The moderately involved and moderately advanced case is the stage most usually seen by the practitioner. Cases earlier than this or with less involvement or at least less clinical evidence may tolerate a larger daily increase of exercise and therefore a quicker resumption of former work, but we find in practice that rarely can a patient be placed on his feet for ordinary light work in less than four or five months after the acute stage subsides, while the average early case takes six to eight. When patients farther advanced than the moderate stage are under consideration all grades of results may be expected. After a high grade of activity for three, four or five months, it is problematical just how far and how soon the patient can be gotten on his feet. Sometimes several weeks must clapse after the patient's temperature is normal before the other clinical symptoms disappear and exercise can be started. Frequently the patient must take several weeks before he can sit up long enough to make walking exercise advisable. Frequently walking exercise must go so slowly that the patient progresses by increases of minutes rather than by increases of five minute intervals. With many patients the place is soon reached beyond which the patient cannot seem to advance without recrudescence of the temperature or other signs of the disease. This is, of course, an unfavorable outlook but even in this class the passage of months often finally brings the resistance up until the patient can get back to a fair degree of light work. Occasionally patients will rebel against a policy of reducing exercise and demand that they be allowed to exercise until they feel ill. Such a course of action has been, though rarely, followed with an apparent recovery, but not sufficiently frequently, however, to make it at all advisable to take the chance of such a course. No doubt almost all such patients later relapse. In far advanced cases only ten or fifteen per cent ever get back to any reasonable degree of working capacity and when it is considered that the far advanced case may often retain a fair degree of bodily comfort or look fairly well, providing exercise is not required, one does not need to become so much discouraged in finding that his patient cannot apparently increase beyond two or three hours light exercise.

As stated at the outset, the matter of rest in the treatment of tuberculosis is the most important single feature we have. Exercise, being the opposite of rest, is not to be considered a part of the treatment but rather that the patient must be adjusted to exercise and work before he is ready to be dismissed from careful observation. Exercise regulation is not often given the careful consideration, and especially the time it requires and until a graduated exercise program is more carefully followed and insisted upon we must not wonder at the numerous relapses we have later among our tuberculous patients.

REPORT OF COMMITTEE ON SUBNORMAL CHILDREN IN THE PUBLIC SCHOOLS.

(Read Before Educational Council of the Iowa State Teachers' Association, by F. T. Vasey, Chairman-November, 1920.)

The word subnormal implies that there is a normal. To define a normal child is difficult. A child is not static. For the purpose of this paper, a normal child is one whose mental age is par with his chronolog ical age. Where the mental age is below what the chronological age should show, the child is characterized as subnormal. Normality or subnormality is determined by standardized mental tests. To be reliable these must be given by trained persons and interpreted with careful consideration of individual history, and physiological condition. The determination of the degree or amount of subnormality is a problem of vital importance to the administration of the schools of the state. The children occupying the lower limits of subnormality are special problems for the state.

Children differ in degree or amount of subnormality. They vary in intellectual power, involving the ability to profit by experience, to exercise prudence, to plan, to execute, to retain, from approximately no capacity to that of a genius. That group of children whose intellectual power ranges below normal is of much concern to every community. It is not the purpose of this report to set out causes of subnormality but to point out the complexity of the problem. That confronts the school system, the community, and the state, in the detection and education of subnormal children.

The children who are immediately below normal have sufficient intellectual power to meet successfully the problems of daily living in our society. To live acceptably, to rear a family with proper attitude towards the state, each member to become a social asset instead of a liability, requires a certain degree of inherited capacity and sufficient mental pow ers to solve successfully the problems that arise. Whenever an individ ual fails to maintain this level, he becomes a case for special consideration and care from organized society. When a child early exhibits the lack of intellectual power, he becomes a cause for concern to both state and community.

Means are at hand to determine the intellectual status of every child. There is no excuse for neglect in ascertaining with fair degree of accuracy the probable social success of any child in solving the prob lem of daily living. If the physiological limits of mind growth are such that they show a mental level too low to acquire the ability to read intelligently, too low to visualize the results of anti-social action,

too low to profit adequately from experience, or to exercise prudence and inhibition, or to plan and execute effectively, the state is vitally concerned. It ought to provide a special type of training adequate to each child's mental development, with aims, materials and methods of instruction designed to equip such a child more adequately to become a useful citizen, and reduce the costs of moral and industrial inefficiency. The term "feebleminded" is used to represent the group of people whose native mental equipment is insufficient to enable them with present facilities to rise to an acceptable social level.

WHAT PER CENT OF THE POPULATION IS FEEBLEMINDED?

Estimates of Experts:

Feebleminded in New York State, nine million population

The Mental Hygiene Committee of the State Charities Aid Association and New York Committee on number of feebleminded children in

If the average of estimates of experts in feeblemindedness finds 43,000 feebleminded in the population of New York State practically every two hundred tenth person; how many feebleminded in the population of Iowa?

The institution for feebleminded at Glenwood cares for approximately 1,600, and perhaps 1,000 are cared for in other institutions, leaving at the lowest estimate, 7,000 still at large in the state.

PER CENT OF DEFECTIVE CHILDREN IN SCHOOL POPULATION, INSTITUTIONAL CASES.

HOW MANY FEEBLEMINDED CHILDREN IN IOWA?

If we use the estimates of experts on the number of feebleminded people in society, Iowa with a population of 2,400,000 has approximately 11,000 cases. School children number approximately 25 per cent of the population, there are then 600,000 school children in the state. One per cent of these is so feebleminded that they are institutional cases. The state now cares for approximately 800. The school systems of the state are caring for approximately 200 feebleminded children of school age. There are then 1,000 cared for with some form of special training. This leaves approximately 5,000 children under 21 who are feebleminded. No adequate care is being given at the present time to five sixths of all the feebleminded children in the state.

What is the situation in the school systems of the state? An inquiry was sent out in August to approximately 500 schools and 311 replies were made. They range in school enrollment from 75 to 10,000 children. For this report the schools are divided into three classes according to their enrollments.

Class I. Schools from 75 to 500 enrollments.

Class II. Schools from 500 to 1,000 enrollments.

Class III. Schools enrolling over 1,000 children.

There were 248 replies from towns in class I, 43 in class II and 20 in class III.

The following is a summary by classes:

CLASS I.

Towns from 75 to 500 in average monthly enrollment.

HOW MANY FEEBLEMINDED IN THE SCHOOLS?

Not reporting or don't know-53 towns or 21.4 per cent.

Number of towns having no feebleminded children up to 16 in school-193

Table I shows that in 193 towns of the state with enrollments ranging from 75 to 500, with 50 per cent of the towns ranging under 200, half of them have two or more feebleminded children in school. This is approximately 1 per cent of the enrollment.

TABLE II.

HOW MANY FEEBLEMINDED CHILDREN IN THE COMMUNITY? COUNTING THOSE IN SCHOOL AND OUT OF SCHOOL?

Forty-eight or 24 per cent of the towns gave no report interpreted as don't know.

Table II shows that 46 per cent of these 248 towns have 3 or more feebleminded or who are regarded as feebleminded by the management of the schools. One fifth of these cities recognize no feeblemindedness, but 54 per cent estimate 2 or less, in the community.

TABLE III.

HOW MANY CHILDREN IN THE SCHOOLS ARE REPEATING GRADES TWO OR MORE TIMES EVIDENTLY

Eliminating those children who are evidently feebleminded, counting those who repeat or are repeating grades two or more times, 12 per cent of these 248 towns report none. But 50 per cent of them report 5 or more. Amounting to approximately 22 per cent of the enrollment. Approximately one fourth or 60 towns report 10 or more who are repeating grades twice evidently unable to learn in regular classes. That the question was variously interpreted is evident. The number of repeaters unable to learn, range from 0 to 38, from no per cent to 8 per cent of the enrollment.

WHAT SHALL WE DO ABOUT IT?

1. Ask for help from state for diagnosis and care?

Yes

No

No answer

80 cities 30 per cent 28 cities 11 per cent -140 cities 59 per cent