198 REPORTS ON THE STATE OF SCIENCE. 



Form and size of the head. — Microcephaly, oxycephaly, rickets, 

 hydrocephalus, marked asymmetry, &c. It seems impossible to lay any 

 stress on the diameters, the variation is as great in normal children, 

 ■pace certain observers. 



Shape of the face. — Features normal or coarse. Shape of the 

 nose, whether a good bridge or sunken, small or large orifices, in- 

 cidentally evidences of catarrh or rhinitis. Changefulness or fixity of 

 expression. Overaction of frontal and facial muscles, coarse or fine. 

 Presence of epicanthic fold. Knitting of eyebrows, grinning, &c. 

 Power of fixation with eyes and eye movement, squint, &c. Move- 

 ment of head instead of eyes in following an object moved a short 

 distance. Defects in these respects may lead to backwardness from 

 inability to fix attention, or inversely may be the sign of a mobile 

 attention. Shape of the ear, of the palate, and tongue. Dribbling. 

 While irregularities in shape, size, &c, accompany mental defects, 

 they are not pathognomonic — defective movements are more important. 



The movements and attitude of the child are noted, erect carriage 

 being as a rule better than slackness. The way in which the hand is 

 held is recorded, but the nervous pose is far more common than 

 mental deficiency. A far more important point is to note whether a 

 child having been asked to do something, say hold out his hand or 

 open his mouth, will leave his hand in position or remain with his 

 mouth open while his attention is directed elsewhere. This is usually 

 a sign of deficiency at the age of six onwards, but errors can arise, as 

 the child may have the drill-lesson so impressed on his mind that he 

 will wait in any prescribed position until ordered to assume some 

 other. In a certain number of children at this stage the power of 

 touching the nose with the finger from the horizontally stretched 

 position of the arm as a starting-point may be tested with the eyes shut. 

 This tests both motor co-ordination, muscular or position sense, and 

 the will-power, both to execute the movement and to keep the eyes 

 shut. A preliminary failure may occur through suspicion on the child's 

 part as to what is to happen while the eyes are shut. It is unfortunate, 

 that the parents and sometimes the teacher tell the child they are to 

 see the doctor and constantly refer to the examiner as doctor before 

 the child. If the child has recollections of uncomfortable episodes 

 associated with doctors confidence is hard to establish, though its 

 absence is a test of memory and sometimes may be utilised to obtain 

 evidence of descriptive power by asking the child why he dislikes 

 doctors. 



At this stage certain defects, as chorea, hemiplegia, various paralyses 

 or ataxia are noted down, though they would really have been noted 

 before much of the foregoing. At this stage, too, the power of imitation 

 is tested in doubtful cases. The movements to be followed may, if 

 desired, begin with fine movements as of the fingers, and if these 

 fail the larger arm or trunk movements attempted. It is better in a 

 case of suspicion to commence with a massive movement as picking up 

 some object, then to try arm and leg movements, finishing off with the 

 fingers. It does not take long, and in cases with a rapid response 

 several stages can be omitted. Any additional movements should be 



