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ciency, or any impairment of the motor mechanisms such as paralysis which might act as a handicap.
Stigmata of degeneration are noted, but the importance of these has been somewhat exaggerated save
so far as they tend to indicate one or other of the types of infantilism. A few definite clinical types may
be recognised, but the bulk of the cases are examples of simple primary amentia.
The general attitude of the subject at the time of examination may be very significant, but too
much reliance must not be placed on superficial appearances, as many, for example, past sufferers from
meningitis may appear bright though their ultimate performances shew considerable defect. Speech
defects, lalling, echolalia, idioglossia, or even mere babyishness, are all very significant. Special
indications may lead to a complete neurological examination. Instability of the nervous system may be
indicated by physical manifestations such as nystagmus, head-nodding, choreiform movements, tics,
habit spasms, dysphagia, enuresis or even epileptic forms of convulsions. With these there is often a
ready onset of fatigue and irritability under stimuli insufficient to affect the normal individual. Such
instability is inherited and is in some measure an indication of physiological failure, but is in itself
insufficient to bring the individual within the purview of the Mental Deficiency Act.
(ii.) Psychological—It is now the practice to endeavour to assess the general intelligence by the
use of one or other of the graduated series of tests which have been proposed for developmental diagnosis.
Of these the De Sanctis tests, the Binet Simon tests and their various modifications, the Healy tests,
the Porteous tests, and the Word Association tests, have been most used in London. As a result of
these various tests which have been standardised for age it is possible to express the resulting evidence
as to intelligence in the form of a mental age corresponding to the number of tests passed successfully.
Temperamental features are more difficult to assess since the information must always come
mainly from others, and no satisfactory series of tests have as yet been devised, though some confirmation
may be made from general observation during the course of the examination. The children
may be classified as being either unemotional or as belonging either to a restrained or an unrestrained
emotional type.
So far as the specific instincts are concerned there is considerable variation, the defective is
usually lacking in some with perhaps an unbalanced exaggeration of others. Information on these
points may be derived from the parents or others. The former, unless the subject has recently been
very troublesome, are apt to minimise all the evidence and should the case need to come before a
judicial authority may go back on their previous statements owing to their desire to keep the subject
at home. Teachers on the other hand are sometimes apt to over-emphasise the detrimental aspects
of a child's conduct and to claim that a child is defective when in reality it is only troublesome. Social
workers, especially if engaged in rescue work, are often inclined to place a sexual significance on every
act, and to refer to suspicions rather than to directly observed facts on which evidence could be given.
Others are more dispassionate but are usually less skilled observers.
Complaints may be grouped along the lines of three main types of instinct, self, sex and social,
though there is naturally a considerable degree of overlapping. In general the instinctive manifestations
in the defective remain fixed in the form of conduct which resembles that of a child of less mature
years. In this way a rough age classification may be made. Dirty habits and lack of care of personal
appearance are common sources of complaint, they vary from extremes like coprophagia or defæcating
into the clothes, to mere lack of care in washing. This is a persistence of infantile traits, but the defective
may continue for years to bite coal, stones, or dirt of all kinds, a condition, which is a fruitful source
of complaints against those who have them in charge. Whereas the normal child is usually dry and of
clean habits by the early part of the third year defectives may remain wet or dirty to five or six or even
longer, enuresis is often cited as evidence of defect, but may be due to other factors.
Transient ungovernable rage is a normal infantile feature, but its persistence in later life together
with a longer duration, is suggestive of feeble mental control. Many of these manifestations, however, are
due to insufficient or irregular home control; great improvement is repeatedly noted when the subject
can be placed in a residential school, hence cases in which the defect is mainly temperamental are better
observed in a place of safety, if this be possible, before a final diagnosis is made. The tendency to bite
those who have offended them is almost normal in young children as a passing phase, but it often
remains in the defective, and the charge of biting other children is frequently made the ground of a
suggestion that the presence of a given child is detrimental to others.
Inefficiency in handwork is a common trouble. The instinct of construction remains as a rule
rudimental in the defective, who is usually handicapped by deficient psycho-motor control. Boys
always seem to like promotion to the manual rooms in the school for the elder defectives, and in some
cases this leads to an improvement in self respect. The first improvement often results from a child
acquiring some useful accomplishment, such as mending boots, which his fellows in the ordinary school
have not learnt.
Petty pilfering is often due to unrestrained action of the instinct of acquisition. Even low grade
defectives collect and treasure some articles. This instinct early conflicts with social requirements and
therefore brings many of the subjects to notice. This is not by itself of great diagnostic significance.
The sex instinct proper is a source of great difficulty. In many defectives the initial strength
of this instinct is sufficiently strong to over-ride social sanction, particularly as their intellectual status
prevents them from appreciating the full consequences or significance of the act.
In normal individuals the sex impulse is sublimated into all forms of artistic effort, but in the
less intellectual this process is more difficult owing to the limited channels available for diversion so
that the impulse is more strongly directed along the original lines or into the crudest forms of pornography.
In school cases much stress is laid by the teachers on precocious sex interests, perversions
or exhibitionism. The latter is a common feature in imbeciles, but in children has often little direct