The
Psychological Clinic Copyright, 1910, by Lightnor Witmer, Editor.
Vol.
X,
No. 7
CONGENITAL
December
APHASIA
AND
15,
1910
FEEBLEMINDEDNESS?A
CLINICAL DIAGNOSIS.1 By Lightner
Witmer, Ph.D., University of Pennsylvania.
As he appeared before the class, Arthur was a well-nourished boy of nearly eleven, good looking, neatly dressed, and respectful in manner. He sat quietly at the table while doing the formboard and cylinder tests. He used his right hand only, keeping the left under the table. As the demonstration proceeded, his gentleness and stillness became more marked. He was apparently a sturdy boy, Yet his behavior during the hour made not particularly shy, and not awkward. an impression of unusual quietness for a healthy boy. It was something like the behavior of an animal who has been severely frightened, and who had acquired the habit of going softly to escape notice. His record confirmed this impression by a history of brutal treatment when a little child. This afternoon he quite evidently found nothing to be afraid of. From time to time he smiled up at Dr. Witmer, and co-operated willingly. There was nothing to suggest an eye defect. Hearing as well as vision was apparently normal. Today his best time on the Witmer formboard was 15 seconds. When first examined at the Clinic a few days before, his best record was 20 seconds. Then he did the Witmer cylinders in 52 seconds. Today he did them in 45 seconds, and again in 49 seconds. He did this kind of work very well, using trial and error method to some extent, but performing the test mainly by the exercise of a high degree of distributed attention and space perception. He noticed instantly if a cylinder was too long or too short for its socket, taking it out and putting it in the right place, which he found quickly by looking for it. As far as concerns this kind of test, he "looks" very efficiently. Dr. Witmer asked him to write his name on the blackboard, and his age. Arthur wrote his name and the number 10. Q. Ten? Ten what? Arthur made no answer. Q. When I ask you how old you are, what do you answer? A. Ten years old. Q. You write years then. Do you know how to write it? Do you know what begins it? Now I will tell you how to spell it, but don't put anything down there until I finish. You spell it, y-e-a-r-s, write that. After some hesitation Arthur wrote y, then stopped. Dr. Witmer had him come to the further edge of the blackboard and write the letters s, r, a, and e, 1A clinical lecture delivered to undergraduates in Psychology 2C on March 23, 1916, and reported by A, Travis, Recorder of the Psychological Clinic. The boy's name is fictitious.
(181)
y
182
THE PSYCHOLOGICAL CLINIC.
one under another. Arthur wrote them correctly; then Dr. Witmer rubbed them out. Q. Now what was the word you were to write on the board? A. Years. Q. And I told you it began with a y, and you put the word on the board. Now put down the rest of the word years. Arthur hesitatingly added an s to the y, and stopped again. Q. What's the second letter you have got there? S? All right, y-s. Do Don't know any such word? Then you know any word that you spell y-s? why did you put that down? Can you guess how the word years is spelled,? years, ten years (pronouncing it very slowly with the full sound of each letter). Can you guess how that is spelled? Can't guess at all? Now I'll tell you once You rub out what you have down there. That word is more how it is spelled?
spelled
y-e-a-r-s, years.
Arthur wrote ye, and stopped again. Q. Y-e, now what was the next letter that I told you? Arthur could not tell. To the class Dr. Witmer said,?Now observe that that word has five letters in it. He knows how to make each one of the five letters, so that it isn't that he doesn't know the letter and can't write it down; but if you give him five letters in succession, he is not able to repeat them in the same order. That is a memory span test, and my demonstration today has the object of showing you the importance of the memory span. The memory span is fundamental in school work. Now we will see if we can find out something about Arthur's memory span. Q. Do you know how to spell the word cat? All right, put that down. Arthur wrote it on the board, and also the word dog from dictation. Q. Eight, can you spell horse? He wrote ho, and then paused. Q. All right, you can't spell that, very good. Can you spell desk7 Again Arthur wrote the first two letters of the word, and paused. Q. Can you spell girl? Try girl, write it down. Arthur wrote gar, and stopped. While writing he fumbled with his left hand toward the eraser and loose pieces of chalk at the bottom of the blackboard, a clear betrayal of his state of uncertainty. Q. Can you spell cow? Right. Can you spell boy f He wrote bog, rubbed it out, wrote b, and then stopped. Q. That's very good. Now I'm going to tell you the spellings of some words. Boy is b-o-y, write it down. Arthur wrote bay. Q. What have you put on the board? Did you put b-o-y on the board? You have got b-a-y. I want b-o-y. Right. Now write g-i-r-1. Arthur innocently wrote goil, to the uproarious amusement of the class, and looked around in wonder to see what they were all laughing about. Q. Do you remember the spelling I gave you? I will spell it again for you,
g-i-r-1. This time he wrote giol. Q. What did I say? Girl? At last Arthur got it right.
I
know, but how did I spell it?
You write
girl.
Q. That's good. Now you can write desk. You write it. Let me see you write desk. Write on the board d-e-s-k. That's right. Can you write the word horse? Can't do that, can you? Know how to spell that? Now you write on the board what I tell you, h-o-r-s-e. Arthur wrote
hose, omitting
the
r.
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 183 Q. What's that word, spell it, h-o-s-e? What does h-o-s-e spell? What the word that I spelled for you a short time ago, the whole word? A. Desk. Q. Desk was one word, but what was the word you were trying to put on the board now? A. Horse. Q. Yes, that was the word, horse. Know what a horse is? A. Animal. Q. Animal, yes. Seen one today? What color was it? A. Brown. Q. Now horse is spelled h-o-r-s-e. Try it again. Arthur got it right on the second attempt. Q. Can you spell teacher? We'll try a shorter one, crowd. Do you know what crowd means? What does it mean, "the place is crowded"? A. Can't get no more in. Q. That's right, we are just laughing because you have got it right. Now Go ahead, put that down. you spell the word crowd, c-r-o-w-d. Arthur wrote cowd, omitting the r, as he had done in horse. Q. Now let's try some easy words. Put beg on the board. He wrote deg, but when asked what he had written, repeated beg. Q. Yes, what have you put down there? Is that b, the first letter? That's Write cart. That's right. Write thank. a d. Arthur wrote th, stopped and stood looking up at it. As usual he had written as far up on the board as he could possibly reach. Q. Now listen again, thank. What have you? You have t-h-e-n-k. What did I tell you to write? Is that what I told you to write? Arthur thought it was, and Dr. Witmer did not press him further. Q. Put down a few numbers for me. Put down 1, 2, 3. Right. Put down was
9, 5,
8.
Right.
Arthur wrote the numbers as he did the separate letters, one below another in a vertical column. For 7, 3, 9, 2, he wrote 7932; for 8, 4, 6, 1, he wrote 8642. For 7, 4, 8, Series of three numbers, as 9, 4, 2, and 8, 5, 7, he wrote correctly. 3, he wrote 7432. Turning again to the class Dr. Witmer continued,?Now you see here a very limited memory span, and you get the distinction between intelligence and certain other qualities which are necessary for intellectual development. I haven't been able to produce any evidence this afternoon that this boy has a memory span of He has a memory span which seems adequate for three, but not more than three. for four digits or letters. Now the first time he did the Healy completion test, he put all the blocks in the right places. That is a test of imagination, a test to show what sort of images he has, what ideas he has. In the same way I gave him a completion test when I asked him what horse meant, and he answered all right. The test here is mainly in the reasons that are given, first the correctness and then the reasons. He gave good answers for all his placements, and that is a test which is sometimes not satisfactorily performed by twelve-year-old children. Handing Arthur a second grade reader, Dr. Witmer said,?There, can you read this? Arthur spelled out the word who, and read the next two words without spelling, "Who is it,?" and paused to rub his eye. As his eyes are all right, this was
evidently a ruse to gain time. Q. What's the next word? Spell it. A. C-o-m-e-s. Q. What does that spell? C-o-m-e-s, that spells comes.
what is the next word? A. W-i-t-h. Q. What does that spell? R-e-i-n (then he stopped). Q. What's the rest of the word?
With, "who is it
A.
A. D-e-e-r.
"Who is it
comes
with
comes," his,"??
184
THE PSYCHOLOGICAL CLINIC. Q. What's that?
Reindeer.
Who does
come
with his reindeer?
A. Santa Claus.
Q. Santa Claus, yes. What's the next word, spell it. By dint of spelling and prompting, Arthur was pulled through the first sentence, "Who is it comes with his reindeer over the ice and snow, with a sleigh just full of good things?" After reading the next sentence, a very short one,? "Tell me if you know," he was asked to repeat the first sentence, but had to be prompted on three words, omitted one entirely, and miscalled two or three others. Dr. Witmer commented,?There you get an idea of his retentiveness. Q. How much are 2 and 2? A. Four. Q. How much are 3 and 4? A. Eight. Q. How much are 5 and 6? A. Eleven. Q. How much are 3 and 4? A. Seven. Q. How much are twice 11, 2 times 11? A. Twenty-three. Q. How much are 3 times 5. A. Fifteen. Q. How much are 3 times 7? A. (After a long pause) twenty-one. Q. Do you go to school? A. Yes. Q. What grade are you in? A. Second grade A. Q. What day of the week is this? A. Tuesday. (It happened to be Thursday.) Q. What day was yesterday? A. Monday. Q. And the day before? A. Sunday. Q. What day will tomorrow be? A. Wednesday. Q. And the day after that? A. Thursday. Q. What day do you think tomorrow will be? A. Wednesday. Q. Tomorrow you think will be Wednesday. What day in the week do you A. Sunday and Saturday. have no school? Q. Did you go to school yesterday? A. Yes. Q. Did you go the day before that? A. No. Q. You didn't go then? Now you see, if you say it, stick to it. Would you be surprised if I told you it was Thursday? Would you? (Arthur shook his head.) Q. You wouldn't be surprised. Would you believe me if I told you it was (Again Arthur shook his head, while the class laughed.) You Thursday? wouldn't? What day do you think this is? A. Tuesday. Q. Would you believe it was Thursday if all these people in the room said it? (Arthur shook his head with a sweet but firm determination.) You wouldn't? There you see, we are all in the same class. Arthur was now released from further examination, and returned Dr. Witmer's "good-bye" with a pleasant smile. Proceeding with his lecture, Dr. Witmer said:
I want to
give you some facts. This boy, Arthur, is ten years and eight months old, nearly eleven years old. He told you he was in the second grade A, which is the first half of the second grade. Consequently he is backward in school progress. That is what we would call true backwardness, pedagogical backwardness. It is retardation on the education scale. He is nearly eleven years old. He ought to be at least in the fourth grade, so that he shows at least two and perhaps we ought to say three years of backwardness. Now
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 185
is, has he just gone to school? He might be a foreigner, just imported from the other side. Our record shows that he was five terms in the first grade, and this is his third term in the second grade. He has been going to school eight terms, that is four years, and this He ought to be in the fourth will be the end of his fourth year. if he had been each Instead of that, he is year. promoted grade B, the in second Here a of very considerable is record only grade. the question
backwardness. Now I have told you there are certain scales1 upon which we rate performances. There are the growth scales, first of all, and there are the culture scales. For the growth scales we have species and age. You have observed this boy physically. He appears like a normal ten or eleven-year-old boy. There is no physical retardation observable in his structure. We observe in his behavior here, the way he handles these mechanical tests, no physiological retardation, he has good control over his muscles, and so on. There is no reason, therefore, to think that on the age scale he is backward. On the species so far as his appearance and behavior go, there is nothing out of the way. He is a well-behaved boy. There is nothing unusual about him, excepting this inability to learn, so that on the species scale we would consider him just an ordinary normal boy.
scale,
To get where he belongs on the age scale mentally, his mental we make certain examinations here. One interesting question is,?is this backwardness? He is now in the second A, but this may age,
be due to the fact that he hasn't been
properly taught.
He has been
four years in a Philadelphia public school, but we must not assume that he has been properly taught. Has it been his fault, or the fault of the teachers he has had, that he has been able to spend several years in those grades? We tried him here in reading, spelling, and a little arithmetic. You got enough evidence, you saw enough of his performance, to make up your mind that there is something the matter with the
boy.
We
can
tentatively
eliminate poor
teaching,
and say there is something the matter with this boy, and address ourselves to the question, what is the matter? We can ask ourselves where he is in his school age. Certainly, so far as school progress is concerned, he has done only the work of the first grade. You can he isn't fit to be advanced to the second half of the second school year. In very nearly four years he has succeeded in getting ahead see
not more than one year.
children 1 Witmer,
are
doing
Lightner. No. 3. May. 1915.
He is
doing
better than he
work which many six-year-old do it today. As far as our
can
On the Relation of Intelligence to Efficiency.
The Psychological Clinic, Vol. IX,
186
THE PSYCHOLOGICAL CLINIC.
here, in his proficiency in school subjects he is about six-year-old child, that is, he has four years of retardation.
record went a
There is
like
set of tests called the Binet-Simon
tests, a series prefor different There is some difference of sumably adapted ages. as to whether are or not. We employ opinion they satisfactory them to supplement our other examinations. When we gave this boy the Binet tests, his age came out as 8.4, so that the Binet tests show him to be retarded in mental age about two years. My exama
ination here today would seem to indicate that he is more retarded than that. I would say that his mental age is certainly not more than 7.5 as shown by these tests. Of culture scales I have said there are two,?the civilization scale and the education scale.
He is well enough dressed, he goes to his people are in moderate circumstances. We would say that on the civilization scale he is normal,?nothing to note about that, he is not some young savage. On the education scale he is retarded three years.
public school,
Now we have another set of scales that I would call proficiency scales. One is the amount of proficiency, and the other is the number of operations in which he may be proficient. What ought a ten-yearold boy be able to do? Among other things he ought to know his multiplication tables entire. This boy certainly does not know beyond the four-times part of the table, and I don't believe he knows the two-times satisfactorily. There is a great limitation in the number of operations which this boy can do at ten years old, and his proficiency in the things he can do is very small. We can say that his proficiency, for a ten-year-old boy, is small, and there is a great limitation in the number of operations, compared with what a ten-yearold boy should do,?spelling, reading,?he doesn't know how to read. A boy of ten ought to be reading for his own personal profit. This boy can't even read a sentence like, "Who is it?" He says, "Who," then he looks at the next word and says, "is," and then looks at the next word and says "it!" with a rush like a person hauling himself In the strict sense of the word up by the arms for the last time. he can't read, and that is an operation to be expected of a ten-yearold boy. He is very deficient in all the school branches. But on the formboard and cylinder test he has all the necessary operations and he does them as well as I have seen some college students do them. He
write, but his proficiency is small. He can write separate He is supposed to have acquired the operation of addition up to 99, but I am confident his proficiency there is limited. As you That is saw, he said 3 and 4 equals 8, and the next time, equals 7. letters.
can
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 187 what I meant when I said his proficiency is small and his range of proficiencies is limited. What does the calendar test show, when I asked him the days of the week? Stubbornness? Not exactly. My recollection is that of the days of the week, Thursday is this boy's special difficulty, and his mother told knows the other ber the word
me
that he
never seems
days pretty well, Thursday and hold
but has
to know never
Thursday.
been able to
He
remem-
it in mind. This happens to be he took the next easiest I him on that to word. tried Thursday, see if it would turn out as they told me, and my interpretation of it is that it is a memory defect. Now let us come to the question of the interpretation of all this. What is wrong with this boy? He is a very interesting case for us, because his deficiency is in the psychological field. It is something the matter with his memory, isn't it? Under memory I gave you two things; one was trainability, and the other was retentiveness. Those are the two things we want to know about memory,?how so
trainable is it, and how retentive is it? But memory uses material. If he is going to remember that crowd is spelled c-r-o-w-d, he has got to remember it with certain memory material, certain images. Memory is based upon
imagination. Under imagination we take imageability, the ability to form images and the association of these images together, or I call it associability, and finally the complexity. Under imageability, did you see any evidence for the opinion that his images were defective? Not much. You might possibly consider there is a little evidence in the fact that when I spelled b-e-g he wrote d-e-g, and when I asked him what he had there, he started off with the b and then he and the d the
right
saw
simply, kind of
he had
which
image
a
d there.
might point of the b.
kind which seemed to
me to
but in the main there
were
There to
was a
confusion of the b
faulty images,
There
were a
that he hadn't
few instances of that
suggest that his images were not good, good, and I took this completion test to show that he did have images. I asked him about the horse, and so His images are good enough for spelling and reading, but he is on. not making as good use of them as he might. Now why? We come across in this boy what seems to me to be the real difficulty, and that is the images do not associate themselves together in his mind. There is deficient associability or deficient memory span. If a boy is going to say, twice two are four, five times six are thirty, and learn his multiplication tables, each one of these sentences which he has to repeat and fix in his mind involves the memory span, the association of images. Now if every one of the image complexes in a table
THE PSYCHOLOGICAL CLINIC.
188
of that kind is beyond the associability point in his memory span of three or at the most four, he can't possibly get it. We got very good evidence here this afternoon of the difficulty that
would have in trying to teach him to spell anything than a three-element word. If you start him in on five or six elements, I don't think he ever would learn in that way. He has got to be taken in hand on the assumption that his associations are limited to three, that his memory span is limited to three. One of our graduate students made a more elaborate examination of him, but saw no evidence of the deficiency of association for ordinary
anybody
more
about the room, or ordinary ideas outside of school subjects, some of the ideas that were presented in the sentences him. He didn't seem to be able to get the complexes there
objects
except in
given
very well, but the ordinary associability was good. He hasn't got the image complexity that a boy of his age should have. The general indications are that his deficiencies in associability and memory are rather limited to
language. Memory is a specific form of imagination. Memory means that If you the images which are associated together form complexes. are to spell the word complexity, that in itself is an image complex. How many times does that have to be repeated until you know how to spell the word? That will give you some clue as to how trainable your memory is. How long after you have acquired the spelling of a word will it be retained? We tested this boy on school subjects, but his memory was not retentive. He had extremely poor retentiveness. He did not have a high degree of trainability, and there was fundamentally lacking the power of associating images, which probably was the chief difficulty, so that we would say that his difficulty is in the field of memory. The next question is, is it general? Does it cover the whole field of memory? We asked him, what day is this? He said Tuesday. But when we asked him questions about the other days of the week, he seemed to have a good memory for that. He seems to have good sense when you ask him ordinary questions. His understandis
He understood these tests right away. His power of It would appear, therefore, that it was limited entirely to the field of memory for language and number, the two important branches of school work. But you understand that the number work is based upon language, so it may be in his case a speci-
ing
good.
attention is
good.
fic defect of language memory. This is what we would then say about this boy: His general difficulty, that which is fundamental, is a deficient associability, a deficient memory span. His specific defect is a deficient memory.
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 189 He has not formed the proper idea complexes which he should have for a boy of his age, and it would appear that the defect is limited to language and number. We can translate this if we please into technical terms, for instance, a lack of memory or a deficient memory is amnesia, that is the alpha-privitive and the Greek word meaning memory, lack of memory.
language,
so
we
The lack of memory applies chiefly to amnesia verbalis, lack of verbal ten-year-old boy he is lacking in verbal memory. may call it
For a One is Your memories today are dependent upon two factors. the amount of training which your memory has received, that is the acquired part of the process. The other is your congenital
memory.
for forming these memory complexes. There can be doubt that you all differ congenitally in memory capacity. You have all differed somewhat in the amounts of acquisition which We take this boy and try to study him as he you have retained. stands before us, nearly eleven years old, and he certainly hasn't acquired language memories. Is that due to his not having had adequate schooling? No, he has been four years in school. Is it due to
capacity
no
the fact that he didn't receive adequate training in school? No, his memory span is deficient. We have got evidence here today that this
boy has a congenital verbal amnesia, a defect of memory which is something inherent in his brain. Just as one boy hasn't got an ear for music, because he hasn't got the kind of brain which stores up musical tones, so this boy hasn't got the kind of brain which stores up memories of words and letters and sentences that are spoken to him. In his case it is probably a congenital verbal amnesia. We are finding that these conditions exist in some children. Take this boy for instance. The principal of the school writes to me "We consider him very slow mentally, but not feebleminded." He doesn't make the impression upon the principal of being feebleHe doesn't make the impression here today of being minded. feebleminded. He does the mechanical tests correctly. But so far as his standing goes, he is in the feebleminded class, and probably as he grows older and falls further and further behind, he will probably be diagnosed as feebleminded, not socially competent to get on with others of the same age. At present he hasn't got mind enough to get on with second grade pupils, and if we are very strict in our diagnosis, I think we would have to call him feebleminded. Some are beginning to recognize a condition in children that they I would say that one line of separation call congenital illiteracy. among people in civilized communities is between literacy and illiteracy, and the literate are all above those about able to do fifth
work.
They acquire reading, writing,
and arithmetic
so
that
grade they
THE PSYCHOLOGICAL CLINIC.
190
as a clumsy tool. They read newspapers, the sporting colanyway,?and they read the signs. Perhaps before they die they cease to be literate, but they do acquire reading and writing. Those who do not acquire reading and writing as a tool, are the illiterate. Are there any children born, who are illiterate in the sense that no matter how hard you try, you can't teach them reading, writing, and arithmetic? Are there children born whom you can't teach to sing a tune? If so they would have amnesia musicalis, or amusia, a term applying to those who are tone-deaf and can't learn to sing. These others we can speak of as congenital illiterates, and since it has to do with language we may call it congenital aphasia. I would say this boy is probably not really feebleminded, but it looks as though he had congenital aphasia. He seemed to understand spoken words pretty well, so that the aphasia would seem to be very largely visual, although I think there was some auditory and motor aphasia too. When it is limited to the reading of words, we call it alexia, that is inability to read. I run across college students, in their papers, who must have a little congenital alexia. For instance, there is a part of the brain which you may have studied, the medulla oblongata, and I have had students taking this course write down "meddling obligato." I have also found students who after taking a year of psychology, maybe two, don't know how to spell psychology, at least not in combinations like "physiological psychology." They just fall down in a heap like that boy when he tried to spell girl. The whole question, when you see deficiency of language memory, is this,?does it mean that this person didn't get an education, or that he couldn't get an education? I assume that this boy is where
have it
umns
he is at the present time because he couldn't get an education. He a typical case of feeblemindedness, because he seems to have
is not
not many defects but
call his chief defect much
as we assume
has not been this
boy's
only
a
few very
specialized defects,
and
we
of memory in the field of language. Inasthat that was with him from the beginning and
one
acquired
as a
chief defect is
a
result of defective
congenital aphasia,
education, we say that and it probably means
that he is in the class of illiterates.
couple of years ago high grade work, who didn't
We very
saw a
an
extremely
able
mechanic, doing
know how to write.
to school and had never learned to write.
He
came
He had gone to us to learn
why it was he had not learned to write, although he had tried to do it. Apparently he had congenital aphasia, or congenital alexia. When he asked us that question we had to explain to him, "You are in the
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 191
position of the person who has no ear for music, who can't learn to sing." My recommendation is that this boy be placed in a special class. He ought to be taken very well in hand. For example, I do think that in the educational backwardness of this boy, one factor is a faulty educational method.
You can't teach
a
child who has any sort
You might just as well of defective memory, by the word method. In all of have to be taught to it these cases my opinion, give up. the A, B, C method,?beat it into their heads. Give them a deal of sound analysis. Start him anew, and quit trying to good For children who are somewhat teach him by the word method. I find the word that method throws them into confusion deficient, for several years. I think this boy can be taught some reading and
read
by
writing. If you are interested in this, you will find in The Psychological Clinic for December, 1913, my report of a boy who was taught for a couple of years and finally learned to read. I don't think that this boy we have seen today will ever get over his defect, but if he can
get
over
it
enough
to
get out of the feebleminded class, I don't know.
though he were a normal child and were ought somewhat difficult to teach. He has got to be taken in hand exactly as we would take in hand a person who is said to have no ear for music. Such a boy can be trained to sing so other people could to be tried as
He
stand hearing him sing, but he couldn't earn much of a living by it. I think this boy could be trained that much in school subjects, and it looks as if he should be trained to a trade. This is only the second time we have seen him. To make sure of all the parts of the analytic diagnosis we would have to teach him and
keep
him under observation for
a
couple
of months.
Psychological Clinic Copyright, 1910, by Lightnor Witmer, Editor.
Vol.
X,
No. 7
CONGENITAL
December
APHASIA
AND
15,
1910
FEEBLEMINDEDNESS?A
CLINICAL DIAGNOSIS.1 By Lightner
Witmer, Ph.D., University of Pennsylvania.
As he appeared before the class, Arthur was a well-nourished boy of nearly eleven, good looking, neatly dressed, and respectful in manner. He sat quietly at the table while doing the formboard and cylinder tests. He used his right hand only, keeping the left under the table. As the demonstration proceeded, his gentleness and stillness became more marked. He was apparently a sturdy boy, Yet his behavior during the hour made not particularly shy, and not awkward. an impression of unusual quietness for a healthy boy. It was something like the behavior of an animal who has been severely frightened, and who had acquired the habit of going softly to escape notice. His record confirmed this impression by a history of brutal treatment when a little child. This afternoon he quite evidently found nothing to be afraid of. From time to time he smiled up at Dr. Witmer, and co-operated willingly. There was nothing to suggest an eye defect. Hearing as well as vision was apparently normal. Today his best time on the Witmer formboard was 15 seconds. When first examined at the Clinic a few days before, his best record was 20 seconds. Then he did the Witmer cylinders in 52 seconds. Today he did them in 45 seconds, and again in 49 seconds. He did this kind of work very well, using trial and error method to some extent, but performing the test mainly by the exercise of a high degree of distributed attention and space perception. He noticed instantly if a cylinder was too long or too short for its socket, taking it out and putting it in the right place, which he found quickly by looking for it. As far as concerns this kind of test, he "looks" very efficiently. Dr. Witmer asked him to write his name on the blackboard, and his age. Arthur wrote his name and the number 10. Q. Ten? Ten what? Arthur made no answer. Q. When I ask you how old you are, what do you answer? A. Ten years old. Q. You write years then. Do you know how to write it? Do you know what begins it? Now I will tell you how to spell it, but don't put anything down there until I finish. You spell it, y-e-a-r-s, write that. After some hesitation Arthur wrote y, then stopped. Dr. Witmer had him come to the further edge of the blackboard and write the letters s, r, a, and e, 1A clinical lecture delivered to undergraduates in Psychology 2C on March 23, 1916, and reported by A, Travis, Recorder of the Psychological Clinic. The boy's name is fictitious.
(181)
y
182
THE PSYCHOLOGICAL CLINIC.
one under another. Arthur wrote them correctly; then Dr. Witmer rubbed them out. Q. Now what was the word you were to write on the board? A. Years. Q. And I told you it began with a y, and you put the word on the board. Now put down the rest of the word years. Arthur hesitatingly added an s to the y, and stopped again. Q. What's the second letter you have got there? S? All right, y-s. Do Don't know any such word? Then you know any word that you spell y-s? why did you put that down? Can you guess how the word years is spelled,? years, ten years (pronouncing it very slowly with the full sound of each letter). Can you guess how that is spelled? Can't guess at all? Now I'll tell you once You rub out what you have down there. That word is more how it is spelled?
spelled
y-e-a-r-s, years.
Arthur wrote ye, and stopped again. Q. Y-e, now what was the next letter that I told you? Arthur could not tell. To the class Dr. Witmer said,?Now observe that that word has five letters in it. He knows how to make each one of the five letters, so that it isn't that he doesn't know the letter and can't write it down; but if you give him five letters in succession, he is not able to repeat them in the same order. That is a memory span test, and my demonstration today has the object of showing you the importance of the memory span. The memory span is fundamental in school work. Now we will see if we can find out something about Arthur's memory span. Q. Do you know how to spell the word cat? All right, put that down. Arthur wrote it on the board, and also the word dog from dictation. Q. Eight, can you spell horse? He wrote ho, and then paused. Q. All right, you can't spell that, very good. Can you spell desk7 Again Arthur wrote the first two letters of the word, and paused. Q. Can you spell girl? Try girl, write it down. Arthur wrote gar, and stopped. While writing he fumbled with his left hand toward the eraser and loose pieces of chalk at the bottom of the blackboard, a clear betrayal of his state of uncertainty. Q. Can you spell cow? Right. Can you spell boy f He wrote bog, rubbed it out, wrote b, and then stopped. Q. That's very good. Now I'm going to tell you the spellings of some words. Boy is b-o-y, write it down. Arthur wrote bay. Q. What have you put on the board? Did you put b-o-y on the board? You have got b-a-y. I want b-o-y. Right. Now write g-i-r-1. Arthur innocently wrote goil, to the uproarious amusement of the class, and looked around in wonder to see what they were all laughing about. Q. Do you remember the spelling I gave you? I will spell it again for you,
g-i-r-1. This time he wrote giol. Q. What did I say? Girl? At last Arthur got it right.
I
know, but how did I spell it?
You write
girl.
Q. That's good. Now you can write desk. You write it. Let me see you write desk. Write on the board d-e-s-k. That's right. Can you write the word horse? Can't do that, can you? Know how to spell that? Now you write on the board what I tell you, h-o-r-s-e. Arthur wrote
hose, omitting
the
r.
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 183 Q. What's that word, spell it, h-o-s-e? What does h-o-s-e spell? What the word that I spelled for you a short time ago, the whole word? A. Desk. Q. Desk was one word, but what was the word you were trying to put on the board now? A. Horse. Q. Yes, that was the word, horse. Know what a horse is? A. Animal. Q. Animal, yes. Seen one today? What color was it? A. Brown. Q. Now horse is spelled h-o-r-s-e. Try it again. Arthur got it right on the second attempt. Q. Can you spell teacher? We'll try a shorter one, crowd. Do you know what crowd means? What does it mean, "the place is crowded"? A. Can't get no more in. Q. That's right, we are just laughing because you have got it right. Now Go ahead, put that down. you spell the word crowd, c-r-o-w-d. Arthur wrote cowd, omitting the r, as he had done in horse. Q. Now let's try some easy words. Put beg on the board. He wrote deg, but when asked what he had written, repeated beg. Q. Yes, what have you put down there? Is that b, the first letter? That's Write cart. That's right. Write thank. a d. Arthur wrote th, stopped and stood looking up at it. As usual he had written as far up on the board as he could possibly reach. Q. Now listen again, thank. What have you? You have t-h-e-n-k. What did I tell you to write? Is that what I told you to write? Arthur thought it was, and Dr. Witmer did not press him further. Q. Put down a few numbers for me. Put down 1, 2, 3. Right. Put down was
9, 5,
8.
Right.
Arthur wrote the numbers as he did the separate letters, one below another in a vertical column. For 7, 3, 9, 2, he wrote 7932; for 8, 4, 6, 1, he wrote 8642. For 7, 4, 8, Series of three numbers, as 9, 4, 2, and 8, 5, 7, he wrote correctly. 3, he wrote 7432. Turning again to the class Dr. Witmer continued,?Now you see here a very limited memory span, and you get the distinction between intelligence and certain other qualities which are necessary for intellectual development. I haven't been able to produce any evidence this afternoon that this boy has a memory span of He has a memory span which seems adequate for three, but not more than three. for four digits or letters. Now the first time he did the Healy completion test, he put all the blocks in the right places. That is a test of imagination, a test to show what sort of images he has, what ideas he has. In the same way I gave him a completion test when I asked him what horse meant, and he answered all right. The test here is mainly in the reasons that are given, first the correctness and then the reasons. He gave good answers for all his placements, and that is a test which is sometimes not satisfactorily performed by twelve-year-old children. Handing Arthur a second grade reader, Dr. Witmer said,?There, can you read this? Arthur spelled out the word who, and read the next two words without spelling, "Who is it,?" and paused to rub his eye. As his eyes are all right, this was
evidently a ruse to gain time. Q. What's the next word? Spell it. A. C-o-m-e-s. Q. What does that spell? C-o-m-e-s, that spells comes.
what is the next word? A. W-i-t-h. Q. What does that spell? R-e-i-n (then he stopped). Q. What's the rest of the word?
With, "who is it
A.
A. D-e-e-r.
"Who is it
comes
with
comes," his,"??
184
THE PSYCHOLOGICAL CLINIC. Q. What's that?
Reindeer.
Who does
come
with his reindeer?
A. Santa Claus.
Q. Santa Claus, yes. What's the next word, spell it. By dint of spelling and prompting, Arthur was pulled through the first sentence, "Who is it comes with his reindeer over the ice and snow, with a sleigh just full of good things?" After reading the next sentence, a very short one,? "Tell me if you know," he was asked to repeat the first sentence, but had to be prompted on three words, omitted one entirely, and miscalled two or three others. Dr. Witmer commented,?There you get an idea of his retentiveness. Q. How much are 2 and 2? A. Four. Q. How much are 3 and 4? A. Eight. Q. How much are 5 and 6? A. Eleven. Q. How much are 3 and 4? A. Seven. Q. How much are twice 11, 2 times 11? A. Twenty-three. Q. How much are 3 times 5. A. Fifteen. Q. How much are 3 times 7? A. (After a long pause) twenty-one. Q. Do you go to school? A. Yes. Q. What grade are you in? A. Second grade A. Q. What day of the week is this? A. Tuesday. (It happened to be Thursday.) Q. What day was yesterday? A. Monday. Q. And the day before? A. Sunday. Q. What day will tomorrow be? A. Wednesday. Q. And the day after that? A. Thursday. Q. What day do you think tomorrow will be? A. Wednesday. Q. Tomorrow you think will be Wednesday. What day in the week do you A. Sunday and Saturday. have no school? Q. Did you go to school yesterday? A. Yes. Q. Did you go the day before that? A. No. Q. You didn't go then? Now you see, if you say it, stick to it. Would you be surprised if I told you it was Thursday? Would you? (Arthur shook his head.) Q. You wouldn't be surprised. Would you believe me if I told you it was (Again Arthur shook his head, while the class laughed.) You Thursday? wouldn't? What day do you think this is? A. Tuesday. Q. Would you believe it was Thursday if all these people in the room said it? (Arthur shook his head with a sweet but firm determination.) You wouldn't? There you see, we are all in the same class. Arthur was now released from further examination, and returned Dr. Witmer's "good-bye" with a pleasant smile. Proceeding with his lecture, Dr. Witmer said:
I want to
give you some facts. This boy, Arthur, is ten years and eight months old, nearly eleven years old. He told you he was in the second grade A, which is the first half of the second grade. Consequently he is backward in school progress. That is what we would call true backwardness, pedagogical backwardness. It is retardation on the education scale. He is nearly eleven years old. He ought to be at least in the fourth grade, so that he shows at least two and perhaps we ought to say three years of backwardness. Now
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 185
is, has he just gone to school? He might be a foreigner, just imported from the other side. Our record shows that he was five terms in the first grade, and this is his third term in the second grade. He has been going to school eight terms, that is four years, and this He ought to be in the fourth will be the end of his fourth year. if he had been each Instead of that, he is year. promoted grade B, the in second Here a of very considerable is record only grade. the question
backwardness. Now I have told you there are certain scales1 upon which we rate performances. There are the growth scales, first of all, and there are the culture scales. For the growth scales we have species and age. You have observed this boy physically. He appears like a normal ten or eleven-year-old boy. There is no physical retardation observable in his structure. We observe in his behavior here, the way he handles these mechanical tests, no physiological retardation, he has good control over his muscles, and so on. There is no reason, therefore, to think that on the age scale he is backward. On the species so far as his appearance and behavior go, there is nothing out of the way. He is a well-behaved boy. There is nothing unusual about him, excepting this inability to learn, so that on the species scale we would consider him just an ordinary normal boy.
scale,
To get where he belongs on the age scale mentally, his mental we make certain examinations here. One interesting question is,?is this backwardness? He is now in the second A, but this may age,
be due to the fact that he hasn't been
properly taught.
He has been
four years in a Philadelphia public school, but we must not assume that he has been properly taught. Has it been his fault, or the fault of the teachers he has had, that he has been able to spend several years in those grades? We tried him here in reading, spelling, and a little arithmetic. You got enough evidence, you saw enough of his performance, to make up your mind that there is something the matter with the
boy.
We
can
tentatively
eliminate poor
teaching,
and say there is something the matter with this boy, and address ourselves to the question, what is the matter? We can ask ourselves where he is in his school age. Certainly, so far as school progress is concerned, he has done only the work of the first grade. You can he isn't fit to be advanced to the second half of the second school year. In very nearly four years he has succeeded in getting ahead see
not more than one year.
children 1 Witmer,
are
doing
Lightner. No. 3. May. 1915.
He is
doing
better than he
work which many six-year-old do it today. As far as our
can
On the Relation of Intelligence to Efficiency.
The Psychological Clinic, Vol. IX,
186
THE PSYCHOLOGICAL CLINIC.
here, in his proficiency in school subjects he is about six-year-old child, that is, he has four years of retardation.
record went a
There is
like
set of tests called the Binet-Simon
tests, a series prefor different There is some difference of sumably adapted ages. as to whether are or not. We employ opinion they satisfactory them to supplement our other examinations. When we gave this boy the Binet tests, his age came out as 8.4, so that the Binet tests show him to be retarded in mental age about two years. My exama
ination here today would seem to indicate that he is more retarded than that. I would say that his mental age is certainly not more than 7.5 as shown by these tests. Of culture scales I have said there are two,?the civilization scale and the education scale.
He is well enough dressed, he goes to his people are in moderate circumstances. We would say that on the civilization scale he is normal,?nothing to note about that, he is not some young savage. On the education scale he is retarded three years.
public school,
Now we have another set of scales that I would call proficiency scales. One is the amount of proficiency, and the other is the number of operations in which he may be proficient. What ought a ten-yearold boy be able to do? Among other things he ought to know his multiplication tables entire. This boy certainly does not know beyond the four-times part of the table, and I don't believe he knows the two-times satisfactorily. There is a great limitation in the number of operations which this boy can do at ten years old, and his proficiency in the things he can do is very small. We can say that his proficiency, for a ten-year-old boy, is small, and there is a great limitation in the number of operations, compared with what a ten-yearold boy should do,?spelling, reading,?he doesn't know how to read. A boy of ten ought to be reading for his own personal profit. This boy can't even read a sentence like, "Who is it?" He says, "Who," then he looks at the next word and says, "is," and then looks at the next word and says "it!" with a rush like a person hauling himself In the strict sense of the word up by the arms for the last time. he can't read, and that is an operation to be expected of a ten-yearold boy. He is very deficient in all the school branches. But on the formboard and cylinder test he has all the necessary operations and he does them as well as I have seen some college students do them. He
write, but his proficiency is small. He can write separate He is supposed to have acquired the operation of addition up to 99, but I am confident his proficiency there is limited. As you That is saw, he said 3 and 4 equals 8, and the next time, equals 7. letters.
can
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 187 what I meant when I said his proficiency is small and his range of proficiencies is limited. What does the calendar test show, when I asked him the days of the week? Stubbornness? Not exactly. My recollection is that of the days of the week, Thursday is this boy's special difficulty, and his mother told knows the other ber the word
me
that he
never seems
days pretty well, Thursday and hold
but has
to know never
Thursday.
been able to
He
remem-
it in mind. This happens to be he took the next easiest I him on that to word. tried Thursday, see if it would turn out as they told me, and my interpretation of it is that it is a memory defect. Now let us come to the question of the interpretation of all this. What is wrong with this boy? He is a very interesting case for us, because his deficiency is in the psychological field. It is something the matter with his memory, isn't it? Under memory I gave you two things; one was trainability, and the other was retentiveness. Those are the two things we want to know about memory,?how so
trainable is it, and how retentive is it? But memory uses material. If he is going to remember that crowd is spelled c-r-o-w-d, he has got to remember it with certain memory material, certain images. Memory is based upon
imagination. Under imagination we take imageability, the ability to form images and the association of these images together, or I call it associability, and finally the complexity. Under imageability, did you see any evidence for the opinion that his images were defective? Not much. You might possibly consider there is a little evidence in the fact that when I spelled b-e-g he wrote d-e-g, and when I asked him what he had there, he started off with the b and then he and the d the
right
saw
simply, kind of
he had
which
image
a
d there.
might point of the b.
kind which seemed to
me to
but in the main there
were
There to
was a
confusion of the b
faulty images,
There
were a
that he hadn't
few instances of that
suggest that his images were not good, good, and I took this completion test to show that he did have images. I asked him about the horse, and so His images are good enough for spelling and reading, but he is on. not making as good use of them as he might. Now why? We come across in this boy what seems to me to be the real difficulty, and that is the images do not associate themselves together in his mind. There is deficient associability or deficient memory span. If a boy is going to say, twice two are four, five times six are thirty, and learn his multiplication tables, each one of these sentences which he has to repeat and fix in his mind involves the memory span, the association of images. Now if every one of the image complexes in a table
THE PSYCHOLOGICAL CLINIC.
188
of that kind is beyond the associability point in his memory span of three or at the most four, he can't possibly get it. We got very good evidence here this afternoon of the difficulty that
would have in trying to teach him to spell anything than a three-element word. If you start him in on five or six elements, I don't think he ever would learn in that way. He has got to be taken in hand on the assumption that his associations are limited to three, that his memory span is limited to three. One of our graduate students made a more elaborate examination of him, but saw no evidence of the deficiency of association for ordinary
anybody
more
about the room, or ordinary ideas outside of school subjects, some of the ideas that were presented in the sentences him. He didn't seem to be able to get the complexes there
objects
except in
given
very well, but the ordinary associability was good. He hasn't got the image complexity that a boy of his age should have. The general indications are that his deficiencies in associability and memory are rather limited to
language. Memory is a specific form of imagination. Memory means that If you the images which are associated together form complexes. are to spell the word complexity, that in itself is an image complex. How many times does that have to be repeated until you know how to spell the word? That will give you some clue as to how trainable your memory is. How long after you have acquired the spelling of a word will it be retained? We tested this boy on school subjects, but his memory was not retentive. He had extremely poor retentiveness. He did not have a high degree of trainability, and there was fundamentally lacking the power of associating images, which probably was the chief difficulty, so that we would say that his difficulty is in the field of memory. The next question is, is it general? Does it cover the whole field of memory? We asked him, what day is this? He said Tuesday. But when we asked him questions about the other days of the week, he seemed to have a good memory for that. He seems to have good sense when you ask him ordinary questions. His understandis
He understood these tests right away. His power of It would appear, therefore, that it was limited entirely to the field of memory for language and number, the two important branches of school work. But you understand that the number work is based upon language, so it may be in his case a speci-
ing
good.
attention is
good.
fic defect of language memory. This is what we would then say about this boy: His general difficulty, that which is fundamental, is a deficient associability, a deficient memory span. His specific defect is a deficient memory.
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 189 He has not formed the proper idea complexes which he should have for a boy of his age, and it would appear that the defect is limited to language and number. We can translate this if we please into technical terms, for instance, a lack of memory or a deficient memory is amnesia, that is the alpha-privitive and the Greek word meaning memory, lack of memory.
language,
so
we
The lack of memory applies chiefly to amnesia verbalis, lack of verbal ten-year-old boy he is lacking in verbal memory. may call it
For a One is Your memories today are dependent upon two factors. the amount of training which your memory has received, that is the acquired part of the process. The other is your congenital
memory.
for forming these memory complexes. There can be doubt that you all differ congenitally in memory capacity. You have all differed somewhat in the amounts of acquisition which We take this boy and try to study him as he you have retained. stands before us, nearly eleven years old, and he certainly hasn't acquired language memories. Is that due to his not having had adequate schooling? No, he has been four years in school. Is it due to
capacity
no
the fact that he didn't receive adequate training in school? No, his memory span is deficient. We have got evidence here today that this
boy has a congenital verbal amnesia, a defect of memory which is something inherent in his brain. Just as one boy hasn't got an ear for music, because he hasn't got the kind of brain which stores up musical tones, so this boy hasn't got the kind of brain which stores up memories of words and letters and sentences that are spoken to him. In his case it is probably a congenital verbal amnesia. We are finding that these conditions exist in some children. Take this boy for instance. The principal of the school writes to me "We consider him very slow mentally, but not feebleminded." He doesn't make the impression upon the principal of being feebleHe doesn't make the impression here today of being minded. feebleminded. He does the mechanical tests correctly. But so far as his standing goes, he is in the feebleminded class, and probably as he grows older and falls further and further behind, he will probably be diagnosed as feebleminded, not socially competent to get on with others of the same age. At present he hasn't got mind enough to get on with second grade pupils, and if we are very strict in our diagnosis, I think we would have to call him feebleminded. Some are beginning to recognize a condition in children that they I would say that one line of separation call congenital illiteracy. among people in civilized communities is between literacy and illiteracy, and the literate are all above those about able to do fifth
work.
They acquire reading, writing,
and arithmetic
so
that
grade they
THE PSYCHOLOGICAL CLINIC.
190
as a clumsy tool. They read newspapers, the sporting colanyway,?and they read the signs. Perhaps before they die they cease to be literate, but they do acquire reading and writing. Those who do not acquire reading and writing as a tool, are the illiterate. Are there any children born, who are illiterate in the sense that no matter how hard you try, you can't teach them reading, writing, and arithmetic? Are there children born whom you can't teach to sing a tune? If so they would have amnesia musicalis, or amusia, a term applying to those who are tone-deaf and can't learn to sing. These others we can speak of as congenital illiterates, and since it has to do with language we may call it congenital aphasia. I would say this boy is probably not really feebleminded, but it looks as though he had congenital aphasia. He seemed to understand spoken words pretty well, so that the aphasia would seem to be very largely visual, although I think there was some auditory and motor aphasia too. When it is limited to the reading of words, we call it alexia, that is inability to read. I run across college students, in their papers, who must have a little congenital alexia. For instance, there is a part of the brain which you may have studied, the medulla oblongata, and I have had students taking this course write down "meddling obligato." I have also found students who after taking a year of psychology, maybe two, don't know how to spell psychology, at least not in combinations like "physiological psychology." They just fall down in a heap like that boy when he tried to spell girl. The whole question, when you see deficiency of language memory, is this,?does it mean that this person didn't get an education, or that he couldn't get an education? I assume that this boy is where
have it
umns
he is at the present time because he couldn't get an education. He a typical case of feeblemindedness, because he seems to have
is not
not many defects but
call his chief defect much
as we assume
has not been this
boy's
only
a
few very
specialized defects,
and
we
of memory in the field of language. Inasthat that was with him from the beginning and
one
acquired
as a
chief defect is
a
result of defective
congenital aphasia,
education, we say that and it probably means
that he is in the class of illiterates.
couple of years ago high grade work, who didn't
We very
saw a
an
extremely
able
mechanic, doing
know how to write.
to school and had never learned to write.
He
came
He had gone to us to learn
why it was he had not learned to write, although he had tried to do it. Apparently he had congenital aphasia, or congenital alexia. When he asked us that question we had to explain to him, "You are in the
CONGENITAL APHASIA AND FEEBLEMINDEDNESS. 191
position of the person who has no ear for music, who can't learn to sing." My recommendation is that this boy be placed in a special class. He ought to be taken very well in hand. For example, I do think that in the educational backwardness of this boy, one factor is a faulty educational method.
You can't teach
a
child who has any sort
You might just as well of defective memory, by the word method. In all of have to be taught to it these cases my opinion, give up. the A, B, C method,?beat it into their heads. Give them a deal of sound analysis. Start him anew, and quit trying to good For children who are somewhat teach him by the word method. I find the word that method throws them into confusion deficient, for several years. I think this boy can be taught some reading and
read
by
writing. If you are interested in this, you will find in The Psychological Clinic for December, 1913, my report of a boy who was taught for a couple of years and finally learned to read. I don't think that this boy we have seen today will ever get over his defect, but if he can
get
over
it
enough
to
get out of the feebleminded class, I don't know.
though he were a normal child and were ought somewhat difficult to teach. He has got to be taken in hand exactly as we would take in hand a person who is said to have no ear for music. Such a boy can be trained to sing so other people could to be tried as
He
stand hearing him sing, but he couldn't earn much of a living by it. I think this boy could be trained that much in school subjects, and it looks as if he should be trained to a trade. This is only the second time we have seen him. To make sure of all the parts of the analytic diagnosis we would have to teach him and
keep
him under observation for
a
couple
of months.
