APPENDIX II A MEDICAL SYMPOSIUM This section is unique in that it is composed of contributions by a number of leading specialists who are deeply interested in the subject of this book, and have honored the author with their co-operation and counsel. They represent a very much larger medical constituency; for this work has succeeded in enlisting the earnest consideration of many practitioners and specialists who have given it ever-increasing attention, and who have encouraged the author by their sympathy and good-will to follow the path he had broken. The first contribution is by the Nestor of American medicine, Doctor Abraham Jacobi, who, however, is by no means agreed that this plan of a symposium is a good one. He writes: I am interested in your subjects, and want you to go into their discussion yourself. . . . Your book should be one man's book." Nevertheless, he gives the author's work his blessing in the following words: Your "Tentative Classification” contains so much material, so many themes for extensive and difficult treatises, that it proves protracted studies on your part and the necessity of filling volumes even for a man whose life is filled with the special studies you have selected for your life work. . . . Feeble-mindedness, "exceptional" conditions, such as apply to you for correct education, training, etc., are subjects for medical studies, it is true; but unfortunately more objects of study than for improvement. On a few pages in my third edition (of 1903) of "Therapeutics of Infancy and Childhood,” which you may have seen years ago, I have discussed the corresponding topics as concisely as I could. In my "non nocere" address before the Roman Congress of 1894 I have discussed premature ossification of the cranium and condemned operative interference. Neurological and psychiatric books treat of the medical (and surgical) aspects of such cases. Little's Disease, as you know, has been the subject of quite an extensive literature, etc. All this shows that the anatomy and physiology of abnormal brains has interested a great many, but what interests you principally is the inability of medicine to aid you in individual cases. The causality of abnormal conditions of the kind has been studied, and in many individual cases with success. The results of such studies point to the possibility of prevention rather than cure. The faulty condition of the embryo and fœtus should be influenced if possible. Diseases of those prenatal developments should be treated and cured. This very day syphilis of parents and grandparents is not sufficiently appreciated; accidents before and during labor may kill the new-born, or, what is more frequent, may add to the incompetency of the new creature for life. The statistics collected by Karl Pearson . prove that inferiority of the first-born is a frequent occurrence, etc. It had been the author's intention to arrange the medical contributions in accordance with the classification of exceptional children which forms the basis of his discussions. But inasmuch as they are somewhat overlapping in content, this plan could not be carried out strictly. The individual contributions are printed without any but casual comment, even where the points of view expressed do not precisely coincide with the author's own convictions. The problem is too big to be a one man's problem, and although this book is intended to present more particularly the author's conception of it, he has felt that this section, at least, should be more in the nature of a forum, where various experiences and methods of approach should have a hearing. He is happy to find that the consensus of opinion, in most of the essential details, favors his own conception. I. GENERAL PROCEDURE By DOCTOR A. EMIL SCHMITT, New York City The procedure which to my mind will bring best results in the study and education of the exceptional child is about as follows: The teacher should state his or her problem regarding the individual child in question after making a comprehensive statement of the pupil's mental, moral, and physical characteristics as observed in school, throwing as much light as possible on the home surroundings and the parentage. The physician should then obtain the history of the early childhood, the past illnesses, and the present condition from the parents, and make a medicophysical examination of every organ and function of the body. The accompanying history form, which was used at the Ethical Culture School of New York, is the outcome of my ten years' experience at that institution, and has proved most helpful and essential, especially when I made the examinations personally. Its only drawback, in fact, was that, most of the examinations being made by the family physicians, the standards varied so much, and the purposes of the examinations were so misunderstood that only one-third of those received were of value for my purpose as medical director of the school. The best results are therefore obtained if the examinations are carried out by one examiner for each institution, and the higher his standards of precision and technic the more satisfactory the data. Combine this with good judgment shown in the suggestions of remediable measures, and they will be of the utmost value. After the remediable physical defects have been corrected, a neuropsychologist should examine and give his opinion on the neuropsychological aspects of the case. There should then be a full discussion with teacher, physician, neuropsychologist, pupil, and parent attending, with a view of having parent and teacher co-operate in the subsequent development of the child according to the suggestions made by the physician and neuropsychologist, whose interest and further advice should be sought according to the requirements of the case. ACCOMPANYING SCHEDULE Confidential.-The information on the record will be held in the strictest confidence by the School Physician and Chairman of Executive Committee. Part I may be filled out by the parent, with or without the assistance of the family physician. Part II is to be filled out by a physician in connection with the physical examination. Number of brothers living....Health....No. dead......Cause.... Check off any of the following conditions from which pupil has suffered, and state year for each affection: Does pupil keep his lips apart or mouth open during day or night?........ Use of tea, coffee, stimulants.. Daily quantity of cocoa....meat....eggs....cream....sweets.... Member of athletic club or recreation group....Nature of exercise..... Appetite............ Mastication...... .Digestion (sour eructations, gas, heaviness on stomach, nausea, vomiting):.............. Abdominal pain. Flatus... Palpitation.. Habit spasms. .Constipation......Diarrhoea.. .Taking medicines of any kind.. .. Short breath......Nervous condition.. OBJECTIVE SIGNS To be filled out by physician. General appearance: Nutrition... .Stigmata... Mouth-breathing.......Speech defects (due to tongue-tie, cleft palate, enlarged tonsils, adenoids, nasal obstruction, paralysis of speech muscles):. Tics.. Pulse. ..Blood-pressure....Height......Weight. Chest expansion: At rest......Inspiration......Expiration. |