View report page

Report of the County Medical Officer—Education. 211
These cases will again come up for review in the light of the Mental Deficiency Act, 1913.
Conditions of incontinence and the like are also met with in the difficult group of cases which are
both physically and mentally defective. Examples of this are found among the sufferers from spastic
paraplegia and some severe cases of hemiplegia. The mental condition of these children may for long
remain at a low level or even deteriorate so that they are unable to make reasonable use of the educational
measures available in schools for the physically defective, while as a result of their paralysis it is difficult
to convey them to schools for the mentally defective. A certain number are so conveyed by ambulances
attached to physically defective schools, but it is found that many children require the attention of a
nurse, during school hours and the midday recess, since owing to their physical disabilities they are
unable to attend to themselves. In many instances it is necessary that their wants should receive
immediate attention and this attention cannot always be given by the class teacher, while in the
intervals there may be no one available. The teachers can scarcely be expected to undertake
responsibility for these cases, some of which have to be invalided as unfit for school attendance.
Though advantage would no doubt be taken of any provision of school accommodation for children
with both mental and physical defects the return to be expected would be of a low order since the
history of many if not the majority of cases is one of ultimate deterioration. Many of such children
for whom inadequate home care is available are likely to be subject to be dealt with under the
Mental Deficiency Act, though the difficulty of finding suitable institutions in which they may be
placed may not cease for some time to come. In 2,000 cases lack of control of reflexes was recorded
26 times and dribbling 23 times.
Stigmata.—Provision is made in the medical record card in use at special schools for records
of any stigmata. In the report for 1912 a series of results were recorded, the extraction of notes has
been continued and the following percentage frequencies have been derived :—
Cretinoid development 1.1
General retardation 5.6
Microcephaly 2.2
Hydrocephaly 1.5
Cranial asymmetry—
In marked degree 5.2
In minor degree 23.0
Maximum evidence of rickets 7.0
„ circumference of head under ]9 inches 6.8
„ „ „ 20 inches 36.2
„ „ over 22 inches 12
Bossed forehead 5.1
Low forehead 2.3
Narrow forehead 3.0
Depressed bridge of nose 1.2
Broad base to nose 11.0
Prominent teeth 6.1
Hutchinson's teeth 1.6
Epicanthic fold 5.5
Mongolism 1.7
High arched palate 12.6
Narrow palate 9.8
Cleft palate 1.2
Webbed fingers 0.1

Reaction of motor mechanism - -Formation and storage of motor ideas. No child in the special
M.D. schools at the time of examination failed to imitate a simple movement such as bending the
fingers or standing on tip-toe, or to carry out single simple commands as "Sit down." Over 90 per
cent. could carry out a familiar but more complex movement such as response to the command
hips firm, heels raise, knees bend, showing a considerable power of motor control and concentration.
Over 80 per cent., however, assumed a slack standing posture while in over 20 per cent. the position
of arms, hands, and fingers when in horizontal extension is described as being of nervous poise. In
2.5 per cent. tremors were noticed, 4.9 per cent. showed marked over-action of the facial muscles,
while twitching is recorded in 12 per cent. and a vacant expression in 8 per cent. There was a
history of infantile convulsions in 19 per cent., and suggestions of minor epilepsy in 9 per cent.
Reactions resulting from sensory stimulation of attention—All the children tested responded
naturally to simple tests; thus their eyes followed an object, they grasped an object proffered them
or picked one up to command. All matched wools coloured red, green, blue, or yellow, though all
did not recognise these colours by name. Two children out of 170 tested failed to pick out the
largest box of a series. On testing with a form board the great majority were able to replace them
with simpler outlines. Tested by replacing triangular tablets, two of which were taken out of the
box, the proportions of successes were:
Age. Succeeding. Age. Succeeding.
875 11 92
9 80 12 100
10 88 13 100
The formation of memory images, the association of ideas, powers of judgment and estimating
relationship were tested by asking the children to name real objects shown them, such as a
knife, a key, or a penny; to point to named objects in a picture or to name the objects depicted,
to state which of two lines was the longer, to compare similar boxes weighted to 6 and 12, 3 and 9
grams respectively, to arrange five weighted full boxes in order of weight. They were also asked to
repeat three or more numerals, to define a simple object such as a cat, and to distinguish by memory
between wood and glass, a cat and a rabbit, or flannel and cotton.
23610 BE 2
Mental
conditions.