C. Removal of Ailments, and Co-operation in Overcoming Educational, Social, and Other Handicaps Resulting Therefrom. Under this head these points have to be considered:

1. A mere removal of some physical ailment is not a complete remedy, nor is it always a simple or rapid process; educational methods must be employed after the medical relief, or even along with it, to accomplish restoration to normal functioning.

2. Thus, diagnosis and treatment require the co-operation of the educator and the psychologist with the physician, inasmuch as the physiological aspect of a case is intimately bound up with psychological and emotional elements, and with facts of educational and social import.

3. Physical difficulty, combined with mental and moral variation, is the keynote of exceptional development in children; hence, in their cases, medical and educational co-operation is particularly indicated.

4. Just as physical conditions affect the mental and moral states, the latter have their specific influence upon physical developments as such. In other words, emotional elements, volitional control, psychic states, imaginings, etc., react upon the body in general and influence functional reactions. Hence, again, the need of an all-sided co-operation.

If all this is to be accomplished by medical inspection, it must be developed to a high state of efficiency. At present we have makeshift arrangements in most places. In lieu of busy practitioners who are employed on a meagre salary to do some ill-organized inspection work in the schools, we should have a corps of specially trained and well-paid physicians with whom this work is a lifecalling. We need them for the schools at least as much as we need them for hospitals and asylums. If we compare the number of trained men and women employed in the asylums for the insane with the number employed

in the schools, we shall realize the inadequacy of the school provisions.

School nurses and social visitors will complete the work by co-operating with the homes of the pupils whenever necessary. An effective following-up system should be devised so that each child may have the full benefit of these provisions.

Repeated Examinations.-Children change, often quite rapidly, in accordance with the laws of growth, which work with each individual in compliance with all the factors which differentiated him from the others, so that there is an endless variety of combinations. In this manner the unfolding of an individual psyche is full of surprises. To catch the budding instincts and capacities, to keep on the track of every new change, it is necessary to repeat the examinations of body and mind at regular intervals.

In this wise we may forestall derailments, or if we cannot turn the course of an undesirable development, we may at least discover its origin and follow

it up.

At certain junctures a child should be under closer observation than ordinarily. For school adjustment, for the sake of his moral evolution, or even for his physical development, he will then need greater care and more minute scrutiny. Co-operation with the home will always be indicated. But each school system should organize observation classes, perhaps even observation schools, for scholastic and disciplinary purposes, without, of course, attaching any penal, stigmatizing, or compromising features to the transfer into classes or schools of this kind. It may be well to have, also, in addition to the observation day school, an observation

parental school, where the children can be observed and studied in their habits of life and conduct.

A System of Clinics.-As has been shown in the chapter treating of the meaning of an educational clinic, these clinics, together with the medical clinics, may be considered as feeders for a number of special clinics in which much expert work shall have to be done, to supplement the work of the clinics of the first order. There will have to be pathological laboratories at the service of the school clinics, for the making of blood tests, sputum tests, examination of fæces, urine, and cultures of all kinds. There should be psychological clinics for the study of cases which require more elaborate and intimate psychological examinations. These psychological clinics will also be helpful through developing accurate methods for determining the vocational aptitudes of the youth of our land. Those children who give evidence of psychopathic derangements should have the opportunity of being referred to psychopathic clinics. There will be so much need of dental clinics that they should be co-ordinated with the regular medical work. But we may further have special arrangements for orthopedic work, also in connection with open-air classes and schools inasmuch as many of the orthopedic cases have a tubercular character.

Clinics for Delinquents and Dependents. A similar system of clinics should be operated in connection with every children's or juvenile court, morals court, and detention home. As a matter of fact, detention homes may be utilized as observation clinics. The problem of charity for dependent and destitute or ill-used children, involves likewise the careful study of the individual case. Therefore private charity bureaus no less than municipal

and State charity commissions should provide for educational, medical, psychological, and other clinics in the same organized manner as has been suggested for the schools. The sociological investigations to which these agencies usually confine themselves tell only part of the story. The best plan will be, as has been recommended repeatedly in these pages, to organize all this work jointly under the educational authorities.

Medical Aspect. In order to exemplify the function and importance of medical relief and co-operation in solving the problem of the exceptional child, the author has invited a number of eminent physicians to contribute to a "medical symposium," each one to treat of this great subject from his own standpoint and experience. He has preferred such expressions from experts to his own statements, for the reason that this method of presentation will make the argument much more powerful and convincing. This brilliant symposium is given in the Appendix.

CHAPTER XXIV

PROVISIONS FOR EXCEPTIONAL CHILDREN IN

SCHOOLS AND INSTITUTIONS

Special and Ungraded Classes.-The terms "special" and "ungraded" classes have been used interchangeably. They mark the first attempt to segregate children who do not conform. But they have been grossly misused, largely through lack of differentiation. They have been a sort of dumping-ground for all those children with whom the regular grade teacher does not know what to do.

In some school systems there is a rule that pupils who have been for two years in the same grade must be moved on to the next higher grade, no matter whether they can do the higher grade work or not. Sometimes this method works beneficially as, with the progress of maturing, the mind of a child wakes up to its higher responsibilities. In other schools the opposite method is followed. The author has had under his observation

1 Germany took the lead in this movement as in so many other educational and cultural movements. Special classes for mentally deficient children were established there in 1867; Norway followed in 1874, and England, Switzerland, and Austria in 1892. In the United States, Providence, R. I., opened three schools for backward children in 1893; Boston organized its first special class in 1899. In 1901 the first special class was established in the public schools of Philadelphia. Other cities followed. In 1911, 220 American cities had special classes for backward children, although many of them followed the bad example of England in allowing low types of defective children to enter.