Mentally Defective Children

by Alfred Binet; Théodore Simon

In a class of nine defective children subjected to a similar examination, we found only one who had but one stigma, another had two, four had three, and three had five. Of the three last, one had a very high degree of retardation; another was mentally ill-balanced to no less a degree. Let us compare these two groups, the one of fifty-eight average children, the other of nine defectives, and group to group, the difference is very clear. The stigmata are usually more numerous when the children are mentally defective. The existence of stigmata is a presumption of deficiency, and this presumption is greater, the greater the number of stigmata.

If we consider which are the stigmata that are most commonly met with, we find that asymmetry of the face is almost constant, but we also find it sometimes in normal children. Malformations of the ear come next. We are often struck by the frequency of badly defective speech—three times in nine defectives, whilst we did not find a single example in the fifty-eight school children taken by chance.

Here, then, is a "group fact" which is of interest from a scientific point of view. But what use can be made of it for individual diagnosis? This is much more delicate, for even if one could state it as a general rule that defectives have more stigmata than the normal, this rule is subject to important exceptions.

One of our abnormal cases had only one stigma, another had two, and in both cases the anomalies were of a very ordinary kind—slight want of symmetry of the face and sticking out ears. Children with stigmata few in number, and little marked (though as a rule we note the presence of stigmata without measuring them), may therefore not be of normal intelligence. The same is true sometimes of children with no stigma at all.

We may therefore conclude that stigmata may be taken into account when we are making an examination, but they should never be regarded as of fundamental importance in diagnosis.

Physiognomy.—In addition to stigmata, we have to note another feature which is of more definite significance. Methodical studies made by means of a collection of sixty photographs of children, normal and abnormal, photographs taken by M. Bertillon in conditions comparable in all cases, have shown us that an intelligent teacher can scarcely go wrong in judging physiognomy. The photographs were beautifully taken, and the expression of the faces appeared extremely lifelike to anyone who was used to observing children. We asked various teachers to examine these portraits, and to express their opinion as to the mental capacity revealed. Mistakes were made, as was to be expected; but the correct estimations were always in the majority, and some teachers exhibited a truly remarkable talent for observation; they were practically never deceived. Let us say in passing that our list included a number of doctors amongst the teachers. They were far from distinguishing themselves. Their percentage was not so good as that of the schoolmasters. This difference in competence, which perhaps may appear surprising, suggests the following anecdote: One day, at the meeting of a commission, we had thrown upon the cloth a collection of photographs of children, the very one which we had been using for our methodical experiments. Everyone looked at the portraits and expressed his opinion. By way of a joke we tackled a medical alienist who had a seat on the commission. He was mistaken in his opinion as often as his colleagues who were most ignorant of medicine.

It seems to us, and the facts mentioned support us, that stigmata are only one part of the complicated whole which constitutes a physiognomy. A physiognomy includes many other things, especially the expression,—lively or sluggish, strong or weak, intelligent or lacking in intelligence; there is the fineness or coarseness of the features, the beauty or ugliness of the countenance, the ordinary or unusual appearance of the face. All this forms an ensemble which the eye does not analyse, but judges en bloc by instinct, without considering the elements separately, and, above all, without being able to give reasons for its judgment. Will it be possible some day to analyse, to dissociate, and to describe all these very various elements? We do not know. In the meantime we think that every examiner, as a matter of fact, allows himself to be influenced by the general appearance of the subject, and that the impression so formed is not entirely without value.

Let us sum up regarding the physiognomy. There does exist between the intellectual level of a subject and his physical development a real correlation, but, unfortunately, it is slight. With regard to the stigmata our knowledge of their significance is still very slight. We have no figures which allow us to place any definite value upon them either singly or in combination. There still remains the general appearance, whose significance is apparently indubitable, but which, at present, is too dependent upon individual estimate to be utilisable. Let us add that these relations between the mental and the physical appear to be of greater significance the lower the mental condition. Now, in a school it is the feeble-minded who are in the majority, and it is they who have to be recognised much more frequently than the idiot or the imbecile, and this lessens the importance of the physical examination. We may therefore conclude with this practical rule: a physical examination can never allow us to dispense with a direct examination of the intelligence. Anthropometry, stigmata, and physical appearance must take a second place as means for discovering in school the feeble-minded and the ill-balanced. Failing direct recourse to the teacher, these methods could, and ought, to be made use of. But in most cases, thanks to the assistance of the teacher, we have better means. In cases on the border-line they might help to incline the balance. Their principal use is not to assist in selecting children for special classes for defectives; their significance is quite different, as we shall see immediately.

Medical Examination of the Children Presented.

We must now define the active rôle of the doctor. In many foreign countries a scheme has been drawn up for the medical examination, which is often extremely comprehensive, almost interminable. We give an example of this kind, though questioning the appropriateness, from our point of view, of certain questions. If one does not simplify the work, the practitioners will simplify it in their own way—by neglecting it. If you ask them to do too much, they will do nothing.