EPILEPTIC 
CHILDREN 
BOARD OF EDUCATION 
THE CITY OF NEW YORK EPILEPTIC CHILDREN THE COMMITTEE FOR THE STUDY OF THE 
CARE AND EDUCATION 
PHYSICALLY HANDICAPPED CHILDREN 
in the 
PUBLIC SCHOOLS OF THE CITY OF NEW YORK 
REPORT OF THE SUB COMMITTEE ON 
EPILEPTIC CHILDREN 
THE BOARD OF EDUCATION 
THE CITY OF NEW YORK 
1941 BOARD OF EDUCATION 
of the 
CITY OF NEW YORK 
DR. HAROLD G. CAMPBELL, Superintendent of Schools 
DR. ALBERTO C. BONASCHI 
ELLSWORTH B. BUCK 
WILLIAM R. CROWLEY 
DANIEL PAUL HIGGINS 
MRS. JOHANNA M. LINDLOF 
james g. McDonald 
JAMES MARSHALL, President THE COMMITTEE FOR THE STUDY OF THE 
CARE AND EDUCATION 
of 
PHYSICALLY HANDICAPPED CHILDREN 
in the 
PUBLIC SCHOOLS OF THE CITY OF NEW YORK 
HON. JAMES MARSHALL, LL.B., Chairman 
President of the Board of Education, City of New York. 
MARGARET W. BARNARD, M.D. 
Director of Bureau of District Health Administration, Department of Health, 
City of New York. 
EDWARD M. BERNECKER, M.D. 
General Medical Superintendent, Department of Hospitals, City of New York. 
CONRAD BERENS, M.D., F.A.C.S. 
Chairman of the American Board of Ophthalmology, New York, N. Y. 
Surgeon and Pathologist, New York Eye and Ear Infirmary, New York, N. Y. 
Directing Ophthalmologist, Midtown Hospital, New York, N. Y. 
Consulting Ophthalmologist, LI. S. Veterans Hospital, New York, N. Y. 
Consulting Ophthalmologist, New York Infirmary for Women and Children, 
New York, N. Y. 
Consulting Ophthamologist, Woman’s Hospital, New York, N. Y. 
ARTHUR C. DeGRAFF, M.D., F.A.C.P. 
Samuel A. Brown Professor of Therapeutics, New York University, College 
Medicine, New York, N. Y. 
Lecturer in Medicine, New York University, College of Dentistry, New York, 
N. y. 
Visiting Physician, Bellevue Hospital, New York, N. Y. 
Chief of New York University Cardiac Clinic, New York, N. Y. 
Chief of After-Care Clinic of Irvington House, New York, N. Y. 
Consulting Cardiologist, Nassau Hospital, Mineola, Long Island. 
Consulting Cardiologist, Meadowbrook Hospital, Hempstead, Long Island. 
Consulting Cardiologist, New York Infirmary fr Women and Children, New 
York, N. Y. 
Consulting Cardiologist, St. Agnes Hospital, White Plains, New York, 
Consulting Cardiologist, Hackensack Hospital, Hackensack, New Jersey. 
BENJAMIN P. FARRELL, M.D., F.A.C.S. 
Formerly Surgeon-in-Chief, New York Orthopaedic Hospital, New York, N. Y. 
Professor Emeritus of Orthopedic Surgery, College of Physicians and Surgeons, 
Columbia University, New York, N. Y. 
Consultant, Englewood Hospital, Englewood, New Jersey. 
EDMUNE) PRINCE FOWLER, M.D., F.A.C.S. 
Consulting Otologist, Manhattan Eye, Ear, Nose and Throat Hospital, New 
York, N. Y. 
Consulting Otologist, St. Mary’s Hospital for Children, New York, N. Y. 
Consulting Otologist, National Hospital for Speech Disorders, New York, N. Y. 
V GEORGE H. HYSLOP, M.D. 
Attending Neurologist, Neurological Institute, New York, N. Y. 
Neurologist, Memorial Hospital, New York, N. Y. 
Assistant Clinical Professor of Neurology, College of Physicians and Surgeons, 
Columbia University, New York, N. Y. 
Consulting Neurologist, New York State Reconstruction Home, West Haver- 
straw, New York. 
Consulting Neurologist, St. Agnes Hospital, White Plains, New York. 
Consulting Neurologist, Nyack Hospital, Nyack, New York. 
DAVID J. KALISKI, M.D. 
Syphilologist, Beth Israel Hospital, New York, N. Y. 
Formerly Assistant G. U. Surgeon and Surgeon-in-Chief, G. U. Clinic, Mount 
Sinai Hospital, New .York, N, Y. 
WALTER O. KLINGMAN, M.D. 
Associate Attending Neurologist, Neurological Institute, New York, N. Y. 
Associate Attending Neurologist, Babies Hospital, New York, N. Y. 
Assistant Physician, French Hospital, New York, N, Y. 
Consulting Neurologist, South Side Hospital, Bayshore, Long Island. 
Assistant Pediatrician, Vanderbilt Clinic, New York, N. Y. 
ELWOOD S. MORTON, M.D. 
Medical Officer-in-charge, Bay Ridge-Sunset Park Health Center, Department 
of Health, City of New York. 
FRANK J. O’BRIEN, M.D. 
Director of Bureau of Child Guidance, Board of Education, City of New York. 
GEORGE T. PALMER, Dr. P.H. 
Deputy Commissioner of Health, Department of Health, City of New York. 
MARSHALL C. PEASE, M.D., F.A.C.P. 
Clinical Professor of Pediatrics, Post Graduate Medical School and Hospital, 
Columbia University, New York, N. Y. 
Physician, Willard Parker Hospital, New York, N. Y. 
Consulting Pediatrician, Lutheran Hospital, New York, N. Y. 
Consulting Pediatrician, Jatnaica Hospital, Jamaica, Long Island. 
Consulting Pediatrician, Fitkin Memorial Hospital, Ashury Park, New Jersey. 
Consulting Pediatrician, Monmouth Memorial Hospital, Long Branch, New 
Jersey. 
Physician, Babies Ward, Post-Graduate Hospital, New York, N. Y. 
HENRY A. RILEY, M.D. 
Neurologist, Neurological Institute, New York, N. Y. 
Consulting Neurologist, Reconstruction Unit, Post-Graduate Hospital, New 
York, N. Y. 
Consulting Neurologist, Englewood Hospital, Englewood, New Jersey. 
Visiting Neurologist, Welfare Hospital, Welfare Island, New York, N. Y. 
JACOB THEOBALD, B.A. 
Assistant Superintendent of Schools, Board of Education, City of New York 
ELIZABETH A. WALSH* 
Director, Bureau for Children with Retarded Mental Development, Board of 
Education, City of New York. 
HERBERT B. WILCOX, M.D. 
Director, New York Academy of Medicine, New York, N. Y. 
Professor Emeritus of Pediatrics, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
VI IRA S. WILE, M.D. 
Associate in Pediatrics, Mount Sinai Hospital, New York, N. Y. 
Lecturer on Disorders of Conduct and Personality, Columbia University, 
New York, N. Y., Hunter College, City of New York, and Brooklyn 
College, City of New York. 
I. OGDEN WOODRUFF, M.D., F.A.C.P. 
President, New York Tuberculosis and Health Association, New York, N. Y. 
Professor of Clinical Medicine, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
Medical Director, Bellevue Hospital, New York, N. Y. 
Educational Consultants 
JOSEPH J. ENDRES 
Chief of Bureau of Physically Handicapped Children, State Education Depart- 
ment, Albany, N. Y. 
NICKOLAUS L. ENGLEHARDT, Ph.D. 
Professor of Education, Teachers College, Columbia University, New York, 
N. Y. 
MARGARET J. McCOOEYf 
Associate Superintendent of Schools, Board of Education, City of New York. 
GEORGE D. STRAYER, Ph.D. 
Director of Division of Field Studies, Institute of Educational Research, and 
Professor of Education, Teachers College, Columbia University, New York, 
N. Y. 
JOHN W. STUDEBAKER, LL.D. 
United States Commissioner of Education, Federal Security Agency, U. S. 
Office of Education, Washington, D. C. 
LEWIS A. WILSON, D.Sc., LL.D. 
Associate Commissioner of Education, State Education Department, Albany, 
N. Y. 
Director of the Study 
HAROLD W. McCORMICK, Ed.D. 
* Deceased April 16, 1940. 
t Retired January 31, 1941. 
VII REPORTS 
of 
THE COMMITTEE FOR THE STUDY OF THE 
CARE AND EDUCATION OF PHYSICALLY 
HANDICAPPED CHILDREN 
GENERAL REPORT 
Physically Handicapped Children in New York City 
OTHER REPORTS OF THE COMMITTEE 
Acoustically Handicapped Children Edmund Prince Fowler, Sr., M.D. 
Chairman 
Cardiac Classes and the Care of Cardiac Arthur C. DeGraff, M.D. 
Children Chairman 
Children With Speech Defects Walter O. Klingman, M.D. 
Chairman 
Children With Tuberculosis I. Ogden Woodruff, M.D. 
Chairman 
Epileptic Children George H. Hyslop, M.D. 
Chairman 
Open Air Classes and the Care of Below I. Ogden Woodruff, M.D. 
Par Children Chairman 
Orthopedically Handicapped Children Benjamin P. Farrell, M.D. 
Chairman 
Psychological Considerations in the Ira S. Wile, M.D. 
Education of the Handicapped Chairman 
The Education of Children in Hospitals Marshall C. Pease, M.D. 
and Convalescent Homes Chairman 
Visually Handicapped Children Conrad Berens, M.D. 
Chairman 
VIII SUB-COMMITTEE ON EPILEPTIC CHILDREN 
GEORGE H. HYSLOP, M.D., Chairman 
Attending Neurologist, Neurological Institute, New York, N. Y. 
Neurologist, Memorial Hospital, New York, N. Y. 
Assistant Clinical Professor of Neurology, College of Physicians and Surgeons, 
Columbia University, New York, N. Y. 
Consulting Neurologist, New York State Reconstruction Home, West 
Haver straw, New York, N. Y. 
Consulting Neurologist, Si. Agnes Hospital, White Plains, New York. 
Consulting Neurologist, Nyack Hospital, Nyack, New York. 
FRANK J. CURRAN, M.D. 
Senior Psychiatrist, Psychiatric Division, Bellevue Hospital, New York, N. Y. 
Assistant Clinical Professor of Psychiatry, New York University Medical 
School, New York, N. Y.. 
WARREN HUBER, M.D. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
Associate Attending Neurologist, Brooklyn Hospital, Brooklyn, N. Y. 
Associate Attending Neuro-Psychiatrist, Welfare Hospital, New York, N. Y. 
ROBERT McGRAW, M.D. 
Chief of Clinic, Department of Psychiatry, Vanderbilt Clinic, New York, N.Y. 
Clinical Professor of Psychiatry, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
Consulting Psychiatrist, North County Community Hospital, Glencove, 
New York. 
VERONICA O’BRIEN, M.D. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
Neurological Department of Vanderbilt Clinic, New York, N. Y. 
New York Infirmary for Women and Children, New York, N. Y. 
IRVING J. SANDS, M.D. 
Assistant Clinical Professor of Neurology, Columbia University Medical 
School, New York, N. Y. 
Associate Attending Neurologist, Neurological Institute, New York, N. Y. 
Neurologist, Brooklyn Jewish Hospital, Brooklyn, N. Y. 
Neuropsychiatrist, Beth El, Kingston Ave. and Coney Island Hospitals, 
Brooklyn, N. Y. 
Consulting Neuropsychiatrist, Brooklyn State Hospital, Brooklyn, N. Y. 
Consulting Neuropsychiatrist, Rockaway Beach Hospital, Rockaway Beach, 
New York. 
Consulting Neuropsychiatrist, St. Joseph’s Hospital, Brooklyn, N. Y. 
NATHAN SAVITSKY, M.D. 
Associate Neurologist, Montefiore Hospital, Bronx, N. Y. 
Associate Neurologist, Morrisania Hospital, Bronx, N. Y. 
Associate in Neurology, College of Physicians and Surgeons, New York, N. Y. 
Consultants to the Committee 
LYMAN C. DURYEA, M.D. 
Director, Crippled Children’s Division, Department of Health, City of 
New York. 
IX ROBERT T. ROCK, Ph.D. 
Head of the Department of Psychology and Professor of Psychology, Fordbam 
University, New York, N. Y. 
Physicians Assisting Committee 
JOSEPH L. ABRAMSON, M.D. 
Associate Attending Neurologist, Jewish Hospital, Brooklyn, N. Y. 
Associate Attending Neurologist, Kings County Hospital, Brooklyn, N. Y. 
Associate Attending Neurologist, Bushwick Hospital, Brooklyn, N. Y. 
Assistant in Neurology and Psychiatry, Long Island College of Medicine, 
Brooklyn, N. Y. 
Chief of Clinic, Neurological Service, 0.P.D., Jewish Hospital, Brooklyn, N.Y. 
EARL A. ADAMS, M.D. 
Assistant Adjunct Neurologist, Lenox Hill Hospital, New York, N. Y. 
Assistant Adjunct Neurologist, 0.P.D., Lenox Hill Hospital, New York, N.Y. 
Instructor in Psychiatry, College of Physicians and Surgeons, Columbia Uni- 
versity, New York, N. Y. 
Associate in Psychiatry, Vanderbilt Clinic, New York, N. Y. 
Psychiatrist to the University Medical Office, Columbia University, New York, 
N. Y. 
Associate in Psychiatry, Stamford Hospital, Stamford, Connecticut. 
H. V. AGIN, M.D. 
Adjunct Neurologist and Neurologist in Charge of Clinic, Beth-El Hospital, 
Brooklyn, N. Y. 
Assistant Attending Neurologist, Kings County Hospital, Brooklyn, N. Y. 
Assistant Attending Neurologist, Jewish Hospital, Brooklyn, N. Y. 
FRANCIS C. ANSANELLI, M.D. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
Assistant Neurologist, Morrisania Hospital, Bronx, N. Y. 
Assistant Adjunct Neuropsychiatrist, Lenox Hill Hospital, New York, N. Y. 
THOMAS E. BAMFORD, Jr., M.D. 
Assistant Visiting Physician (Neurology), Bellevue Hospital, New York, 
N. Y. 
Adjunct Neurologist, Lenox Hill Hospital, New York, N. Y. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
IRVING BIEBER, M.D. 
Adjunct Neurologist, Mt. Sinai Hospital, New York, N. Y. 
Assistant Neurologist, Queens General Hospital, Jamaica, L. I. 
WALTER D. BRIEHL, M.D. 
Associate Attending Psychiatrist, Vanderbilt Clinic, New York, N. Y. 
Instructor in Psychiatry, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
MATTHEW BRODY, M.D. 
Assistant Physician, Brooklyn State Hospital, Brooklyn, N. Y. 
Clinical Assistant, Neurology, Jewish Hospital, Brooklyn, N. Y. 
Clinical Assistant in Psychiatry, Brooklyn Child Guidance Clinic, Brooklyn, 
N. Y. 
X PETER G. DENKER, M.D. 
Neurologist, Hospital for Ruptured and Crippled, New York, N. Y. 
Instructor, Clinical Neurology, Cornell University Medical College, New 
York, N. Y. 
HENRY HARRIS DREWRY, M.D., Ph.G., 8.5., D.Med.Sc. 
Visiting Neurologist, Neurological Institute, New York, N. Y. 
Assistant Attending Neurologist, Vanderbilt Clinic, New York, N. Y. 
Psychiatrist, Domestic Relations Court, New York, N. Y. 
WALTER EINHORN, M.D. 
Clinical Assistant, Visiting Physician of the Neurological Clinic and Female 
Medical Clinic, Morrisania Hospital, Bronx, N. Y. 
Assistant in Cardiac Clinic and Female Medical Clinic, Lebanon Hospital, 
Bronx, N. Y. 
JACOM H. FRIEDMAN, M.D. 
Associate Visiting Neurologist, Fordham Hospital, Bronx, N. Y. 
Chief, Mental Hygiene Clinic, Lebanon Hospital, Bronx, N. Y. 
Visiting Psychiatrist, Hastings Hillside Hospital, Hastings-on-Hudson, New 
York. 
MAURICE FROCHT, M.D. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
Assistant Attending Neurologist, Vanderbilt Clinic, New York, N. Y. 
Instructor in Neurology, College of Physicians and Surgeons, New York, 
N. Y. 
Adjunct Neuropsychiatrist, Lenox Hill Hospital, New York, N. Y. 
Attending Neuropsychiatrist, Lenox Hill Dispensary, New York, N. Y. 
ALFRED GALLINEK, M.D. 
Assistant Neurologist, Neurological Institute, New York, N. Y. 
Assistant Neurologist, Vanderbilt Clinic, New York, N. Y. 
Assistant Visiting Neuropsychiatrist, Welfare Hospital, New York, N. Y. 
Assistant in Neurology, Columbia University, New York, N. Y. 
EDWARD M. GOULD, M.D. 
Attending Neurologist, St. John’s Long Island City Hospital, Long Island, 
New York. 
Attending Neuropsychiatrist, Queens General Hospital, Jamaica, New York. 
Consultant Neurologist, Rockaway Beach Hospital, Rockaway Beach, New 
York. 
THEODORE G. HOLZSAGER, M.D. 
Associate Pediatrician, Cumberland Hospital, Brooklyn, N. Y. 
Adjunct Pediatrician in charge of Children’s Neuropsychiatric Clinic, Jewish 
Hospital, Brooklyn, N. Y. 
Assistant Pediatrician, Kingston Avenue Hospital, Brooklyn, N. Y. 
KNUT H. HOUCK, M.D. 
Assistant Attending Neurologist, Beekman Hospital, New York, N. Y. 
Assistant Neurologist and Psychiatrist, New York Post-Graduate Hospital, 
New York, N. Y. 
Attending Neurologist and Psychiatrist, New York Post-Graduate Dispensary, 
New York, N. Y. 
Assistant Neuropsychiatrist, Welfare Hospital, New York, N. Y. 
XI DAVID JOHN IMPASTATO, M.D. 
Visiting Neuropsychiatrist, Columbus Hospital, New York, N. Y. 
Associate Neuropsychiatrist, Welfare Hospital, New York, N. Y. 
Associate Neuropsychiatrist, City Hospital, New York, N. Y. 
Instructor in Neurology, New York University Medical School, New York. 
OLGA KNOPF. M.D. 
Assisting Visiting Physician (Neurology), Bellevue Hospital, New York, 
N. Y. 
ABBOTT A. LIPPMAN, M.D. 
Assistant Neurologist, Brooklyn Jewish Hospital, Brooklyn, N. Y. 
Assistant Neurologist, Kings County Hospital, Brooklyn, N. Y. 
MOSES J. MADONICK, M.D. 
Assistant Psychiatrist, Psychiatric Institute, 0.P.D., New York, N. Y. 
Assistant Neuropsychiatrist, Morrisania City Hospital, Bronx, N. Y. 
Adjunct Neurologist, Montepore Hospital, Bronx, N. Y. 
Adjunct Neuropsychiatrist, Sydenham Hospital, New York, N. Y. 
Instructor, Neurology, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
JOHN A. MARCHETTI, M.D. 
Assistant, Neurology, Kings County Hospital, Brooklyn, N. Y. 
Clinical Assistant, Neurology, Brooklyn Hospital, Brooklyn, N. Y. 
MEYER MASKIN, M.D. 
Clinical Assistant in Psychiatry, Beth Israel Hospital, New York, N. Y. 
IRWIN MASON, M.D. 
Adjunct Neurologist, Bronx Hospital, Bronx, N. Y. 
Assistant Neuropsychiatrist, Morrisania City Hospital, Bronx, N. Y. 
MARY E. O’SULLIVAN, M.D. 
Assistant Visiting Physician (Neurology), Bellevue Hospital, New York, 
N. Y. 
Assistant Clinical Professor of Neurology, New York University, New 
York, N. Y. 
JOSEPH OWEN, M.D. 
Assistant Attending Physician (Neurology), Bellevue Hospital, New York, 
N. Y. 
Psychiatrist, 0.P.D., New York Hospital, New York, N. Y. 
Instructor in Clinical Neurology, New York University Medical School and 
Cornell University, New York, N. Y. 
J. LAWRENCE POOL, M.D. 
Assistant Neurosurgeon, Bellevue Hospital, New York, N. Y. 
Consulting Neurosurgeon, Orange Memorial Hospital, Orange, New Jersey. 
Consulting Neurosurgeon, Meadowbrook Hospital, Hempstead, Long Island. 
Assistant in Research, Columbia University, New York, N. Y. 
ELIAS REED, M.D. 
Director and Chief Psychiatrist, Brooklyn Child Guidance Clinic, Brooklyn, 
N. Y. 
Associate Neuropsychiatrist, Brooklyn Jewish Hospital, Brooklyn, N. Y. 
Assistant Neuropsychiatrist, New York Post-Graduate Hospital, New York 
N. Y. 
Attending Neuropsychiatrist, Boro Park General Hospital, Brooklyn, N. Y. 
Attending Neurologist, Long Island College Hospital, 0.P.D., Brooklyn, 
XII ABRAHAM ARNOLD RICHMAN, M.D. 
Assistant Neurologist, Coney Island Hospital, Brooklyn, N. Y. 
Assistant Neurologist, Israel Zion Hospital, Brooklyn, N. Y, 
ALEXANDER H. RUBINOWITZ, M.D. 
Assistant Attending Neurologist, Neurological Institute, New York, N. Y. 
Attending Neurologist, Beth Moses Hospital, Brooklyn, N. Y. 
Diplomat, American Board of Neurology and Psychiatry in Neurology and 
Psychiatry. 
HERMAN SELINSKY, M.D. 
Adjunct Neurologist, Mount Sinai Hospital, New York, N. Y. 
Visiting Psychiatrist, Hastings Hillside Hospital, Hasting-on-Hudson, N. Y. 
JUDITH SILBERPHENNIG, M.D. 
Psychiatrist to Out-Patient Department, New York Hospital, New York, 
N. Y. 
Assistant Psychiatrist, Mount Sinai Hospital, New York, N. Y. 
DONALD J. SIMONS, M.D. 
Instructor in Medicine (Neurology), Cornell Medical College, New York, 
N. Y. 
Assistant in Neurology, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
Physician to Outpatients New York Hospital, New York, 
N. Y. 
Assistant Psychiatrist to Outpatients, Payne Whitney Clinic, New York 
Hospital, New York, N. Y. 
SONIA STIRT, M.D. 
Assistant Neurologist, Neurological Institute, New York, N, Y. 
Persons Consulted by the Committee 
BEVERLEY L. CHANEY, M.D. 
Attending Neurologist, Neurological Institute, New York, N. Y. 
Visiting Neurologist, Welfare Hospital, Welfare Island, City of New York. 
Associate in Neurology, College of Physicians and Surgeons, Columbia 
University, New York, N. Y. 
TRACY J. PUTNAM, M.D. 
Director of Services of Neurology and Neurosurgery, Neurological Institute, 
New York, N. Y. 
Professor of Neurology and Neurosurgery, College of Physicians and 
Surgeons, Columbia University, New York, N. Y. 
Other Persons Assisting Committee 
SYLVIA FINSTON, B.S. 
Medical Social Worker, Bronx Hospital, Bronx, N. Y. 
EVELYN SHELTER, M.S. 
Psychologist, Morrisania City Hospital, Bronx, N. Y. 
XIII CONTENTS 
I. Preface 1 
11. Organization of Subcommittee and Definition of the 
Problem 3 
111. Organization of the Survey, and Departmental Organi- 
zation 7 
IV. Reports from Other Cities in the United States 17 
V. Analyses of Questionnaires and the Register of Pupils 
Receiving Home Instruction 21 
VI. Results of Visiting Program and Comments 31 
VII. Conclusions and Recommendations 55 Preface 
'T* his statement of findings and conclusions of the com- 
A mittee studying the problems of epileptic children is one 
section of the report of the Committee for the Study of the 
Care and Education of Physically Handicapped Children in the 
Public Schools of the City of New York, The Committee was 
appointed by the Board of Education in 1936. All of its in- 
quiries, which extended over a period of more than three 
years, have been made by sub-committees. No appropriation 
was given the Committee for the employment of technical and 
clerical personnel. The studies were possible only because of 
the voluntary assistance of physicians, educators and other 
specialists who have given much time and consideration to the 
problems presented by handicapped children, the provisions 
now made for them and the ways in which the existing program 
can be improved. Clerical and statistical help was provided 
by the Works Project Administration and numerous philanthropic 
organizations. 
In addition to the persons listed in this report the Com- 
mittee is indebted to the Superintendent of Schools, Dr. Harold 
G. Campbell, to the teachers and school officials and others who 
have helped in the survey. The Director acknowledges his 
personal indebtedness to Dr. Lyman C. Duryea and to Dr. 
Robert T. Rock, Jr. Finally he is indebted to the Public Health 
Relations Committee of the New York Academy of Medicine 
which has critically reviewed this and the other reports of the 
Committee. 
Harold W. McCormick, 
Director. 
1 Organization of the Committee 
and Definition of Problem 
T N October, 1939, a committee was formed to participate 
in the general survey being made for the Board of Education 
with respect to the care and education of physically handicapped 
children. 
Although other cities of the United States have recognized 
that certain epileptics involve a special educational problem, this 
Committee’s effort has been to get all the available and relevant 
information about children in New York City. For approximately 
twenty years the Department of Education of New York City 
has had a special branch or division for the instruction of physi- 
cally handicapped children. 
With respect to the incidence of epilepsy, one should first 
attempt to define the term. In recent years, the word "epilepsy” 
is being replaced by the term "convulsive seizure,” and the 
tendency to such attacks is known as a "convulsive disorder.” 
While it is recognized that there are many seeming causes for 
the occurrence of attacks in individuals, it is becoming recognized 
that in a large proportion of cases there is probably an inborn 
predisposition to such physical reaction. A person may have one 
attack during a life time; on the other hand, seizures may first 
appear at any time in life and continue for varying periods, 
sometimes with years of freedom from attacks. In general, the 
"epileptic” is understood as a person subject to repeated seizures, 
regardless of what seems to be the precipitating cause. Since 
the tendency to seizures occurs as a symptom in a number of 
organic or structural defects of the brain—either prenatal or 
post-natal in origin—it is recognized that the incidence of some 
degree of mental deficiency is greater among those subject to 
repeated epileptiform attacks than it is in the population at 
large. The percentage of tire population subject to epileptiform 
seizures is reported by various authorities as varying from one 
3 Definition of Problem 
in a thousand of the population to one in two hundred. With 
respect to the age at onset of seizures, various authorities state 
that from perhaps thirty to as high as fifty percent of individuals 
subject to repeated seizures have their first attacks during or prior 
to puberty. 
Any good textbook in psychiatry or neurology will present 
in readable form, intelligble to a properly trained educator, 
the facts with respect to the tendency to recurrent epileptiform 
seizures. Nevertheless, a very brief description of this disorder 
may be helpful. 
An "epileptic” seizure, or fit, or "grand mal attack” man- 
ifests itself in three stages. The first stage, or onset, may last 
two or three seconds or in some instances as long as half a 
minute. The sufferer may utter a cry, stiffen out, collapse, and 
become unconscious—or unresponsive to stimuli. There may 
be pallor, but congestion of the blood in the face is more 
common. The next phase is the convulsive atack itself. In 
the great majority of cases, there are involuntary and uncontrol- 
lable jerks or twitchings, which may be limited to one ex- 
tremity, the face muscles, or one half the body; commonly, 
the entire body is involved in such convulsive movements. 
Frothing at the mouth and emptying of the bladder may occur. 
In a few moments, usually not more than ten minutes, the 
convulsive movements gradually cease, the color of the skin 
returns to normal, and the sufferer may appear to be asleep. 
The third stage, or "after-stage” varies considerably. Weak- 
ness and lassitude, headache and mental confusion and retard- 
ation are often evident, and the sufferer may fall asleep. Us- 
ually within half an hour the sufferer appears to have returned 
to normal. 
It is this sort of fit which seizes the attention of the lay- 
man, and which produces anxiety in the minds of school 
officers. 
Less severe types of epileptic manifestations include the 
so-called "Jacksonian seizure” and the petit mal attack. The 
4 Definition of Problem 
former may commence in a manner similar to the grand mal 
attack, with the movements usually limited to one side of the 
body, but as a rule consciousness is retained and the patient 
does not completely lose control, and is able to afford himself 
some protection against injury due to a fall. In the "petit mal” 
attack, the manifestation may be so slight that its occurrence 
passes unnoticed. A failure to attend momentarily to what is 
going on, with a brief twitching or quivering of the body, may 
be all that can be observed. Usually, the sufferer is unaware 
that the attack is occurring, but immediately afterward knows 
that it has taken place. 
While it is not yet definitely established or agreed to by 
all authorities that there is often a congenital or hereditary 
predisposition to all epileptiform manifestations, it is recog- 
nized that predisposing or precipitating factors can usually be 
determined through the study of an individual sufferer. The 
incidence of some form of structural disease of the brain is 
rather high in sufferers from epileptic seizures. Attacks occur 
relatively frequently in individuals with mental deficiency, 
whether or not the defect is demonstrably connected with any 
structural changes in the brain. Children with certain types 
of unstable nervous systems are prone to convulsive seizures 
or epileptic attacks when their health is impaired by some 
transient disorder. It has long been known that emotional 
or mental stress serves to increase the frequency of seizures. 
The search for primary, secondary and contributing causes 
requires the attention of a physician familiar with diseases of 
the nervous system. In the more difficult problems, the medical 
inquiry may require hospital study, the performance of various 
special tests, and observation which may not yield results 
enabling a conclusion until a year or more has passed. 
Epileptic seizures are physiologically related to other par- 
oxysmal episodic disorders which may affect other organs in 
the body. The most important criterion of a true epileptiform 
attack is a complete loss of consciousness or awareness of 
5 Definition of Problem 
surroundings during an attack. There are many individuals 
whose "attacks” are difficult to differentiate from the acute 
emotional disturbances and displays of individuals who are 
suffering from some purely psychological disorder. A rather 
rare form of true epilepsy consists of transient uncontrollable 
displays of reasonless temper, and even episodes of seemingly 
silly or purposeless conduct of which the individual is unaware 
and has no recollection. 
It is well recognized that those who have repeated and 
frequent grand mal seizures may develop a progressive loss 
of intelligence. This fact is of particular importance to the 
educator whose primary function and purpose it is to discipline 
the mind and teach the things which may not only enable the 
individual to be a self-sustaining member of society, but make 
him a useful citizen. 
The Committee made a survey of literature dealing with 
methods of measuring intelligence, and the intelligence of 
epileptics. A comprehensive and accurate presentation of this 
literature would have extended the work of the Committee 
beyond its basic purpose, and required an expenditure of time 
not available. The subject has therefore been omitted from 
this report. 
6 Organization of the Survey 
and Departmental Organization 
Questionnaires were sent to every teacher of epileptic 
pupils under home instruction. 
The questionnaire sent to the principals of all the 
public schools in New York City was so phrased that inevitably 
certain children would be included who may have some form 
of syncope or loss of consciousness, but are not subject to 
recurrent seizures of definite epileptiform character. A few 
children in poor general physical condition or with certain 
types of cardiac disease were known to be subject to ordinary 
syncope, a small number of children with diabetes mellitus 
required the special attention of teachers because they might 
develop insulin shock and either go into a coma or have a 
convulsive seizure. Of the total of 958 children reported, 
there were certain other sources of error in attempting to get 
an accurate total. A few children reported as having been 
excluded from school during the two years previous to the 
reporting date had either returned to regular class or had 
been placed on home instruction, and thus their names appeared 
twice. A number of children were reported as having been 
transferred from one school to another; in most instances the 
new school did not report these children as enrolled—thus 
suggesting that the school system does not have a smoothly 
working and accurate system of recording and keeping track 
of these children. 
After a study of the questionnaires that were returned, 
and tabulation of certain data obtained from these question- 
naires, a program of visits to pupils was arranged. 
The work of visiting the reported pupils was scheduled 
in the following manner. The borough of Richmond was 
excluded because of its inaccessibility to physicians serving on 
the Committee and the small number of pupils reported. Each 
7 Departmental Organization 
of the other boroughs in New York City had designated as 
supervising physician a member of the Committee, who was 
responsible for the direction of other physicians giving voluntary 
service as assistants. 
In selecting physicians to engage in the visiting program, 
an adequate background in neurology and psychiatry was 
regarded as a requisite. 
The pupils known to the school system as subject to 
epileptiform convulsions were reported in three groups. First 
were those still attending school; second were those excluded 
from class any time during the two years prior to the reporting 
date, which was approximately January 1, 1940; third were 
the pupils who had been assigned to home instruction. 
Visits were made to children in the first and third groups. 
Of the second group, a number were found reported as under 
home instruction; of the others in the second group, some 
presumably changed residence and dropped out of sight, and 
an attempt to arrange authorization by the parents to make 
a home visit was regarded as sufficiently difficult and time 
consuming to justify omission. 
Inasmuch as a total of 958 children were reported, the 
visiting program was restricted to the personal examination 
of a sufficient number of children to represent a correct sample 
of the entire number. Since study of the returned question- 
naires showed certain apparent common and important facts, 
and since additional information was regarded as desirable 
with respect to a certain number of pupils, the visiting list 
was made up accordingly. 
For example, children whose diagnosis seemed dubious 
were selected for visits. In certain instances children presenting 
a vocational training problem were selected. Perhaps half of 
the children presented these or analogous special problems. 
The remainder of the children visited were picked at random. 
8 Departmental Organization 
The procedure in making visits was as follows. The 
physician visiting a child in regular class first arranged with 
the principal of the school for a convenient time. The principal 
attempted to obtain written parental consent for the examina- 
tion of the pupil. When the parents refused such an examina- 
tion, the physician limited his contact with the pupil to in- 
spection and questioning of the child on presumably relevant 
matters. When reporting to the school in question, the visiting 
physician reviewed the information in the principal’s office and 
then conducted an examination of the pupils, filling out a special 
visiting form. The visting forms were forwarded promptly 
to the Borough Supervisor who then forwarded them to the 
Chairman of the Committee. 
With respect to pupils under home instruction, the pro- 
cedure was different. Each physician doing such visiting work 
first interviewed the teachers of pupils assigned to him. Then, 
if written parental authorization for a visit was obtained by 
the teacher, an appointment was made for the physician to 
examine the child in its own home where the visiting form 
was filled out. These visiting forms were forwarded directly 
to the Chairman of the Committee. 
In general, it can be said that the principals of schools 
and the teachers of children under home instruction had a 
cooperative attitude. In a few instances, it was necessary to 
reassure principals or teachers that the various physicians were 
engaged in a survey authorized by the Board of Education and 
there were occasional instances where the attitude was very 
suggestive of opposition to the proposed visits. 
In the course of the visiting work, over 260 children were 
examined. Of these about 200 were pupils in school; the 
rest were under instruction at home. 
From the questionnaires, the names of 62 children reported 
as having been examined or cared for in one of the units of the 
Columbia-Presbyterian Medical Center were given to a member 
9 Departmental Organization 
of the Committee who made a special study of the medical 
records of these children. 
Although the pupils excluded from school were not visited 
personally, those who had been reported as examined or cared 
for at certain of the larger municipal or voluntary hospitals 
were selected and the medical records of those children studied. 
The additional medical information thus obtained was found 
to add little to what was previously known. 
In connection with the preliminary work of this Committee, 
its Chairman interviewed certain officers of the Department 
of Education. 
On March 19th, the Director of the Survey of the Physically 
Handicapped, and the Chairman of this Committee had an 
interview with the Associate Superintendent in Charge of the 
Education of the Handicapped and the Assistant Director in 
charge of instruction of physically handicapped children. The 
Associate Superintendent had another appointment which made 
it necessary for her to leave before the interview was completed. 
The Associate Superintendent and the Assistant Director 
concurred in giving the following information: 
1. Procedures with respect to epileptic children have not 
changed since 1933. 
2. It is seldom that a parent voluntarily informs the 
school of the existence of fits. In the majority of instances, 
discovery occurs if a fit happens during class hours or on the 
school premises; occasionally instances of epilepsy are discovered 
in the course of examination of children referred to the Bureau 
of Child Guidance because of their behavior, or to the Bureau 
for Children with Retarded Mental Development. 
3. Before considering excluding the child from school, 
efforts are made to obtain the cooperation of the parents, with 
respect not only to medical examination and attention but other 
matters that are germane. If exclusion of a child is considered, 
10 Departmental Organization 
then the Medical Board is responsible for making an examin- 
ation and giving a recommendation as to exclusion. Neither the 
Associate Superintendent in Charge of the Education of the 
Handicapped nor the Assistant Director in Charge of the Di- 
vision of Physically Handicapped Children were able to state 
the Medical Board’s standards for recommending exclusion, but 
they both agreed in saying that its recommendations are almost 
invariably followed. There is no psychiatric or psychological 
examination given to the child prior to exclusion unless it has 
been in a class for children with retarded mental development. 
4. Once a child has been excluded from school, it is 
placed on home instruction as soon as opportunity is available. 
There is a further check up of the child before assignment to 
home instruction. Reports from physicians are obtained, the 
school record is studied, and a psychometric examination is 
made. Unless a child is regarded as non-educable or unable 
to benefit from home instruction, this facility is granted. Since 
the State law arbitrarily establishes an I. Q. of between 50 
and 75 for classification as mentally retarded, children in this 
intelligence level group may be referred to the Bureau for 
Children with Retarded Mental Development and if regarded 
as non-educable and certified as such by the Superintendent of 
Schools, home instruction may be denied. 
5. If a child is regarded as subnormal mentally, after a 
complete survey, and there is doubt as to the feasibility of 
home instruction, a trial is given and home instruction continued 
if satisfactory progress is being made. The Assistant Director 
stated, in response to a letter of inquiry from the Chairman 
of this Committee, that approximately 26% of the epileptics 
under home instruction are below border line intelligence and 
had been continued under home instruction as part of an 
experimental study. 
6. Teachers assigned to home instruction are not pro- 
vided with the results of psychometric tests. Teachers giving 
home instruction are required to submit regular reports as to 
11 Departmental Organization 
the progress of the child, the occurrence of seizures, and 
whether or not medical attention is provided by the parents. 
If progress is unsatisfactory, a child may be referred to various 
institutions in the city, particularly Bellevue Hospital, and in- 
stitutional care arranged for if it is deemed advisable. 
There are no standards for what might be regarded as 
satisfactory progress under home instruction. Children origin- 
ally identified as retarded or defective mentally are not required 
to submit to repetitions of the various psychometric tests. 
7. "Every child has the right to individual study and 
adjustment.” Information was not available as to how fre- 
quently it is that a home instruction teacher reports satisfactory 
progress. Only a very small percentage of epileptics under 
home instruction are reported as deficient in progress, and 
many of these children may return to school after six months 
or a year of home instruction. About October, 1939, the 
ruling was made providing that if a child has been free of 
seizures for six or eight months, it returns to regular class 
work—such children no longer being routed through the office 
of the Medical Board. 
The Asistant Director in Charge of the Division of Phy- 
sically Handicapped Children gave the following additional 
information: 
1. Children remain under home instruction unless they 
improve sufficiently to return to regular class, or unless they 
are regarded as not benefited from the special home teaching. 
What the turnover has been during the past years is not readily 
determinable, but the facts could be obtained by reference to 
the semiannual lists of children under home instruction and 
determining by the names whether or not a child’s status has 
changed. The guess was ventured that perhaps twenty-five of 
about three hundred epileptics under home instruction as of 
June 30, 1939, might have returned to school since that date 
and that perhaps there is a ten per cent turnover. Of the 
12 Departmental Organization 
few excluded from any instruction, most of them are sent to 
the Craig Colony. 
2. More than fifty per cent of the epileptics under home 
instruction are assigned by request of their parents (after 
submitting adequate medical information) and these children 
have not been examined by the Medical Board and have not 
been officially excluded from regular class by the usual routine. 
While under home instruction, medical care is required. That 
is, the home instruction teacher reports at least twice a year 
with respect to the medical care provided. There is no know- 
ledge of any case of an epileptic under home instruction not 
receiving medical care. 
3. When asked again with respect to the question of 
repeating psychometric tests, the reply was to the effect that 
I. Q.’s are a "movable item,’’ that giving this information to 
home instruction teachers is contrary to policy, and that although 
the home instruction teachers were sufficiently trained, one 
could judge the progress of the child by many factors, and 
that one made allowance for the sort of progress which a 
child might be predicted to make before assignment to home 
instruction. 
4. When asked what might be the procedure if a sixteen 
year old child had been under home instruction for several 
years and was still at the 3A grade level, the reply was to the 
effect that such a thing was not known, would not happen in 
a thousand years, but that if it should occur it would have 
been a great waste of money or that the child would have 
landed somewhere else. Then it was said, "One can’t regiment 
epileptics; any doctor who is experienced with such children 
knows this is true.” 
5. While the State law provides that a pupil may remain 
under home instruction until the age of 21, this would not 
be permitted unless the pupil was benefited. 
13 Departmental Organization 
6. When asked as to how many epileptics there are 
remaining under instruction in school, the reply was to the 
effect that "there are not many of them.” 
The Director of the Bureau for Children with Retarded 
Mental Development was not available, but in her absence 
three physicians attached to the Division for Children with 
Retarded Mental Development were interviewed April 10, 1940 
and the following information was received: 
1. No detailed analysis of the children referred to this 
Bureau, which deals with about 1500 different cases a year, 
was available. 
It is the custom of this Bureau to submit reports to the 
sources referring children and in some cases the reports are 
also sent to the Assistant Director of the Division of Physically 
Handicapped Children. 
2. There are the following figures as to the incidence of 
convulsive seizures in the group referred to this department: 
School year 1936-37 78 children 
” ” 1937-38 75 children 
” ” 1938-39 81 children 
3. Of these various children, some were not enrolled 
in the public schools of New York City but were referred from 
certain institutions not connected with the Department of Ed- 
ucation. There are no accurate figures available as to the 
number of children referred from the office of the Assistant 
Director in charge of instruction of physically handicapped 
children. Such cases were infrequent, and represented a very 
small percentage of the annual total of children having con- 
vulsive seizures. (If one were to accept the statements of these 
three physicians as reasonably accurate, it would be fair to 
infer that of the 81 children with convulsive seizures seen by 
the Bureau in the 1938-39 school year, definitely less than 
half were referred from the Division of Physically Handicapped 
14 Departmental Organization 
Children and it would not be unreasonable to assume that 
perhaps only 25% were so referred.) 
The Inspector of Industrial and Placement Work for 
Physically Handicapped Children was interviewed on April 3, 
1940. She stated that her field of work does not include 
contacts with epileptic children and that she does not have 
such cases referred to her either from the Division of Physically 
Handicapped Children, or from any of the vocational or 
regular high schools which may be confronted with the problem 
of epileptic children. Her responsibilities are limited to other 
types of physically handicapped children in the elementary 
schools. i 
Her experience does not enable her to give any information 
or suggestions as to children subject to convulsive seizures. 
On March 11, 1940, the Chairman of the Committee in- 
terviewed physicians attached to the Medical Board. According 
to their estimate approximately 200 epileptic children are an- 
nually referred by school officers for examination and advice 
as to disposition. The exact figures from the school records 
are as follows: 
School year 1936-37 166 
” 1937-38 - —166 
” 1938-39 - 220 
Approximately 25% of the children who reported during 
these years v/ere revisited. 
Some of these children had medical records or information 
from the school principals which the examining physicians 
found useful. An average of perhaps fifteen minutes time 
was spent in the examination of each child. If a child was 
regarded as retarded or defective mentally, it was referred to 
the Bureau for Children with Retarded Mental Development. 
Recommendations as to exclusion from attendance in school 
is forwarded to an Assistant Superintendent and action on the 
recommendation is not always reported back to the Medical 
Board. 
15 Departmental Organization 
The Medical Board has no information about children 
who have passed the 8B grade. Occasionally a child once 
excluded from school applies for readmission to regular class, 
but it is seldom that such children are referred for examination. 
The Chief Medical Examiner was interviewed by telephone 
on March 26, 1940. 
In response to questions he stated the following: 
1. Many of the children referred to his Department as 
epileptics have had only one convulsion and some form of 
"allergy” is a common cause in such cases. 
2. There is no rigid standard for excluding a child from 
attendance at regular class. A "committee” of principals and 
superintendents has agreed that a child may have as many as 
two attacks in class in one semester or term and remain in 
school. Variations from this criterion are discretionary with 
the principals of schools. Other factors may be of importance 
in determining whether or not a child should be excluded 
from regular class. 
3. Once a child has been excluded from school, there 
is no system or requirement for any sort of medical follow-up. 
The Director of the Bureau of Child Guidance was inter- 
viewed on March 19, 1940. His office has referred to it during 
the course of a year perhaps half a dozen children whose medi- 
cal problem is that of convulsive seizures. Of the various 
children referred to his office because of some form of behavior 
or conduct disorder, the occurrence of epileptic seizures is re- 
vealed perhaps six times a year. 
The Director stated that it was his impression that the 
school system does not follow any particular standard for the 
exclusion of the child from regular class, and does not require 
any systematic medical follow-up of such children who have 
been excluded or placed under home instruction. 
16 Reports From Other Cities 
In The United States 
ertain other cities in the United States have dealt with 
the problem of epileptic school children. Below are ex- 
cerpts from letters describing what has been done in other cities. 
1. Letter of Charles F. Good, M.D., Directing Supervisor, 
Medical Inspection, Board of Education, Cleveland, Ohio: 
"Epileptic children are discovered by examination and history 
at the time of entering school or from information given by 
the teacher or principal. If the attacks are mild and infre- 
quent the child continues in regular school, is excluded from 
gymnasium and competitive athletics, may have mental tests 
given upon recommendation of the examining physician, and 
is followed more closely than normal children by the nurse and 
school physician. Children with frequent convulsions or mental 
deterioration may be excluded from school. Home tutoring 
may be applied for, subject to the approval of the State. (There 
are very few of these tutored cases). For the older children 
instruction in trade or occupational work may be provided at 
a teaching center if the families are deemed worthy of such aid.’’ 
2. Letter of C. Morley Sollery, M.D., the Acting Director 
of School Health Service of the Board of Education of the 
City of Los Angeles, California: "The first step in educational 
placement is expert medical and neuropsychiatric care, which 
may frequently reduce the number of attacks so that the 
children can attend regular school. Children with normal in- 
telligence with an occasional attack for the most part attend 
regular school so as to give them the advantage of normal 
social contacts. Children with frequent attacks are sent to the 
school for the handicapped, while those whose attacks are so 
frequent as to disturb other students in a school for the 
handicapped are provided with home teachers. Children with 
subnormal intelligence with an occasional attack may be cared 
17 Reports From Other Cities 
for in development schools. Mental defectives with epilepsy 
are not admitted to school but are recommended to State 
institutions. 
"In the City of Los Angeles, fourteen epileptic children 
are attending regular school; thirteen epileptics are in schools 
for the handicapped; there are approximately sixty epileptic 
children with home teachers. 
"School physicians and nurses make an effort to see that 
epileptic children are kept under constant medical supervision, 
and medical care is provided for the indigent in the various 
public and part pay clinics of the municipality.." 
Arthur R. Timme, M.D., wrote briefly on certain aspects of 
the epileptic child in school, in the April, 1940 number of the 
Los Angeles City School District Health News. He stated 
that it is his experience that children are not frightened or 
upset at the sight of a convulsion, and he states that it is his 
opinion that it is a false philosophy to spare them such a pos- 
sibly "terrifying” sight. As for the epileptic child, he states that 
"there is no better treatment of his whole problem than to 
expose him to all the experiences of the average child.” Dr. 
Timme goes on in the same vein, points out the ways in 
which a teacher can readily control the situation when a child 
is subject only to occasional seizures, and in general indicates 
that an epileptic child should not be excluded from school 
merely because it is subject to fits. 
Apropos of Dr. Timme’s viewpoint, in reviewing the 
questionnaire returned by principals of the New York City 
school system in connection with the survey made by this 
Committee, it is interesting to note the frequency with which 
a teacher or principal seems to stress the possible untoward 
effort upon other children in the class of an epileptic pupil, 
and to emphasize the possible risk of injury to a child in the 
course of a fit. As a matter of fact, of the 958 children 
reported, there were less than half a dozen instances in which 
18 Reports From Other Cities 
any sort of injury to a child occurred in the course of seizures 
occurring either in school hours or at home. Statistics as to the 
incidence of injury in the course of seizures have to be evalu- 
ated in the light of the particular type of epileptic referred to. 
In State or other institutions caring for large numbers of epi- 
leptics the clinical material consists of individuals with the 
most severe and frequent attacks and a fairly large incidence 
of mental deterioration. Such epileptics represent the minority 
of all people subject to seizures. In private practice, and in 
dealing with epileptics seen in public dispensaries or out-patient 
clinics it is rare that one finds an injury of any significance 
occurring during the course of a fit. 
3. Letter of Paul S. Barrett, M.D., Director, Bureau of 
Child Hygiene, Department of Public Health, San Francisco, 
California: "Epileptic children in San Francisco are under 
the instruction of home teachers so long as their mental 
equipment is normal. Subnormal children are taken care of 
by the State Institutions. 
"The Department of Public Health makes no attempt at 
treatment and requests for home teachers are made by the 
private physician or the clinic attended by the child.” 
4. Letter of Joseph G. Molner, M.D., Director of School 
Health Service, Department of Health, Detroit, Michigan: 
"Detroit commenced experimental schools for epileptics in 1935. 
At the present time there is a special school in which 140 
epileptic children are enrolled in classes running from the 
first to the tenth grades; transportation is offered to the children, 
who are served with a hot noonday meal at the school. 
"Admission to this special school is on recommendation 
from private physician, school teacher and nurse, and prior 
to admission children are examined by a physician hired by 
the Board of Education. In addition to the medical supervisory 
work mentioned, there has been experimentation with certain 
therapeutic agents.” 
19 Reports From Other Cities 
Various institutions in the State of New York were 
written to. There is considerable variation in their policy 
with respect to the handling of children with epileptic seizures, 
each institution apparently being influenced by the particular 
type of child with which it is chiefly concerned. At the Craig 
Colony children with an I. Q. below 50 are excluded from 
scholastic activities. At the Letch worth Village classes are 
available to mentally defective children whenever their I. Q. 
is sufficiently high to justify training, but since this institution 
is primarily for the care of mental defectives, its standards 
can scarcely be applied to the situation in a regular public 
school system. 
20 Analyses of Questionnaires and The Register 
of Pupils Receiving Home Instruction 
June 30, 1939 
Summary of Tabulations From Questionnaires 
Questionnaires were distributed to the principals of schools 
during December, 1939. Each principal submitted reports as to 
children attending class, who were known to be subject to some 
form of seizure or syncopal attack; reports also were submitted 
as to children who had been excluded from attendance at school 
on or after January 1, 1938, because of the occurrence of seizures. 
Additional questionnaires were sent to the teachers of children 
under home instruction. Analyses of these data are shown in 
the following tables. 
Table I 
Number of Pupils Known to Have Seizures 
Attending 
School 
Excluded from 
School 
Receiving Home 
Instruction 
Number of Pupils 
498 
229* 
231 
*Some of these children are 
receiving home 
instruction and are 
included in the 
home instruction group. 
Table II 
Classification by Sex of Pupils Having Seizures 
Attending 
School 
Number of Pupils 
Excluded Receiving Home 
from School* Instruction 
All 
Groups 
Males 
275 
131 
105 
511 
Females - 
223 
98 
126 
447 
Totals 
498 
229 
231 
958 
21 Analyses of Questionnaires 
Table 111 
Years During Which Pupils Attending Public Schools 
Had Their Last Seizures 
Years 
Number of Pupils 
1939 - 
1938 - 
292 
49 
1937 - - - 
17 
1930-1936 
Unstated 
28 
112 
Total 
498 
Note: A certain number of children reported as epileptics do not apparently 
have a tendency to recurrent convulsions. Diabetics who might have or actually 
do have insulin shock, a few instances of psychoneurotic episodes, and a few 
instances of apparently ordinary syncope have been included in the series 
reported as "epileptics.” 
Table IV 
Frequency o£ Seizures Among Pupils 
Attending 
School 
Number of Pupils 
Excluded Receiving Home 
from School* Instruction 
Frequency 
More than one a month 
37 
16 
107 
More than ten a month 
13 
7 
10 
Totals - - 
50 
23 
117 
*This question was not asked because principals obviously would have no 
information about many of the excluded children. Nevertheless, a few reporters 
volunteered this information. 
It seemed to the Committee that statements made to school 
authorities as to frequency of seizures might be inaccurate. 
While it would seem likely that frequency would be greater 
among children excluded from school or under home instruc- 
tion, some attempt to obtain information from other sources 
seemed desirable. For this reason, the names of pupils re- 
ported as having been examined or under care at the Vander- 
bilt Clinic (Presbyterian Hospital) were listed and the consent 
of the hospital authorities was given to review the records 
of these pupils. The pupils who had attended this clinic 
22 Analyses of Questionnaires 
were from every borough of New York City. Also, these 
children were represented among those continuing in school, 
excluded from school, and under home instruction. The total 
of 62 thus represented a really chance sampling of the total 
number of 958 pupils reported by the school authorities. The 
information from the hospital records as to frequency of 
seizures in these children seems to show pretty clearly that 
the information given the school authorities was inaccurate. 
Table V 
Occurrence of Seizures in Reporting Period 
Attending 
School 
Number of Pupils 
Excluded Receiving Home 
from School Instruction 
Pupils Having Seizures 
253 
80 
153 
Pupils Not Having Seizures 
123 
4 
7* 
Not Reported _ - .. 
122 
145 
71 
Totals — - 
498 
229 
231 
* Without seizures for one year or longer. 
Table VI 
Medical Care Received by Pupils Having Seizures 
Type of Care 
Attending 
School 
Number of Pupils 
Excluded Receiving Home 
from School Instruction 
Hospital and Clinic Care 
220 
81 
114 
Private Medical Care 
208 
46 
109 
Not Reported 
70 
102 
8* 
Totals 
498 
229 
231 
*One child was reported to have had no medical attention for three years. 
No information was given as to adequacy of care. Three 
children in the entire group were reported as under the care 
of a Dr. Harry L. James of Chicago, Illinois. This man has 
for many years advertised his compounds for the treatment 
of epilepsy, and does his work by mail. 
23 Analyses of Questionnaires 
Table VII 
Occurrence of Apparent Defective Mentality Among Pupils 
Having Seizures 
Number of Pupils 
Attending 
Excluded 
Receiving Home 
School 
from School Instruction 
Although a statement 
Elementary School Pupils 
as to I.Q. was request- 
ed, the information on 
this point was given 
I.Q. Less than 80 
84* 
49** 
in only 13 instances. 
Examination of the 
I.Q. Over 110 
52 
5 
other information 
Not Stated 
113 
80 
given indicated that 
46 of the pupils had 
a definitely defective 
mentality. Review of 
High School Pupils 
the questionnaire list- 
ing 231 children 
I.Q. Less than 80 
7 
3 
showed that the 
I.Q. Over 110 
9 
3 
teachers reported poor 
learning capacity in 
Not Stated 
14 
6 
109 pupils, and be- 
havior problems in 39 
pupils. 
* Equivalent to 19% plus. 
*'"Adding pupils in classes for children with retarded mental development, low 
I.Q. and ungraded classes, totaling 14 pupils, those with I.Q.’s under 80 reach 
a total of 63 in 171 pupils reported in the grades, or approximately 38%. 
Note: By review of questionnaires from two boroughs on children attending 
school, judging probable mental level by information supplementing whatever 
was stated with respect to 1.Q., in a total of 240 pupils, I.Q. of less than 
80 was found in 60, or 25%. 
The statements of various authorities as to the appearance 
of mental defects among epileptics have to be considered in 
the light of both the number of individuals in a reported 
series and the type of patient studied. 
The failure to report the results of psychometric tests 
in a sizable proportion of the pupils reported by the New York 
City school system makes it obvious that the incidence of 
mental deficiency may be even higher than what was revealed 
by a study of the questionnaires. In any event, the evidence 
is clear that epileptic children present a special problem because 
of the frequency of mental deficiency and any educational ex- 
periment must make proper allowance for this complicating 
handicap. 
24 Analyses of Questionnaires 
Table VIII 
Intelligence Quotients of Children Having Seizures Who Are 
Reported Also to Have Behavior Disorders 
Intelligence Quotient 
Attending 
School 
Number of Pupils 
Excluded Receiving Home 
from School Instruction 
I.Q. Less than 80 
9 
13 
I.Q. Probably Less than 80 
I.Q. 80 to 90 
4 
I.Q. 91 to 110 - 
5 
I.Q. More than 110 
4 
1 
I.Q. Not Stated 
14 
12 
39 
Totals 
38 
31 
39 
While the number of pupils reported as conduct problems 
is too small to justify any inferences from the above figures, a 
certain trend seems likely. Although many mentally defective 
children are docile, and present no behavior disorder, it is of 
some significance that so large a percentage of mental deficiency 
was found in the children reported as presenting some form 
of conduct disturbance. 
Table IX 
Duration of Home Instruction 
Years in Which 
Home Instruction Began 
Number of 
Children 
Prior to 1933 to date 
1934-1935 to date 
1936-1937 to date 
1938-1939 to date 
Not Stated - 
9 
25 
- 72 
92 
33 
Total - 
231 
An analysis of the figures shown in Table IX indicates that 
two-thirds of the children under home instruction on January 1, 
1940, have been educated in this manner less than four years. 
The instances selected from the register of pupils under home 
instruction on June 30, 1939, (see Table XIV), indicating that 
this facility did not result in any benefit to the pupils, raises 
the question as to whether the home instruction program 
should not have been more strictly prescribed. 
25 Analyses of Questionnaires 
Table X 
Classification by Grades of Pupils Having Seizures 
Grades 
Attending 
School 
Number 
Excluded 
from School 
of Pupils 
Receiving Home 
Instruction 
Total 
Kindergarten 
5 
1 
0 
6 
1A through 4B 
_ 155 
52 
76 
283 
5A through 8B 
.... 198 
74 
110 
382 
Ungraded, Low I.Q. 
and CRM Classes 
35 
30 
0 
65 
Other Special Classes* 
9 
4 
1 
14 
9A through 12 B 
63 
58 
39 
160 
Not Stated (mostly under 9A).... 
33 
10 
5 
48 
Totals 
498 
229 
231 
958 
*These include opportunity and certain special classes and placement in other 
classes for the physically handicapped. 
The "normal” age-grade level can be calculated on the 
basis that a child enters the first year of primary school at the 
age of six, and completes grammar school education in the 
grade 8B at the age of 14. Grades 9A to 128 represent the 
high school level. The continuation school law requires some 
form of school instruction for practically all children up to 
the age of 18. The fact that only 160 children were reported 
by the high schools as subject to seizures can be accounted 
for on the ground that the high schools are not adequately 
informed as to the occurrence of seizures in children who 
have been graduated from the grade schools. 
If this information is transmitted to the high schools on 
the elementary school medical record forms it apparently is 
routinely filed and forgotten. 
The semi-annual report of the Division of Handicapped 
Children under date of June 30, 1939, was studied. Exactly 
200 epileptic children were reported as under home instruction. 
The following tables represent an analysis of 86 of this group, 
who showed deviation from the expected age-grade level: 
26 Analyses of Questionnaires 
Table XI 
Ages and Grades of Epileptic Children Receiving 
Home Instruction 
Tune 30, 1939 
Grade 
10 
Ages of Children 
11-13 14 15 16 
in Years 
17 18 
19-20 
and over 
Totals 
1A-3B 
5 
9 2 
3 
1 
3 
1 
24 
4A-5B 
1 10 
9 
7 
4 
1 
32 
6A-6B 
2 
3 
3 
15 
7A-8B 
1 
3 
7 
4 
7 
9A-12B 
1 
2 
3 
1 
7 
Totals 
5 
10 14 
13 
15 
16 
11 
2 
86 
Of 29 aged 17 or more under home instruction 9 are in 
grades 5B or below. 
Table XII 
Distribution by Ages and Length of Periods of Home 
Instruction of Epileptic Children 
June 30, 1939 
Years under Home 
Ages of Children 
in Years 
19-20 
Grade 
10 
11-13 
14 
15 
16 
17 
18 
and over 
Totals 
1939-1/1/40 
1 
3 
2 
2 
1 
1 
10 
1938-1/1/40 
2 
1 
3 
1 
2 
2 
1 
12 
1937-1/1/40 
2 
6 
5 
4 
5 
4 
2 
28 
1936-1/1/40 
1 
1 
2 
3 
3 
8 
5 
1 
24 
1935-1/1/40 
1 
1 
1 
2 
1 
2 
8 
1934-1/1/40 
2 
1 
3 
1933 or previous 
to 1/1/40 
1 
1 
Totals 
. 5 
10 
14 
13 
15 
16 
11 
P 
86 Analyses of Questionnaires 
Table XIII 
Distribution of Grades and Length of Periods of Home 
Instruction of Epileptic Children 
June 30, 1939 
Period of Home 
Instruction 
1A-3B 
4A-B 
Grades 
5A-B 
of Children 
6A-B 7A-B 
8A-B 
9A-12B 
Totals 
1939-1/1/40 
1 
3 
2 
2 
1 
1 
10 
1938-1/1/40 
7 
1 
2 
2 
12 
1937-1/1/40 
10 
6 
3 
3 
5 
1 
28 
1936-1/1/40 
4 
5 
5 
3 
2 
4 
1 
24 
1935-1/1/40 
2 
2 
2 
1 
1 
8 
1934-1/1/40 
2 
1 
3 
1933 and previous 
to 1/1/40 
1 
1 
Totals 
24 
17 
15 
8 
9 
6 
7 
86 
Of those under home instruction from 1936 to date six 
are in grade 3B or below. 
Of those under home instruction from 1934 to date two 
have not advanced to more than the 4A or 4B grade. 
The following instances are cited as bearing upon the policy 
of the Division for the Physically Handicapped in assignment 
to home instruction and to continuance under home instruction. 
28 Analyses of Questionnaires 
Table XIV 
Selected Examples Showing Epileptic Children Receiving 
Home Instruction Showing Their Ages, 
Years of Home Instruction Received 
and Grades Attained 
Case No. 
Sex 
Age 
Years under Home 
Instruction 
Elementary Grade 
Attained 
1. 
Female 
14 
2 y2 
4A 
2. 
** 
15'/2 
5 
3A-4A 
3. 
M 
16 
3'/2 
4B 
4. 
18 
2'/2 
6B 
5. 
10 
2'/2 
IB 
6. 
I8I/2 
3 
6B 
7. 
17 
3*/2 
5A 
8. 
,f 
16 
3 
5B 
9. 
** 
151/2 
5 
4A 
10. 
** 
15 
2 
4B 
11. 
** 
13 
2 
2B 
12. 
l4'/2 
2 
3B 
13. 
17 
31/2 
3B 
14. 
l6'/2 
2'/2 
5A 
15. 
17'/2 
3'/2 
6B 
16. 
12 
3'/2 
2A 
17. 
Male 
14 
3'h 
2B-3A 
18. 
15 
2'/2 
4A 
19. 
17 
l'/2 
2A-2B 
20. 
** 
15'/2 
3 
4A 
21. 
151/2 
4 
5A 
22. 
17 
4 
7 A 
23. 
** 
19 
3 '/2 
4A 
In this same report of the Division of Physically Handi- 
capped Children were two instances involving other types of 
physical handicap, which are mentioned as illustrative of 
what may occur. 
Case 1. Male, aged 9V^,under home instruction 4 years, 
in grade IA, and suffering from hydrocephalus and spina 
bifida. It would seem that as a result of four years of 
home instruction this child had not left the starting post. 
29 Analyses of Questionnaires 
Case 2. Female, aged 121/2, under home instruction 2 
years, in grade 2A. This child was a sufferer from Mongolism. 
Individuals with Mongolism seldom rate higher than imbecile 
in intelligence, and a large proportion of them die before 
reaching maturity. 
Eighty-six of these epileptic children were of an age and 
grade in school suggesting some definite degree of intellectual 
impairment. There were ten children over fourteen years of 
age who were in the first, second, or third primary grades 
(grades lA to 3B); there were twenty-one children over 
fourteen years of age who were in grades from 4A to 5B; there 
were twelve children over sixteen years of age in grades 6A 
or 6B; there were eleven children over seventeen years of age in 
grades from 7A to 88, 
Forty-two of the 86 children were still less than sixteen 
years of age. 
Forty-one of the 86 children have not reached the 5A grade 
Regardless of age distribution in this sub-group, it is indicated 
that nearly half of the number regarded as probably defective 
mentally are not likely to be able to reach the 8B grade and 
it is a legitimate question to ask whether there is going to 
be anything like an adequate return for the time and effort 
expended in attempting to teach the standard curriculum to 
these children. 
30 Results of Visiting Program and Comments 
Information Obtained from Visits 
to Pupils 
I. Statistical Analysis'. 
Although a total of about 260 pupils were visited, exi- 
gencies of time made it inconvenient to submit all the reports 
to a complete statistical analysis. The first 175 reports received 
were analyzed for information which seemed to be of particular 
importance, with the following results:* 
1. Medical supervision reported as 
satisfactory 68 cases, about 38% 
2. Medical supervision reported as 
unsatisfactory 28 cases, about 16% 
One child in a high school had not seen a physician for five 
years, although grand mal attacks occurred on an average of 
once a week. ] 
3. Medical supervision, character 
uncertain 28 cases, about 16% 
4. Medical supervision not 
reported 51 cases, about 30% 
5. Learning capacity of pupils reported 
as poor 87 cases, about 49% 
In the pupils under home instruction, poor learning ca- 
pacity was reported in 60% of the cases. 
In this group, reported as having poor learning capacity, 
are included all children with definite mental defect as well 
as those with apparent normal mentality but difficulty in 
learning. 
*The reports which were received later were examined and inspection of them 
did not indicate any change in trends. 
31 Results of Visiting Program 
6. Presence of physical handicap: 
a. Physical handicap having some causal 
connection with the epileptic 
seizures 34 cases, about 19% 
b. Physical handicap independent of the 
epileptic seizures 30 cases, about 17% 
Chorea, refractive errors of vision, orthopedic de- 
fect without nervous system involvement and rheumatic 
heart disease, are illustrations of physical handicaps 
regarded as not causally connected with the tendency 
to epileptic seizures.) 
c. Objective signs of organic disease of 
the central nervous system . .34 cases, about 19% 
(In some of these children the organic nervous 
disease was not apparently connected.) 
d. Cerebral trauma possibly the cause 
for seizures (Birth injury 
included) 12 cases, about 7% 
7. Active coordination and cooperation 
between teachers and physicians 
in charge of pupils 13 cases, about 8% 
In the great majority of instances, the pupils did not 
seem to require any continuous exchange of information be- 
tween teacher and physician. In several instances, the teacher 
in charge of a pupil was unaware of its tendency to seizures, 
although the school principal had the information. 
Two boys were assigned to courses in aviation mechanics 
in a vocational high school: apparently the instructional staff 
did not recognize that such an occupation was distinctly haz- 
ardous to these pupils, and that they could not possibly get 
work in this field if an employer knew of their physical 
handicap. 
32 Results of Visiting Program 
8. Coordination between teachers and 
home of pupil reported 
as poor 9 cases, about 5% 
In these cases, the fault usually lay at the door of the 
parents, who were apt to neglect not only the child’s medical 
needs, but failed to cooperate with respect to the educational 
efforts of the teacher. 
9. Poor economic environment 13 cases, about 8% 
10. Home environment emotionally 
handicapping 11 cases, about 7% 
11. Pupils reported as presenting some 
behavior problems 9 cases, about 5% 
This percentage is about half that which was revealed 
from study of the questionnaires. The discrepancy is of no 
real significance because the visiting program excluded most 
of the individuals reported as presenting a behavior problem. 
12. Diagnosis of epilepsy uncertain 
or in error 35 cases, about 20% 
The incidence of uncertain or erroneous diagnosis is higher 
than occurred in the questionnaires, because pupils about whom 
diagnosis was uncertain were specially selected for information 
which would be gained from a visit by a physician. 
In a number of instances, seizures of any form were denied. 
Eight children were subject to syncopal attacks or convulsions 
as a complication of the insulin treatment with diabetes. Three 
or four children apparently were subject to tantrums or hysterical 
seizures; one child was subject to syncope because of organic 
heart disease; a few children apparently suffered from chorea. 
An analysis of the records of 62 pupils who have been 
examined or treated at the Vanderbilt Clinic or other units of 
the Columbia-Presbyterian Medical Center revealed: 
33 Results of Visiting Program 
1. Frequency of seizures more than 
once a month 39 cases, about 62 % 
2. Frequency not more than 
eight attacks a year 18 cases, about 28% 
3. Frequency of seizures once a year 
or less 3 cases, about 5% 
4. Frequency not stated or 
seizures denied 2 cases, about 3% 
5. Occurrence of brain injury 
at birth 5 cases, about 8% 
6. Seizures following central nervous 
system infection 6 cases, about 10% 
It is of interest that in many of these children seizures 
were reported as occurring with greater frequency than their 
school records revealed. 
34 Additional Comments 
The work of this committee may be subject to criticism 
on the ground that its members have not been provided with 
detailed or accurate information from the Division of Physically 
Handicapped Children. It is quite obvious that if this Division 
were in the possession of adequate records and statistical reports, 
the work of this Committee would have been simplified. The 
interview with the Director of the Division and the Associate 
Superintendent in charge of the Education of the Handicapped, 
was arranged several days in advance. The chief officers of the 
Division of Physically Handicapped Children have been familiar 
with the fact that a survey of the work done by their Division 
has been carried out by a number of subcommittees, each 
dealing with a particular type of physically handicapped child- 
ren. The members of this Committee make no pretense at 
being expert educators. However, it is not necessary to be 
an educator to judge with reasonable accuracy whether physi- 
cally handicapped children are classified in accordance with 
any accurate medical or psychiatric standards, nor does one 
have to be an educator to judge whether elementary medical 
and psychiatric principles are systematically and efficiently main- 
tained in the attempt to provide special teaching facilities for 
children suffering from some form of physical handicap. 
Allowing for the inclusion of really non-epileptic children 
among the total of 958 individuals reported, approximately 925 
can be regarded as subject to one variety or another of recur- 
rent epileptiform seizures. With approximately one million 
one hundred thousand children enrolled in the public school 
system, between the ages of 6 and 21 (only a small percentage 
are over 18), epileptic seizures were reported in less than one 
tenth of one percent. If one were to assume that the public 
school system reported all of the pupils actually subject to 
recurrent epileptiform seizures, and also that individuals under 
the age of 18 represent 50% of all persons subject to such 
35 Additional Comments 
seizures, then the disorder might be estimated as occurring in 
about one in 500 individuals of the total population. It is 
perhaps unsafe to place much reliance upon this calculation. 
In particular, caution is required because there are children 
in the public school system who are not known by school 
officers to be subject to seizures. Bearing on this point is the 
fact that information in the questionnaires as to the frequency 
of seizures was frequently inaccurate, and that it was fairly 
common to find that parents reported to physicians of this 
committee visiting the pupils that the seizures were more fre- 
quent than principals reported them as being. 
It is not necessary to demonstrate by statistics the well 
known tendency of people to minimize symptoms or disability 
if knowledge of them were to result in deprival of privileges 
or to be contrary to their interests. 
The enactment of the Education Law and the creation of 
boards of education and school districts throughout the State 
were legislative acts in obedience to the mandate of the Con- 
stitution that a common school education shall be provided 
for all children. In the light of the Constitutional mandate, 
it is reasonable to assume that a child is entitled to an education 
by which it can benefit and it is also reasonable to assume 
that such was the purpose of the legislature as expressed in 
the following sections of the Education Law: 
In Article 23 of the Education Law (entitled "Compulsory 
Education’’), there is the express provision that 
"A minor***** who is feebleminded to the extent 
that he is unable to benefit from instruction, shall 
not be permitted to attend*****” (Section 624, 
Subdivision B) 
Article 39-A (entitled "Home Teaching in Special Classes”) 
provides 
The Board of Education**** shall have power to 
furnish suitable educational facilities for physically 
36 Additional Comments 
handicapped children by means of home teaching, 
transportation to school or by special classes. Where 
there are 10 or more physically handicapped child- 
ren such Board shall establish such special classes**** 
(Section 1020, Subdivision 2) 
We have italicised "physically” in the foregoing quo- 
tation as a means of pointing out that the legislature did not 
provide the educational facilities for those who were so men- 
tally handicapped that they could not benefit by the education; 
the legislature limited such educational provision "for physically 
handicapped children.” 
With this emphasis in mind, the purport of the following 
language contained in the same section of the Education Law 
may be readily understood: 
The need of the individual child shall determine 
which of such services shall be rendered**** such 
Board shall establish such special classes as may be 
necessary to provide instruction adapted to the 
mental attainments and physical conditions of such 
children, (italics ours) 
In the light of the foregoing provision of the Education 
Law of this State, the Board of Education of the City of 
New York adopted the bylaw that: 
A pupil**** who is so feebleminded that he can- 
not benefit from instruction, may be suspended from 
attendance****. (Section 67, Subdivision 11) 
It would seem reasonable to say that the State laws in- 
tended that the officers of the school system should exercise 
good judgment in determining whether or not an individual 
child was likely to benefit from the instruction available, and 
to give first consideration to children who are reasonably 
certain to benefit. What does one mean by the word "benefit”? 
It would seem to this Committee that the term implies that 
the pupil possesses the ability to understand and to retain what 
is taught—whether or not the knowledge is ever put to re- 
munerative use. 
37 Additional Comments 
Merely taking up somebody’s time and keeping a pupil 
out of mischief, or taking over some one or more of the 
proper responsibilities of parents is not providing an education, 
as one generally understands is the province of the public 
school system. It may be charity and it may be kindness to 
provide transportation to a special class, or to send a special 
teacher to the home, in the case of a child whose physical 
handicap is permanent, perhaps progressive, and will result 
in death before the attainment of adult years. It may ease 
the grief of parents of a child who is a burden in the home 
and who is seriously mentally defective, to go through the 
motions of providing educational facilities which can be grasped 
only by a child of normal intelligence. But with the handicap 
of a limited amount of funds, it would seem to this Committee 
that if society is going to benefit and if educators are going 
to contribute any constructive information, financial resources 
at the disposal of the Department of Education should be 
expended by preference upon those of the physically handi- 
capped who can be expected to yield a return to society in some 
manner or through education reduce the cost to society of 
the burden of their care. In fact, presumably as argument 
for the expansion in the Division, instances are cited of in- 
dividuals who were made useful citizens as a result of special 
teaching facilities. In any event, the Division of Physically 
Handicapped Children, which has been in existence for about 
twenty years, can justify its existence only if it is so organized 
that the children under its supervision are intelligently handled 
and if there is an accurate and competent continuous study 
and reporting upon the results of policies in force. 
In considering the disposition to be made of a child 
suffering from recurrent epileptiform seizures, a number of 
factors have to be taken into account. Assuming that the 
child has no other physical handicap and no mental defect, 
the character and frequency of seizures is the first item in 
determining whether or not the child may interfere with the 
education being provided for other children in class. From 
38 Additional Comments 
the standpoint of the school system, exclusion from regular class 
may be necessary in the case of a child whose condition or 
behavior interferes with the purpose of the class. From the 
standpoint of the child subject to seizures, their frequency and 
character may be such that he is incapacitated often enough 
so that he cannot benefit from regular class instruction. In 
any given instance, decision as to exclusion because of the 
character and frequency of seizures should depend upon re- 
liable information obtained from parents or guardians and the 
physicians who have examined the child. The school system 
should avoid premature action or a hasty diagnostic assumption, 
and should recognize that one epileptiform seizure does not 
mean "epilepsy.” A seizure may be symptomatic of some other 
physical disorder, the nature of which can be determined only 
after medical investigation. 
The pupil with mental retardation or definite mental de- 
ficiency may be subject to epileptiform seizures. The learning 
capacity of such a child is not determined by the occurrence 
of epileptiform seizures but by the mental defect, which is 
the basic handicap. Most school systems recognize that the 
pupil with a definite mental defect has to be classed as a 
psychological rather than a physical problem—at least as far 
as its educability is concerned. Exclusion from regular class 
in such instances should be on the basis of mental capacity 
rather than the occurrence of epileptic seizures. Assignment 
to home instruction should likewise be determined by the 
learning capacity of the child as judged by its mental develop- 
ment rather than the occurrence of epileptiform seizures. 
A certain number of epileptic children exhibit behavior 
disorders and are disciplinary problems. In the cases reported 
as a result of the questionnaire submitted to the public schools 
of New York City, a large proportion of the epileptic children 
who were disciplinary problems were definitely defective men- 
tally. Thus these children possessed a multiple handicap, and 
exclusion from school would in their cases be determined by 
their behavior rather than the occurrence of seizures. 
39 Additional Comments 
With respect to the epileptic children reported under home 
instruction as of June 30, 1939, analysis of those reported on 
home instruction on the returns from the questionnaire (ap- 
proximately February 1, 1940) may be of interest. 
While it is recognized that the scanty information sub- 
mitted in response to requests for information on certain points 
would expose one to serious error in attempting to select the 
children with probable mental defect, the attempt was made 
nevertheless. Of the 231 children reported, 46 were judged 
to have a definitely defective mentality—approximately 20 %. 
The letter of the Assistant Director under date of April 16, 
1940, states that approximately 26% of these children (the 
231 children mentioned above) are "below borderline intelli- 
gence.” It will be seen, therefore, that the results of the 
analysis of the questionnaire were not very far off, and certainly 
did not make the mistake of over-estimating the percentage 
of those with probable mental defect. With respect to the 
problem of attempting to read between the lines of the ques- 
tionnaires apropos of children still in school, and also those 
reported as excluded from school, and including children whose 
I. Q. ratings were not definitely stated, it would seem that 
the clinical judgment of the individual who surveyed the 
questionnaires was reasonably dependable. 
Statistics as to the incidence of mental deficiency in epi- 
leptics will naturally vary with the source of the clinical 
material studied. The patients in institutions for epileptics 
are by and large those who are most seriously afflicted. What 
is true of the institutional group will probably not hold true 
of individuals less seriously affected, and who are able not 
only to live at home but engage in competitive and remuner- 
ative employment. 
The New York State Craig Colony* reports that only 
Charles 8., "Racial and Geographical Distribution of Epilepsy,” 
Association for Research in Nervous and Mental Disease, 1931, Vol. 7, 
pages 117-134. 
40 Additional Comments 
14% of the inmates were of normal mentality; the same 
authority stated that 65% of non-institutional epileptics have 
normal mentality. Epileptics who are severely afflicted are 
more apt to deteriorate mentally than other epileptics. These 
points should be kept in mind in attempting to determine 
what educational facilities are feasible or likely to lead to 
accomplishment in epileptics with frequent seizures and a 
definitely established mental deficiency. It is safe to assume 
that such individuals can never be expected to continue in 
remunerative employment; moreover, after they have completed 
whatever education opportunity has provided, they will either 
forget what has been learned or fail to use it—unless perhaps 
some simple manual occupation has been taught. 
On the assumption that the tendency to repeated epileptic 
seizures is symptomatic of some brain disorder or defect, one 
would be interested in the incidence of objective evidence of 
central nervous system structural pathology. Lennox and Cobb* 
found signs of central nervous system pathology in 15% of 
their non-institutional series. Analysis of the questionnaires sub- 
mitted v/ith respect to children under home instruction as of 
February 1, 1940, showed the occurrence of organic cerebral 
lesions in 10% of the cases. 
Following are quotations from material in an abstract 
of reports submitted to this Committee by the Division of 
Physically Handicapped Children: 
I—During1—During 1931-1932 a total of 595 epileptics were known 
to the Department of Education; 58 were receiving home 
instruction. 
2—A statement was made implying that education and 
training of epileptics might prevent their eventually becoming 
State or City charges, at a cost annually greater than that 
necesary to provide educational facilities. 
*"Epilepsy”, Medicine Monographs, Volume 14, Williams and Wilkins, 1928, 
p. 368. 
41 Additional Comments 
3—lt is stated, "An experimental study has shown that 
many epileptics improved physically during the period of home 
instruction but that assignment to a regular class usually un- 
stabilizes . . We feel that while it is generally recognized 
that contented epileptics have fewer fits, and that contentment 
in general is of benefit to one’s health, it is extremely difficult 
for a physician experienced in disorders of the nervous system 
to believe that three sessions a week under a home teacher 
has any specific effect upon an epileptic child’s health. It is 
not unreasonable to suspect that if there had been no home 
instruction provided, the results would have been the same 
and that if any credit were to be apportioned, one would have 
to investigate into not only the child’s routine but whether 
or not active medical supervision played a part. 
4—The figures for epileptic children receiving home in- 
struction from 1931 to 1937 are shown in Table XV: 
Table XV 
Number of Epileptic Children 
Receiving Home Instruction 
Year 
1931-1937 
Number of 
Children 
1931 - 
94 
1932 
58 
1933 
43 
1934 
1935 
— 
37 
103 
1936-1937 .... 
220 
The last two years represent the results of an increased 
budgetary appropriation for home instruction. 
s—lt5—It is stated that it is very difficult to obtain adequate 
information regarding the number of epileptics, and that the 
only children studied are those who show by attacks in school 
the need of investigation. 
42 Additional Comments 
Considering the fact that many administrators have more 
to do than they can well handle and that apparently minor 
matters are omitted or forgotten, the requirement for an 
annual report from the principal of every school on children 
known to be subject to seizures would have given more com- 
plete information. Under the present system many of the 
children reported are apt to be lost sight of. There were 
a number of instances of principals submitting questionnaires 
which stated that children had been transferred to some other 
school anywhere from three months to a year or more pre- 
viously—yet in practically every instance the new school in 
which the child enrolled failed to report the existence of the 
child as subject to seizures. One would expect that the children 
subject to epilepsy who had graduated from the grade schools 
would be known to the principals of whatever high schools 
enrolled them. The returns from the questionnaire indicated 
that such is the exception rather than the rule. Thus, if the 
Department of Education is to make a serious attempt to 
maintain a record of epileptic children, a better system of re- 
porting is necessary. 
6—lt is stated that the Division of the Physically Handi- 
capped Children makes an effort to secure a complete neuro- 
psychiatric study of children reported as epileptics. 
Since it was not feasible for this Committee to inspect the 
medical records in the possession of the department, an opinion 
as to the execution of policy has to be based upon indirect 
evidence. In visits to children under home instruction, it 
seemed quite clear that the Department of Education contented 
itself in a great many instances with nothing more than a 
brief statement from a physician that the child had seizures, 
and after the child was placed on home instruction there was 
no systematic effort to learn either from a family physician 
or a clinic anything about the child’s progress under medical 
supervision. The routine reports submitted by the teachers 
of these children were of no medical value whatever. 
43 Additional Comments 
As for the statement that treatment is arranged for neg- 
lected cases in proper clinics, the evidence is very strong that 
this policy is not carried out. There were a number of children 
who were regarded by the physicians visiting them as receiving 
inadequate or haphazard medical attention. Whether the De- 
partment of Education should as a matter of principle or 
policy insist upon any particular standard of medical supervision 
involves sooner or later a possible infringement upon the rights 
of the individual. Perhaps an inexpensive and simple way of 
encouraging parents in providing more adequate medical at- 
tention would be the insistence that a given child must submit 
a certain type of medical information before it may be placed 
on the list of eligibles for home instruction, and then requiring 
reports from the clinic or attending physician every six months— 
these reports to be on forms supplied by the Department of 
Education and given to the parents who will be responsible 
for getting the needed information. 
With respect to the implied coordination between the 
teaching personnel and physicians, the results of the program 
of visiting epileptic children would indicate that it is excep- 
tional to find that the teaching personnel have any contact 
whatever with physicians, or know in the slightest degree what 
a physician might conceive as important with respect to the 
educational, recreational, and other requirements of the child. 
It is a fair criticism to say that the majority of physicians 
dealing with epileptic children limit their interests to the purely 
medical problem and perhaps neither know nor care anything 
about the educational problem. This would be particularly 
true of physicians engaged in general practice and untrained 
in neurology and psychiatry. 
If one were to consider the time and energy, and the 
personnel involved, in an effort to extend medical responsibility 
to all the conceivable economic, sociological and educational 
aspects of the problem of epilepsy, it should be easy to see 
why the physician taking care of an epileptic child must by 
necessity limit his endeavors. 
44 Additional Comments 
7—lt is stated that all epileptics receive psychological 
examinations. 
The Assistant Director’s attitude about psychometric tests 
appears elsewhere in this report. If all the epileptics referred 
to the department receive psychological examinations, where 
these tests are given is not clear. Group tests given in class 
are recognized as only approximations of what can be measured 
by individual tests in the hands of a thoroughly competent 
psychologist. There are only a few qualified psychologists 
attached to the Department of Education, and the figures given 
by the physicians attached to the Bureau for Children with 
Retarded Mental Development would indicate that these fa- 
cilities are not used. A study of the records of the reported 
epileptics who have been treated in several of the large clinics 
in New York City shows that psychometric tests are not rou- 
tinely done. In fact, the Assistant Director stated in the inter- 
view on March 19, 1940, that psychometric tests are performed 
routinely for only those children whose records indicate that 
there may be a measurable mental deficiency. This Committee 
agrees with the principle that every epileptic should receive 
an adequate psychometric examination, at least in every in- 
stance where an epileptic is being considered for home in- 
struction. The Committee also believes that psychometric tests 
should be repeated at suitable intervals on every epileptic child 
under home instruction. Instances were found in the visiting 
of epileptic children, showing that not only those still in regular 
class, but those under home instruction were deteriorating men- 
tally, and that psychometric tests have been performed in clinics 
two or three years or more after the date of psychometric 
examination known to the Department of Education—but that 
as far as is known the results of the later tests were not 
transmitted to the Department of Education. 
A decline in intelligence level would be important with 
respect to disposition of the individual child. Routinely 
repeated psychometric tests would contribute to a proper record 
45 Additional Comments 
system. The Department of Education should be in a position 
to provide personnel for the psychometric examination of 
children being given special forms of instruction, and should 
not depend upon an indeterminate number of outside agencies. 
In view of the fact that educators and psychologists familiar 
with psychometric tests realize that in equally competent exam- 
iners there is bound to be a certain amount of the personal 
equation, accuracy and continuity are best served by having all 
the testing in the hands of the same examiners. 
B—lt8—It is stated that all of the epileptics graduated from 
the elementary schools have been adjusted to self-support. 
This Committee questions the accuracy of this statement, 
in view of the study of epileptics under home instruction and 
the data of the 86 children selected from the report of the 
Division of Physically Handicapped under date of June 30, 
1939. This Committee may be unfair in its assertion, but 
unless the Division has reliable information, which would offset 
the experience of this Committee, skepticism is justified. There 
is a serious obstacle in the New York State Workmen’s Com- 
pensation Law. The interpretations apropos of epileptics who 
sustain an injury in the course of a seizure make it very dif- 
ficult for a known epileptic to obtain any employment. What 
chance to "adjust to self-support” either in some simple form 
of office work or a so-called trade is there for an epileptic 
with inferior intelligence who lacks the ability to make accept- 
able grades in school or complete the elementary grades? 
Nevertheless, such children are "graduated” every year from 
elementary schools. 
As far as this Committee is aware, there are no reports 
available as to the experience of industry with individuals suf- 
fering from epilepsy. The first requisite for a competent study 
would be reliable information as to the number of epileptics 
engaged in remunerative employment, and the kind of work 
they do. There are certain occupations in which the duties 
do not present any hazard and do not tend to alter the fre- 
46 Additional Comments 
quency of seizures. With respect to the administration of 
Workmen’s Compensation laws in various states, the epileptic 
presents a potential financial hazard to the organization re- 
sponsible for paying disability benefits. It is thus obvious 
that an individual subject to epilepsy, and engaged in an 
industry which is covered by Workmen’s Compensation insur- 
ance, is almost certain to conceal his disability from the em- 
ployer. 
9—ln the description of the educational program for 
children in special classes and under home instruction appears 
the following statement: 
"Parallel with the academic course, hand training is con- 
ducted for the skillful use of tools, study of form, color and 
construction in the primary grades and in the grammar grades 
and junior high school grades for instruction in the funda- 
mentals of various industries, trades and industrial arts by the 
Inspector of Industrial and Placement Work. This instruction 
provides not only an opportunity for expression for the motor- 
minded child which enables his teacher to study his ability for 
occupational training and placement later, but it is reflected 
in his improved motor ability and coordination in relation to 
the academic program, particularly for the crippled child.” 
It would seem to this Committee that the above quotation 
is not supported by facts. The Bureau for Industrial and 
Placement Work has nothing to do with epileptics; in the 
visiting of epileptics still in school, the Committee found no 
corroboration of the statement that hand training is conducted 
for the skillful use of tools in the primary grades or that 
instruction in the fundamentals of various industries or trades 
is routinely provided for epileptics in the grammar grades and 
junior high school grades. No such instruction is available 
for every child enrolled and the Committee found no evidence 
that the vocational high schools have any program or pay any 
particular attention to the problem of the epileptic. 
47 Additional Comments 
10. Each child under home instruction has three sessions 
a week with a teacher, each session for one and one-half hour. 
It is the custom to change teacher assignments when a child 
changes residence, or when the route traveled by a teacher 
makes a change convenient. The teachers doing home instruc- 
tion work have to deal with children varying widely in age and 
attainment. 
Members of this Committee who interviewed teachers doing 
home instruction were favorably impressed with the sincerity 
of the teachers they met. However, if it is fair to assume that 
the teaching of a handicapped child involves really special 
experience and training, then it would be appropriate to assign 
as teachers those whose records show the needed special quali- 
fications. It may be that the funds available do not permit 
the engagement of such fully qualified instructors. If such 
is the case, then it must be recognized that the accomplishments 
of the Division are handicapped by the relative inexperience 
of many of the teaching personnel assigned to home instruction. 
There was apparently inadequate or at least unsystematic 
procedure with respect to correlation between character and 
frequency of seizures and asignment to and continuance under 
home instruction. One pupil, aged 18, was dismissed from 
regular classwork at the age of 14, having reached the 7A 
grade. Home instruction had been given for four years and 
the pupil advanced only one year during this time. Seizures 
were reported to occur about four times a year and have never 
been more frequent. One pupil had petit rnal seizures on the 
average of twice a week, but was kept on home instruction for 
three years. One pupil aged 16 was in the 4A grade and 
seizures occurred not oftener than once a year. Another pupil 
with occasional petit mal seizures was in 6A at the age of 16. 
Another pupil aged 18 was allowed to swim and play sandlot 
baseball—although presumably his seizures were of such char- 
acter that he could not attend school. Other examples of the 
policy as to assignment to home instruction are quoted above 
48 Additional Comments 
in excerpts from the departmental report under date of June 
30, 1939. 
The following comments were made spontaneously by a 
number of the physicians who assisted in this survey. They 
are quoted because the Committee regarded them as represen- 
tative and of practical interest. In connection with the organi- 
zation of this Committee and the work done by the physicians 
who assisted in the visiting program, it should be kept in mind 
that each physician worked independently in carrying out as- 
signments, and the physicians doing visiting work were in no 
manner informed as to the knowledge or opinions held by 
other members of the Committee. 
1. There is no provision made for the proper exchange 
of information between physicians, parents and school authori- 
ties. 
2. Occasionally parents express opposition to having their 
children examined by physicians representing the Department 
of Education. In a number of instances this opposition was 
motivated by fear that the physicians would report adversely 
to what the parents conceived to be the interests of the child. 
3. No provision is made for intelligent handling of the 
problem of vocational training and placement. In a number 
of instances, mental deterioration was suspected by the exam- 
ining physicians and corroborated by repetition of psychometric 
tests made at various clinics. The school authorities were 
apparently unaware of these facts. 
4. Too frequently, the decision to exclude the epileptic 
child from regular class is based upon individual prejudice of 
a teacher or principal. 
In a noticeably large proportion of the children with 
definite mental defect it is this handicap rather than the 
character or frequency of seizures which seems to determine 
49 Additional Comments 
the exclusion from regular class as epileptics. Such children 
should be classed educationally as mentally defective, (These 
comments corroborate the inferences to be drawn from the 
statistics as to frequency of mental defect in the pupils reported 
as subject to seizures). 
5. Of medical rather than educational interest are the 
children who either are not definite epileptics, or whose seizures 
have apparently stopped, for periods from one to as long as 
ten years. 
6. The physician in charge of the visiting work in the 
Borough of Manhattan reported the following observations: 
a. Epileptic children are not receiving adequate medical 
care. (It should be kept in mind that "adequate medi- 
cal care” is a very elastic concept. Private patients 
with epilepsy are prone to be haphazard about con- 
sulting physicians and they frequently fail to live up 
to or follow the advice given. Competent physicians 
will vary widely in their ideas as to what examinations 
and treatment measures are indicated in a particular 
patient. Finally, as long as a patient is entitled to 
decide whether or not to follow a physician’s advice, 
there will always be occasion for a meticulous or con- 
cientious physician to feel that a sizeable proportion 
of the population is not having or is deprived of 
adequate medical care). 
b. Special classes for epileptics are not indicated or 
desirable. 
c. Epileptic seizures in classrooms do not constitute 
trauma (that is, an undesirable experience) to other 
children. 
d. Some principals of schools are antagonistic toward any 
medical investigation and some of the school workers 
were uncooperative with the doctors engaged in the 
survey. 
50 Additional Comments 
The frequency with which some physical defect, not ap- 
parently connected with the epileptic seizures, was found in 
these children has certain implications. First is the effect of 
such defect upon their general physical and mental efficiency. 
Next is the problem of determining whether the persistence 
of such defects indicates that the parents are ignorant or de- 
liberately neglectful with respect to needed medical attention. 
One hears a great deal about the correlation between the 
below-par child, the underprivileged class, and poverty. Many 
physicians v/ho practice among the lower economic groups are 
perfectly familiar with the fact that the intelligence and 
attitude of the parents determines their behavior and that one 
finds well cared for and healthy children when the family 
resources are intelligently expended. This is not a new phe- 
nomenon in human nature and a reading of the history of 
the English Poor Law covering the past five or six centuries 
suggests that unintelligent behavior is often a manifestation of 
biological defect rather than environmental stresses. Any effort 
on the part of society to correct undesirable health conditions 
will be futile unless there is either intelligent cooperation upon 
the part of the parents or a dangerous totalitarian sort of 
discipline applied in spite of the ignorance or poor cooperation 
of the parents. 
With respect to the children in this study visited at home 
and found to live in squalid surroundings, and in dire poverty, 
there was apparently no effort made to secure the assistance of 
available hospitals and welfare agencies. As for the children 
whose environment was undesirable from the purely psychiatric 
standpoint, there was no evidence that welfare agencies, the 
special departments of the educational system, or the courts 
were consulted. In one instance a very obviously neglected child 
was reported as living with alcoholic parents. In another in- 
stance, the school authorities found it necessary not only to feed 
but to clothe and even attend to the toilet needs of the child. 
Such situations have perhaps no direct bearing upon the ade- 
quacy of medical care of the epileptic seizures, but they do en- 
51 Additional Comments 
ter into the general problem of mental or physical handicap 
and the educability of children. 
Obviously, special class or home instruction is not the solu- 
tion for situations which require ordinary medical or sociological 
corrective measures. As for the epileptic child whose learning 
capacity is handicapped by a below-par general physical condi- 
tion, the best that the school system can do is to provide a re- 
duced or limited schedule of regular class work during the pe- 
riod of physical handicap, and to present as strongly as possible 
to the parents the need for corrective medical care. 
Teachers, principals and assistant superintendents refer to 
the idea that an epileptic child presents a hazard either be- 
cause of the circumstances under which a seizure may occur, or 
as a potential source of panic to other pupils if a seizure should 
take place at the time of some school emergency. This Com- 
mittee feels that such fears are ungrounded and largely the 
product of ignorance. The mathematical probability that a 
major seizure will occur during a fire drill or some actual 
school emergency is exceedingly small. Naturally, a child 
subject to major seizures or severe petit mal attacks who has 
such symptoms as often as once a week during school hours 
would justify some concern on the part of the school authori- 
ties. As a matter of fact, the returns from questionnaires in- 
dicate that such children are excluded from attendance at a 
school. 
The mathematical probability that a seizure might be a 
hazard can only be measured roughly. However, the attempt 
has been made on the bases of the following factors: 
1. Frequency of fits 
2. Average duration of a fit 
3. Frequency of fire drills 
4. Length of fire drill 
52 Additional Comments 
5. Length of school year 
6. Waking hours 
7. Length of school day 
The probability that an epileptic child will have a fit 
during a fire drill is a product of these two fractions: 
a. Proportion of waking time spent in fits. 
b. Proportion of waking time spent in fire drills. 
The computations are based on a period of a week, since 
there is assumed to be one fire drill per week. 
The chance that any one out of the approximately 1000 
epileptic children will have a fit during fire drill in any week 
is about once in eight years. 
One can speculate as to the degree of excitement produced 
by a fire drill and the possibility that the excitement might 
precipitate a fit. A few epileptics may have their hts occa- 
sionally precipitated by an identifiable sudden and intense emo- 
tional reaction. But routine fire drills are quite a different 
matter and the experience of this committee indicates that the 
educational authorities need have no concern about the lire drill 
"hazard.” 
53 Conclusions and Recommendations 
Conclusions 
1. The Department of Education is incompletely informed 
as to the total number of children enrolled in the New York 
City Public School System who are subject to recurrent epilep- 
tiform seizures. 
2. Of those known to the Department of Education, a 
definite degree of mental deficiency was present in over 20% 
of the cases, and the percentage of mental deficiency is definitely 
higher in the groups of children excluded from school or being 
educated under the home instruction plan. 
3. Although the Department of Education has on paper 
an organization which might result in efficient handling of the 
medical and educational problems presented by this special 
group of children, there is lack of coordination in the various 
divisions of the Department of Education. 
4. The Division of Physically Handicapped Children, 
which has had a program for those subject to epileptiform 
seizures, is apparently ill informed as to the facts which the 
survey of this Committee revealed, and the reports of this Di- 
vision imply a state of affairs which the work of this Com- 
mittee does not corroborate. 
5. The criteria for diagnostic classification and for teach- 
ing assignments are apparently inefficient and haphazard in 
many instances. 
Individual standards of teachers, principals and assistant 
superintendents apparently often determine the decision as 
to the exclusion of a pupil from school. Mental deficiency 
and other physical handicap seem to determine what should 
be done rather than the nature and frequency of seiures. 
Both the assignment to and continuance of pupils under home 
instruction are often dictated by other than medical reasons. 
6. No systematic, intelligent consideration is given to 
the problem of vocational training and placement of pupils 
suffiering from recurrent epileptiform seizures. 
55 Conclusions 
7. The occurrence of epileptiform seizures, without other 
physical or mental handicap, does not justify exclusion of the 
pupil from regular class attendance unless the seizures are so 
severe, so frequent, or so protracted that their occurrence in a 
classroom interrupts and retards the instruction of the other 
pupils. 
Most of the children subject to seizures should lead as 
normal a life as possible, and their segregation is not only 
unnecessary but apt to be harmful. With respect to the effect 
of a seizure upon other children who may witness it, good 
sense on the part of the teacher will perhaps serve to make the 
experience profitable to those who witness the attack. It 
should be kept in mind that children of school age may 
witness such seizures outside of regular class hours, and that 
no one would propose the total isolation of a child merely 
because it is subject to epileptic seizures. 
8. If a child’s seizures are of such character that atten- 
dance in regular class is deleterious to the child’s health, or a 
definite handicap to the rest of the class, teaching under home 
instruction is the best and most practicable method to adopt. 
9. The number of children in the New York City Public 
School System whose handicap is limited to frequent or severe 
seizures is so small that it is economically unsound to provide 
any special school or other institution where medical attention 
and education could be provided. Some of these children, 
however, would benefit from more intensive medical study and 
treatment. 
10. Children who have seizures but are definitely defective 
mentally should not be regarded from the educational stand- 
point primarily as problems in epilepsy, but should be dealt 
with in accordance with the provisions made for the instruction 
of those with definite mental defect. 
Children with the double handicap of mental deficiency 
and seizures which justify exclusion from any class work will 
not benefit from teaching under the home instruction program, 
and should be excluded from instruction. Their care and 
education in one of the institutions for mental defectives is the 
only sensible alternative. 
56 Conclusions 
11. The incidence of organic brain defect, mental defi- 
ciency, and physical defect of other organs, which may or may 
not be causally connected with a tendency to epileptiform 
seizures, was reasonably within the areas of what might be 
expected in view not only of the presumed nature of the 
tendency to seizures but reasonably reliable statistics based upon 
work of accredited experts. 
12. It is the feeling of this Committee, that nothing is 
really served by avoiding facts and that the word "epilepsy” 
need not be replaced by a term or terms which in a short time 
will lose the deceptive quality due to their novelty. 
Apart from the purely medical or educational aspects of 
the problem, one must consider the sentiments of lay people 
in general as to what is meant by the terra "epilepsy.” While 
there are wide ranges of frequency and severity of seizures, 
the diagnostic label has connotations which serve to the disad- 
vantage of a sufferer. As a consequence, medical nomen- 
clature has dabbled in attempts to devise terminology which 
will perhaps avoid the frequent disadvantages in the use of 
the word "epilepsy.” This Committee feels that most people 
realize that a fit is a fit, no matter what fancy term may be 
devised to conceal the real essence, and that it is better in 
the long run to be frank and direct and reserve one’s ammuni- 
tion and influence for the purpose of convincing the laity 
that the possible tendency to recurrent epileptiform seizures 
is not synonymous with the really progressive and malignant 
disorder which occurs in the minority of cases. 
13. While it is generally recognized that sudden emotional 
excitement or emotional tension may at times seem to precipi- 
tate a grand mal epileptic seizure, it is the opinion of this 
Committee, based not only upon their study of the problem 
of the Department of Education, but their general experience, 
that this factor is of little or no importance with respect to 
the school system. 
14. The great majority of the children reported were under 
medical care, the adequacy of which depended considerably 
upon the parental attitude and cooperation with physicians. 
57 Recommendations 
Examination and Classification 
1. Whenever a teacher or principal of a school becomes 
aware that a particular child may be an epileptic, the school 
authorities must be supplied with adequate and reliable diag- 
nostic information. 
From the school administrative standpoint, a child known 
to be subject to any episodic and transient loss of mental 
and physical control presents a very definite problem of 
management no matter what the cause or nature of such an 
episode may be. 
The information which is needed to enable a diagnosis 
must be determined by medical officers. Whether such medical 
personnel is attached to the Department of Education or the 
Department of Health depends upon the particular adminis- 
trative organization. Such medical officers should determine 
the procedure to be followed, and devise report forms which 
may be used by physicians and school administrative officers. 
2. As a result of the information obtained apropos of 
any pupil in question, the medical officer should be responsible 
for making a diagnosis and determining whether or not the 
child is medically fit to continue in school. 
If there is medical ground for exclusion of the child 
from class work in a school, the probable duration of exclusion 
should be estimated as accurately as possible. Also, it should 
be stated whether recommendation as to exclusion or continu- 
ance in school is based upon the existence of physical and 
mental defect apart from whatever handicap may be estimated 
as due solely to the tendency to episodes of loss of physical 
or mental control. In the case of children with multiple 
handicaps including epilepsy, educational treatment should take 
into consideration the complex of conditions rather than be 
based merely on their classification as epileptics. 
In this way, final classification will be definitely more 
accurate than the methods which have applied hitherto in 
the New York City Department of Education. 
58 Recommendations 
3. Care and tact should be exercised to make certain that 
the parents of a pupil may have the privilege of selecting the 
physician or physicians who will supply the information re- 
quired by the Department of Education. 
The occasional instance when a private physician may feel 
constrained or inclined to conceal relevant facts can to a 
great degree be obviated by the use of a properly compre- 
hensive reporting form. 
4. More extensive use should be made of the special 
divisions affiliated with the Department of Education for the 
purpose of special psychiatric and psychological examinations 
of pupils. 
5. The results of any medical and psychological survey 
of the pupil should be kept on the child's school health card 
and also in a central pie or registry and correlated with partial 
or complete re-examinations made at later dates. 
Decision as to Exclusion from School 
6. If either medical or psychological examination lead to 
a decision that a child should be excluded from school, tem- 
porarily or permanently, educational officials should accept and 
abide by this recommendation, subject, however, to additional 
medical evidence which would justify a changed ruling by the 
medical examining officer. The occurrence of epileptiform 
seizures per se should not necesarily exclude a child from 
school unless their frequency, severity or duration interferes 
ivith the regular work in class. 
Periodic Checks 
7. If a child has been excluded from school temporarily 
for medical reasons, re-examination at the end of the stated 
period should be conducted by medical officers. 
If a child is allowed to continue in school subject to 
medical check-up, proper medical information should be ob- 
tained at the intervals indicated for the particular child, and 
the situation reviewed and recommendations made from time 
to time. 
59 Recommendations 
If an epileptic child is excluded from school, solely be- 
cause of epileptic seizures, and placed under individual home 
instruction, adequate medical reports should be submitted at 
least every three months, and if a situation should arise which 
shows that the child is unfit to receive any form of instruction, 
appropriate action should be taken immediately. 
8. All epileptic children continuing under any form of 
instruction should have competent psychometric examinations 
done at least once a year. Mental deterioration should auto- 
matically require revision of the pupil’s curriculum. 
Transfer of Children 
9. Transfer of a child to and from school and home 
instruction should be prompt, though it may be undesirable 
to resume regular class work after the middle of a school term. 
While there may be administrative reasons for changing 
instructors of a child under home instruction, the special 
difficulties of adaptation between teacher and pupil maxe it 
desirable that such changes occur not oftener than once a year, 
so that the teacher assigned to a child at the beginning of the 
fall term should continue until the end of the spring term. 
10. Home instruction should not be made available to 
epileptic children with definite mental deficiency. 
The attempt to instruct a mentally defective child in the 
regular curriculum, with a teacher devoting four and a half 
hours a week to the child, appears to accomplish little or 
nothing, if one is to place any value upon the age-grade 
levels reported by the New York City Department of Education. 
11. There should be systematic cooperation with the of- 
ficers responsible for decision as to vocational training. 
The selection of an occupation must take into account 
the fact that the tendency to a seizure may present a definite 
hazard in particular types of work. Furthermore, it should 
be recognized that, at least in New York State, the Workmen’s 
Compensation Laws serve as a definite bar to employment in 
many occupations. 
60 Recommendations 
Medical Supervisory Staff 
12. It is unnecessary for the City authorities to supply 
medical attention for these children. Medical supervision for 
administrative purposes should be supplied by specially quali- 
fied physicians of the School Medical Service of the Department 
of Health. 
If the problem of the epileptic children, totaling perhaps 
1,000 in New York City’s school system, is to be intelligently 
handled, and if educators as well as physicians expect to 
learn anything or to measure the accomplishments of what- 
ever educational program is devised, there should be con- 
tinuous and competent medical supervision of these children. 
The physicians assigned to such supervisory duty should be 
competent to judge the value of medical reports submitted 
by private physicians or hospitals, and be able to make per- 
sonal interviews and examinations when indicated in order 
to supplement the information obtained from the various 
sources. 
Such a staff, with authority and responsibility, would also 
serve to minimize the attempts of parents and others to in- 
fluence school officers unwisely or improperly on matters 
which are basically of medical or psychiatric nature. 
Adequate Records 
13. Any department responsible for the handicapped should 
keep adequate records and submit analyses and reports which 
are supported by facts. 
Eastern Printing Company, Brooklyn, N. Y. 
61