The Parents' Review
A Monthly Magazine of Home-Training and Culture
"Education is an atmosphere, a discipline, a life."
Backward Children, Part 2
by E. Downes, M.D.
[This article is the second part of a two part article. I chose not to transcribe part one as it deals exlusively with the diagnosis and causes of feeble-mindedness. - Wendi]
III. The Treatment of Feeble-Minded Children.
The treatment of the feeble-minded, to use a French expression, should be "medico-pedagogic." In other words, the doctor, the nurse and the teacher must combine their efforts, if they would be successful in reclaiming these children, who, if left to themselves, would surely gravitate towards the workhouse, the gaol, or the asylum.
We will divide our subject of such treatment into four heads, for sake
--and say a few words on each head.
(1) General and Medical.
Dr. Langdon Down says that, in his experience, he meets with two great obstacles to success at starting. The first is, that the family medical adviser, through failing to recognise the gravity of the situation, encourages, in too many cases, the parents to hope that nature will put everything right in time. It is a common idea that with backward infants, some sort of crisis will occur when the child reaches the age of seven; after that time, if there is no great improvement, it is said that at the age of 14, great things may be hoped for. It is true that these ages represent more or less the critical ages of dentition and adolescence, but these crises are times to be regarded with anxiety and met with care, rather than times when the mind will receive an awakening, and improvement may be expected. The fact is, that these cases cannot be taken in hand too soon; no time should be lost, and to listen to such false encouragement is to throw away the only real hope that we possess.
The other obstacle which Dr. Langdon Down complains of is the popular idea that feeble-minded children should not be allowed to mix with others like themselves. The consequence is, that either they are kept at home, and their solitary habits and peculiarities are intensified, or they are sent to school with stronger-minded children than themselves, and are subjected to unkindness and ridicule and sometimes utterly ruined; whereas, if they were sent to an institution where they were understood, and associated with children like themselves, they would reap considerable benefit.
These remarks of Dr. Langdon Down allow us to establish two principles of great importance: first, that when children are mentally feeble they require very early and very careful attention; and secondly, that such children should be associated with other children whether at home or in an institution, and not be left to themselves.
Children of this class are usually delicate. Dr. Shuttleworth estimates that nearly 75 percent of them die of consumption. Hence it is obvious that they should receive every care. By so doing, we not only shall be doing our best to prolong their lives, but we shall be taking the first step towards reclaiming their intellects. Therefore proper accommodation, proper food, proper clothing and every sanitary condition, always important, are here absolutely essential to success. Cod liver oil, tonics, perhaps stimulants, become absolute necessities.
Those children who have fits will, of course, require special medical attention.
Cleanliness is attended to in every well-ordered nursery, but here special attention should be paid, for the children are not only delicate, but their habits are naturally apt to become uncleanly in many ways. The nurse must pay particular attention to this matter, it is necessary on sanitary grounds; but besides, this habit of cleanliness should form an important part of their education, perhaps almost the first step in advance. Besides cleanliness, there are other matters which are important and must be most carefully attended to, such as general tidiness in their person, and in keeping their toys, &c., in the proper places, tidiness in eating and drinking, slovenliness must be stopped, and care must be taken that the knife, fork and spoon are deftly handled. These matters, and others of a similar kind, may seem to be of small importance, but for feeble-minded children they are in reality matters of great consideration, and form very important parts of education.
(2) Intellectual Training.
The principle started in 1843, by M. Sequin, at Paris, is the one still followed in the education of the feeble-minded. It is simplicity itself, but it has transformed that class of persons from that day forward; while before his time, doctors and teachers alike shook their heads hopelessly, when asked whether aught could be done to educate the mentally feeble. The principle is this: M. Sequin noticed that the muscular system of idiots was nearly always faulty; many of them had insufficient control over their muscles; none could properly perform what are called co-ordinated actions. He educated the muscles and the senses, viz., touch, hearing, sight, and even smell and taste. He commenced by teaching simple movements of the limbs, and went on with more and more complex movements, which he taught in a kind of drill. He had even a drill for movements of the tongue, whereby he corrected faulty articulations. He educated the sense of touch by what is called "a peg table," consisting of pegs with large tops, which fitted into holes in a board arranged like a chessboard; the pupil had to remove them one by one and replace them in various ways. He also had other boards which he called size boards and form boards, in which the tops of the pegs were, in the former case, circles of different sizes; and in the latter case, circles, squares , triangles and other figures. By such contrivances he taught accurate movements of the fingers, and also other elementary knowledge. The drills were accompanied by dumb bell and club exercises, and were rendered cheerful by music, the tune of the music rendering the exercises more accurate and lively. By simple means like this, he found that his pupils' health and nervous system improved: their speech and mental faculties were developed, and, stranger than all, the actual size of their heads often increased, as he found by accurate measurements.
He expressed his principle in these words: "The mind must be educated through the senses."
Sight was educated by means of the size and form boards, and by making the pupils match different coloured ribbons. Hearing was chiefly educated by music. He passed on to various exercises more or less resembling our ordinary dissected puzzles, and the next step was to reading and writing. Such is the method of M. Sequin, and such is the method still in use in private and public institutions for the education of the feeble-minded all over Europe at the present day. The method somewhat resembles the kindergarten method of teaching, and can be combined with it to any extent. This is how backward children should be taught undoubtedly; and, little by little, their faculties will be developed until, at any rate, reading, writing, and arithmetic will be mastered, in most cases.
Great caution is often needed, lest their faulty nervous systems should be overtaxed. To show what a danger this is, I will read an account which Dr. Langdon Down gives of a case which was brought to him for advice, which seems to me to be singularly instructive: "A large number of boys and girls come under my notice, who have in a high degree the prow-shaped forehead, and who have their nervous system in such an unstable equilibrium that the least intellectual pressure at developmental epochs is attended by disastrous results. They are brought to me on account of severe frontal headache, or of wayward petulance, or incapacity for sustained mental exertion. I cannot better illustrate the kind of case which so frequently comes under my observation, and the serious character of which it is of the first importance early and clearly to recognise, than by quoting from the letter of the mother of one such patient. She says: 'I have a boy eight and a half years old who is continually suffering with headache from temple to temple and over the front half of head. He is a child of fine physique, capable, practical, clever, so far as the head permits of lessons, which means but a short amount, and often missed altogether, for the same reason--headache, apparently the picture of health, high spirits, active, bright, yet done up with so little. The child is not a rickety creature--more is the puzzle. We shall bring him to see you on Tuesday next, and I think it better to give you all particulars before our visit, that you may form an opinion on the whole. In the spring after a certain pressure of the usual morning work, he would turn grey, gasp for air, and with windows all open, say that he was choked. These attacks were frequent and the sensation in the throat seemed to frighten him greatly. Lately I have heard less of this; now it seems 'head' affection 'all over,' as he expresses it. Since then he has grown tall and much stronger, crickets fairly well, can handle any tool properly, has good sense, good memory, a bad or rather tempestuous temper--quickly over, strong will, and ought to be a boy well to the front; but, alas for such hopes, there is ever something cropping up which knocks it all over. Then fatigue, long journeys, lessons, and all is depression and pain, and a heavy dulness of power (never of intellect) which is heart-grieving to me. Writing tires him, yet he works his Latin sentences with ease aloud, only two a day. Two hours' work has become half an hour; sometimes, lately, five minutes. He remains still over-full of life and go at times, with no real strength, irritable, open, upright, self-willed, loving, very true, still all wrong, and why?' When the boy presented himself to me he displayed a typical neurotic (prow-shaped) forehead, and there was a very complete history of severe emotional disturbance on the part of the mother, a short time before his birth. I counselled complete abstention from intellectual work during the remaining period of second dentition. It was very clear to my mind that any continued pressure would lead, through convulsions, to developmental idiocy."
It is impossible to read this sad story without feeling very much for the poor mother and her boy.
I tell the story as I read it to show how some boys are compelled to become backward; and as it is a choice of the lesser of two evils, we must be content to let them be so. In all neurotic and feeble-minded children, we must watch carefully the effect of work, and be prepared to stop it. The story also illustrates what I said in a former part of my paper about "prow-shaped" foreheads, and the necessity for neurotic parents to avoid emotional disturbances, no matter what it costs them to do so.
(3) Exercise and Recreation.
All children imperatively need exercise and recreation, but feeble-minded children need them more than the others.
Exercise should be largely combined with fresh air and sunshine. The systematic exercise obtained in a gymnasium, such as club and dumb-bell drill, is very useful, but the greater part of the physical exercise should be taken in the open air. We have seen already how prone feeble-minded children are to become consumptive, and it is an established fact that consumption is to be warded off by means of fresh air more than by all other remedies put together. Exercise such as games of cricket and football, are not only healthful, but are valuable from an education al point of view. But such games are not suitable to all, and are in any case only for boys. Girls and little children must have simpler games provided for them, such as hoops, ball, skipping-ropes, &c. Considerable ingenuity is required in the matter of games; for example, with very stupid infants, with an impassivity that at first sight seems hopeless, it has been found of the greatest service to induce them to have a game with one of the nurses at catching small bags containing a small quantity of peas, beans, or maize.
At first the poor child has no idea of catching, and shows no willingness to learn. The first step is to throw one of these bags gently at the child's head. He soon objects to being pelted, and puts his hand out to save his face. The next step is that he catches the bag in his hand, and the last step in this simple game is that he throws it back to the nurse. Having mastered this game, the child soon proceeds with musical drill, and other games.
Some of the older children should be encouraged to work in the garden, but in this they will require special instruction and supervision. Anything which combines physical exercise and useful employment is particularly to be recommended, such as carpentering. In their out-of-door pursuits, interest in animals and all natural history is to be cultivated, since the concrete rather than the abstract is the kind of instruction which they will most understand and appreciate. Kindness to animals is to be taught and insisted on, for, very often feeble-minded children, though cowards, are naturally cruel.
One more word about amusements: they should always be calculated to raise the intellectual and spiritual tastes. Coarse buffoonery and low jests are always too attractive to the young, and, like rank weeds, kill every high aspiration.
In the feeble-minded, higher aspirations hardly seem to exist, and if they are to be implanted and cultivated, the greatest care must be taken that the soil is not choked with a poisonous crop of weeds. The greatest care must be taken to guard their ears against low, blasphemous, and obscene words and expressions: these, alas! Are too easily learned, though the acquisition of sound knowledge is so slow and painful.
(4) Moral Teaching.
We have rather anticipated some of the things which might be said on this head while speaking about recreation. We need, however, not dwell at great length on this head. Suffice it to say that in dealing with feeble-minded children, the greatest stress should be laid on the necessity of a moral life in every particular. In all education this is a most important particular, but among the feeble-minded, who are so much more at the mercy of all that is wicked and bad in the world, moral teaching is more than ever necessary. A great argument among lower natures is that "good brings its reward, wrong and evil brings its punishment." This lesson must be driven home among this class of young people on every opportunity, and with every possible illustration. There is a class of feeble-minded persons who seem to be incapable of learning this lesson in any way; these have been called very aptly "moral imbeciles." There is only one thing to do with such people, and that is to keep them separate from others, so that they should do no harm; perhaps some day a method may be discovered in which even they may be influenced for good. As for the feeble-minded in general, they are just as easily taught to be moral and upright as other people , and it is all-important that they should be thus taught.
Lastly, the question arises, can they be affected by higher principles and motives than this higher kind of selfishness which we have spoken of? Can they be induced to think about love? The love of God and man? Experience says: "Yes, they can." I will illustrate this point by a quotation, not from a goody-goody book, but from a learned work by Dr. Shuttleworth, called "Mentally Deficient Children." He says as follows:--"The golden rule, that even the feeble-minded should do unto others as they would be done by, should be inculcated; and, happily, such persons are often susceptible, not only to moral, but to religious influences. Their very simplicity leads them to accept without hesitation, ideas of a Universal Father, who is at the same time an all seeing God, of a loving Saviour, and of a sanctifying Spirit; and however imperfect may be their comprehension of these mysteries, there is no doubt that such notions tend to exert a wholesome restraining influence upon conduct. No one who has had large and intimate experience of mentally deficient children will deny that, in many, the religious sense is not wanting. In this connection we are tempted to quote from the letter to his sister of an imbecile, formerly in the Royal Albert Asylum, a letter written unprompted and unassisted. Referring to the Sunday service, the poor lad writes:--'How beautiful it is to think of our dear Saviour who loved us all. He knows that I could not do anything for our dear Lord, and it makes me happy to think about Him and to sing about Him as well. We must pray to God to make people happy in our dear Lord and Saviour, and the Holy Spirit.'"
One word more in conclusion about backward children. These remarks have been made regarding feeble-minded children, which term includes backward children and mentally deficient children. I explained that it is hard, sometimes impossible, to separate these two classes one from the other; and therefore it was necessary to speak of them both as a whole. I have forever endeavoured to give such information which would be more especially relevant to backward children. It will be remembered that I endeavoured to distinguish backward children from deficient children, by saying: that in the case of the former, we might imagine that a child belonging to this class of a certain age would correspond to a normal child some years younger, but in the case of mentally deficient children, no such comparison is possible.
Now with regard to the education of simply backward children, the hints thrown out under the previous heads apply to them even more than to imbecile children. Their state is a similar one to that of the mentally deficient, indeed, they are in great danger of falling into that class; but, if properly taken in hand, their progress will be quicker and more satisfactory in every way than that of the more serious class of cases. Dr. Darwin, Sir Walter Scott, Washington, and other great men were once backward children. So we must take courage and hope that our backward children may someday develop into some of the great ones of the earth. Only let us have patience; let us make allowance for their difficulties; let us begin with concrete rather than abstract ideas; let us develop their bodies; and through their games and recreations let us try to find some portal to the slumbering intellect; above all, let us watch over their moral nature with even greater jealousy than we do in the case of ordinary children. If we cannot teach the sciences, we can, at any rate, employ the dim twilight of the slow developing mind in pressing home the value of truth, honesty, and purity; let us tell of the love of "God, the salvation of Christ, and the guidance and comfort of the Holy Spirit. Let us do this conscientiously, and await the dawn of the mind's sun; when that sun rises, it may be more beautiful, more lovely than we ever could have imagined. Our toil will be a thousand times repaid, not perhaps by the successful result of a competitive examination, but by a useful, loving, and healthy life.
"They that sow in tears shall reap in joy."
Proofread by Leslie Noelani Laurio, July 2008
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