Knox: Tests for Mental Defects 



127 



The dull, stupid immigrant is not so 

 entirely because of his previous environ- 

 ment and opportunities. The environ- 

 ment and opportunities are the same 

 now as they have been for countless 

 centuries because of the immigrant's 

 inability to change them. This country 

 is as it is simply because it has been 

 improved by men from prosperous 

 northern European countries, which 

 countries were prosperous simply be- 

 cause of the type of men who inhabited 

 them. The civilization in Mexico is in 

 its present state because of the nature 

 of the people who settled there. It must 

 be remembered that the form of govern- 

 ment is the same there as in our own 

 land and the natural resources are even 

 greater. These factors are not to be 

 blamed for the pitiable condition of the 

 class of people that are coming to our 

 shores at this time. They are simply 

 undesirables and can never be assimi- 

 lated to our advantage. 



In a paper of this kind it is impossible 

 to detail all the principles that underlie 

 the deficiency tests used by the Public 

 Health Service, nevertheless an outline 

 can be given in such a way that one will 

 understand the rationale of the exami- 

 nation and just what factors each test 

 tends to bring forth. 



In the higher and inore refined grades 

 of deficiency, the most important ele- 

 ment in the diagnosis is the "human 

 test" or the ability of one human being 

 to take the mental measurement of 

 another by conversing and associating 

 with him. This intuitive ability can be 

 very highly developed in persons of a 

 strong and pleasing personality and good 

 physique. It must be based on the ex- 

 perience of having seen and examined 

 many positive and also normal cases 

 and the examiner must be a broad- 

 minded, big-souled man keenly alive to 

 the frailties and shortcomings of the 

 human race in general, including him- 

 self. 



SOME definite SIGNS. 



At the various ages in the lives of the 

 simple minded there are definite signs 

 that may be observed and which should 

 aid one in forming a correct conclusion. 

 Those seen in infancv arc the ones least 



commonly known. They are seen in 

 infants who are excitable or unusually 

 quiet and apathetic. The eyes may 

 roll about in an aimless stare. The 

 child may be slow in learning to sit up, 

 to walk or to use its hands. It may be 

 slow to recognize objects and it may not 

 respond to the caresses of its parents. 

 It may be restless and irritable (exclu- 

 sive of illness) and refuse to be pacified. 

 It may sleep long and fitfully and there 

 may be twitching of the face or limbs 

 during sleep as well as bed wetting (in 

 older children) and drooling both when 

 asleep and awake. This drooling and 

 failure to grasp the nipple properly are 

 due to lack of muscular tone, protrusion 

 of the lower jaw (prognathism), faulty 

 reflexes, and too much blood (hyper- 

 aemia) in the salivary glands. These 

 signs with clumsy use of the muscles are 

 very frequently seen in infant defec- 

 tives. The lower the grade of deficiency 

 the greater the number and more 

 marked are the signs presented. There 

 may be in addition developmental 

 digestive errors, vomiting without ap- 

 parent cause, diarrhoea, poor hearing 

 and delayed speech. It should be re- 

 membered that normal children are 

 active, buoyant and playful while de- 

 fectives may be possessed of a general 

 inertia, sullenness and apathy that is 

 altogether unnatural in that period of 

 life. The child may be flighty and 

 changeable, frequently indulging in silly 

 laughter and chatter. The features 

 lack individuality. The head may be 

 malformed. The mouth may be coarse 

 and expressionless and the teeth de- 

 cayed and irregular. The breath and 

 secretions may have a foul odor. 



These are some of the obvious signs 

 that would cause a child to be detained 

 and submitted to a more detailed exami- 

 nation. Suffice it to say that the signs 

 observed in older defectives are more 

 numerous and perhaps more definite. 

 It is true, however, that defectives are 

 detected nearly every day who possess 

 but few or no outward signs at all. 

 This variety of inferior is detected solely 

 by talking with him, and something is 

 said to every immigrant who passes 

 through Ellis Island or any other port 

 of entry. At the primar\- line-inspec- 



