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Disabilities

48. THE MENTALLY HANDICAPPED CHILD

THE knowledge that one’s child is not developingnormally usually comes very slowly, beginning with anagging fear and growing like a dark cloud as the monthsgo by. Because of this the natural tendency is to breakaway from the menace and refuse to face the situation.In these days the child-welfare clinics are à great helpto the young mother ; but there are many who avoidthe clinic, as well as friends, from the time when theyfirst realise that their baby is not doing the things thata normal child does at his age. This is a great pitybecause every moment is valuable and if the situation isthere to be faced, and the task to be done, the soonerone begins on it the better.When my baby was a year old she had cut no teeth

and made no attempt to sit up ; she just lay and smiledplacidly, and sucked all her food. She had had a veryprolonged birth, and although I did not realise it at thetime, had had pressure on the brain which would

partially disable her for the rest of her life.By the time she was two we had found a doctor who

put us in touch with expert advice and we learned thatwe were faced with an uphill task, but one that we wereassured had promise of achievement. Those were thedarkest days of all because they were so full of

uncertainty. It was difficult to believe in a promise thatthe child would eventually walk and talk. She wastwo-and-a-half before she walked at all, and then

awkwardly and with a dragging movement. By thetime she was four, when my next baby was born, I wasstill-in spite of persistent attempts at training-washingnappies, and coping with dirty beds. She had teethnow, but no desire to use them for purposes of mastica-tion. I am afraid I laughed somewhat bitterly when thespecialist said that she would one day be a 75% goodcitizen ; but his words encouraged me, and I kept onwith that queer doggedness that is nature’s gift to mothers.We tackled the problem of clean habits by a vigilance

that must have irritated the child as much as it did us,for at last the miracle happened. At night we tried everymethod that anyone suggested and at last found our ownparticular answer to the trouble. For a period we liftedher every 2 hours, then every 3, working oIl to 4, andso on, until finally she went from 10 P.I. until 6 A.M.,and the battle was as good as won. We found in this,as in other things, that rhythm and routine are the onlysubstitutes for an active brain.

Feeding was a difficulty that was to concern us formany years. First of all because ,we had to teach thechild to chew by means of games, constant facial con-tortions, and exaggerated movement of our jaws. Evenafter the first essential was grasped, this was a thingwe had to watch for years. Then she had to be taughtto feed herself. Her hands were spastic, and she foundit difficult to hold a spoon-impossible to find her mouth.Our method here was to play with a spoon at timesother than meal times-to have a bowl of lentils orpeas, and try to ladle them from one dish to another.Then, when the art of holding the spoon was achieved,the next move was to put honey on the spoon, andguide it to her mouth. After we had tried a few goes atthis, she made a rough (very rough) attempt at findingher mouth for herself ; and the washing of face, head,and garments that this entailed was well worth while.By the age of seven an onlooker at a party had no idea,that there was anything wrong. A party with creamcakes and jelly is a pretty good test !The first walking was, as I have said, very awkward.

Here I owe a big debt to a series of dancing teacherswho have given exercises and remedial drill which havedone wonders. These exercises have not been merely

for feet and legs, but for hands and arms, and generalharmony of movement. I believe that the coordinationof bodily movement has done much to help her withspeech. The use of the hands is very important too.We did not start with a pencil, but with a long paint-brush which was easy to hold, and required the move-ment of the whole arm. From this we went on to colouredpencils, and when the child was able to hold a pencilproperly we went on to form. My method may seemstrange but it worked. We put two dots on a piece ofpaper, and, imitating train-noises, we travelled fromone to the other. Sometimes the line made someextraordinary journeys in between, but eventually wetravelled the shortest distance. Then we used fourdots and at last we got the shape of a primitive house.The curl of smoke that we added to the chimney wasMother’s exclamation mark of triumph ! We have nowtravelled through many stages-through crude wool-work, raffia-work, felt-work-up to the ultimate triumphof making Mother a frock at the local L.C.C. dressmakingclass ; and it is wearable ! More than that ; this yearanother miracle happened when a kind friend taughtthe art of toy-making, and by the sale of soft-toysactual money has been earned towards the summerholidays. This was something I had never contemplated.What if it has taken twenty-one years ? ‘I -

Speech meant a long journey, too. Here again Iowe much to a speech specialist who helped not onlymy child but me as well to tackle this big problem.My advice to parents of children with retarded speechis talk to your child ; talk, and keep on talking. Pointout things, even if he doesn’t seem to respond. Talk

clearly and in simple words. At one time I was afraid

people would think I was a foreigner-because Imouthed my words and I spoke so deliberately anddistinctly. Lip-control is usually poor with retardedchildren, and there are many useful exercises for thiswhich can be turned into games ; blowing a ping-pongball across a polished table is one, and another is to makea miniature clothes-line and pin paper clothes on itwhich must be blown dry by a strong wind. At 41/2my child could only say " Daddy." At her twenty-first birthday party she replied (in a memorised speech,it is true) to her toast. Speech may never becomeperfect, but so long as it frees the child to express himselfit is worth waiting for. ,

One essential is to let the child lead as normal a lifeas possible. Perhaps there is a tendency to keep himin the background and confine him to the home. Onehas to fight one’s pride and make a bid for normalcontacts ; and I have always found other children kind-anyhow up to the age of adolescence, when they becometoo much occupied with their own affairs. Then onehas to depend on the friendship of older people. If it is

possible for the child to have at least some corporatelessons in whatever kind of school is possible, that is agood thing ; but I found that the actual teaching mustbe done individually. We had a teacher for some yearswhose methods were worth noting. For example, shetold the story of Dick Whittington, then mv little girlread the story in a very simplified form. Next, sincewe are fortunate enough to live in London, they wentup to see the Mansion House and the Royal Exchange.After that they went down to the river and watched aship unload its cargo. The story had become visual andalive. The next day they talked about it, trying toremember what they had seen. Then they read thestory again, and the words in the book were shapes ofsomething real, and therefore remembered.The development of independence is a subject in

itself. The beginning is difficult because the backwardchild lacks initiative, and has to be persuaded, cajoled,and led. It would be so much easier to do up his shoes,wash his hands, and comb his hair one’s self ; and it is

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so very difficult to refrain from doing it again when ithas been clumsily and badly done.The most difficult stage in the struggle to give him

independence is when the child has to be trained to dothings outside the home by himself. The first day(and for many days afterwards) that a- small figurewalked to school alone, I walked, heavily disguised,on the other side of the road. There are certain risks youmust take if your child is going to have a life worthliving.

Later on, when my little girl was trained in road sense,she learned to shop-at first with someone, and lateralone. This is a great joy to her. If the name of any-thing is difficult we write it down, and since she is nottoo clever about money she always has more thanenough in her purse, and in coins of large denomination.

Lethargy is an enemy that has to be watched, especiallyduring the years when the accomplishments are few.We have always tried to keep her active and interestedwithout unduly tiring her ; and as the things that shecould do mountedup this vigilance became less necessary.

During the difficult years the child may feel frustrated.I found that attempts to counteract this by praising herfor accomplishment had to be very judicious. It is,however, important to let the child feel that, at least - "in the home, she is a person of significance. Thereare many simple jobs and responsibilities that will givethis sense of mattering which every human being needs.Never mind if the cups get broken or the milk spilt.The aim is not to achieve perfection, but ’to give thechild a chance of growing up into a person able to do someservice, not only for himself, but for the community.

- Special Articles

HEALTH SERVICE ESTIMATES

THE gross cost of the National Health Service inGreat Britain during 1950-51 is estimated at f:464,514,400.This figure is given in- the Civil Estimates publishedlast week.

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For England and Wales the gross cost is estimated at413,260,400 (compared with 400,183,432 in 1949-50) ;and the net cost, allowing for appropriations-in-aidat :t351,541,000 (compared with :t317 ,873,250 in 1949-50).For Scotland the figures are : gross cost :E51,254,000(compared with 49,988,300 in 1949-50) ; and net cost

41,394,000 (compared with :t40,636,300 in 1949-50).Thus the net increase is :t33,667, 7 50 for England andWales ; and 757,700 for Scotland.

"

For England and Wales the following estimates of

gross cost are given : -

1. Civil Estimates for the Year ending March 31, 1951. Class v :Health, Housing, Town Planning, Labour, National Insurance,and Contributions to Local Revenues. H.M. Stationery Office.Pp. 154. 3s. 6d.

Under the heading of general medical and dentalservices, pharmaceutical services, and supplementaryophthalmic services, the distribution in England andWales is as follows :

Among other services in England and Wales/the cost’of compensation for loss of the right to sell medicalpractices is estimated at 5,315,000, compared with7,165,000 in 1949-50. ,

MEDICAL GAS CYLINDERS

THE Association of Anaesthetists of Great Britain andIreland and the Medical Defence Union have interestedthemselves for some time in safety measures to eliminate,as far as possible, avoidable ansesthetic deaths. Withthis object in view, these two bodies have collaboratedwith the British Standards Institution in preparinga code of practice for anaesthetists, and in additioIihave approved certain recommendations coiieerningthe colouring and marking of cylinders containinggaseous anaesthetics. Most of the changes suggested areimmediately practicable, and together they form a

short-term policy. ,

As a long-term policy, there have been prepared, withthe assistance of the manufacturers of anaesthetic gasesand apparatus, specifications for standardised non-interchangeable couplings and coloured leads ; and itis hoped that when these come into general use, wrongconnections between gas cylinders and anaesthetic or

inhalational apparatus will be virtually impossible anddeaths from such accidents avoided. ’

It is eminently desirable, however, that these couplingsshould be adopted by international agreement which has,not yet been obtained. There is also disagreementinternationally as to the colouring and marking ofcylinders. This is a matter of great signifibance in war-time : lack of inter-Allied uniformity led to manyunfortunate occurrences during the late war.