen Boys 823. Girls 693. 
 
 Numbers noted 138. 104. 
 
 DIVISION XII. 1 Voluntary School, Jewish Children, Poorer 
 Social Class. 
 
 The Jews' Free school, Whitechapel. This is the same school as 
 was examined in 1891, but care was taken that different children 
 were examined, and only part of the school was seen. 
 
 Numbers seen Boys 440. Girls 394, 
 
 Numbers noted ,, 155. 78. 
 
 These twelve divisions of schools are arranged so as to be com- 
 parable with those seen in 1888-91, and the terms used in describing 
 them bear the same significance as those previously used. Summation 
 of the groups here given will afford information concerning all the 
 board schools and voluntary schools, as well as of those of the social 
 classes and of nationalities. 
 
 . Such information may be needed in future enquiries, and many 
 additional divisions of schools may be prepared by summation of 
 those given. 
 
10 
 
 OHAPTEE IT. 
 
 EXPLANATION OF THE METHODS USED IN THIS 
 ENQUIRY, AND COMMENTS ON THE KEPOKT. 
 
 Methods of Observation and ResearcJi. 
 
 The methods of examining the physical condition of children seen 
 in schools must necessarily be more limited than those used in the 
 consulting room. Arrangements already exist in the reports of 
 H. M. Inspectors for determining the intellectual acquirements of 
 school children ; their family history and evidence as to their home 
 life could not be obtained, and school managers naturally object to 
 questions being asked of the children concerning their health, which, 
 if put, would not be likely to elicit any trustworthy information ; it 
 is also impracticable to handle the children for the purposes of 
 physical examination. 
 
 The observer must therefore depend mainly upon inspection, and 
 having determined beforehand what points to look to, he must 
 record accurately what he sees. 
 
 The importance of deciding on a number of physical signs for 
 observation and record was appreciated before the work was com- 
 menced on a large scale. 
 
 For the purpose of observing those finer balances and reactions of 
 the nerve system which indicate neuro-mental potentialities, it is 
 better to deal with the children in a uniform manner, and not to 
 handle them. 
 
 The terms used in giving descriptions of children should each 
 indicate a fact seen and capable of verification and comparison, the 
 essence of scientific description. 
 
 Viewing a child, we see its body and some of the indications of 
 brain action. 
 
 The signs observed are of two kinds : (A) points of form, propor- 
 tion and indications of type of development of the body and its 
 
11 
 
 separate parts ; thus, looking at the child, we note the cranium and 
 the separate features, the ears, the nose, the palpebral fissures and 
 the mouth, i.e., its physiognomy; also its growth and the indications 
 of nutrition. 
 
 (B) Nerve signs are seen in the balance of the head, the spine, the 
 upper extremity and the digits, as well as in the facial action and eye 
 movements. These movements and balances of action or postures 
 are observed as signs of the action and condition of the nerve- 
 centres. Inspection of the children is most conveniently conducted 
 in a large and well-lighted room, the pupils being drawn up in ranks, 
 a standard at a time, or in groups of about forty, so that the 
 inspector may view each individual. It is convenient to fix the 
 child's eyes by asking each in turn to look at an object held up, e.g., 
 a shilling at the end of a pencil. The trained observer can read off 
 the physiognomy of the individual features and their parts, the facial 
 condition and eye movements, the balance of the head and body, &c., 
 as quickly as a printed line. 
 
 The children in the group are then requested to hold their hands out 
 straight, the action being shown them momentarily ; the balance is 
 noted as a further indication of the nerve-condition. Finally, the 
 palate is inspected in every child. 
 
 At each stage of the inspection, children presentiug deviations 
 from the normal are asked to stand aside; any dull children or 
 special cases not picked out by inspection may now be presented by the 
 teacher; the selected cases are kept and the other children are dis- 
 missed to the class-room. 
 
 Each of the selected cases is then reviewed individually and 
 described on a schedule form ; the teachers' report concerning the 
 child is taken down or filled in by them afterwards. Occasionally 
 some detailed enquiry concerning a child may be made, or some brief 
 mental examination may be desirable, but as a rule no questions are 
 asked of the child. 
 
 This method works smoothly and uniformly with a minimum of 
 trouble to the teachers and pupils. The teachers almost universally 
 acknowledged that the dull children had been selected by inspection, 
 and very few were subsequently presented by them. 
 
 In taking notes of the cases selected by inspection as presenting 
 some points of deviation from the normal, a schedule form was filled 
 in for every child. 
 
12 
 
 On the schedule form the first column is headed " Development, 
 Physiognomy, &c.," and as sub-headings the words Palate, Ears, 
 Growth, are printed ; these are ticked if the parts of child corre- 
 sponding are found normal on inspection, and abnormalities are 
 described. The second column is headed "Movements, Postures, 
 &c.," with sub-headings " Expression, Orbicularis oculi, Eye move- 
 ments, Hand balance, Head balance, General balance." In a column 
 headed " Physical Health and Nutrition," particulars of this class are 
 recorded. 
 
 The teachers give their opinion of the child as to mental status in 
 the column " School Eeport." The more important points of the 
 case are entered by the inspector in the final column. Such schedule 
 was filled in for each of the children noted as presenting some 
 deviations from the normal. At the same time the name, age, and 
 standard in school is entered by an assistant on the name-sheet, with 
 a reference number, which is repeated on the schedule, and thus the 
 case is identified in subsequent analysis. The number of children 
 seen in each standard (boys and girls) and the date of the visit, 
 together with the names of any visitors present, are endorsed on the 
 school report. 
 
 For the purpose of preparing statistics, each case as described in 
 the written report taken in the school, is entered in a Register in 
 which the headings of the columns indicate the defective conditions 
 observed, "Cranial Abnormality," "Palate Defective," "Expression 
 Defective," "Low Nutrition," etc; the case being entered under such 
 headings as correspond to its defects. Further columns were added 
 to the Register as additional defects were observed in the progress of 
 the enquiry. Thus the headings of the columns form the list of 
 defective conditions given in the Nomenclature (see page 72). 
 
 There are four main classes or divisions into which the defective 
 conditions observed may be grouped. 
 
 A. Defects in Development of the body and its parts; in size, form, 
 or proportioning of parts. (See Nomenclature of defects, 1 to 42.) 
 
 B. Abnormal Nerve-signs; certain abnormal actions, movements, 
 and balances. (See Nomenclature of defects, 43 to 63.) 
 
 C. Low Nutrition, as indicated by the child being thin, pale or 
 delicate. 
 
13 
 
 D. Mental Dulness. The teachers' report as to mental ability was 
 added to the record of each child registered, and those stated to be 
 below the average in ability for school work were registered as 
 "Dull." 
 
 The importance of these Main Classes of defect is indicated in the 
 following Table. 
 
 TABLE I. (cases seen 1888 91). Showing Number of Children 
 with each Main Class of defect, and the percentage of each class 
 respectively that presented conditions of defect co-related thereto. 
 Percentages are taken upon the numbers given. For numbers of 
 cases presenting the combined conditions, see Catalogue on page 82. 
 For facts corresponding in cases seen 1892 94, see Table XXIV. 
 
 Number presenting main 
 Class of Defect alone or in 
 combination. 
 
 With Group 28, 
 Defect in 
 Development 
 alone or in 
 combination. 
 
 With Group 29, 
 Nerve Signs 
 alone or in 
 combination. 
 
 With Group 30, 
 Low Nutrition 
 alone or in 
 combination. 
 
 WithGrp.31. 
 Mental 
 Dulness 
 alone or in 
 combination. 
 
 Boys. Girls. 
 Defect iu Development, 1 
 Group 28. L 
 3616 2235 | 
 
 Boys. Girls. 
 
 Boys. Girls. 
 54-6 49-0 
 
 Boys. Girls. 
 20-2 32-0 
 
 Boys. Girls. 
 38-3 41-5 
 
 Nerve Defect. ] 
 Group 29. \ 
 3413 2074 J 
 
 57-8 52-8 
 
 
 
 18-6 28-8 
 
 40-1 42-4 
 
 Low Nutrition. "1 
 Group 30. 
 1030 973 J 
 
 711 74-6 
 
 61-0 61-4 
 
 
 
 39-0 405 
 
 Mental Dulness. ] 
 Group 31. ( 
 2216 1463 
 
 63-0 63-4 
 
 61-8 60-1 
 
 18-1 27-0 
 
 
 
 Many of the children present two or more defects, and consequently occur 
 more than once in this and similar Tables. 
 
 A. Defects in bodily development are frequently found to be co- 
 incident with brain defects, usually lowering mental status. The 
 connecting link between defects of body and defective mental action 
 is the co-incident defect of brain which may be known by observation 
 of "abnormal nerve-signs." It is to this view of the question as 
 demonstrated by the original researches of Dr. Francis Warner, that 
 the Committee attach great weight. It is the coincident observation 
 of Conditions of development of the body, and "nerve-signs" 
 indicating brain-action, that forms a special feature of the present 
 investigation, and distinguishes the methods used from older phy- 
 siognomical research. 
 
14 
 
 Another fact co-related with defect in development is the tendency 
 of such cases, especially girls, to become pale, thin, and delicate. It 
 is in the co-relation of abnormalities in the proportion of parts of the 
 body, with abnormal nerve-signs, low nutrition and mental dulness, 
 that we find a criterion of the really defective status connected with 
 the abnormality and the value of such signs. This is illustrated as 
 follows: 
 
 TABLE II. (cases seen 1888-91). Showing Number of Children with 
 Defects in Development in Resident and Day Schools, and the 
 percentage of these Cases that presented co-related conditions taken 
 upon the Cases with Defects in Development. 
 
 Number of Development Cases. 
 
 Percentage 
 with Low Nutrition. 
 
 Percentage 
 with Abnormal Nerve 
 Signs. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Kesideut Schools, I.-XXXIV. 
 B 1324 G 671 T 1995 
 
 15-7 
 23-3 
 20-2 
 
 19-8 
 37-8 
 32-0 
 
 16-6 
 29-2 
 24-9 
 
 61-9 
 50-3 
 54-6 
 
 52-6 
 47-5 
 49-0 
 
 58-8 
 49-2 
 52-4 
 
 Day Schools, XXXV .-CVL 
 B. 2292. G. 1564. T. 3856 
 
 Total for all Schools, I.-CVI. 
 B. 3616. G. 2235. T. 5851 
 
 Number of Development Cases. 
 
 Percentage with 
 Low Nutrition and 
 Nerve Signs. 
 
 Percentage 
 reported as Dull. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Resident Schools, I.-XXXIV. 
 B. 1324. G. 671. T. 1995 
 
 9-0 
 12-7 
 11-3 
 
 11-3 
 19-5 
 17-0 
 
 97 
 15-5 
 13-5 
 
 39-8 
 37-9 
 38-3 
 
 44-2 
 40-3 
 41-5 
 
 41-3 
 38-7 
 39-7 
 
 Day Schools, XXXV.-CVL 
 B. 2292. G. 1564. T. 3856 
 
 Total for all Schools, I.-CVI. 
 B. 3616. G. 2235. T. 5851 
 
 In reporting for the purpose of selecting "the worst made 
 children " a definitely high standard must be maintained, the most 
 marked cases only being noted ; on the other hand, for the purpose 
 of determining the causation of defects, a lower standard of de- 
 fectiveness should be adopted, ranging from the minimum that 
 
15 
 
 can be distinctly observed and described to the maximum of the 
 pathologist. 
 
 If conditions of defective development are looked for in children 
 brought for examination, on account of their known physical or 
 mental feebleness, a very much higher co-relative value wil] be put 
 upon the individual signs observed than that obtained in this enquiry 
 where each feature was observed in all the school children. 
 
 Many cases with one or two defects are otherwise perfectly 
 average children; it is by an association of signs in development 
 and in the nerve system that we recognise the defective condition 
 of the children. 
 
 B. Nerve signs are of value as they indicate brain states ; their 
 general significance has been dwelt upon. 
 
 Many of these signs indicate action and balance of nerve centres 
 at the moment of observation ; the same thing may be said of 
 mental tests, and here is presented a body of signs for clinical use, 
 such as represent the finer shades of conditions among the nerve 
 centres. 
 
 In all cases described in the notes the nerve-sign was looked for 
 on two occasions ; when inspecting the children in rank, and again 
 when describing the individual case ; in most cases its repeated 
 occurrence only was recorded, if not repeated the sign was not 
 noted. 
 
 The co-relations of abnormal nerve-signs respectively with defects 
 in development, low nutrition, and mental dulness are given ; the 
 first and second may be looked upon as possibly having a casual con- 
 nection wdth the nerve sign. 
 
 C. Nutrition as applied to the children in this enquiry implies that 
 the child as seen was thin, pale, or delicate looking. It is not 
 sufficient evidence as to good nutrition to look at the face only, this 
 part may be well nourished and yet the limbs may be thin ; it is 
 usually well to feel the child's arms or legs. 
 
 The most important fact noted with regard to these cases of low 
 nutrition, is that 73 per cent, were cases presenting visible signs of 
 deviations from the normal in development of the features and other 
 parts. 
 
 It seems then that there is a large group of children, amounting to 
 
16 
 
 nearly 3 per cent, of the children seen, who are so defective in make 
 as to be usually of low nutrition when seen in school. 
 
 It appears that these children are of lower general constitutional 
 power and tend to an ill-nourished condition under the stress of life 
 and the many causes of mental excitement which, while they render 
 them sharper mentally, militate against nutrition of the body and its 
 tissues. 
 
 That the amount of mental stimulus received by children does 
 lower their general nutrition seems to be further indicated as 
 follows : 
 
 On dividing 36,000 day scholars, seen 1888-91, into two groups, 
 10,200 seen in day schools of upper social class, presumably well fed 
 children, 5*2 per cent, were found to be of low nutrition, and among 
 the 25,000 children in the poorer day schools 3'9 per cent. ; the only 
 explanation offered is that the upper class children have more stress 
 upon them than those of poorer social position. 
 
 The statistical methods employed were not the same in the earlier 
 'as in the later portions of the enquiry. 
 
 During 1888 91, for the purpose of preparing statistics of co- 
 incident or combined conditions, a list of all cases presenting each 
 principal condition was prepared from the register, and parallel columns 
 were headed with the names of such conditions as it was desired to 
 show in co-relation with it. Thus the list of "cranial abnormalities'' 
 had columns by its side, headed "abnormal nerve-signs" and "nutri- 
 tion low," etc., in which the case was also entered if these conditions 
 had been registered against the child. 
 
 Proceeding systematically in this way, the co-relation of the more 
 important defects was obtained. 
 
 Actuarial methods of arranging statistics were employed 1892 94, 
 which, while simpler in form than those used earlier, afford a much 
 more nearly complete and useful analysis of cases. 
 
 The Statistical Sub-Committee, taking the Register as the basis of 
 this actuarial work, prepared a card of the form shown on the next 
 page, on which the list of defects is printed, such card was filled in 
 for each case registered, presenting all the information contained in 
 the Register of the case, the defects present being indicated by 
 drawing the pen through the name of the defect. A formulated 
 epitome at the right hand lower corner of the card indicates the main 
 division of defect in the case. 
 
FACSIMILE OF EECOEDING CAED. 
 
 Schoo 
 
 / . ... Card No. 
 
 
 V 
 
 Stf- 
 
 Re* No. 
 
 
 GIRLS. 
 
 A~e 
 
 
 
 . Spl Rep*- 
 
 
 
 
 
 A 
 
 DEVELOPMENT DEFECTS 
 
 47 
 
 O.oculi lax 
 
 a 1 
 
 CRANIUM 
 
 48 
 
 Eye movements 
 
 2 
 
 Large 
 
 49 
 
 Head balance 
 
 3 
 
 Small 
 
 50 
 
 Hand weak 
 
 4 
 
 Bossed 
 
 51 
 
 Hand nervous 
 
 5 
 
 Forehead 
 
 52 
 
 Finger Twitches 
 
 6 
 
 Frontal ridg3 
 
 53 
 
 Lordosis 
 
 
 
 54 
 
 OTHER NERVE-SIGNS 
 
 b 11 
 
 EXTERNAL EAR 
 
 
 
 c 12 
 
 EPICANTHIS 
 
 C 
 
 NUTRITION 
 
 d 13 
 
 PALATE 
 
 D 
 
 DULL 
 
 14 
 
 Narrow 
 
 E 
 
 EYE-CASES 
 
 15 
 
 V-shaped 
 
 64 
 
 Squint 
 
 16 
 
 Arched 
 
 65 
 
 Glasses plus 
 
 17 
 
 Cleft 
 
 66 
 
 Glasses minus 
 
 18 
 
 Other types 
 
 67 
 
 Myopia, no glasses 
 
 e 19 
 
 NASAL BONES 
 
 68 
 
 Cornea disease 
 
 / 20 
 
 GROWTH SMALL 
 
 69 
 
 Eye, lost accident 
 
 I/ 21 
 
 OTHER DEVELMT. DFTS. 
 
 70 
 
 Eye, lost disease 
 
 B 
 
 NERVE-SIGNS 
 
 F 
 
 RICKETS 
 
 43 
 
 General balanca 
 
 G 
 
 EXCEPTIONAL CHILDREN 
 
 44 
 
 Expression 
 
 i 82 
 
 CRIPPLES 
 
 45 
 
 Frontals overact 
 
 
 
 46 
 
 Corrugation 
 
 A B 
 
 C D E F G 
 
 In sorting the cards for the purpose of compiling the Tables relating to the 
 cases seen 1892-94, the defects included under E, F, and G were not considered. 
 Thus a card with A and F marked was counted as A only ; B, C, and E as B C 
 only; and so on. Combinations of A, B, C, or D, with E, F, or G, have not been 
 tabulated. 
 
 B 
 
18 
 
 CHAPTER III. 
 
 METHODS OF STUDYING THE BESULTS OF OBSERVA- 
 TIONS RECORDED WITH REFERENCE TO TABLES. 
 
 Having described and enumerated the cases observed, we proceed 
 to study the records obtained. This may be done by means of Analysis, 
 Grouping, Co-relation, and the Distribution of Conditions. 
 
 Analysis. We may take a case and regard only one of its defects. 
 This is done in the Nomenclature of Defects (see page 72), in which 
 the numbers of children presenting each defect respectively are given 
 independently of the consideration of whatever else the child may 
 present. In the Catalogue of Groups of Cases (see page 82) the 
 Primary Groups 13 to 27 are obtained by analysis, and give the smallest 
 groups of cases, viz., those presenting only one or more main classes 
 of defects. Groups 28 to 55, containing more than one main class 
 of defects, are larger. 
 
 Grouping. Cases are grouped in various ways. This mode of 
 study is explained and illustrated in the catalogue (see page 82). 
 Many other methods of grouping cases might be arranged for special 
 purposes, and the tables are so arranged as to be available for research 
 in any direction which science may suggest. The analysis of all cases 
 into the 16 Primary Groups (see catalogue) will be found convenient 
 in many respects. Analyses of groups of cases may be distributed in 
 various ways, and in the process co-relations may be obtained by 
 taking proportions. 
 
 Co-relation. It is in the co-relations of defects that new informa- 
 tion is mostly to be looked for, supplying evidence as to the real 
 significance of the defects respectively, and as to their causation. 
 Much attention has been given to the methods, and facilities are 
 afforded for further actuarial research in this direction. Inasmuch as 
 it has been shown by the comparison of groups of schools that the co- 
 relation of the main classes of defects varies as to degree, with the 
 character of the environment, it is advisable to determine the per- 
 centage of co-relations of defects upon similar groups of cases under 
 different environment. To some extent this has been done by giving 
 the co-relations of the main classes of defects, and individual defects, 
 as seen in children in day schools and in residential schools. The 
 
19 
 
 difference in the numerical values of these co-relations under different 
 environments are in some degree a measure of their effect. 
 
 Table XV. gives individual defects as observed with their co- 
 relations, the cases being distributed for divisions of schools seen 
 1888-91. In the summary of Tables XVI. and XVII. for all schools 
 (I. to CVI.) seen 1888-91 the co-relations are given in percentages. 
 
 Tables XI.. XII., and XVIII. give binary combinations of defects. 
 Certain co-relations are also given in The British Medical Associa- 
 tion's Report. Other co-relations may be obtained by comparison of 
 the groups of cases. 
 
 The co-relation of a main class of defects may be studied by 
 analysis of the class into two groups, in which one contains all cases 
 with the condition to be co-related, the other division containing the 
 remainder of cases without that condition. The percentage of the 
 first division of cases taken upon the number in the main class of 
 defect presents the percentage co-relation. Thus : To determine 
 the percentage co-relation of Development cases with Nerve-signs. 
 
 Group 28, All Development cases, 9,777. 
 
 Group 32, All Development cases with Nerve-signs, 4,545. 
 
 The co-relation of Development cases with Nerve-signs is the per- 
 centage of the latter upon the former number = 46 per cent. 
 
 An average co-relation upon 100,000 children can thus be calcu- 
 lated for any group of cases from the figures given in the Catalogue 
 of Groups of Cases. 
 
 Distribution of Cases. It follows from what has been said as to 
 co-relation that it is useful in research to give the distribution of 
 Groups of Cases. 
 
 Table IX. gives distribution of the defects in Divisions of Schools 
 for children seen 1888-91. 
 
 Table X. gives distribution of the Groups of Cases in Divisions 
 of Schools for children seen 1888-91. 
 
 Table XVIII. gives distribution of binary combinations of defective 
 development for Groups of Schools 1888-91. 
 
 Tables XIX., XX., give distribution of various groups of cases 
 among the children of the Nationalities. 
 
 In all Tables children seen with the enquiry 1888-91 are kept 
 separate from those seen 1892-94, but so far as possible it is arranged 
 that the set of cases may be comparable and capable of summation. 
 
'20 
 
 CHAPTER IV. 
 
 THE SIGNS OBSEEVED IN DESCRIBING CHILDREN. 
 
 The principal signs of defect are here described, with remarks as 
 to their significance. The numbers in brackets refer to the nomen- 
 clature given on page 72, in which all defects are defined and enume- 
 rated ; their co-relations are given in Tables XV., XVI., XVII., 
 XVIII., for the cases seen 1888-91. 
 
 (1). Cranial abnormalities. Of all defects in development, abnor- 
 malities of the cranium appear to be the most important, being the 
 most numerous, and having the highest pathological co-relations. 
 The size and probable volume of the brain is a point of first-class 
 importance, and the size of the cranium is in children a fair indication 
 of the size of the brain. 
 
 The following standard of the normal in a well-developed child of 
 good potentiality may be given: Head circumference at nine months, 
 17'5 inches, at twelve months, 19 inches, at seven years, 20 to 21 
 inches. This is probably a high standard of the normal, too high if 
 deviations therefrom are to be considered as pathological ; after 
 three years of age 19 inches cranial circumference is too small ; in 
 this investigation no head of any age was described as small which 
 was up to a circumference of 20 inches. In estimating the volume 
 of a cranium it is preferable to proceed by inspection ; noting its 
 form and not solely the circumference or other measurements ; good 
 estimate of both form and volume may be obtained by placing the 
 open hand on the child's head, subsequently using a tape measure. 
 It also appears that defects in form of the cranium are often core- 
 lated with brain deficiences. Defects of the cranium may be divided 
 into sub-classes. 
 
 (2). Large Heads. It seems probable that a large proportion of 
 these cases resulted from rickets at an earlier period, for of 168 cases 
 of rickets with defect of cranium, 55-3 per cent, were large heads. 
 
 (3). Small Heads. In this group, contrary to the usual rule, the 
 defect is more common among girls. If there be no other defect, 
 
21 
 
 mental faculty may be average, but the child usually remains thin 
 -and delicate ; such children may, in after life, undertake good work 
 and do it, but are more liable than others to exhaustion, migraine, 
 and breakdown of the nerve-system. At school these children are 
 often delicate and irregular in attendance from ailments. 
 
 (4). Cranial Bosses. Cranial bosses are most usual at the site of 
 the ossific centres of the two halves of the frontal bone ; they may 
 occur at the sides of the head over the parietal centres and elsewhere, 
 as well as at the site of the anterior fontanelle. As to the frontal 
 bosses which are the more common, they are not always outgrowths 
 or thickenings of bone ; it is often found on section that they depend 
 upon a thrusting out of the frontal bone, a forward projection of the 
 wall of the cranium independent of bone thickening, and apparently 
 due to abnormal proportion in the bone growth. Occasionally these 
 bosses are unequal in development producing asymmetry of the head. 
 These bosses are probably largely due to rickets ; were all possible 
 means adopted for prevention of rickets, we should probably have 
 fewer children with cranial abnormalities and defects co-related 
 thereto. 
 
 (5). Defect of Forehead. All marked defects of the frontal bone, 
 other than bosses or frontal ridge and asymmetry, are here grouped 
 as a rather miscellaneous collection. The most common defect is 
 narrowness, the forehead being often at the same time shallow, but 
 cases of wide and overhanging forehead were included in the same 
 group. 
 
 (6). Frontal Ridye. The vertical suture between the two halves of 
 the frontal bone may be the site of a bony ridge present in all degrees 
 up to the prow shaped forehead of the scapho-cephalic child. Ap- 
 parently in its lesser forms this sign is not very important, unless it 
 be associated with a contracted forehead or other defect of cranium. 
 
 (7). Head Asymmetrical. As already said this asymmetry may be 
 due to one large lateral cranial boss or angular development ; it was 
 much more common to find the forehead on the left side sloping 
 away towards the temple. 
 
 The defect does not appear to be of more consequence than other 
 irregularities of the cranium when found in children otherwise 
 normal. 
 
 (8). Dolicho-cephalic. These long heads are usually also large, and 
 
22 
 
 the condition itself appears to be hardly pathological, certainly many 
 of these children were bright and intelligent. 
 
 (10). Other types of Cranium. This group includes 7 cases of 
 hydrocephalus : boys 5, girls 2 ; also oxycephalic, or elevated and 
 conical heads, and others with the anterior portion of the skull much 
 larger than the posterior segment. As these cases did not appear to 
 afford data for precise knowledge without detailed examination, they 
 are here passed over. 
 
 (11). Ears defectively made. Deviations from the normal in the size 
 and proportions of the parts of the external ears appear to be defects 
 in development, and not due to mechanical pressure in infancy. 
 
 The most usual defect is an ear large and outstanding, coarse in its 
 cutaneous covering, and red or bluish, often with slight varicosities, 
 the antehelix is often absent or imperfectly formed, and the helix may 
 be absent or contracted forming a cave-like ear. Such ears, like cold 
 blue hands, are liable to chilblains. The helix may be absent partially, 
 as in the middle part of the margin or for the whole rim. Such 
 defects are usually symmetrical, but not always. 
 
 As to the adherent lobe of the ear it was often seen, but not 
 specially in ears otherwise defective, and no reason appeared for con- 
 sidering it a marked sign of defect. Supernumerary ears were 
 represented by outgrowths in front of the* tragus, and depressions, 
 apparently representing remnants of branchial clefts, were occasionally 
 seen at the upper termination of the helix. There were two or three 
 children with almost total absence of the concha, which was represented 
 by a cartilaginous growth only. In one girl the ear was displaced 
 several inches by the contraction of a cicatrice. 
 
 (13). Defective condition of Palate. Defect of the palate, though less 
 frequent than that of the cranium, stands next to it, as having an 
 almost equally high pathological co-relation. Some facts will be 
 given as to the concurrence of defects of the palate with the cranium 
 and nasal bones as well as with rickets. 
 
 The principal defects of palate are in its proportions as seen in the 
 horizontal or vertical plane. Without being otherwise altered the 
 palate may be contracted laterally or narrow. The V shaped palate 
 is pointed more or less sharply at its anterior extremity, the alveolar 
 processes being nearly straight lines meeting anteriorly at an acute 
 angle. The high-arched or vaulted palate deviates from the normal 
 in the vertical plane. No observations are offered as to the relative 
 
23 
 
 value of these types. Among less common forms are the flat or low 
 palate, in some cases with forward projection of the upper incisors, 
 which are strongly inclined forwards in equine fashion in place of 
 being vertical ; this type is not common. 
 
 The suggestion having been made that defects of the nasal bones 
 might be associated with defect of the palate, the following particulars 
 are given from enquiry, 1888-91 : 
 
 Boys. Girls. Total. 
 
 Palate defective in cases of rickets 23 8 31 
 
 and cranium defective in rickets 21 6 27 
 
 defective, and nasal bones thick, wide, or sunken ... 14 15 29 
 and cranium defective, with nasal bones thick, wide or 
 
 sunken ... 43 7 
 
 Cranium abnormal, and nasal bones thick, wide, or sunken ... 36 29 65 
 
 Palate Crypts. One or more small pits or puncta are sometimes 
 seen on either side the raphe of the hard palate at its posterior 
 extremity, or they may be represented by slender lines sloping out- 
 wards and forwards, looking almost like scars. We do not know 
 their origin or significance, but they do not appear to be either a 
 normal development or an effect of disease. They were not looked 
 for in all palates, as a good light and convenient circumstance are 
 needed for their detection. 
 
 (19). Nasal Bones Defective. The bony bridge of the nose may be 
 wide and thick, or it may be sunken and depressed. It appears to be 
 sometimes a temporary condition. A family of children was seen in 
 whom this feature was marked in the younger children only and we 
 were told that the older members presented the same condition in 
 their earlier years. This condition has been referred to in describing 
 palates; in only 4 cases of Kickets was this noted. 
 
 (20). Children small for aye. The co-relations appear to indicate 
 that small grown children are at a disadvantage. Many of the 
 children with small heads were small in growth also; in such cases 
 the child was registered under both headings, but it will be seen that 
 the number of children with small heads was much larger than the 
 number with small growth. This is an example where normal 
 proportion in the body is not to the child's advantage; the small 
 headed child is probably better fitted for after life when its growth is 
 otherwise normal. 
 
 Some of the cases appear to be due to Rickets. 
 
 Among the smaller groups to be dealt with, the co-relation value 
 varies greatly. It seems as though some of the less common defects 
 
24 
 
 were greater indications of departure from the normal, than those 
 more commonly seen. 
 
 (21). Cases presenting "other defects in development" This group 
 contains the signs of defective development not printed as headings 
 in the columns of the Register; the group is kept together for the 
 sake of convenience in dealing with "Binary defects in development." 
 Further work in determining the value of these signs respectively is 
 obviously desirable ; some appear to have a high co-relative value. 
 
 The number of cases in many of these sub-groups is too small to 
 suggest a complete analysis of them, but the co-relations of the most 
 numerous or the most interesting are given. 
 
 Sub-groups are as follows : 
 
 Cases seen 188891. 
 
 (30). Hands blue and cold . . Boys 17. Girls 11. Total 28. 
 
 With nerve-signs ,,14. 8. 22. 
 
 With low nutrition ,, 3. 4. 7. 
 
 With defect in development 12. 6. 18. 
 
 Dull 9. 6. 15. 
 
 This group though not numerous demands attention, as those 
 children presented many defects. This condition appears to be more 
 common in resident than in day schools ; it appears independent of 
 weather, though cold may increase it and cause chilblains. The cases 
 were seen in the following months March 1st, July 2nd, September 
 2nd, October 16th, November 7th. Among these cases were : Cranial 
 abnormalities 5, Defective palate 3, Icthyosis 1, Ptosis 1, Mentally 
 defective 5. 
 
 (39). Palpebral Fissures, small. The eyelids may be small as well as 
 the opening between them, both in the transverse and vertical 
 measurement. In some cases the opening is not symmetrical, being 
 w r ider on the inner than in the outer half; the transverse axis may 
 slope downwards and outwards, or upwards and outwards in place of 
 being horizontal. In these cases we sometimes find the mouth also 
 small, so that the face being of the normal size, the space between its 
 openings appears large, giving a peculiar aspect or physiognomy. 
 
 We now pass on to the abnormal nerve-signs observed. 
 
 (44). Expression defective. We may describe the visible muscular 
 action seen in a face, and still there may be an expression in it 
 which entirely baffles description in anatomical terms. Further, 
 a face may be balanced or moved abnormally by the action of certain 
 
25 
 
 muscles, and yet it may carry upon it a good expression. We may 
 describe action in the frontal muscles, the corrugators, the orbicularis 
 oculi, &c., and over and above this we have the general expression 
 of the face superadded. Certain terms are useful in describing 
 expression ; there may be a fixed expression, want of variation, i.e., 
 one fixed uniform action or balance of muscular tone ; or we may have 
 to use more general terms, such as " defective," " bad." There may 
 be no expression, i.e., none other than that indicated by form or 
 modelling of the features. 
 
 (45). Frontals Overacting. The frontal muscles almost always act 
 symmetrically, at the same time and in similar degree ; their action 
 produces horizontal creases in the forehead, which may be deep if 
 these act strongly. Sometimes the muscles are seen working under 
 the skin in vermicular fashion, with an athetoid movement; in other- 
 cases the action is fine, producing minute creases, and what might be 
 called a dull forehead. This over-muscular action does not necessarily 
 erase expression. Such overaction may be seen in children from 
 earliest infancy upwards ; the condition may be temporary, and 
 having lasted a sufficient number of years to produce creases in the 
 forehead, it may pass away. These muscles are often more quiet 
 when the child is at work or being talked to than when let out to 
 play ; the mental attitude termed quiet attention is that under 
 which the frontal area is the most quiet. 
 
 (46 ). Corrugation. Corrugation, or knitting of the eyebrows, is due 
 to overaction or hypertonicity of the corrugator muscles ; vertical 
 creases are produced by overaction, and a fine wrinkling of the skin 
 producing local dulness is sometimes seen. This sign seems more 
 closely associated than any other single sign with some forms of 
 mental stress, and may be seen in children suffering from the effects 
 of fright, illusions, &c. ; it may form part of a fixed immobile expres- 
 sion. Corrugation may be associated with overaction of the frontal s 
 in a similar athetoid defect, producing square creases vertical and 
 horizontal, or in finer degree the combined action may produce a dull 
 forehead. 
 
 When the athetoid condition is present we cannot judge of the 
 mental state by such expression. 
 
 (47). Orbicularis Oculi Relaxed. In a strong and well toned face the 
 lower eyelid appears clean cut and well moulded, and the rotundity 
 of the eyeball and convexity of the lower lid are seen ; this sharpness 
 
26 
 
 is due to the good tone of the orbicularis oculi. When this muscle 
 is relaxed and toneless the skin under the lower eyelid bulges forward 
 and is baggy. This relaxed condition is indicative of fatigue and 
 exhaustion, and is seen in the nerve depression accompanying severe 
 and incessant headaches; these puffy eyes are usually symmetrical. 
 
 That the condition is muscular is demonstrated by making the 
 patient laugh when the swollen look is removed. 
 
 (48). Eye Movements Defective. Some children, when an object is held 
 in front of them and then moved, follow it, not with the movement 
 of the eyes, but with the head, keeping the eyes fixed. In other 
 cases there are restless uncontrolled movements of the eyes ; both 
 conditions are included under this heading; the former is most 
 commonly met with ; the two conditions may co-exist. 
 
 (50). Hand Balance Weak. When the hands are held out to 
 command, the average balance, is with both upper extremities hori- 
 zontal on a level with the shoulders, the hands being pronated, and the 
 metacarpal bones and digits all in the same plane; such is the normal. 
 In the type described as "Hand balance weak," the hand, when 
 held out, is slightly drooped or flexed at the wrist, the palm or 
 metacarpus slightly contracted or arched laterally, and the digits 
 moderately flexed. The type may be varied: with less degrees of 
 weakness the hand is as in the normal with the thumb drooped 
 only ; in exhaustion and great feebleness the metacarpus is more 
 contracted or adducted, and the degree of flexion is greater. 
 
 A bad type is seen when children holding out their hands droop 
 both thumbs and bring them together in the median plane. 
 
 (51). Hand Balance Nervous. In this posture the wrist is slightly 
 drooped or flexed, the palm of the hand slightly contracted, the 
 thumb extended backwards, and the fingers at the knuckles are 
 over-extended. 
 
 The various elements in this posture may vary in degree; the 
 most essential element appears to be the extension backwards of the 
 fingers at the knuckle joints, and this may affect the various fingers 
 differently. The term used for this posture is empirical. 
 
 It is common in children with slight chorea, and in those who are 
 the subjects of night-terrors and tooth-grinding, it also accompanies 
 recurrent headaches. 
 
 It has been represented by artists in antique bronzes and drawings 
 on vases, as well as in modern works, especially in female figures. 
 
27 
 
 (53). Lordosis. This arching forward of the lumbar spine is due 
 to weakness of action among the spinal muscles. When a child 
 holds out his hands the centre of gravity of the body is moved 
 forward. In a strong child this is not followed by marked change of 
 posture in the spine, but in a weak child lordosis may follow, often 
 with temporary lateral curvature and unequal balance of the 
 shoulders while the head and neck are thrown back. 
 
 (56). Grinning and Over-Smiling. Grinning or over-smiling is 
 usually symmetrical, but may be unequal on the two sides of the 
 face. 
 
 With low class brain conditions it is sometimes seen as almost the 
 only facial movement occurring upon any stimulus as a uniform 
 movement, almost as athetoid in character as the frequent overaction 
 of the frontal muscles. 
 
 Habitual grinning, and in particular the finer forms of over- 
 smiling, often leave permanent naso-labial creases marked upon the 
 skin ; these may remain after the habit has been lost. If the skin be 
 thin, a duplicate or triplicate naso-labial crease may be formed ; this 
 is more common in neurotic than in imbecile subjects. 
 
 (57). Mouth Open. The open mouth in a child usuaUy depends 
 upon the dropping of the lower jaw. This habitual dropping of the 
 jaw depends upon want of tone in the temporal and masseter muscles, 
 rather than upon spasm of the depressors ; it may be called to mind 
 that this want of tone is due to lessened stimulus of the motor 
 division of the fifth nerve, whose sensory branches are largely 
 distributed to the meninges ; weakness of this nerve leads to open 
 mouth, irritation of it to tooth-grinding. Of course this condition 
 of " mouth open " is only to be looked upon as a nerve-sign when the 
 respiratory passages are unobstructed. 
 
 (59). Response in Action Defective. Dealing with groups of children 
 in a uniform method of examination as described, it becomes easy to 
 note the response to the word of command as seen in the action fol- 
 lowing. Response in action may be accurate or uncertain, there may 
 be delay between hearing the command and the response; some 
 children look at the others before responding in their movements, 
 they seem more easily controlled through the eye than through the 
 ear. 
 
 The response should be quick and accurate, the standard to be 
 expected is soon learnt by a little experience. The action may be 
 
28 
 
 long continued, the hands of the child being held out long after the 
 others have dropped them. There may be want of impressionability 
 to the stimulus of the command, which may have to be repeated 
 before the action follows ; response in imitation by sight may be, and 
 often is, much better than that following the word of command. 
 There are some children in whom the sound of a command may be 
 followed by a number of irregular movements, whereas an indication 
 through the eye, by a gesture of command on the part of the inspec- 
 tor, is quickly followed by accurate and good response. 
 
 (60). Speech Defective. Defective conditions of palate are consistent 
 with good speech, an impediment is not usually the mechanical effect 
 of the form of palate. It does however often happen that with defect 
 of speech we find an arched or a narrow palate with co-existent cere- 
 bral feebleness. 
 
 The speech of children is very important; it may be almost absent, 
 or accompanied by stammering or impediment. On putting a question 
 it may be long before the reply comes, the question may be repeated 
 without further reply ; speaking to the child may be followed by a 
 large number of irregular movements and asymmetrical postures 
 awkward action but not by a verbal reply. 
 
 Binary Defects in development as to their numbers and co-relation with 
 Mental Dulness, Abnormal Nerve-signs, and Low Nutrition. The 
 defectiveness in the make of a child is more strongly indicated when 
 two malformations are present than with one only. The cases of 
 binary defects have been arranged in Table XI, which shows that the 
 frequency of occurrence of the combinations differs greatly. The 
 number of combined defects registered was: Boys 1240, Girls 683; 
 total 1923. (Cases 1888-91 only). 
 
 The number of children presenting binary defects has not been 
 determined ; some children presented more than two defects so that 
 their number must have been less than the number of cases given 
 above, probably not two per cent of the children had more than two 
 defects. 
 
 A fair estimate of the co-relation of the combined defects may be 
 given in percentages. 
 
 With Mental Dulness 45'7. 
 
 With Low Nutrition 31-0. 
 
 With Nerve-Signs 60-3. 
 
 This co-relation is higher than for single defects. 
 
Information is then given as to the co-relations of Defects in 
 development of the body as they occur, singly and in combination. 
 
 The statistical records of the cases seen 1888-91, and of cases seen 
 1892-94, are in the hands of the present Committee, and have been 
 used as the basis for this Eeport. Figures relating to each enquiry 
 are given in the various Tables. 
 
30 
 
 CHAPTEE V. 
 
 IS T OTE BY DR. FKANCIS WAKNEB 
 
 On the scientific value and significance of the signs employed. 
 The Cases here referred to ivere seen in 1888-91. 
 
 Commencing my research by the study of physiognomy, cranial 
 form and conditions of development of the body, it soon became 
 obvious that these points were too far removed from the direct 
 evidence of mental status such as it was desired to obtain. Indica- 
 tions of the individual's status in development are signs of his con- 
 genital make rather than of his culture ; signs of habitual and 
 actual present modes of working of the nerve system were needed. 
 It then became necessary to study brain conditions by direct observa- 
 tion of nerve signs expressing them. 
 
 In the methods ordinarily employed in clinical study of the nerve 
 system, movements of various kinds are the principal signs looked 
 for and recorded ; we note such actions as the patient may perform 
 and we experiment by applying certain stimuli to the nerve centres, 
 by examining reflex actions, by electrical tests, and by movements imi- 
 tated through the eye or performed to the word of command. All 
 expression of mental action is by movement, whether in speech, 
 gesticulation, and facial expression, or by writing, which is a result 
 of movement. It is by logical analysis of the neural action corres- 
 ponding to such visible movement that we may hope to demonstrate 
 the kinds of nerve action which correspond to mental states. My 
 former endeavours in this direction have been published [" Mental 
 Faculty," Cambridge University Press]. In seeking to arrange a set 
 of signs available for the present enquiry it was then in motor signs 
 that the work had to be advanced. In 1879 I was able to publish a 
 few more nerve signs,* and in 1883 87 described apparatus for 
 recording movements by graphic methods ; the apparatus is now in 
 the South Kensington Museum. 
 
 Tracings of movements are permanent records capable of analysis ; 
 they indicated the part moving and the time, and frequency of action 
 in the nerve-centres corresponding, and also rendered it possible to 
 record the conditions antecedent to such action. 
 
 While studying visible movement it became obvious that certain 
 
 * Brit. Medical Journal, Dec. 6th. Journal of Physiology, Vol. IV. Vol. VII. 
 
31 
 
 typical postures often correspond with definite and definable physio- 
 logical and pathological conditions, and might, therefore, be used in 
 recording such states. Such observations and lines of study lead to 
 the enumeration of new clinical signs ; we shall observe the part 
 moved, the time and the quantity of action, and where possible the 
 antecedents and sequents of the act. The value of such nerve-signs 
 lies in the fact that they indicate to us the action of nerve-centres or 
 loci of nerve tissue, thus affording evidence of action in the brain 
 mass. The part moving and the direction of its movement are of 
 course described in anatomical terms, the time and the quantity of a 
 motor act are its observable attributes, the former is seen during the 
 act, the quantity is often best estimated by the balance or posture of 
 the parts resulting from the movement hence we study movements 
 and postures. 
 
 The antecedent of the movement is important to the value of the 
 observation, hence in the school enquiry great care was taken as to 
 uniformity of method and of word of command in viewing the 
 children. Analysis of movements enables us to give definite nerve- 
 signs; it is in terms implying combination and series of movements that 
 general nerve-states are most conveniently described. Movements are 
 often observed without any known circumstances stimulating them 
 such are seen in the infant's movements in uncontrolled movements 
 of eyes and in finger twitches. The movement of a single part may 
 be uniform in time and quantity, or it may vary. When action in 
 several parts is noted we have a combination and series of com- 
 binations of acts, making up a complex phenomenon such series 
 may be classified as follows, and the nerve-action corresponding may 
 be indicated. 
 
 1. Uniform series of acts. 
 
 2. Diminishing series of acts. 
 
 3. A series of acts adapted by circumstances. 
 
 A uniform frequently repeated or athetoid series of acts is seen in 
 the overaction of the frontal muscles and corrugators to be described, 
 as well as in some forms of defective expression and in tremor. It 
 corresponds to action of a certain group of nerve-centres in repeated, 
 often uncontrolled action. 
 
 An augmenting series of movements, corresponding to a spreading 
 area of nerve-action may be seen in a spreading smile or facial 
 expression, or a burst of laughter, and in the march of movement as 
 from face to head and hand in protrusion of the tongue on any 
 
32 
 
 stimulation; in the head held on one side when any question is asked, 
 and in the fidgetty fingers of the examinee. Such spreading action is 
 antithetical to good intellectual function. 
 
 A diminishing series of acts with lessening of the area of motor 
 cells in activity, is seen in the child who is getting quieter after some 
 excitement. 
 
 In action adapted by circumstances, we have a high-class function 
 commonly called co-ordinated action, and if the co-ordinating con- 
 ditions were some time antecedent, the action is considered more 
 strictly mental in character. 
 
 Let me describe the facts seen in an infant, and make deductions 
 therefrom. In a healthy new-born infant we find movement in 
 all its parts, while it is awake, i.e., while its brain is in full 
 functional activity. These movements may be seen in the limbs, 
 especially in the digits, which may move separately ; they are slower 
 than most of the movements in adults, they are almost constant and 
 are but little under control of impression through the senses. Such 
 spontaneous movement I described under the term Microkinesis in 
 1888.* When the infant is about three months' old we may observe 
 some control of its movements through the senses. The microkinesis 
 remains as the marked character, but the combination of nerve- 
 centres acting, are to some extent co-ordinated by sight and sound. 
 At the age of four or five months further evidence of control of the 
 centres through the senses is seen ; the sight of an object may tem- 
 porarily inhibit the movements, and this may be followed by turning 
 of the head, eyes and hands, towards the object seen, i.e., the co- 
 ordinated movement occurs sequent to a period of inhibition of 
 spontaneous action following stimulation. We infer from such 
 observations that at birth the nerve-centres act slowly and in- 
 dependently of one another, and the time and order of their action 
 may be temporarily suspended by external stimuli, and during the 
 time when no efferent currents are passing from them to produce 
 visible movements, they undergo a change, subsequently indicated by 
 new and special co-ordinated movements. 
 
 This appears to be a new and great advance in the infant's cerebral 
 evolution.t When a year old, action well adapted by impressions 
 received becomes very marked, and the child makes certain charac- 
 
 * Proceedings of the Royal Society, Vol. XLIV., and Journal of Mental 
 Science, April. 
 t The Study of Cerebral Inhibition. Brain, Vol. LXIII. 
 
33 
 
 teristic sounds on sight of certain objects ; its spontaneous brain 
 action becomes gradually more and more capable of co-ordination. 
 
 It appears that whereas at birth the most marked character of the 
 nerve-centres is the spontaneous action of individual loci of nerve 
 tissue in advancing evolution this spontaneity is not lost, but remains 
 as the foundation of so-called voluntary and intellectual action 
 becoming more controllable by circumstances. Aptitude for mental 
 action appears to depend upon the capacity of nerve-cells for control 
 through the senses, such impressions temporally inhibiting their 
 spontaneity and arranging them functionally for co-ordinated action. 
 The imbecile infant does not show this microkinesis in the normal 
 degree, its nerve-centres are wanting in spontaneity, and later 
 in capacity for co-ordination. 
 
 It is not my intention here to branch off into the study of physio- 
 logical psychology, but it is quite possible to follow the apparent 
 grouping of action in nerve-cells corresponding to many well-known 
 modes of mental action. It may be shown that well co-ordinated visible 
 movements usually accompany well controlled mental action, and a 
 spreading area of movement not controlled often accompanies mental 
 confusion. 
 
 This spontaneous movement, slightly under control, is the character 
 of healthy brain action of children in the infant school, so that 
 postures are less available as signs among these very young children, 
 and spontaneous movements of their fingers is the normal action. 
 The parts of the infant are then full of spontaneous movements ; an 
 exception is in the eye movements, which are not frequent in many 
 cases. One of the endeavours of infant training should be to en- 
 courage eye movements, then to control them. 
 
 Speaking briefly of the neural action corresponding to some form 
 of mental action, we may take the common example of imitation 
 through the eye. Here the objects imitated are gestures or move- 
 ments in another person. "When the child imitates the teacher, it 
 appears that the sight of certain movements in the teacher is followed 
 in the child by action in the nerve-centres, which correspond to those 
 in action in the teacher. This appears to be a result of their common 
 inheritance. 
 
 Imitation may also be through the ear, as when the pupil repeats 
 the question asked. Many of the children performed the movements 
 desired better by imitation from my movements than from the word 
 of command. Imitation may be followed by adapted action, as when 
 after repeating the question asked, the child proceeds to answer it. 
 
 C 
 
34 
 
 Imitation through the eye seems to be the simpler for the child than 
 to obey a verbal command ; children slow in action will look to see 
 what the other children do and then copy them. 
 
 The postures or attitudes of the body imply balances, or ratios of 
 action in the nerve-centres corresponding ; the clenched fist or con- 
 vulsive hand is common in fits and in tetany. These postures indicate 
 relations in quantity of action among nerve-centres. If we take the 
 2,285 cases seen 1888-91 representing deviations from the normal 
 balance of the hand when held out, we find that 1,029 of them 
 presented visible defects in development also, that is to say, in nearly 
 half of these cases with unusual or defective ratios of nerve-action the 
 proportioning of parts of the body was visibly abnormal. This suggests 
 the hypothesis that the forces or antecedent conditions which caused 
 ill-proportioning of the body may also have caused a tendency to ill- 
 balancing of nerve-centres. The converse of the proposition may be 
 true ; we have not as yet had sufficient evidence, but the suggestion 
 may guide enquiry; it may be found that as over-action of the 
 frontal muscles is very common with defects of the cranium, and 
 overaction of the frontals is largely the outcome of want of mental 
 stimuli, further culture of the mental faculties will improve the 
 average cranial development and lessen over-action of the frontals at 
 the same time. 
 
 In former writings* I have given a catalogue of specimens showing 
 .that in living things the time, quantity, proportions, and kind of 
 growth may be controlled by physical forces, such as mechanical strain, 
 heat, light, gravity, sound, &c. 
 
 It has also been shown that the distribution of abnormalities of 
 development varies greatly in different districts ; this may be owing 
 to local circumstances. If we take the 5,487 cases with abnormal 
 nerve-signs, we find among them 3,071, or 56*0 per cent., who also 
 present defects in development ; conversely among the 5,851 cases of 
 defects in development, we find 3,071 cases with abnormal nerve- 
 signs, i.e., 52*4 per cent. 
 
 If we take cases with two defects in development, such as are given 
 in Table XVIII., we see that they are co-related with nerve-signs 
 in percentage, varying from 43'2 up to 68'0. 
 
 The general statement that mal-proportioning in visible parts of 
 the body and abnormal nerve-signs are often coincident, may be 
 
 " Anatomy of Movement," Hunterian Lectures, 1887. 
 
35 
 
 further illustrated, and such enquiry may lend some support to the 
 hypothesis that both kinds of defects may be due to the action of 
 physical forces controlling quantities or ratios of vital action. 
 
 In Eickets there is a marked tendency to mal-proportioning in the 
 skeleton : this is seen in epiphyseal over growth, in unequal bilateral 
 growth of the shafts of bone producing curvatures, and in the skull 
 producing bosses and deformities. This tendency to mal-development 
 may affect the features and soft parts; among 196 rachitic children 
 15 were small in growth, and 40 presented defects of ear, epicanthis, 
 features, palpebral fissures, mouth, &c. This also is a condition that 
 falls much more commonly upon the boy than the girl, about one- 
 third of these mal-proportioned rachitic children presented abnormal 
 nerve-signs and mental dulness. 
 
 In observing conditions of development and physiognomy as indica- 
 tions of probable conditions of mental status, as in older physiognomical 
 studies, the assumption is made that visible conditions of defect in 
 form are more or less necessarily coincident with defective brains. 
 Such correspondence does, doubtless, often occur, but the generaliza- 
 tion is too empirical to be applied with safety to the individual 
 child. Here the observation of a number of abnormal nerve-signs, 
 helps to supply the missing link and observations quoted show that 
 among children with defects in development and abnormal nerve-signs 
 one-third are reported by the teacher as dull at school lessons. 
 
 In the .Report and in quotations from it the term "Defect in 
 Development" is frequently used; this signifies deviation from the 
 average or normal. I do not wish to assert that these signs are 
 degenerations, the evidence derived from ancient works of art shows 
 that many are of ancient date, it appears that in some classes there 
 may be irregularities which further evolution, if wisely guided, may 
 remove with their attendant evils. 
 
 Among the 2,961 Jew day school children, an ancient race, 
 uniformality of development was very marked with 7'5 per cent, of 
 deviations from the normal, and all points in nutrition, nerve-action, 
 and mental status, appeared more regular among them than with 
 our English children. When it is pointed out that of English day 
 school children 10*8 per cent, and of the Jew children 7*5 per cent, 
 present deviations from the average development, it is obvious the 
 proposition may be put thus, the English children to a percentage of 
 89'2 and the Jew children to a percentage of 92'5 have evolved to an 
 average type. 
 
 It is very usual to see disordered conditions of the nerve system in 
 
36 
 
 children with defective construction of body, this was the case in 3,071 
 children; we may see these nerve disturbances in children of normal 
 construction of body, this was noted in the report in 2,416 children, 
 here such signs would appear to result from the disorder produced by 
 special circumstances rather than from defects in original construction. 
 
 In illustration, children fatigued and in the condition of chorea, 
 may be described. Among signs of fatigue are the slight amount of 
 force expended in movement often with asymmetry of balance in the 
 body, the fatigued centres may be unequally exhausted, spontaneous 
 finger twitches like those of younger children may be seen and slight 
 movements may be excited by noises. The head is often held on one 
 side, the arms when extended are not held horizontally, usually the 
 left is lower, the hand balances in the weak type of posture often 
 again more markedly on the left side. 
 
 Facial expression is lessened and the orbicular muscles of the 
 eyelids relaxed, leading to fulness under the eyes, while the eyes 
 themselves fix badly. 
 
 The purpose in view is to show that we may give descriptions of 
 children in terms connoting signs observed even when we are recording 
 indications of brain-states indicative of potentiality for mental action. 
 A description may be given of a typical case of what is commonly 
 called a " nervous child," such children are apt to be irritable and 
 passionate and often suffer from headaches and hacking cough 
 without lung disease. Let the hands be held out, with the palms 
 downwards, and the fingers separated. The left upper extremity is 
 often at a lower level than the right ; the " nervous hand " is seen 
 on either side, perhaps more marked on the left. There may be 
 finger twitching, separate digits moving in flexion and extension, or 
 laterally in adductor and abductor movements. The spine is arched 
 too forward in the lumbar region, often with inequality in the level 
 of the shoulders and slight lateral curvature. The face as a whole is 
 usually too immobile, although there may be some over-action of the 
 muscles widening the mouth on one or both sides. The tongue when 
 protruded is too mobile. 
 
 The eyes move, mostly in the horizontal direction, their movements 
 not being fully controlled by the sights and sounds of the objects 
 around, except under strong stimulation. The head is sometimes 
 partially flexed with inclination and slight rotation towards the same 
 side. 
 
 Some of the teeth are usually found ground at their tips ; this is 
 most commonly the case with the canines. This grinding action is- 
 
37 
 
 produced by the masticatory muscles during sleep, and is owing to 
 irritation of the fifth pair of cranial nerves. We may here call to 
 mind the fact that the sensory division of the fifth nerve is distri- 
 buted to parts inside the skull as well as those outside it. 
 
 The individual signs suggested for observation in this enquiry 
 have been given, but it is convenient here to make some remarks 
 upon the parts of the body whose movements and balances in action 
 are the most expressive of special nerve conditions. 
 
 The face is the most accurate index of the action of brain. 
 
 It is convenient to divide this region into three zones, the frontal 
 above the line of the eyebrows, and a middle zone separated from the 
 lower by a line at the level of the lower margin of the orbits. 
 
 The greatest degree of expression is, I think, seen in the frontal 
 region, mainly produced by action of the frontal and corrugator 
 muscles. 
 
 In looking at the mid-zone of the head and face, the observer's 
 eye traverses it from ear to ear, noting these features, the palpebral 
 fissures and the tone of the large orbicularis oculi muscles, the bridge 
 of the nose both in its bone and soft tissue, as well as the eyeballs 
 and their movements. 
 
 Signs are given for each of the three zones. 
 
 The hand when held out free and not mechanically restrained, 
 affords the next most important index by its movements and the 
 balance of its parts ; I have described eight typical hand postures, 
 but found in practice that two were sufficient for the present 
 purposes. 
 
38 
 
 CHAPTER VI. 
 
 THE GKOUPS OF CHILDBEN AND GEOUPS OF 
 
 CASES. 
 
 We proceed to review the children as groups of cases arranged 
 according to their mental and physical status ; as we proceed many 
 children must be shifted from one group to another. As far as 
 possible the groups specially referred to are given in the same order 
 as in the catalogue (see page 82), in which the groups are enumerated, 
 and to which reference numbers are appended. For the purposes of 
 comparison and remark, it has been found convenient to bring 
 together the dull children and the afflicted children. 
 
 GROUP 1 Normal or Average Children. 
 
 Such children are the average as presenting no visible defects or 
 abnormal conditions in development, in nerve-signs, or in ordinary 
 work with the teachers in school. These children were passed over, 
 and no notice was taken of them, beyond their number and distri- 
 bution in the school standards. 
 
 It would be interesting to review these children for the purpose of 
 determining their relative points of excellence ; this could be done, 
 taking as the standard points of excellence, and using anthropometric 
 and nerve-tests indicating superior development and perfection of 
 nerve-action. Scholarships and the means of higher education might 
 with advantage be given to the children of best physique and brain 
 power. It is seen here, as elsewhere, that the girls take a general 
 precedence of the boys in freedom from defects during school life. 
 
 GROUP 3 Eye Cases. 
 
 No tests were used as to acuteness of vision, or errors of refrac- 
 tion, but when the eyes were looked at obvious defects were noted. 
 Cases of ophthalmia were not registered, but some of its late effects 
 were recorded under the headings "Disease of Cornea" and "Eyes 
 lost by Disease." Ophthalmia was seen in several day schools. 
 The number of children said to have lost an eye by accident seems 
 to be large ; in one school two brothers had each lost an eye from 
 playing with toy guns. 
 
 Under the heading " Squint," cases of organic strabismus requiring 
 
39 
 
 operation, as well as examples of varying strabismus, are recorded; 
 probably many are instances of hyper-metropic strabismus that might 
 be corrected by spectacles. 
 
 Children using spectacles in school were enumerated among " Eye 
 Cases," and as errors of refraction are known to be very common, a 
 majority of them must have been undetected in this inspection, it 
 follows that a small number of eye cases here noted in a school does 
 not necessarily indicate the presence of but few cases requiring 
 attention. The group of children registered as "Eye Cases" demon- 
 strates what a large amount of ophthalmic work is needed among 
 children, and the fact that with 1,622 cases of Squint, only 644 
 children had convex glasses, shows that spectacles must be required 
 by many who do not use them. 
 
 GROUP 4 Cases of Rickets. 
 
 188891 .... Boys 157. Girls 39. Total 196 
 Probably more children were or had been rachitic than those 
 registered ; when the conditions seen in the bones left no doubt the 
 case was registered accordingly, but the body could not be examined 
 in detail under the conditions of this inquiry. It seems that a great 
 characteristic of the conditions termed rickets is the malproportion of 
 growth in the skeleton, especially about the cranium. It is shown 
 that the palate is frequently ill formed, and also that defects in 
 development other than cranium and palate were found. The patho- 
 logical question might be raised whether a large proportion of the 
 cases registered as " Cranial Bosses," a sub-group of the cranial 
 abnormalities, were not really cases of rickets. These rachitic 
 children are badly proportioned ; among them were as follows : 
 
 Conditions presented by the Rachitic children. 
 
 Boys. Girls. Total. 
 
 143 25 168 Cranial abnormalities arranged below in sub-classes. 
 79 14 93 Head large and ill-formed. 
 51 9 60 Cranial bosses, principally frontal and usually 
 
 symmetrical. 
 
 819 Forehead mis-shapen. 
 303 Head asymmetrical; sometimes one frontal boss only 
 
 developed. 
 
 101 Dolicho-cephalic. 
 112 Headsmall. 
 23 8 31 Palate defective in form. 
 21 6 27 Cranium and Palate defective. 
 
40 
 
 Boys. Girls. Total. Condition presented by Rachitie children (cont.) 
 
 58 11 69 Defects in development other than cranium and 
 
 palate. 
 
 32 13 45 With indications of low nutrition. 
 54 15 69 With abnormal nerve-signs. 
 64 10 74 Eeported as dull by the teachers. 
 
 Of these Rachitie children 69 presented defects other than those 
 analysed above, they were as follows : 
 
 Boys. Girls. Boys. 
 
 Small in growth . . 10 5 Features coarse 3 
 
 Defect of Ear .. .. 23 2 Palpebral fissures small .. 2 
 
 Epicanthis . . . . 6 2 Mouth small 1 
 
 Deaf 2 1 Forehead hairy 1 
 
 Nasal bones wide . . 4 Congenital defect of hand . . 1 
 
 Prognathous .... 1 Congenital defect of eyes . . 2 
 
 Frontal ridge .... 1 1 Epilepsy 1 
 
 GROUP 28 Cases presenting Defects in Development. 
 
 Conditions of mal-development stand as the largest class of visible 
 defects observed ; their co-relation is high, and as signs easily 
 recognised and capable of description and classification, they stand 
 prominently forward as pathological conditions characterising por- 
 tions of the child-population as deviating from the average or normal. 
 
 The importance and the difficulty of defining and maintaining a 
 fixed standard of defectiveness or deviation from the normal has been 
 referred to. Analysis and comparison of cases show the signs of 
 defective development observed to be of different value and signifi- 
 cance, to demonstrate this the co-relations of each sign have been 
 determined; from the point of view of estimating the potential 
 mental capacity, these signs are only of value in as far as experience 
 gained by observation shows their average co-relations with cerebral 
 or mental defects. 
 
 Defects in development mainly indicate congenital and constitu- 
 tional conditions or results of inherited impressions, perhaps in 
 part due to the environment of the parents, with a pre-disposition 
 to delicacy both in body and in brain-action ; they are very frequently 
 met with in all classes of society, not least so among the upper social 
 grade. (See Tables XVI., XIX., XXVI., XXVII., and XXVIII.) 
 
 It appears probable that to a great extent, such defects may be 
 rendered less numerous among the population by hygienic care with 
 regard to buildings, light, and air. 
 
 If State medicine is to make any effort to remove these faults in 
 
41 
 
 development among the population, descriptions of groups of children 
 must be given in terms indicating their bodily condition, and defects 
 in form and proportions will probably first attract the attention of 
 scientific workers in this direction. 
 
 If we could discover the causes of mal-development and remove 
 them, we should have fewer children with abnormal nerve-conditions, 
 low nutrition, and mental dulness. It appears that one means of 
 studying the causation of physical defects may be by observing their 
 local distribution. The cases seen in 1888 91 distributed in 20 
 localities and in certain groups of schools were given in a former 
 report.* 
 
 It should be distinctly stated that a defect in development may not 
 be accompanied by any defective condition in the individual, yet the 
 case may serve us in giving some clue as to the causation of such 
 defect ; for this reason each defect, or rather its absence, was looked 
 for in each child seen. Children presenting one, or even two defects, 
 are by no means necessarily in any further sense abnormal children, 
 or exceptional from an educational point of view. Cases of mal- 
 development form a good standard for determining the material 
 in a school. 
 
 GROUP 29 Cases Presenting Abnormal Nerve Signs. 
 
 This group of children is nearly as large as that presenting defects 
 in development, this fact and its co-relations demonstrate that the 
 observation of movement and balances of the parts of the body may 
 give important indications of the conditions of children. 
 
 This group of signs indicates the activity and balance of action of 
 the nerve centres ; the conditions thus indicated may be temporary ; 
 the observer can but note what he sees and repeat his observations. 
 In some cases the postures assumed are in imitation of the teacher, or 
 have been taught in the school, and many defective actions are 
 clearly removable by careful training and well regulated exercises. 
 
 These defective signs indicating as they do brain status much 
 associated with mental dulness, may in most cases be removed by 
 good training here is an outcome of this work presenting a hopeful 
 aspect and one worthy of earnest attention on the part of educators. 
 It is of more importance to have a child's brain in good working order, 
 and well trained and brought under control, than that he should 
 acquire any special knowledge without this. The purely physical aspect 
 of the case is that all abnormal nerve signs are largely co-related with 
 
 * Journal of the Royal Statistical Society. Vol. LVI. March, 1893. 
 
42 
 
 defects in development, that is to say, some mal-proportion in the 
 parts of the body is largely associated with a tendency to ill-balance 
 among the nerve centres. 
 
 The significance of these signs varies in two directions ; some indi- 
 cate an over mobile nerve system, the centres tending to separate and 
 spontaneous action, not well under control through the senses, of 
 which finger twitching is the type ; and a second set which indicate 
 low class brain development, these are mostly repetitive uniform 
 movements, athetoid in type and represented by chronic overaction 
 of the frontal muscles and repeated grinning. Much further analysis 
 as to the grouping of these signs is needed to elucidate their full 
 significance. Others again indicate general low nerve power specially 
 relaxation of the orbicularis oculi, the weak hand posture and lordosis. 
 The type commonly called a nervous child is characterised by lordosis, 
 the nervous hand posture and finger twitches; such children are often 
 mentally bright and these signs have the lowest pathological co- 
 relation. 
 
 Of all signs the tone of the orbicularis oculi is the earliest sign of 
 commencing fatigue, a relaxed and toneless condition may be due to 
 many causes, such as late hours the previous day, mental exhaustion 
 or ill-ventilation. It is very common as an accompaniment of head- 
 aches. 
 
 As to the children presenting irregularities in action of the nerve 
 system, " Nerve cases," their careful training in school may do much 
 to prevent them from growing up permanently nervous or mentally 
 dull ; under unfavourable training the proportion with nerve signs 
 and the proportion with mental dulness rises. 
 
 GROUP 30 Cases Presenting Low Nutrition. 
 
 Low nutrition was recorded against any child seen to be pale 
 and thin or delicate ; it is not sufficient to look at a child's face, the 
 limbs should be felt to ascertain that the child is not thin in the 
 body, though fat in the face as is commonly the case with nervous 
 children, in whom the face is often the best nourished part. No 
 enquiries were made as to the feeding of these children, but it may 
 be assumed that in the resident schools, and among the children 
 attending "the twenty better class schools," food was supplied in 
 sufficient quantities. 
 
 The most obvious fact concerning the children of low nutrition is 
 that a large proportion of them presented some defects in development, 
 whether in day or resident schools, or in those of upper social class. 
 
43 
 
 Here then we see one of the ill effects arising from defects in develop- 
 ment. 
 
 Life in a resident school greatly reduces the amount of low nutrition 
 among the cases of mal-development. (See Table II., page 14.) 
 
 In the boarding school there appear to be two conditions at work, 
 (1) the regular feeding, sleeping, &c. ; (2) uniformity in living, and 
 freedom from the many impressions and troubles of the less protected 
 life at home and day schools, where the child has its life at home, life 
 in the streets and in school, often with late and irregular hours of 
 sleep. 
 
 TABLE III. (seen 1888 91) Showing Number of Children ivith Low 
 Nutrition in Resident and Day Schools, and the Percentage of these 
 Cases that presented co-related conditions taken upon the Cases 
 of Loiv Nutrition. 
 
 Number of Cases of Low Nutrition. 
 
 Percentage of 
 Development Cases. 
 
 Percentage of 
 Nerve Cases. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Resident Schools, I.-XXXIV. 
 B. 291. G. 156. T. 447 
 
 68-3 
 72-2 
 71-1 
 
 85-2 
 72-5 
 
 74-6 
 
 74-2 
 72-4 
 
 72-8 
 
 66-6 
 59-6 
 61-6 
 
 69-0 
 60-0 
 61-4 
 
 67'3 
 59-8 
 61-5 
 
 Day Schools, XXXV.-CVL 
 B. 739. G. 817. T. 1556 
 
 For all Schools, I.-CVI. 
 B 1030 G 973 T 2003 
 
 
 Number of Cases of Low Nutrition. 
 
 Percentage of Nerve 
 Cases with Development 
 Defects. 
 
 Percentage of Cases 
 reported as Dull by the 
 Teachers. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Boys. 
 
 Girls. 
 
 Total. 
 
 Resident Schools, I.-XXXIV. 
 B. 291. G. 156. T. 447 
 
 40-8 
 39-6 
 40-0 
 
 48-7 
 37'3 
 39-1 
 
 43-6 
 38-4 
 39-5 
 
 33-3 
 
 41-2 
 38-1 
 
 54-4 
 37-9 
 40-5 
 
 40-7 
 39-5 
 397 
 
 Day Schools, XXXV .-CVL 
 B. 739. G. 815. T. 1556 
 
 For all Schools, I.-CVI. 
 B 1030. G. 973. T. 2003 
 
 
 GEOTIP 38 Cases with defects in development, Abnormal Nerve- Signs 
 
 and Low Nutrition. 
 
 This group appears to represent a special class of develop- 
 ment cases, in which the inheritance has produced not only 
 
44 
 
 visible mal-formations or ill-proportioning in the body, but also a 
 constitutional tendency to low nutrition and a state of nerve-centres, 
 ill-balanced and acting badly. Such children may be said to be 
 delicate, and in 1888-91, 44 per cent., and in 1892-94, 50 per cent, of 
 them were reported as dull. 
 
 The children when dull are included in Group 12, who appear to 
 require special care and training. 
 
 GEOUP 42 Children presenting development defects without Abnormal 
 
 Nerve-signs. 
 
 These development cases with a well-regulated nerve system 
 present less mental dulness than those with nerve-signs, showing 
 the importance of studying nerve-signs. 
 
 Of development cases with nerve-signs (1888-91) 43 per cent., 
 (1892-94) 49 per cent, were dull. 
 
 Of development cases without nerve-signs (1888-91) 35 per cent., 
 and (1892-94) 37 per cent, were dull. 
 
 GEOUP 45 Children presenting Abnormal Nerve-signs without defect 
 
 in development. 
 
 Here no defect in development accounts for the nerve-signs, 
 they appear due to other causes ; they are slightly more frequent 
 among the resident children, and among the upper classes than in 
 the average day schools, so that low feeding does not appear as a 
 necessary cause. It is probable that in this group we have children 
 of normal make who are ill-trained, neglected, and over-pressed by 
 the stress of life. These seem to be the children most improvable by 
 altered conditions and appropriate training; many of them are dull. 
 
 GEOUP 55 Children presenting no defects in development or Abnormal 
 Nerve-signs, but reported as dull by the Teachers. 
 
 Such cases present good physical development, and a sound 
 condition of brain as indicated by motor action. It appears that the 
 brains of these children, though capable and healthy, had but little 
 power for school work. It is important to differentiate such pupils 
 from those with defective conditions. 
 
 The Group is small and includes some children noted as crippled by 
 disease, epileptic, with eye defects or low nutrition, and the cases 
 presented by the teachers as dull in whom no defects were found. 
 
 The mental examination and history of some of these cases is im- 
 portant, as it may show grave defects in moral sense and intellectual 
 power, unobservable by simple physical observation. 
 
45 
 
 G-KOUP 31 All Dull Children. 
 
 The children reported by the teachers as mentally dull or below 
 the average in ability for school work were mostly selected by the 
 signs observed before the teachers presented any who were passed 
 over by the observer, and the teachers generally acknowledged that 
 the dull children had been so selected. This fact in itself shows the 
 strong link existing between physical conditions, including nerve 
 signs, and the causes of mental dulness. Tables XVI. and XVII. 
 show the number of cases presenting certain conditions, the pro- 
 portion of these mentally dull, and the percentage of the latter, 
 taken upon the number presenting the conditions respectively. 
 
 In the facts here given it is seen that defects in development and 
 abnormal nerve signs are largely co-related with mental dulness. The 
 brain, disorder so largely accompanying defect in development is also 
 largely productive of mental dulness, it is to this fact that attention 
 is particularly directed. The nerve-signs are an index of the brain 
 condition, and methods of training which remove the nerve-signs tend 
 to produce a brain condition with better aptitude for mental work. 
 These nerve-signs can be dealt with in detail, and school training 
 may be adapted to removing in turn each bad balance of body, while 
 physical exercises are used for the cultivation of quickness and accu- 
 racy and full power of eye movements, etc. 
 
 Children "feeble-minded," or exceptional in mental status. 
 This is one of the most important classes of children, though 
 happily it is small in number. As the research proceeded further 
 analysis was made concerning these cases, which will therefore be 
 presented separately for the two enquiries made. (See Tables XIV., 
 XXIX., XXX.) 
 
 TABLE IV. (cases seen 1888-91 ) Children "feeble-minded" or 
 exceptional in mental status, their coincident defects. 
 
 Boys. Girls. TotaU 
 
 Number found in schools 124 110 234 
 
 Of these children the following presented coincident defects: 
 
 Cases defective in development 84 75 159 
 
 Abnormal nerve-signs 96 77 173 
 
 Nutrition low 26 25 51 
 
 Development defective with abnormal nerve-signs and 
 
 low nutrition 17 13 30 
 
 Epileptic 5 5 10 
 
 Crippled or paralysed 538 
 
 Eye cases 20 16 36 
 
 Hands blue and cold 235 
 
46 
 
 In one National school and also in one Poor Law school there 
 were three cases from one family. 
 
 It is difficult to define what physical conditions seen, as apart from 
 mental signs, indicate the child unfitted for the average methods of 
 training, and any arbitary attempt to do so must fail. For distribution 
 of these cases in Divisions of Schools, see Table X. This afflicted class 
 includes idiots, imbeciles, children feebly-gifted mentally, and children 
 mentally exceptional ; as to definitions and numbers (see Catalogue, 
 page 82), 174 are entered as feebly-gifted mentally, i.e., of defective 
 mental capacity short of actual imbecility ; it is probable that some of 
 these children would be found on further examination to be imbecile, 
 and many may be capable of great improvement. 
 
 Cases seen 1892-94. 
 
 Children " feeble-minded," or exceptional in mental status, include 
 Groups 6, 7, 8, 9. They are presented in Tables XXIX. and XXX. 
 arranged as to standards and ages, and their distribution into primary 
 groups of defects ; a few comments may be added as to each group. 
 
 GBOUP 7 Imbeciles. 
 Boys 3. Girls 2. 
 
 None were epileptic ; 1 girl was paralysed. 2 boys had cranial 
 defect, 1 defect of palate, and 1 nystagmus. Neither of the girls had 
 defect of cranium, palate, or eyes. 
 
 GROUP 8 Children feebly gifted mentally. 
 
 Boys 49. Girls 52. Epileptic : Boys 3. Girls 5. Crippled : 
 Boy 1. Girls 2. 
 
 16 boys had defect of the cranium, and five defect of palate. 
 
 8 boys had eye defects, including 3 with nystagmus. 
 23 girls had defect of cranium, and 7 defect of palate. 
 
 5 girls had eye defects, including 1 with nystagmus. 
 
 GROUP 9 Children mentally exceptional. 
 Boys 4. Girls 3. 
 
 None were epileptic or crippled ; there were no eye cases. 
 1 boy had defect of cranium ; there was no boy with palate defect. 
 1 girl had palate narrow ; none with defect of cranium or eyes. 
 The experience of hospital physicians and philanthropic societies 
 
47 
 
 shows that neglect of feeble-minded children of all grades leads to 
 much social evil. The blind and the deaf are happily now cared for 
 under the provisions of the Elementary Education Act (Blind and 
 Deaf,) 1893, and teachers are specially trained for this work ; but 
 except in a few centres the children of the various grades of feeble- 
 ness, short of imbecility, children who present a deficiency, are in 
 many schools unwelcome, and no encouragement is given to the 
 school authorities to collect or care for them, they are an incum- 
 brance if not properly provided for, and untrained, they tend to 
 social failure, pauperism, and criminality. 
 
 GROUP 10 Epileptics, and Children with History of Fits during 
 
 School Life. 
 
 Seen 1888-91. Boys 36 . . Girls 18 .. Total 54. 
 
 With defects in development. . ,, 19 .. ,, 9 . . ,, 28. 
 
 With nerve-signs 22 .. 13 .. 35. 
 
 With low nutrition ,, 6 .. 5 .. 11. 
 
 With mental dulness 23 .. 12 .. 35. 
 
 These cases were enquired for in every school, and in some instances 
 children not attending school were sent for by the teachers. Any 
 case with a history or indications of fits during school-life was re- 
 corded for what it may be worth. A list of these cases has been 
 published.* It would appear that most epileptic children are absent 
 from school. Of the cases given, 5 boys and 5 girls were mentally 
 defective. 
 
 In 1892-94, 21 boys and 35 girls were registered in this group : 
 Crippled no boys, 1 girl. 3 boys had cranial defect; none had 
 defect of palate. There was 1 eye case a boy. 2 girls had cranial 
 defect, and 1 defect of palate. 1 girl, eye case. 
 
 GBOUP 11 Children Crippled, Paralysed, Maimed, or Deformed. 
 
 (Not Eye Cases.) 
 
 Seen 1888-91. Boys 155 . . Girls 84 . . Total 239. 
 
 With defects in development . . 44 .. 27 .. 71. 
 
 With nerve-signs 51 .. 22 .. 73. 
 
 With low nutrition 44 .. 18 .. 62. 
 
 With mental dulness 57 .. 36 .. 93. 
 
 These children varied greatly in brain power some were mentally 
 bright, others dull; they also varied in conditions of health. The 
 conditions of disease causing crippling were in various stages, and 
 
 * See "The Feeble-minded Child and Adult." C. 0. S. Series. 15, Bucking- 
 ham Street, Strand, W.C. 
 
48 
 
 many of these children were capable of work and play. 5 boys and 
 5 girls were mentally defective. 
 
 Cripples from congenital defects .. Boys 7 .. Girls 9 .. Total 16. 
 
 disease or injury . . 88 .. 53 .. 141. 
 
 paralysis 60 .. 22 .. 82. 
 
 Seen 1892-92 Boys 75 . . Girls 60. 
 
 7 boys had cranial defect ; 3 had defect of palate ; 4 had eye defect. 
 5 girls had cranial defect ; none defect of palate ; 2 had eye defect. 
 
 The classes of cripples are enumerated in the nomenclature. (See 
 page 72.) 
 
 DEFECT (55) Children Deaf or partially Deaf. 
 Seen 1888-91. Boys 34 . . Girls 33 . . Total 67. 
 
 With defect in development 27 . . 22 . . ,,49. 
 
 With nerve-signs 27 .. 23 .. 50. 
 
 With low nutrition 3 . . 13 .. 16. 
 
 With mental dulness 18 .. 21 .. 39. 
 
 Tests for hearing were not commonly used, but when a child was 
 found to be deaf, this was recorded ; children almost totally deaf, as 
 well as others deaf and dumb, were met with among the other 
 children in public elementary schools. The 51 children (boys 31, 
 girls 20) in the school for the deaf and dumb are not included in the 
 group above ; the report of 1888 gives the following account of them. 
 
 DEFECT (81) Children Deaf and Dumb. 
 Seen 1888-91. 
 
 With cranial abnormalities Boys 14 . . Girls 4 . . Total 18. 
 
 With nerve-signs 15 .. 6 . . 21. 
 
 With low nutrition 5 . . 4 . . 9. 
 
 With mental dulness 4 . . 2 . . 6. 
 
 Eye cases 2 . . 3 . . 5. 
 
 Analysis of 51 Deaf and Dumb Children. In this school each child 
 was examined separately, and the condition of the palate was noted. 
 
 Particulars as to head measurements and conditions of general 
 physical health were most kindly filled in by Dr. Martyn, medical 
 officer to the institution. The Secretary of the institution very 
 kindly filled in some particulars of the history of each pupil from the 
 records kept. 
 
 The ages of these children varied from 7| to 11 years, average 
 age 8 years. The following table indicates the cause assigned for 
 the deafness. 
 
49 
 
 TABLE V. (Cases seen 1888-91). Deaf and Dumb Children. 
 
 Congenitally deaf Boys 21 . . Girls 11 . . Total 32. 
 
 Sequent to measles 2 . . 1 . . 3. 
 
 whooping cough 1 .. 1 .. 2. 
 
 scarlet fever - . . 1 . . 1. 
 
 sunstroke 1 . . - . . 1. 
 
 Fits or brain disease 3 . . ,, 2 . . 5. 
 
 Effects of a fall 2.. -.. 2. 
 
 First dentition ,, - . . ,, 3 . . ,, 3. 
 
 Cause not stated 1 . . 1 . . 2. 
 
 ai 20 51. 
 
 In 3 cases the children were the offspring of first cousins. 
 
 In 5 cases, deafness was acquired between the ages of 3 to 6 years, in 
 
 2 cases without cause assigned. The palate was examined in all these 
 cases. In 2 cases it was "vaulted," in 2 "narrow," in 3 "arched." 
 
 Of these 7 cases 5 occurred among the congenitally deaf pupils, and 
 
 3 coincided with other defects of the cranium. In 7 boys and 7 girls 
 the teeth were found ground. The various conditions found in these 
 children are given in preceding tables. 
 
 It is noteworthy that most of these children fixed their eyes on any 
 one speaking to them remarkably well. 
 
 GROUP 12 Children that appear to require special care and training. 
 
 Some difficulty has been experienced in giving anything like a 
 definition of this class of children. Eye cases and the deaf and dumb 
 are not included, not on account of their small number but because 
 these cases could not be specially investigated in this enquiry, and 
 attention has been fully drawn to their condition in other reports. 
 
 The group includes, "children feeble-minded or mentally excep- 
 tional," epileptic, cripples, and the "development cases with low 
 nutrition and nerve-signs, who were reported as dull mentally/' 
 The group as thus arranged, allowing for overlapping cases, contains 
 (see Table XIV.) 817 children (Boys 473, Girls 344), or 1-6 per 
 cent of the 50,000. Seen 1888-91. Of the number given 165 are 
 included on physical grounds, not being mentally dull. 
 
 The numbers of children requiring special care and training as seen 
 1892-94, are given in Tables XXIX. and XXX. arranged as to 
 Standards and ages. 
 
 Of the 226 boys 218 girls requiring special care, as seen in enquiry 
 1892-94, 61 boys and girls, 52 are included on physical grounds, not 
 being mentally dull. 
 
50 
 
 CHAPTER VII. 
 
 THE BEAEING OF THIS ENQUIEY ON THE EDUCATION 
 AND CAEE OF CHILDEEN. 
 
 The State has undertaken a great work and heavy responsibilities 
 in making the education of children compulsory upon all, and this 
 labour has not been lessened by the recent provision of free education. 
 
 Besides this educational provision for children living at home with 
 their parents, the State has taken complete charge of large bodies of 
 children under the Poor Law, and children with criminal tendencies 
 in the certified industrial schools under the Home Office. In addition 
 to these groups the care of imbeciles, the blind, and the dumb children 
 in part falls upon the State. 
 
 One of the pleasing results that has followed the improved intelli- 
 gence of the population is a material diminution of crime, yet we 
 continue to make but little provision for the care of feeble-brained 
 children, and exempt them on the ground of their feebleness from 
 the education shown to be necessary for the success of the average 
 children. Might not due care of these boys and girls help still 
 further to lessen crime as well as pauperism, and other forms of 
 social failure ? 
 
 No work is more generally popular than that undertaken to benefit 
 the whole people, and among no section of the population are such 
 efforts more needed and more useful and hopeful in their results 
 than among the children. Very much is said and written about 
 educational methods and the care of children, but have we as yet the 
 necessary information concerning the child-population, the classes 
 that have to be provided for, the methods of classifying them, and 
 the means of meeting their special needs ? 
 
 Where children have already been grouped as blind, imbeciles, 
 dumb, &c., information has been collected as to their physical condi- 
 tion, and arrangements for them are founded upon such experience. 
 
 As to the mass of the child-population, the 6,000,000 in public 
 schools, upon whom we spend in taxes, apart from School Board 
 Eates and subscriptions, 10,000,000 a year, we have but little 
 knowledge, except such as may be gleaned from the reports of 
 school examinations by H.M. Inspectors and the returns of births 
 
51 
 
 and deaths. The Royal Commission on blind, dumb, and children 
 requiring exceptional methods of education, was satisfied upon 
 a small amount of evidence supplied to them that among the 
 pupils in elementary schools there were many " feebly gifted," and 
 others physically incapable of benefiting by the ordinary education ; 
 and gave it as their opinion that many of the feeble children, partly 
 through incapacity, in a larger degree through irregularity of atten- 
 dance due to feebleness, remain practically untrained, and that they 
 are unprovided for in our Public Educational system which, under 
 the code, is designed for average or normal children. 
 
 It is not on such grounds only that we would urge the necessity 
 of accurate knowledge of the bodily and brain conditions of the 
 child-population. The great object sought by State medicine in its 
 various divisions is to acquire such knowledge, based upon scientific 
 enquiry, as may serve to render the population healthy, long-lived, 
 and prosperous, while universal education is provided that all may 
 receive a mental development, fitting each as a citizen to provide for 
 himself, and take his place among his fellows. 
 
 Public hygiene is concerned not only to lessen the death-rate and 
 remove disease as far as possible, but also to render the population of 
 all classes as healthy and well-developed as possible well-made in 
 body and sound and strong in brain power. For such work we need 
 something like a census of the children which it has been shown may 
 be commenced by examination in schools where attendance is now 
 compulsory. 
 
 If the work were carried out on a sufficiently large scale in several 
 districts and centres of population, we might soon be able to give 
 answers to important questions, such as, " What proportion of the 
 population of children require special educational provision?" " What 
 are the observable effects of higher education, technical education, 
 town life, crowded living, large block residences, deficient light, 
 adjacent railways, cottage residences, elevated land, drainage and 
 water supply, adjacent open spaces and trees ? " " Is poverty a 
 fruitful cause of defects in children; are these defects local in 
 distribution, and to what extent are they determined by local 
 conditions ? " Comparison of children in various localities would show 
 much of the hygienic effects of town and country, the peculiarities of 
 children respectively in northern and southern counties, and the 
 districts where degenerative developments are most prevalent ; thus 
 their causation might be determined. 
 
 Some evidence was advanced in the last chapter that such problems 
 
are not purely speculative, and that their solution is likely to be 
 attended with practical results beneficial to the public interests. 
 
 The children who fall to the care of the State appear to be those of 
 more mal-development than the average of the public elementary 
 schools ; this suggests the economy of lessening such evils. 
 
 In the application of this work to State medicine the co-observation 
 of conditions of development and nerve signs will have their place, 
 but probably efforts might at first be directed to lessening the mal- 
 development. 
 
 The nerve signs are indices of the finer impressions made upon the 
 brain, forces so slight as often to be called " moral influences," the 
 sound of words, their tone, sights imitated, &c. Badly made heads 
 and palates are largely coincident with frontals over-acting, causes 
 increasing the latter may be connected with the causation of the 
 development defects. To the teachers and others in charge of children 
 we must principally look to remove defective-nerve signs, while we 
 try to discover the cause of defects in the child's material structure. 
 
 Among points for investigation may be suggested the study of the 
 environment of different classes of children, under what conditions is 
 each defect most commonly met with ; the effects of environment 
 apart from heredity might be sought. Thus we might study the 
 effects of diminished light, railway noise, deficient exercise. 
 
 The State becomes heavily burdened by the defectively made 
 portion of the population, which probably tends to accumulate under 
 extensive emigration, leaving with us the weak, tending to pauperism, 
 starvation, vagrancy, and crime ; a large body of the " unemployed " 
 and others capable of earning only small and varying wages ; the field 
 for recruiting the services is also limited. Were this lower stratum 
 raised it would pave the way for social improvement, higher education^ 
 better wage earning power, and less social failure. It must be 
 remembered that these feebly-gifted children are confined to no social 
 class, and appear to be not less numerous in the upper grades. 
 
 These observations show the harm that probably arises from 
 exempting the feebly-gifted and defective children from all educa- 
 tional training because they are unfitted to compete in the school 
 with those of average capacity. It is as important to know the 
 average condition of the children, as the rate of mortality in any 
 given locality. Mal-development has been shown as far as the facts 
 go to be a potent factor predisposing to both mental dulness and low 
 nutrition. It is not solely for the purpose of attaining a condition 
 of the people with a smaller percentage of badly made heads, palates r 
 
53 
 
 ars. noses, or other bodily defects, that a strong effort is called for. 
 In removing the causes of such defects we may hope to lessen the 
 average of co-attendant " mental feebleness " and " low nutrition." 
 
 The ends which it is desired to attain are to improve the average 
 development, nutrition, and potentiality for mental faculty, and thus 
 to lessen crime, pauperism, and social failure, by removing causes 
 leading to degeneration among the population, and by encouraging 
 the means of improvement. 
 
 It is desirable to obtain a normal of the child-population such as is 
 required in all branches of vital statistics. 
 
 In seeking information concerning the mortality of a town we 
 compare its rate of mortality with the average, and if it be high we 
 seek for the cause, so we may enquire into the average development 
 of children in a town or district, and where the conditions are bad 
 try to find a remedy ; we need to determine an average or normal 
 upon sufficiently extended observation to enable us to say what 
 groups of children or districts are above or below the average. 
 
 A large number of children must be examined under different 
 circumstances of life and in different districts to afford any satisfac- 
 tory evidence upon such points, as for example, " children with small 
 heads ; " at least 30,000 or 40,000 should be seen in each district. 
 
 Crime in childhood is an unnatural action, and suggests in all such 
 cases an abnormal condition of the child, so that a physical examina- 
 tion should be made. The National Vigilance Association have 
 shown that a large number of those with whom they deal in work- 
 houses and elsewhere are feeble-minded. This strongly suggests 
 that the best means for preventing " ill-development " and " feeble- 
 mindedness " are also means of preventing crime and social failure. 
 It seems not unlikely that many of those who wander homeless are 
 defective. Crime may probably be lessened by early care, while 
 exemption from even ordinary discipline and culture tends greatly to 
 aggravate the congenital tendency to failure. 
 
 Co-relation or the Relations of Physical and Nerve-signs to Low 
 Nutrition and Mental Dulness. 
 
 In Tables XV., XVI., XVII., the number of cases presenting each 
 sign has been shown, and the co-relation has been added showing 
 the number of cases presenting the sign who were also registered 
 as presenting "low nutrition, abnormal nerve-signs, mal-development, 
 or mental dulness " respectively. These co-relations are also given 
 in the form of percentages in the Tables referred to. 
 
54 
 
 It is not wished to represent the percentages as having an absolute 
 value of co-relations to the sign which may be applied to an indi- 
 vidual child. The co-relation for some signs is probably of small 
 value on account of the small number of cases observed, but it is 
 given as illustrating that each physical or nerve-sign has a co-relation 
 with mental dulness, nutrition, &c. When the co-relation is on a 
 small number of cases, the need of further observations in this 
 direction is indicated. 
 
 The percentage form is useful as indicating that some generalisa- 
 tions, drawn from large groups of cases, apply equally to the indivi- 
 dual signs characterising the group. Thus defects in development 
 have a higher co-relation with abnormal nerve-signs in boys than in 
 girls, but as to nutrition and mental dulness the girls suffer most. 
 
 As a contribution towards the etiology of defective development, a 
 Table was prepared (see paper in the Statistical Journal, March, 1893, 
 by Dr. Warner), distributing these cases in twenty Metropolitan 
 districts. It is shown that the distribution is very unequal, being 
 high in the Western district of Kensington and Chelsea, viz., 12*5 per 
 cent, on the numbers seen, and lower in the poorer schools of 
 Islington, viz., 7*5 per cent. This table also gives the percentage 
 distribution of the principal defects registered, taken in two ways : 
 (1) Upon the number of children seen ; (2) Upon the number of 
 development cases. If such observations are confirmed by further 
 experience, this method of arranging the facts may afford evidence 
 upon the causes in the district tending to produce defects in develop- 
 ment, and possibly for determining the particular kind of defect 
 most prevalent. 
 
 In certain districts the ratio of boys and girls presenting the same 
 conditions is not the average. As a preliminary to determining the 
 means that may be used to try and lessen the physical causes of 
 mental dulness, Tables are given of the conditions and groups of 
 conditions accompanying it, showing, as far as the present work 
 goes, the co-relative value of each sign in development and nerve 
 action observed, as well as the distribution of these signs in certain 
 areas or districts, in certain classes of schools and in the nationalities. 
 
 In cases seen 1892-94 the percentage of mental dulness rises 
 from 38 for development cases without nerve- signs to 48 when both 
 are present, reaching 52 when the mal-development is accompanied 
 by low nutrition and abnormal nerve-signs. 
 
 Development Cases considered in Relation to Sex and Residence. 
 
 If we take 100 boys and 100 girls with defects in development, we 
 
55 
 
 shall find many of them with abnormal nerve-signs, low nutrition, 
 and mental dulness. Following the experience gained, the following 
 estimate may be given showing the probable results of placing them 
 first in a day school and then in a resident school : 
 
 TABLE VI. (Cases seen 1888-91). IN THE DAY SCHOOL. 
 
 Boys' Side. 100 lays with defects 
 in development. 
 
 Nerve cases 50 
 
 Nutrition low . . . . 23 
 Eeported dull . . . . 38 
 
 Cases of nutrition low, 
 nerve-signs, or dull . . Ill 
 
 Girls 9 Side. 100 girls with defects 
 in development. 
 
 Nerve cases 47 
 
 Nutrition low . . . . 38 
 Keported dull . . . . 40 
 
 Cases of nutrition low, 
 nerve-signs, or dull . . 125 
 
 TABLE VII. (Cases seen 1888-91). IN THE EESIDENT SCHOOL. 
 
 Boys' side. 100 boys with defects 
 in development. 
 
 Nerve cases 62 
 
 Nutrition low . . . . 16 
 Eeported dull . . . . 40 
 
 Cases of nutrition low, 
 nerve-signs, or dull . . 118 
 
 Girls' side. 100 girls with defects 
 in development. 
 
 Nerve cases 52 
 
 Nutrition low . . . . 20 
 
 Eeported dull . . . . 44 
 
 Cases of nutrition low, 
 
 nerve-signs, or dull . . 116 
 
 It is thus obvious that residence contrasted with home life and 
 day school produces marked effects, different among boys and girls. 
 On both sides of the resident school nutrition becomes higher, more 
 markedly with the girls. 
 
 Nerve-signs increase with residence, especially with boys. 
 Mental dulness increases with residence slightly, more so among 
 the girls. 
 
 The loss and gain from putting 100 boys and 100 girls with defects 
 in development in resident schools may be represented thus : 
 
 Boys. Girls. 
 
 Fewer cases of low nutrition . . . . 7 . . 18 
 
 More cases of abnormal nerve-signs . . +12 . . 4- 5 
 
 More cases of mental dulness . . . . + 2 . . + 4 
 
 The methods of procedure and report that have been explained 
 afford useful results and might be enlarged as follows : 
 
 1. A body of vital statistics indicating the average condition 
 the normal at the present time of the school population; varia- 
 tions therefrom in different localities, under different circum- 
 
56 
 
 stances, and at different times, might become known and lead to 
 action for the removal of defects by hygiene and training. 
 
 2. The children in a district may be better known, the cripples, 
 the epileptic, the mentally defective, as well as those presenting low 
 nutrition and eye defect, &c., something like a census of conditions 
 (as apart from surroundings) is obtained. 
 
 3. A large body of collated observations would enable a complete 
 estimate to be made of the value of each sign and condition, this has 
 already been done in part. 
 
 4. Information would be obtained as to causes affecting develop- 
 ment of body and brain power, nutrition and the relations of 
 abnormal nerve signs to mental dulness, while the varying child 
 material in schools and results of training might be studied. With 
 such a collection of information as that here arranged, problems can 
 be defined and illustrated and methods for their solution may be 
 found. 
 
 Should a public school be managed with the purpose of producing 
 the best educational results, i.e., the greatest number of well trained 
 intelligent children ; or as a means of conferring the greatest benefit 
 on the neighbourhood in preventing the evils of non-education and 
 minimizing the number of subsequent failures in life ? Probably a 
 few higher grade schools have the former function as their duty, 
 while the largest number of local schools have the latter and more 
 difficult task to perform. 
 
 A School Board has both functions to fulfil. The Higher grade 
 school may then select the best made pupils, those with the best 
 faculty for benefiting by intellectual training. The Local school has 
 to do the best it can for all and each child. The practical difficulty 
 arises with regard to the feebly-gifted, the weak, the defective child- 
 dren, those whose physical health and brain power are below the 
 average for which arrangements are made. 
 
 It has been shown that these children may be known and a list of 
 them prepared for the managers. It is thought by many that while 
 our public system gives direct encouragement to teachers to show the 
 best intellectual results with the average and better class children, no 
 public approval is bestowed upon the special attention they give to 
 the feeble, deficient, and lowly-gifted. 
 
 These children should be kept under special notice and a premium 
 or special commendation might be given for the regularity of their 
 attendance, and for care and arrangements adapted for their improve- 
 ment. 
 
57 
 
 Constitutional Differences betiveen Boys and Girls, and their Relation 
 to Educational Requirements. 
 
 How do boys and girls respectively bear the effects of their 
 environment ? 
 
 The first fact to be observed is that more boys than girls appear 
 in most of our groups of cases presenting some defective conditions 
 an exception is in relation to low nutrition. (See Catalogue, p. 82.) 
 
 This exceptional fact suggests further analysis. In a school of 
 1000 boys and 1000 girls, according to the average (cases seen 
 1888-91) there will be children with low nutrition as follows : 
 
 Boys. Girls. 
 Low nutrition with development defect . . . . 27 31 
 
 without . . 11 11 
 
 It is seen that without defect in development girls do not appear 
 to be more delicate than the boys; but those with development 
 defects are much more delicate. Due care of the "development" 
 cases might prevent the manifestation of insomnia, hysteria, and 
 other troubles in the girls' school, while the normal children may 
 work hard. 
 
 Let us compare the boys and girls from the point of view of the 
 teacher's experience they soon find out who are dull at lessons. 
 
 Among 1000 boys and 1000 girls the average number is : 
 
 . Boys. Girls. 
 
 Dull . . 82 63 
 
 Dull and delicate .. .... .. 14 17 
 
 Dull, with nerve-signs . . . . . . 51 38 
 
 Among the dull boys there are fewer who are delicate, more with 
 nerve disorder; and physical training is more likely to lessen the 
 proportion of dull boys than girls. 
 
 The Child Material in a School. 
 
 In any State school for boarded pupils a medical certificate is 
 required, and applicants suffering from disease, the epileptic and 
 those with brain defects, are refused admission and have to be 
 provided for elsewhere. 
 
 Children can be exempted from attendance at public elementary 
 schools on similar grounds by means of a certificate from any medical 
 practitioner, but these rejected cases are not provided fo*r* education- 
 ally, probably their names are removed from the school register if 
 permanent cases. 
 
58 
 
 Teachers are well aware that their educational results depend in 
 great part upon the child material admitted into the school; when 
 the school places are not full they are not free to select applicants for 
 admission ; but this does not apply in all cases. 
 
 The proportion of ill-made brains appears to vary much in different 
 schools, and probably varies in different localities ; in a school 
 designed to represent the requirements of a neighbourhood, it seems 
 that allowance should be made in assessing results for the average 
 material placed under the care of the teaching staff. A high per- 
 centage of defects in a district calls for special attention on the part 
 of the Sanitary Authority, and also for special care in training the 
 children, while a lower standard of intelligence must be expected. 
 Favourable opinion was formed concerning some of the endowed 
 parochial schools where special attention was given to the require- 
 ments of the neighbourhood, one or two epileptics, one or two feeble- 
 brained children who could only be trained and not presented for 
 examination were allowed to attend, and the admission of a few ill- 
 favoured applicants made the schoolroom a fair sample of local 
 childhood, with the result that in examination a less favourable 
 report was made than would be the case if the best children only 
 were admitted. 
 
 These points are mentioned not as praise or in criticism, but to 
 illustrate that a correct allowance for the material in a school is fair 
 in estimating the money grant earned, and that the care of the feeble 
 children, as well as of the average, may be encouraged by judicious 
 assessment of the child-material and their intellectual culture. 
 
 On the other hand certain philanthropic institutions claim credit 
 for the' badness of the material collected and justly claim support on 
 the ground that it is to the public interest that the best should be 
 done for the paralysed, the crippled, the blind, &c., and for those of 
 criminal tendencies. If these principles be accepted, if it is true that 
 the national interest lies in having a population of children well made 
 and well trained, is it to our advantage that the day school system 
 should ignore or reject the weak and defective children, and might 
 they not in appropriate cases be kept under their parents' care, and 
 at day schools, with due allowance to the teachers, thus being 
 retained in their own neighbourhood ? 
 
 Certain schools, if not all, and in particular the endowed schools of 
 a parish should be encouraged to show results in dealing with the 
 worst child material of the neighbourhood, and in preventing it from 
 gravitating to the Poor Law, or to degradation and failure. 
 
59 
 
 Assessment of Results of Intellectual and Physical Training in a School, 
 making allowance for the Physical Condition of the Children. 
 
 HaviDg obtained a report on the physical condition of the children 
 in a school we may proceed to estimate the number of dull children 
 and the number of nerve cases to be expected making allowance for 
 the material in the school. The estimate is founded upon the 
 conditions seen and in comparison with a now established average of 
 100,000 children. 
 
 There are two results of physical training characterising it as 
 satisfactory; (1) in cases of defective development to remove or prevent 
 abnormal nerve-signs; (2) in children of normal development to 
 prevent, or at least not to produce nerve-signs. Thus taking the 
 development cases in a school, a high percentage of abnormal nerve- 
 signs among them is against the effects of the training, and a high 
 percentage of nerve cases without defects in development suggests 
 that the training is not good. So also in each case a high percentage 
 of mental dulness shows want of adaptation of methods of teaching 
 to the special requirments of the children. 
 
 We may estimate as Dull Children (seen 1888-91). 
 
 Boys % Girls % 
 
 Of development cases with nerve-signs . . 43 43 
 
 Of development cases without nerve-signs . 33 39 
 
 Of nerve cases without development defects 37 41 
 
 We may estimate as the average number of cases u>ith Nerve-signs. 
 
 Boys % Girls % 
 
 Of the development cases 55 49 
 
 Of the total number of children seen as 
 
 presenting defects in development .... 5 4 
 
 Educationalists may desire a further knowledge of the conditions 
 of child life, and the groups of children that have to be cared for, 
 as an aid to the solution of many points in school management. 
 
 What modifications of the ordinary course of education are needed 
 for 
 
 1. Cases feeble-minded, or semi-imbecile, those admissible as 
 
 candidates for an asylum, but also suitable for admission to 
 classes of special instruction in day schools. 
 
 2. Children feebly-gifted, motionless, statuesque or dull. 
 
 3. Delicate but bright children. 
 
 4. Children mentally bright but defective in moral sense. 
 
60 
 
 5. Children well made, but exhausted temporarily, or as a chronic 
 
 condition. 
 
 6. Children partially deaf. 
 
 7. Children crippled or paralysed. 
 
 8. Epileptics, specially such as are harmless in a day school. 
 
 9. Eye cases. 
 
 What are the conditions of children and the consequent educational 
 requirements in the following group? 
 
 10. The poor class. 
 
 11. The wealthy class. 
 
 12. High-pressure schools. 
 
 13. Schools considered "inefficient/' 
 
 The Training Colleges. 
 
 It is to these we must look for the trained teachers ; and to Univer- 
 sity provision for their further training. It is possible to systematise 
 this kind of work, and to give instruction to candidates for the teach- 
 ing profession without touching upon medicine, such as may enable 
 them to observe for themselves and make deductions from what they 
 see ; such training should be based upon scientific knowledge, and 
 the methods of mental- action may be taught by reference to the visible 
 facts of its expression and its application to the study of psychology 
 and the conditions of child-life. Many subjects of importance to 
 teachers might be dwelt upon, but we shall only give a few illustrative 
 points. When the children are allowed to choose their seats in 
 school, something like a process of natural selection occurs ; nervous 
 children are gregarious, defective children are solitary ; the former 
 are usually bright at lessons, and congregate on the back seats, where 
 they often do their work and then play, while the duller children are 
 kept in front under the teacher's eye. Eye-movements need training, 
 and where this is neglected in the infants' school, results in learning 
 to read are apt to be slow, and some children are bad and inaccurate 
 observers. 
 
 The speech of all children needs careful cultivation, and incipient 
 stammering will best be combated by the teacher who observes the 
 first indications of the spasm affecting the face. 
 
 Imitation as an Element in Training. 
 
 This is mainly exercised through sight, and is universally employed 
 by teachers, specially among infants. When the pupil faces the 
 teacher his right hand is opposite to the teacher's left. Experience 
 shows that when told to do as the teacher does, if the teacher raises 
 
61 
 
 his right hand the pupil tends to hold out his left. So strongly is 
 this faculty marked that, to obtain results in action, many teachers 
 habitually use their left hand for imitation by the child's right. It 
 seems hardly surprising then that children confuse their right hand 
 with the left when subsequently directed by word of command. 
 Imitation by vision is probably one of the most direct means by which 
 the teacher knowingly or unconsciously controls the pupil's brain a 
 means of transference of nerve-status often called a moral influence, 
 still a very real, true, and powerful one for good or ill. 
 
 Military Drill. 
 
 Boys thus trained present much uniformity of action, and response 
 to verbal command is quick. When examined in groups these good 
 effects are obvious when examining a boy individually, specially if 
 the master be not at hand, the finer movements and symmetry of 
 balance is usually lost, and it often seemed that less true balance and 
 self-command over the nerve-system was present than among children 
 trained by free exercises. 
 
 Each method of physical training has its advantages, the effects 
 must be observed in the individual child alone. 
 
 GENEEAL BESULTS. 
 
 The work that has already been done affords a considerable amount 
 of evidence to the following propositions : 
 
 It is practicable to inspect, report upon, and classify the 
 children seen in a school by means of facts seen and the teacher's 
 report. Evidence of scientific value is thus obtainable of importance 
 to the State, to education, and to philanthropic efforts. 
 
 The average child material in a school or district may be deter- 
 mined. The conditions of development and the nerve-signs vary 
 very much in different schools ; as to the latter, observation suggests 
 that adapted methods of training may remove them. 
 
 The co-relation of visible signs with low nutrition and mental 
 dulness has in many cases been demonstrated. 
 
 Ill-made and feeble children tend to gravitate to the Poor Law 
 and Certified Industrial Schools, and to the lower standards of day 
 schools. The want of provision for mentally feeble children in day 
 schools, and in many cases their exemption on medical certificates, 
 tends to throw such cases upon the care of the State, and many 
 become degraded. 
 
 Feebly-gifted children, the paralysed, and in some cases the 
 
epileptic, may in many cases and in limited numbers be educated in 
 special classes in day schools. 
 
 If any special knowledge concerning the condition o the child- 
 population in our towns and sanitary areas is to be obtained, and if 
 we desire to remove the defects among them and improve the 
 average standard, then is highly desirable that the modes of pro- 
 cedure should be systematized, and plans arranged for carrying on 
 such work as has been explained, as a Department of State Medicine, 
 side by side and in aid of our Public Hygiene. 
 
 Having given some account of the 50,000 children seen 1888 91, 
 we may proceed to arrange them in groups, as seen in resident schools 
 and day schools, dividing the latter into sub-groups of higher 
 and lower social standing ; lastly the children may be examined as 
 seen in schools for English, Irish, and Jew children. 
 
 The facts referred to are given in Tables XIX. and XX., and we 
 may take as a basis for comparison the average for the 50,000 cases ; 
 the tones of figures representing conditions may be higher or lower 
 than this average. 
 
 The percentages go against the resident schools, except as to 
 bodily nutrition. The material they receive is worse than the 
 average, and their results are not so good; this is accentuated in 
 the certified industrial schools, and less marked in the homes and 
 
 Taking the average condition of the day schools and comparing with 
 it the children of upper grade with those of poorer class, there is a pre- 
 ponderance in favour of the lower class as less dull 9r defective. 
 
 As to the nationalities the differences are more marked than among 
 the social classes. In day schools the Jewish children the families 
 of the Whitechapel Jew immigrants stand as by far the best in 
 all conditions: Development cases 7*5 per cent., Dull 5*1 per cent., 
 Low Nutrition 2*7 per cent.; as against the English children with 
 Development cases 10*8 per cent., Dull 6*8 per cent., Low Nutrition 
 4-3 per cent. ; and in all Irish with Development cases 20'0 per cent., 
 Dull 13 per cent., Low Nutrition 5*5 per cent. 
 
 School Organisation. 
 
 School organisation by the teachers is mainly founded upon their 
 experience of the child's mental ability and work in school. This 
 takes time and frequently a new pupil is not placed in a suitable 
 standard till some weeks' experience shows the child's mental capacity. 
 A knowledge of the points observed in this enquiry might greatly 
 
63 
 
 facilitate the responsible work of classification for educational 
 purposes. Two Standards frequently, though not always met with 
 in schools, call for special remark. In Standard O or Primers the 
 children are collected who, being over age for the Infant School, are 
 still too backward for Standard I. In Standard Ex VII. we find the 
 children who have passed through the ordinary classes of the school. 
 Among the 63 schools seen, 1892-94, there were 25 with either 
 Standard Ex VII. or Standard O at the visit. The numbers seen in 
 these standards is indicated in the following Table. 
 
 TABLE VIII. Cases seen 189294. 
 
 
 Total number 
 seen in schools. 
 
 Ex VII. 
 only. 
 
 Stand'rdO 
 only. 
 
 Ex VII. & Stand'rd 0. 
 
 Ex VII. 
 
 Stand'rd 
 
 Boys. 
 
 Girls. 
 
 B. G. 
 
 B. G. 
 
 B. G. 
 
 B. G. 
 
 11 schools with Standard 
 Ex VII only 
 
 6,373 
 4,508 
 2,362 
 
 5,727 
 4,143 
 2,107 
 
 110 
 
 101 
 
 
 
 
 
 
 
 10 schools with Standard 
 only 
 
 255 
 
 212 
 
 
 
 
 
 4 schools with Standard 
 Ex VII. & Standard 
 
 25 . 
 
 34 
 
 30 
 
 99 
 
 111 
 
 
 
 
 
 13,243 
 
 11,977 
 
 110 
 
 101 
 
 255 
 
 212 
 
 34 
 
 30 
 
 99 
 
 111 
 
 
 In these 25 schools we find as follows : 
 
 In Standard Ex VII. : Boys, 144 ; Girls, 131. Eeported as dull : 
 Boys, 4; Girls, 5. In Standard 0: Boys, 354; Girls, 323. Ex- 
 ported as dull : Boys, 93 ; Girls, 107. For conditions of children in 
 these Standards see Table XXI. 
 
 More accumulations of dull children in a certain class, whether a 
 class of Primers, or in a lower section of Standard III. for older 
 children, may make the other class rooms brighter; but when 
 children below the average in mental power are accumulated, there 
 arises a greater responsibility for their individual care, which must 
 be met by the provision of a sufficient staff of specially-trained 
 teachers. 
 
 Secondary education, such as is carried on in the Standard Ex 
 VII. of our public elementary schools, tends to accentuate the 
 difficulties arising from the classification of children solely according 
 to mental status. In elementary schools of higher grade, a boy 
 entering Standard I. in the boys' school is unacceptable unless he can 
 work well ; after a certain age, the dull boy cannot conveniently be 
 kept in the infant school, for which he is too big. He must then 
 
64 
 
 either be kept among the infants, for whom he is not good company, 
 or go among classmates with whom he cannot profitably work. To 
 meet such cases it often happens that there is a class of Primers or 
 Standard O, but without any special arrangements for individual 
 culture of these dull or backward pupils. 
 
 In such schools the brighter children are well educated; at 
 fourteen years of age they get the prizes of the school and enter 
 social life at an advantage ; the dull children on the other hand have 
 not only been left comparatively uncultured, but by raising a class 
 distinctly superior to them, they find the struggle for existence 
 becoming intensified. 
 
 " Schools of Special Difficulty" 
 
 Until the year 1890, certain schools under the London School 
 Board were officially recognized as schools of special difficulty ; three 
 of these schools were visited in 1892 and the fourth in 1894. An 
 account of the children in these schools is given in Tables XXVI., 
 XXVII. and XXVIII. On reference to Table XXVIII. it will be 
 seen that while presenting a percentage of dull pupils much higher 
 than the average of Board Schools, they also contained more than the 
 average number of children with all the Main Classes of defects. 
 
 Schools where the Number of Children in Attendance is Small in 
 
 Relation to the School Accommodation. 
 
 In two London Board Schools, with an aggregate accommodation 
 of 1828 places, there were present only 566 boys and 451 girls : 
 this was explained by the diminishing child-population of the neigh- 
 bourhoods, and both schools were about to be closed. The conditions 
 of these children are indicated in Tables XXVI., XXVII. and 
 XXVIIL, and on reference to Table XXVIIL, it will be seen that 
 the child-material was much below the average and presented a 
 super-abundance of abnormal nerve-signs. 
 
65 
 
 OHAPTEE VIII. 
 
 EECOMMENDATIONS. 
 
 A Appointment of a Scientific Commission of Enquiry by 
 Government. 
 
 It is desirable that a small Scientific Commission of Enquiry should 
 be appointed by the Government for the purpose of determining the 
 conditions of portions of the School population as to their mental and 
 physical power; ascertaining the numbers of such as are of imperfect 
 development, their distribution, and the possible causes of such 
 defects. 
 
 B-Need of Enquiry as to Feeble-minded Children. 
 
 In view of the harm resulting not only to the individual, but also 
 to society from the educational neglect of the feeble-minded child (the 
 defective child growing up dependent, and possibly delinquent) it is 
 expedient that the State should officially obtain information as to the 
 social necessities of this class, and of the physical signs of mental 
 deficiency indicating the need for special training. Investigations 
 with this object should be made in various urban and rural districts 
 throughout the country, and may incidentally furnish information as 
 to the influence of the special circumstances and occupations of a 
 given locality upon the mental and physical conditions of the 
 population. 
 
 C Desirability of a Parliamentary Enquiry as to Feeble-minded 
 Children, their Condition and Training. 
 
 It is desirable that a Committee be appointed by the House of 
 Lords, or other public body, to examine the evidence now afforded as 
 to the conditions of childhood; the best means of dealing with 
 children who are dull or deficient ; the means at present available for 
 their educational care ; and to report generally upon the status and 
 needs of dull and defective children, and the working of methods of 
 education as they affect such children. 
 
 E 
 
66 
 
 D Recommendations of the Royal Commission on Blind, Dumb, 
 &e., as to the Feeble-minded. 
 
 The Royal Commission on the Blind and Dumb, &c., having 
 reported " That with regard to ' feeble-minded ' children, they 
 should be separated from ordinary scholars in public elementary- 
 schools, in order that they may receive special instruction; and 
 that the attention of school authorities be particularly directed to 
 this object." It is recommended that the Act to make better 
 provision for the Elementary Education of Blind and Deaf Children 
 in England and Wales [56 and 57 Viet., chap. 42], should be 
 extended to include children with other mental and bodily defects 
 as well as the epileptic. 
 
 E Expert Scientific Advice to Government Departments. 
 
 That the Government be recommended to appoint scientific experts 
 to assist the Education Department, the Local Government Board, 
 and the Home Office, with regard to the means to be adopted for 
 the education of children requiring special care. 
 
67 
 
 CHAPTER IX. 
 
 SUGGESTIONS AS TO THE CONDUCT AND 
 ADMINISTRATION OF THE EDUCATION OF FEEBLE- 
 MINDED CHILDEEN. 
 
 RECOMMENDATIONS AS TO ADMINISTEATION. 
 
 1 School Board Census should note Mentally-feeble and 
 Afflicted Children. 
 
 That School Boards, in taking the triennial census of their district, 
 should register any mentally-defective children, or children otherwise 
 .afflicted. 
 
 2 Feeble-minded Children should attend a Special School or Class. 
 
 The fact that a child is found to be feeble-minded is no reason for 
 excluding him from school attendance, but special arrangements should 
 be made by school authorities to provide such teaching as is appro- 
 priate to feeble-minded children. These cases appear to be not more 
 than one or one and a half per cent, of the children seen. 
 
 3 Feeble-minded Children to be trained in Day Schools or 
 Boarded Institutions. 
 
 In making provision for the special instruction and training of 
 " feeble-minded " children, the character of the home surroundings 
 and the care which the child will receive out of school should be taken 
 into consideration in determining whether attendance at a day school 
 -or residence in a boarding institution is preferable. 
 
 4 Day School Classes of Special Instruction. 
 
 It appears desirable that day schools or classes of special instruction 
 should be established at a sufficient number of centres for " feeble- 
 
68 
 
 minded " children. This is needed primarily that such children may 
 have special instruction provided for them and not be excluded from 
 school attendance ; pupils from other schools might be conveniently 
 transferred to them so as to meet local requirements. 
 
 5 Report on Individual Feeble-minded Children in Schools. 
 
 It is desirable that children in schools or classes for " the feeble- 
 minded" should be separately and individually reported on as to mental 
 and physical condition, both on admission to the school, and after 
 definite periods of instruction ; and that for this purpose independent 
 Government Inspectors should be appointed for the Public Elemen- 
 tary, Poor Law, and Industrial schools. 
 
 6 Trained Teaching Staff for Feeble-minded Children. 
 
 That, in order to provide a' staff to undertake the educational care 
 of weak and mentally-feeble children, a special course of training for 
 such teachers should be arranged. 
 
 7 Lectures and Training for Teachers of the Feeble-minded. 
 
 That lectures should be instituted on the observation, study, and 
 classification of children, as to conditions bearing on mental life and 
 education. This might consist of an elementary course and of Uni- 
 versity teaching. Arrangements should be included for demonstra- 
 tions in a practising school. 
 
 8 Discrimination and Report on Feeble-minded and 
 Afflicted Children. 
 
 The selection of and report on children who are feeble-minded or who 
 on other grounds require special care and training, should be made 
 upon a methodical plan by a Medical Officer. Children found to be 
 absent from school on account of mental weakness or bodily affliction, 
 as well as pupils presented by teachers as unfitted for the ordinary 
 classes should be carefully reported on in order that suitable training 
 may be provided for classified groups of children. 
 
69 
 
 9 Certificate as to a child requiring Special Educational Training. 
 
 Name of child. 
 
 Age. 
 
 Address. 
 
 Physical health and condition. 
 
 Developmental defects. 
 
 Nervous defects. 
 
 Defects in mental power. 
 
 Eacts communicated by others (stating from whom). 
 
 Opinion and recommendation as to the case. 
 
 Date. (Signed). Medical Officer. 
 
 10 Classes for Dull and Backward Children not Feeble-minded. 
 
 Where the school organization includes a special class for the dull 
 and backward children as with Primers or Standard O, which mostly 
 contains the children too old for the Infant School and too backward 
 for Standard I. ; or a class where older children who are dull are 
 accumulated higher up in the school, the arrangements, the number 
 of pupils in each class, and the selection of the teacher, should be 
 adapted to the special difficulties of dealing with these children 
 whom it has been shown particularly need careful and individual 
 attention. 
 
 11 Instruction for Teachers in Training Colleges. 
 
 Special practical and theoretical instruction should be given to 
 all teachers in Training Colleges and elsewhere as to the physical 
 indications of weakness and mental-feebleness in children, and 
 as to the points to which they should direct attention in school 
 classification and teaching thus enabling them to describe and if 
 necessary report on individual children to the School Authority. 
 
 12 The Special Care of Dull and Feeble-minded Children 
 is imperative. 
 
 The educational care of Dull children and those Feebly-gifted 
 mentally, is as much a duty devolving on the Community as is the 
 Education of bright and healthy children. 
 
70 
 
 13 Children in Punitive Schools under tlie Home Office sliould be 
 individually reported on. 
 
 In certified industrial and other schools under the Home Office, 
 where children are detained for lengthened periods under a magis- 
 trate's order, it is of special importance, with regard to preventing 
 mistaken harshness, and in consideration of the punitive discipline 
 of such establishments, that a report should be made upon the admis- 
 sion of an inmate as to his mental and physical condition, in addition 
 to an annual report upon each child, in order that cases of bodily 
 and brain defect may be dealt with according to circumstances. It 
 has been shown that cases of defectiveness are very common in such 
 establishments. 
 
 14 Recommendation to Boards of Guardians relative to Feeble-- 
 minded Children. 
 
 That the attention of Boards of Guardians be specially directed to 
 the importance of discriminating the dull, backward, and mentally- 
 deficient children under their care, and to the best means of providing 
 for their special training, and to the desirability of preparing a special 
 annual report concerning the mentally-deficient and otherwise afflicted 
 children for whom they are responsible. 
 
 15 Feeble-minded persons in Workhouses and those seeking relief. 
 
 That Guardians should prepare returns showing the number of 
 "weak-minded" applicants for relief, and inmates of workhouses 
 with whom they have to deal. 
 
 16 Recommendation to Philanthropic Societies as to 
 discrimination of the " Feeble-minded." 
 
 That the attention of institutions, societies and philanthropic 
 bodies dealing with dependent and afflicted children and young 
 persons, be directed to the careful discrimination of the weak-minded 
 for whom special provision is necessary. 
 
 This is specially important in dealing with young people crippled, 
 paralysed, epileptic, and those with a tendency to delinquency as well 
 as with others failing in self-dependence. 
 
All such bodies are strongly recommended to seek professional 
 assistance and advice, both when undertaking the care of cases and in 
 dealing with special difficulties as they rise. 
 
 17 Preparation of Vital Statistics. 
 
 That in the preparation of all vital statistics males should be 
 distinguished from females, and that in returns of mortality 
 Developmental diseases should always be included. 
 
 DOUGLAS OALTON, 
 
 Chairman of Council. 
 
 E. WHITE WALLIS 
 
 Secretary. 
 
 June, 1895. 
 
72 
 
 a 
 
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 OQ 
 
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 PP 
 
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73 
 
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74 
 
 Of total of 
 100,000 in 
 Schools see 
 18881894. 
 
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 defect is enum 
 combination 
 
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75 
 
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76 
 
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 (^37). 
 being ho 
 (ff 38) 
 sunken 
 (ff 39) 
 small a 
 their v 
 
 m 
 is 
 
 ym 
 ax 
 
 not 
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 inst 
 (ff 40 
 (g 41 
 growths 
 (ff 42) 
 inclu 
 
 lance Defec 
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 Defective. 
 uscular acti 
 be an expr 
 nced or moved 
 pressio 
 veracti 
 ead, 
 
 r 
 n . 
 ng. 
 which 
 
 slo 
 n 
 m 
 ay 
 lan 
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 ill slip 
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 iiiiiiii 
 
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 ^^S^^^ <^ _.rS . g^S^B 
 
 neral Ba 
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 there m 
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 the 
 
 ls 
 fore 
 
 B. 
 
 . 
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 ses 
 
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 43). 
 uld 
 44 
 sion 
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77 
 
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 rlfra-iilrrl 
 
 *a!":iibi a 
 flflJiis' 1 
 
 ^O^G^ 
 
 S -.3 * "^ _j H ^ a) P* 55 S<' ' ~~ G-^ "' ' o ' ' fQ 
 
 188 --1-2^ g ftx,g I d l^l^l 
 
 lll5lt^l 8 ig < S^12l^'Sf s 
 
 o 2 o^m P^"^ CB S^.S^^-S^ 29 '^'^^ 2 
 
 "S^^ 
 
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78 
 
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 CD 
 
 .2 $S 
 
 18*7 
 
 2 SS 3 $ $ $ 
 
 Ilia 
 
 m i I 
 
 N 
 
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 ^ 
 
 7- CO M MM VO 10 
 
 
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 m 
 
 
 iU-l^^-ill^Miinr 
 
 "s-s H S,s^.5 gSa g sSsI ^^ 
 
 Each defect is enumerated, whether alone or in 
 combination with other defects. 
 
 (h 54). OTHER ABNORMAL NERVE SIGNS less frequently observed, 
 ouped for convenience of primary arrangement as being less fr< 
 occurrence than those given earlier, but not necessarily of less i 
 nee 
 (55). Deaf, or Hearing Defective. Children deaf, or partiallyjdeaf. 
 r hearing cannot be used in a school enquiry 
 (56). Grinning, or Over-smiling. Over-smiling or grinning may be s 
 sous, or may occur on any stimulation to effort. The lines formed 
 ,so-labial region of the face may be fine or coarse ; there may be a du] 
 triplicate naso-labial groove partly depending upon the thinness or 
 sss of the skin ; permanent skin creases may result 
 (57). Mouth Open or Jaw Drooped. The jaw may be drooped, < 
 outh may be open with the teeth closed. This should not be re< 
 a nerve sign if it is probably due to obstruction of the respi 
 .ssages 
 (58). Over-Mobile. Constant spontaneous movements. Among child 
 e infant school, and in some over 7 years, spontaneous movem 
 irmal ; it is most common in the fingers _ ... 
 (59). Response in Action Defective. Response in action following i 
 and or in imitation may be accurate or uncertain, prompt or slow, 
 ay be an interval between the command and the response, or the 
 ay be continued unduly long. Response may be better when stim 
 rough the eye or through the ear respectively 
 (60). Speech Defective. Stammering (spasm), or defect in artici 
 rtain sounds. Speech may be nearly absent ; it may be indistinct, 
 ental defect, the question asked may be repeated without a reply 
 
 
 " 3 o3 O vj as f-i <u H 03 cc -fl u dc3C^3 CJM 
 
 bc.s -S <s a p o c 9 a- a s s 5-5 s a 
 
79 
 
 
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 e regis- 
 asked 
 l were 
 d been 
 wn by 
 istered 
 
 Signs 
 
 s 
 
 very ca 
 city wa 
 in schoo 
 fects ha 
 upils kno 
 were reg 
 
 rted by the 
 rning the chil 
 d as below a 
 ildren presen 
 ited to prese 
 grades of m 
 , 78) 
 
 D. DULL Mentally, or so Repor 
 red the teacher's opinion concer 
 d written down ; those reporte 
 gistere dull. After the chi 
 cked o he teachers were invi 
 em to mentally dull. All 
 der th ading see (76), (77?, 
 
 uint, one 
 ooking at 
 tropia ... 
 sight ... 
 
 ry 
 t was not 
 e present 
 
 DEFECTS OF EYES. When the eyes were looked at obvio 
 noted, but no tests were used as to acuteuess of vision or 
 tion, and the ophthalmoscope could not be used in the scho 
 ia was not registered, but some of its late effects are recor 
 ase of Cornea," "Eye lost by Disease "(68), (70) 
 . Squint. Under this heading are registered cases of organic s 
 being turned; also temporary or varying convergence when lo 
 bject two feet from the face, which probably indicates hyperme 
 Using Convex Glasses. Evidence of hypermetropia or long s 
 Using Concave Glasses. Evidence of myopia or short sight 
 Myopia not Using Glasses. Short sight ascertained on inquir 
 Disease of Cornea. Inflammation, ulcers, white patches. I 
 convenient to record ophthalmia, but if disease of cornea we 
 
 E. 
 
 ere 
 frac 
 almi 
 Dise 
 (64) 
 e b 
 ob 
 (65) 
 (66) 
 (67) 
 
 sc-^fl sa w g 
 
 ^ ,53 S A52 S3 ? H S 3 0) c8 
 
 ). 
 ound 
 
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80 
 
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 rated, whether alone or in 
 with other defects. 
 
 fect is 
 comb 
 
 tLSi t^.5S a 21rt*+? s * R 
 
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81 
 
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 II 1 ! 
 
 : g?^ 1 ? : 
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 i all children pr 
 menclature of 
 af these defect 
 of these cases 
 
 according to con 
 and educational 
 
 >>< S 
 
 . -s-a 05 ^ . 
 
 n3 -,-d : 
 ^^.^ ' 
 
 ^l!i 
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 ID. This includes 
 given in the No 
 ted one or more < 
 i filled in for each 
 
 ll 
 
 ! fi?! : 
 
 til! 
 
 groups of children are arra 
 tance, and are of special, s 
 
 tal number of children see: 
 
 EMAL CHILDBEN. This 
 visible defect in Develop] 
 abnormal Nerve-signs, 
 numbers in the school St 
 1892-94 
 
 ILDREN NOTED AND REGIS 
 any of the signs or def 
 Each of these children p 
 Mentally dull ; a schedul 
 
 ^a 
 
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 s 
 
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 2 | 
 
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83 
 
 I 
 
 
 
 1 
 
 <N 
 
 % 
 
 
 E CASES. This includes all children showing any of the defects of eyes 
 enumerated in the Nomenclature of defects (64 to 75). Tests for 
 acuteness of vision or errors of refraction could not bo used in the 
 schools, but when spectacles were used, or when inspection showed 
 obvious defects of the child's eyes, such facts were recorded. Cases 
 of ophthalmia were not recorded as such, but some of its late effects 
 were registered under the headings "Disease of Cornea, 68," and " Eye 
 lost by disease, 70 
 
 :LDREN THE SUBJECTS OF EICKETS. When bent legs or pigeon 
 breast indicated Eickets the fact was recorded; conditions of the 
 cranium were not accepted as evidence of Rickets, but were entered 
 under their respective headings, see "Cranium (1 to 10) in Nomencla- 
 ture of defects." Probably more children than those registered were 
 or had been rachitic 
 
 OPTIONAL CHILDREN. This includes all children whose physical or 
 mental conditions show them to be obviously at a permanent 
 disadvantage therefrom in social life. This group includes: Idiots 
 (76); Imbeciles (77); "Children Feebly gifted Mentally (78); Children 
 Mentally exceptional (79); Epileptics and children with history of fits 
 during school life (80); Dumb children (81); and all children Crippled, 
 Deformed, Maimed, Paralysed, see Group 11 and in Nomenclature (82). 
 All these Exceptional Children need to be considered individually as 
 to their special requirements 
 
 its Includes all children who on account of their bodily and brain 
 defects and the absence of mental power might be certified as idiots 
 under the Idiots' Act and sent to an asylum. See Nomenclature (76) . . . 
 
 beczles.This includes all children who might be certified as mentally 
 imbecile and transferred to an asylum. Speaking generally, these are 
 less hopeless cases than the idots and more educible under industrial 
 training. Some of these cases were the result of disease, not of 
 congenital defect of brain. See Nomenclature (77) 
 
 
 *o 
 
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 e of Groups of Children and Groups of Cases Continued. 
 
 kildren Feebly- Gifted Mentally." These children are distinctly deficient 
 in mental power but might not be certified as imbeciles, and are 
 therefore not fit for such medical certification. No child was registered 
 in this group unless it was believed upon evidence observed and the 
 teacher's report combined to be incapable of school work in the 
 ordinary classes. It is difficult to define what physical conditions 
 seen, as apart from mental tests, indicate the child as unfitted in 
 mental capacity for the usual methods of education, and an arbitrary 
 attempt to do so has not been made. There appears, however, to be 
 a large class of "children feebly-gifted mentally" with defect of 
 mental power short of imbecility but still with some deficiency. See 
 Nomenclature'(78) 
 
 'Idren Mentally Exceptional. These children while not necessarily 
 mentally dull, and without brain power, appeared deficient in certain 
 mental characteristics and in moral sense, such as, habitual liars, 
 thieves and incendiaries; others were liable to attacks of total mental 
 confusion, or periods of total mental inaptitude or violent passion, or 
 were moral imbeciles. Some of these children were the offspring of 
 insane parents or criminals. It is quite possible that some of these 
 children were really epileptic or subject to petit-mal. Some of these 
 children while thus mentally exceptional were not ordinarily dull 
 pupils in schools. See Nomenclature (79) 
 
 'leptics and Children with History of Fits during School Life. In every 
 school enquiry was made for children subject to fits, whether occurring 
 in school or alleged to occur at home during school life and given as 
 a reason for absence from school. A report given as to history of fits 
 was recorded and the case was entered in this group, but at the 
 
 i 
 
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 3 
 
 
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 p. 
 
 
 
 
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 00 
 
 inspection of a school, facts could not be usually observed 
 the child to be epileptic. See Nomenclature (80) ... 
 Children Crippled, Maimed, Deformed, or Paralysed. Any child 
 maimed, deformed, or paralysed was included in this groi 
 ditions of disease and paralysis were in various stages, butii 
 the child appeared to be at some permanent disadvant! 
 conditions causing crippling were in various stages; rnanj 
 children were quite capable of work and play, seme were 
 defective, they varied greatly in brain power and in physic 
 Eye cases are not included in this group. See Nomenclatur 
 Children who appear to require special Care and Training. Tl 
 includes all cases given as "Exceptional Children," see Grouj 
 addition "all children mentally dull, with defects in Dev 
 abnormal Nerve-signs and Low Nutrition, i.e. Group 27 
 
 CASES NOTED ABBANGED 
 
 A large number of Groups of cases may be arranged 
 cation and research ; they vary much in number and appai 
 There are Four Main Classes of Defectiveness: 
 
 * 
 
 *OQ 
 
 .2 
 -2 
 
 1 
 
 
 
 
 9 
 
 03 
 ^ 
 
 % 
 
 f 
 
 Abnormal Nerve-signs Certain abnormal actions, movements, 
 clature (43 to 63). 
 
 Low Nutrition as indicated by the child being thin, pale, or deli< 
 
 Mental DulnessThe Teacher's report as to mental ability wa 
 and those stated to be below the average in ability for sch 
 
 
 
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 1-4 r-H i 1 i-H i 1 i-H 
 
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 OO 
 
 oo 
 
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 velopment cases: Dull only.. Each case presents one or more defect in 
 Development with Mental dulness, but neither Abnormal Nerve-signs 
 nor Low Nutrition 
 
 rve cases with Low Nutrition only. Each case presents one or more 
 Abnormal Nerve-sign and Low Nutrition, but neither defect in 
 Development nor Mental dulness 
 
 rve cases : Dull only. Each case presents one or more Abnormal Nerve- 
 sign and is Mentally dull, but presents neither defect in Development 
 nor Low Nutrition 
 
 !0 Nutrition cases : Dull only. Each case presents Low Nutrition and 
 Mental dulness, but neither defect in Development nor Abnormal 
 Nerve-sign 
 
 velopment cases with Abnormal Nerve-signs and Low Nutrition only. 
 Each case presents one or more defect in Development and one or 
 more Abnormal Nerve-sign with Low Nutrition, but not Mentally dull. 
 
 velopment cases with Abnormal Nerve-signs and Dull only. Each case 
 presents one or more defect in Development and one or more Abnormal 
 Nerve-sign with Mental dulness, but not Low Nutrition 
 
 velopment cases with Low Nutrition and Dull only. Each case'presents 
 one or more defect in Development with Low Nutrition and Mental 
 dulness without any Abnormal Nerve-sign 
 
 rye cases with Low Nutrition and Dull only. Each case presents one 
 or more Abnormal Nerve-sign with Low Nutrition and Mental dulness 
 without any defect in Development 
 
 velopment cases with Abnormal Nerve-signs, Low Nutrition, and Mental 
 Dulnsss Each case presents one or more defect in Development, and 
 one or more Abnormal Nerve-sign with Low Nutrition and Mental 
 
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 r * 
 
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 CD a, rrt . Ct3 3 
 
 "^H ^ 
 
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 one or more Abnormal N 
 ), either with or witbout i 
 tion or Mental dulness. !: 
 mobility, others, want of 
 or want of due co-ordin 
 igns indicate defectivene 
 
 is thin, pale or delicate, e 
 Development, Nerve-sig 
 
 a *l 
 
 IWI 
 
 W-H i a 
 
 III: 
 
 wl* S 
 
 *^il 
 &>>& i 
 
 ^ g-^o? 
 
 QJ^ ~ 3 t~ 
 
 -S^S^X 
 
 - Classes of Defects, 
 
 filiation. 
 
 rmal Nerve-signs. Each 
 md one or more Nerve-s 
 ivith Low Nutrition, M 
 
 All Nerve cases. Each case presents 
 signs, see Nomenclature (43) to (63 
 defect in Development, Low Nutiii 
 of the Nerve-sigDS indicate over- 
 action or response to stimulation, 
 from efficient training. Other s 
 organisation of the brain 
 
 All Low Nutrition cases. Each case 
 with or without some defect in 
 Mental dulness 
 
 All Dull cases. Each case is repo 
 Mentally or below the average in 
 with or without some defect in De 1 
 Nutrition. All grades of Mental 
 group. See Nomenclature (76) (77 
 
 ^ 
 
 f 
 "1 
 
 00 
 
 
 
 < 
 1 
 
 *<?* 
 
 ^ 
 
 o 
 
 <3 
 
 1 
 1 
 
 All Development cases with Abno 
 presents defect in development f 
 either alone or in combination < 
 dulness or both 
 
 
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 00 
 
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 OOOO 
 
 QQOO 
 
 
 
 000 
 
 CQOOCQCQOm 
 
 ooQoooom 
 
 QQQCQOOm 
 
 
 
 CQCQCQCQ 
 
 O<03OCQ< O<CQOCQ< 
 
 CO 
 
90 
 
 * 
 si 
 
 
 oo 
 
 i 
 
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 Q Q Q Q Q 
 
 OQO QQO OQO QQO QQO 
 
 ODQOCQ QDQOCQ ODQOCQ QOQOCQ QOOCQ 
 
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 CO CO CC 
 
91 
 
 s 
 
 
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93 
 
 
 
 
 
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 o 
 
 CO 
 
 T 1 
 
 r-H 
 
 3 
 
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 CO 
 
 o 
 
 T- T 
 
 3 
 
 r-T 
 
 00 
 
 
 
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 ro 
 
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 i 
 
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 m 
 
 co 
 
 
 
 ! 
 
 1 
 
 vo 
 
 Th 
 
 00 
 
 S 
 
 oo 
 
 CO 
 
 i r 
 
 H 
 
 i 
 
 00 
 
 
 
 1 S S : 
 
 * a a ' 
 
 <L : 
 
 1 S $ ' 
 
 o : 
 
 1 fl fe I 
 
 R a &T : 
 
 fa; 
 
 -:- 
 
 &~ P ' 
 
 stT? 
 
 <to <D <I> 
 
 8 sa ' 
 
 ^i- 
 
 O> rt 
 
 ls.y 
 
 i^i 
 
 'r r > 
 
 f. 
 
 -! . 
 
 1-1 
 
 "S S -^ ' 
 
 8 ' 
 
 ^3 > S 
 *3 f-t % 
 
 S : 
 
 S * 
 
 J^ o : 
 
 fe O Q * 
 
 2|g 
 
 S3 a 
 -*& i 
 
 'ila : 
 
 ^^ S 
 l^ 
 Js-3 ! 
 
 P- - 
 
 |3 P : 
 
 IS 
 
 JH 
 
 S^fl 
 
 8 gS 
 
 1|| . 
 
 ^3^ 
 
 ^ a > 
 
 3'l'^ 
 
 *ll 
 
 -:Sfi 
 
 **i 
 
 |=5 
 
 <; p ^ 
 
 S <& c* 
 
 g'oW- 
 
 oS : 
 
 1 g.2 : 
 
 i*.s; 
 
 l-s-i; 
 
 ^a* 
 
 ^ S rS 
 
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 S^J Q} n? 
 
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 ^S ^> (> 
 
 Q S 01 
 
 *o -^ 1^ 
 
 C S o 
 
 (CD +). All cases of Low Nutrition wit 
 Each case presents Low Nutrition withoul 
 alone or in combination with defect in 
 more Nerve sign, or both 
 
 (AD + ). All cases of Mental dulness wi 
 ment. Each case presents Mental duln 
 Development, either alone or in combin 
 Low Nutrition, or both 
 
 (B D +). ^4// cases o/" Mental dulness wi 
 signs. Each case presents Mental dulnes 
 either alone or in combination with defec 
 Nutrition, or both 
 
 (CD +). ^4// cases of Mental dulness wi 
 Each case presents Mental dulness withou 
 alone or in combination with defect in De 
 or both 
 
 ' without defect tn Development and with 
 case presents no defect in Development '< 
 may present Low Nutrition, Mental dulne 
 
 without defect in Development and withou 
 tally dull Each case presents Mental di 
 Development and no Nerve-sign, either 
 Nutrition 
 
 without either defect in Development, Net 
 or Mental dulness. These cases present 
 classes of defects ; they belong to the cl 
 Rickets; or G, Exceptional Children (79) t 
 
 I 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 1 
 
 
 
 Q 
 
 Q 
 
 Q 
 
 ^ 
 
 ^ 
 
 
 
 O 
 
 OODQ QQQ QQQ QQDQ Q Q 
 
 O<m< QDQQDQ G<o< Q<OQ< ooo QO 
 
 o o >b u5 o 10 
 
94 
 
 TABLE IX. (cases seen 1888-91). Distribution of Signs or Defects under 
 
 Divisions of Schools. 
 
 For Definition of Signs, see Nomenclature on page 72. 
 
 For Description of Divisions of Schools, see List of Schools on page 5. 
 
 For Further Distribution in Divisions of Schools, see sub-table XX. 
 
 Numbers refer to Nomenclature. 
 
 1. 
 
 Poor Law 
 Schools. 
 
 2. 
 
 Certified 
 Industrial. 
 
 3. 
 
 Homes and 
 Orphanages. 
 
 4. 
 
 Public 
 Elementary 
 Day Schools. 
 
 A. DEFECTS IN DEVELOPMENT. 
 (a 1). CRANIUM defective 
 
 Boys. 
 
 387 
 76 
 42 
 131 
 80 
 7 
 22 
 7 
 22 
 257 
 
 124 
 
 216 
 114 
 85 
 15 
 2 
 
 Girls. 
 I 7 I 
 
 19 
 67 
 24 
 41 
 
 6 
 
 8 
 
 2 
 
 81 
 
 101 
 
 133 
 
 73 
 
 54 
 5 
 
 i 
 
 Boys. 
 160 
 7 
 24 
 49 
 43 
 4 
 9 
 7 
 17 
 106 
 
 28 
 67 
 35 
 6 
 22 
 1 
 3 
 
 Girls. 
 
 4 
 
 I 
 26 
 3 
 
 7 
 
 i 
 
 i 
 i 
 
 3 
 
 18 
 3 
 4 
 ii 
 
 Boys. 
 34 
 4 
 14 
 12 
 2 
 
 "i 
 "i 
 
 41 
 
 14 
 32 
 19 
 10 
 2 
 1 
 
 Girls. 
 79 
 
 2 
 
 53 
 16 
 
 3 
 
 i 
 
 3 
 
 i 
 9 
 
 18 
 30 
 *7 
 
 12 
 
 I 
 
 Boys. 
 
 947 
 
 170 
 247 
 305 
 58 
 78 
 52 
 28 
 10 
 643 
 
 348 
 448 
 282 
 134 
 47 
 11 
 7 
 
 Girls. 
 758 
 24 
 592 
 
 82 
 
 27 
 
 21 
 
 6 
 
 2 
 
 3 
 
 175 
 
 262 
 
 344 
 198 
 
 101 
 
 25 
 5 
 ID 
 
 (a 2). CBANIUM large 
 
 (a 3) CBANIUM small 
 
 
 (ci 5). Forehead defective 
 
 (a 6). Frontal ridge 
 
 (a 7). CRANIUM asymmetrical... 
 (a 8). Dolichocephalic 
 
 (a 10). Other types of CRANIUM.. 
 (11). EXTERNAL EAR defective 
 (c 12). EYELIDS WITH EPICAN- 
 
 THIS 
 
 (d 13). PALATE defective in shape 
 (d 14). PALATE narrow 
 
 (d 15). PALATE V-shaped 
 
 (d 16). PALATE arched 
 
 (d 17). PALATE cleft 
 
 (d 18). Other defects of PALATE. 
 (e 19). NASAL BONES defective... 
 
 (/20). GROWTH SMALL, short ... 
 (^21). OTHER DEFECTS IN DE- 
 VELOPMENT ... 
 
 41 
 
 254 
 3 
 2 
 69 
 20 
 4 
 13 
 2 
 7 
 1 
 3 
 14 
 3 
 
 74 
 259 
 423 
 38 
 121 
 120 
 
 48 
 
 160 
 9 
 3 
 
 42 
 
 3 
 3 
 
 7 
 
 i 
 
 3 
 
 2. 
 2 
 J 7 
 
 32 
 146 
 107 
 
 66 
 75 
 
 21 
 
 122 
 7 
 3 
 28 
 11 
 
 6 
 
 21 
 10 
 
 3 
 
 27 
 
 "3 
 
 9 
 
 38 
 
 6 
 
 144 
 
 505 
 6 
 13 
 47 
 9 
 9 
 3 
 8 
 3 
 22 
 28 
 63 
 11 
 
 115 
 362 
 681 
 129 
 359 
 554 
 
 146 
 426 
 
 "s 
 
 46 
 
 3 
 3 
 4 
 4 
 14 
 26 
 
 57 
 
 134 
 276 
 
 145 
 25 
 262 
 
 367 
 
 (g 22). Adipose type 
 
 (g 26). Face small 
 
 (g 27). Features coarse 
 
 (g 28). Forehead hairy 
 
 (g 29). Frontal Veins large 
 
 (a SO). Hands blue and cold 
 (g 31). Hare lip.. 
 
 1 
 
 I 
 
 ... 
 
 ... 
 
 (#32). Jcthyosis 
 
 
 
 
 
 (^rS4). Mouth small 
 
 3 
 2 
 16 
 
 7 
 
 12 
 56 
 175 
 
 28 
 30 
 
 87 
 
 I 
 
 5 
 6 
 
 21 
 14 
 
 5 
 5 
 ii 
 
 1 
 
 *5 
 1 
 
 17 
 43 
 4 
 12 
 37 
 
 4 
 
 i 
 
 3 1 
 28 
 6 
 10 
 32 
 
 (#36). Nose soft tissue 
 
 (g 39). Palpebral fissures 
 
 (g 40). Prognathous type . 
 
 B. ABNORMAL NERVE SIGNS. 
 (43). General balance 
 
 (44). Expression defective 
 (45). Frontal overacting 
 
 (46). Corrugation 
 
 (47). Or bicularis oculi relaxed.. 
 (48). Eye Movements defective. 
 
95 
 
 ABNORMAL NERVE SIGNS, can. 
 (49) Head Balance 
 
 1. 
 
 Poor Law 
 Schools. 
 
 2. 
 
 Certified 
 Industrial. 
 
 3. 
 
 Homes and 
 Orphanages. 
 
 4. 
 
 Public 
 Elementary 
 Day Schools. 
 
 Boys. 
 66 
 189 
 93 
 80 
 36 
 
 144 
 15 
 29 
 31 
 1 
 
 25 
 41 
 
 U 
 
 128 
 16 
 5 
 3 
 17 
 5 
 9 
 6 
 10 
 1 
 2 
 
 38 
 
 64 
 9 
 10 
 7 
 4 
 
 Girls. 
 
 47 
 66 
 
 55 
 25 
 45 
 
 7 1 
 9 
 15 
 iQ 
 
 Boys. 
 13 
 49 
 35 
 25 
 14 
 
 34 
 3 
 
 8 
 15 
 
 Girls. 
 8 
 14 
 5 
 3 
 4 
 
 13 
 
 i 
 
 2 
 2 
 
 Boys. 
 1 
 
 47 
 
 2 
 2 
 
 2 
 
 8 
 *6 
 
 Girls. 
 2 
 41 
 
 1 
 
 6 
 
 13 
 
 4 
 4 
 
 i 
 
 Boys. 
 
 139 
 430 
 420 
 338 
 132 
 
 248 
 16 
 32 
 82 
 3 
 
 81 
 71 
 2 
 13 
 
 317 
 
 108 
 17 
 5 
 42 
 12 
 2 
 19 
 9 
 1 
 10 
 
 113 
 
 67 
 13 
 9 
 2 
 
 7 
 
 Girls. 
 262 
 383 
 447 
 225 
 224 
 
 J 37 
 19 
 
 22 
 
 37 
 
 37 
 4i 
 
 4 
 
 222 
 I 4 
 21 
 
 8 
 39 
 
 10 
 
 4 
 6 
 
 9 
 *3 
 23 
 
 43 
 ii 
 6 
 
 i 
 4 
 
 (50) Hand. Balance weak 
 
 (51). Hand Balance nervous ... 
 (5^) Finger twitches 
 
 (53) Lordosis . 
 
 (h 54). OTHER ABNORMAL 
 NERVE SIGNS 
 
 (55). Deaf, or Hearing defective 
 (56) Grinning 
 
 (57) Mouth open 
 
 (58). Over-Mobile 
 
 (59). Eesponse in action defec- 
 tive 
 
 ii 
 
 22 
 
 3 
 
 7 
 
 69 
 10 
 
 2 
 2 
 9 
 
 8 
 4 
 3 
 
 2 
 
 3 
 
 12 
 
 21 
 3 
 
 5 
 
 i 
 i 
 
 4 
 
 4 
 
 *3 
 25 
 
 "i 
 
 12 
 1 
 1 
 
 4 
 
 I 
 2 
 
 12 
 
 I 
 
 4 
 
 2 
 
 15 
 "2 
 '4 
 6 
 
 4 
 6 
 
 19 
 
 2 
 2 
 
 4 
 
 (60) Speech defective 
 
 (61). Statuesque or Immobile... 
 (62). Tremor 
 
 E. DEFECTS OF EYES. 
 (64). Squint 
 
 (65) Using convex glasses 
 
 (66). Using concave glasses 
 (67). Myopia, not using glasses. 
 (68). Disease of cornea . 
 
 (69). Eye lost by accident 
 
 (70) Eye lost by disease 
 
 (71). Nvstagmus 
 
 (72). Ptosis 
 
 6 
 
 ... 
 
 1 
 
 ... 
 
 (73) Pupils unequal 
 
 (75) Miscellaneous defects... 
 
 8 
 5 
 
 5 
 
 "2 
 1 
 1 
 
 3 
 
 2 
 
 I 
 I 
 
 1 
 
 19 
 2 
 4 
 1 
 1 
 
 4 
 
 18 
 3 
 5 
 
 2 
 
 F. CASES OF RICKETS 
 
 G. EXCEPTIONAL CHILDREN. 
 (82). Crippled, maimed, &c. ... 
 (83) Disease of hip . 
 
 (84). Disease of spine 
 
 (85) Disease of upper limb 
 
 (86) Disease of lower limb .... 
 
 
 (88). Amputation of arm 
 
 
 
 
 
 
 
 
 I 
 5 
 
 i 
 
 2 
 
 2 
 
 I 
 
 (89). Amputation of leg 
 
 7 
 1 
 
 i 
 
 
 ... 
 
 4 
 
 3 
 
 4 
 
 2 
 
 (90). Congenital absence of 
 greater part of upper 
 
 (91). Congenital absence of hand 
 (92). Congenital defect of hand. 
 (93). Congenital absence of foto 
 (94) Club foot 
 
 
 
 
 
 2 
 
 
 
 
 
 
 2 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 (95). Hemiplegia 
 
 7 
 
 2 
 
 
 ... 
 
 *2 
 
 2 
 
 7 
 
 5 
 
 (96). Paraplegia 
 
 (97). Infantile palsy, upper limb 
 (98). Infantile palsy, lower limb 
 (99). Torticollis 
 
 3 
 13 
 
 2 
 4 
 
 
 
 
 
 7 
 13 
 1 
 
 2 
 2 
 
 1 
 
 ... 
 
 5 
 
 I 
 
 
 
 
 
 
 
96 
 
 TABLE X. (cases seen 1888-91). Distribution of Groups of Children 
 
 under Divisions of Schools. 
 
 For Definition of Groups of Children, see Catalogue on page 82. 
 
 For Description of Divisions of Schools, see List of Schools on page 5. 
 
 For Further Distribution of Divisions of Schools, see sub-table XX. 
 
 Numbers refer to Catalogue. 
 
 1. 
 
 Poor Law 
 Cases. 
 
 2. 
 
 Certified 
 Industrial. 
 
 3. 
 
 Homes and 
 Orphanages. 
 
 4. 
 
 Public Elemen- 
 tary Day 
 Schools. 
 
 NUMBER OF CHILDREN SEEN 
 
 Boys. 
 5857* 
 4,552 
 1,332 
 205 
 38 
 109 
 
 Girls. 
 
 3,947 
 3,262 
 685 
 
 112 
 12 
 6l 
 
 Boys. 
 1,588 
 1,088 
 500 
 54 
 5 
 5 
 
 Girls. 
 407 
 316 
 
 91 
 20 
 
 "s 
 
 Boys. 
 
 774 
 602 
 172 
 28 
 1 
 21 
 
 Girls. 
 1,049 
 863 
 186 
 27 
 4 
 32 
 
 Boys. 
 18,638 
 15,063 
 3,575 
 549 
 113 
 168 
 2 
 18 
 
 55 
 3 
 32 
 67 
 
 296 
 
 600 
 496 
 19 
 180 
 
 510 
 164 
 296 
 
 99 
 281 
 34 
 
 148 
 352 
 
 77 
 49 
 
 145 
 
 2,292 
 2,080 
 739 
 1,415 
 
 Girls. 
 17,74 
 I5, 95 
 2,645 
 478 
 
 23 
 103 
 
 7 
 
 37 
 6 
 16 
 43 
 
 215 
 
 316 
 353 
 3 
 75 
 
 254 
 179 
 217 
 
 1x8 
 
 236 
 
 10 
 
 184 
 184 
 109 
 67 
 
 121 
 
 1,564 
 1,517 
 8I 7 
 1,022 
 
 1 Normal children 
 
 2. Children noted and registered 
 3 Eye cases 
 
 4 Children with Rickets .. 
 
 5 Exceptional children 
 
 6. Idiots 
 
 
 12 
 
 32 
 
 "i 
 64 
 
 137 
 
 189 
 172 
 15 
 50 
 
 262 
 46 
 92 
 
 47 
 95 
 3 
 
 61 
 
 186 
 18 
 12 
 
 34 
 
 888 
 889 
 236 
 510 
 
 7 
 
 33 
 
 i 
 i 
 
 21 
 
 74 
 
 127 
 70 
 7 
 15 
 
 108 
 
 20 
 67 
 
 6 
 
 54 
 
 10 
 
 28 
 93 
 13 
 
 10 
 
 ^9 
 
 475 
 
 388 
 
 93 
 281 
 
 "5 
 16 
 
 65 
 66 
 
 4 
 
 2 
 2 
 14 
 9 
 
 2 
 
 19 
 24 
 
 2 
 17 
 
 2 
 II 
 
 I 
 
 18 
 4i 
 
 *7 
 
 18 
 
 8. Children feebly gifted men- 
 tally 
 
 9. Children mentally exception'l 
 10 Epileptics ... 
 
 11. Crippled, maimed, paralysed. 
 12. Children who appear to re- 
 quire special training 
 
 PRIMARY GROUPS OF CASES. 
 13 Development cases only 
 
 14 Nerve cases only 
 
 15. Low Nutrition cases only ... 
 16 Dull cases only 
 
 13 
 101 
 6 
 
 57 
 
 5 
 52 
 1 
 
 9 
 79 
 1 
 9 
 
 11 
 
 329 
 332 
 41 
 223 
 
 3 
 II 
 
 5 
 7 
 5 
 
 12 
 
 8 
 
 12 
 
 4 
 3 
 
 6 
 
 62 
 
 57 
 28 
 
 47 
 
 47 
 6 
 19 
 
 1 
 
 J6 
 2 
 
 2 
 26 
 3 
 
 1 
 
 2 
 
 107 
 112 
 14 
 
 68 
 
 17 
 24 
 8 
 25 
 
 18 
 
 4 
 29 
 7 
 5 
 
 ii 
 134 
 
 112 
 
 35 
 H3 
 
 17. Developm'n teases with Nerve 
 signs only 
 
 18. Development cases with Low 
 Nutrition only ... 
 
 19. Development cases who were 
 Dull only ... 
 
 20. Nerve cases with Low Nutri- 
 tion only t... 
 
 t Nerve cases Dull only 
 
 22. Low Nutrition cases Dull only 
 23. Developm'nt cases with Nerve 
 signs & Low Nutrition only 
 24. Developm'nt cases with Nerve 
 signs and Dull only 
 
 25. Development cases with Low 
 Nutrition and Dull only ... 
 26. Nerve cases with Low Nutri- 
 tion and Dull only . 
 
 27. Developm'nt cases with Nerve 
 signs, Low Nutrition, and 
 Mental Dulness 
 
 THE LARGEST GROUPS OF CASES IN 
 THE MAIN CLASSES OF DEFECTS. 
 28 All Development cases 
 
 29 All Nerve cases 
 
 30. All Low Nutrition cases 
 31. All Mentally Dull cases 
 
 * See note on page 73. 
 
97 
 
 THE LARGEST GROUPS OF CASES IN 
 
 Poor Law 
 Schools. 
 
 Boys. 
 
 TWO MAIN CLASSES OF DEFECTS. 
 
 32. All Development cases with 
 
 Abnormal Nerve signs | 543 
 
 33. All Development cases withj 
 
 Low Nutrition , 
 
 34. All Development cases with 
 
 Mental D ulness 
 35. All Nerve cases with 
 Nutrition 
 
 Low 
 
 36. All Nerve cases with Mental 
 
 Dulness ........................... 
 
 37. All Low Nutrition cases with 
 
 Mental Dulness .. ..... 
 
 THE LARGEST GROUPS OF CASES IN 
 THREE MAIN CLASSES OF DEFECTS. 
 
 38. All Development cases with 
 
 Nerve signs & Low Nutrition 
 
 39. All Development cases with 
 
 Nerve signs and Mental 
 Dulness 
 
 40. All Development cases with 
 
 Low Nutrition and Dulness 
 
 41. All Nerve cases with Low 
 
 Nutrition & Mental Dulness 
 
 THE LARGEST GROUPS OF CASES IN 
 
 ONE MAIN CLASS OF DEFECTS, AND 
 
 ABSENT FROM AT LEAST ONE OTHER 
 
 MAIN CLASS OF DEFECTS. 
 
 42. All Development cases with- 
 
 out Nerve signs 
 
 43. All Development cases with- 
 
 out Low Nutrition 
 
 44. All Development cases with- 
 
 out Mental Dulness 
 
 45. All Nerve cases without de- 
 
 fect in Development 
 
 46. All Nerve cases without Low 
 
 Nutrition 
 
 47. All Nerve cases without Men- 
 
 tal Dulness 
 
 48. All Low Nutrition cases with- 
 
 out Defect in Development 
 
 49. All Low Nutrition cases with- 
 
 out Nerve signs 
 
 50. All Low Nutrition cases with- 
 
 out Mental Dulness 
 
 51. All Mentally Dull cases with- 
 
 out Development Defect ... 
 
 52. All Mentally Dull cases with- 
 
 out Nerve signs 
 
 53. All Mentally Dull cases with- 
 
 out Low Nutrition 
 
 54. All cases without Develop- 
 
 ment or Nerve Defect ... 
 
 55. All cases without Developm't 
 
 or Nerve Defect but Dull... 
 
 159 
 330 
 154 
 347 
 
 67 
 
 95 
 
 220 
 52 
 46 
 
 345 
 729 
 558 
 346 
 735 
 542 
 77 
 82 
 169 
 180 
 163 
 443 
 
 44 
 
 Girls. 
 
 248 
 
 80 
 
 192 
 
 63 
 I 7 6 
 
 52 
 47 
 
 112 
 32 
 29 
 
 22 7 
 
 395 
 283 
 140 
 
 325 
 
 13 
 30 
 
 105 
 229 
 
 22 
 
 Certified 
 Industrial 
 
 3. 
 
 Homes and 
 Orphanages. 
 
 Boys. 
 
 200 
 27 
 
 148 
 34 
 
 151 
 22 
 
 20 
 
 90 
 12 
 20 
 
 129 
 
 302 
 
 181 
 
 132 
 
 298 
 
 181 
 
 14 
 
 7 
 
 19 
 
 75 
 
 72 
 
 201 
 
 13 
 
 Girls. Boys. 
 
 37 
 23 
 2Q 
 22 
 
 33 
 
 13 
 14 
 
 18 
 
 10 
 
 9 
 
 25 
 39 
 33 
 20 
 
 35 
 
 24 
 
 5 
 
 6 
 
 15 
 
 18 
 
 14 
 34 
 
 77 
 13 
 50 
 
 6 
 45 
 
 8 
 
 28 
 5 
 3 
 
 3D 
 
 94 
 
 57 
 
 35 
 
 106 
 
 67 
 
 1 
 
 8 
 
 6 
 
 18 
 
 23 
 
 60 
 
 Girls. 
 
 68 
 30 
 76 
 23 
 63 
 20 
 
 15 
 
 40 
 18 
 16 
 
 66 
 104 
 
 58 
 44 
 89 
 49 
 5 
 
 12 
 15 
 
 37 
 50 
 93 
 
 4. 
 
 Public Elemen- 
 tary Day 
 Schools. 
 
 Boys. 
 
 1,155 
 534 
 870 
 441 
 827 
 305 
 
 293 
 
 497 
 222 
 194 
 
 1,137 
 
 1,758 
 
 1,422 
 
 925 
 
 1,639 
 
 1,253 
 
 205 
 
 298 
 
 434 
 
 545 
 
 588 
 
 1,110 
 
 239 
 
98 
 
 TABLE XI. (Cases seen 1888-91). Conditions of Defective Development 
 in Relation to Low Nutrition, Mental Dulness, and Nerve Defects. 
 
 Among 2,794 Boys, 2,550 Girls. 
 January, 1889. 
 
 Low 
 
 Nutrition. 
 
 Mental 
 Dulness. 
 
 Nerve 
 Defects. 
 
 
 B. 
 
 G. 
 
 B. 
 
 G. 
 
 B. 
 
 G. 
 
 Total of cases presenting some defects of deve- 
 lopment, including cranial abnormalities, 
 
 
 
 
 
 
 
 palate, ears epicanthis, and other defects 
 
 
 
 
 
 
 
 (not including squint) boys, 274 ; girls, 125 ; 
 
 
 
 
 
 
 
 total, 399 .. ... 
 
 62 
 
 A.Q 
 
 86 
 
 "3 Q 
 
 101 
 
 AA 
 
 Cranial defects alone, not in combination 
 
 22 
 
 12 
 
 33 
 
 ii 
 
 31 
 
 12 
 
 Palate defective alone 
 
 6 
 
 
 5 
 
 12 
 
 9 
 
 
 Ears defective alone 
 
 5 
 
 A 
 
 8 
 
 
 11 
 
 4' 
 
 Epicanthis folds alone ... 
 
 1 
 
 T" 
 
 3 
 
 j 
 
 1 
 
 2 
 
 The 73 cases with defects other than those 
 
 
 
 
 
 
 
 mentioned presented . 
 
 10 
 
 4 
 
 18 
 
 4 
 
 23 
 
 4 
 
 
 Cases of Binary Defects. 
 
 
 
 
 
 
 
 Defects of cranium and palate 
 
 12 
 
 4 
 
 12 
 
 4 
 
 20 
 
 7 
 
 ears 
 
 6 
 
 
 
 11 
 
 
 
 12 
 
 o 
 
 epicanthic folds 
 other defects than those 
 
 
 
 
 1 
 
 
 
 3 
 
 2 
 
 mentioned 
 
 5 
 
 3 
 
 6 
 
 2 
 
 6 
 
 2 
 
 palate and ears 
 
 2 
 
 
 
 7 
 
 O 
 
 6 
 
 O 
 
 epicanthic folds 
 
 1 
 
 
 
 2 
 
 2 
 
 4 
 
 2 
 
 other defects 
 
 
 
 I 
 
 4 
 
 2 
 
 5 
 
 2 
 
 ears and epicanthis 
 
 1 
 
 I 
 
 8 
 
 2 
 
 3 
 
 O 
 
 other defects 
 
 2 
 
 
 
 5 
 
 O 
 
 1 
 
 O 
 
 B. G. 
 
 
 
 
 
 
 
 Cases of Triple Defects. 24 7 
 
 11 
 
 6 
 
 14 
 
 2 
 
 11 
 
 6 
 
 The Palate was examined in 459 cases : 
 
 
 
 
 
 
 
 It was found normal in 265 77 
 
 
 
 
 
 
 
 
 
 
 abnormal in ... 77 40 
 
 
 
 
 
 
 
 
 
 
 Defects of palate : 
 
 
 
 
 
 
 
 Arched, narrow, high, or vaulted 68 37 ] 
 
 
 
 
 
 
 
 V-shaped, not included above ... 6 2 I 
 
 29 
 
 13 
 
 22 
 
 2O 
 
 29 
 
 16 
 
 Of the flat type 3 ij 
 
 
 
 
 
 
 
 77 40 
 
 
 
 
 
 
 
 Defects of ears : 
 
 
 
 
 
 
 
 Symmetrical 37 13 
 
 12 
 
 2 
 
 13 
 
 2 
 
 15 
 
 3 
 
 Asymmetrical 27 4 
 
 5 
 
 2 
 
 11 
 
 2 
 
 9 
 
 2 
 
 64 17 
 
 
 
 
 
 
 
 Epicanthic folds : 
 Symmetrical or double 27 17 
 
 5 
 
 4 
 
 9 
 
 6 
 
 6 
 
 3 
 
 Single or most marked on one side 10 4 
 
 1 
 
 I 
 
 1 
 
 o 
 
 1 
 
 
 
 37 21 
 
 
 
 
 
 
 
99 
 
 
 HS5g 
 
 J 
 
 t-co 
 
 3 
 
 co oo 
 
 r-H i-H 
 
 o 
 
 a'S 
 
 ^ 
 
 oo Ti- 
 
 M 
 
 IO W 
 
 X* 
 
 ti% 
 
 T-H l-H 
 l-H i-H 
 
 05 OS 
 
 CO CO 
 
 l-H i-H 
 
 S-i 
 
 8 o 
 5.2 
 
 ^5 10 M 
 
 CO CO 
 l-H 
 
 O IO 
 
 O O 
 
 lOCO 
 
 o o 
 
 X 
 
 
 p CO O 
 
 01 co 
 
 
 
 lOCO 
 
 
 .2 
 
 H -*. 
 
 os co 
 
 t^^l 
 
 
 iQCO 
 
 a 
 
 
 
 
 
 
 ad 
 
 ^5 c* O 
 
 IO O 
 
 ro 
 
 X 
 
 O O 
 
 S" 
 
 pq'coco 
 
 
 
 f (M 
 
 
 10 CO 
 
 
 H'29 
 
 CO O 
 
 T-H 
 
 
 ^^ 
 
 ^0 
 
 IJ 
 
 ^Jj w O 
 
 o o 
 
 X 
 
 m o 
 
 o o 
 
 
 S3 
 
 coo 
 
 i-H 
 
 
 * 
 
 * 
 
 
 ^-cogs 
 
 
 coo 
 
 os co 
 
 T-H 
 
 Ij 
 
 O GO 10 
 
 X 
 
 
 
 100 
 
 O iO 
 
 
 p='2S 
 
 
 COO 
 
 
 
 CO CO 
 
 111 
 
 O X 
 
 CN <M 
 
 CO IO 
 
 i-H t-H 
 M 
 
 100 
 
 T-H 
 
 10 M 
 
 <1 
 
 PQ 
 
 s% 
 
 T-H l-H 
 
 c. 
 
 CO O 
 
 T-H 
 
 bo 
 
 .05 CM 
 
 co Sco 
 
 t~ O5 CO 
 T-H TT CO 
 
 T-H CO 10 
 CO TT i 1 
 
 co t-co co 
 
 iO r^ CO > 
 
 p) 
 
 
 
 T-H 
 
 
 
 o 
 
 
 
 
 
 
 | 
 
 d N 
 
 IO CO M 
 
 O fO ^" 
 
 H M 
 
 M O VO VO 
 
 01 M M 
 
 "g OS 
 
 p 
 
 8S 
 
 CO CO Tt^ 
 
 i> toco 
 
 t CO <M 
 
 CO CO T-H 
 
 CO CO <M 1 iO 
 
 
 
 ^^ 
 
 . 
 
 , 
 
 <D - 
 
 >tal of Cases presenting each Sign resp 
 2,794 Boys, 2,550 Girls. Jan. 
 
 Cranial Abnormalities. 
 10 Public Elementary Schools.. 
 4 Special Schools 
 
 Palate Defective. 
 .0 Public Elementary Schools.. 
 4 Special Schools 
 
 Ears Defective. 
 tO Public Elementary Schools .. 
 4 Special Schools 
 
 Epicanthic fold 
 L Public Elementary Schools .. 
 4 Special Schools 
 
 Other Defects than those abov 
 .0 Public Elementary Schools .. 
 4 Special Schools 
 
 EH 
 
 a - 
 
 l-H ~ 
 
 
 
 r 
 
 5 S 
 
100 
 
 
 H '-<* * t- OCO 1C OO 5MrH 
 
 <fi CC 
 
 Or- ^ 
 
 gj 
 
 
 
 rH rH <N 
 
 Si! 
 
 _^ CO CO QiW ON OO COO 
 
 CO m 
 
 O\ N M 
 
 ii 
 
 ss -- - as <- 
 
 CO CO 
 
 SR S 
 
 .1! 
 
 E^'rHOO COO r- t- COO O 
 * O N in CO O M ON col 
 
 - X 
 
 ;: i 
 
 ' 
 
 PS' JO W CO rH COCO CO 
 
 
 1C CO CO 
 CM (M Ttc 
 
 Orbicular 
 Muscle of 
 Eyelids 
 Toneless. 
 
 * | COM NO | x 
 Q O rH CM O rH CM 
 
 o 
 
 C0| 
 
 CO 
 
 CO Tfl CM 
 CM 
 
 MM ro 
 
 rH CO 
 
 Ii! 
 
 3 M M MO x | 
 
 CO 
 
 o N 
 
 w co n 
 
 
 oq as t~ ceo coco ex 
 
 coco 
 
 ss: 5 
 
 
 ,..=000 
 
 s i - 
 
 so c^ oo 
 
 I 
 
 rh W VO CO ^ w O WO 
 
 M 
 
 t\VO ro 
 
 * o 
 
 ^ 
 
 OO fHCC COCO O i < 
 
 r-0 
 
 SS 8 
 
 
 -_* t> CO CO l> ^< CO 
 
 000 
 
 JJCS ^ 
 
 11 
 
 ^|| x * M M f 01 - 1 
 
 ^co 
 
 rt S 
 
 
 PQ rH CO CO O rH (M 
 
 coco 
 
 " S 3 
 
 
 EH " S2 
 
 rH 00 
 
 CO 
 
 Sg5 3 
 
 il 
 
 d x || < N ^| 
 
 vo o> 
 
 rt- in 
 
 
 M - oo o t- o 
 
 us O 
 
 as ot co 
 
 COrH 10 
 
 
 fn'rHCO T*< COCN IO U5CN t- * l>< CN* 
 
 i $ S 
 
 : s : 
 
 to 
 
 68" tt S^ "S 5- 10 ^ N ,7 ^ S M 
 
 M ^2 CO 
 
 . . 
 
 \ 
 
 ri5;s ss s 2 32 rt;^ 
 
 2 SS S 
 
 
 1 
 
 : : : : : : : : : : 
 
 : : 
 
 
 a. . 
 
 
 
 
 CO 
 
 u 
 
 1 : : 
 
 ;; 
 
 ' 
 1 i 
 
 Total of Cases presenting each Nerv 
 2,791 Boys, 2,550 Ui 
 
 60 H ' 
 
 _ a co .Stn <n 
 
 ^^ : o'o : s'o : 
 
 SO* So m' =30' W * 
 
 ii S-g -s-s s-g ^-g 
 
 B OQ . S . 03 . >K . S05- . 
 
 S w 5 #^ : >, : >,: o >, : 
 
 Hi ^1 i! Hi Ill 
 
 s^ !^ s s e s^ ^s^ 
 
 si ii .i si Isi 
 
 & , , & & 
 
 PHJ pnC/2 PH O2 d, QQ OpnCQ 
 
 Finger Twitches. 
 Public Elementary Schools 
 Special Schools 
 
 Total, 10 Public Elementary 
 4 Special Schools 
 
 Final Total 
 
 
 Orh 0^ Or o^ 0-* 
 
 OrJ< 
 
 
 
 jfls 'S sr re tr 
 
 J = 
 
 
101 
 
 ill 
 
 EH. 
 
 *n 
 
 _3_ 
 
 OOOOO 
 
 Ol ^| ^H 
 
 COMCO HCO 
 
 
 -* t g 
 " 5^ 
 
 H"CO 00 K 
 
 Si 
 
 o : i 
 
 
 << .Poao.<l> ( ... 
 
 r J .i! i 
 
 **^ ' bri^-5 "^ ^~ < ^ *" H ^ 3 
 
 ^ . j tf "3 .f^ J^g^.is S ^S ^? 
 
 . 
 
 -ii 
 
 ' 
 
 
 
 
 '' 
 
 iiilSII' 
 
 HO 
 
 Os O 
 
 
 COCO 
 t^* ^ 
 
 0000 
 
 C^ CO O (M 
 
 -^ i-HO O C^ 
 
102 
 
 ^ 
 
 6 
 
 
 M 
 
 i.l 
 
 * M rj- n CO CTi M 
 
 ro roO 00 ^O 
 
 t- 00 GO CO 00 CO 
 
 JS fO ro O t^ CT> * 
 
 .S o^ o 10 m N TJ- 
 
 O U~l Tj- MM 
 
 .2 CO O> 
 t3 ^- u-) 
 O t~>. ro 
 
 i5 
 
 10 
 T-H 
 
 i-H t i ( ?D CO 
 
 10 GO "H TT CO t- 
 T-HTf CO I-H (M (M 
 
 . o Oi o ^ oo co 
 
 ^^.^ _^_, 
 
 S M 
 
 5 m <M 
 
 | CO O i-t O (M CO 
 
 '-' 
 
 s oo t^ co O 
 
 C CTi O^ M N co N 
 
 3 M w 
 
 S co M O N VO <* 
 
 CD rH O Tt< t^ 
 
 c< M o oo t^ o\ 
 "5 CTIOO co co mo 
 
 " 
 
 S 
 
 _o 
 S t-^ 
 
 c o moo N Tt- o 
 
 S 00 CO M M M N 
 
 CO 1C Oi 
 i I CO CO 
 
 oi 00 -^- CO OMO Tt" 
 .- TJ- CTi Tj- COO Oi 
 
 CO !> VO O5 O5 CO 
 rfi CO O lO CO t- 
 
 1C CN <-^ 1 ^H 
 
 II 
 
 I ~ 
 1-21 1 
 fi ^ s 
 
 .- 
 
 a* 
 
 1 
 
 ill 
 
 O 
 
 O> 
 
 aoot~<MGOf i^-iosco^oo 1 1 i 
 
 iosococ}kOTti'*:oaoGiTj<D-o 
 
 i C4CNI C^CO i IT i i i i I 
 
 lOOC5GCr-llOGOO lOrH 
 
 VO VOMt^CS 
 W M M 
 
 co -^1- co O co cooo 
 
 M iovO OMMIOMMNMT*- 
 
 TtHcoco'* | coo 
 
 t^ co Th M M covo t^ O 
 
 't~THcDOCOGi<MCOft 
 id CO r-t (M O CO <M T-H ft 
 
 COCOM^M 
 
 TfiCOiOO5COt^COCOt~t>.TiHCOiO 
 
 Tji?OOOi< 
 
 iO ft ft 
 
 fiOiOOiO 
 (MCO'^if i OS 
 
 Total of elopment c 
 Cranial rmalities . 
 Externa r defective. 
 Eyelids with Epicanthi 
 Palate defective .......... 
 Other defects in Develo 
 
 a 
 
 1 
 
 Dev 
 bno 
 
 3- 
 
103 
 
 ~ 8 
 
 X 
 
 1 1 
 
 O ^ 
 
 p p 
 "*"" 2 
 
 ^ 'O 
 
 o 
 
 1 
 
 % g 
 
 2 
 
 
 11 
 
 ,_, cj 
 
 3.s 
 
 G - 
 
 I 
 
 C5S 
 
 II 
 
 SI 
 
 s'S 
 
 Is 
 51 
 
 Is 
 1 
 
 roup 29, 
 alone or 
 
 li 
 
 <S5 
 s| 
 
 II 
 
 l 
 
 in in oo in ;* 
 
 p oo in co oo O 
 
 <b l> O M OO tx 
 
 -r OO tx co VO ro 
 
 co CO O C7 
 
 -<tliOiOOC^^t- 
 CO CO CO ^< G3 <N GO 
 CO ~~* CO *""* CO 
 
 m op M tx qo p in oo ro in co fx 01 
 
 01 in Vt- oo vb ~o> *CT> oo oo vo" vb H CT> 
 
 t> co r- i i i 
 
 O \o -^- t-> 
 'o\ b b ro 
 Tt- in m ^h 
 
 CT> co vp O co 00 Vp 
 
 b^ V- 01 In in oo oo 
 
 85 
 
104 
 
 :s 
 
 
 
 E 
 
 H 
 
 
 H 
 
 o 
 2 
 
 1* 
 
 S &c 
 
 0) O 
 
 ~ 3 s 
 
 III 
 
 |S 1 
 
 S o 
 
 I 
 
 bo 
 a 
 
 a 
 
 2? 
 
 If 
 
 Is 
 
 .go 
 
 Low N 
 ombina 
 
 5*3 
 
 If 
 
 tj 
 Qd 
 
 oo'O 
 <^ a, 
 
 & 
 
 2J 
 
 -1 
 ^ 
 
 i.i 
 
 ^5 
 
 .S N H co ) N *> m in io CS "CTI O ro 
 
 tn'O c^ rovo 
 
 j^co t^iom 
 
 H 00 MM 
 
 o . 
 
 IHOO N moo Ooo invnvo M ^ro 
 N ION Tj-t^t^. t^oo N c< m ft ^~ 
 
 MC4HIMI-I M 
 
 ajOOVOVO 
 - 
 
 O io cjioo in M cs w M 
 
 ^200 t^'^-vp O ro^oocio t^CTifOOOO Tj-oocpip 
 J3 N CTI c?i 'o\ in in M in oo b> i^-do K. N Vj- i^ N vb 
 
 ^00 Opr^t-rH 
 |>. 00 rH 
 
 ajvovo o> in N TJ-OO oo o in CTI t^ in 
 
 T'CTiOON ^}-N N CTit^.C?iO O N O f"O 
 "O POM N<NMM<S MM 
 
 oJiCQOCOCOOrHO "OC 
 
 r 
 
 H B * 
 
 os o> 
 
 8- 
 
 
105 
 
 I 
 
 4 
 
 o " 
 
 03 O 
 
 OJ 
 
 si ^3 
 
 Q ** 
 
 s -a 
 
 CQ <rt 
 
 00 
 
 ^> ro 2 
 
 o a 
 
 3 
 
 1! 
 *l 
 
 tc 
 
 c o 
 
 o ^ 
 
 ^ 3} 
 
 S o 
 
 5 a 
 
 o s 
 
 
 o> 
 
 a ^ 
 
 c *-> 
 
 fc fl 
 
 "3 3 
 
 I! 
 
 !! 
 
 * s 
 II 
 
 1! 
 
 Pi 
 
 .. 
 
 23 jo ro en 
 
 
 
 
 
 P*o 
 
 w 
 
 I 
 
 
 
 fe o 
 
 3 I 
 
 1 1 
 ^^ 
 
 ^H CO 01 
 
 co ro H 
 
 C^ CO 
 
 * oo 
 
 TP l"o 
 
 <N <M 
 
 ,t^ 
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 . 
 d3 "M 
 
 M H p 
 
 . t- fr- 
 
 pq t O 
 
 CO T O 
 
 f i i c^ 
 
 . 
 
 Ot^- 
 
 M M M M 
 
 T iQOii 
 
 "S 
 
 ! a> 
 
 S 
 
 - 
 
 co ^H. 
 
 
106 
 
 ga 
 
 ^ OD^ E *" 
 
 ^ fi c^ S 
 
 l5 ! 
 
 
 g< 
 
 X 
 
 (g) 
 
 5^. dnojQ 
 
 Zf dnoaf) 
 
 88 dnoao 
 Moq piiis 
 
 put? ju8tu 
 
 aoi}t!aiqraoo 
 ni ao gaoiB HUQ 
 
 Q8 dnoa) 
 uop'Butqaioo ut ao 
 
 uoii'BUTqraoo ut ao 
 
 8 dnoao 
 
 898130 9Ag 
 
 g dnoao 
 
 11 
 
 . 
 
 PQ 6 * 6 6 o o b b 6 A, o 
 
 WT 
 
 O vb bivb vb rhTt-Ti-V>nv 
 
 5000 coop vp vp N 00 pi rh 
 
 6 C 8 ( L ( 9 
 
 P9 putui 
 
 -9^99,1 
 
 . N NOO Tl-OO mO O OMJltx 
 
 ls. 
 
 as 
 
 ools 
 
 Sch 
 ial 
 cial 
 
 Schools 
 Industrial S 
 nd Orphanages 
 ent Schools 
 lementary D 
 ools, Upper S 
 ools, Poorer 
 Day Schools 
 rish Schools 
 ay School 
 chools seen 
 
 1. Poor La 
 2. Certified 
 o. Homes a 
 4 All Eesi 
 5. Public El 
 6. Day Sch 
 7. Day Scho 
 8. English 
 9. All the I 
 10. Jewish D 
 All the S 
 
 CO t O CO CO 
 
 gggs * 
 
 o\ en Tf TJ-VO 
 
 
 o *c >o o es 
 
 SS85 
 
 ^^ ; 
 
 
 e 
 nted 
 
 al clas 
 al 
 
 Figures used in obtaining abov 
 percentages, and not pr 
 elsewhere : 
 
 C. Day Schools, Upper Social 
 7. Day Schools, Poorer Social 
 8. English Day Schools 
 V). All the Irish Schools 
 10. Jewish Day School 
 
107 
 
 oT O 
 
 so <* 
 
 "^ 
 
 ^1 
 
 bjos 
 
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 li 
 
 s 
 
 CB CD 
 
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 CC CN CO CO 
 
 
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 CO 
 
 8 
 
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 ^a 
 
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 9 
 
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 $33 
 
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 03 
 
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 Divisions of Schools. 
 
 s 
 o 
 
 a 
 
 3 
 
 D 
 g 
 
 English Children 
 8. Day 
 Poor Law 
 Certified Industrial 
 3. Homes and Orphanages 
 
 Total English Children 
 
 Irish Children- 
 Day 
 Poor Law 
 Certified Industrial 
 
 9. Total Irish Children 
 
 Jewish Children 
 10. Day 
 
 Grand Total, all Children ... 
 
 
 
 8. English Children, Day Schools. 
 9. All Irish Children 
 10. All Jewish Children 
 
R R 
 
 
 
 S 
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 I 
 
 0,3 
 
 "^ oo O 
 
 <ri O 
 
 ^ 
 
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 11 
 
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 ^ l|l fi Hi 
 
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 g 1J| | p| 
 
 W ^3 a "-' -43 ^ bo 
 
 " r2 - 
 
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 11 
 
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 6 TR~c? v 2ooS 3-' or ^ t ^co 
 
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 Divisions of Schools. 
 
 Upper Social Class (No. 
 Divisions 1, 6, 7. \No 
 Average Social Class ( N^o 
 Divisions 2, 5, 8, 11. }No 
 Poorer Social Class fNo 
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 oooooooo 
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 London Board Schools fNo 
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 Schools of special difficulty. See page fNo 
 6t -JNo 
 Schools with few children in relation jfNo 
 to accommodation. See page 64 ...(No 
 
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 31 
 
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 <N 
 
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 dJ& c^ t 
 
 oo oo vo oo 
 
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 m vo M w M ; ; ; M e 
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 O 
 
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 p=s g s? 
 
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 rn ir corn ; : : i 1 - 1 
 
 gl dnojo 
 
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 : : : : 
 
 V 
 
 M'| I 3 
 
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 s<i w eo us ^< .._.<? 
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 M-' o ;:::::: 
 
 
 
 
 -B ' 
 |I*.S 
 
 Divisions of Schools. 
 
 Upper Social Class 
 Divisions 1, 6, 7. 
 Average Social Class 
 Divisions 2, 5, 8, 11. 
 Poorer Social Class 
 I Divisions 3, 4, 9, 10, 12 
 
 English Children 
 Divisions 1, 2, 3, 5, 7, 8, 
 Scotch Children 
 Division 6. 
 Irish Children 
 Division 10. 
 Jewish Children 
 Divisions 4, 11, 12. 
 
 : Si : ^ : : - : : 
 
 lil&cj: 
 
 5 * '-S 1 c > "pp a a't 
 
 CjS K.H . S OS"O, 
 
 s B ^|iiIL, 
 
 ! 
 
 3 2,8 aaJlsssao 
 
i* 
 ii 
 
 
 
 ! 
 
 i o 
 
 S2 
 
 CM O 
 
 O rH 
 
 So + 
 
 Nerve-signs without 
 Development 
 Defoct, alone or in 
 combination. 
 Group 45. 
 
 |g 
 
 dS ^ 
 
 M CO O (< 
 
 Oo do >'? o 
 
 S vb S vo" 
 
 r 1 V 5 P 
 
 rH CO t- CS 
 
 "P 9 r 1 
 
 O CO O CO 
 
 -- t- 
 
 r- ci cs oo 
 
 O <B 
 
 5 o 
 
 .S5 CO r-. 
 
 OS 8 
 
 M WJ O * 
 
 Oi -t- 
 
 PH" Th S 00 
 
 i s s s 
 
 Cs| "^ 
 
 Development 
 Defect without 
 Xerve-signs, alone 
 orincoiubination. 
 Group 42. 
 
 S a 
 
 d , 5 * 
 
 u-i (O CO tx 
 
 UO ."I" P 
 
 -i- (0 vo -t- 
 
 *S S, S 
 
 CO CN 1 f 
 
 T* 1 < * 
 KJ r- us us 
 
 o.S 
 
 ^ o 
 
 . M -d- 10 
 
 ?T ^ 
 
 5 S 8 
 
 co o 01 oo 
 
 ril 1 1 
 
 1 - S H 
 
 ^~ 5* 
 
 Development 
 Defect, Nerve-signs 
 and Low Nutrition, 
 alone or in 
 combimition. 
 Group 38. 
 
 co "a 
 
 o O co 
 
 O b b b 
 
 -f M VO 
 
 o o o o 
 
 b b b 
 
 -v -t* O ( 
 
 ^ O O 
 
 P 7* cp 
 0000 
 
 CO 00 Cft CO 
 
 o o o o 
 
 o'l 
 3 
 
 d^ S & 
 
 
 % tx CO CO 
 
 .CO C5 <M 
 
 CO ^J 
 
 -t< 00 US O 
 
 0-3 r | . 
 
 r 
 
 O vo tx 
 O ^J C* N 
 
 _^ .0 
 N C* o^ N 
 
 'M 'M "M c* 
 
 I Developme 
 Defect an 
 N.-rve-sign 
 alone or 
 in combinnt 
 Group 32 
 
 rig c? 1 
 
 r 1 ^ r- 1 
 
 CO CO US CO 
 
 <d- 
 
 rH CO CO rH 
 
 CO TC 10 Tt" 
 
 li 
 
 d E ? "t 
 
 VO IO M 1-1 
 
 s i 1 
 
 I 3 s 
 
 US OS CO CM 
 
 Mental Dulness, 
 alone or 
 in combination. 
 Group 31. 
 
 Jf 
 
 d 
 
 tx VO <O O 
 
 M oo tx 10 
 
 (X O\ M VO 
 
 .O CO * 
 
 PQ o oo do 
 
 rH <* rH 
 
 00 CJ 00 00 
 
 C5 CO CO CO 
 ^ r-l CO t- 
 
 li 
 
 da S S 
 
 M JH 
 
 -1-00 co O 
 
 OO O 10 vo 
 
 rij? 
 
 1 " 1 s 
 
 us cc r- <R 
 
 I* " o 
 
 v Nutrition 
 one or in 
 nbination. 
 roup 30. 
 
 ii 
 
 o ; ^ 
 
 * S ct 
 
 -t- ro 10 O> 
 CO Vj- "lO IN 
 
 ^ CN CO CO 
 
 00 CN CO 
 
 (M C^ CO CO 
 
 CO CO rH rH 
 (M CO & CO 
 
 
 
 d s ^ 
 
 O N tx VO 
 
 ^ * ^ 
 
 -j 
 
 .00 *C O 
 
 PQ "*+" '^ *^ 
 
 (M 00 rH GO 
 
 rH CO CN CO 
 
 Nerve-signs, 
 alone or 
 in combination. 
 Group 29. 
 
 *1* 
 
 03 
 
 | 
 
 Ocb do oo 
 
 Tt- ro O p^ 
 
 do b a> K 
 
 do do M b> 
 
 ml 2 2 
 
 O CO Tf rH 
 
 O O CO 
 
 O 10 VO CO 
 
 co m tx cj 
 
 O VO N 10 
 
 rii 1 i 
 
 co us ri co 
 
 rH O C^ rH 
 rH ?-( CO CO 
 
 SCO O ^* 
 O Ci US 
 
 CO rH 
 
 Development 
 Defect, alone or 
 in combination. 
 Group 28. 
 
 *1 
 
 d K 
 
 OO VO .-f ro 
 
 vb "* do vb 
 
 vo K do vb 
 
 PQ do do cb 
 
 "* tO CN 
 
 CO CO rH C5 
 
 us op o o 
 
 CO rH rH O 
 
 OS 
 
 At 
 
 -1- N N 
 
 10 co vo vo 
 
 M MM 
 
 cs vo o <y\ 
 
 M -^ 
 M 
 
 .50 CR CO 
 
 | S S | 
 
 1 S s g 
 
 E 
 
 I s 
 
 d ! H 
 
 VO tx <M OO 
 
 N_ 00 O) VQ_ 
 
 OO" M <M 
 
 "co *& 10 Ix 
 v^ * v? 
 
 O <M O 
 
 .CO ffO <N 
 
 pq * o. 
 
 50 00 rH 
 
 (0 00 rH CO 
 
 
 eCN CO -t< 
 C-I CO CO 
 
 Divisions of Schools. 
 
 w '*2i ' 
 
 : - " ; i ; ; . ; & ;- 2 fl - : ^ i 
 
 *-" i < " - 1 ^'"3 g.2 o 
 
 W -S- ' C : : - :- ^51 =sl : 5 : 
 
 i-^l- -'i ' ': |> li 's ' 
 
 5^qo^ E^lf-l |gis . fe S .a . 
 
 "lllgg sglgSgc-i 211 5 II :P : 
 ||ls|| || i| 115 ^ | 
 
 l-l I 5 I s ! ^ ! i Q iyl3i 
 
 rii liLl^l iy*H* 
 
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 1* S- 
 
 11 
 
 ^llJ2_ " -:- 
 
 ? ^ 
 
 s 
 
 ^ Si 
 
 fl 
 
 
 9 t2 
 
 i 
 
 1 <- 
 
 1 
 
 0" ::::::::: ::::::::.:::::: 
 
 : 
 
 _, 
 
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 c l ~ ( 
 
 
 
 
 ^ .sJ 
 
 60 
 
 **':: ::-*:::: ^ :- t ! : : : : i : : : :- 
 
 - ; 
 
 -. 
 
 ** rt ^ 
 
 rg 
 
 
 
 
 P-S* ^U C Q 
 
 ^ 
 
 
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 pq o : : ; ; IH oo ; ; : IH I-HIH;IH^IH<M: :::::: 09 
 
 f-i 
 
 H 
 
 fca I** 
 
 s 
 
 . 
 
 OO M 
 
 Cl 
 
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 li-l 2^ 
 
 1 
 
 M - M .... :w .... ^ ..... .^ ....... .^ 
 
 ra ^ 
 
 10 
 
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UNIVERSITY OF CALIFORNIA LIBRARY 
 BERKELEY 
 
 Return to desk from which borrowed. 
 This book is DUE on the last date stamped below. 
 
 MAY 6 1948, 
 
 
 LJNJV. 
 
 Q1956LB 
 LIBRARY USE 
 
 MAR8-1958 
 
 LD 21-100m-9,'47(A5702sl6)476 
 
 "jjr. KUBORN, Seraing-Liege. 
 Sir PHILIP MAGNUS, B.Sc., B.A. 
 General MOBRBLY. 
 SHIBLEY MURPHY, M.K.C.S., M.O.H., 
 
 London County Council. 
 
 REC'D LD 
 
 MAR 8C3 
 
 APR 
 
 LOAN 
 
 BERK. 
 
 a E. WHITE WALLIS, F.S.S. 
 l2 FnANcis WARNER, M.D., F.R.C.P. 
 Rev. J. C. WELLDON, Head Master 
 
 of Harrow School. 
 X D. YELLOWLEES, M.D., LL.D. 
 
 Hon. Secretary. 
 E. WHITE WALLIS, F.S.S. 
 
 PARKES MUSEUM, Margaret Street, London, W. 
 
 The following bodies are represented on the Committee: 
 
 1 The British Medical Association. 4 The Eoyal Statistical Society. 
 
 2 British Association. f> The Sanitary Institute. 
 
 3 The Charity Organisation Society. 6 Foreign Representatives. 
 
UNIVERSITY OF CALIFORNIA LIBRARY