DEFECTIVENESS

DEFECTIVENESS (from Latin defectus-insufficiency), a term used mainly in neurology and psychiatry, especially in relation to children, since most forms of D. are congenital, constitutional, or acquired in early childhood. D. is divided into two main categories corresponding to the two main types of human activity, namely physical and mental, with the latter in turn being divided into insufficiency in the emotional-voluntary sphere and intellect. In practice, pure forms of D. are rarely encountered; instead, one usually deals with the most varied combinations. The etiological factors underlying any D. mainly reduce to two basic groups: 1) internal (or endogenous) factors, closely related to the biological peculiarities of a given organism, and 2) external (or exogenous), which are in close connection with a number of socio-domestic conditions and accidental causes. In fact, both of these factors in various combinations influence the manifestation of one or another type of insufficiency. Endogenous causes include hereditary, mainly degenerative constitutions, to which psychopathic constitutions can be attributed. Among exogenous causes, one should note: 1) factors that affect fetal development during conception and pregnancy, such as various kinds of exhaustion (physical, emotional and mental), injuries (physical and psychological), poisoning (alcohol, morphine, cocaine, etc.), infections (acute and chronic); 2) all factors affecting life, especially those strongly affecting children due to the peculiarities of an organism that has not completed its development. Here, mainly infectious diseases play a major role, very often causing damage to the nervous system in children, as well as lesions of the endocrine glands, which show an effect on growth and the development of the central nervous system. In addition, exhaustion, injuries and poisoning should be taken into account. The influence of socio-domestic conditions, and in particular the phenomenon of child homelessness, also plays a significant role. I. Physical D. This includes physical or somatic insufficiency of the organism, which leads to partial or complete disability and requires special types of assistance and preventive measures. The main place in this group is occupied by: 1) disorders of the motor apparatus, namely diseases of the bone and muscle system, which may be of congenital and acquired nature; the latter are divided into residual phenomena after various diseases and consequences of the so-called accidents, i.e., injuries in the narrow sense (as a result of war, accidental injuries); 2) a large group of disabilities due to organic diseases of the central nervous system (congenital and acquired); 3) deaf-mutism and 4) blindness.-Insufficiency of the bone apparatus is characterized by 1) either changes in the bones themselves on the basis of rickets, tuberculosis of bones and joints, underdevelopment of bones due to disorders of the endocrine system and their softening during rapid growth, 2) or the absence of one or another part of the motor apparatus (armless, legless, absence of hands, feet, etc.,-see Amelia) and finally 3) a number of defects (e.g., weakness of the ligamentous apparatus, etc.). The most frequent changes are found in the spine in the form of congenital and acquired deformations, which are aggravated in school age with improper construction of school furniture and improper posture during work processes. Deformation of the spine leads to deformation of the chest cavity, resulting in displacement of internal organs and disruption of their functional activity, especially of the heart (for example, the so-called cor kypho-scolioticum). Changes in individual joints and in the extremities also occur. Statistical data provided by Besalsky (for the period from 1906 to 1926) indicate that in Germany, 36.7% of all physical D. consist of changes in the bone system.- Of the defects of the muscular system leading to complete disability, progressive muscular atrophy should be noted, with Besalsky counting 364 cases over 20 years, of which 292 needed medical assistance. 16% of all physical D. is accounted for by residual phenomena after organic diseases of the central and peripheral nervous systems (both during intrauterine life and in early childhood), as well as as a result of traumatic injuries during difficult births. Here, childhood paralyses of both spinal and cerebral forms occupy a prominent place, postencephalitic states with a number of forced and convulsive movements, postmeningeal diseases accompanied by deaf-mutism and blindness, as well as a number of diseases of the central nervous system on the basis of hereditary syphilis, injuries during childbirth, which may be accompanied by hemorrhages into brain tissue with various disorders in the central nervous system, as well as in the peripheral. A. The organization of assistance for the physically defective is much more complex than it seems at first glance, since here the question is not about preserving the biological personality of the defective person, but about restoring their ability to work. The organization of this assistance should include the following aspects: 1) orthopedic treatment with the aim of correcting the existing defect as much as possible, 2) special education and upbringing corresponding to the psycho-physical peculiarities of this type of disability, and 3) conducting proper professional orientation and professional consultation with the aim of placing professional education in the most favorable conditions. The ultimate goal is to enable the disabled person to emerge victorious in the struggle for existence and become a full-fledged social personality. An example of a correct organizational setup can be the institution for the disabled in Berlin (Oscar-Helene-Heim). Orthopedic assistance is represented here by an orthopedic clinic consisting of a number of departments (for infants and preschool age, for boys and girls, for older age, department for bone and joint tuberculosis, operating room, department for armless, room for therapeutic gymnastics, therapeutic office and orthopedic workshop). For education and upbringing, there is a three-class primary school, a two-class auxiliary school, an orthopedic class for exercising the upper extremities, a class for armless, a vocational school, a kindergarten, nursery, club activities, etc. The entire educational and teaching part is in the hands of specialists, since the approach to disabled people, due to their peculiar psychology, has a specific character. In them, special characterological features are developed, conditioned by the consciousness of their inferiority and the special position that a disabled person occupies in the family and life. Physical insufficiency often for them is an obstacle in solving certain life problems; the disabled person always feels helpless compared to others, he is often the subject of ridicule and contempt from those around him; as a result of all this, a morbid sense of self-esteem develops in him. A typical disabled person is characterized by heightened ambition, great irritability, envy, bitterness, distrust, great stubbornness and persistence. All these features must be taken into account when setting up education and upbringing, which is why a special pedagogy for the disabled has been developed. For further vocational education, the institution has a number of workshops to which students are sent after special vocational orientation conducted with the participation of both teachers and specialist doctors. The institution has an outpatient clinic where outpatient treatment-orthopedic, surgical, therapeutic-is carried out; there is also a special school for day students and a vocational counseling point. This is also connected with a number of educational and scientific institutions. B. Preventive measures mainly consist of providing medical assistance as early as possible, since only in this case can disability be prevented. It is very rational if the state takes on all responsibility for the disabled and, through appropriate legislation, carries out a number of preventive measures. It should also conduct among doctors, middle and junior medical personnel and the population extensive propaganda that early assistance can significantly reduce the number and severity of disability. Orthopedic training should be given proper place in the medical faculty, it is necessary to instill in doctors the awareness that all deformities of joints and bones should be directed to a specialist for treatment as early as possible, since established severe changes are much more difficult to help, and sometimes completely impossible. To recognize all defects in a newborn child, not only the doctor but also the midwife should be able to do so, in order to timely advise parents to consult a specialist.

Parents and educators should also be acquainted with recognizing early signs of physical defectiveness and be informed that timely measures can save the child from complete disability. The organization of a series of systematic and occasional lectures, traveling exhibitions, and special museums can serve as a good means of propaganda. In factories and plants, a whole range of preventive measures against accidents should be introduced. As for the deaf-mute and blind, assistance should be expressed in the organization of special educational institutions (see Deaf-muteness and the Blind). Preventive measures (in addition to those described above) come down to the fight against ear and eye diseases; furthermore, each such patient should be provided with timely medical assistance. In terms of prevention in the USSR, consultations organized at the Department for the Protection of Motherhood and Infancy of the People's Commissariat of Health play a major role, where advice is given to pregnant women as well as on the care of infants. P. Psychical defectiveness. Deficiency in the emotional-volitional sphere includes a group of people very diverse in their psychic structure. The etiology of psychical D. is fully exhausted by the above data; and here it should only be emphasized that the environment (especially homelessness) leaves a great imprint on this group of children and sharpens the manifestation of all pathological peculiarities. Critical ages play the same role. The classification of psychical D. in general presents great difficulties due to its diversity. The following grouping can be taken as a basis. A. Congenital pathological conditions - constitutional nervousness. B. Psychopathic constitutions: 1) hysteroids, 2) cycloids, 3) schizoids, and 4) epileptoids. C. Organic diseases of the central nervous system, accompanied by disorders in the emotional-volitional sphere (epidemic encephalitis, hereditary syphilis, etc.). The first group is characterized by the presence of pathological symptoms, more or less painfully experienced by the subject himself, excitability of the nervous system, restlessness, and anxiety. Disorders of vegetative functions also play a major role here. Constitutional nervousness manifests from the earliest childhood and is accompanied by a series of both mental and somatic symptoms. The distinctive feature is the discrepancy between the actual cause that triggered a particular reaction and the degree of mental excitement. To this is added great fatigue, rapid exhaustion, sleep disorders, poor appetite; sluggishness of the intestines and a whole series of sexual irritations. Sometimes in such children there is a whole range of obsessive states in the form of obsessive thoughts, fears, ideas, desires, movements, etc. Disorders of drives are also often noted, expressed mainly in an irresistible desire to fulfill all their desires at all costs, which, when materially impossible, leads to lying, theft, and a whole series of aggressive actions. All these symptoms affect the general well-being and mood. Unfavorable external circumstances, such as accidental illnesses, inadequate nutrition, tuberculous intoxication, overwork, etc., increase the manifestation of morbid nervousness. Among this group there are many children with rich imagination, great talent, and great demands, which gives them the opportunity not only to study in a normal school but often even to stand out among their peers. Their presence in the class in some respects raises the general level of the school group. In terms of prognosis, it should be noted that favorable living conditions, proper hygiene both mental and somatic, proper regimen, and in general proper organization of general living conditions have great positive significance, since reactivity to their environment is extremely heightened. The other group consists of psychopathic constitutions. By psychopathic constitution in the narrow sense are meant such pathological conditions that lie on the border between mental health and disease, therefore these are borderline states representing abnormal variants of personality. Psychopathic states are very diverse in their forms, rarely occur in a pure form, but mostly in different combinations. They affect all areas of mental life and indicate unevenness in the development of mental processes, disharmony of personality, which constitutes their main distinctive feature from normal individuality. These are personalities with heightened drives, emotions, unbalanced, easily falling into opposite moods. Among them, the majority have normal intelligence, there are even gifted children, but mostly one-sidedly, partially. What in a healthy person lies in the germ and manifests gradually and within certain limits, and sometimes is completely suppressed, bursts forth violently in psychopaths. Thus, these pathological states do not represent anything that would not be physiologically inherent in the organism, but only the form, strength, and extent of their manifestation, as well as the time of their occurrence, do not correspond to the normal state. The external environment plays a very important role for psychopaths, since they are more than normal people susceptible to the influence of external influences. The classification of psychopathies is very difficult, incomplete; individual forms are not clearly enough delimited. The grouping outlined by Kraepelin can be taken as a basis. 1. Hysteroids are somatically characterized by infantile-gracile or picnic body build, richness and gracefulness of movements, expressive facial expressions. The mental peculiarities are imbalance, increased suggestibility, suggestibility, tendency to affectation and egocentrism. They often have increased imagination along with incorrectness of memory images, which leads to pathological lying. These qualities make them often intolerable in life and at school. 2. Cycloids - in terms of body build, picnics with very skillful and smooth movements. The distinctive feature of their psyche is the fluctuation in mood, with periods of hypomania alternating with depressions. They are very accessible and sociable. Work capacity in the hypomanic period is often impaired due to the inability to concentrate attention for a longer time, since their thoughts flow at a fast pace and they quickly jump from one job to another. In the depression period, the opposite phenomenon is noted - great inhibition! 3. Schizoids - asthenic or dysplastic type of body build with very clumsy, awkward motor sphere, facial expression is not very expressive, mannerism, affectation are noted. In their mental makeup, they are unsociable, inaccessible, do not get along well with the environment, do not submit to any regimen and discipline, are prone to reasoning, abstract thinking, fruitless philosophizing. They are very stubborn, negativistic, impulsive, and prone to absurd obsessive acts. A whole series of oddities and whims distinguish them from others. 4. Epileptoids - in body build mostly athletes or dysplastics, mentally very affective, with a great tendency to outbursts of anger and malice. In moments of irritation, these subjects completely cannot control themselves. They are cruel, stubborn, picky, vindictive, and vengeful. Along with this, there is often a decrease in intelligence and a whole series of antisocial tendencies, such as theft, lying, rudeness, and sexual perversions. During outbursts, they become dangerous to those around them. Disorders in the emotional-volitional and motor spheres in organic diseases of the central nervous system represent either accompanying or residual phenomena. In recent times, cases with residual phenomena after having had epidemic encephalitis are often encountered. Such subjects are characterized by excitability of the entire nervous system, there are phenomena of parkinsonism, i.e., mask-like facial expression, facial expression not corresponding to internal experiences, a special gait with a forward-leaning torso, inhibition in movements and psyche, unnatural laughter and crying, unmotivated drives and actions. The same disorders in movements and psyche are often initial forms in hereditary syphilis, but here early signs of beginning dementia can already be established. Intellectual deficiency, or mental retardation, includes a group of children with delayed mental development, mainly with decreased intelligence. This intellectual deficiency is organic, congenital - either on the basis of heredity or due to various diseases of the central nervous system during intrauterine life, or acquired in the first years after birth when the entire nervous system has not completed its development - and as a result we are dealing with the most diverse forms of underdevelopment. This is that composite group which, according to Kraepelin's terminology, is called oligophrenia.

In differential diagnosis, this group should be distinguished from 1) pedagogically neglected children, who are often confused with the mentally retarded; while their intelligence is within normal limits, their neglect is the result of a number of exogenous factors (unfavorable social conditions, illness); and 2) secondary feeble-mindedness, which is a consequence of mental illnesses and represents a disintegration of personality, not a developmental delay. When considering individual forms of underdevelopment, the degree of mental deficiency is mainly taken into account. The usual divisions into three stages—idiocy, imbecility, and debility—do not provide an exhaustive representation of the essence, and the boundaries between these three groups are arbitrary. Attempts to compare degrees of mental underdevelopment with a particular age (Binet, Simon, etc.) do not withstand criticism, since a mentally retarded person cannot be equated with a normal child who has only lagged in development at a certain age; this group of children represents a type that is quantitatively and qualitatively incomplete, and their development follows completely different paths. Nevertheless, when describing the mentally retarded, the aforementioned division is used as the most common. A brief description of them is as follows: idiots are completely incapable of learning, they often lack articulate speech, all intellectual abilities are in an embryonic state, they do not orient themselves in their surroundings and only react to the satisfaction of their lower needs. There are milder forms of idiocy; some contact can be established with such children. They recognize people who are in constant communication with them, grasp the simplest questions, and understand the purpose of the most basic things. Imbeciles are capable of some learning; all intellectual processes in them are significantly reduced, especially processes of analysis, comprehension, and combination; memory is better developed, particularly of visual perceptions and concrete concepts; will processes are also unstable. Speech disorders are very common in imbeciles. Among them, pathological characters are often found. They are incapable of independent labor, even very simple labor, and constantly need supervision and guidance. Debiliacs are closer to normal, they are capable of acquiring some knowledge, can be educated in special schools, and can be given vocational education. In addition to intellectual retardation, a number of shortcomings are noted in the emotionally-volitional and motor spheres in mentally retarded individuals. Early recognition of mental retardation is very important because it involves processes of underdevelopment. The earlier such children are placed in conditions of education and training corresponding to their psycho-physical characteristics, the greater correction can be expected, because what a mentally retarded person misses at the right time, he can never catch up with later. Recognition of mental retardation should be based on a comprehensive study of the personality (detailed anamnestic data on heredity, child development, illnesses with consideration of socio-domestic conditions, and detailed somatic and physical condition of the child), in which experimental-psychological research should be given due place. There is a whole range of methods for assessing the degree of retardation; preference is given to those that most take into account formal abilities rather than general development, and on the basis of which not only mental deficiency can be determined, but also indicate where there are gaps in intelligence and to what degree, in order to know how to correct them, as well as to take into account all positive aspects to use them in teaching. For recognizing mental retardation in early childhood (preschool age), there are very few methods, such as: research of elementary representations by the methods of Rossolimo, Binet, Simon, Weigandt, and Dekeerd. Recognition of mental retardation at this age should be approached with great caution, as it is very difficult to establish the rate of development. In school age, Rossolimo's methods are used, both individual and mass, which make it possible to, on the one hand, give a quantitative assessment of psychomechanics, and on the other hand, establish in which processes there are failures, and finally, by comparing all data, determine the type of work capacity. The Binet and Simon method illuminates the overall picture of development and makes it possible to reveal pedagogical and social neglect. In addition, there are a number of other methods. In-depth study of the personality of a mentally retarded child should be conducted not only for the purpose of selection, but also throughout the entire period of education, as this will provide valuable material for vocational orientation and vocational counseling, which is extremely important for the further fate of these children. As soon as mental retardation is established, such an individual should immediately be placed in conditions of auxiliary education, where not only is the program different, but the basic principles of teaching also differ sharply from those of a normal school. Thus, the organization of assistance to the mentally retarded should be constructed as follows: for idiots—special institutions of the boarding type with predominance of the principle of care, for imbeciles—institutions where they should be taught as much as possible, but the focus should be shifted to manual labor, to labor processes of self-service and training in some simple craft. Agricultural labor is most suitable for them, and therefore the organization of labor colonies and artels is the best form of assistance. Such imbeciles should remain under supervision and guidance throughout their lives. For debiliacs, it is necessary to organize auxiliary schools with 5 years of education and then direct them for vocational education either to production or to specially organized factories and schools for them, to which they should be sent after comprehensive and in-depth vocational orientation. In addition to auxiliary schools, auxiliary classes should be organized in schools for normal children where there are no separate auxiliary schools. In addition, for severe oligophrenics, it is necessary to have institutions of the boarding type, and a whole network of such institutions should be established in order to be able to properly organize them both by age and by type of mental retardance. In all these institutions, teachers who have received special defectological education should work. To prepare such a cadre of specialists, defectology departments exist in pedagogical higher education institutions (Moscow, Leningrad), where defectology is taught. Just as pedology, according to Blonsky's definition, studies the symptom-complexes of various epochs, phases, and stages of childhood age in their temporal sequence and their dependence on various conditions within the norm, so defectology studies the same thing, but within the limits of a defective child. Defectology thus includes the study of the pedology of the mentally retarded child, surdopedology, typhlopedology, and socio-pathological pedology.

S. Rabinovich. Organization of assistance to defective children. Neuropsychiatric assistance to the child population in the RSFSR is still extremely insufficient. In the RSFSR there are only 32 school-sanatoriums with a total of more than 1,500 beds. Meanwhile, the population's need for institutions for nervous, unbalanced, and disharmonious children is very great. Statistical data from children's preventive dispensaries reveal a significant percentage of schoolchildren who, in the course of educational work with them, require special conditions of school-sanatorium regime, such as: reduced group loads, better sanitary and hygienic conditions of premises, hygienic nutrition, appropriate methods of educational work, therapeutic physical education, etc. The final link in the chain of institutions serving children with anomalies in the neuropsychic sphere are psychiatric and nervous departments of hospitals or children's psychiatric and nervous hospitals as independent institutions at the district, provincial, or regional level. At present, there is still a considerable number of children kept in general psychiatric hospitals. In connection with the circular issued by the People's Commissariat of Health in 1922 on the organization of special children's departments in psychiatric hospitals with a special medico-pedological regime, a definite growth in specialized psychiatric assistance to children has been observed in recent years. Methods and content of pedological work with mentally anomalous children. Such children can be divided into 2 main groups: a group in which initial instruction in literacy and arithmetic is conducted with pedagogical exercises for the development of mental functions, and a group for pedological work with literate children, which sets itself the task of regular instruction for those children who are capable of mastering school literacy; the subjects of its work can be: rudiments of political literacy, oral and written speech, arithmetic, mental orthopedics, rudiments of natural science, illustrative drawing, adapted to the peculiarities of a given child. Teaching methods: labor method, complex method - the latter being conducted in the form of specially designed short lessons. Individualization of instruction is widely practiced; a number of lessons are conducted simultaneously with a group of children numbering 6-8 people. It is desirable not to break the children's ties with their group even during non-school hours, for example, a small library can be at the disposal of the group, the group can participate in various types of manual labor, physical education, etc. Great attention should be paid to manual labor classes; types of work: carpentry, carving, sawing (woodworking), papier-mâché products, bookbinding and cardboard work, soft toys, weaving, sewing, etc. If possible to set up a woodworking workshop, a separate room should be allocated. - A prominent place belongs to aesthetic education (music, singing), and for children with one-sided talents, individual lessons should be organized. Measures of influence (or rather pedagogical influence) are completely inseparable from therapeutic measures and first of all from psychotherapy in the broadest sense of the word, bordering on persuasion and conversation. The application of psychotherapy, of course, requires preliminary thorough study of the somatic and mental condition of the patient. The daily routine, the entire way of life of the psychiatric department, including here the therapeutic-pedological measures, should be calculated for the mental and physical improvement of children and for the correction of corresponding deviations, which requires individualization of approach, and consequently, proper dosing of therapeutic-pedagogical influence. A children's psychiatric hospital should have at least 3 departments - admission-observation, calm, and restless; the latter - separately for boys and girls. Children with disorders of the mental sphere are to be admitted to the children's psychiatric hospital, namely: a) endogenous psychoses (schizophrenia, manic-depressive psychosis), b) post-infectious psychoses, c) acute psychotic states of psychogenic origin, d) epileptic twilight states and mental equivalents of epilepsy, e) neurosyphilis with predominance of mental symptoms in the clinical picture (including progressive paralysis). As for psychopathy, only those cases are accepted which give temporary exacerbations or deterioration in connection with somatic or life-episodic factors. The following should not be admitted to the children's psychiatric hospital: a) oligophrenics requiring schooling, b) deep oligophrenics - imbeciles unable to learn and idiots, c) epileptics with convulsive seizures, especially with preserved intellect, d) psychopaths and neuropaths, e) organic nervous patients without sharp psychotic symptoms. - For the listed categories of children with pathological disorders of the neuropsychic sphere, special institutions are organized, which are independent links in the network of institutions for nervous and mentally ill children. Thus, for oligophrenics requiring schooling, there are medico-pedagogical institutions of auxiliary type, under the jurisdiction of the People's Commissariat of Education - auxiliary schools for day oligophrenics and boarding schools. For deep oligophrenics - imbeciles and idiots, institutions of the psychopedological school-sanatorium type are created (Tver), but more simplified, due to the more elementary tasks facing these institutions, which aim to develop hygienic skills and acquire elementary knowledge (especially for epileptics with preserved intellect). In the network of the People's Commissariat of Health of the RSFSR, there are five such institutions of regional and interregional importance (Tomsk, Kostroma, Orel, Tula, Kuban - near Krasnodar). Institutions for severe chronic cases (idiots, epileptics, organic nervous patients, epidemic encephalitics) can be attached to the children's psychiatric hospital as departments; institutions for epileptics with preserved intellect should be set up outside the territory of the psychiatric hospital, near the city, on the type of an agricultural colony, in which labor processes can be widely developed. The main institution of the psychoneurological school-sanatorium type is the institution for psychopathic and neuropathic children with full intellect. A psychopedological school-sanatorium of this type is best arranged outside the city, but not further than 3-4 km from the city. A greater distance from the center has a number of economic inconveniences in terms of food delivery and, in addition, creates isolation of the school-sanatorium in relation to medical and pedagogical work. The most convenient arrangement for the school-sanatorium is the pavilion system, or premises consisting of separate apartments. With such premises, children can be divided into small groups and spend the whole day (classes, meals, sleep) separately. Such division of children into small groups is a necessary condition for the proper functioning of the school-sanatorium, as it makes it possible to create the calm atmosphere necessary for the school-sanatorium, and with small groups the possibility of bad influence of some children on others is reduced (more severe cases can be separated from milder ones). The premises of the school-sanatorium should not only satisfy all sanitary-hygienic rules (be sufficiently spacious, light, dry, and warm), but in addition should be cozy and correspond to the aesthetic needs of children. The premises should consist of a sufficient number of work rooms for classes, club rooms, dining room, bedrooms, gymnasium room, medical office, room for teachers, room for a museum of children's work, separate room for a cloakroom, infirmary for somatic patients, isolation room for children isolated for mental indications, bathroom (which should be equipped with a sufficient number of bathtubs, showers, and washbasins) and two toilets. Rooms should be arranged so that bedrooms are sufficiently separated. One of the bedrooms should be large (observation room), the others small, so that it is possible to isolate both more excited children and more neuropathic, impressionable children suffering from children's noise. The infirmary for somatic children should preferably be allocated in a separate building. A terrace should be attached to the school-sanatorium, where daytime rest is conducted (for winter time for lying in the open air, fur bags should be prepared). A garden-vegetable garden is necessary at the school-sanatorium premises, where children could work in gardening and horticulture. In addition, physical education grounds should be equipped, in winter a skating rink and a snow hill. The external environment of the school-sanatorium also includes furniture and children's clothing. Furniture should satisfy hygienic rules, correspond to the age of children, desks in work rooms should be individual. Clothing should not only be simple and hygienic, but also satisfy aesthetic requirements. Sufficient attention should be paid to the selection of children for the school-sanatorium, as the correct selection of children is the guarantee of productive work.

The selection of children can take place in a pedological or psychoneurological office or in preventive outpatient clinics, where they exist. In places where there are no preventive outpatient clinics, selection can be made by a psychoneurologist from a sanatorium school. The school should be given the right to accept children only for a preliminary period (institutions referring children to sanatorium schools must give a guarantee that children who are not eligible for admission to the sanatorium school will be taken back). Persons admitting children to sanatorium schools must be informed that only children with various deviations from the norm in the direction of nervousness and psychopathy (these neuropathic and psychopathic conditions can be either congenital or acquired on the basis of unfavorable external conditions) are eligible for the sanatorium school. Children who are not eligible for admission to the sanatorium school are: 1) normal children who are only socially neglected, 2) mentally retarded children. Of the individual forms of psychopathy, only mild and moderate forms are eligible for the sanatorium school; severe forms of psychopathies, mainly sexual and antisocial psychopaths, are not eligible for admission to this type of sanatorium school; special sanatorium schools with a special regime are arranged for them. The number of beds in a sanatorium school averages 50. It can be increased to 75 only in cases where the nature of the premises allows children to be divided into small groups. The age of children eligible for admission is from 8 to 13 years inclusive; for adolescents from 14 to 17 years, separate sanatorium schools of the same type are arranged. Approaching the pedagogical work with nervous and psychopathic children, the teacher of the sanatorium school must know that his main task is not so much to give the student a certain amount of knowledge as to teach him to study and work independently. In most cases, children who do not know how to work are admitted to the sanatorium school; they do not listen well in class, get distracted quickly, and perceive everything superficially, so all the energy of teaching should be directed towards developing the child's ability for self-regulation. The teacher should avoid mechanical memorization and should only give material that would stimulate the creative forces of the child. Disorders of attention and rapid exhaustion of nervous children require constant intervention from the teacher. In the complex of classes, the teacher should proceed by concentrating the attention of the pupils on various aspects of the same object; in the curriculum, he should go deeper than broader; when children have increased fantasy (a symptom often found in neuropaths), the teacher should proceed by attracting interest to the real (here the biological complex is of great importance). The teacher must strictly individualize his teaching methods in relation to each individual pupil, taking into account all his pathological features that prevent him from studying. To accomplish this task, it is necessary to have 1) small classes (no more than 15 people per teacher), 2) higher qualification of the teaching staff of the sanatorium school. The teacher of the sanatorium school must not only be fully qualified in terms of knowledge of his subject, but also pedologically educated. In addition, the teacher must have certain individual characteristics (sufficient self-control, ability to control oneself, ability to feel the child's psyche, etc.). He must always be active, with sufficient creative initiative. A feature of the pedagogical work of the sanatorium school is that educational work here is inseparable from pedagogical work. The distinguishing feature of children eligible for the sanatorium school is their antisociality. They do not get along well with each other, the feeling of comradeship is insufficiently developed in them; these are the children who are called disruptors in school; therefore, at the beginning of his work, the teacher has to spend a large part of his time on organizational work in the group (organization of group self-government, uniting children by any common interests). Along with organizational work, the teacher also has to spend a lot of time on instilling in children elementary skills of personal hygiene (clothing, etc.) and necessary behavioral skills (in relation to comrades, educators, etc.). As for the curriculum, it is based on the existing programs of the State Scientific Council, which must be somewhat adapted to the current composition of children of the sanatorium school. The features of the sanatorium school curriculum are as follows. 1. The curriculum must be more flexible than in a normal school. 2. The curriculum must be sufficiently interesting to interest the students. This condition is especially important for the sanatorium school, as children with little ability for systematic academic work are admitted here, and the very process of school classes is incomprehensible to them. The task of the sanatorium school is to instill in its students interest and love for the learning process itself (for this, it is often useful to introduce a greater aesthetic element into the school curriculum). 3. In the implementation of the sanatorium school curriculum, there must be greater gradualness than in a normal school, as children slowly get involved in work. Of the individual teaching methods, the laboratory-research method gives the best results in the sanatorium school, as it most corresponds to the main task of the sanatorium school - to foster independence and activity in children. The excursion method also gives good results, as it interests children more than others, but during the first half of the year, excursions should not be too long and frequent until children are accustomed to systematic intellectual work. From other elements of the pedagogical work of the sanatorium school, we should also dwell on the features of club work, which includes physical, artistic, and socio-political education of children. By physical education in the sanatorium school should be understood not only physical exercises, gymnastics lessons, rhythmic exercises, games, but also the entire set of hygienic elements aimed at the correct psycho-physical education of the child. Elements of physical education also include a properly organized hygienic regime, proper dosing of study and rest hours, rationally organized after-lunch rest, walks and games in the fresh air. As for physical exercises, they must be individualized not only according to the biological age groups of the school's children, but also according to the neuropsychiatric characteristics of individual children. In other words, the grouping of children for physical education classes should be built not only on an age basis, but also in accordance with the psychological characteristics of the children. Children with increased nervous excitability require a different load and a different lesson curve. The selection of games must be strictly taken into account in the sanatorium school so as not to cause excessive emotional stress in children. Individual elements of physical education that are at the same time a means of artistic education is rhythmic gymnastics. Rhythmic education is one of the strong means of therapeutic-pedagogical influence. In rhythmic exercises, the most excited, unstable children often calm down. Rhythmic education is especially important as a therapeutic means for children with motor insufficiency and with severe disorders of attention. The education of instinctive rhythm here affects the development of coordination of movements, and disorderly, fussy movements become more purposeful. Artistic education in the sanatorium school should not stand apart, but should penetrate the entire life of the school. As already noted, the entire environment of the sanatorium school (premises, clothing, furniture) should serve to cultivate the aesthetic needs of the child. Individual subjects included in aesthetic education (drawing, music, etc.) should be connected with the entire educational plan and school curriculum. Thus, teaching painting and drawing in the school serves not only special purposes of artistic education, but also represents an important step in the development of the motor apparatus and technical abilities of children. As the experience of the Moscow sanatorium school has shown, the progress of individual children in drawing is also reflected in their work in the woodworking workshop and in school classes. Other elements of artistic education (music, literature) are also important therapeutic-pedagogical means, as they serve as outlets for the excessively increased affectivity of nervous children. Music often calms excited children and raises the vital tone of depressed and shy children. In the sanatorium school, music is given to children as an active action in choral singing and as passive - listening to music. When listening to music, works of major composers are selected, but accessible to children's understanding. Dramatization is one way to understand the emotional life of a child, as in the game children reveal themselves more fully. A properly distributed day of the student, his work in class and in the club are the first element of labor education. For the correct implementation of the latter in the sanatorium school, it is also necessary to organize workshops.

Children most willingly work in the wood-working workshop, in the cardboard and book-binding workshops. Elements of labor education also include children's self-service, which is conducted in the form of duty in bedrooms, dining rooms, workrooms, etc. This can also include work in the garden, vegetable garden, care for animals, birds, etc. The question of treating difficult-to-educate children is relatively little developed in the medical-pedagogical literature. The combination of teaching and education methods, to a small extent drug treatment, etc., constitute medical-pedagogical measures aimed at preventing the possibility of pathological manifestations in a child and creating an environment in which only successful re-education and treatment work can be carried out; this is the regime of the institution, which the sanatorium school instills in children the necessary social and other reflexes; this is a sensitive, attentive attitude toward the child, a labor regime saturated with positive emotions and interests, giving an outlet for the child's activity with the correct use of the child's individual characteristics. Among the individual symptoms with which one has to fight, nocturnal enuresis should be noted. The most valuable method in combating a child's increased excitability is to interest him, to give him the opportunity for affective experiences of a different order but equivalent in strength (sublimation). Treatment of enuresis comes down to general strengthening therapy and regime. Psychotherapy is given a large place in cases where it can be assumed that enuresis is one of the symptoms of insufficient self-regulation. Incompleteness in the emotional-voluntary sphere, and hence the possibility of correcting social attitudes in children of this category, dictates the need, along with developing labor automatisms in them, to also instill automatisms of a social nature. Therefore, great attention in the sanatorium school should be paid to socio-political education, which should be expressed in linking all educational work with educational work—the study of society, nature, and labor—and in developing the initiative of children's organizations (club and circle work, self-government). In the system of educational influences for difficult children, pioneer work acquires special significance as most closely meeting the needs of the children's masses, work that should permeate the entire system of educational work in psychoneurological-type children's institutions. A necessary condition for pioneer work in general is contact with the external environment, based not only on external organizational ties but also on a certain, socially useful work carried out in this environment. Excessive fear of contact with the external environment can lead to the children's collective being isolated and all work being carried out formally. The organization of pioneer work among difficult children should begin with the organization of an outpost, led by a Komsomol member-teacher. The excessive excitability of neuropsychopathic children requires caution in selecting counselors from among the children. The composition of the pioneer detachment as a guiding children's active group should truly be advanced and correctly purposeful. General guidance of pioneer selection should be carried out by a pioneer commission consisting of a Komsomol representative, a teacher, and a physician. m. Falk.