He said, "I never asked that, never thought of it; I never speak of it; I never care about hearing about it; none of the boys ever talked to me about it-I never heard of it. If anything dirty is said I walk away, that's why they wouldn't play with me in the city-they called me a Saint." As the examiner felt there was a remote possibility that he might become interested in the subject and seek information from an undesirable source, it was deemed best to tell him a few simple facts in a medically educational way, but it was soon apparent that he was indifferent to the whole subject, and it was, of course, immediately dropped. An interview with the teacher brought forth the same observations. "He's a show off, he modifies everything in a little different way, so as to get special attention." He had that day presented the teacher with a religious book from his home, and when she demurred at accepting it he assured her she should, saying that they "had a whole trunkful at home just like it." This statement when investigated was, as expected, entirely false. In reality he had taken the book without consulting anyone in the home. The father said, "We often miss things, especially pictures, later to find them in some neighbor's house." This of course is only a childish endeavor to seek favor and popularity, as he lacks intrinsic truth in any form, of an adult interchange. He is most anxious to enter the Ungraded Class, as the work benches attract him and he believes he can accomplish manual work. He says, "Once I made a dog house in the yard and God seemed to help me make it, because I didn't get nervous. I thought He was looking out for me and helping me, but the rain came and knocked it down," and here again one feels the childish expansiveness of his make-up, coupled with the absolute failure of corresponding accomplishment. He rather vehemently denied any deep desire to work in an undertaker's establishment, saying, “I want to be a carpenter, always jobs to get, and lots of houses to be built and I like to make furniture. I'd like to fix floors, build frames of houses, and I'm crazy to paint furniture or anything like that." Summing up the case one finds that the boy is psychologically retarded 6 years he is a shallow childishly expansive make-up; there is much of the exhibitionist about him. He blatantly lacks appreciation in sensing values; yet there are promising features, which make the task of training him interesting and well worth the effort-for during the next two years he will receive help in centering and directing his energies and he will be given every school opportunity for any possible worth-while self-expression. There is, of course, the wish, which has developed late, to do carpentry and kindred work, and one cannot forget that there is considerable of the artistic force in his own family. Above all, in his home and in the school, a constant effort must be made to make the boy honest with himself and with his comrades. MENTAL HYGIENE CLINICS AND HEALTH CENTERS WALTER B. JAMES, M.D. Former Chairman, New York State Commission for the Feeble-Minded The proposal of the State Department of Health to establish health centers throughout the state, in order to furnish to the people of the smaller cities and the country districts aid in the maintenance of health which is not now to be had, marks a distinct advance in our view of the duty of such a department to the public. The following suggestions are made with a view of widening the usefulness of such health centers and of securing even broader health service to the people of the state. The Department of Health is not alone in being concerned with state health problems, there being many other divisions of the government which are almost equally interested. The importance of mental health as well as its relation to bodily health is daily becoming more and more widely recognized. There is a universally admitted need throughout the state for an extension of the opportunity for having mental examinations made of persons whose intellectual soundness is suspected. This need is felt by at least seven important state agencies: The State Hospital Commission, the State Commission for the Feeble-Minded, the State Department of Health, the State Department of Education, the State Commission of Prisons, the State Probation Commission and the State Board of Charities with its numerous affiliated associations. In addition to these state agencies, there are closely affiliated private organizations which also have a very direct interest in the establishment of such clinics, especially the State Charities Aid Association, which has already done a great deal of most valuable clinical work along this line and which has stimulated the establishment of mental clinics by the State Hospital Commission. The State Hospital Commission now has between twenty and thirty clinics, many of which are doing successful work, but these are not extensively or generally used by the other agencies above mentioned and it seems unlikely that they will be so used unless the remaining state departments can have some part in and some responsibility for them. The present plan for state mental clinics, therefore, proposes a board of joint control, to consist of one of the leading officers of each of the above mentioned seven agencies. This board has already been formed at a meeting at which all of the organizations were represented. It is proposed that it encourage the creation of clinics throughout the state wherever they may be found to be needed. It is intended that, for the most part, the clinics shall be maintained by local agencies already existing, such as hospitals, dispensaries, county boards of child welfare and others. Thus it is clear that this plan is merely an extension of the health center scheme which is being developed by the State Department of Health. This department had already considered having a room for mental hygiene in connection with the various health centers and it is possible, indeed, that it may seem wiser to drop the name "mental clinic" and in each case to merely call the agency a "health center" and to develop gradually in each such center all of the activities that can be made of value to the inhabitants of the district. It is not intended, and this should be clearly understood, to establish departments of medicine and surgery, or to furnish a substitute for the medical and surgical advice that is already adequately provided throughout the State by practitioners of medicine, but rather to cover ground which at present is not covered, especially in the abnormalities of the mind. Special services will be furnished from the staffs of the State Hospitals for the Insane, from the State Commission for the Feeble-Minded, the Board of Education and the State Board of Charities and its institutions, and the State Department of Health. It is believed that in this way a maximum of service to the people of the state can be had at a minimum of cost through the utilization of agencies already existing. It is the intention of the board of control to begin with the creation of such clinics in five or six selected towns, where immediate coöperation and interest can be had, and it is hoped and believed that from this beginning a state wide system can be gradually developed. It has been thought best that at the outset the Board of Control of Mental Clinics, or, as it may be called in the future, of "Health Centers," should be informally created and not by act of legislature. Later, it may seem best to make it a matter of legislative enactment. The idea of such a clinic is not a new one, as it already exists in an admirable form at Waverley, Mass., where it is conducted by Dr. Fernald, head of the institution for the feeble-minded. The present plan proposes to make the invaluable services of such a clinic as Waverley available to as many as possible of the citizens of the state. Such a clinic would naturally operate somewhat as follows: There would be a fixed day when patients could be brought for preliminary study, when the various mental tests would be made, the history taken, perhaps a physical examination made and when an inquiry into the environment of the patients could be started. On a subsequent date, a few days later, the patients would be again brought to the clinic, when the State Hospital psychiatrist, especially chosen and fitted for such work, and who would be at the head of the mental division of the center, having all of the above data prepared and recorded, would make a diagnosis, arrive at a conclusion, put the patient upon rational treatment and give the wisest counsel. It is believed that such a system would provide as widely as possible for the citizens of the state the benefits of the best modern knowledge of mental disorders which are not available today. The experience of the new American army in relation to psychiatry and the valuable facts and principles that have been accumulated through the labors of the psychiatric division of the army, have made it even more evident than it was previously, that great benefits can be made to accrue through the early detection and the skilful management of the mental disorders and abnormalities and maladjustments that are so common throughout the community. The plan, as outlined, contemplates coöperation between a number of distinct and independent state mechanisms and the utilization in common of the resources of these for the attainment of a common aim. This is a principle which may be somewhat new in governmental relations, but it has so much to commend it that it seems more than worth while to attempt a successful accomplishment. AMERICA THE BEAUTIFUL Katherine Lee Bates. Tune, Materna. Samuel Augustus Ward. O beautiful for spacious skies, America! America! God shed His grace on thee O beautiful for pilgrim feet, America! America! God mend thine every flaw, O beautiful for heroes proved In liberating strife, Who more than self their country loved, And mercy more than life! America! America! May God thy gold refine, And ev'ry gain divine! O beautiful for patriot dream God shed His grace on thee And crown thy good with brotherhood METHODS HOW FIVE LOW-GRADE CHILDREN ARE LEARNING TO READ JULIA M. STEPHENSON In the February number of UNGRADED, I attempted to explain the use I made of a set of "War Reading Books,"-how I tried to interest some low-grade children in words constantly in use in the newspapers in connection with the war. I hoped, that by comparison, certain familiar words might become fixed in their memories. In this number, I shall tell about the succeeding lessons, and how five low-grade children are actually learning to read. As soon as the armistice was signed, the head-lines of the newspaper ceased to contain the crisp pointed statements in large type,-words that had attracted our attention and held our interest, and I found that I must think of something else that would be of vital moment. Too, the period following the signing of the armistice brought a more abstract phase of war conditions which low-grade children could not as easily understand. Christmas was coming on with all its multitude of interests. Already the familiar face of Santa Claus had appeared in the newspaper advertisements and had been pointed out to me with heated enthusiasm. That was my cue. Why not an individual Christmas book? We "talked it over" in the Class, deciding what we might find for a Christmas book, what our cover pages should be, and so on. Before the books were ready for use, President Wilson sailed for France and the newspapers contained many pictures of him, of the George Washington and of Captain McCauley, of the Pennsylvania and Admiral Mayo. The children themselves said, "Let's have a Wilson book!" "One Wilson book for all?" I asked. Several children looked disappointed. I waited and someone said, "May I have one for myself?" And immediately we set to work to make the Wilson books. These two sets carried us some distance in advance of our War Reading Books. The Christmas books differ as the children differ,—some are crude and very simple, others are well arranged and contain a great variety of pictures and words, which represent articles used as gifts. These words |