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138
Annual Report of the London County Council, 1911.
Dr. Shrubsall, one of the assistant medical officers (Education), conducted each examination,
which occupied about four times the amount of time usually given to the examination of a special school
child. Dr. Shrubsall has dealt with the subject as thoroughly as school circumstances, without special
laboratory provision, would permit.
Before a child can be admitted to a special school he must be examined and certified as suitable
by a medical officer specially recognised for the purpose by the Board of Education. These examinations
are held at special centres. The children regarded as unfit for ordinary elementary schools are nominated
on special forms by the head teachers, often on the advice of the school doctor, or in the case of those
not in attendance at a school by the divisional superintendents. Most children are nominated between
the ages of 7 and 10, that is, at the earlier stages of their stay in the senior departments. "When
arrangements have been made for the admission examination the teacher and the parents of the child
are invited to attend, and their help is of great importance. Many parents are brought to realise on
such occasions that their children are not all that they imagined, and in any case it is desirable that
they should know from personal observation that the child had been given every chance.
At each admission examination the medical officer considers the present condition, the personal
and, if necessary, the family history of the child. He has the statement of the facts noted by the teacher,
and if the child has attended school for a reasonable time and with fair regularity, this statement may
be regarded as definite experimental evidence of the extent to which the child has shown itself irresponsive
to tuition. The medical officer generally verifies these statements and searches for any pathological
explanation of the retardation revealed.
The medical examination varies with the appearance of the child, which in some cases may at
once reveal a definite defect or in others, as obvious idiocy, be such as to render further examination
a waste of time. The doctor seeks to determine whether there are any defects of vision, hearing or
other sense which have prevented the child from profiting by the instruction offered him, or any more
general defect or ailment which may have exerted a retarding influence. He decides how far such
defects are likely to be remediable and whether the child's condition is such that he may return to the
elementary school while this treatment is being carried out or should be invalided from school attendance
for a time to receive treatment, to be called up if desirable for a further examination after a period
of from three to six months. Mental improvement can scarcely be expected until some time after
the defect has been remedied, and in the past, when facilities for treatment were not easily obtained,
some children were presented for re-examination who had actually deteriorated owing to the continued
action of the primary cause of retarded mental development. Such children could not be educated
in the elementary schools ; but this class, which we termed "spurious defectives,'' at one time common,
has now nearly disappeared. The examination is extended in any direction suggested by the appearance
or history of the individual, and includes the record of stigmata or deformities and any nervous
ailment which might cause deficiency, or even contra-indicate an attempt at formal education.
In addition some psychological and pedagogical elements are usually introduced. They serve
more particularly to determine the question of educability and comprise tests of the power of attention
and of response to stimuli. The most usual tests are selected from the response to simple commands,
the power of recognising the nature and use of simple objects, colour matching and recognition, and
the extent to which objects are recognised in pictures.
The pedagogical tests serve as a slight check on the teacher's estimate when the application form
for medical examination has been filled in, or to give the requisite data when all such information is
lacking. The tests usually cover the power of reading, writing and counting. When examining children
the aim of the medical officers is not to find out what the child knows or has learned, but the extent
to which the ordinary channels of education are open and available. The amount of schooling the child
has actually received is considered and, so far as the history relates, his physical condition. It is a
common thing for teachers to report that, in spite of special attention, often extending over a period of
one or two years, the child has not progressed. This may be regarded as expert evidence of unsuitability
for ordinary school methods, and if such a child is found to be dull of perception or appreciation,
and particularly if his attention is difficult to fix, he is deemed to be deficient and to require such a
special form of education as the ordinary elementary school cannot at present supply. Whenever age
permits, a border-line case, which might be an example of delayed evolution although in some senses
defective, is returned for a period to the infants' department.
One of the serious difficulties hitherto confronting the medical officers at admission examinations
is the number of cases which have to be examined in a short space of time. This renders it sometimes
impracticable to establish such friendly relations with the child as to persuade him to put forth his
best efforts and reduces the number of tests it is possible to apply. The difficulty is lessened by devoting
the maximum of time to the doubtful cases and passing the apparently obvious cases with considerable
rapidity. This necessity renders the teacher's report of great importance, since at times it is from this
alone that the child's attainments can be judged.
The children are re-examined about three months from admission, and after that at intervals
of from six months to a year. The medical officer looks at the teachers' reports and the children's
exercise books and manual work. The examination, in the main, follows similar lines to that at
admission, but there is more opportunity, as a rule, to go into details or to follow out any particular
line of inquiry. Up to the age of about 12$, children deemed reasonably able to work in Standard II.
have been returned to the ordinary elementary school. After this age they lose so much by association
with children much below their age, and their presence being often regarded as harmful by the class
teachers it has been considered that, they benefit more in the special schools for elder children. Such
children, who are some three to five years behind their proper standard, are considered to come under