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Report of the Medical Officer (Education)
149
lose most of the blackboard instruction, and would soon become discouraged and deteriorate. The
return to the ordinary school means not only different and more rapid work, but instruction in larger
classes and the loss of much of that individual instruction which had been available in the special school.
Such a child is then clearly incapable of deriving benefit from the instruction in an ordinary elementary
school, and is certifiable under the Act of 1899. When he is over 14 the circumstances are different ;
it is no longer a choice between two types of school, but between school and work. At some period
between 14 and 16 the parents, if anxious that the child should go to work, will obtain a situation for
him, or make some proposal for his employment. This proposal with a report of the teacher is submitted
to the medical officer who examines the child.
The question of exemption is then considered when the boy's intellectual status is markedly
in front of his educational, save, perhaps, so far as manual training is concerned, the benefits to the
three R's of a year or even a year and a half of extra schooling may be measured by an improvement
in grade of perhaps a quarter of a year, perhaps even by none at all. His general intelligence and his
manual dexterity and knowledge of some trade will naturally show a much greater advance. Should,
however, an opportunity offer of his entering suitable and instructive employment, and he be able to
take reasonable care of himself under more or less supervision, it is usual to state that he is fit to
leave if suitable work be found. If when a child is examined with a view to exemption, his response
is bright and he is able to pass a fair number of the general and educational tests mentioned above,
or such others as may be preferred by the particular medical officer conducting the examination, it is
necessary to state that satisfactory evidence could not be given to support any steps taken to enforce
attendance. If, on the other hand, the tests are not passed satisfactorily, exemption may still be recommended
if suitable work is available, but any necessary action to enforce attendance could be supported
by evidence in court. It is perhaps well to be clear that facts which would amply justify certification
under 14 are not necessarily adequate for children over that age. The suitability of the individual
for the proposed employment is but rarely a matter for medical attention. The main problem before
the medical officer in considering children under 14 at admission examinations, or at visits to the special
school, is whether the child will benefit by education at one type of school but not at another. The
question whether or no a child has failed to benefit by education in the ordinary school is primarily
pedagogical, and the medical officers should be able to regard nomination for examination as definite
evidence to that effect given by an expert. The standardisation of educational attainments qualifying
for such nomination is also a purely pedagogical matter. In practice the medical officers have to be
on the watch against the bias of individual teachers to prevent any unloading on to the special schools
of children who are troublesome or unlikely to do credit to the education they receive, and for one cause
or another, about three-fifths of the cases nominated are sent back to the ordinary elementary schools.
The child, once nominated, it is the duty of the medical officer to ascertain whether the deficiency is
due to any preventable cause, and, if so, to notify it in order that the necessary steps may be taken.
Now that medical inspection takes place in all infants' departments, the number of such cases is likely
to be reduced. The causes of spurious deficiency being excluded, the question of permanency of the
defect and of retarded development have to be considered, together with a few specialised defects which
have relatively little influence on the general intellectual status. Diagnosis depends on the summation
of a number of almost intangible character observations of behaviour, movement, attitude and response
which, however, make up a well-recognised whole. Some tests of a phychological nature are needed,
included among which are those employed in the present investigation. The decision must depend
on the interpretation of the relation found to exist between the intellectual and emotional status, on the
one hand, and the educational on the other.
Unfortunately, the psychology of education is as yet in a comparatively rudimentary state,
in which much more experimental research is urgently needed, the only point on which there is general
agreement is that the tests should be numerous and varied. Because a child fails at some one test
involving the powers of attention, memory or perception, it does not follow that he will fail at another
apparently involving the same factors. This renders evaluation difficult. In time, when a numerical
expression of the norms for many tests has been determined, the matter will be much simplified. There
is also the difficulty that the degree of reliability of each test has as yet to be ascertained, which can
only be done by continued investigation of a group of children. It is in this direction that work such
as that of Dr. Spearman and Mr. Abelson, described on page 63, is of value to the medical officers
certifying under the Act of 1899. Until this standardisation has been completed by experimental
research, it is only possible to use a number of tests and judge from the general result. Probably four
cases out of five, if not a higher proportion, offer no special difficulty, the odd cases require prolonged
investigation, spread over some weeks, to avoid the influence of chance variations. These doubtful cases
could only be accurately diagnosed by the more detailed application of psychological methods such as
are available at the psychological clinic in Philadelphia or in the training school where Goddard works
at Vineland, New Jersey. Such investigations could be carried out in some central school with a staff
specially trained in medico-psychological methods. Their labours, however, might be expected not only
to decide on methods of diagnosis, but to throw a definite light on the psychology of teaching methods
in general. It is possible that some children owe their extreme degree of retardation to the methods
in use not being adapted to their needs.
Reliability of methods of examination is of the utmost importance both for education and for
the determination of the border line between the child who can be made a passable citizen and the
one who needs permanent custodial treatment.
This uncertainty as to reliability is the weak point in the tests of Binet and de Sanctis, which
are the best graded series at present available.