The factors producing degeneration act by causing nervous exhaustion in the first generation. This implies a practical degeneration in function since tone is lost. Every nerve cell has two functions, one connected with sensation or motion, and the other with growth. If the cell be tired by excessive work along the line of sensation or motion the function as regards growth becomes later impaired, and it not only ceases to continue in strength, but becomes self-poisoned. If these nerves become tired the organ fails to perform its function, the general system becomes both poisoned and ill-fed, and nervous exhaustion results.
In most cases, [Pg 39] however, the brain and spinal cord are first exhausted. The nerves of the organs are thus allowed too free play, and exhaust themselves later. This systemic exhaustion has local expression in the testicles in the male, in the womb and ovaries in the female. Through this the body is imperfectly supplied with natural tonics antitoxins formed by the structures, and the general nervous exhaustion becomes still more complete.
All the organs of the body are weakened in their function. Practically the neurasthenic in regard to his organs has taken on a degenerative function albeit not degenerating in structure, since the restlessness of the organs is a return to the undue expenditure of force which occurs in the lower animals in proportion as it is unchecked by a central nervous system. Through the influence of various exhausting agencies the spinal cord and the brain lose the gains of evolution and the neurasthenic is no longer adjusted to environment.
Since the reproductive organs suffer particularly, children born after the acquirement of nervous exhaustion, more or less checked in development as the influence of atavism is healthy or not, repeat degenerations in the structure of their organs, which in the parent were represented by neurasthenic disorders in function. As the ovaries of the neurasthenic women generally exhibit prominently the effects of the nervous exhaustion, the offspring of these do not retain enough vigour to pass through the normal process of development.
Heredity, like other biologic factors, starts with the cell. As elsewhere pointed out, reproduction is first unicellular in type and involves an expenditure of nutritive force antagonistic to the growth of the cell. As Geddes remarks,  no one can dispute that the nutritive, vegetative, or self-regarding processes within the plant or animal are as opposed to the reproductive, multiplying, species-regarding processes, as income to expenditure or as building up to breaking down. But within the ordinary nutritive or vegetative functions of the body there is necessarily a continuous antithesis between two tissue-changing sets of processes, constructive and destructive metabolism.
The contrast between these two processes is seen throughout nature, whether in the alternating phases of cell-life or in the great antithesis of growth and reproduction. The starfish, deprived of an arm, replaces this by a fresh growth; crabs can renew the great claws which they have lost in fighting; even as high up as the lizard the loss of a leg or a tail can be made good.
In a great variety of cases a kind of physiological [Pg 41] forgiveness is shown in the reparation of even serious injuries.
The Project Gutenberg eBook of Degeneracy: Its Causes, Signs, and Results, by Eugene S. Talbot.
By continuous growth the cells of a persistent stump are able to reproduce the entire number. A sponge, a hydra or a sea-anemone may be cut into pieces with the result that each fragment grows into a new organism. The same is done with many plants; and though the division is artificial the result shows how very far from unique is the process spoken of as reproduction, which is but more or less discontinuous growth. This is well shown in the evolution onward insensibly from cases of continuous budding, as in sponge or rosebush, to discontinuous budding in hydra zoophyte and tiger-lily, where the offspring vegetatively produced are sooner or later set free.
The enormous expenditure of force required for unicellular reproduction is lessened by conjugation with another cell through satisfaction of cell hunger; and this, by making two cells do the work of one, lessens the amount of nutritive force expended by each. Evolution in fertilisation has the following steps:—. As Maupas has shown, by the time conjugation of two similar cells is reached, the paranucleus in both is incipiently hermaphroditic.
The impelling force leading to conjugation is, as Rolph has shown, cell hunger. Conjugation, he remarks, is a necessity for satisfaction, a gnawing hunger which drives the [Pg 42] animal to engulf its neighbour, to isophagy self-eating. The process of conjugation is only a special form of nutrition which occurs because of a reduction of the nutritive income or an increase of the nutritive needs. Therefore, too, is it that the small starving male seeks out the large, well-nourished female for purpose of conjugation, to which the latter, the larger and better nourished, is on its own motive less inclined.
The phenomena of this demonstrate that the female element is the highest in evolution. Spitzka  has shown that the ovum possesses an inherent activity independently of fructification. How far this may extend in the direction of more mature development is shown by what is known about parthenogenesis. This is the development of living beings without a father. Bees, some butterflies, ants and wasps notoriously multiply their kind without sexual congress. As a rule the parthenogenetic offspring are themselves incapable of further procreating their kind. But to this there are remarkable exceptions.
The aphides multiply for many generations without the intervention of a male. Weigenbergh has shown that the silk-moth can be propagated as long as the male element is permitted to act at every fourth generation. The Artemsia salina , a minute crustacean [Pg 43] living in saline springs, reproduces its kind for years without a male being present, males being produced at definite intervals only Von Siebold.
Among the vertebrata parthenogenetic development has also been observed, though rarely reaching maturity. Thus, segmentation occurs in unfertilised ova of the chicken Oellacher , of the fish Burnett and Agassiz , and of frogs Moquia-Tanden. Spitzka has seen a blastoderm form in unfertilised ova of the toad-fish Batrachus tau. Hensen isolated the oviducts of a rabbit, thus rendering the admission of semen impossible, while the ova, discharged at heat, were compelled to remain in these oviducts.
Three years later he killed the animal and found the ova had developed into twisted, club-shaped, hollow sacs. The development in the female ovary also, though very rarely, in the male testicle and parotid gland, which show such a remarkable metastatic sympathy in mumps , of dermoid cysts containing bones recognisable as maxillaries with teeth, hair, and skin, rudimentary bowel, gland, and brain traces , even in undoubted virgins, proves that even the human ovum is capable of parthenogenetic development.
While such development, so far as known to science, is always abortive, and while, as Washington Irving remarks, the ingenious maiden who to-day would attribute conception to any other cause than sexual congress would find it difficult to overcome the prejudice of scientists, yet embryology, while declaring immaculate generation improbable, does not pronounce it impossible. A worker bee may be an offspring of an unimpregnated queen bee.
What is a regular occurrence in one class of animals is sometimes observed as an [Pg 44] exceptional one in another class. If the startling and apparently miraculous nature of a virgin generation of a living child be regarded as the sole objection to receiving such a fact, its defender might urge that the virgin generation of a dermoid cyst with all the traces, however aborted, of vertebrate organisation, is only a shade less startling and miraculous.
This power of parthenogenesis, however, cannot continue indefinitely without extinction. This has been shown by the careful experiments of Maupas, who had observed generations of an infusorian without sexual union. He found that then the family became extinct. Powers of nutrition, division, and conjugation with unrelated forms come to a standstill. The first symptom of this senile degeneration is decrease in size, which may go on till the individuals only measure a quarter of their normal proportions.
The important paranucleus is fatally sterile. Such senile decay of the individuals and of the isolated family inevitably ends in death. Sexual union in those infusorians, dangerous perhaps for the individual life, a loss of time so far as immediate multiplication is concerned, is, in a new sense, necessary for the species. The life runs in cycles of a sexual division which are strictly limited. Conjugation with unrelated forms must occur else the whole life ebbs. Conjugation is the necessary condition of their eternal youth and immortality. Starting from this standpoint the relative functions of the two sexes in heredity are apparent.
The original function of reproduction, that of cell division, is the part of the female. The male in the lower instances simply supplies the female with nutriment. Thus in certain plants there is nothing but a subtle osmosis between the sexes. This is also the case with some of the lower infusoria. With a rise in evolution protoplasm becomes differentiated. At the outset of the subject of heredity it is evident, therefore, that the female furnishes the type which is best capable of development when properly nourished by a highly developed male.
To deficiencies in both particulars are due defects and variations in the offspring. As the product of fructification is longest under the nutritive control of the female, her influence is most emphatic in either redeeming defects or producing them. Direct heredity consists in the transmission of paternal and maternal qualities to the children. This form of heredity has two aspects: 1 The child takes after father and mother equally as regards both physical and moral characters, a case strictly speaking of very rare occurrence; or 2 the child, while taking after both parents, more especially resembles one of them.
Here again distinction must be made between two cases. The first of these is when the heredity takes place in the same sex from father to son, from mother to daughter. The other [Pg 46] which occurs more frequently, is where heredity occurs between different sexes—from father to daughter or from mother to son. Reversional heredity or atavism consists in the reproduction in the descendants of the moral or physical qualities of their ancestors.
It occurs frequently between grandfather and grandson, as well as between grandmother and granddaughter. Collateral or indirect heredity, which is of rarer occurrence than the foregoing, and is simply a form of atavism, subsists, as indicated by the name, between individuals and their ancestors in the indirect line—uncle, or grand-uncle and nephew, aunt and niece.
Finally 3 there is telegony, or the heredity of influence, very rare from the physiological point of view, which consists in reproduction in the children by a second marriage of some peculiarity belonging to a former spouse. In dealing with heredity the position of Weismann and others, that acquired characters cannot be inherited, needs a short examination. In his later work Weismann has practically abandoned the essential basis of his position by admitting that maternal nutrition may play a part in determining variation.
He  now asserts that the origin of a variation is equally independent of selection and amphimixis, and is due to the constant occurrence of slight inequalities of nutrition in the germ plasm. This is an emphatic [Pg 47] though concealed abandonment of the central position of Weismann.
One of the stock arguments of the Weismann school is drawn from results of the Jewish rite of circumcision. While the operation is not calculated to make a profound impression on the constitution, and furthermore, as being performed on the male, less likely to affect the race, still the alleged non-inheritance of its results is much over-estimated. William Wolf,  of Baltimore, Maryland, who has circumcised six hundred Jewish children, finds on careful examination, that 2 per cent. Remondino,  of Los Angeles, California, has seen a large number of cases of absence of the prepuce which proved to be hereditary.
After a confinement his attention was once called to the child by the nurse, who thought it was deformed. The nurse was astonished at the size and appearance of the glans penis. On examination the prepuce was found to be completely absent. On inquiry, the father and another son, born more than twenty years previously comprising every male member of the family , were found to have been born with the glands fully exposed.
He has seen a French family similarly affected. Similar, but much stronger, results have been obtained by me through the courtesy of the Reverend Drs. Bauer, M. Cohen, and B. Gordon, all of Chicago. Cohen, who has been two decades in the practice, has performed 10, circumcisions. He has found the prepuce wanting in cases; partially developed in cases; slightly developed in 2, cases. Gordon has performed 4, circumcisions in twenty-five years. He has found the prepuce absent in 15 cases; partly wanting in , and slightly developed in 2, cases. These, it should be remembered, are only cases where preputial change forced itself on the observer, who was not pursuing investigations on this point.
The volume of Hebrew casuistic religious literature collected in the Medrash, evidences as I have elsewhere  shown the frequency of congenital preputial defect. That acquired characters can be transmitted has been definitely shown by the experiments of George Roe Lockwood,  of New York, anent hereditary transmission of mutilations. White mice were selected, as they begin to breed when thirty days old, and breed every thirty days. He bred in-and-in for thirty-six generations, destroying the weakly, and thus obtained finer animals than the first pair. He selected a pair, caged them by themselves, and clipped the tails of the young.
When they were old enough to breed, he selected a pair and clipped the tails of their progeny. In the seventh generation he obtained some tailless mice, and finally a tailless breed. The experiments have one possible element of error; white mice, like all albinoes, are a degenerate type.
At the same time these experiments show that accidental mutilations favoured by circumstances are inherited. In order to obtain short-tailed pups the owner had the tails of both shortened. The bitch from that time produced repeatedly short-tailed pups only. As the most careful attention was paid to the parents, no error can be suspected in this case, which, moreover, excites no surprise among dog-breeders.
Exophthalmia eye protrusion was inherited by guinea-pigs in whose parents this protrusion of the eyes had occurred after an injury to the spinal cord, and so were bruises and dry gangrene, as well as other trophic disturbances in the ear, due in the parents to an injury to the restiform body of the brain. Loss of certain phalanges or of whole toes of the hind feet which had occurred in the parents in consequence of division of the sciatic nerve was inherited.
Diseased conditions of the sciatic nerve occurred in the offspring of guinea-pigs in which this nerve was divided. Forty guinea-pigs in which one or both eyes showed more or less morbid change were descended from three individuals in which one eye had become diseased in consequence of transverse section of the restiform body. Twenty guinea-pigs exhibited muscular atrophy on the upper and lower sides of the thigh, when in the parents such atrophy had been caused by section of the sciatic nerve.
Indeed, Weismann has been forced to that reductio ad absurdum in science, narrowly limited definitions, in order to maintain his position. This much may be maintained: that influences which are mostly of variable nature, tending now in one direction, now in another, can hardly produce a change in the structure of the germ plasm, and this is the reason why the cause of inheritable individual differences must be sought elsewhere than in these varying influences.
But these are acquired characters in the above sense. True, they must once have appeared for the first time, but we cannot say exactly from what causes; we only know that at least a great proportion of them proceed from the germ itself, and must therefore be due to alterations of the germinal substance. If Virchow could show that any single one of these hereditary deformities had its origin in the action of some external [Pg 51] cause upon the already formed body soma of the individual and not upon the germ cell, then the inheritance of acquired characters would be proved.
But this no one has yet succeeded in proving, often as it has been maintained. The crucial test which Weismann demands is furnished by Dupuy,  who made one thousand experiments on guinea-pigs to the fifth generation, critically rejecting all results which did not correspond to the most rigid tests of direct heredity, excluding all instances of indirect heredity, however demonstrable.
He found that certain lesions of the spinal cord, or the brain or the sciatic nerve, give rise in guinea-pigs to epilepsy. In from three to six weeks after the operation an alteration in the nutrition takes place in an area of skin which is limited by a line starting from the outer canthus of the eye, and running to the median line on the upper lip, enclosing the nostril, thence backward enclosing the lower jaw, to the anterior portion of the shoulder to the median dorsal line, to the base of the ear and inner canthus of the eye.
The alteration in nutrition occurs on the side corresponding to the injury. The pain, heat and cold sense disappear by degrees, while touch appears to be exalted. Very soon, tickling this zone of skin gives rise to twitchings limited to the muscles of the eye and the eyelids on the same side.
Later, the muscles of the mouth and of the face are affected, still later the contractions become more general, until the whole side is the seat of convulsions, then the convulsions attack the other side also. When things have come to this point the convulsions precede by a very short time complete [Pg 52] loss of consciousness.
If the subject of experiment be white, it is found that there is paleness of the face, but in all cases there is little foam at the mouth and dilatation of the pupils. The animal sometimes utters a cry corresponding to the epileptic cry in the man. Not only are the convulsions identical with those in epileptic man, but there is also loss of consciousness, a state of torpor, stupor, and even sometimes insanity. When epilepsy is due to the destruction of the sciatic nerve, the foot of the affected side loses the two outer toes, so that the animal has only one toe, the inner.
When young are born to such a parent or parents for it matters not whether one or both of the parents have been operated upon , they have very often only one toe on the posterior foot. Sometimes, however, they have additional toes, which, in this case, are attached by a pedicle to the limb. Those peculiarities observed in the parents are in all their details witnessed in the guinea-pigs hereditarily born toeless, who have developed epileptic phenomena.
The mutilations were made under antiseptic precautions. The descendants of this cat had traces of the mutilation, and its results until the fourth generation, when the breed became extinct. This instance certainly fulfils all Weismann requirements. In the Lambert family a skin deformity, the last result of degeneracy in previous generations, was transmitted. This peculiarity appeared first, according to Proctor,  in the person of Edward Lambert, whose whole body, except his face, the palms of the hands and the soles of the feet, was covered with a horny excrescence.
He was the father of six children, all of whom as soon as they had reached the age of six weeks presented the same peculiarity. The only one of them who lived transmitted the peculiarity to all his sons. For five generations all the male members of the family were distinguished by the horny excrescence which had adorned the body of Edward Lambert. Shwe-Maong, one of the hairless Burmese, when thirty years old had his whole body covered with silky hairs, which attained a length of nearly five inches on the shoulders and spine.
He had four daughters, but only one of them resembled him. She had a son who was hairy like his grandfather. The case of this family illustrates rather curiously the relation between the hair and teeth; for Shwe-Maong retained his milk teeth till he was twenty when he attained puberty ; then they were replaced by nine teeth only, five in the upper and four in the lower [Pg 54] jaw.
Eight of these were incisors, the ninth in the upper jaw being a cuspid tooth. Certain motor expressions of disturbed functions are also inherited. Galton describes the case of a man who, when he lay fast asleep on his back in bed, had the curious trick of raising his right arm slowly in front of his face, up to his forehead, and then dropping it with a jerk, so that the wrist fell heavily on the bridge of his nose.
The trick did not occur every night, but occasionally, and was independent of any ascertained cause. Sometimes it was repeated incessantly for an hour or more. At one time an awkward sore was produced that was long in healing on account of the recurrence, night after night, of the blows which first caused it. His wife had to remove the buttons from the wrist of his nightgown, as it made severe scratches, and some means were attempted of tying his arm.
Many years after his death his son married a lady who had never heard of the family incident. She, however, observed precisely the same peculiarity in her husband; but his nose, from not being particularly prominent, has never as yet suffered from the blows. The trick does not occur when he is half asleep, as, for example, when he is dozing in his armchair, but the moment he is fast asleep he is apt to begin. It, as with his father, is intermittent, sometimes ceasing for many nights, and sometimes almost incessant during a part of every night.
It is performed, as it was with his father, with his right hand. One of his children, a girl, has inherited the same trick. The face of a child is often fully developed, yet, owing to some of the constitutional diseases, arrested development of the face at this point takes place. The second generation inherits this deformity, while the grandparents possess normally developed faces. The following case came under my own immediate observation. The grandfather was in the habit of sitting in front of the fire with fingers locked together twirling the thumbs in one direction, and then occasionally knocking the thumb nails together.
Two of his three sons inherited this habit; the third brother had the habit of biting his nails when in a fit of abstraction.
Born to Triunph
The nephew of the last has a similar habit under the like conditions. The children of this nephew have in two instances shown a tendency to pick at the nails when in an unconscious state, from acute disease. The third child has a periodical tendency to do the same since it was four months old. Gibney,  of New York, has reported a family consisting of father and mother, five children, and one grandchild. The father and mother are semi-ambidextrous. All of the children and the grandchild are semi-ambidextrous to an annoying degree; [Pg 56] all of the movements which they perform with one hand are simultaneously performed by the other hand.
The girls are obliged to use only one hand when dressing themselves, or when cutting patterns, and hold the other hand down by their side, because the two hands perform the same movements at the same time and would interfere with each other. The dreams had nothing of the nightmare which would cause sudden contraction under the influence of a terrifying idea.
They were merely the ordinary phenomena of sleep. The organisation of a morbid predisposition may be largely influenced by an accident accompanying conception or gestation. In some degenerates cannot be found a trace of hereditary defect. These congenitally degenerated beings ab utero can hardly be distinguished from those having direct heredity. The opinion which refers the origin of birth-marks to intense mental impressions on the part of the mother is not without physiological foundation.
Concurrently with the motor phenomena, stigmata  may become developed by vascular and nutritive troubles produced under the influence of a strong excitation or by the imagination. Spitzka,  who approached maternal impressions from an actively sceptical standpoint, had his scepticism shaken by specimens preserved in the British Museum of newly hatched chicks, all of which had a curved beak like a parrot, and the toes set back as in that bird.
According to the report of the curator the hens in the farmyard where these monstrosities were hatched had been frightened by a parrot which, having escaped, fluttered among them some time before the eggs were laid and greatly frightened those from whom the malformed chicks were [Pg 58] received. It is certain that the chief argument of those who deny that maternal impressions are transmitted is defeated by this case. They have usually asserted that the explanation of the nature and cause of a birth-mark was always an after-thought on the part of the mother.
But there was no after-thought in this case. The hens did not publish a theory as to the malformation of their chicks. It was their owner, a gentleman of intelligence and culture, who observed the casual occurrence, and who verified the almost photographic truthfulness of the germ monstrosity by depositing it in a museum as a permanent record at which none may cavil.
Since then, the singular freaks attributable to maternal impressions of women, seen by Spitzka, have become so numerous that he has been compelled to negative the argument that they were merely accidental coincidences. He has never seen an idiotic, malformed child or one afflicted with morbid impulses derived from healthy parents free from hereditary taint in which a maternal impression could not be traced. In a large number a direct correspondence between the maternal impression and the nature of the deformity or peculiarity could be discovered. He reports the case of a woman, about five months pregnant, who, while standing in her yard, saw her husband stab into the belly of a goat he had slaughtered.
The sight of the suddenly protruding visceral mass, which happened to be imperfectly bilobar, shocked her extremely, and, starting back, she, in her great revulsion, feeling a strange sensation at the nape of the neck or back of the head, clutched the former with her right hand. The impression [Pg 59] continued to haunt her. In reality they were the convolutions of a hernia containing the posterior ends of both cerebral hemispheres. The accidental resemblance of the deformity to the mental impressions was striking.
Lagorio  brought before the Chicago Medical Society several cases in which maternal impressions had produced decidedly abnormal births with deformities resembling those feared by the mother. Kiernan, in discussing these, pointed out that all were instances of checked development. He was of opinion that moral shock, generally directed, played the chief part in maternal impressions through checking development and causing either general or local reversion. Here, as Spitzka  shows, the statistical method can be applied. It has been long known that profound grief, mental or physical shock acting on the mother, produce cerebral defect or generally arrested development in the offspring.
Of 92 children born in Paris during the great siege, , 64 had mental or physical anomalies and the remaining 28 were weakly, 21 were intellectually defective imbecile or idiotic , and 8 showed moral or emotional insanity.
After the great Chicago fire in birth-marks, deformities, and mental defects were noticed to occur among the offspring whose mothers were pregnant with them pending the exciting time during and after the conflagration. Spitzka has seen in practice, constitutionally melancholic or mentally defective children in whom no other predisposing cause could be discovered than that the mother was struggling with direct or indirect results of the financial crisis of In several of these cases the death of the father was a contributory cause of maternal depression.
In Berlin the financial crisis of was followed by an increase in the number of idiots born. Lombroso attributes a series of cases of microcephaly to profound mental impressions occurring during pregnancy. To the same class of cases belong the hermaphrodites born by mothers who have been frightened in their first pregnancy and who continue to bear hermaphrodites. The continual and not ill-founded dread that the succeeding children may resemble the first is to be regarded as a contributory cause.
Kiernan,  after citing instances reported by Amabile, Carson, F. Earle, Erlenmeyer, F. Hubbard, C. Hughes, Mattison, and others, of congenital opium habit where opium was needed to preserve the infant during the first months of life, states that inheritance of the opium habit seems at first an isolated phenomenon, but zoologists have pointed out that pigeons whose ancestors were fed on poppies became intractable to opium.
Murrell found that the same was relatively true in England of persons descended from Bedfordshire ancestors who used infusions of poppies as a prophylactic against malaria. Nervous diseases were, however, relatively prevalent in these districts. Narcotic habits in the ancestors produces descendants in whom the normal checks on excessive nervous action are removed, so that paranoiacs, periodical lunatics, epileptics, hysterics, congenital criminals, congenital paupers, or other degenerates result. This influence is most strongly exerted when the maternal ancestor is the one affected, for to her is committed the development of the ovum prior to conception and of the child subsequently.
If either is interfered with by a habit, a being defective in some respects is the result. The direct inheritance of the opium habit has been shown experimentally by Levenstein, who found by experiments on pregnant dogs and rabbits that the use of opium during pregnancy produced either abortion or still-births, or rapidly dying offspring. This brings the observer face to face with the problem of morbid heredity. It may at once be admitted that, as has been claimed by a large number of observers, morbid heredity, especially in its graver forms, is much less frequent than at first would be expected.
In some cases all apparent morbidity or abnormality is wanting. In other cases slighter abnormalities are to be detected. As Kiernan has shown, atavism at times tends to preserve the type, and offsets the influence of degeneracy. This element of atavism underlies not merely the production of the sound scions of degenerate [Pg 63] stock, but also those in whom the degeneracy affects the earlier and not the later acquirements of the race.
The contrast of the moral imbecile who is unable to acquire an idea of right, or the idiot of the lowest grade who can hardly be taught to keep himself clean, with the otherwise sound, sane, able victim of hereditary gout, is very great. Yet all the links of the chain connecting, in the same family, these contrasted types, can often be found. The law laid down as to absolute extinction through degeneracy by Morel and others can only be regarded as absolutely true when applied to a given type rather than the race as a whole.
Indeed, environment may play a part in preserving a degenerate who would otherwise die out. Thus in societies at a certain stage of culture imbeciles, paupers, lunatics, and congenital criminals live at large and even propagate through legal marriage. The seemingly enormous increase of the defective class which occurs in frontier communities when the classes begin to be placed in public institutions is an excellent illustration of this. Manifestations of morbid heredity result not in inheritance of the whole defect but in disturbance of relations of structure and hence of function, producing, as Kiernan remarks, a constitutional deficiency which takes the line of least resistance.
The extent and direction of this line of least resistance depend on the amount of healthy atavism which separate organs and structures of the body preserve. The line of least resistance sometimes taken is excellently illustrated in the occurrence of stigmata already pointed out in the case of epileptic guinea-pigs. This unilateral predisposition which, as Kiernan has shown, is due usually to heredity or intra-uterine [Pg 64] causes may be artificially produced. Kasparek  cut one sciatic nerve of a guinea-pig and after all inflammatory symptoms had subsided injected the opposite ear with cultures of pus microbes.
He killed the animal after some days. The sound side was found free from suppuration, but immense abscesses existed on the side of the cut nerve. Such local predisposition was pointed out by Merrill  over forty years ago. Sometimes these manifestations are limited to the side free from nervous trouble. As a rule they attack the side which is the predominant seat of nervous symptoms. Localisation of nervous trouble occurs on the side most affected by hare-lip.
Heuse has observed the co-existence on the same side of congenital cataract and of deformities of the skull and chest. Hernia is often an expression of hereditary defect Le Double taking the unilateral line of least resistance. Testicle inflammations of microbic origin venereal or otherwise occur as a rule on the side where hernia is located in the groin. In one-sided malformations of ovary or testicle decreased or increased in size, or changed in shape or location microbe inflammation almost always occurs at the [Pg 65] seat of the anomaly.
This principle is illustrated in the experiments of Dupuy. The same principle is shown by certain observations of Charin and Gley,  who for five years conducted experiments calculated to throw light on the influence on the offspring of parental reception of virus. Either both male and female have been inoculated with the bacillus of blue pus or its toxins, or but one animal has been inoculated. The results have not been uniform. Most frequently there ensues sterility, abortion, or birth of progeny that die immediately.
In rare instances the offspring survive; more rarely still are they healthy. Certain rabbits born of these undeveloped animals were provided with enormous epiphyses ends of bones , the shafts of the bones being shortened. Two rabbits were born of a couple of which the male alone received inoculations of sterilised culture.
Five rabbits were born of these two, of which two were normal, and a third whose ears were rudimentary died in a few days. In the remaining two the ears comprised only fragments with jagged upper edges. The tails were but two centimetres long. The external orifice of the vagina one rabbit was a male and the other a female was oblique. One of the limbs the hind in the male and the fore in the female was much shorter than its fellow, the difference being four centimetres.
The [Pg 66] shortened limb ended in a kind of stump, there being no foot or toes. These experiments illustrate the transformation of heredity, that is the manifestations which show the line of least resistance that the morbid heredity has taken. Some have refused to admit that mental faculties were subject to heredity, because the mental characters of the descendants were not precisely those of the progenitors.
Each generation must copy the preceding. Father and son must present the spectacle of one being, having two births, and each time leading the same life, under the same conditions. But it is not in the heredity of functions, or of organic or intellectual facts that the application of the law of heredity must be sought, but at the very fountain-head of the organism, in its inmost constitution.
A family whose head is insane or epileptic does not of necessity consist of lunatics or epileptics, but the children may be idiotic, paralytic, or scrofulous. This is what is to be understood by hereditary transmission. Alienists have, perhaps, more frequent occasion than others for observing not merely this hereditary transmission, but likewise various transformations which occur in the descendants. They are aware that simple neuropathy nervous tendency of the parents may produce in the children an organic disposition resulting in mania or melancholia, nervous affections which in turn may produce more serious degeneracy and terminate in the idiocy or imbecility of those who form the last link in the chain of hereditary transmission.
What is true of the organism as a whole is true of the cells forming its organs. It should be remembered that while cell life is altruistic or subordinated to the life of the organ, through the law of economy of growth, recognised by Aristotle, and through it to the life of the organism as a whole, altruism is not complete enough to prevent entirely a struggle for existence on the part of the cells or the individual organs. With rise in evolution this struggle decreases, to increase with the opposite procedure of degeneracy.
From it results the phenomenon of arrested and excessive development. As Dareste has shown and the fact has been corroborated by Spitzka  , embryologists can imitate natural malformation of the nerve centres by artificial methods. More delicate injuries produce less monstrous development.
Partial varnishing or irregular heating of the egg-shell, in particular, results in anomalies comparable to microcephaly little head and cerebral asymmetry. This latter fact showing the constancy of the injurious effect of so apparently slight an impression as the partial varnishing of a structure not connected with the embryo at all directly suggests the line of research to be followed in determining the source of the maternal and other impressions acting on the germ.
What delicate problems are to be solved in this connection may be inferred from the fact that eggs subjected to the vibration and shocks of a railroad journey are checked in development for several days, or permanently arrested. A more delicate molecular shock during the maturation of the ovum, during its fertilisation, or finally during embryonic stages of the more complex, and therefore more readily disturbed and distorted human germ, accounts for the disastrous effect of insanity, emotion, or other mental or physical shock of the parent on the offspring.
The cause of the majority of cerebral deformities exists in the germ prior to the appearance of the separate organs of the body. Artificial deformities produce analogous results because they imitate original germ defects, either by mechanical removal, or by some other interference with a special part of the germ. Early involvement of the germ is shown by the fact that the somatic malformations of the hereditary forms of insanity often involve the body elsewhere than in the [Pg 69] nervous axis.
The stigmata of heredity—defective development of the uro-genital system, deformities of the face and skull, irregular development of the teeth, misshapen ears and limbs—owe their grave significance to this fact. Like deformities of the brain, these anomalies are also more marked and constant with the lower forms of the hereditarily based systematised perversions of the mind than the higher. It is easy from these results to understand how far and how the nervous system has its part in the disorders of general development.
It can be easily understood how the individuals who present most deformities are equally those who suffer from most decided disorders of the nervous system. These morbid manifestations of heredity occur in certain categories, either local as to organs or structures, or affecting the body as a whole. These categories Moreau de Tours lucidly sums up as: First, absence of conception; second, retardation of conception; third, imperfect conception; fourth, incomplete products monstrosities ; fifth, products whose mental, moral, and physical constitution is imperfect; sixth, products specially exposed to nervous disorders in order of frequency as follows—epilepsy, imbecility or idiocy, deaf-mutism, insanity, cerebral paralysis, and other cerebral disorders; seventh, lymphatic products; eighth, products which die in infancy in a greater proportion than sound infants under like conditions; ninth, products which, although they escape the stress of infancy, are less adapted than others to resist disease and death.
The explanation of these morbid manifestations lies in the very foundations of embryology. Bearing in mind the principles of individuation pointed out [Pg 70] by Spencer, it is easily understood how reversal of this principle would produce greater and greater destruction of the complex functions, resultant on increased reproductive power of cells whose environment is not suited to such reproductions and thus lead to such a struggle for existence as to produce sterility from interdestruction of the ovum cells, or the cells forming the spermatozoon.
This condition is further increased by the operation of two biologic principles. The first relates to the cells or organs forming an organism. The second, as Von Baer has shown, deals with the relation of the organs to each other. Vertebrate embryos of a common type, at their origin, assume successively a number of common forms before definitely differentiating.
Dareste points out that supernumerary organs do exist in these common forms at one phase of embryonic life. This community of embryonic types and this last fact explain repetition of teratologic types or monstrosities in vertebrates. This community of origin, moreover, indicates that a higher vertebrate embryo contains in essence the organs and potentialities of lower vertebrates, and that under the influence of heredity or accidental defect an organ belonging to another species may develop, or an organ constant in a species may be lacking in an individual, without the necessity of explaining the immediate effects by distant atavism.
Some anomalies found among degenerates recall types less elevated than man, and very distant from him, even his possible Lemurian precursor. It is obvious from the principles already demonstrated that the secondary effects of infectious [Pg 71] disorders and injuries are reproduced in various types in the offspring. The malformations of the limbs experimentally demonstrated to be due to ancestral infection by Charin and Gley, and to injury by Dupuy, noticeably occur in men. Moor has observed supernumerary fingers in an imbecile girl; her grandfather and one uncle are polydactylous and insane.
Coolidge has had under observation a case which excellently depicts these deformities in men. Kiernan  reports the case of a man whose grandfather and father had been prophets of the Lord, as shown by the fact that on one side of the body they had six toes and six fingers, and the two sides of the body were unequal, the six-fingered one being smaller than the other. This father and grandfather were highly regarded in a secluded vale in Norway as religious teachers and for their power to cure disease by charm. The father had ten children, of whom three were born dead and six died in infancy.
This was regarded by the father as the result of persecution by the devil, who was desirous of trying him as Job was tried. It was revealed to him that his son should likewise suffer persecution, which would also be the work of the devil. The son heard unseen persons, who [Pg 72] pointed him out in school as the son of the sham wizard. Into this family the son married; then, pressed by his unseen persecutors, he came to the United States.
Here he worked at his trade as a carpenter, and had no return of any persecutory delusions, although he still believed he was a prophet. On admission to the insane hospital, twenty years after his arrival in the United States, he was found to have such a decidedly asymmetrical body that suspicions of general hemiatrophy were excited, but the condition was found to be congenital. The hand and foot of the seemingly atrophic side had six fingers and toes. His wife, who applied for his discharge, was also a paranoiac. They had had ten children, of whom three were still living at the ages of six, eight, and ten.
Two of these were six-toed and six-fingered unilaterally, and one of them, a boy, had the peculiar general asymmetry of the father. The third child was seemingly normal. This is demonstrated by study of the [Pg 73] degeneracy stigmata of phthisical families. James, Ricochon,  C. Paddock,  and others have shown that in addition to the ordinary stigmata the biologic stigmata of degeneracy such as plural and quickly repeated births are frequent among phthisical families.
The same phenomena often occur in families whose scions are attacked with diabetes, obesity, articular rheumatism, cancer and gout. De Giovanni  finds that particular nervous states exist in those predisposed to tuberculosis, whom he divides into erethists restless , torpids, and energetics. There is a diminutive heart, whose right ventricle has comparatively exaggerated dimensions, while the arteries have lessened calibre. A family illustrating excellently the transmutation of morbid heredity is one followed through five generations by Kiernan.
The daughter had led a lonely life till her courtship at the age of 28 by the farmer, then three years younger. He then found lead on his farm and went to a city. A stock-company bought his farm and launched him into the stock market, where he made money more as a cunning tool than an adventurer. He became a high liver, gouty and dyspeptic, and died with symptoms of gouty kidney at The couple had five children. He married a society woman, the last scion of an old family.
The second [Pg 74] child, a daughter, was club-footed and early suffered from gouty tophi. She married a society man of old family who had cleft palate. The third child, a daughter, had congenital squint. She married a man who suffered from migraine of a periodical type.
The fourth child, a daughter, was normal. She married a thirty-year-old active business man, in whom ataxia developed a year after marriage. The fifth child, a son, was ataxic at eighteen. The migrainous man and squinting daughter of the farmer stockbroker had a sexually inverted masculine daughter, a daughter subject to periodical bleeding at the nose irrespective of menstruation, as well as chorea during childhood, a normal daughter, a deaf-mute phthisical son, a daughter with cloacal formation of the perineum, an ameliac son, a cyclopian daughter with one central eye born dead, and, finally, a normal son.
Doutrebente reports the following family history: First generation: Father intelligent, became melancholic, and died insane. Mother nervous and emotional. Second generation: Ten children; three died in childhood, seven reach maturity as follows: Daughter A, melancholiac; daughter B, insane at twenty; daughter C, imbecile; daughter D, a suicide; son E, [Pg 76] imbecile; son F, melancholic; son G, a melancholic.
Third generation: A has ten children; five die in childhood, one is deformed, one has fits of insanity, one is eccentric and extravagant, two are intelligent and marry, but are childless. B leaves no issue. C has one child, a deformed imbecile. F is childless. G has one child, who is imbecile.
Strahan  gives a genealogy which shows very clearly the close kinship existing between the cancerous diathesis and other forms of constitutional degeneration whose outward manifestations are infantile convulsions, suicide, epilepsy, insanity, lymphatism, and sterility. The father of this family died of stomach cancer at sixty. He had a brother who cut his throat at fifty-six; the mother, an apparently healthy woman, died of a fit, at the age of fifty-four.
To this pair seven children were born: 1. A son who died of stomach cancer at fifty-eight. A son who died in convulsions at thirteen weeks. Three daughters who died of phthisis, one at sixteen, the other two later in life, and after being married for many years; none left any issue. A son who is epileptic, and has twice been confined in lunatic asylums; married, but no issue.
A son who is sane, and enjoying fair health. Here the taint in the mother appears to have been slight; still, it was there, and while certainly preventing reversion, it [Pg 77] doubtless deepened the degeneration of the father in the children. While it was exhibited as cancer in him, it took the form of suicidal impulse in his brother. In the children of this pair the disease of the father is transmitted to the eldest son; but can it be denied, Strahan asks, that the infantile convulsions, the liability to tubercular disease, the epilepsy, the insanity, and the marked sterility were but the varying evidences of the degenerate nature, inherited from a father who might have died earlier of some acute disease, taking the secret of his nature with him?
The Rougon-Macquart family of Zola which had its actual prototype in the Kerangal family described by Aubry  had, like these, several scions in whom former normality regained its power through atavism. Sometimes this atavism is not shown to any greater extent than a slight modification of the abnormality or morbidity. Telegony, the so-called and much-debated heredity of influence, whereby the children of a second marriage resemble the first husband, may be explained by a biologic principle demonstrable in the lower animals, whereby conjugation not sufficient to fecundate ova is sufficient so to impress them that when finally fecundated they bear characteristics of the [Pg 78] first conjugation.
Its part in either normal or degenerate heredity is but slight. Some instances charged to it might be attributed to mental impression on the mother. The individual who comes into the world is not an isolated being separated from his kindred. He is one link in a long chain which is unrolled by time, and of which the first links are lost in the past. He is bound to those who follow him, and to the atavic influences which he possesses; he serves for their temporary resting-place, and he transmits them to his descendants.
If he come from a race well endowed and well formed, he possesses the characters of organisation which his ancestors have given him. He is ready for the combat of life, and to pursue his way by his own virtues and energies. But inversely, if he spring from a stock which is already marked with an hereditary blemish, and in which the development of the nervous system is incomplete, he comes into existence with a badly balanced organisation; and his natural defects, existing as germs, and in a measure latent, are ready to be developed when some accidental cause arises to start them into activity.
Consanguineous and Neurotic Intermarriage. Byron has sung  of the old popular belief in the advantages of cross-breeding, which arose originally in the practice of exogamy marriage outside the tribe , or, more often, outside those having the same [Pg 80] totem, or coat-of-arms. In all probability casual observation of deformities after intermarriage enforced the prohibition which arose after the killing of female children had led to exogamy.
In the article that follows, David Holladay and Caryn Navy of Massachusetts describe how their daughter Diya prepared to reach one of the most important milestones in the Jewish tradition. Just before the closing prayers at the service where Diya became a bat mitzvah, she danced joyfully along with other children and adults. The energy and pride bubbled over as a stirring klezmer song celebrated Diya's accomplishment. We were all moved by her poise and the clarity and beauty of her voice as she led parts of the service and chanted from the Torah. We listened with rapt attention to the rabbi's moving description of Diya and her journey toward this day.
Diya came to the United States from India when she was twenty-one months old. As she was getting used to her new home, she encountered Jewish family and community life for the first time. It was during her first year with us, at a community Jewish holiday celebration, that a friend in the congregation who was a speech therapist suggested that Diya might have autism.
Our friend also told us that autism is hard to diagnose in blind children since they often have autistic-like behaviors that they outgrow. Over the next few years Diya's preschool teachers and others often raised the question of autism. Diya was reluctant to play with toys, and she had very limited verbal interactions. Diya was finally diagnosed on the autism spectrum by a developmental pediatrics team, but we always felt a little uncertain. In addition to regular preschool, Diya attended a Sunday preschool class in our congregation for one year.
The kids learned about Jewish holidays and other topics with their parents. Though Diya didn't tune into much of the learning, she fell in love with counting from one to ten in Hebrew. Since Diya had a hard time speaking, it was often helpful to give her a structure in which to insert her own words.
In an extracurricular religious school program, however, those familiar resources wouldn't be available. Or so we thought. This innovative program provided religious school classes for kids with special needs. Diya has continued to attend Sunday classes at Gateways except for one year. One of the things she loves about going to Gateways on Sunday is the long car ride with Daddy.
When Diya first attended the Sunday classes, she was very timid and barely spoke a word. Over the years she became comfortable with the other children, staff, and volunteers, and allowed her light to shine through. One of the things that we love about Gateways is the system of having a teenage volunteer for each student.
Diya and her special teenage buddy always bond well. There were no other blind children in Diya's Gateways classes, but the staff and teachers learned more each year about the activities that work well for Diya. Music and dance are at the top of her list. Gateways has a special two-year Thursday class for kids preparing for the service where they would become a bar or bat mitzvah.
When Diya was twelve, we pondered whether to have her prepare to become a bat mitzvah. Would it just be something for us, or would it be meaningful to Diya herself? Diya had attended several bar and bat mitzvah services, including the one for her brother Seth. If she had a bat mitzvah service, we wanted the celebration to help our extended family and community recognize her as an individual. We took our cue from Diya. Yes, she wanted to become a bat mitzvah.
She started the preparation class at Gateways, with long Thursday afternoon drives with her after-school caregiver. In the program Diya would have to learn to lead some of the blessings, prayers, and songs that are part of our congregation's Saturday morning service. She would also learn to chant a portion of the Torah. The Gateways staff was very uncertain how Diya's training would work. That's where their experienced tutor, Paula Korman, came in. Paula is a pioneer in special-education issues in the Jewish community.
Diya and Paula quickly felt an affinity with each other. Diya speaks intermittently, but her ears are magnets. I can teach her through her talents for music and singing. Through hard work with her dedicated one-on-one aide at school, Mrs. Snyder, Diya's Braille skills were starting to blossom. Snyder used rhythm to draw Diya into writing with a Perkins Brailler, tapping out the patterns of the dots that formed each letter. While writing and reading English Braille were coming together for Diya, nobody wanted to make the pot boil over by adding Hebrew Braille to the mix.
Brailling out the Hebrew text, transliterated into English, might have been helpful. However, transliteration was never considered an option for any of the other kids, and it was not considered for Diya either. She learned the Hebrew blessings, prayers, songs, and Torah portion of the service orally. Since music and rhythm are among Diya's strengths, she learned well with this method. She did use Braille to practice her answers to questions on her Torah portion for a dialog with Daddy after the chanting. As she had more practice sessions, Diya became more confident and proud of her accomplishments.
Nevertheless, she was still very inconsistent. Some days she spent more time laughing than practicing. Coordination with our congregation was another major piece to be folded into the preparations. Usually the kids preparing for this milestone have been going to religious school at the temple. The rabbi gets to know them and they have many opportunities to communicate. Our rabbi, Shoshana Perry, didn't really know Diya yet. She worked hard to change that and to plan with us. She has a gift for recognizing the uniqueness of each bar or bat mitzvah student and building the service around the student's special qualities.
Rabbi Perry helped us find a congregation member to work as a local tutor for Diya. The sessions with Paula were in a very different setting, and it was important for Diya to have a few practice sessions in the sanctuary with her local tutor. At home we tried to be more consistent about observing and including Diya in Jewish rituals, such as lighting the Sabbath candles.
A few times the rabbi also arranged for Diya to lead the candle lighting blessing with us at Friday-night services. The first time we couldn't hear Diya's voice, but the next time it was clear and strong. Diya also attended bar and bat mitzvah services for other kids in our congregation and for other Gateways students. It is common for parents to present a tallith prayer shawl to their young adult as a gift at their bar or bat mitzvah service. Our search for a meaningful tallith for Diya led us to a wonderful artist in Australia with a business called House of Rose.
She made a tallith for Diya partially of silk brocade from India. The painted design, which is also tactual, shows lotus flowers. In India the lotus is a symbol of beauty and growth toward the light. We felt as if our new friend from Australia would be at Diya's bat mitzvah ceremony beside us. Each bat mitzvah student at our congregation is asked to keep a journal about the mitzvot, or good deeds, she performs. Diya wrote about her effort to listen to the shofar, or ram's horn, during the High Holiday services; the piercing sound was painful to her ears, and she was happy that she was now able to hear it without distress.
She also wrote about how much she likes to help and guide other people. In addition to Diya's own reflections, her mom described a number of incidents that show Diya's compassion. She says that she did not like it. I think the part that was the hardest for her was when Lior was crying at his mother's grave. Sometimes in the car she would say, 'Talk about George Bush. She knew that we agreed about George Bush and she wanted to help us be in agreement. Sometimes we had to remind ourselves what it was really all about. We had to make sure not to lose our focus on Diya. On the morning of the bat mitzvah service we gave Diya some of her favorite foods from her gluten-free, casein-free diet.
We wondered anxiously whether all Diya's preparation would pay off. As it turned out, we need not have worried. A friend in the congregation wrote to us afterward, expressing the beauty and richness of that extraordinary day in our lives. She chanted the prayer for Torah before the Torah reading. I thought someone else would read the Torah portion, but how wrong I was! She just continued right into a long Torah portion and the closing prayers. True, her teacher stood with her and from time to time helped her continue, but Diya really did it all.
Her voice and demeanor are sweet. There was hardly a dry eye when the three of you spontaneously got up and danced in the front of the sanctuary to one of Diya's favorite songs. Then more joined in, including the many Gateways students present, and soon the entire congregation was dancing in the aisles and at their seats. All in all the day was so good it is off the charts! My tears were tears of pride and joy. Even Rabbi Perry admitted that she was holding her emotions in check, but that she no longer could, and she shed a few tears with all of us.
The teaching cane strategy can also prove valuable for introducing the cane to other blind children, with or without additional disabilities. The world-renowned deafblind educator, Jan van Dijk, describes the following four major developmental areas that are impacted by deafblindness van Dijk, : 1 access to sensory information; 2 communication and movement; 3 incidental learning, including concept development and mental imagery; and 4 emotional development, including sense of self, motivation, perception of safety, and isolation.
The cane is a tool that addresses these areas of development by increasing the availability of sensory information to a child through auditory, tactile, kinesthetic, and vibratory feedback. Cane use promotes active movement, contact with the world, opportunities for exploration, and a sense of safety. The teaching cane strategy, a process put forth by this author, is an approach to early cane use. It facilitates all areas of development and has valuable applications for children who are deafblind.
It is a role-release approach in which an orientation and mobility specialist teaches the adults, including parents, who work most closely with a child to use a cane in the child's presence. Subsequently, once a child expresses an interest in an adult's cane and joins with the adult in handling it, the child receives his or her own cane.
Rather than requiring a child to demonstrate an ability to use a cane before it is introduced, the teaching cane strategy promotes early cane use as a way to facilitate the development of fine motor, cognitive and sensory skills. The decision about whether, or when, to begin using the teaching cane approach depends on a child's spatio-temporal development and physical ability, the level of support for the process from parents or other caregivers, and the availability of an orientation and mobility specialist who is comfortable with a role-release model of service delivery.
When using a role-release approach, the majority of the orientation and mobility specialist's time is spent observing and coaching parents or other important adults in a child's life. Because of their consistent relationship with the child, these adults are in a favorable teaching position. Learning to use a cane is a process during which individual differences are acknowledged and addressed.
Children as young as one year of age may be introduced to a cane using the teaching cane strategy. As a child matures, so does his or her use of the cane. The four stages of the strategy are described below. Best practice applications from the field of deafblindness can be integrated at each stage. An ability to walk is not necessary in order to use the teaching cane strategy. The only requirement is the ability to hold the cane in a manipulative grasp.
Children transported in wheelchairs or strollers can use a cane for tactile and vibratory feedback, extending reach, previewing a walking surface, and exploring. Stage 1: Cane Exposure to Promote Awareness The purpose of the first stage is to create conditions that encourage a child to become aware of the cane and how it is used during daily activities. This is accomplished by teaching adult role models e.
As role models use the cane during everyday activities, the child may notice their movements or may notice the cane itself. Role of the Orientation and Mobility Specialist:. Teach role models to use a cane appropriately, with attention to grip, the sound and rhythm of movement, and extension of reach. Demonstrate how to use the cane while carrying a child, pushing a child in a stroller or wheelchair, or walking hand in hand. Demonstrate the use of techniques to engage and positively reinforce a child's interest in the cane. Discuss how to take cane walks with the child and the types of walking environments that will be of auditory, tactile, and visual interest to a specific child without being overwhelming.
Stage 2: Encouraging Interest in the Cane When a child begins to express interest in the adult's use of a cane, it is time to encourage him or her to participate in its use. The goal of Stage Two is for adult role models to learn to recognize and reinforce child behaviors that indicate interest in the cane and to apply individualized strategies that facilitate a child's understanding and participation. This should be based on a child's level of interest and motivation. At no time during this stage should the cane be forced on a child with direct instruction.
Children express interest in many different ways. The adult should observe the child for behavioral signs that indicate the child has noticed some aspect of cane use. For example, the child may reach for the cane, pause while walking, turn toward the cane, or show increased excitement or stillness when exposed to the cane. These are critical moments during which an adult should respond to the child's expressed interest.
A child may participate in cane use by hanging on to the cane while the adult moves it back and forth or makes contact with an object. If the cane is long enough, the adult can invite the child to walk in front, placing his or her hand on top of the adult's hand to hold the cane together. The vibration or sound produced when the cane contacts an object has meaning for the child if he or she is made aware of the object the cane has encountered. The child is encouraged to follow the shaft of the cane with his or her hand to the object for tactual exploration. This suggests that the child is ready to move to Stage 3.
Stage 3: Giving a Cane to the Child Once a child's interest and coactive participation indicate readiness or a desire for a cane, it is time to help him or her experiment with it. The child can be encouraged to discover the possibilities the cane offers for learning about the environment through inspection, exploration, and play. Avoid the assumption that a child will automatically know what to do with a cane or will be able to imitate the adult role model.
A child may initially reject his or her own cane. Even though the child has already been exposed to an adult's cane, his or her own cane may be perceived as a new object. Using the child's cane together coactively as described in Stage 2 with the adult cane, may be a necessary first step. Because of the cane's ability to provide auditory, tactile, and vibratory feedback and facilitate physical, cognitive and social growth, a child who is willing to interact with it is learning. A child who is able to use familiar tools, such as a spoon, toothbrush or comb, may independently be able to experiment with the cane as a tool Cutter, Malls for indoor travel and parks or residential neighborhoods for outdoor travel are examples of environments that are interesting to explore.
Conversations can be sparked by objects, sounds, textures, vibrations, and smells. Role of the Orientation and Mobility Specialist. Encourage continued modeling of cane use and coactive use of the cane through cane walks. Discuss the child's preferences and sensory limitations. Discuss the types of environments that are most likely to provide and promote interest and motivation for the child. Provide ongoing observation and support.
Stage 4: Shaping the Child's Use of the Cane When developmentally appropriate, the child's use of the cane is shaped toward its intended use as a travel tool. Through continued modeling and direct instruction from an orientation and mobility specialist, a child's use of a cane increasingly approximates formal cane techniques in form and function. Travel becomes oriented toward a task, activity, or destination, and the child becomes increasingly mobile under his or her own power.
Check the adult's ability to identify behaviors that may indicate a child's readiness for specific techniques such as stairway travel, diagonal trailing, or touch technique. Explain that skills already mastered may not be accessible to a child who is mastering a new skill, especially if it includes a gross motor milestone. Build a relationship with the child prior to providing direct instruction. Participate in IEP planning and in the child's transition process from early intervention to early childhood services once a child turns three. References Cutter, J.
Jensen, E. Miles, B. Remarkable conversations, a guide to developing meaningful communication with children and young adults who are deafblind, Watertown, MA, Perkins School for the Blind. Roman-Lantzy, C. She lives in Baltimore with her husband, Tony. Although my parents tried to shelter me when I was growing up, I inherited their self-determination, which in turn fueled my desire to be as independent as possible.
My parents exhibited their self-reliance by asking for assistance only rarely. In financially difficult times, instead of asking for aid from our extended family, the church, or the government, my mom got a second job to help support the family. When my siblings were older, they were also expected to get jobs and be independent. For me, however, the standard was different. Although I didn't want to rely on the government, my parents urged me to apply for SSI when I turned eighteen. Even after I demonstrated my ability to listen for traffic and make good travel judgments, they wouldn't allow me to travel independently on the rural road where we lived.
Despite what they said to me, I chose to follow their example of self-sufficiency. I refused to let my disabilities get in the way of my desire for independence. I was born legally blind, and for me my blindness has always just been another part of my life. I haven't always known how to deal with situations surrounding my blindness, but I do not dwell on what life would be like if I weren't blind.
However, I haven't always used a wheelchair. When I was five years old I was diagnosed with a bone disease. I could still walk until age eleven, when my right leg was amputated above the knee. Although I went through physical therapy, I was never able to walk normally, and I have used a wheelchair ever since. I didn't want to let being in a wheelchair stop me, but I always wished for the ability to walk again. Throughout high school and college, I got by, mostly by using the little remaining vision I had.
However, after toppling down several flights of steps and falling off a curb into a busy street, I had to admit that my vision was getting worse. It was no longer reliable. For a while I dealt with this by limiting my activities and only going to familiar places.
When I did travel to an unfamiliar place, a sighted person usually went with me to push my wheelchair. I continued getting by until I attended my first National Federation of the Blind convention in Louisville in There I met a blind man who traveled the hotel independently, successfully using a cane from his wheelchair.
I had always thought that as a wheelchair user I couldn't use a long white cane. During high school, my orientation and mobility instructor told me that instead of using a cane I should put a tall pole with an orange flag on the back of my chair so that people in cars could watch out for me. I never took this advice. The flag looked ridiculous and was extremely cumbersome when I traveled indoors. Furthermore, this solution took responsibility for my safety out of my control.
Now, in Louisville, I was amazed by the idea that I could travel with a cane. I immediately bought an NFB cane and started using it at the convention. Suddenly I felt free to travel on my own. I didn't have to wait for my coworkers or strain to look down to see the curb cuts. I was no longer limited in my travels.
It took me a while to adjust to using a cane, but I persisted. Since I first started using a cane, I have learned some tips through trial and error. I want to share them so that others, too, can put them to use. I hope that parents and teachers of blind children who use wheelchairs will take what I have learned and will help these children travel independently.
Your child can use a manual chair and a cane. I prefer a manual chair because of its portability. Since I don't have a car, I need a wheelchair that can fold up and fit into almost any vehicle. Grasping the handrims of my wheelchair with each hand, I hold the cane in my right hand at the same time. I can push both wheels while holding onto the cane and arcing it with my right hand. Training in the techniques of nonvisual travel is essential. I have not had extensive training with sleepshades, but I have discovered that when I do activities nonvisually I am more observant of my surroundings.
I wish I had received training under sleepshades in high school or before I went to college. From my blind friends who obtained such training I know it would have increased my confidence significantly. Find the cane that works. I currently use a sixty-one-inch fiberglass NFB straight cane. The length of the cane helps me to make a wider arc, and the narrow handle works best for me because I can grip it and the handrim on my wheelchair at the same time.
I didn't start out by using a straight cane. I thought it would be easier to store a telescoping cane, but I became frustrated because my cane randomly collapsed. Now, after using the straight cane for a while, I have discovered that it really works well, and the inconveniences are minor.
Make your home wheelchair accessible. Your child needs to be able to get into and around the house independently like any other kid. For a while my parents carried me up the steps, but this limited my independence because I couldn't go outside on my own. Eventually they made the necessary changes, and I could come and go freely.
Sometimes it's better not to use your cane inside. Like many blind people who do not use chairs, I have discovered that in familiar places, such as my home, I don't need the cane. I don't always use it in unfamiliar places, either. For example, it's easier to go through interior doors, which are usually not very wide, without the cane in use. I tuck my cane under my chin and grab onto the doorframe with my hands.
I can feel where the door is, line myself up, and pull myself through. It's okay to travel slowly when necessary. For safety, I slow down when I am on a downhill slope or when I come to an intersection and need to find a curb cut. Educate others. People don't understand how I travel independently. I talk to them about it and explain how my blindness and being in a wheelchair are not barriers for me. For example, recently I was out shopping with my husband when I encountered a man who was trying to give me directions to a ramp.
He had seen me stop just before getting to a flight of stairs. He was extremely worried that I was going to fall down the stairs. I explained to him that I was using my cane. He was trying to tell me how to get to the ramp, but his directions were horrible. I explained to him that I would find the ramp by myself by using my cane.
I told him that if I discover it myself, it would be easier for me to find the ramp in the future. He left me alone, and I successfully found the ramp and was on my way. Let your child be independent. Don't push your child's wheelchair just because you don't think he or she can travel independently. For example, when you're at the mall with your child, he or she will most likely want to be independent.
Don't take this away by pushing your child's chair. Here is my final advice. Don't limit your child just because of blindness and being in a wheelchair. It may be doubly tough to get stared at in public while your child learns to wheel and cane at the same time. Remind yourself that your child will someday thank you for believing in him or her.
I'm independent, and your child can be independent, too. The journey is one I'd never anticipated, yet it's taken me to people I admire and to a life I've never regretted. When my son was born deafblind twenty-one years ago, I had never before met a blind person. I knew people with Down syndrome, multiple sclerosis, paraplegia, quadriplegia, and deafness.
I knew that they experienced life differently than I did, and I knew that, given the opportunity for an equal playing field, they lived full lives. Yet, how would I level the playing field for my deafblind child? Two principles guided my approach to solving that problem. First, thanks to exposure to some of the most creative, exciting, and out-of-the-box thinkers in the field of disability, I realized that I had to believe in my own parenting abilities.
Secondly, and wholly through experience, I learned that deafblindness is a unique disability. It's not simply deafness plus blindness; it requires a different skill set to make sense of the world. In fact, some deafblind people and some hearing, sighted professionals in the field have begun to use the term deafblind, without a hyphen. This term indicates that deafblindness is, indeed, a distinct disability. The first time I held my son Jon I was taken by his big, beautiful, blue eyes. Granted, everything about Jon was big. Born by Cesarean section, he weighed nine pounds, nine ounces and measured twenty-two inches in length.
My mother claimed he was the size of a three-month-old at birth. As I held him, I was impressed by the way he seemed to be looking at everything outside the window of my hospital room. I told my husband to bring us lots of toys because this kid was curious! Jon turned out to be a difficult baby. He wanted to be held almost constantly, and he cried whenever I put him down. By the time he was a few weeks old, I realized that, although his eyes moved back and forth, he didn't focus visually. The condition was called pendular searching nystagmus. Jon had no pupillary reflex. He was totally blind.
The diagnosis was Leber's congenital amaurosis LCA , a genetic disorder that affects the retina. We enrolled Jon in an early-intervention program with infants who had a variety of disabilities. At each weekly meeting, the teachers impressed upon us moms how important we were to the success of our babies. They emphasized that it was our responsibility to work with our children each day at home. I accepted this role willingly and seriously. He flapped his arms, resisted change, laughed at inappropriate times, didn't respond to verbal cues, and preferred to play alone or only with me.
When Jon was fifteen months old we switched him to a brand new early intervention program specifically for babies who were blind or visually impaired. The teachers were bright, enthusiastic, and energetic. They, too, encouraged parents to participate as their children's first teachers. We were several months into this program when the speech therapist expressed concerns about Jon's hearing.
Just before his second birthday, we learned that Jon was profoundly deaf. The diagnosis was not a total surprise since there were people on both sides of our family who had hearing loss, including my husband. Now, suddenly, everything made sense to us. No wonder Jon had been such a clingy, difficult infant! Because he couldn't see or hear, I was his only connection with the world. I tried to imagine how frightened he must have been during those first few months before he came to trust me. I now understood why he didn't know his name, respond to verbal cues, or make sounds that we could interpret as words.
With nothing to look at or listen to, perhaps he flapped his hands for something to do. Because of his incredibly acute sense of touch, we hadn't recognized Jon's hearing loss. When we walked into a room, the vibrations on the floor signaled him to turn to us. When the doctor used a tuning fork, he turned toward the vibrations. When my husband came home at night and opened the kitchen door, Jon quickly turned to face the change in the air flow.
I drove home from the audiologist's office with a heavy heart. All of the blindness skills we were learning weren't enough. Our audiologist had given us a new list of resources, but where should we begin? I wasn't entirely confident in my ability to parent a child who experienced the world so differently from the way I did, but I was determined to be a good mom to my son.
The clinic offered a distance learning program for families of deafblind children, and I signed up immediately. When my packet of information arrived, I was hooked. I loved the program's approach to family education. It focused on the importance and contributions of every family member.
Soon after we started the John Tracy program, I discovered a school for the deaf twenty-seven miles from our home. This school, too, offered early intervention services, and we signed up. Jon was now attending a program for the blind and a program for the deaf. He was the only deafblind child in either one, and none of the teachers had any experience working with the deafblind. A blind baby hears something in the distance and is curious about the sound.
A deaf baby sees movement and activity and wants to join in. My baby didn't see or hear. He knew only personal touch, a change in temperature, a breeze, a vibration. How would I motivate my baby to explore a world that he didn't know existed? He needed a link to the world, and I would be that link. But how would I create meaning for him through touch alone?
The infant brain is very malleable. When the right stimulation occurs at an early age, neuronal connections are made and the capacity for learning improves. Jon's early intervention teachers showed me how to use his senses of touch and smell, as well as his awareness of body position and movement. They also encouraged me to help him use his limited eyesight to learn about the world.
By the time he was two, Jon had developed some usable vision. He could see an object if he held it two to three centimeters from his eyes. It was not really functional vision, but it provided another channel through which he could interpret what he was touching. The more meaning he derived from his experiences, the more curious he became. Jon's orientation and mobility instructor cautioned me about putting him in a playpen.
If he had free reign of his environment, he surmised, Jon would be more likely to explore. The more he explored, the more he would gain knowledge of the world. Our hardwood floors served Jon's mobility needs very well. He would lie on his back and propel himself by pushing with his feet. He slid all over the floor, taking in information from his largest sensory organ, his skin.
He explored every inch of every piece of furniture from the floor up to as high as he could reach. Then he started to climb. Any time we put him into his crib, he climbed out. Despite our best efforts to keep the stairs off limits, he frequently climbed up the outside of our open staircase, and would hang from the handrail ten feet above the floor! My stomach jumped into my throat nearly every day with his antics, but I kept focused on my goal of encouraging him to be independent and curious.
Jon started walking at age three and a half, and then his knowledge of the world grew exponentially. He liked to move the furniture around. Within ten minutes he could rearrange my living room completely. When he started walking outside, he discovered that his long white cane provided him with incredibly interesting information. He would measure bushes by the cane's length.
He would let the cane roll down the neighbor's driveway. He dropped it down sewers and off bridges as he tried to touch the bottom. When Jon was five, his favorite toy was a refrigerator box that he had made into a fort. It was complete with artwork drawn on the walls with smelly markers, and it was lighted by flashlights placed in holes he had cut in the walls. Our strategy for encouraging Jon's curious exploration was working. Jon was becoming both clever and creative.
Yet another challenge remained. How would we bring language to his experiences? I started learning sign language as soon as the first information packet arrived from the John Tracy Clinic. I taught Jon everything I learned. In addition, we were both learning to sign at the school for the deaf. After a year, however, I realized that to become fluent we needed a Deaf teacher. The term Deaf, with a capital D, refers to someone who uses American Sign Language and considers himself or herself part of the Deaf community; it is a cultural identification based on a shared language, ASL.
I enlisted the assistance of a Deaf family in our town. We met weekly, and they became our lifeline to the Deaf community. It took me about five years to become fairly fluent in sign language. At about this time, it became apparent that Jon could not read print without fatigue. I began a quest for Braille instruction. I knew that I faced a huge challenge. At that time there were no laws about considering Braille for a partially sighted child. Nonetheless, I was certain that Braille provided the only hope for my son to attain literacy. Unfortunately, our state agency for the blind didn't agree.
Upon my insistence, we decided to get an impartial evaluation. Six individuals--three blind and three sighted--would evaluate Jon and offer their opinions. We agreed to go along with the consensus. The six evaluators unanimously agreed that Jon should learn Braille. Our next challenge was to make the classroom instruction at the school for the deaf accessible.
Jon had always used tactile sign language. He took in signs by placing his hands on top of mine or by touching the shape of my hands. If he wasn't in a one-on-one situation with his teacher, he had no idea what was going on in the classroom. These professionals provided tactile sign language for Jon until his high school graduation. Some of the other tools that leveled the playing field for Jon were technology and deafblind-specific orientation and mobility.
He benefited from accessible classroom materials including large print, colors, tactile graphics, and Braille. We also trained some of his classmates to be support service providers SSPs. SSPs act as the eyes and ears for a deafblind person. Jon had peer support service providers instead of adult paraprofessionals for in-school activities.
Jon graduated from high school in He was a member of the National Honor Society. Jon enjoys all kinds of sports, including golf, martial arts, boxing, hiking, and rock climbing. He is the only deafblind belayer in New Jersey. As for communication, Jon uses whatever works. In some situations it is tactile sign language.
In others it is Braille or a notebook and marker. He uses AIM and email to keep in touch with friends, and he surfs the Web with the assistance of screen enlargement software and a Braille display. He uses a videophone to call me and we communicate through a webcam-like device in sign language. He uses the videophone along with the relay system to order a pizza or call a friend who is hearing. He uses a long white cane and travels independently on paratransit. Right now Jon is taking classes at a community college while he completes a vocational training program for the deafblind at the Helen Keller National Center.
I'm not going to tell you that blazing this trail has been easy. In fact, it's been the biggest--and most rewarding--challenge of my life. I've always believed that with the appropriate skills and accommodations--a leveled playing field--Jon would live a full life as an active member of his community. I've never given up on this quest. I'm grateful every day for all that he and I have learned from each other. I encourage you to believe in yourself as your child's first--and best--teacher.
If you don't take the lead, who will? Today it's much easier to access resources, connect with others in a similar situation, and search for innovative solutions than it was twenty-one years ago. A host of resources empower you in opening the gateway of opportunity for your child. Never give up on your dreams or expectations, and I promise you that this journey will reward you in ways that you've never imagined.
Kenneth Jernigan suggested that independence for blind people is not strictly defined by the use of Braille and the long white cane. In this article Barbara Hammel ponders the nature of independence for her twin sons who are blind and on the autism spectrum. In my husband, David, and I started on a journey that changed our lives forever. On June sixth, the morning of our seventh anniversary, we entered the adoption center in Kunming, Yunnan, China and met our almost three-year-old twin boys.
Ji Ming and Ji Kun sat so still that I, as a totally blind person, didn't quite believe they were there. I don't know what the woman from the orphanage finally said to them, but suddenly Ji Ming became our Paul. He came right to me and wanted me to pick him up. When David picked up Ji Kun, he became our Jesse as he let out a squawk of displeasure. When we first learned about the twins, we knew that they both were blind. I looked forward to teaching them to become capable, confident blind men some day. I couldn't wait to introduce them to the world of books through Braille and the world itself through the tip of a cane.
David dreamed of chess champions and half of a barbershop quartet. By our second day together Paul recognized his name. After six months we knew that both boys understood what we said to them. Nevertheless, they did not begin to speak. Even after tubes were inserted in their ears to correct mild hearing losses, their language output was minimal. Two months before the twins' fourth birthday we received a stunning diagnosis.
We learned that both of our sons were on the autism spectrum with developmental delays and disruptive behaviors. So began a journey down a road far different from any we had expected. Each person with autism has a unique set of strengths and difficulties, and you cannot use a cookie cutter approach.
That's why autism is called a spectrum disorder. People on the autistic spectrum may have atypical development in such areas as eating, sleeping, and communication. Our boys are challenged in each of these areas. There are many theories about why autism occurs and many helpful treatment strategies are available. The first thing David and I discovered is the importance of good sleep. We tried melatonin to help the boys get into a regular sleep pattern, but it did not work for them. From melatonin we moved on to Clonidine, a blood pressure drug that sometimes helps children with sleep problems.
For Jesse it seems to be useful, but in Paul it triggered problem behavior. Our counselor then suggested an herbal compound, valerian root. Paul's behaviors haven't decreased but the anger behind them seems to be less intense. Light therapy may also be helpful, and there are many other options for us to explore. These are just the stops we have made so far on our journey.
Eating has been a major issue for the boys. We know that nutrition is important, but when little lips and tongues don't want to touch fruits and vegetables you feed whatever you can. Paul has always been a good eater, but a picky one. Some of his behavior problems may be due to the fact that he is a noodle-hound. If that deficiency can be corrected, we may see improvement. Jesse has presented us with many feeding challenges. To this day he does not feed himself independently.
We still have to load his utensil, and this is a grand improvement for the little boy who ate almost nothing when he first came home to us. Jesse would eat apple at the beginning, so we knew he had the proper skills for chewing and swallowing. His preschool added pears to his diet. We thought he would soon learn to like more and more new foods. After a month of preschool, however, Jesse quit eating solid food of any kind.
We still have no idea why he stopped eating. For a year he lived on PediaSure, a food-replacement drink used by children who have feeding tubes. Two months after Jesse stopped eating we consulted a feeding specialist who started us on a program to reintroduce solid foods. First we had to get a spoon into Jesse's mouth. We dipped the tip of the spoon in baby applesauce and touched it to his lips.
When he finally tolerated that, we started to push the spoon in farther, still with just a little bit of food. Funions and pretzels became his rewards for taking spoonfuls of applesauce and other foods. By the time we went to the NFB convention in Atlanta, Jesse was eating one to two jars of baby food per meal, but still drinking PediaSure from a baby bottle.
Two years to the day after Paul gave up the bottle, Jesse took the same major step. Coming home from Atlanta, he tried drinking soda from a straw--and hated it. We found that drinking straws didn't work for him, as he tended to bite down when he sucked. Instead we used a sturdy straw cup. By the end of that year he'd moved up to pureed food. Grandma stopped pureeing when she took care of the boys during the Dallas convention of '08, and he hasn't looked back.
He eats few noodles but he loves rice and meat. And did I mention he loves meat? Steak, Smokies, ham, hamburger, chicken--the boy who once abhorred solid foods now relishes them all! Since it's still virtually impossible to get the boys to eat fiber, the problem of constipation looms large. We combat it with a stool softener called Miralax. Miralax is a kind of powder that we put in their food or cups of water.
It smells like glue, but the boys don't seem to mind. Paul, the more extroverted of the twins, has acquired some limited language. He cannot seem to say most of what he wants to tell us, however, and becomes easily frustrated. Unfortunately, right now his main mode of communication is a set of disruptive and hurtful behaviors frustrating to everyone around him.
The school continues to push for more speech. We, his parents, would like to explore the use of an augmented communication device that could help Paul express himself more freely. Jesse, the more introverted twin, seems to have little ability or desire to communicate verbally.
This is a huge step for the little boy who scarcely responded to any stimuli when we adopted him five years ago! Autistic people who are sighted are generally thought to be visual learners. Most of the teaching methods used with autistic children are based on visual pictures. Sighted experts seem to be stumped when they have to find alternative communication tools for kids who combine autism with blindness.
Paul can now remember a whole day's worth of activities. He learns new symbols quickly, after being exposed to them only two or three times. He is rapidly advancing beyond the symbols we have available. If he were a sighted child, his book of pictures would be far more extensive and would greatly enhance his communication options. There is a tremendous need for nonvisual materials to meet the needs of blind children on the autism spectrum. In the Federation there is a constant emphasis on independence. Before I met Paul and Jesse, I believed that independence meant Braille literacy and travel with the long white cane or dog guide.
The twins have given me a new perspective. Perhaps Braille will always be a mystifying jumble of bumps on paper for them. Maybe for them the cane will never be more than an extension of the arm, a means to reach out and hit people. We face the possibility that our children may not become independent in the ways we once envisioned. We will never stop trying to teach them, but our understanding of independence has begun to take a new shape. For some people, independence may be the ability to dress and feed themselves.
It may mean the ability to convey one's basic needs to others, whether through speech, signs, or a communication device. Paul's progress has been slow but steady. Today he knows the words to more than a hundred songs. That little boy who wouldn't eat or walk, who cried all the time and hated to be touched, the little boy who was only happy in a cardboard box? He is blossoming, not in slow, steady steps like his brother, but in leaps that startle and amaze us.
I know we are not alone on this journey we've begun. Many other parents are learning to dream different dreams for their children with multiple disabilities. We travel a different road and the milestones may seem small to the rest of the world, but they are giant steps for us. In her blog Marie Smith of Alabama described how she reacted when her son was bullied due to his atypical appearance. Her blog post expanded into an article for Future Reflections on this important and often painful topic. This is Jack. He is four years old.
To me, he is the most awesome, brave, hardworking, self-motivated person who has ever lived. But if you walked by Jack in the grocery store, you'd probably take a second glance--and not for the reasons I've just mentioned. Apert syndrome is a rare craniofacial disorder. It causes a number of issues that vary from one affected person to another.