CHAPTER IV[ToC]
THE MEDICAL EXAMINATION OF DEFECTIVES
Hitherto we have been studying the defective from the point of view of his school relations. This point of view is incomplete, and should not make us forget that there is another—the medical. It is quite certain that in the organisation and the practical working of the special schools the doctor has a rôle, and an important rôle, to fill. All foreign countries recognise this, and give him a large place. It is even regretted in some countries that doctors detach themselves too much from such questions, and are content to make a rapid and superficial examination of children on their entrance to school, instead of collaborating actively in the important work of the teacher.
After this declaration of principles, it may not be without interest to fix precisely the rôle which belongs to the doctor and the services which he can render. It seems to us, in fact, that there is often some confusion as to his attributes, and two opposite tendencies may be recognised. According to one, the more widespread, the defective are often, if not always, invalids, and belong to him by right. It would be an encroachment upon his privileges to concern oneself with them. The opposite opinion consists in not committing to him any particular authority in the matter. This is the case in Germany, where there are schoolmasters who carry things with a high hand in the special schools. Let us add that the doctors themselves have done nothing to bring about an entente. Speak of defectives before them, and they say, "That is our business," and they are perfectly right; but having affirmed their right, they pay very little attention to the territory they defend.
It seems to us that the field is sufficiently great for everyone to glean, and the efforts of all will not be too great to clear it. There are some questions which escape the doctor, unless he is also an educationist and a psychologist. But there are also some, in our opinion, for which he has special competence, and where no one can take his place. To define his rôle is not to lessen it; on the contrary, it is to assure him an authoritative position. It is not his business to select the abnormal from the normal. But from the children picked out as abnormal he will differentiate certain types and prescribe certain measures with regard to their care and treatment.
The Doctor not to pick out the Detectives from amongst the Children in School.
There is a general misunderstanding with regard to the special knowledge and aptitude of the doctor. One tends to credit him with a kind of omnipotence and infallibility against which he protests in vain. He is made to judge questions which do not belong to his special province—namely, the medical, and upon which he expresses opinions which are neither more nor less valuable than those of any other intelligent person. Recently, at various congresses, we have seen doctors with the best intentions laying down educational programmes, comparing the educative value of science with that of letters, and expressing a variety of opinions, no doubt very sensible, but with which the medical art had nothing whatever to do. As regards the selection of defectives, one is influenced by the same prejudice. We have discussed this with many people, and especially with educationists, and when we have insisted on the difficulties of examination, they usually reply, "That is the doctor's business!" The prejudice we have noted is very tenacious, and will doubtless be difficult to overcome, for there are many people who have interests to maintain of a pecuniary nature. Let us consider this question from two points of view—the estimation of educational retardation, and the physical examination of defectives.
Estimation of the Degree of Mental Inferiority.—We have seen how easily, in spite of the commonly accepted opinion, experienced teachers and inspectors accomplish this part of their task. If a doctor were charged with it his embarrassment would be great. Just imagine a doctor introduced into a school of 300 children in order to pick out the defectives by strictly medical methods. No doubt every doctor, especially if he is an alienist, is called upon to estimate the intellectual level of children, and to sign certificates of idiocy, imbecility, and feeble-mindedness. But just consider how things are managed at the consultation. The parents bring the child. They know very well that he is "not like others." They bring him for that very reason, and consequently the doctor does not require to distinguish the child from a normal one. He only requires to sit and listen to the parents, who give him a crowd of particulars. When he questions and examines the child, it is only to verify what he has learned, and to add his own personal impression. As a general rule the case is a severe one; the deficiency is so evident that any sensible person would notice it. The task of the doctor is therefore narrowed. He has only to certify the mental deficiency of the patient, stating in technical terms the diagnosis which the parents have brought to him ready made. Even his estimation of the gravity of the case, apart from special investigations on his part, is not very different from that of ordinary people who readily distinguish between the idiot who cannot speak; the imbecile, who can make himself understood, though he cannot be educated; and the feeble-minded, who can do some work, but is not able to provide for his wants, or to behave himself sensibly.
When the doctor thus certifies the intellectual level of the patient, does he try to do so with precision? By no means, for it is not expected of him. The parents do not come to him in order to ask him, "Is my child backward in his mental development?" Alas they see it only too well, and little it matters to them whether his backwardness amounts to six months or a year. But they do come to ask, "Why does this child not make the usual progress? Is there not some medicine, doctor, which can help his development?" When they come to the doctor, it is not even with the hope that some medico-pedagogical treatment will cure their child. They know very well that the devoted care which they have always bestowed upon him from his infancy is superior to anything which can be given to him at a dispensary for children; but their indomitable hope leads them to seek chimerical measures. In all this, let us repeat, the doctor does not require to estimate the degree of mental deficiency with any delicacy. But if he should try to do so, what methods would he use?