ABNORMAL CHILDREN BV THE SAME AUTHOR NERVOUS DISORDERS OP MEN NERVOUS DISORDERS OF WOMEN THE MODERN PSYCHOLOGICAL CONCEPTION OF THEIR CAUSES, EFFECTS, AND RATIONAL TREATMENT Kegan Paul, Trench, Trubner <^ Co., Ltd. ABNORMAL CHILDREN (NERVOUS, MISCHIEVOUS, PRECOCIOUS, AND BACKWARD) A BOOK FOR PARENTS, TEACHERS, AND MEDICAL OFFICERS OF SCHOOLS BY BERNARD HOLLANDER, M.D. AUTHOR OF " THE MENTAL FUNCTIONS OF THE BRAIN ", " MENTAL SYMPTOMS OF BRAIN DISEASE ", " FIRST SIGNS OF INSANITY ", "HYPNOTISM AND SUGGESTION", ETC. ILLlTSTRiTEI) LONDON KEGAN PAUL, TRENCH, TRUBNER & CO., LTD. BROADWAY HOUSE, 68-74, CARTER LANE, E.G. 191§ PREFACE The greatest event in the life of parents happens when a child is born to them. Their prayers go forth that he may prove a worthy successor, handsome in appearance, brilhant in intellect, and great in character ; or, if it be a daughter, that she may be endowed with all the female graces and virtues. Alas ! Often within an hour, week, month, or year, though sometimes not until he is nearly grown up, he is the cause of great anxiety, not on account of temporary ailments, but because he or she is not like other children. A child may be born diseased, he may suffer at birth from a deficiency of brain, he may be late in development, he may acquire various disorders, certain diseases may arrest the growth of the brain or disturb its functions ; or he may grow up normally and even give promise of a brilhant future, yet, as he approaches adolescence, he may manifest mental unrest and pecuhar conduct. 9u A 2 •> r; vi ABNORMAL CHILDREN This book deals with the nervous defects of children, and the various forms and degrees of mental and moral deficiency that may occur from infancy up to the age of twenty-one. It deals not merely with the deeper grades which form the subject of many excellent books already in existence, but also with those minor defects of mind and conduct, to which all children are liable, and which, if not avoided or corrected by careful training, influence their whole career in life. Recent legislation has brought this subject into special prominence ; the Mental Deficiency Act and the Defective Children Bill will neces- sitate the systematic examination of persons suspected of mental defect. But this book deals not merely with the subnormal child — the idiot, imbecile, feeble-minded, and back- ward ; it deals also with the supernormal — the precocious and the talented child. Were as much attention devoted to the supernormal child as is already devoted to the subnormal — to the discovery of hidden talents as much as to mental defect, were special instruction provided in accordance with the individual aptitudes for children of unusual inborn ability, as is now PREFACE vii provided for the mentally deficient, and were thus the right man always trained for the right kind of work, the prosperity of the State would be vastly increased and the individual himself rendered most happy. True, there is no science as yet existing which would enable us to predict with certainty the future of the young ; but physiological research into the functions of the brain, pathological observation, anthropometrical investigation and psychological analysis have furnished enough data to enable the diagnosis of the mental and moral capabilities and defects of children to be made with tolerable accuracy, and to render possible safe advice being given as to the methods of training that should be adopted. This book should convince the reader, at least such is my hope, that the education of children is a problem not for parents and teachers only, but that the co-operation of the medical psychologist is an absolute necessity. It is for the physician to note in their earhest stage the symptoms which should put parents on their guard, to point out the causes of brain and mind failure, to show how to counteract the effects of evil heredity, bad environment, viii ABNORMAL CHILDREN and disease, to advise what precautions can be taken, how to bring up such children, how to educate them, and what careers to choose for them to fit their capacities. Bernard Hollander, M.D. 57, WiMPOLE Street, LONBON, W., November, 1915. CONTENTS CHAPTER I PACK Causes of Abnormality. Effects of Heredity, Injury, and Disease . . 1 CHAPTER II Idiocy and Imbecility . ... 29 CHAPTER III Feeble-Minded Children. Table of Average Mental Development of an Infant . 46 CHAPTER IV Backward Children . . ... 63 CHAPTER V Character Defects in Children. Ill-temper, Jealousy, Vindictiveness, Callousness, Cupidity, Bragging, Stubbornness, Impudence, etc. 79 CHAPTER VI Moral Weak-Mindedness. Youthful Criminals . . . . . 95 CHAPTER VII Nervous and Precocious Children . . .107 ix X ABNORMAL CHILDREN CHAPTER VIII PAGE Nervous Disorders of Childhood. Epilepsy, Night Terrors, Chorea, Stammering, Morbid Shyness, etc. . . . . 121 CHAPTER IX Insanity in Childhood and Adolescence . . 145 CHAPTER X Abnormal Heads of Children and their Signifi- cance . . . ... 166 CHAPTER XI What to do with our Boys and Girls. Their Education and Choice of Pursuits . . .180 CHAPTER XII The Moral Education of Children . . .195 APPENDIX Points to Observe in the Medical Examination of Mentally Defective Children of School Age . 217 INDEX 221 LIST OF ILLUSTRATIONS PLATE F I. Microcephalic Idiot II. Moderate Hydrocephalus. Fairly sharp boy, but addicted to lying and stealing III. Cretins ..... IV. Two different Types of Imbeciles V. Feeble-minded Boy. Was taught elementary work VI. Backward Boy. Slightly hydrocephalic head VII. Determined, obstinate Boys, but clever VIII. Healthy, precocious Infants. . IX. Precocious Infants, nervous and excitable. With heads too large for their bodies X. A rather broad Head. A rather high Head, rather long Head XI. The Student Type. The Business Type. Naval or Military Type , . . XII. Clever, well-behaved, aflfectionate Children The PAGk 30 32 34 K 42 56 66 90 114 132 172 190 200 ABNORMAL CHILDREN CHAPTER I CAUSES OF ABNORMALITY EFFECTS OF HEREDITY, INJURY, AND DISEASE According to official statistics one person in 266 is of unsound inind, and at least one in 217, or nearly one-half per cent, of the population, is mentally defective. When children on the school registers are considered, the proportion appears still higher; partly because mentally defective persons tend to die earher and partly because proportionately more children than adults come under supervision and observation on the ground of mental defect. Taking the average of the results obtained from figures collected by medical investigators, the propor- tion is one to 127, being approximately 1 per cent, in urban and 0-5 per cent, in rural districts. In some towns the proportion is higher than 1 per cent., being in Birmingham 1-12 per cent., in Manchester 1-24 per cent., and in Lincoln '2- " • -ABNdRMAL CHILDREN 1-10 per cent. Thus in these districts there is at least one mentally deficient child to about every eighty-five ordinary school children. It must be noted that these figures refer only to children on school registers, and do not neces- sarily include all mentally deficient children, nor do they include the neuropathic children. In addition, over 3000 cases of young persons of both sexes under the age of twenty years are registered as becoming insane every year in England and Wales, and insanity at this age, according to the Lunacy Commissioners' reports, is on the increase. Heredity is by far the most frequent and the most potent predisposing cause of nervous and mental diseases. It commonly underlies all other causes. Without it, there would be Httle degeneracy in the world. If all hereditary tendencies to mental and nervous unsoundness and defects could be counteracted, humanity might breathe freely. It must be understood, however, that it is not any special nervous or mental defect or disturbance that is inherited, but that it is either a general defect of brain nutrition or an instability of working in the higher nerve cells — in fact an unstable nervous system. That children inherit the outward bodily eon- CAUSES OF ABNORMALITY 3 figuration and manifest peculiarities of one or other of their parents is well known ; and that they likewise derive from them that more hidden weakness of certain organs, by which these are prone to develop diseased action, is proved by the experience of ages. But what is not so well recognised is that not only bodily taints and infirmities but even moral dispositions and ten- dencies may descend from father to son. The mind of the human infant is not at birth a mere blank sheet of white paper on which anything, either good or bad, may be written. Each in- dividual is born with a physical and mental predisposition which he has inherited from his parents. Hereditary transmission applies to psychical tendencies as well as to physical pecuharities, and by psychical tendencies we mean not only intellectual capacities but also character dispositions and tendencies to par- ticular forms of virtue and vice. The majority of parents are surprised when they find defects of character in their children not due either to force of example or faults of education, and want to know where they come from. Parents ought to know that the faults which they detect in their children depend on their native mentahty, and that there is nothing innate vvithin them that is not the legacy 4 ABNORMAL CHILDREN of preceding generations. When they discover in their children some intellectual or moral blemishes, they need not go far afield in looking for the causes. If they examine their own character, that of their father and mother, and of their grandparents, they are almost sure to find the germ of fatal tendencies. " The fruit does not fall far from the tree " ; but how many there are who have never dwelt on this reflection ! The child may inherit the characteristics of one parent only, or partly those of one and partly those of the other. We must remember that the character is made from a number of elementary dispositions ; and just as two ele- ments in chemistry, each of them harmless, can combine to form a virulent poison, so two elements of character, of themselves harmless, one derived from one parent and one from the other, can be inherited by the child and form a combination which, if not checked early, may be detrimental to its future. Sometimes children bear a resemblance not so much to their father or mother as to their grandfather or grand- mother. Sometimes the qualities of the grand- father may be masked in the father by the presence of some antagonistic or controlling influence which does not exist in the mother, CAUSES OF ABNORMALITY 5 or it may be dormant in the father till meeting in the mother with favouring or reviving cir- cumstances. In any case, we can be certain that if two parents produce a child which is unlike them both, this child is not an accident ; the unhkeness consists in a new combination of old elements. No one feels surprised when a child resembles one of its parents. Indeed we are astonished if qualities, whether of mind or body, manifest themselves in a child which we have not known in his progenitors. If any abnormahty appears in a child, we cast back, even involuntarily, and search for it in his ancestors, and are satisfied if we know that some similar abnormahty has occurred in the family of the father or mother. But if a normal person can transmit his " hke " to an offspring, there can be no doubt that an " unstable " parent is more likely to produce an unstable than a stable child, or at all events a child predisposed to an unstable nervous system. That this is not always so we know, otherwise the world would rapidly become filled with weakhngs. A child may escape when only one parent is unstable, but I feel certain that the offspring seldom escapes the taint when both parents are unstable. A healthy father may counteract the unstable qualities of the 6 ABNORMAL CHILDREN mother and may beget healthy children, or a healthy mother may counteract unstable quali- ties of the father with the same good result in the offspring ; but I think it is almost impossible for the offspring to escape when there is a bad heredity from both parents. The more carefully the members of a neuropathic family are ob- served, the more evident it becomes that even the apparently healthy offspring frequently manifest trivial forms of neuroses which are a grievous burden to such people; and if their symptoms, regarded at any given time, do not appear important, yet the sum of their suffer- ings throughout a lifetime are certainly worthy of consideration. One of the dangers, and one that might be averted, arises from those men and women who have been once insane. Recurrent insanity in this respect is much more dangerous than per- manent insanity, because the subject suffering from recurrent insanity is periodically given his or her liberty, and the woman often becomes the mother of children, has a relapse, and goes back again. Statistics of the number of children borne by women discharged from asylums prove instructive reading, but they tell less than half the tale ; the male lunatic has still his progeny not recorded and unrecognised, and he is CAUSES OF ABNORMALITY 7 obviously a greater power in the production of offspring, good or bad, than the female. It is positively criminal to withhold the fact of a girl having been once insane from a man about to propose marriage. But it is done by parents, or else the history of the attack is minimised and spoken of as only nervousness or hysteria. Some people even think that marriage may effect a cure. My ad\ace on this subject has often been asked, but not always followed. As a matter of fact, the danger of a relapse is very great, for the woman has to face the trying periods of child-bearing. No one who has had one attack of insanity can be pronounced free from the risk of another ; for it is a disease which confers no immunity in the future on its victims, like some others we have to treat. On the contrary, each attack, if there be more than one, does not diminish, but in- creases, the liability to others. The misfortune is that most tainted people get engaged first, and ask our advice after having made an ill- judged selection ; and that is the real reason why medical advice is so seldom followed. Although not every child of an insane parent is insane, yet it is impossible to predict with certainty that this one or that one will escape. The most unHkely and most steady-going are ABNORMAL CHILDREN often those who break down under excessive strain, while others who have been obviously eccentric remain always eccentric and never go beyond. It must not be forgotten that insanity is not the only result of such inherited pre- disposition ; nervous diseases of all kinds may be developed in the children of insane parents : epilepsy, dipsomania, criminal tendencies, idiocy, and the like. People boast that there is no insanity in their family when nearly all their offspring are the victims of some nervous com- plaint, some eccentricity, perversion, obsession, or mere incapacity to earn a liveHhood for them- selves. If a member of a tainted family is to marry, it is important that he or she be in good health and marry one who is also in good health and has a good family history. If a girl is delicate and neurotic, she should not marry a very poor man; for poverty, the daily necessity of pinching and saving and denying herself the small luxuries of life, is an additional and constant anxiety. The maternal heredity is the more important, for to the mother is committed the development of the foetus. If the woman is healthy, and only the man has a bad family history, the chances of the children becoming affected are less ; but even so, the man's per- CAUSES OF ABNORMALITY 9 sonal history and physical and mental state should be carefully examined, as there will always be a risk. Where both parties have a bad family history, the chances of tainted off- spring are enormous, and marriage should be forbidden, especially when they are blood rela- tions. The danger of the marriage of tainted persons is increased immeasurably w^hen they are cousins. Whatever may be said as to the MARRIAGE OF COUSINS who are both healthy and of a healthy stock, there can be no question that such a union of relatives in famihes where nervous disorders exist, is fraught with the greatest peril. The pathological tendencies become fused and concentrated. And cousins in such famihes show a curious proclivity to attach themselves to one another. Such people, having known each other from childhood, are less shy with each other than with strangers ; and so they drift into an engagement often very much against the wish of the parents, who know the family history better than do their children. Sometimes the parents prefer to ignore the risk. They hope for the best, or deny that any malady has ever existed ; -or they invent plausible excuses for the cases that have occurred, at- tributing them to sunstroke, to falls on the 10 ABNORMAL CHILDREN head, or some other circumstances of a purely physical nature. In consanguineous marriages there is an ac- centuation of all family characteristics. If there be any taint in the family, each member of the family will have inherited more or less of it from the common ancestor. Take the case of cousins who are the descendants of a common grand- parent who was insane and of an insane stock. Here the cousins are certain to have inherited more or less of the insane diathesis. Even if the taint has been largely diluted in their case by the wise or, more Hkely, fortunate marriages of their blood-related parents, they will still have inherited a certain tendency to nervous disease ; and if they marry, they must not be surprised if that taint appears in an aggravated form in their children. Some of the children of such parents may be idiotic, epileptic, or dumb, and the parents marvel whence came the im- perfection. It may be, in some cases, that the parents, and possibly the grandparents, of the unfortunate children have not up till that time displayed any outward evidence of the tendency to disease which they have inherited and handed on to their descendants ; and, not looking farther back, the parents boldly assert that such a thing as insanity, epilepsy, scrofula, CAUSES OF ABNORMALITY 11 etc., is unknown in their families. They them- selves have never been insane, why then should their children be so ? In like manner, children may be epileptic, blind, deaf-mute, criminal, drunkards, or deformed through direct inherit- ance, and yet the family line be honestly declared to be healthy. As pointed out already, the morbid condition may remain dormant for a generation ; and the latent character may be called into existence by the union of an individual in whom it is latent, with another individual in whom it is potent. In those fortunate people who escape the family taint, if judicious unions are con- tracted, the morbid tendency may gradually eliminate itself and a return to the normal condition finally occur. I have also mentioned that in morbid heredity, nervous conditions are seldom transmitted in the same form from parent to offspring. What the parents transmit to the children is not necessarily the disease from which they are suffering but a disturbance of relations of structure, and hence of functions; producing a constitutional deficiency which takes the line of least resistance. It is not as a rule the special pathological characters themselves which are transmitted but a predisposition — manifested 12 ABNORMAL CHILDREN usually by a morbid affection of nutrition, a feebleness of development, and certain func- tional incompetence — which is capable of en- gendering under favourable influences diseases of very different appearance, one form of neurosis appearing in the parent, another in the child. An epileptic parent may have an imbecile child, a drunken parent an epileptic child. I know of a family in which insanity predominates with the exception of one brother, who is an acknow- ledged man of genius known to all the world — and he has an only child who is deaf and dumb. In FEEBLE-MINDEDNESS the influence of hered- ity is so potent that, even if only one parent is mentally defective, the children will rarely be up to the normal standard ; where both parents are defective there is no escape. Eighty to ninety per cent, of all feeble-minded are the result of a morbid inheritance, the remaining small proportion being caused by accident, or some form of acquired brain lesion. Children born at the extreme limit of the reproductive age of either parent are also sometimes defec- tive, and the last offspring of a large family is often either stillborn, or dies in infancy, or is feeble in mind. Drunkenness in the parents is a potent cause of hereditary neurosis and degeneracy ; CAUSES OF ABNORMALITY 13 not only the intoxicated state of the father but more so inebriety in the mother during preg- nancy. It is especially manifest in the causation of idiocy, imbecility, and epilepsy, a very large proportion of the victims of these affections having a history of parental intemperance. So long as the mother is an abstainer, the danger is not nearly so great. Opinions differ as to whether the habit of drinking is itself inherit- able ; but I have known two cases of women whose fathers were inebriates, and, though they referred with disgust to the drunken scenes they had witnessed, they themselves became addicted to secret drinking ; but they sought the doctor's aid and certainly co-operated with him to break themselves of the habit. The children of drunken parents are born into the w^orld with a defective nervous organisation, and such weak inhibitory w411-power as to make them an easy prey to the trials and temptations which beset them on every hand. With a weak mental endowment, they easily gravitate into the many highways and byways of sin. On the other hand, we must not forget that since many people drink to excess because they are not quite sound mentally, we do not know how many of the children of drunkards are heredit- arily affected for the reason that their parents 14 ABNORMAL CHILDREN drank, and how many because their parents were originally unbalanced in mind. That a drunken father, and more certainly still a drunken mother, may produce idiotic and epilep- tic children, I have had absolute proof in my own professional experience. It might be asked how it is, as so often happens, that a chronic alcoholic may have offspring mentally and physically sound. The answer is involved in the causes which lead a man to drink ; and observations seem to show that a man who can drink continually for a number of years and keep out of a lunatic asylum, a prison, or a hospital, must possess an inherently stable physical and mental organisation. The virility of his stock remains potent in spite of his vicious habit ; although it is undeniable that his offspring in all probability would have been stronger and better had he been a temperate man. Epilepsy seems to be propagated more directly than other neuropathic diseases. In many cases epilepsy appears in the collateral lines, and sometimes passes over the son or daughter to affect the grandchild. Sometimes, on the other hand, the neurosis takes another form. Epilepsy may be also caused by injuries to the head. CAUSES OF ABNORMALITY 15 The immorality common to urban life spreads one particular disease — syphilis — which has a far-reaching and most disastrous effect on the brain and nervous system, and may affect the offspring even after all external signs have dis- appeared. The scourge of this disease has been the most deadly enemy to the upward progress of the human race the world has ever seen. Its disintegrating power in destroying human life has been greater than even plague and war. The children of parents affected with the primary or secondary stages of this disease are born with hereditary syphilis. A large proportion of them die of convulsions or meningitis. If they sur- vive a few weeks or months, the disease reveals itself by defective development, slowness of growth ; and even at adult age such subjects are often stunted, and the brain or other parts of the body may show arrested development. Idiocy, imbeciUty, or simple weak-mindedness and epilepsy may occur. Either father or mother, or both, may be HIGHLY NERVOUS without having any actual disease ; or they may be descended from parents in whom there is a history of nervous disease, epilepsy, drunkenness, or other serious affliction, though in them the tendency has remained dormant. Their children may be normal; but 16 ABNORMAL CHILDREN the chances are that under circumstances which are a tax on the nervous system, or owing to faulty education, the neuropathic tendency will manifest itself. A number of investigations have shown that the state of the infant at birth is greatly affected by the conditions under which the mother HAS lived during the months of gestation. The children of those working women who are able to rest during the later months of pregnancy are to a marked degree larger and finer than the children of working women who pursue their occupation to within a short time of their confinement, even though the women who thus continue their work may be entirely healthy and robust. Moreover, such rest is a powerful agent in preventing premature birth, which renders the infant liable to perish or else to lead a permanently enfeebled life. Or the mother, throughout her pregnancy, may be insuffi- ciently or improperly nourished, or may per- sistently drug herself with alcohol or morphia ; and thereby affect the development of the brain no less than the body of her unborn offspring. One factor in heredity concerning which there has been much dispute, and whose exist- ence has been denied, is that of maternal impressions. Accidents to the mother influence CAUSES OF ABNORMALITY 17 sometimes the organisation of a morbid pre- disposition in the child. That this is so, I have personally convinced myself by the investiga- tion of a number of cases, at the instigation of the late Dr. Alfred Russel Wallace, the great naturalist. Violent emotions, especially fright, in the mother during pregnancy appear to give rise to profound nutritive troubles in the foetus, especially in its nervous system. In a large number, a direct correspondence between the maternal impression and the nature of the deformity or peculiarity can be traced. The shock seems to check the development of the foetus, and cause either general or local reversion. We have shown so far how weak-mindedness, and the neuropathic constitution in general, may arise upon an hereditary basis, and how it may be due to injurious influences exercising their effect during foetal life, such as exhausting diseases, or drunkenness, or other habits of the mother. We have now to deal with the effects of injuries, and acute diseases, after birth, and the results of a faulty bringing up of children. Labour in civilised races has become more difficult. The pressuke to the child's head in a narrow pelvis, or from prolonged labour at the period of birth, as well as injury by the careless or unskilled use of forceps, account for 18 ABNORMAL CHILDREN some of the cases of idiocy. Cases of idiocy are much more numerous among males than among females ; and this may be in some measure due to the fact that the male head is larger than the female and therefore likely to receive more pressure. The heads of infants may be sub- jected to great pressure without interference with brain growth or intelligence if the pressure be gradually applied ; but sudden or violent compression of the head in infancy may set up permanent mischief, and the forceps have been responsible for no little mental weakness. I have seen several unmistakable cases in which idiocy was due solely to injuries of the head by the forceps, and many mental defects short of idiocy may thus be accounted for. Formerly women were willing to stand the pain of con- finement, and in natural delivery the head of the child is compressed evenly and gradually. Modern society women are hypersensitive and require to be anaesthetised ; as a consequence, labour is no longer natural and the child has to be extracted with instruments, usually a per- fectly safe procedure, but I have seen cases in which the head was gripped so badly that haemorrhage into the brain took place with disastrous results to the mentahty of the child. Another cause of idiocy or feeble-minded- CAUSES OF ABNORMALITY 19 ness is to be found in the attempts to pro- cure ABORTION. When that is instrumentally attempted without success, injury may be done to the head of the foetus ; and when drugs are used these may disastrously interfere with nutrition and growth. These attempts at abortion, and also the practices employed to prevent pregnancy with a view to the restriction of the family, have a detrimental effect on the nervous system of the woman; and thus act unfavourably on the health of any child that may be subsequently born. Many children suffer through the ignorance OF THE MOTHER. A child that comes into the world perfectly healthy and normal should re- main so, if properly brought up. But how often do we find a mother who has devoted the least attention to the study of the infant constitution, to the principles on which it ought to be treated, or to the laws by which its principal functions are regulated ? She enters on her important charge with less preparation than if it were a plant or flower, instead of a being in whose existence and happiness her whole soul should be centred. The infant looks to the mother for that cherishing and affectionate care which its delicate frame requires ; to her it directs every appeal, in the full confidence that she will be 20 ABNORMAL CHILDREN ever watchful for its happiness and relief, and that from her a look or a cry will procure the requisite sympathy or aid. But when we enquire to what extent her education has fitted her for the intelligent discharge of her duties we find that, in the majority of instances, she has married and become a mother without a suspicion of her deficiency in the most ordinary information concerning the nature and functions of the infant whom she is suddenly called upon to cherish and bring up. This is one of the principal causes of the great infant mortality, and of the nervous disorders and mental defects of childhood. It may be alleged that mothers require no knowledge of the laws of the infant constitution and its development, because medical aid is always at hand to correct their errors. Accord- ing to the present habits of society, however, professional men are rarely consulted till the evil is done and the health broken ; but even when we are consulted, inteUigence and informa- tion are needed in the mother, to enable her to follow our instructions in a rational and beneficial manner. Many cases of mental defect are due to INSUFFICIENT AND IMPROPER FEEDING in infancy and childhood. Breast feeding has gone out of CAUSES OF ABNORMALITY 21 fashion ; and various kinds of condensed milks and proprietary foods are substituted for the natural nutriment of the infant. Many of these are of low nutritive value. Immense harm is done to infants by the indiscriminate use of such foods. Babies fed on them may look plump, but they are pale and flabby and often suffer from rickets. They are really partially starved ; and partial starvation, at a time when the brain is growing rapidly, may and often does dwarf it more or less. Infants thus fed become peevish, lethargic, and dull, and mental defect is no doubt sometimes thus induced. But in- fants are not only semi-starved by foods deficient in nutritive value, they also have given to them by ignorant mothers and nurses all kinds of articles of diet which they cannot digest, or which are contaminated, and by which intestinal irritation is set up. Intestinal irritation in in- fants with any tendency to nervous instability brings on convulsions, which again retard cerebral development and may end in idiocy. It has been shown that the death-rate from convulsions rises steadily A;vith that from infantile diarrhoea. The greatest mortality from convulsions is during the first six months of Hfe, before the teeth have cut through the gums ; and convul- sions formerly ascribed to teething are now 22 ABNORMAL CHILDREN known to be largely due to bad feeding causing entero-colitis. When the mother's milk is healthy, it is desirable that she should suckle her child. There is no complete substitute for mother's milk, and no beneficial influence on a child's life that can replace the loving and in- telligent care of its own mother, even if the child is suckled by another woman. The mortality of hand-fed infants is sometimes more than three times that of the breast-fed ; but even among the breast-fed, it has been found that the mortahty of infants suckled by strangers is double that of infants suckled by their own mothers. Rickets is common when the diet is faulty, and this physical condition unfavourably affects the mental development. What has been said of the feeding of infants is also true of older children. Semi-starvation in children, as well as in infants, is responsible for a considerable amount of feeble-mindedness. All through childhood the brain is expanding and elaborating its structure and extending its activities, and requires to be well nourished, and deprivation of nourishment at this period may do it lasting damage. A child born perfectly healthy and of healthy parents, but born in extreme poverty and half-starved during the whole period of its infancy and childhood, may CAUSES OF ABNORMALITY 23 grow up weak-minded, or at all events with morbid nervous tendencies, owing to an un- nourished brain or badly nourished brain during the growing period. In endeavouring to estimate a child's nutrition or malnutrition, we must think not only of bulk and of weight, but of ratio of stature to weight, of the general appearance and '' substance " of the body, and of its carriage and bearing ; of the firmness of the tissues ; of the presence of subcutaneous fat ; of the condition and pro- cess of development of the muscular system ; of the condition of the skin and the redness of the mucous membranes ; of the nervous and muscular systems as expressed in hstlessness or alertness, apathy or keenness ; of the condition of the various systems of the body ; and, speaking generally, of the relative balance and co-ordination of the functions and powders of digestion, absorption, assimilation of food, and of the excretion of waste products. Convulsions may occur before teething com- mences, but frequently cutting of the teeth is the exciting cause in a child when nutrition is impaired. The child is thrown into fits, often long continued, and returning with short inter- mission, placing its hfe in the utmost danger. In the great majority of cases the convulsions 24 ABNORMAL CHILDREN pass away, leaving no trace of their occurrence upon the nervous system of the child. Some- times, however, infantile convulsions merge into efile'psy, which again in a large proportion of cases causes mental disorder or enfeeblement ; and even when the fits do not do so, but are arrested, they may blunt the fine edge of talent and permanently weaken the mind. The stupe- fying effects upon the mind seem to depend more upon the frequency of the fits than upon their severity. The earlier the age at which epilepsy springs up, the more disastrous are its results; but epilepsy may exist without any intellectual failure. Febrile diseases in infancy and childhood, measles, scarlatina, typhoid fever, smallpox, and whooping cough are responsible for a certain number of cases of mental defect. Various other afflictions of childhood may affect the mental development, such as ade- noids, post-nasal growths common between the ages of five and fifteen, which not only make the children look stupid owing to the nasal ob- struction and consequent mouth-breathing, but such children are actually inattentive, dreamy, and of dull intellect. Chronic tonsilhtis and chronic earache have also a retarding effect. An important cause of weak-mindedness in CAUSES OF ABNORMALITY 25 a considerable number of cases is injury to THE HEAD of the child. I know, from actual experience, that such injury, although often trivial and leaving sometimes no external signs on the head, can yet cause serious damage. The consequences following head injury may appear immediately after the accident, or the effects may not become apparent until years later. I have pubhshed a number of cases in which the damage done to the head was circumscribed in extent, and a surgical operation had successfully restored the normal mental state of the patient.^ How- ever, not every history of a fall or blow on the head is genuine. Many relatives are fond of imagining such a history, being unw^lHng to admit hereditary influences or other constitu- tional causes. In infants the skull bones, from their soft character, readily yield to sHght blows, and are therefore not easily susceptible to injury, unless it be severe enough greatly to damage the brain or to destroy life. Bad hygienic conditions have a deleterious influence on the child. The Hfe of a child should be made as natural, healthful, and happy as possible, in order to provide against nervous breakdown ; and this can be accompHshed only by a proper admixture of indoor and outdoor ^ See Mental Sytri'ptoms of Brain Disease, 1910. 26 ABNORMAL CHILDREN life, which is often practically impossible in cities, at least in the winter months. In large cities, in which houses are poorly supplied with grounds for outdoor exercise, the children even of the well-to-do suffer from undue confinement within doors. Sometimes organisation and education act together in the production of a psychopathic disposition, as when parents transmit to their children not only by way of heredity an un- fortunate organic constitution, but also by force of BAD EXAMPLE and DEFECTIVE EDUCATION. Nothing exerts so great an influence on the psychical organism as what may be termed the moral atmosphere which is breathed by it from the very earliest stage of conscious existence up to the time of its full maturity. This influence is far more potent than is generally supposed; and, commencing in the nursery, it prolongs itself alike in the home and in the school, through the whole period of childhood and youth, and by no means dies out in adult age. Faulty education may predispose the child to nervous and mental disorders. Thus a common crime is the practice of early teaching the child to fear. Unfortunately, and with most dis- astrous consequences, the child is taught to fear the dark, to fear strange noises, to fear its parents, CAUSES OF ABNORMALITY 27 to live in constant dread of being caught by the bogey-man ; and the little ones are even taught an unnatural and unhealthy fear of de\als and demons, as well as to live in constant dread and unwholesome fear of the Supreme Being. The result of this early Ufe of fear is to disturb the emotions and deform the conceptions ; in fact, thoroughly to demoraHse the psychic hfe of the growing child. Sometimes the foundation is laid for future trouble by the too strict and harsh treatment of an impressionable and emotional child, who is sensitive and in need of loving care. On the other hand, an education that is too soHcitous, which can deny nothing and excuses everj^hing, cultivates obstinacy, unbridles passions and emotions, leads to defective self-control, and inabihty to practise self-denial. According as the infant has been treated considerately and consistently, or has been thoughtlessly, im- patiently, and fitfully regarded, so will neces- sarily his feelings have been affected and his temper formed. If petted at one time and snubbed at another, now treated as having both feelings and intelhgence, and anon as though he had neither the one nor the other, his temper will partake of the same fitful nature. As is the sowing, so will the harvest be. 28 ABNORMAL CHILDREN Another cause of nervous disorder is the premature awakening and strain of the intel- lectual powers at the cost of the emotions of childish simphcity and bodily health. This cause makes itself doubly felt where brilliant and often one-sided capabihties excite the pride of parents and guardians, and lead to overstrain of the mental powers of the precocious child. CHAPTER II IDIOCY AND IMBECILITY Whereas the development of the body, as far as its functions are concerned, is complete at, and even before, birth, it is otherwise with the brain, and especially with its highest arrange- ments, whose imperfection is the physical cor- relative of feebleness of mind. These arrange- ments do not exist at birth, and slowly come into being during the years of infancy and youth. It is obvious, therefore, that they are much more at the mercy of accidents, and much more liable to interference by insufficient and im- proper food, and other pernicious agents, than are those parts of the body which are developed earher. The brain develops up to a certain grade, and then, for some reason, the process ceases before the normal standard is attained. When the development is permanently arrested at the stage of infancy or in fceto, the result is idiocy. When development proceeds to the stage of later childhood and then comes to an end, the 29 30 ABNORMAL CHILDREN result is imbecility ; and arrest at a still later stage results in feebleness of mind. IDIOCY The most extreme form of mental deficiency is that of idiocy. It is a congenital condition in which the intellectual faculties have never developed, or at least not sufficiently. Idiocy, as well as imbecility, has defective heredity as the most frequent background for its develop- ment. Some idiots have abnormally large heads, while others have abnormally small ones. Faults of development, lack of symmetry, receding foreheads, deformed ears, badly placed teeth, defective hearing, inco-ordination of the muscles, stunted growth, and many other defects make these children pitiable objects to behold. Some idiots are so defective that their attention cannot be fixed even momentarily, while others are capable of a Httle direction in the attention. The lowest idiots are incapable of intelhgent expression in speech or action ; they cannot care for themselves or make known their wants ; they are the prey of their ungovernable mipulses and their animal-like propensities. Pathologically, we may differentiate various types of idiots. There are children with heads too small for MicR()(i:i'ii.\i.i( iiiKVr. IDIOCY AND IMBECILITY 31 normal intelligence, i.e. microcephalics. Their brain may weigh as little as eight ounces. It was suggested some years ago that the defective brain development was due to premature closing of the skull bones, arising from the mistaken notion that the brain adapted itself to the skull. Hence it was proposed to excise pieces of bone from the skull to give the brain more room. This was actually done in some cases, and it was claimed that after operation the children mani- fested some signs of increased intelKgence. Longer experience has, however, shown that the improvement, if any, is very slight and only temporary, and that death from " shock " is frequent. As a matter of fact, we know now that if the brain is destined to develop it will grow, and the skull will grow with it. The skull is only a hard covering for the protection of the brain, and being a living substance adapts itself perfectly to the size and shape of the brain. Surgical operation for congenital microcephaly is therefore useless. There are children who have heads larger than the normal size, i.e. macrocephalics. Among these is a particular form consequent upon an inflammatory process terminating in HYDROCEPHALUS, a Condition in which the brain is distended by an excessive accumulation of the 32 ABNORMAL CHILDREN cerebro-spinal fluid, and the skull in consequence becomes huge and of a globular form. The normal circumference of the new-born child's head is from 13 to 14 inches, and the signs of hydrocephalus may develop rapidly after birth, the circumference reaching twenty-five to forty inches or even more. Their brain may weigh as much as seventy ounces. Their skulls are often greatest in dimension from side to side instead of front to back. The region of the anterior fontanelle is often raised, the eyes are deep-set and fairly wide apart, the forehead is rounded and very prominent. The face, by contrast with the enormous head, looks small ; the bones of the face are feebly developed, but the palate seldom presents any signs of deformity. How- ever, all cases of congenital hydrocephalus do not take a serious turn ; and in some of them the accumulation of fluid ceases and a tolerably fair and even normal mental development may ensue. While thus marked hydrocephalus is not invariably inconsistent with considerable mental development, the majority of those afflicted with it are idiots of low grade. They are inattentive and indolent, sitting quietly, amusing themselves with picking at their clothing or in making slow movements of the fingers, rhythmical in char- acter. Their vocabulary consists of a word or X ■^. ■\ V. M ^^^^v ^ /iii^amL^ mL. r^ m MODKR \ I I-. \\\ l)k( sh.nn lu.v. I.UI .i.lilirlr.l IDIOCY AND IMBECILITY 33 two, and is rarely much more extensive. Besides the limited articulate language, they may pos- sibly learn a simple tune ; they are docile and affectionate towards their fellow-patients and attendants, but are incapable of any notable degree of education. Another class are the cretins, idiots of ex- tremely dwarfed, stature with excessive breadth of the long bones in proportion to their length, and a doughy yellowish skin. Their condition is due to the absence or atrophy of the thyroid gland, which secretes a substance essential for the development of the body and mind. A hypertrophic condition is rare, except in the endemic variety associated \vith certain moun- tainous districts, as in the Alps and in the dales of Lancashire and Yorkshire. The cretin, hke other infants destined to normal or abnormal growth, rarely shows any defect at birth. It is only in the second year, when there is continued failure in corporeal development and inability to walk or talk, that attention is attracted to the child. Now, in addition to these signs, the infant loses its vivacity, and becomes fat ; and its abdomen is pendulous. A typical cretin is dwarfish, seldom more than three feet in height, and exhibits strange and ungainly disproportion between the various 34 ABNORMAL CHILDREN parts of his person. A large head, expressionless eyes with puffy eyelids, thick neck, flattened nose, an habitually open mouth, thick everted Hps, and protruding tongue with dribbling saliva, a relatively enormous abdomen, soft bones, and carious teeth make up his unattractive appear- ance. Yet the cretin is an amiable creature, usually very affectionate, slow to anger, indeed slow in everything, for intense deliberation characterises him in every direction, and in his ponderous way he is genial and easily pleased. The faults with which he may be charged are due not so much to a true perversion of the emotions, or to impulsive tendencies, as to the innocent expression of his natural instincts without the corresponding influences of the intellect and moral sense. The long bones of the cretin aft'ord perhaps the most characteristic sign of the disease. They show a breadth altogether out of proportion to their length, not from rachitic deformity, but from retardation of their growth in the long diameter with a disproportionate broadening. The head is usually too large for the size of the body, and the hair is scant and wiry. The bony deformities are associated with a boggy, thick- ened skin, firm and inelastic to the touch, non-pit- ting on pressure, a condition which is present all IDIOCY AND IMBECILITY 35 over the body, but is especially noticeable about the face, neck, and shoulders, where it may be raised from the subjacent tissues in great folds. The thickened skin gives the face a peculiar rounded swollen aspect. The voice is high pitched, with a peculiar timbre. By feeding the patient with the thyroid gland remarkable cures have been achieved. The earlier the age at which this feeding is begun, the better the results both as regards bodily and mental development. Another type is the so-called mongolian, the members of which are of short stature, have gruff voices, small round heads, ilattish noses, rough skins, short thin hair, straight eyebrow^s, square hands, short thick fingers and loose joints. Mentally they are very happy, placid little persons, fond of music, very imitative, but incapable of improvement beyond routine ac- quirements. Another type is the epileptic type, in which constant fits have retarded the mental progress, rhey are listless and dull, with occasional periods ■f excitement which is impulsive and uncon- foUable. Often they are affectionate but sus- picious, imagining harm when none is meant. There are other idiots showing deformities of the skull and long bones due to improper or 36 ABNORMAL CHILDREN insufficient nutrition in infancy, termed rachitic idiots. Another class are the paralytic and PORENCEPHALIC idiots, who present paralysis from congenital or acquired defect in the brain substance ; and yet another class, the traumatic, whose skull was compressed or injured on ac- count of difficult delivery or faulty use of forceps. Fevers and inherited syphilis also cause idiocy. The lowest type of idiot is one devoid of all understanding, in whom is found an entire absence of intelligence. Being incapable of any reasoning power, he has no appreciation of the commonest physical dangers. His faculty of attention is also wanting, except a momentary attraction by loud noises, bright lights, and similar exciting objects. Of most of them it may be said that they do not appear to be conscious of their own existence, much less of ordinary feelings of pleasure, pain, fear, and love, except in the most rudimentary way. The sight of food alone has the power to draw them from their indifference, and they may show attach- ment to whichever person takes care of them, transferring their affection readily. There is no will-power and no trace of the faculty of initia- tion. They have no power of expressing them- selves by means of articulate language, but some IDIOCY AND IMBECILITY 37 of them succeed in maldng known their desires by certain signs, cries, or sounds, understood only by those in immediate attendance upon them ; this inabihty to express their thoughts verbally, and to understand the verbally ex- pressed thoughts of others, being due solely to defective inteUigence and not to any disturbance of hearing nor to any affection of the organs of speech. Their temper is easily excited. Char- acteristic is the blankness of their facial expres- sion, the pecuHarity of their carriage, the general awkwardness of movement, and, above all, their restlessness. They concern themselves little about other people and roam about the room, taking hold of everything, pulHng down what they can, and always fearless of the consequence. If they cannot employ themselves in any other way, they will keep up a constant motion with the fingers, twisting and braiding them. They bite the nails, and are apt to tear their garments. DrivelHng is common. It is only in idiots of higher degree that we are able to determine voluntary attention, and by that to develop their general intelhgence. As a rule they do not learn to read, but some of the more educable ones may learn the alphabet and make out some detached syllables ; but they rarely get to the point of understanding the 38 ABNORMAL CHILDREN printed words. Even when we succeed in teach- ing them to read, their reading is staccato, some- times sing-song, but never normal. Their writing, if at all possible, is still worse than their reading, for they lack the co-ordination of movement. Those who do succeed can write only from a copy, and never from dictation or spon- taneously. Calculation is impossible for the lower grade idiot, and even the higher grade learns only the elementary figures and those with difficulty. Not having any understanding, or but little, idiots rarely laugh; except when they laugh continually, as is the case with certain incurable idiots who giggle constantly while making their balancing movements. They are extremely timid ; everything frightens them, because they cannot explain anything. Love of property exists sometimes to a considerable degree in higher class idiots. They do not hesitate to appropriate anything they want, especially if it be food, which more than anything else excites their desires. They are not naturally lazy, for they can be got to work if we know how to set them to it and they have been trained to it. They are only inactive from want of attention and slowness of conception and movement. The musical sense is often preserved in them, quite IDIOCY AND IMBECILITY 39 disproportionately to the other mental faculties ; and not infrequently those who cannot speak at all can hum tunes correctly, so that parents base thereon, sometimes, false hopes that their child cannot be so very defective when he apparently appreciates music. Idiots should never be kept at home, but sent to special homes for permanent care. Parents must realise that though such children can never be brought up to the normal, they can be con- siderably improved mentally and physically, if trained at an early age by competent teachers and the special methods in use at all recognised institutions for the feeble-minded. IMBECILITY The imbecile is one whose mental defect exists from birth or infancy, and is so great as to render him incapable of earning his own living, although he has intelligence enough to guard himself against the common physical dangers. Imbecihty is a mental deficiency, either in- herited or recognisable in the first few years of life, or occasioned by cerebral injury at or imme- diately after birth, or consequent on brain disease acquired in infancy or early childhood. In imbeciles we find defective mental powers of various degrees, from pronounced enfeeble- 40 ABNORMAL CHILDREN ment to grades of intellectual development, capable of fair education, but retaining a defect in some mental faculties. As a rule, imbeciles are fairly conversant with their immediate surroundings ; they know their own names and are able to respond to them when addressed. Li lower grade imbeciles, the command of language is extremely limited ; they are only able to pronounce a few words, or at any rate a few phrases, the correct significance of which they know. They can make themselves under- stood, but they fail to learn how to communicate their thoughts in spontaneous writing or to understand what they read ; this failure being due to defective intelligence. Voluntary atten- tion exists within certain limits, but it is inter- mittent, and they pass from one subject to another without there being any relation between the two. Their memories are defective, and they do not retain from one day to another what they have learned with care and trouble. Weeks and months are spent over the alphabet before it is finally, and then only imperfectly, mastered. In some, the memory is apparently greatly developed ; but if we observe closely, we notice that they recite a piece always in the order in which they have learned it, and that the slightest interruption in the recital cuts it short, for they IDIOCY AND IMBECILITY 41 rarely understand what they are saying. Even an apparently good memory is therefore not a proof of intelligence ; when they learn quickly, they forget with equal rapidity. It is difficult to educate them to read ; and although some learn to write, they never form their letters well. They are unable to count beyond a certain number, and arithmetic is usually beyond their power. We may succeed in getting them to understand addition, but it is often very difiicult to teach them what subtraction is ; certain of them can never learn to understand it, even those who may be fairly well developed in other respects. The principle of multipHcation is not understood, and in the great majority of cases division is impossible. Yet imbeciles have been known in whom the memory for figures was not only well preserved, but developed to an extra- ordinary degree. Some have a special memory for dates and a perfect appreciation of past or passing time. Imbeciles are very much influenced by rhythm, hence they like music, and some even the recital of poetry, though they may not understand a word of it. They have often a good memory for tunes. They readily acquire simple airs, and rarely forget them. This is the more striking because of the utter absence of any other 42 ABNORMAL CHILDREN evidence of artistic taste. A beautiful landscape or a lovely picture is powerless to move them. It is a curious fact that the musical faculty is preserved in persons of the lowest intelligence. In insanity, too, it is often the last to go. Some imbeciles reach a higher degree of mental development and are capable of conversing cor- rectly, but their knowledge, as well as their vocabulary, is limited. Despite the apparent facility of language, thought is really slow. Patients of this class do not comprehend quickly, and there is a frequent tendency to the repetition of any question addressed to them. They some- times seize readily upon anything that is gro- tesque in a person, and may express it in com- parisons which are really quite droll, and which make them appear to be more intelhgent than they really are ; more often, however, these comparisons are absurd and usually trivial or vulgar. Some of them exhibit a wonderful power of repartee and a dry form of humour, all the more surprising on account of its unexpected- ness. The creduHty of imbeciles, as might be expected from their want of understanding, is very great. Imbeciles are very egotistic, and occupy them- selves above all with their physical well-being. They are easily disturbed by the least physical TWO TVPKS OK IMBKCII.KS. IDIOCY AND IMBECILITY 43 pain which they sulTer, and give expression tu their discomfort in a lively manner. Similarly, they manifest joy in a noisy manner, out of all proportion to the cause of it, getting more and more excited. They often laugh without motive, even perhaps under sad circumstances, if some little thing which they think funny attracts their attention. Imbeciles are fundamentally lazy, unless some special inducement to action is offered, rewards that they love or punishment that they fear. If they are fond of some amusement or occupation they may carry this on for a time fairly well ; but they have no endurance and give it up, being unable to adhere assiduously and constantly to one pursuit. They are often vain, quarrelsome, easily irritated, and frequently a source of annoyance to the household from their propen- sities to lying, thieving, and their general shame- lessness and uncontrollable character. They are / capable of manifesting a certain kind of affection ^ to those who treat them kindly and with whom they hve ; but the feehng is never profound. They are capable of a certain amount of training and discipline in the direction of their external behaviour. If left to themselves, their instincts and manners become so repulsive that it is impossible to live in their society ; but if properly 44 ABNORMAL CHILDREN trained they learn to dress themselves, to eat inoffensively, and to control their animal pro- pensities. By careful exercises and proper gymnastic training, much can be done to avoid the outward appearance of imbecility to which parents so seriously object; and by competent teaching their behaviour may be brought as closely as possible to that of the average child. With regard to the mental training, we may prevent the defective brain becoming more degraded by sending such patients to a Training Institution. There are several excellent ones in existence, and more will be licensed under the " Mental Deficiency Act." Often there is a difficulty in keeping an imbecile child at home, especially if there are other children ; and home is not suitable, for it rarely happens that both parents are judicious in the management, and one is irritated and hasty, while the other screens his faults, takes his part, and harms him by foohsh kindness. Imbecile children kept at home are often handed over to servants or attendants, and this fosters their natural love of inferiors. Those that can be improved require the personal superintendence and care of edu- cated people who are competent, by temperament and love of the work, to undertake the up- IDIOCY AND IMBECILITY 45 hill task of educating these blighted waifs of humanity. The first thing is to find out the taste or capacity of these children. They are not idiots, and many are capable of doing some one thing and doing it well. If this can be dis- covered it should be developed ; it may be music or carpentering or needlework. Anything that will give occupation and employ the mind and body for a certain number of hours daily should be encouraged. Other education should be regulated by the individual capacity, for it is useless to torment a child with lessons which it is wholly unable to comprehend or profit by. The only effect is to engender a hostile feeling between the teacher and pupil which is very prejudicial to the latter. It is often surprising to see how much can be accomplished with these unfortunates. In some instances, however, the task is a hopeless one, and all the evidences of imbecility can rarely be eradicated. CHAPTER III FEEBLE-MINDED CHILDREN We describe children as feeble-minded when they are superior to idiots and imbeciles, but still suffer from such an incomplete cerebral develop- ment that they are behind other children, of the same age and station in life, in mind and con- duct, and do not profit by their environment and by education to the same extent as average children. They cannot be taught in ordinary public schools, but, unlike idiots and imbeciles, they are capable of a certain amount of education if they receive individual attention and instruc- tion. Many of the local education authorities have established special classes for such children of the poor, and their attendance is made com- pulsory until the age of sixteen years ; when, unless sufficient progress has been made, they will be taken care of in special Institutions, as empowered by the Mental Deficiency Act of 1913. The majority are defective from birth or at least from infancy, having been normal until a 46 FEEBLE-MINDED CHILDREN 47 fever, convulsions, or other disturbance damaged their brain, and left a permanent defect. The earlier a physician is consulted, the better for the child. But modern parents leave their children so much to nursemaids and governesses, that often they do not notice those signs which would attract the attention of a careful observer. Some parents are able to make a general state- ment that their child was late in development, but they are not able to furnish any actual data. For purposes of comparison, we append at the end of this chapter a table of the average mental development of an infant, according to our observation, corrected by the statements of a number of parents; but, of course, allowance must be made for individual differences, and therefore it would be wrong to assume that because a child is later in one or other of the acquisitions, it is feeble-minded. Proper observation will reveal any delayed development already in infancy. It will be found that in many of them dentition takes place much later than usual, that they assume the upright position and learn to walk at a much later period than ordinary children, and that sometimes it takes them three years or more before they begin to speak. Articulation often remains defective. 48 ABNORMAL CHILDREN Throughout their infancy and school years, mentally defective children compare unfavour- ably in their bodily growth and mental acquire- ments with normal ones. Their height is usually several inches under the average, and their weight a good many pounds below the normal, especially among the poor. Among the well-to- do classes, I have found them often sturdy and of tolerably good physique. Like the idiot and imbecile classes, they have defective circulation, and frequently suffer from the consequences which arise therefrom. Some are very slow in movement, others move in excess and cannot remain in one position for long. Some acquire muscular twitches and tricks and all sorts of habits, which require correction. One of the earliest and commonest defects of the feeble-minded is in their power of atten- tion. Attention is neither active nor lasting. Even when readily gained, it is with difficulty held. The majority have no power of concen- tration. Not being able to concentrate their minds on anything for long, they are unable to learn things, or at least not so quickly as other children. Moreover, being inattentive and having little understanding, they cannot retain things they have observed or learned, and are thus slow in acquiring even elementary know- FEEBLE-MINDED CHILDREN 49 ledge ; such subjects as history and geography being quite out of the question. They are feeble in perceptive and reasoning power, de- ficient in common sense, have no faculty of evolving new ideas, are imitators rather than originators, have no constructive imagination and inventiveness, and are lacking in the logical and aesthetic senses. Their permanent stock of ideas is small, and they have little capacity for using it and adding to it. Whilst the musical faculty is often preserved, as in idiocy and imbecility, the faculty of number is deficient. I have seen many feeble-minded youths who understood all the ordinary rela- tions of life, could conduct themselves well in society, go about alone, learn to read, and had quite a respectable amount of general intelli- gence ; but nevertheless could not work in figures, could not multiply by two up to twenty without stumbhng, and could not give change for a shilhng. Still there are some feeble-minded children in whom the arithmetical powers are not only unimpaired but extraordinarily active as if all the rest of the brain had been damaged and the only uninjured region received more than its usual blood supply. Thus I knew of a feeble-minded boy who could multiply mentally any three figures with perfect accuracy. 50 ABNORMAL CHILDREN Other feeble-minded have the memory for names, dates, or locaUties well preserved. I have met one who could tell the name and address of every confectioner's shop that he had visited in London — and they had been numerous — and could as readily tell the date of each visit ; another could tell all the calendar dates for years gone by and for several years to come ; another knew an elementary school-book on geography entirely by heart, and would recite it with great rapidity, though he had not the least under- standing of it. With suitable training, the feeble-minded make tolerable progress in simple knowledge, so as to be able to write an ordinary letter, or read an elementary book, and perform simple arith- metical exercises. They can be trusted to carry out simple commissions and may be taught handicraft, but they rarely acquire sufficient knowledge of money values. In a certain sense it may be said of them that they do not grow old with their years. They remain childish, easily satisfied with trifles, and display interest in things which have long ceased to interest normal people of the same age. While, for in- stance, a fourteen-year-old boy is already able to shape plans for his future, the mentally defective boy of a similar age is still happy FEEBLE-MINDED CHILDREN 51 with his toys, and wants constant supervi- sion. The course of proper treatment is definite. All but elementary education must be discarded once and for all. The powers of observation must be utilised as far as possible, and a special scheme of instruction adopted, such as is carried out in the better establishments for the feeble- minded. Of course, it is all a question of degree. There are feeble-minded children, almost imbe- cile, who will be difficult to train, and there are others at the other end of the scale, who are httle more than backward, and may be so well brought up that, superficially observed, the deficiency will not be apparent.^ ^ The Mental Deficiency Act, 1913, which came into force on April 1, 1914, enables the paretU or guardian of a defective who is an idiot or imbecile, or who belongs to the class of " feeble-minded," and is under the age of twenty- one, to place him in an institution, certified house, or an approved home, or under guardianship, upon the medical certificates of two duly qualified practitioners, which in the case of the "feeble-minded" child, must be counter- signed by a judicial authority after such enquiry as he shall think fit. Where a mentally defective has been placed by his parent or guardian in an institution or under guar- dianship it shall be lawful for such parent or guardian to withdraw him from the institution or guardianship at any time on giving notice in writing to the Board of Control, unless the Board, after considering what means of care and supervision would be available if he were discharged, determine within seven days that the further detention of the defective in the institution or under guardianship is required in the interests of the defective. Further, this Act reqxiires the local Education Authority 52 ABNORMAL CHILDREN Surprising progress is often made under suit- able tuition. The body and niind can generally be trained to some occupation which is useful because it exercises the mental powers and trains the muscles. Boys can be taught the handi- crafts, girls the ordinary domestic duties, and to ascertain what children within their area, between the ages of seven and sixteen years, are defective children within the meaning of the Act, and to notify the Mental Deficiency Committee of those defective children who are found iinsmtable for admission to, or retention in, special schools, and who, on or before attaining the age of sixteen, are about to be discharged from special schools, and who would, in the opinion of the Education Committee, benefit by being sent to an institution or by being placed under guardianship. The Elementary Education (Defective and Epileptic Children) Act, 1914, which became operative on January 1, renders compulsory the hitherto optional provision of special education for mentally defective children whose age exceeds seven years, and who are found to be incapable of receiving proper benefit from instruction in ordinary elementary schools. Further, all children in attendance at sjDecial schools are to be medically examined at intervals of not more than twelve months, with a view to ascertaining whether they are fit to return to an ordinary elementary school ; whether they are incapable of receiving further benefit from instruction in a special school or class ; or whether they cannot be instructed in a special school without detriment to the interests of the other children. If the report shows that a child also needs supervision or guardianship out of school hours, the Education Com- mittee will notify the case to the Board of Education, and subsequently to the local authority under the Mental Deficiency Act, 1913. This will also be done in the case of a child about to be withdrawn or discharged from a special school or class, if the Education Committee are of opinion that it would be to his benefit that he should be sent to an institution or placed under guardianship. In all cases of any action proposed to be taken under the arrangements, the parents of the child will be duly informed. FEEBLE-MINDED CHILDREN 53 music, at which they often excel, while intel- lectual efforts must be restricted to that know- ledge which is essential in Hfe. Sometimes these feeble-minded children pass tolerably through their elementary education, but their defects become apparent as they reach puberty. It is when they leave school and pass out of supervision that they soon go downhill mentally and physically, more especially if unoccupied. Absence of occupation has a far greater influence on the feeble-minded than on the ordinary child in leading to bad habits and moral degradation. That those who are mentally feeble should show moral deficiencies is only natural, con- sidering that the lower the intellect, the feebler the control over the instincts and passions. They are greatly wanting in initiative, and are easily influenced by others. Their moral sense is very defective, they have little self-control and power to resist temptation, when it comes in their way. Already at school, or while taught at home, this lack of inhibitive power will have shown itself. True, some are well-behaved, affectionate, and obedient through having no will of their own ; but many others are mis- chievous and cunning enough to invent Hes to escape the consequences of their misdeeds. Even the feeble-minded of a milder degree lack 54 ABNORMAL CHILDREN imagination in their outlook upon the affairs of everyday life. This deficiency is proved by their indifference to public affairs, and by the care- lessness with which they face the future, even in regard to their own personal interests. They are careless for the future, because they are incapable of picturing it. The inevitable death of parents who provide for their support, their own failure in every career, the prospect of poverty, the responsibility of founding a family, the spectre of old age in a house of charity, etc., are all eventualities to which the feeble-minded pay no attention, because they do not think of them. The few who have vain imaginations of what they would Hke to do or become, are lacking in the necessary intelligence or will to direct their attentions accordingly. Indeed, one of the most pronounced features of the feeble-minded is their utter lack of purpose. Their horizon is bounded by yesterday and to-morrow. It is only necessary to question a feeble-minded youth, even one of the more inteUigent, as to his plans, his preparations, and his hopes, to ascer- tain that he does not possess any. If, indeed, he does possess a programme, he has only one and it is difficult of reahsation, ill-defined, and very childish, such as to amuse himself, to incur FEEBLE-MINDED CHILDREN 55 debts, or to continue in the even tenor of the Hfe which, half through obedience and half through choice, he has hitherto followed. Obviously it is a necessity to prevent these unfortunate per- sons from coming into contact with those who are ever ready to take advantage of the weak- willed, and also to prevent them from becoming a prey to temptations, which, by reason of their inherent weakness, they are naturally unable to resist. Efficient supervision and care of such older children should enforce (1) constant occupation and (2) absence of temptation or of bad examples. Feeble-minded persons are so easily led that they quickly copy bad examples, and thus de- velop bad habits. ,0n the other hand, if they are kept free from all vicious influences, they are just as readily guided into lines of good con- duct. Taking the best of them, who approach those who are merely backward, we can say that, with quiet and uneventful surroundings which do not overtax their mental energies, they may manage to pass through life in the undis- turbed possession of their meagre mental out- fit, with comparative ease and comfort ; but the moment they are subjected to complex con- ditions of life, which require greater mental and physical activity to gain a subsistence, they are 56 ABNORMAL CHILDREN sure to weaken and falter by the way and so gravitate to the vagrant and pauper ranks. Some feeble-minded persons are placid, well- behaved, and industrious, but the life of such is one of conformity to habit, and not to ideals. If given work and told exactly what to do, they may often be trusted to do it ; they may even acquire the habit of performing the same task day after day, year in and year out, without supervision. But the work must be strictly of a routine nature, for they would be quite unable to cope with any unforeseen occurrence. The lighter grades of feeble-mindedness often fail of recognition; but as soon as some unusual situation arises, demanding discretion, decision of action, and self-control, incapacity becomes evident. And should they lose their employ- ment, they are incapable of any strenuous attempt to seek more. To use a homely phrase, we may say that the bread of these persons must be put into their mouths. Feeble-mindedness appears in all ranks of life, probably as frequently among the well-nourished and well-to-do as among the poorly-nourished and overcrowded, only that the feeble-minded of the upper classes are better cared for and protected than those of the poorer classes, and are less noticeable. Among the well-to-do FKKBI.E-MINDKD I50V. Was taught fleiin-ni.iry v.ork. FEEBLE-MINDED CHILDREN 57 feeble-minded, it is not the inability to earn a livelihood which attracts notice, but the lack of capacity to keep whatever they possess. Defect in the administration of the means may be due to general defect of intelhgence, so that the sub- ject of it is unable to appreciate the amount of his income, unable to grasp the relative values of different commodities, unable to appreciate the different purchasing power of different sums of money ; so that he is at the mercy of any dis- honest person who chooses to ask him half a sovereign for an ounce of tobacco or a box of matches, or to palm off upon him a coloured hthograph as a genuine Raphael, a broken- winded screw as a certain winner, ormulu and glass as gold and diamonds. In consequence, he expends his income and sinks into debt, from sheer inabihty to appreciate the relation between income and expenditure. Another defect is the inabihty to say " No." There are very many persons of weak character who are unable to withstand solicitation, who give to every beggar, and lend .to every " sponge," money which they cannot well afford, from lack of moral courage, force of character, or strength of will to refuse. These are the people who are ruined by endorsing bills and becoming security for their friends ; who buy worthless shares 58 ABNORMAL CHILDREN forced on theto by unscrupulous agents of financiers ; who malce collections of antique furniture, pictures, etc., which are manufactured specially to delude the unwary. These are the people whose wills are disputed on the ground of undue influence, who make wills or deeds of gift in favour of their nurses or landladies, to the exclusion of their own near relatives. FEEBLE-MINDED CHILDREN 59 Average Mental Development of an Infant During First Few Days The child recognises difference between light and dark objects. Follows with its eyes object moved slowly before it. It begins to hear about the fourth day. At the End of First Month The child recognises sounds. Learns to distinguish between bitter and sweet. Recognises disagreeable odours. Expresses its displeasure by turning its head away and by crying. Sixth Week Passive attention develops, so that the child will turn its head in the direction of a sound and reach out towards an object. It recognises the human voice. Seventh Week Development of the smile. Recognition of its mother. It is quietened by a song. Ninth Week Instinct to handle objects first observed. 60 ABNORMAL CHILDREN Eleventh Week Movements hitherto aimless assume purpose- ful aspect. Instinct to imitate sounds appears. Surprise and fear are shown, especially fear of change, which by the fourth and fifth month is crystallised into an instinctive shrinking from strangers. Anger appears. Third to Fourth Month Earliest exhibition of humour and amuse- ment. Laughter shows itself. During the Fifth Month Child sits up alone. It carries objects to the mouth. Distinguishes one person from another ; and Stretches out his arms to be taken up. Sixth Month Follows objects dropping out of his hands. Recognises its image in mirror with cordial pleasure ; and Points with finger at pictures. Eighth Month Child takes pleasure in making a noise ; throws things on the floor for that purpose. FEEBLE-MINDED CHILDREN 61 Ninth Month First language : " Mama," " Dada," " Baba," " Nana " appear ; but sometimes earlier. Tenth Month Instinct of locomotion appears. The child takes intense mterest in its food. Recognises its parents after absence of several days. Eleventh Mo7ith Instinct to stand ; continually tries to get on its feet. Twelfth Month Walking instinct developed, but often a little later. Thirteenth Month Jealousy appears. First signs of moral qualities, sense of right and wrong. Sixteenth Month First volimtary language appears ; says "no," but " aye " only a few months later. It cries on being scolded. Eighteenth Month Proper language commences : " Dada gone," " puff-puff," etc. Nineteenth Month Memory appears. 62 ABNORMAL CHILDREN Acquisitiveness develops, also greediness. Takes other children's toys. Discovers its own hiding-places. Twentieth Month Sociability develops. About End of Second Year Child ceases to be wet and dirty. Active cleanliness appears. Mentality of Third Year Instinct of make-believe and play develops. Idea of time, past and future, hence anticipa- tion. Instinct of rebellion appears. Child gains consciousness of self. The child distinguishes well the lie from the truth. It can play with fear and realises what " for fun " means. Touches nose, eyes, mouth, and pictures of these, as directed. Repeats sentences of six short words with no error. Repeats two numerals. Enumerates famihar objects in pictures. Gives family name. CHAPTER IV BACKWARD CHILDREN Whereas idiots and imbeciles, and sometimes even the feeble-minded, may be recognised in the cradle, and their parents may therefore be early reconciled to their misfortune, it is other- wise with backward children. Their mental weak- ness often remains unsuspected until they reach school age, so that the hopes of parents are kept aUve for a longer time, making the subsequent disappointment all the greater. Moreover, while the deeply defective children, such as idiots, imbeciles, and feeble-minded, are in the eyes of parents merely helpless children, those of lesser defect — backward children — are, and remain, frequently a source of great trouble and anxiety to their parents. The mental defect may exist from birth, though not recognisable, or it may be due to some disease which weakened the brain in in- fancy ; and many are backward temporarily only, through debihty, the exhaustion of disease, enfeebling habits, improper feeding, defective 63 64 ABNORMAL CHILDREN hygiene, eye-strain, defective hearing, adenoid growths, and other causes, so that in all cases a thorough physical examination is the first essential. Backward children closely resemble normal children. It has to be remembered that we are all backward — or, more correctly speaking, " feebly gifted " — in some subject ; one is deaf to music, another is a dullard at figures, another has no skill for drawing; one has no memory for history, another fails in geography, a third in mathematics ; one has no capacity for science, another none for classics, and so on. The back- ward child is a child that is slow in learning, and fails not in one but in a large number of subjects, generally all those that require book-learning. He is a child with a mental defect or pecuKarity which prevents him from fully profiting by the ordinary methods of instruction in use in our schools. If the child is unable to keep up with the classes suited to his age, if he is unable to profit like other children from the education provided, this shows that he has not the same degree or the same kind of intelHgence as his companions; and there is a presumption that his intelligence is inferior to the average, or that his character is different.^ The intellect is below * The best known of the methods for testing the mental abiHty of school children is that devised by Binet, the pur- pose of which is to rank them according to mental age. BACKWARD CHILDREN 65 that of the normal child, and it is not infrcquont that such a child is also dull at games and awk- For example, a certain child is chronologically, let us say, 15 years old, yet physiologically he may bo only 11, in- tellectually 10, and jiedagogically 12. The last nuinber indicates his past achievements at school. Tlie child's grade in the school does not always correspond with his mental age, and it becomes highly important to ascertain what his mental age is — that is the purpose of Binet's tests. For instance, the eight tasks that any child should credit- ably perform, who has a mental age of 7 years, are (1) to indicate the omissions in a figure drawn in outline ; (2) to give the number of one's ten fingers ; (3) to copy a written phrase ; (4) to copy a triangle and a diamond-shaped figure ; (5) to repeat three numbers ; (6) to describe an engraving ; (7) to count thirteen separate pennies ; (8) to name four pieces of money. A normal child of 12 should be able to repeat seven figures, at 10 six, below 8 he breaks down at five, at 4 he handles three, at 3 two. The length of a series of figures, letters, or names is a test of a child's control over his attention and the inherent grip of his memory, and this ability is quite independent of any practice in learning by heart. So it is with other tests of the Binet scale. At 5 years a child should be able to copy a figure of a square, that of a diamond only two years later. Below 7, as mentioned above, he wall not notice that the outline drawing of a " lady " lacks arms. Up to 11, one can tell him that one has locked oneself in a room and is unable to get out because the key was left on the outside, and he will believe one. At 14, given any time by the clock, he should be able to say what time it would be if the hands were interchanged. A good deal of discussion is waging round these tests. It is easy to doubt the value of some of them, but on the whole they give a fair estimate of mental development, not merely a measure of the intelligence, but of the memory, attention, muscular control, and of the powers of observa- tion and linguistic expression. They do not tell one very much about the real mental idiosyncrasies of the child, but they enable the qualified psychologist to use his skill and natxu-al gift to better effect. Anyhow, the principle is right and it should be ea.sy to improve upon the details, F 66 ABNORMAL CHILDREN ward in his behaviour. In contrast to the feeble-minded, backward children, unless dis- eased, are usually well developed, often fat and robust. Besides the children whose backwardness is recognised in early life, there are others bright and vivacious, acquitting themselves well in their classes, learning with ease, and regarded as clever, though perhaps slightly eccentric or excitable, in whom the defect is not apparent until the later school years, when it is found that they lack apphcation. As soon as they tire of one thing — and they do so quickly — they take up another; so the youth grows up, and when he is of an age at which others have made some progress in a definite career, the backward youth is still undecided. He cannot see why he should learn something for the sake of future benefit ; all he cares for is immediate gratification. Sometimes there is artistic talent, when the lack of apphcation may be overlooked by the parents. This class of defectives may draw, paint, sing, play, or write verses and make various pretty things with easy dexterity ; but their lack of industry prevents them from ever attaining mastery of the technique of any art. They exhibit plenty of artistic taste and feeling, but they are always amateurs ; they are never ;a(K\\.\ki) iu)v. Ily Imlrucplialic !i [To face piigc 0(>. BACKWARD CHILDREN 67 really good. Before they can be commended, allowance must always be made for this and for that. Every effort should be made in our elementary schools to distinguish between the backward and the normal child, and it should be part of the teacher's duty to classify them. The attempt to force an education demanding con- siderable brain power upon children incapable of receiving it is bound to fail; consequently they leave school unfitted to begin life in any capacity. If w^e take a child that is really mentally subnormal and put him in school with normal children, he cannot do well, no ma^tter how hard he tries. He tries again and again, and fails. Then he is scolded and punished, kept after school, and held up to the ridicule of the teacher and other students. Masters and mistresses are apt to mistake his inabiUty for idleness, and to press and punish him unduly, assuming that because one subject is well learned, it is mere idleness that prevents all being equally well done. Special teachers are required who will not lose their equanimity, but will, with patience, bring forward what talent may lurk in the backward ^mind. As before mentioned, many backward children have a special aptitude for some one pursuit, 68 ABNORMAL CHILDREN as music, drawing, carpentering, or even mathe- matics or mechanical engineering ; and it is the teacher's business to discover the hidden talent and develop it by every available means. Back- ward children must be taught preferably occu- pations which are mechanical, for which, after the skill is once acquired, little conscious mental effort is necessary. The first problem of the teacher of backward children is, then, to discover tasks that are within the grasp of these children. The things must be so simple that they can be accomplished, and at the same time so interesting as to awaken enthusiasm and the willingness to make effort. If a boy is decidedly backward, it will be better to abandon the ordinary school lessons alto- gether, and to occupy the whole of his time in instructing him to do something that he can do, rather than to spend the time in trying to instil into him something which he has proved him- self incapable of absorbing. The teacher should proceed systematically to examine the child for his mental capacities, whether he is stronger in observation, memory, reasoning power, or imagination. The child may be good in all four, but as a rule one or the other is weaker. In the backward, we find fre- quently deficient and inaccurate observation, BACKWARD CHILDREN 69 a weak, or what is even worse, a misleading memory, a feeble reason, and a slight imagina- tion. Their perceptive powers frequently cannot be trained to observe all particulars, and are rarely exercised consciously and voluntarily ; that is to say, they notice things by chance, but are not constantly on the look-out for every- thing which is passing around. The ideas they derive from the evidence of their senses are strongly affected by suggestion ; so that they con- stantly err in their observations and, what is worse, are unconscious of the fact. The observa- tion, which is probably an inaccurate one, is stored up in the memory, and then, when re- quired on a future occasion, it is either altogether forgotten or is perverted into something else. Individuals vary not only as regards their power of observation but as regards the various details of perception : form, size, weight, colour, order, and number of objects. Similarly, they differ as regards their memory, whether for facts and events, dates, figures, music, etc. Some boys are entirely indifferent and have to be made alert. They must be aroused to take pleasure in their particular study. This will aw^aken and keep their attention. As a rule, the children do not profit by the teaching because they are expected to 70 ABNORMAL CHILDREN pay attention to what does not interest them. In order to be attentive the child must be interested, and it will be interested according to its inborn faculties. Some boys are backward simply because their natural capacities have not been studied and they are taught subjects for which they have no natural talent, or they are taught in a manner which does not appeal to their type of intellect and understanding. To illustrate the latter statement, I should like to quote a personal reminiscence. I recollect very well how in one college I was at the bottom of the class in mathematics, so that my parents were advised to try other education for me ; but when instead I was put in another college under a distinguished mathematician, I at once as- sumed the first position amongst sixty pupils and remained at the top of the class, while I was under him. This teacher had an excel- lent method of instruction which appealed to my type of intellect ; and once he had overcome my natural timidity, he drew out a talent for mathematics, which evidently was latent in me. The reflective faculties give an enquiring mind ; they demand the reason for everything. They are not satisfied with the mere fact that certain things exist, but they must know the reason why. They give not only a desire to BACKWARD CHILDREN 71 know the causes, and the effects, of things sur- rounding us; but also a capacity to enquire into them and find them out. The mere desire to know would be of no use to us without the capacity to ascertain. All boys are not equally endowed in this respect. Some boys predominate in a reflecting and generalising turn of mind, which tends to induction and deduction, to com- pare and to co-ordinate, systematise, and draw consequences. Their knowledge will rest chiefly on reason, be theoretical, as opposed to the practical knowledge, the knowledge of facts, of the boy of observation. Others, with a weak reflective power, walk through the world bhnd to the reason why things are as they are. Some boys, defective in reason, hardly ever reflect for themselves, but have extreme faith in authority. A=B because C said so, is quite enough to satisfy their demand for evidence. When they grow up, they are inclined to accept everything they see in print as correct. They are often cocksure on the very subjects they know least about. They do not reahse how ignorant they are, or they admit frankly that they neither know nor want to know anything. They are often literally narrow-minded. They read very little, judge the world according to their own experience, and imagine that their 72 ABNORMAL CHILDREN conclusions are correct. They are often intensely bigoted, think it a sign of weakness to change their opinions, and mistake blind obstinacy for firmness. In order to determine the intellectual power of an individual, we ought not to Hmit ourselves to the measurement of his permanent stock of ideas, but should take into account also the capacity, not always the same, that he exhibits for using it. Boys with fair knowledge often give disappointing replies if asked their probable course of action under everyday circumstances. Some backward youths are capable of receiving considerable education, and may be even bril- liant in some subjects ; while at school, all may go well, but as soon as they attempt to take their places in the outside world, their lack of mental balance becomes apparent. The normal man, with his clear-minded, logical thought, sound judgment, and strong will, sees where the backward only gropes ; he plans and acts, where the latter only dozes and dreams. To earn a livelihood needs steady industry. It requires such self-control, such self-denial, and such a degree of self-abnegation as will allow of the steady pursuit of an uninviting and perhaps re- pellent employment, in spite of solicitation of others by which immediate pleasure may be BACKWARD CHILDREN 73 gained. It means, in short, the postponement of immediate pleasures for those to be enjoyed in the future. But of such patience and per- severance, the backward youths have usually next to none. They may be excellent company, pleasant companions, good-natured, easy-going, and urbane, but they frequently have one peculiarity : their self-esteem remains un- diminished in spite of their repeated failure in the most important affairs of life. The normal effect of failure, especially in important matters, is to depress ; it produces dejection, diffidence, lack of self-confidence, and of self-reliance. But the youths here described are continually fail- ing, yet they are cheery and content, and their confidence in their own powers remains undi- minished. It is true not only of the intellect but of the character, that there is a natural inequality in men. One would like to achieve wealth, another power, a third rank, a fourth fame, while not a few would seek their happiness in a round of pleasure. Even given the same intellectual capacity in two boys, one may be backward from lack of motive power, none of his feelings being strong enough to supply the motive and impulse for intellectual activity. These ele- mentary feelings — and indirectly the character 74 ABNORMAL CHILDREN tendencies which spring from them — are not acquired but inherited, and are primarily due to the varieties of brain-organisation, as we already admit intellectual qualities to be. From his_ very c hildhood__dQea,ajnan show the charac te r whichjwilljiistinguish him-JTi adultj^ears. He is haughty or humble, prudent or careless, affectionate or cold, harsh or kindly, because it is his nature to be so. Educational experience and other external influences may draw out these quahties and may alter them, but they cannot create them. The tendencies are pre-determined ; and this is the reason why so frequently a son, happening to inherit somewhat exclusively the quahties of his father, will fail with his failures, sin with his sins, surmount with his virtues, and generally get through life in much the same way. But tendencies are, of course, not actualities ; and the growth of character is subjected to such a variety of influences that the ultimate constitu- tion may differ considerably from the original disposition. We have to find out whether the boy is back- ward from lack of industry, energy, perseverance, self-reliance, or other force of character on which success depends, or whether he is lacking in understanding. The boy may lack the am- BACKWARD CHILDREN 75 bition to exert himself. Without ambition to learn there is no motive for study. He may lack concentration. His mind may flit from subject to subject and take hold of none. Then there are boys who grow tired easily and can- not fix their attention on one subject for any length of time. Others work by fits and starts. They are capable of great momentary efforts, but these are divided by long intervals of cerebral inactivity. Other boys are wanting in self- esteem, in self-reliance. I have seen boys who were naturally talented and knew their work well, fail repeatedly at examinations from lack of self-reliance, timidity, and too great a fear of consequences. They are nervous boys who get easily confused, and their memory deserts them at the critical moment. Some boys want en- couragement. There is no one to tell them " well done," when the work is well done. Indeed, many parents and teachers err on the point of severity, they criticise but they do not bestow praise ; and as a consequence not infre- quently the pupil's desire for work is destroyed, and he is rendered incapable of doing it. Some boys are lacking in will-power, and this may be due to a variety of causes, as from defective nutrition of the nerve elements in delicate children ; or, for instance, when a child is growing 76 ABNORMAL CHILDREN very fast, he may be disinclined to work, or he may be merely quiet and apparently idle through lack of energy from some other cause. The delicate boy will require different treatment from the healthy boy, who delights in idleness and is happy in it. The boy may have no method. He may have no enthusiasm, no liking for his work, so that he will make excuses for his idleness when the slightest difficulties present themselves. Often a boy is said to have overworked himself and is taken away from his studies, never to be taken up again ; when in reality he has done not too much work but has arranged his work badly. Such are the boys who work by " fits and starts " and not consecutively. The one thing which requires an expenditure of force is the setting in motion. If the student does not work regu- larly and without interruption, he is constantly obliged to renew the setting in motion, to com- pel his brain to become attentive, and this is fatiguing. The start is the only difficult and painful task. Work becomes hard for the idler, the timid, the wobbler, the boy who watches the clock, the careless, the unmethodical, and the boy who is afraid of difficulties and obstacles. We must study therefore the character as well as the intellectual capacity of the student. BACKWARD CHILDREN 77 What is of value to a youth is the character organisation which enables him to do well in the world after he has left school. This organisation he is born with ; his teachers may modify it but they cannot supply it. The greatest men the world ever possessed received little or no higher education, and few of them distinguished themselves in their school-days ; on the con- trary, they were considered dunces and no one ever suspected their talents and force of character. Even when a boy does well at school and examinations, he may not have the appearance, the neatness, the presence, the speech and the social qualities, which in active life mean success much more often than actual ability. Our Civil Service Commissioners have at last dis- covered this fact, and I understand that in future they are going to interview the candidates for Colonial administration before admitting them to the competitive examinations. Experience has conclusively proved that the pupil who takes first prize at school is not necessarily the best fitted of all candidates for a post of honour and difficulty in the outer world ; and naturally so, since the requirements in each case are totally distinct. One boy may be found in a class learning dihgently, and 78 ABNORMAL CHILDREN another unable to assimilate anything at all from his books. That is a question of active endowment. In due time both boys leave school — the one still with a taste for reading, the other with latent forces of an unknown character. The reading boy settles down into a bookworm, and is happy in obtaining a post as librarian or private secretary ; or if of a scientific turn, he may devote himself to some special study and read papers at meetings of learned societies. The dull boy may turn out to be possessed of courage and daring, combined with ascendancy over his fellow-men, and become a famous administrator, helping to maintain the greatness of his native country. CHAPTER V CHARACTER DEFECTS IN CHILDREN ILL-TEMPER, JEALOUSY, VINDICTIVENESS, CAL- LOUSNESS, CUPIDITY, BRAGGING, STUBBORN- NESS, IMPUDENCE, ETC. A GREAT deal has been written on the child's intellect, but we are only just awakening to the study of the child's character. The intellect may be highly developed, and the feelings and propensities which constitute character may be very ill-developed ; or the reverse. If the in- tellect is poor, the feeUngs are stronger naturally from lack of control. The greater the intellect, the greater the check upon the emotions and passions ; hence a child, a savage, and persons of slight culture are Uttle able to restrain their inclinations. We train the intellect of children, but we do not train their passions. Yet it is by their pas- sions that men of genius and talent are moved to great deeds, and that they are inspired to enthusiasm for their art. Indeed, the activity 79 80 ABNORMAL CHILDREN of the mind depends on the activity of the pas- sions. It is to the passions that the arts and sciences owe their discoveries. If they are also the sources of the vices and of most of the mis- fortunes of men, this shows only the necessity of an early " moral " training of children, not in order to curb the passions, but to direct them to proper ends. Most people are ready to admit that the in- tellectual faculties and talents cannot be created by education, but some believe that the affective faculties are produced by the environment. They seem to overlook the fact that external circumstances cannot by any means account for the great variety of passions and sentiments in human beings, which are manifested long before the child begins to reason. Children show from their earliest years the different dispositions to fear, anger, love, etc., in varying degree, quite independent of their intellectual capacity, and sometimes all training fails in curbing the natural inclinations. Education does not make these dispositions, but it can teach self-control and a more refined manifestation of them. A child may be well developed intellectually and present from a moral standpoint profound defects, strange peculiarities, and surprising lapses of conduct. The inculcation from the cradle of CHARACTER DEFECTS IN CHILDREN 81 habits of self-control and of consideration for others, if necessary for the normal child born of a good stock, is even more important when the child inherits tendencies towards the abnormal. Unfortunately, it is in just such cases that the child is less hkely to get a proper training. Very often ethical ideas are learned by these children and repeated without becoming part of their individuahty ; but only when this assimilation has been made, do ideas influence thought and conduct. Ill-tempek. Vindictiveness. Discomforts, as, for instance, hunger, make infants irritable and easily angered ; but older children sometimes have fits of crying and screaming for no apparent reason, and retain a violent temper at an age when some amount of self-control might be expected. The more these children are allowed to indulge in these feelings of anger and vin- dictiveness, the more prone they become to such outbreaks, and the less able are they to control the manifestation of wrath ; and mere trifles will excite storms of passion. Exhibitions of irritabiUty of temper from slight causes, a tendency to take offence easily, noisy arguing, unpremeditated violence, and, to a lesser extent, designed violence, are not at all uncommon in children, and require appropriate 82 ABNORMAL CHILDREN moral treatment. Parents and tutors should re- member that all anger is temporary madness ; for the main characteristic of madness is loss of self- control, and this is exactly what happens to people in a passion. All considerations of reason and logic are thrown to the winds, the impulse of the moment is blindly followed, and words are said, actions done, which may cause the greatest harm ; yet while the person in a passion knows this, he is powerless to act otherwise. Anger in children may be manifested without any known cause, but generally it is provoked by thwarting a strong purpose, by contradiction, hmitation of freedom, wounded pride, jealousy, antipathies to bathe, dress, etc. Children often manifest anger on very slight provocation and in a manner rather alarming, because still free from restraint. They chnch the fists, become rigid, they emit cries, they stamp the ground, writhe, butt their heads against the wall, make faces, bite, scratch, pinch, pull, kick, and strike. Some children manifest explosions of violence when thwarted in the least and become impul- sively destructive, even to the extent of making assaults on persons. I have seen a number of children with such tendency in whom it was not faulty education that produced the outburst. Excessive meat diet, internal ear trouble irritat- CHARACTER DEFECTS IN CHILDREN 83 ing the adjacent brain, insufficient open-air exercise in a full-blooded child, these were some of the causes in the children that came before me. As the child grows older, it may show a ten- dency to teasing, tormenting, bullying, and fighting. Persistent and ingenious cruelty, obviously induced by sheer deUght in inflicting and witnessing pain, is also not uncommon. Sometimes a boy will fight without any more cause than the mere presence of another boy, from the same instinct as two roosters in the farmyard, or two strange dogs in the street, make for one another. Some children suppress the outward manifestation of anger and sulk, brood, and nurse their grievance, and are taciturn and malevolent. Cupidity and Geeed. Thieving. Love of possession is a natural disposition in the human organisation, and shows itself in children in the impulse to " collect." Cupidity and greed are caused by general selfishness combined wath the love of possession, and dishonesty is only the result of the absence of controlHng motives. Thieving does not necessarily imply love of possession, for many children steal only in order to give away again ; on the other hand, a child may be moral and yet grasping. A child, being 84 ABNORMAL CHILDREN still ignorant, will appropriate what does not belong to it ; it seizes everything. In other children the fascination of a new toy, or the appe- tite aroused by a favourite food, may prove too strong to be resisted. There is an inabihty to withstand any sudden temptation. In young children judicious and timely punishment will invariably eradicate the faiHng; and most chil- dren grow out of the tendency as the idea of property, what is his and somebody else's, gradually develops. Sometimes the older child persists in appropriating things, now no longer from the pleasurable sensation of handling them, but from the enjoyment which the articles taken bring to him. He no longer takes a penny for the pleasure the handUng of a bronze coin gives to him, but because of the anticipated enjoyment of the sweets he can buy with it. With the development of moral sense, the propensity will change its character and will inspire the honest acquisition of property by proper work, and the original impulse will be suppressed. Occasionally at puberty it reasserts itself ; but even then, if no other sign of deficiency, such as lying, is evident, the moral defect may be purely transi- tory. Children are often captivated by novelty and wearied almost the same instant. Whatever CHARACTER DEFECTS IN CHILDREN 85 new object they see, they covet with a degree of ardour only equalled by the eagerness they exhibit to get rid of it as soon as it becomes their own. To see, to desire, and to become indifferent, are three stages which follow each other with astonishing rapidity. Some children will annex what they regard as unconsidered trifles merely to enjoy the pride of possession, although they would not dream of taking money or anything which they consider really valuable. Taking things from parents, brother or sister seems to be quite usual, the feeUng apparently prevaihng that taking things from members of one's own family is not quite so bad as taking them from others. Besides, if caught, so severe a penalty would not be inflicted. There are children who know and appreciate quite well that, when they are steahng, they are doing wrong, but they have not sufficient self-restraint to withstand temptation. "Whatever they see that is desirable they take for their own use, even at the cost of prompt and severe and certain punishment. Some steal merely from the itch of stealing and from no strong desire of posses- sion ; for they will give away the stolen object to the first comer. In school, pilfering the property of companions is not uncommon. Robbing orchards, vine- 86 ABNORMAL CHILDREN yards, etc., is considered good sport by most boys ; it does not necessarily imply a dishonest nature when it is done in a mere spirit of adventure. We have to distinguish thieving from klepto- mania, a complaint not uncommon particularly in girls during the early years of menstruation. Kleptomaniacs are those persons in whom there is a strong desire to take possession of things quite irrespective of their value and regardless of the risks of detection and the consequence of exposure, accompanied by a feehng of restless- ness and anxiety when the impulse arises, and a pleasurable feehng of rehef and satisfaction upon the execution of it. As in the infant, it is the appropriation which gives the satisfaction and not the enjoyment of the article taken. In consequence, in these cases the articles stolen are either thrown away, hidden, or they are forgotten. There may be a difficulty in distinguishing a kleptomaniac from a thief when he or she happens to have the moral quahties insufficiently developed, so that there is a lack of inhibitory power to check the impulses. They steal then not so much from the satisfaction stealing gives them, but from the ideas of enjoyment of the stolen goods which prevail in their consciousness. CHARACTER DEFECTS IN CHILDREN 87 Petty thieving is by no means infrequent in weak-niinded individuals, who generally bear evident signs of physical degeneracy. It is especially common in idiots and imbeciles, the intellect being too deficient to check the animal instinct. As a rule, they steal without reflection, although they display sometimes a considerable amount of ingenuity and low cunning. Of theft in the " morally " weak-minded, we shall speak in the next chapter. CuNNiNGNESS. DECEIT. While some children are by nature frank and open, others are reserved ; and some, who are lacking in moral sentiment at the same time, are secretive, insincere, cun- ning, and deceitful. Some children are positively incapable of telling the truth. I do not refer now to the child of a lively imagination seeking the approbation of those with whom it comes in contact, but to the actual Hars, children who he to themselves and to others continually, until they are no longer capable of distinguishing clearly between that which has been experienced and that which has been invented. This habit, unless treated early, becomes rooted and remains through hfe. Some children cheat and make up things quite unconsciously ; they confuse the products of their fancy with realities, and present them so ingeniously and naturally, with such 88 ABNORMAL CHILDREN an innocent expression, that they succeed where another child, conscious of speaking an untruth, who coolly and clearly measures his words in constant fear of contradicting himself, meets with instinctive mistrust. Affectation. Bragging. Impudence. The little child turns instinctively to its mother or those most closely associated with its daily life for sympathy, not only in all its troubles, but in its pleasures also. Love of praise and fear of reproach soon become powerful incentives in the child's mind. The child having found that approval is a pleasant experience begins to do things, not wholly because of pleasure in the activity itself, but either partially or solely for the sake of praise and approbation. This desire for praise and approbation, unless wisely guarded, may lead to all sorts of showing off, affectation, boldness, and vanity, especially in children of strong social tendencies. Consciousness of clothes is shown at a very early age, girls especially showing pleasure in fresh, clean clothes and attractive colours, and this natural and instinctive pleasure seems especially liable to perversion into an exaggerated sense of the importance of dress, and forms a fruitful soil for the seeds of vanity and self- conceit. CHARACTER DEFECTS IN CHILDREN 89 Closely connected with affectations of dress are those of speech and manner. Both boys and girls imitate their elders or those who attract them, but the boy affects a roughness of speech and action in marked contrast to the affectations of the girl. With some children there is a constant effort to attract and concentrate upon themselves the attention of other people. They try to be always in the " limelight," that is to say, they seek to render themselves conspicuous by devices which ostensibly have some other purpose. In their desire to create an impression such children are given to romance-weaving ; if not to actual untruthfulness. In bragging (ostentatious pretending of abihty to do things), although the motive of self- aggrandisement is the obvious and immediate antecedent, its manifestations vary from an expression of rivalry and emulation, with state- ments founded on fact, to the braggart lie in all its forms. In its primary form, bragging is simply an assertion of the abihty to do some- thing better than someone else, or an expression of pride in one's possessions, tinged with a satisfaction that they are superior to those of another. But from this beginning it passes through various stages of degeneration, losing 90 ABNORMAL CHILDREN more and more its actual foundation until it culminates in pettiness and meanness. Boys brag more about their ability to do things, girls more about their possessions. Children in whom the element of self-assertion is naturally strong, and in whom it has been increased by unwise encouragement of its early manifestations, and who are perhaps regarded as " cute," and children who come into frequent conflict with authority to which they feel them- selves superior because they have learned that it can be set aside, furnish painful examples of this form of aggressive self-assertion. A spoilt child soon reahses that his Hkes and dislikes, his crying and his smiles, his wants and his amuse- ments are of paramount importance ; and then begins the reign of tyranny. The intense egotism of these children makes them unduly regardless of the feelings and rights of others. Everybody and everything must give way to them. Their comfort and convenience are to be secured though everyone else is made uncom- fortable or unhappy ; and sometimes they dis- play positive cruelty in their treatment of persons who come in contact with them. Jealousy. From the egotistic feeling and that of vanity arises the feehng of jealousy. Children sometimes conceive a violent affection i)i;ii:kminki). onsi inaik l;<)^•s. lu r ci.kn kk. [To face page 90. CHARACTER DEFECTS IN CHILDREN 91 for one or other of their comrades, which affection may not be returned with equal ardour ; and endless quarrels arise if the beloved one forms a friendship with any other boy or girl. Some children are jealous of favours bestowed by their parents on brothers or sisters. The emotional display of this feehng, which some- times remains throughout life, leads to sus- picion and doubts, and makes Hfe miserable. Suspicious persons will find ground for jealousy in the most trivial circumstances. Girls may grow up the best of friends until the first awaken- ing of sexual love creates a feehng of jealousy between them, w^hen one is more favoured by men than the other. Stubbornness. Obstinacy. Some children yield readily, following the least impulse, and are easy instruments of all who have their care. Others are just the opposite ; they are of a resolute character, not easily influenced by others. When this self-reliance is in excess, it may give rise to stubbornness and obstinacy. Lack of consideration for others. Cal- lousness. Some children lack that mental susceptibiHty which is the basis of sympathy and generosity, and are noted for their callousness and imperturbability. They are insensible not only to painful but also to agreeable excitements, 92 ABNORMAL CHILDREN and do not know either " delight " or " distress." Children who lack this sentiment lack appreciation of kindness done to them, are ungrateful, and often insolent and arrogant to those who have served them. Runaways. Some men hate the restraints and responsibiUties of settled life ; and this disposition manifests itself even in early boyhood, commonly at puberty, by a dislike of regular work, of surroundings which have become " famihar," and as an instinctive rebel- Hon against limitations of freedom and un- natural methods of education, as well as against poor homes. The habitual environment seems dull, and there is a great increase in impatience and restraint. Dislike of school and passion for outdoor life are other causes. Thus I have seen boys who seemed possessed by a mania for simply going away and enjoying the liberty of nomadic life. One of these, when he left school, would never stop more than three months in one employment, when the impulse would seize him to wander. It was only necessity each time that brought him back. At first the woods and fields formed the attraction ; but as he grew older he sought distant parts, once as a stowaway, once by enlisting in the army, from which he deserted after the usual three months. CHARACTER DEFECTS IN CHILDREN 93 This disposition shows lack of adaptability to the environment ; and with the release from home restraints the liability to offences, espe- cially fraud and theft, is enormously in- creased. Emotional instability. This is particularly frequent in young girls at or after the age of puberty, endowed with considerable intellectual vivacity, but capricious, fantastic, incapable of serious or consecutive work, impressionable, coquettish, tr3dng to call attention to themselves, and manifesting a tendency to contradiction, controversy, paradoxical ideas, excessive sensi- bility, and to imitation, suggestion, and auto- suggestion. There are perpetual and sudden changes in the feelings and affections, irrelevant enthusiasm, a propensity to dissemble, deceive, and fabricate. There is a constant desire for change, for making a show, to occupy the interest of the neighbourhood, to do things theatrically, or to weave the thread of some inextricable romance. There are habitual dreams, images Hving or mystical in type, or erotic. All these signs, whether unified or, as is more frequently the case, appearing only in fragments, reveal an unstable emotional nature, greatly aggravated, as a rule, during the time of the menstrual period. Unless checked early, such girls develop 94 ABNORMAL CHILDREN typical hysteria, which becomes the more diffi- cult to eradicate the longer it lasts. To cure these character defects by moral education, we must first of all remove all that cramps the soul of childhood. We must reahse that some children need hard work and will be saved by it, while others need rest and leisure ; some are spoiling for lack of kindness and some for lack of severity ; some need more control, some more freedom. When ordinary moral remedies fail, there is nothing like psychotherapy for wayward children. They are very susceptible to it, and are soon made to cease the indulgence of their evil propensities. CHAPTER VI MORAL WEAK-MINDEDNESS YOUTHFUL CRIMINALS If the mental defect of a youth is of the intel- lectual variety, there is usually no difficulty in recognising it. But if the defect is a moral one, it is often difficult for anyone not an expert to distinguish between iniquity and folly, wicked- ness and crime. Many youths without any unusual incentive to crime, but with every possible inducement to virtue, are observed to abandon themselves wilfully to evil practices, and from their childhood to manifest a disposi- tion presenting a strange compound of intel- lectual power and moral culpabiUty. They suffer from an abnormal excitement of the passions and imperfect development of the higher senti- ments. The morally deficient child is a child who, by reason of arrested development of some part of his brain, displays at an early age a morbid defect of the moral disposition and higher 95 96 ABNORMAL CHILDREN altruistic qualities of the human race, associated frequently with vicious propensities on which punishment has no effect; and often, but not necessarily, combined with some sUght limitation of intellect. The child with this faihng is the greatest anxiety to parents. We exclude idiots, imbeciles, and other mentally deficient children, who are so deficient in intellect that they cannot appreciate moral conduct. We mean such subjects only who, while to all appearances intellectually normal, from the time when a child should show moral capacities, are different from other children, and whose anti-social nature ill fits them to take their place in the community. Their most marked characteristic is a lack of power to recognise ethical distinctions, a lack of conscience, of the sense of right and of duty ; and through this moral deprivation there is a serious lack of balance between the thinking and acting capacities. Without this power there is no check to the lower passions except by the intellectual consideration of utihty and expedi- ency, and unbridled egoism has full play. The condition is, therefore, one of deficiency of an important part of the mental endowment ; and we may count it as akin to imbecility or idiocy in the moral sphere. In the mildest cases the individual may merely be exceptionally self- MORAL WEAK-MINDEDNESS 97 centred, incapable of appreciating the rights and feelings of others, and governing his conduct entirely by his own likes and dishkes, to which everything has to give way. And in the more marked cases, and in cases where there is also a transient intellectual defect, the latter pre- vents him from seeing beyond the moment's gratification to the unpleasant consequences which will follow. Since punishment has no effect, or only a temporary effect on these children, the only way to prevent what is apparently an in- eradicable defect is to keep the child out of temptation. The " morally weak-minded " are persons whose mental development stopped short when it reached the altruistic sentiments. These higher attributes of human nature do not exist in them. The intellect of these people is tolerably developed, and they possess a certain amount of knowledge, which they exploit with some craftiness. Their memory and reasoning power may be up to the average, but their views are narrow and they do not concern themselves about their future. The parents have not observed any backwardness in talking, early receptiveness, or any difficulty of education ; but as the child grows up, it is noticed that the moral sense is defective. The moral development of a 98 ABNORMAL CHILDREN child is, in all cases, largely a matter of education, but these cases lack the basis that is essential to a moral sense; hence their moral development does not take place as in normal children. They lack natural affection, are especially rebellious to authority, are unkind to their brothers and sisters and to animals ; they are addicted to maHcious teasing and to ill-treatment of their playmates, unresponsive to kindness ; they are irritable and hasty in temper, sulk when cor- rected, and become sullen and morose. They tend to associate with those beneath them in the social scale, tell lies, and do not fully grasp the difference between right and wrong. As they get older they may be addicted to petty thefts, which are often concealed with an amount of cunning that would hardly be credited by those who have no experience of these cases. They do not appreciate the enormity of their offence, and when found out exhibit no sense of shame. When they get into trouble — or rather when they are discovered — they express regret for what they have done and promise amendment, but this is quite forgotten when the next temptation comes. They may be told with the greatest care, and in the most impressive manner, that it is wrong to steal and wrong to lie. They will repeat what is said to them, and assure us that MORAL WEAK-MINDEDNESS 99 they know it is wrong ; but they learn it as a lesson, and it all goes out of their head like a lesson in Roman history or the Latin grammar which has been imperfectly learnt ; and they go back to their abnormal and vicious habits quite unreformed. Not only are they unmanage- able at school, but harm may be done by their vicious conduct to the other children ; conse- quently no school or tutor will keep them. Next to their lack of industry, their most conspicuous quality is their incurable mendacity. If in other arts they never rise above the status of amateurs, as liars they take professional rank. The readiness, the resource, the prompti- tude, the elaborate circumstantiahty of their lies are astonishing. The copiousness, and un- impeachable efficiency of their excuses for failing to do what they have undertaken to do, would convince anyone who had no experience of their capabihty in this direction. They care only to indulge their passions and evil propensities. They are often addicted to bad habits and sexual immorality. This is especially a source of anxiety in the case of girls, who get into trouble, thereby bringing disgrace upon the family. Many of them are quite unfit, if left to themselves, to lead decent, inoffensive lives ; they require care and discipline. 100 ABNORMAL CHILDREN They have an imperfect and inconsistent conscience, and, above all, a wax-like will which never succeeds in governing their desires and low instincts. They simply let themselves go, as they often tell us, without thinldng of or without reflecting upon the consequences. Some insist that they know what is right and what is wrong, but they know it only theoretically. When they are exposed to temptations their conscience is too weak to stop them, while their natural appetites, on the other hand, are vora- cious and insatiable. Some of them are wicked enough either to plan or to permit suspicion or blame to fall upon others. I have known boys with plenty of pocket-money to steal wherever they happened to be staying, and not only allow suspicion to fall on innocent servants, but to stand by and see them go to prison. Other cases are less extreme ; the moral potentiahties are there to a certain limited extent ; and while these children are wayward and hard to bring up in a respectable way, they are not absolutely incapable of learning self- control and appreciating the higher motives of conduct to some extent. Some can be managed by their parents and guardians while they are children ; but when they emerge from child- hood and have to assume responsibilities, the MORAL WEAK-MINDEDNE:-S 101 troubles commence, and they come before us, the parents in distress and grieved to tears, the boys or girls calmly listening to the recital of the evil they have done, unmoved. We recognise moral weak-mindedness in the gilded youths who live for the moment, who have no serious thoughts for the future, are selfishly unmindful of others' rights, interests, con- venience, and pleasures ; who live to eat, drink, dress, study the musical comedy, with its lady performers, and are addicted to vices, or become the victims of impostors. AYe see it in the spend- thrift who muddles away his patrimony, as though the needs of a family and the regulation of income and expenditure were matters too base to be allowed to occupy the attention of superior intelHgence. We see it in the rowdies, inebriates, and hosts of other people, whose early life promised well ; but who disappointed the expectations of fond parents and friends, and descended in the social scale. Youths suffering from moral deficiency are particularly impulsive — of course all children act on impulse. Education is supposed to train us to dehberation and hesitancy, but even adult persons are seldom free from occasional impulses, sometimes of a harmless nature, sometimes leading to acts which are inconsistent with 102 ABNORMAL CHILDREN strictly moral rectitude. Impulsive acts are common among the weak-minded from their lack of self-restraint. Thus they are easily provoked to personal assaults or to acts of destructiveness, to resistance to police orders, and so on. Sometimes there is no motive, but more often there is one, only, as a rule, a totally inadequate one. There are other characteristics sometimes. Among them is, for example, the occasionally observed periodic vagabondage in young boys, or even children of tender years, which is asso- ciated sometimes with a very marked and cause- less depravity. In a case of this kind that came under my observation, a boy fourteen years of age, unusually bright for his years and generally a model in behaviour, had periodic impulses to run away, and would sometimes go long dis- tances. At these periods also he would steal money or anything that took his fancy, would lie, and in other ways show a complete absence of moral sense which was not ordinarily lacking in his make-up. After the impulse was over he could give no explanation of his conduct, though there was no defect of memory or any disturbance of the continuity of consciousness whatever so far as could be ascertained. During these periods, he was as complete an example of MORAL WEAK-MINDEDNESS 103 apparent absence of moral sense as was ever seen ; between them he was a docile, well- behaved lad, rather exemplary than otherwise. The diagnosis is facilitated in these cases by the periodicity of the morbid impulses. I have seen quite a number of young men, of normally clean, sober, and chaste life, who were attacked from time to time, at intervals usually of a few months, with an overpowering desire to kick over the traces. In some cases the desire is merely for drink ; in others it is not for any dissipation, but merely for a life free from the conventions and restraints of civilisation. Whatever the particular craving may be, it comes on very rapidly, and is so powerful as to be, in most cases, irresistible. The paroxysm is short-lived ; and after a few days, or a week, they return to decency and propriety and live an exemplary Hfe until, after an interval of a few months, the fit seizes them again. When they are closely examined, such people often deny — and there is no reason to doubt the denial — that they have, when they break out, any pronounced craving for drink or for any other indulgence. What they experience is a horrible, ill-defined, voluminous, indescrib- able and unbearable sense of uneasiness. Every schoolmaster of experience could, if 104 ABNORMAL CHILDREN he were free to speak, tell of boys who must, in his judgment, be failures and the cause of trouble to their relations. Every sohcitor can think of chents in deahng with whom the difficulty has been to appear to treat them as rational beings, and at the same time to protect them from the consequences of their own infatuation and folly. Every magistrate and judge could tell of persons who, though not exactly feeble-minded or lacking in intelhgence, are not their own masters, but are the slaves of recurring impulses and appetites. Such persons may mechanically know the laws of morahty, but if such laws enter their con- science these persons do not experience any real appreciation, still less regard, for them. The moral laws to them are cold, lifeless statements. The morally defective know not how to draw from them motive for omission or commission. Morality they do not understand. Law is nothing more to them than police regulation, to be honoured in the breach and not in the observ- ance. As a rule, the morally weak-minded is de- scended from parents, not themselves criminals, but neuropaths of some kind. He himself suffers from a tendency to recurring paroxysm, in which the field of consciousness is narrowed, sometimes even restricted to one idea, with an MORAL WEAK-MINDEDNESS 105 incapacity for reflection and a total absence of the opposing impulses usually engendered by prudence, wisdom, and experience. Place such a youth where there is an object of temptation and he will fall, perhaps not at once, but at recurring intervals. If his memory did not fail him at the critical moment, he would know that the satisfaction to be got out of a fraud or theft is very Hkely to turn to his detriment. A criminal does often escape detection, the morally weak- minded hardly ever. He acts as if in a dream, and when the crime has been committed he is astounded by what he has done. It seems to him that it is the deed of another, and so, in fact, it was ; there was another personahty, all shrunken, without recollection, points of com- parison, or judgment. After the deed entire consciousness, which understands what that other has done, comes back. To such minds the idea of punishment is of no account, for they forget it precisely when they have the greatest need of it; and intimidation cannot have any hold except upon intellects which are completely coherent and sound. Sometimes there is a history of nervous disease in the family of the degenerate. Sometimes there is a history of intoxication. Where there is no hereditary taint, or at least not a serious 106 ABNORMAL CHILDREN one, educational measures can sometimes correct immoral tendencies. The prognosis depends, above everything else, upon the good sense that one finds in the youth, on the spark of moral life which is hidden under his unbalanced acts. Attempts at education will be fruitless when the most important incentives, love and ambition, are lacking. As a rule, education alone cannot eradicate what heredity has created. Before we endeavour to inculcate moral habits and good feelings, we must treat the tainted and weakened nervous system of the child. Only on a sound physical basis can sound moral ideas take root. Not all can be rescued. I have seen children — ^boys and girls — with such defective heads that I predicted a criminal career ; and to the notes in my case- book have since been added newspaper cuttings reporting the numerous misdeeds for which they have been sent to prison. Now that the Mental Deficiency Act has come into force, we may be able to help them; but hitherto we could only make vain appeals to magistrates, judges, and the Home Secretary. CHAPTER VII NERVOUS AND PRECOCIOUS CHILDREN The " nervous " child is often a cliild of parents in whom or in whose family there is a history of nervous disease or other ill-health ; on the other hand, he may be the descendant of families where great abihty or genius predominates. The nervous child is frequently the only one, or what is practically the same thing, a long in- terval of years separates it from brothers and sisters. Besides heredity, faulty education may pre- dispose a child to nervousness. The children of the upper classes are generally consigned for their early training to the care of dependents, who, even if not ignorant, neither feel nor could be inspired with the same sense of responsi- bility as parents. This custom is responsible for some of the bad results in nervous children. Later, such causes as domestic mismanage inent, overwork, lack of sleep, or overuse of emotional and imaginative faculties, acting on such a 1U7 108 ABNORMAL CHILDREN nature, readily lead to exhaustion of energy and nervous bankruptcy.^ The nervous child of a marked type generally presents his peculiarity in some form from his cradle upwards. He appears hypersensitive in all his special senses ; he responds to the sUghtest noise, is sensitive to slight changes in his feeding, subject to fits of prolonged and apparently causeless screaming, and is generally a trouble to bring up. Unusual timidity is often an early sign. Little infants will start, tremble, and scream at a noise at which ordinary children would be un- concerned. The approach of a stranger, the ^ As regards school, a nervous child finds a difficulty in sitting in a fixed position for hours and having to learn set lessons. Both these evils are obviated by Madame Montessori's method of teaching, which allows the child to assuine any position he likes, on movable chairs or on the floor, and by which, in a large part, the child teaches himself. There is no enforced discipline, yet by tactful management the children acquire good manners. They are taught by tlie example of the others, by reasons and ex- planations instead of commands. Their memory is not taxed, but the power to think for themselves, to solve their own difficulties, is cultivated. They learn by means of their senses. Some are more receptive to visual impres- sions, others to auditory impressions, and all are trained in refining the sense of touch by suitable exercises. They are taught as much by their failures as by their successes. Success, in fact, by being self-accomplished, leads the way to further attainment. Thus children at the age of four have learned to write in a month and a half, and after writing for six months are equal in theii' capacity to children in the third elementary class in the public schools. PRECOCIOUS CHILDREN 109 sight of everything which is new to them, ex- cite, not the normal curiosity of a child beginning to take notice, but wild screams of unreasonable alarm. Mothers will say that they dread to take their infants out because they become so frightened at everything they see. This un- natural timidity persists as the child grows older. Often this instinct of fear in childhood is unduly developed by bad training and example. In early childhood fear is very easily awakened ; so easily, in fact, that a few words, the expres- sion of the face, or a frightened manner are enough to start it into activity. Nervous children become easily afraid of darkness or being alone, of ghosts, of thunder and lightning, of dogs and cats, of black men, of anything at all which has been connected with the crude instinct of fear ; and too often these impressions remain far into adult life, or possibly for ever, giving a hue of timidity to the entire character. As a result, the child is apt to become deficient in self-con- fidence, in aggressiveness, even in the possibihty of enjoyment, and is hkely to grow shy and self- conscious. He will not associate with other children or take part in their games, and looks bewildered and anxious at the noise they make. He prefers the society of adults, and soon ac- no ABNORMAL CHILDREN quires a precocity and old-fashionedness which make him unpopular in the nursery and with his school-fellows. From sheer timidity the child may become untruthful. He may become reserved, morose, jealous, and spiteful, and fail to respond to kindness because he is always brooding over fancied or real slights and grievances. Yet he is often a prey to agonies of remorse for all his misdoings, real or supposed. In some children timidity takes the form of highly imaginative superstition. A fairy tale fills them with imaginary fears, and a sad story leads to floods of tears or unnatural mental depression. Their thoughts run on ghosts, witches, and death. All subjects which are terrible and uncanny fascinate them, and they dream of them all night. Night-terrors and nightmares are common. The digestion and general health suffer. Sometimes sleep is disturbed in nervous children by the trivial events of the day becoming converted into distressing dreams by night — just as in adults who are mentally overworked. Sometimes, early-school tasks, and especially initiation into the mysteries of simple arith- metic, are responsible for this condition. A common story is that the child is " doing sums in his head all night long." The children who PRECOCIOUS CHILDREN 111 suffer from this form of insomnia are usually- precocious and learn without difficulty ; but the symptom is an obvious indication of cerebral activity which may soon end in exhaustion — and this is even more likely to affect dull con- scientious children who dream of lessons. Another feature of nervous children is an abnormal degree of excitabihty, getting unduly excited in their games. If sent to an entertain- ment they become unduly elevated, and the " treat " very commonly ends in sickness, general exhaustion, and sleeplessness. In appearance, the nervous child is often pale, thin, and sallow, and generally shows ex- cessively mobile features and general restless- ness. He seems to be constantly engaged in numerous physical activities which are wholly useless and unnecessary. Among such nervous activities are uncontrolled movements of the head, wriggling movements of the body, in- ability to hold the hands naturally and com- posedly, restless movements of the fingers, twiddling of an object, such as a pencil ; biting the nails, general tremor, bending of the legs, and inco-ordinate gait ; or, if sitting, fidgeting of the legs, crossing them and recrossing them, tossing the foot, tapping the foot on the floor, beating an incessant tattoo with his hands on 112 ABNORMAL CHILDREN the chair. Some part of the anatomy must be in rhythmical and incessant action. Others will twist their hair or everlastingly adjust their clothes ; while some are addicted to giggling, to " nervous laughter," " sheepish " expression or inabihty to look one straight in the face, the eyes glancing up, down, on one side, or askance ; and these physical signs are accompanied often by mental confusion, flurry, the employment of wrong words, the making of ridiculous remarks and the doing of ridiculous things. All these needless and useless manoeuvrings constitute a tremendous nervous and vital strain on the child's constitution, a constant leakage of ner- vous force and muscular energy. The expression of the nervous child is ani- mated, he talks fast and volubly, often stammers and asks strings of questions without waiting for an answer. For days together he will be full of life and tireless energy, then collapse suddenly in consequence of some trivial ailment. The intellectual activity — as seen in the amount of talk, in the questions asked, and worse still, in habits of introspection or vague, undefined " talking and thinking to himself " and excessive imagining — is carried to the point of exhaustion. Not uncommonly, the nervous, child is reticent and thought dull ; he may be sensitive and PRECOCIOUS CHILDREN 113 desirous of sympathy but too proud to solicit it ; he may be gloomy, sohtary, and become revenge- ful, or develop abnormal moral scruples or " phobias " ; or he may be impetuous, enthu- siastic, vain, intelhgent, and full of energy, but timid and readily discouraged. Retired within himself, he may take to brooding over his woes and disappointments ; little by little he accustoms himself to melancholy, and later on he will be more incHned than others to pessimism, moral depression, and discouragement. The ordinary feelings and naughtiness of a child are greatly exaggerated in nervous children. Pain and deprivation are resented by them with keenness and provoke outbursts of wrath and weeping. Naughtiness and irritabihty become changed into violence. They draw attention to themselves by their whims, their headstrong ways, their cruel instincts, or their convulsive attacks of anger. Their whole frame becomes agitated and they strike inanimate objects and sometimes themselves. Emotional instabihty, unsteadiness of temper, changes from exag- gerated merriness to crossness, attacks of apathy and activity, excitement and torpor, fits of enthusiasm and depths of despair over the sKghtest and most trifling things, will scarcely ever be entirely absent. 114 ABNORMAL CHILDREN Most nervous children suffer at some time or another from obsessions. Some must step on stones ; others must walk on or avoid cracks ; some must ascend the stairs with the right foot first ; many must Idck posts or touch objects a certain number of times. Some must count the windows, pictures, and figures on the wall- paper ; others must bite the nails or pull the eyelids. Akin to the nervous child is the precocious CHILD, bright, quick, and intelHgent, apt to learn, and the pride of his teachers. He is often en- couraged to compete for places or prizes at school, which increases his tendency to nervous disorder. This cause makes itself doubly felt where brilliant and often one-sided capabihties, as they occur in neuropathic and hereditarily predisposed children, excite the pride of parents and guardians, and lead to overstrain of the mental powers.^ The intellectual power is prema- turely developed in^a frail and sickly constitution without the necessary mental balanee—on^the^ emotional and volitional side^ In these cases we have the material for possible failure and breakdown, and a state of things which needs judicious management and guidance. Much harm may be caused to these unstable individuals by the surroundings in which they find them- iiKAi.iin. i'Ki;(()( loi s i\i- \^ [■'■" /"•■'■ /"'i^'-' ' '4- PRECOCIOUS CHILDREN 115 selves, or from harmful conditions cleKberately imposed upon them from want of understanding. Often we find in the same family some cases of mental defect and some of extreme brilliancy, both based on an abnormal nervous constitu- tion ; but more commonly the precocious child is an only child, precocious through lack of companions of his age and association with grown-up people only. Such a child is made much of by his parents, who stimulate his brain more than is good for him. U^recocity is a morbid psychic condition, and those manifesting it often lack vitality and re- sisting power. Indeed, the more refined and complex the organisation, the greater the ha- biUty to breakdown^ In the precocious child, the brain, given to excessive thinking, works harder than the other organs, appropriates a larger amount of nutriment, thereby impoverish- ing the rest of the organisation and placing it in a condition of inferiority for contending against disease. | Those who come early to their season of mellow fruitfulness often die young, hke those wjiom the gods love.'y ^ (Precocious children are generally small for their age ; the brain has developed at the ex- pense of the body, ^-^ For a time the brain develops alone and growth in bodily stature is stationary ; 116 ABNORMAL CHILDREN and if tins period is prolonged the child may become a marvel of precocity. When these children begin to grow, they generally fall behind eventually ; and when the growth is very rapid, a hitherto intelligent child may become stupid, dull, and clumsy. The developmental energy has been switched off from his brain and switched on to his body. Later, the processes of intellectual and bodily growth may proceed together in harmony. Prodigies are quite as childish as other children in everything but the talent by which they are particularly distinguished. They show an extraordinary gift for some particular study, but what they often lack is the power to per- severe with it. They sometimes possess the faculties of imagination, invention, and expres- sion in a very high degree ; the things they lack are judgment, continuity, logic, and unity of direction in their intellectual achievements. Li order to develop into geniuses, they would have to be consistent in the one thing for which they have a special capacity and are original. There is a contradiction between an apparent richness of means and poverty of results. As adults they are Utopians, the theorists, and the dreamers who are taken up with beautiful ideals, but who never accomplish anything. PRECOCIOUS CHILDREN 117 It must be remembered also that the child may stimulate himself unduly by concentrating all his energies on some one interest such as excessive reading, and perhaps induce greater nerve tension than ever; or he may be quite unable to face the excitement and competition of ordinary schoolboy or childish games without serious mental disturbance ; or he may lack mental discipline and the power of concentra- tion which is necessary to turn his natural gifts into useful accomplishments. The child may be precocious only in his ideas, but may never acquire the capacity to materiahse them. He may lack the abihty to do, as well as to con- template. Such youths are prone to dream of great things, but it never comes to anything. They are wanting in practical execution, and their visions come to naught. Another reason why precocious youths often fail to make their mark, is the faulty system of our education, which has no reference to the characteristic talents of the scholars. That is why most men of genius have done badly at school. For all these reasons, it is never safe to predict of a child that is precocious that it will set the Thames on fire. I say nothing about musical prodigies or calculating prodigies, because music 118 ABNORMAL CHILDREN and mathematics have no relation to general ability. They may be highly developed in the dull, and they may be absent in exceptionally clever men. It is of the utmost importance that the nervous and precocious child be early recog- nised as such, and that steps be taken for his protection. In infancy he should lead as simple an existence as possible, and must not be stimulated and exhibited for the amusement of an admiring circle ; indeed, a quiet, uneventful childhood is required for his normal develop- ment. Most necessary is proper feeding, so that he may avoid those dyspeptic troubles which so readily induce in the nervous child a state of exhaustion. His intellectual powers should not be stimu- lated at the cost of the emotions of childish simpHcity and bodily health ; his training should not be so much stimulating, as inhibitory. He should rather have manual training, and learn to associate knowledge with ability to do some- thing. When the growth is rapid, intellectual exertion should be restricted and watched with vigilance, especially if there is in the family any tendency to nervous or mental disorder. If the child is very restless, given to involuntary move- ments, it is much benefited by specially adapted PRECOCIOUS CHILDREN 119 physical exercises and well-regulated gymnas- tics ; for purposeless automatic movements subside as the child's attention is engaged in carrying out, at the word of command, the regular movements of drill, and as the super- abundant nerve energy is directed into appro- priate action, controlled by the will. No ill results need be feared from stimulating the intelHgence of a child, even of a precocious child, provided it is healthy in body, eats well, sleeps well, and is not disturbed by dreams, and provided we do not continue the stimulation into the period when bodily growth has started and development of mind has no backing. Wherever there exists anything like a strong or a marked nervous heredity, the fact should be kept in view in education. That process, where such a condition exists, should be carried out on stringent physiological and hygienic lines, and the doctor's advice should be taken as to its details. The question of schooling is of vital moment, and the problem must be separately considered in each individual case. As a rule, the large public schools are not to be recommended for these children, and competi- tion, cramming, and even in some cases schooling of any sort, may have to be forbidden. As regards choice of work, there is always a 120 ABNORMAL CHILDREN temptation to put a bright, neurotic boy or girl who is active mentally, receptive, sympathetic, and ambitious to professional or other head- work. I do not for a moment say that this is always contra-indicated. It all depends on whether the brain is working normally or is hyper-active ; but I say that this question should be faced and most carefully considered before the life-work of such young people is finally determined on. If the nervous tendency exists among near relations, or is exhibited in the individual, an occupation implying an out- door life, or one where there is a good deal of non-exciting routine or where temptations are at a minimum, should be selected. CHAPTER VIII NERVOUS DISORDERS OF CHILDHOOD EPILEPSY, NIGHT TERRORS, CHOREA, STAMMER- ING, MORBID SHYNESS, ETC. It would not come within the scope of this book to do more than refer to acute meningitis, arising from inflammation of the coverings of the brain after infectious fevers, injuries to the head, or of tubercular origin and sometimes without assignable cause. It is one of the most fatal diseases ; and if the patient survives, the growth of the brain is not infrequently arrested. It is unnecessary also to do more than mention infantile 'paralysis, which within a few hours or days may completely mar a life by permanent and hopeless crippling. But we must call par- ticular attention to rickets, as it is one of the commonest diseases of early life, and affects not only the bones but the entire system, in- cluding the nervous system, which is rendered unstable thereby. In association with the in- testinal disorder, due to defective feeding, 121 122 ABNORMAL CHILDREN convulsions may occur, which still further retard the development of the child. Convulsions Convulsions are common in childhood, and may arise from gastro-intestinal irritation as in rickets, or from the irritation produced by tumour or tubercular deposit in the brain, or may be a symptom of hydrocephalus, or of acute cerebral congestion, such as results from sunstroke or from exposure to a very heated atmosphere, or no special reason may be found. Among the causes of arrested development of the brain none is more important than convulsions. The entire development of a child may be normal until a convulsion occurs. From this time on- ward mental decadence may set in ; and a child that was previously healthy and of normal mental development may begin to exhibit more and more marked mental defects until it reaches the con- dition of complete idiocy. The more definite the cause which produced the fit, the greater the ground for hope of cure. Those, on the other hand, which come on at uncertain times, without any distinct exciting cause, are much more hkely to become permanent. NERVOUS DISORDERS OF CHILDHOOD 123 Epilepsy Convulsions which have a tendency to recur at certain intervals, without obvious exciting cause, receive the name of epilepsy ; they retard mental development or occasion a retrogression of powers already acquired, and this in propor- tion to the frequency of their return and the apparent causelessness of their occurrence. They often leave the child feeble-minded or, at all events, changed in character. Head injury is often regarded as the cause of the fits, but usually is the result, the child having fallen in a first attack and injured himself. Epileptics who have had fits for years are not necessarily mentally affected, but many of them suffer from a mental deterioration which pre- sents special features. Weak-mindedness is commoner with them than mental aberration. The patients lack initiative ; they are restricted in their ideas and tedious in their expression of them. Unfounded aversions, especially towards their relatives or attendants, are common among epileptics, and tales of woe and ill-treatment are poured into the ears of strangers. Their power of attention is of Hmited range and easily diverted. Sometimes they are highly rehgious ; at least they pray a good deal. A prominent feature of the epileptic is his irritability, showing itself in 124 ABNORMAL CHILDREN attacks of temper or an unpleasant peevish dis- position, and impulsiveness, which may exist in every degree to the most dangerous acts. Fortunately only a very small proportion of those who have convulsions during childhood develop true epilepsy in later years. Often there is nothing more than a transitory clouded consciousness — petit mal — without any muscular twitchings, and the loss of conscious- ness may be so slight that the child is supposed to have been " absent-minded " or merely " faint." A state of mental confusion, wherein the child is quite unconscious of its actions, may occur with or follow both the more serious and slight attacks ; or there may be complete forgetfulness afterwards. Thus, whilst wide awake and in the midst of some occupation, the patient affected by such a seizure suddenly stops working, leaves the place in which he has been, and begins to wander about aimlessly until discovered and roused from his dream. A patient about to take a bath and seized by an attack may enter the water fully dressed; or while surrounded by people, he may in a fit divest himself of all his clothing and may do some strange and improper actions. More rarely his behaviour is fairly orderly and the series of his actions rather NERVOUS DISORDERS OF CHILDHOOD 125 complex. Thus he may go to the railway station, purchase a ticket, and make a long journey, stopping, changing carriages, and taking refresh- ments at proper times and places without attracting any special attention. When the seizure is over, he awakes as if from a dream, and has no recollection of what has happened. Night Terrors Night terrors occur in children between three and eight years of age. They are due to reflex irritation of the brain and probably to digestive disturbance. The child, without apparent reason, will suddenly start up in bed and scream con- tinuously for some minutes, and have his hands outstretched as if to shield himself. His face expresses the wildest alarm, his eyes are wide- opened, with pupils dilated, and he gazes in- tently at the ceiling or towards some quarter of the room in which he locates the apparition which frightened him. The child may cling instinctively for protection to anyone within reach, but he does not at first look at or recog- nise persons ; his attention is fully taken up by the imaginary object of his fear. The period of terror lasts from a few moments to half an hour. The child usually then recognises his surround- ings, but he perspires and trembles, turns pale, 126 ABNORMAL CHILDREN and seems shocked and exhausted. He will beg not to be left alone in the dark again, and that his hand may be held. Although visual hallucinations are the com- monest sort in young children, other hallucina- tions, such as those of hearing and of common sensation, besides those of sight, may occur in night terrors. A healthy child may be merely frightened and will be none the worse the next day, whereas the emotional and neurotic child will be haunted by it. Unusual timidity is often an early sign. He grows up shy and self-con- scious, and becomes neurasthenic or hysterical. Night terrors are to be distinguished from nightmares. Night terrors seldom occur in children over eight years of age. They may occur while the child is in the best of health; but generally the child is neurotic or there is a family history of nervousness. As a rule, there is no recurrence of the vision the same night, but there is on succeeding nights ; and the vision never varies. The child wakes in a great fright, still seeing the vision which has terrified him, and remains for some time unconscious of his surroundings. Nightmares may happen at any age, and several attacks may happen in the course of the night. The child dreams them. The objects of apprehension have been met NERVOUS DISORDERS OF CHILDHOOD 127 during waking hours and are not invariably the same. They occur generally in chronic ill- health of the child, but there is no family history of neurosis as a rule. He is actually wide awake, though confused by the recollection of the troubled dream, and he dreads a recurrence. Somnambulism Children about the age of puberty and older are sometimes given to walking in their sleep. After a longer or shorter time of sleep, the sleep-walker rises from his bed and walks about the room without coming in contact with the furniture. Sometimes he walks about the house. He may go out into the open air, walk upon known or unknown paths with apparently as much confidence as in his waking state, avoid all obstacles which may stand in his way, and may cHmb dangerous heights, which he would never have thought of attempting when awake. He will read printed and written papers, it has been reported, though his eyes be closed. Many of the remarkable statements made in regard to the mental performances of somnambuhsts require careful sifting before they can be ac- cepted ; but there is sufficient evidence to show that elaborate work may be performed, and even lessons learnt, and the scholar find in the morn- 128 ABNORMAL CHILDREN ing to his or her surprise that the lesson can be correctly repeated. There are few persons who exhibit all the phenomena mentioned. Most of them only wander about without any pecuhar manifesta- tion. When the period of his somnambulism has elapsed, he returns to his bed and falls back again into his natural sleep, and on awakening he has not the slightest remembrance of what has occurred. In all probabihty a dream im- mediately precedes and accompanies the action taken by the somnambulist. Out of the dream vivid hallucinations arise which may determine the character of the act performed. I have seen several girl sleep-walkers and found " suggestion " treatment most successful in curing their habit, but the general health also wants attention. St. Virus's Dance (Chorea) El ratio contractions of individual muscles, or of groups of muscles, are fairly common in children between five and fifteen years of age ; the proportion of sexes so attacked are three girls to one boy. In true chorea the muscular movements are involuntary, purposeless, and liable to intensification under the influence of mental perturbation or emotional excitement. NERVOUS DISORDERS OF CHILDHOOD 129 They cease during sleep. The demands made by education upon the nervous reserve of quickly growing children, particularly such as are of an anxious temperament and ambitious of attaining a high degree of excellence in their school-work, are responsible in no small measure for the onset of the disease. It occurs frequently in children with a history of heart disease con- sequent on rheumatism. The early phases of chorea are marked by a condition of psychical unrest. The child begins to get out of control of parents or teachers. She is inattentive in class, forgetful, and dis- obedient. Her power of concentration lessens, and her brain goes wool-gathering on the shghtest provocation ; every little occurrence diverts her mind. Her school-work deteriorates, the short- comings being particularly noticeable in arith- metic and writing. Her sums are all wrong ; her figures and letters are badly formed, irregu- larly spaced, and sloping at various angles. This change in writing and arithmetic may often be noticed some weeks before erratic movements are obvious. What wonder then that her teacher sometimes metes out a punishment which ac- centuates the attack ! What wonder also that the parents frequently ascribe the malady to admonition or punishment at school ! At home 130 ABNORMAL CHILDREN a like fate may await her, for the mother often makes long complaint when the child is first brought for treatment, that she has been spite- ful, irritable, and sulky — indeed that she can do nothing with her. After these premonitory evidences of failing health, lassitude, irritability, emotional excita- bihty, broken sleep, and impaired appetite, the child will be observed by and by to exhibit clumsiness in movement and to have a difficulty in sitting still for long. Erratic muscular con- tractions then ensue ; these are at first one- sided, and may show themselves in the face or arm, or less frequently in one leg, but the oppo- site side of the body soon participates in the spasmodic movements. The face may be twisted into all sorts of grotesque grimaces, and one or more limbs become subject to violent spasmodic and inco-ordinate movements. When these movements become general there is often con- siderable loss of muscular power, and the child is deprived of the power of walking or of grasp- ing, swallowing is difficult, and speech impos- sible. But they do more than this, for they weaken the mind and dull the perception ; and, long after the movements have ceased, the in- tellectual powers are left impaired by the attack. Accompanying the chorea there is often a NERVOUS DISORDERS OF CHILDHOOD 131 mild mental disorder. The character of the child afflicted becomes changed ; there are lapses in the moral sense, mendacity, perverse- ness, emotional outbreaks, irritability, and con- stant repetition of meaningless actions ensues. Disturbances of memory and of the faculty of attention are also common. The child apparently loses what it has previously learned ; reading and writing become difficult, and there may be maniacal delirium. Speaking generally, the condition is serious, not from its immediate danger to life, but because of its rheumatic origin, its chronicity, and its tendency to recur. In this way it interferes greatly with school Hfe, hampers education, and keeps the child below the standard of her fellows, although she may be endowed with more than the average amount of talent. The essential part of treatment during the active stage is rest both for the body and for the mind. The child should be put to bed in a quiet room, preferably darkened. All sources of excitement should be prohibited, and visits of friends and relations should be avoided as far as possible. Next in importance to rest is a nutritious and easily digested diet. As long as the child is sleeping well and can be fed natur- ally, no untoward result need be feared. Even 132 ABNORMAL CHILDREN in mild cases it is usually best to remove the child from school and its social surroundings to the country, where it will be free from mental embarrassment and nervous strain. The most severe cases often terminate the most abruptly, and those with an extreme degree of movement frequently return to com- plete health in a much shorter time than others of a very moderate severity. There are certain forms of chorea, all excepting the very severe, over which " suggestion " treatment has the most salutary influence and in which recovery is brought about wholly independent of the in- ternal remedies em.ployed. Habit Spasms Habit spasms are jerking movements due to nervous instability, often due to mental strain or mental shock, and sometimes due to local irritation, so slight that the child is not con- scious of it, yet the removal of the irritant may stop the habit spasm. Children so affected are often quick at learning ; but the strain of excite- ment of competition, the dread of failure and punishment, the teasing and bullying of other children, affect the nervous child. Sometimes the study of certain subjects is irritating, to one " sums " and to another " spelling." When )l S IM-ANIS, M;R\()1 S AM) i;X( IIAI Wiih 1i.-.k!- lun l.iri^.- for lli.-ir l»Kli,>. [To /..a- t>afic .3.. NERVOUS DISORDERS OF CHILDHOOD 133 watched the child will be able to exercise some control. Trivial as the movements may be, their fre- quent repetition is most worrying and distress- ing to parents. The most frequent form of habit- spasm is a rapid blinking of the eyes and a " screwing up of the eyes," jerk of the head, twitch of the nose, sudden drawing up of one angle of the mouth, or sudden elevation of the eyebrows, grunting noises. Other morbid habits are teeth-grinding, head-rolling, head-nodding, head-banging, and body-rocking. Speech Defects Delayed Speech. Every mother rejoices over the first word her baby utters, more than over the appearance of the first tooth which pierces its gums or than over its first successful attempt to stand alone. Each of these events makes the day a red-letter day, but the first time the child calls on its father or its mother is high festival in the little world of home. And, on the other hand, few things cause so much anxiety as when the time passes at which the infant usually begins to talk, and the mother waits on in mournful expectation for the sounds which are to prove her little one's right to full citizen- ship. But it by no means constantly follows 134 ABNORMAL CHILDREN that tardy acquirement of the power of speech impHes a deficiency of intellect. There is one class of children to be well dis- tinguished from the idiot, to whom the power of speech comes late. These are the backward children. Their history is sometimes that of having had convulsions soon after birth or during dentition, and of the mental progress having been retarded since then, and bodily progress too. Or else, without any special assignable cause, they have advanced but slowly ; they com- menced to notice and observe later than other children ; they had no power to hold up their heads long after the period when other children could support theirs ; they were late before they could sit up, late before they could stand. At eighteen months or two years old such children do not attempt to talk, and their parents become very anxious about them and fear that they will never talk at all. But such fears are needless ; sooner or later almost every child who is not deaf will talk. In such case, if we find that the child, though far behind the ordinary attain- ments of its age, yet corresponds in its condition with what we might expect at an earlier period of life — grasping with its hands, carrying objects to its mouth, noticing fight and sound or bright colours, or trying to stand, or, supported by the NERVOUS DISORDERS OF CHILDHOOD 135 nurse, endeavouring to walk, and expressing pleasure, or pain, or desire, in tones variously modulated though not articulate — speech will certainly follow. The power of speech once acquired may be impaired. Lisping is a very common form of minor defect, and is usually caused by wrong manage- ment of the tongue. The fault lies in a pro- nounced forward action of the organ. Stammering is an infirmity which comes with mental culture and self-consciousness, and a highly wrought nervous system. Children do not stammer before the commencement of the second dentition. Stammering originates in many ways, but the most common are imitation and mocking of other stammerers, attempting to talk hurriedly, fright, and general weakness. There is lack of breath control, and consequently much misdirected energy, which interferes with the smoothness and ease of the speech mechanism. This at first affects chiefly the Hps and the tongue ; but if allowed to grow, the habit leads to most frantic efforts and struggles, and disturbs not only the particular organs mentioned, but even the facial muscles and the limbs. When the stammerer has reached this pass the greatest terror of all comes on : he is afraid to try to 136 ABNORMAL CHILDREN speak. This constant fear and dread of speech failure is at the bottom of nearly all permanent stammering. It leads its victim into all kinds of pitfalls, such as a too cautious hesitation in articulation, needless repetition, halting, and a nervous magnifying of the slightest oral diffi- culty. The faculty of self-reliance is so weakened that natural utterance becomes impossible. This bad habit brings on fear, and fear increases the difficulty of overcoming the habit. As a general rule stammering takes place in connection with the explosive consonants ; but it is by no means limited to these, for it may occur not only in the utterance of the continuous consonants, but even in that of vowels. In its slightest degree stammering consists in the simple momentary arrest of speech, which may be scarcely appreciable by the listener, or in the occasional repetition of a letter or syllable. In more marked cases the lips, or the tongue, as the case may be, becomes arrested in the position necessary for the evolution of the letter the stammerer is about to utter, and remains thus for some seconds while the patient is vainly en- deavouring to continue his speech ; or, in place of the actual silence which under such circum- stances would usually be present, he may go on repeating the sound in stuttering fashion. NERVOUS DISORDERS OF CHILDHOOD 137 It is important to observe that even confirmed and bad stammerers do not always stammer in equal degree, and may at times not stammer at all. The best treatment, in my experience, is " sug- gestion " treatment. It must be directed to give self-confidence to the patient, to render him less self-conscious and more concentrated on his ideas than on the manner of expressing them. I have seen splendid results of this treatment, the only exception being cases in which there were other complications of nervous disorders and symptoms of degeneracy. Morbid Shyness Some children are morbidly self-conscious and evince shyness before strangers. They fear praise as well as adverse criticism. They blush readily. Though blushing is indicative of modesty, self -attention is, in all cases, the primary and essential element. The feeling of being looked at seems of primary importance. Shyness is common at puberty. In girls one takes it perhaps as more or less natural, but boys afflicted with it feel it more keenly. They feel when in company as if they were always ob- served, and were doubtful that the observation may not always be sympathetic ; or else they are 138 ABNORMAL CHILDREN eager to make a good impression and conse- quently become nervous. Shy persons may blush, get confused, have tremors, show restless movements, have a nervous laugh, and a foolish expression with the eyes glancing restlessly in all directions. They sometimes try to hide their discomfort. In consequence of these feehngs they isolate themselves from society and even from ordinary companions sometimes. Nervous movements and awkwardness are characteristic signs of bashfulness famihar to all ; clutching and pulling at the dress, movements of the hands and feet, putting a finger in the mouth and biting the nails are common manifes- tations of this uncomfortable consciousness of self. Some of these movements become auto- matic and require considerable effort to break ofi the habit. Some are so embarrassed at being observed or spoken to that they drop and spill things, become absurdly conscious of hands and feet, stumble against any objects which are in their way, say or do the wrong thing ; and as a psychic accompaniment to their various blunders, imagine that everyone is observing the whole train of unfortunate occurrences. Children often suffer from shyness more than is reahsed, and the first day at school is often a trial which tests the child's courage to the NERVOUS DISORDERS OF CHILDHOOD 139 utmost. The shy child who takes refuge in silence and inactivity suffers, but the timid child, who with fluttering heart and trembhng knees, with tears just ready to burst forth, nevertheless forces himself to attempt what is asked of him, deserves both sympathy and admiration for genuine courage. Headaches Headaches are symptomatic of many organic and functional conditions. Headaches due to ancemia occur commonly in children between the ages of eight and fifteen years. They are fre- quently attended by a shght giddiness and a feeling of faintness. Headaches due to nervous exhaustion occur in children from emotional conditions, strain of school work, rivalry between classmates. Headaches due to hypercEtma occur after some unusual excitement and at the begin- ning of menstruation. Headaches due to gastric disturbances are a very common occurrence m children of all ages ; they are generally associated with bad breath, coated tongue, flatulency, con- stipation, or diarrhoea. Headaches may be also due to hraifi disease and do occur in the prodromal stage of acute infectious diseases. After puberty migraine or " sick headache " is not uncommon, especially in girls. The headache is intense, 140 ABNORMAL CHILDREN frequently unilateral, associated with a feeling of nausea or with vomiting. Thus it is seen that there is a great variety of headaches which require treatment according to the particular cause, and it will be also evident how useless and dangerous it must be to trust to headache powders, as many mothers do. Incontinence of Urine Another common disorder in nervous children is incontinence of urine. The child in whom the habit is established is almost always timid and reserved, and not infrequently slow and dull. Usually the condition has been allowed to be- come a habit before it is taken seriously. The act of micturition is as a rule under the control of the will of the child in the third year of hfe. Occasional lapses may occur, but if they happen frequently a physician should be consulted. The greatest number of cases occur between the ages of three and ten years, though I have had many cases of older children. As a general rule the patients are able to retain control of the bladder, at least to a moderate degree, during the day, but this control disap- pears during sleep ; but in a certain number of cases incontinence occurs by day as well as in the night. Sometimes, and this is especially NERVOUS DISORDERS OF CHILDHOOD 141 true in neglected cases where the condition has been present for years, the bladder seems to have become so irritable as to be unable to tolerate the presence of more than a few drachms of urine at a time, so that the patient passes urine at intervals of a quarter of an hour by day and night. When no sufficient cause can be discovered by physical examination, and when the history and symptoms of the case present nothing which can arouse a suspicion of the presence of some un- usual cause, one is justified in considering the case as one of simple incontinence, when " sug- gestion " treatment will be found the quickest and surest method of cure. Self-abuse Self-abuse is undoubtedly the commonest sexual manifestation in childhood to attract attention and arouse anxiety in the parents' minds. Its occurrence at an early age, especially at an age below puberty, when no definite cause for the practice can be detected (such as un- cleanliness, worms, tight clothing), should always arouse a certain degree of suspicion as to the complete nervous soundness of the child and the stock he belongs to. It is often acquired by imitation, and quite as often it would seem the 142 ABNORMAL CHILDREN result of natural tendencies. In a nervously predisposed child the habit, once formed, may then be very difficult to eradicate. When the nervous system is burdened here- ditarily, or an unstable condition of the brain exists from any other cause, the practice of self- abuse may be really serious. Such children experience a debihty of both mind and body. They lose flesh and nerve. Their hands are often cold and clammy, the action of the heart is easily disturbed and irregular, the appetite capricious, food is not well assimilated, they have occasional night-sweats and wretched dreams ; they lose interest in their usual avoca- tions and the society of friends ; become timorous, emotional, easily excited, and often restless. They are inclined to seek seclusion, to avoid persons of the opposite sex, will not look one in the eye, prevaricate, deceive, have httle of settled purpose, and are depressed. In a large number of these cases the practice is not the cause but the consequence of a psycho- pathic constitution. It is common among girls as well as boys, but when not carried to excess the effects are not so serious as these patients usually fear, and can be remedied by proper hygienic and moral measures. I believe that half the sins of boys and girls NERVOUS DISORDERS OF CHILDHOOD 143 proceed from ignorance, not from knowledge. Nature begins to speak, but the child does not understand its language, and when it does know it is often too late. Why do the young so often regard an obscene work or print with such fear- ful but such irresistible curiosity ? Not from mere depravity, as we often assume, but because they are thus unconsciously seeking information. When children are curious and ask questions they should not be shut up, but told as much as they can possibly understand as soon as they want to know. Sexual knowledge is not wrong ; its tendency is not necessarily injurious, but our mistaken methods of secrecy have undoubtedly the most unfortunate effect of stimulating the imagination to the highest point. The informa- tion should be imparted in some form which will enlighten the reason without exciting the pas- sions. Often the child is told he is naughty and must not ask questions about such subjects. Thus repulsed, he goes away to ponder these things in his own heart, or to discuss them with his playmates ; who, in nine cases out of ten, fill his mind with the most distorted medley of approximate facts which, conceding that the nature is a high one, overwhelms him with a miserable perplexity or, as unfortunately happens, rouses in him a morbid desire to hear more state- 144 ABNORMAL CHILDREN merits of a like character, and develops in him that form of corrupt taste which results in the hypocrisy and deceit of peeping into books which he knows would be forbidden by his superiors. The proper person, and the only person, to instruct the child in matters of sex hygiene is the parent ; and in the case of very young children the mother can do this more tactfully as a rule than the father. At or after puberty the mother should instruct her daughter and the father his son, but frequent reference to the subject should be avoided. CHAPTER IX INSANITY IN CHILDHOOD AND ADOLESCENCE Mental derangement in children is likely to develop if one or both parents have been insane, if one or both have been afHicted with a severe neurosis, if one or both have been inebriates, or the parents are related and belong to a family in which nervous or mental disease has been of common occurrence. Among the causes of insanity acquired in early childhood are injuries to the skull and brain, and it is interesting to observe that the derangement may not take place until years after the injury ; but, unhke idiocy, it can frequently be cured by sur- gical operation. Another and a potent cause is excessive self-abuse in a nervously predis- posed child. The continuance of the habit brings about a rapid deterioration of the indi- vidual's mental state. Next, defects of education are apt to give rise to mental disorders in those predisposed. 1. By too strict or harsh treatment of an extremely impressionable and emotional child, h 145 146 ABNORMAL CHILDREN who is sensitive and in need of loving care, not only is the development of proper feeling pre- vented from its incipiency, but, at the same time, a foundation is laid for painful relations with the world, ending perhaps in a retiring disposition and melancholy. 2. On the other hand, an education that is too solicitous, which can deny nothing and excuses everything, cultivates obstinacy, unbridled pas- sions and emotions, defective self-control, and inability to practise self-denial. A mother's darling seldom amounts to much. Social life demands self-control and deference to the majority, power of resistance to the storms of life, and resignation. Where these quahties are wanting there is no escaping disappointments, bitterness, and pain. Sometimes the later rough school of life makes up for defects of education and forms the character ; but this cannot occur without great trouble, which threatens, in many instances, the mental equilibrium. 3. Too early awakening and strain of the intellectual powers at the cost of the emotions, of childish simpHcity and bodily health, makes itself doubly felt where brilliant and often one- sided capabilities, as they occur in neuropathic and hereditarily predisposed children, excite the pride of parents and guardians and lead to over- INSANITY IN CHILDHOOD 147 strain of the mental powers of the precocious child. 4. There can be no doubt that the increased educational demands and injudicious training are largely responsible for many of the milder forms of mental disorders among school children, and that frequently the foundation is laid at this period of unsoundness of mind in adult years. Educational overpressure is harmful not merely because of the great mental fatigue entailed, but on account of the bad hygienic conditions to which the pupils are subjected during their enforced bodily inactivity. The irksomeness of useless and antiquated teaching, and the dread of unmerited punishment, or of too severe examinations, add an emotional factor to the fatigue. Of course, it is often con- stitutional weakness of the nervous system which causes children to break down from the strain of study — overpressure acting upon pupils of a weakly nervous constitution, the sequence of parental defects or parental vices — and it should be the aim of parents and teachers to safeguard such unstable individuals at every turn. On enquiry into the previous character of such children, it will generally be found that for a long period there has existed much irregularity and absurdity of thought, eccentricity and singularity 148 ABNORMAL CHILDREN of conduct. These children were, without any cause, sometimes sad, and at other times wild and ungovernable. They could never apply themselves steadily to work. Either they had no talent, or, if it existed, it only flared up brilHantly for a moment. They would submit themselves to no rules. Some were apathetic ; others exhibited a volubility that could not be restrained. When the family or other children were engaged in social converse, the child retired quickly to his own room, where he was discovered abstracted and brooding ; at other times he was loud and vociferous, ungovernable and un- trainable. Or the patient may have been restless, abstracted and moody during the day, and at night slumbered and slept uneasily, often when awaking complaining of headache, mental con- fusion, or giddiness. During his sleep he may have been subject to slight attacks of muscular twitching, somnambulism, temporary illusions of the senses, and frightful and distressing dreams. The children who are exclusive, who never care to play with others, who sit silent when their comrades frolic about — those are the children who require special care. Moody, irritable, queer, and " cranky," they go along well enough until they have to compete with others in the struggle for existence, or until they are overcome INSANITY IN CHILDHOOD 149 by some severe grief, by strong emotion, by religious or other excitement ; then their delu- sions, which may have been latent for a long time, come to the foreground. Pubescent Insanity Hereditary taint exercises a more direct influence in the production of this form of in- sanity than any other factor. The degree, in which this inheritance will affect the system and lead to derangement, will depend not only on the conditions of life, that is, whether favourable or unfavourable, but also upon the counteracting healthy heredity from ancestors, and more es- pecially from one healthy parent. This latter is, in the majority of cases, quite sufficient to affect the inherited possibihties of disease, so that indi- viduals pass safely through the period of develop- ment ; and most certainly will this be hkely to prove true if such persons are surrounded by favourable conditions, and have the advantage to be derived from a definite and systematic course of physical and moral education. Thus we find that a majority of the cases of pubescent insanity arise in children who inherit neurotic tendencies, and are either overworked or under- worked. Many of them are left too much to themselves, and have little or nothing to do in 150 ABNORMAL CHILDREN the way of labour and regularly imposed tasks, and are not required by the force of family discipHne to learn obedience to the laws of home life, health, and activity. i Whenever^a^neuropathic inheritance is known or suspected, a special watch must be kept. Mental excitement and overpressure in study must be avoided with the utmost care ; but on the other hand, constant occupation of a congenial kind is a necessity, for nothing is so likely to favour a latent tendency to mental disorder as introspection and self -analysis, which always arises when the thoughts have nothing to keep them occupied. Besides heredity, education, and environment, the evolution of the sexual function is another factor very influential in disturbing the mental state of the child. Its manifestations mark a new era in life, and greatly change and modify those tendencies which have hitherto existed. There are great changes in the development of the brain at this period, which are shown mentally by the processes of thought becoming stronger, experiences becoming organised into memories, and memories into ideas, opinions, and purposes. Reason, judgment, and imagi- nation become more pronounced, and the higher mental capacities which will characterise INSANITY IN CHILDHOOD 151 the future individual are all evolved and begin to move toward maturity. It is the evolution of all these which calls into activity the vital energy of the system to its fullest extent, thus rendering this period of Hfe most important to all, and critical in the lives of many. In girls at this period there exists a specially sensitive condition of the nervous system, which is often manifested by vague emotions and longing for indefinite and imperfectly understood wants ; and not infrequently physical likings and tastes change ; persons and things become distasteful which formerly had been regarded wdth favour. Altogether the evolution of the sexual functions profoundly affects the whole system and taxes its energies more strongly, perhaps, than any other. Disturbances of menstruation in girls with such an inheritance should receive more attention than would be necessary in girls without it, and any symptoms of hysteria or undue excitement, either during the periods or at other times, must be promptly treated. Above all there must be abundance of sleep, and nothing should be allowed to interfere with the night's rest. Still, mental disorder is rare at this period, because the causes which ordinarily are potent in the production of insanity are not yet opera- 152 ABNORMAL CHILDREN tive. The larger cares and responsibilities which are incident to the conduct of business, and to providing for other persons, have not yet been assumed; there have never been protracted experiences of uncertainty as to the issue of important trusts and the care of property, nor have the effects which result from the protracted use of stimulants or narcotics been experienced. The sympathetic portion of the nervous system, which exercises such a profound influence on the mind in later life, has not become sufficiently developed to be greatly affected by disappoint- ment and the loss of friends, and such effects as do result soon pass away ; and finally, the brain centres have not become fully developed, and, unless in exceptional cases, have not become enervated by any protracted and severe strain. In fact, heredity is about the only factor in the causation of insanity which can exert much influence at this period of life, apart from the developmental processes above mentioned ; and the sound influence, proceeding from the healthy parent, probably more often acts as a sufficient preventive than otherwise. The child inheriting a predisposition to in- sanity must receive such a course of education — using this word in its broadest sense — as will tend to carry it through this important period INSANITY IN CHILDHOOD 153 of physical and mental development with the least possible strain upon the nervous system. In the first place, the education of such children should be individual rather than general. What- ever may be said as to the efficiency and desir- ableness of the system of public schools for educating children who have sound, vigorous constitutions, cannot be regarded as true in the case of those w^hose inheritance is one of insanity. The strain on the brain in pubhc-school educa- tion, with thirty or forty other pupils competing in the same class, all of whom are endeavouring to understand and absorb a multitude of dry facts and constructive propositions, is almost sure to develop any latent tendency towards instability which may exist in the brain into something more than a tendency. Such a brain, therefore, requires special attention in its training. Manual training and learning some handicraft helps to check the aimless expenditure of nerve force. In other w^ords, the system of education should be industrial — learning how to do and make things, rather than how to remember facts. Education should also relate chiefly to the phe- nomena in natural history and science, which can be observed, and should not be learned from books. The powers of observation rather than 154 ABNORMAL CHILDREN of retention require special instruction and exercise. Melancholia. The most constant prelude is a period of low spirits, of diminished energy, lessened intensity of emotion and action, or of conscious nervousness or want of interest in life, lasting for weeks or months in different cases, and tend- ing to be remittent in character. Often this goes no further than a general condition of sadness, depression, inaction, and helplessness. The patients avoid all work, all occupation, and all society ; they withdraw into their rooms, where they sometimes shut themselves up for days at a time without wanting to see anybody, passing their time either sitting or lying down, unable to make up their minds or to make any effort. To these symptoms, which may exist alone, are sometimes added unhealthy medita- tions giving rise to hypochondriacal ideas, or to ideas of persecution, religious ideas, or con- scientious scruples. But in spite of these con- ceptions, which are confined, for the most part, to very narrow limits, the child preserves his lucidity, knows he is ill, and may try to resist his pathological tendencies. In the female sex the accentuation is either coincident with menstruation, or it immediately precedes or follows it. While this state lasts INSANITY IN CHILDHOOD 155 life seems dreary and uninteresting, the social instincts are lessened, the appetite is diminished, and sometimes sleep is impaired ; but in other cases the patients sleep too long and will not get out of bed in the morning. The ideation, though not apparently far wrong, yet is apt to be fanciful, tending to hypochondriacal notions and to morbid self-consciousness. Both sexes sometimes think themselves in love, the object of their affections often being strangers, or nearly so; but melancholy, in my experience, more often affects girls. The patient is sad, anxious, weeping, restless by day and night, wanting in the HveHuess and changeabiUty of normal girls — depressed, wor- ried, yet ImoAving not why. Experiences which would please others make no impression upon her saddened mind. She does not care to play with other children, whose frolicsome ways are a source of annoyance to her. Games, books, and entertainments have no charm for her ; she seeks seclusion, sits in a corner by herself all day long ; will not speak spontaneously, and, if spoken to, either does not answer at all or rephes in monosyllables and with much hesitation. No reason for her moodiness is given. At a later stage there may be mistaken self-accusations. She may state that she knows everyone is 156 ABNORMAL CHILDREN against her, that her parents do not care for her, that she is to be punished because she has not loved them enough. Or she may accuse herself of unkindness toward others, of want of respect and love for her elders. Sometimes she develops abnormal conscientious scruples of a moral or religious nature. In all cases, she is inclined to be introspective and to take all things seriously. Melancholia in children seems to be less serious than in adults. By far the larger number make a complete recovery. Still, suicides are not uncommon, especially in boys, due to trifling causes without any noticeable previous depres- sion, from fear of punishment, a trifling chastise- ment, chagrin over an unmerited rebuke. At other times, it is the result of melancholia. Like the adult, the boy seeks to put an end to a life that is so full of trouble and misery. Sometimes he is driven to it by want of care and ill-treat- ment. Another psychological motive to suicide among young children is to punish others who will be grieved at their death. Often the suicide is due to disillusion. Early youth is always more or less under the influence of great expectations. Later comes the love motive in suicide. Love seems more closely associated with thoughts of death in youth than in maturer years. A fear INSANITY IN CHILDHOOD 157 of examinations is another frequent motive. Most of these children will be found abnormally sensitive. Mania. Often a period of more or less marked depression and morbid self-consciousness, brood- ing, and silence is followed by an exhibition of marked excitement. There is an exaggeration and acceleration of the thoughts, feelings, and actions of the individual. The patient talks and shouts in excited manner, is nearly always very egotis- tical, with a tendency to exaggerated physical activity. In many cases, the explosion of the excitement is sudden and the display of motor activity great. The acute part of the attack usually commences with an exaggerated sensation of well-being, an elevated emotional condition and exaggeration of self, a complete setting at defi- ance of conventional restraints and the rule of parents and elders. These children become ridiculous in their conduct and difficult to manage. They become fault-finding, and think they can do everything better than their parents. They become impudent, use foul language, and soon their habits change for the worse. Boys show pugnaciousness and premature manly airs ; girls, a tendency to tear and destroy things, and exaggerated coquetry. All this time sleep is much impaired, the patients insist on sitting up 158 ABNORMAL CHILDREN half the night. They eat well, often inordinately in this stage, but they soon begin to look haggard. The excessive restlessness and the rapid flight of ideas are not followed by a feehng of fatigue, which would be natural in a normal person. If not treated at once, the next stage will be one of acute mania, when the speech becomes incoherent, the conduct outrageous and violent, and the habits filthy and de- graded. I have known several cases of mania in chil- dren, chiefly of girls between 15 and 18 years of age, in private schools and colleges. In each of these cases, the parents had said nothing of the insane trait and previous history of their daughter, so that no precautions as to study and treatment were taken. Suddenly one day the child would break out in active dehrium, talldng rapidly and disconnectedly, tearing and destroy- ing everything within reach, inflicting injuries on her playmates, using foul language, exhibiting indecency and impropriety, and upsetting the whole school. After the event, the schoolmistress would recollect peculiarities of thought and conduct in the child previous to the attack ; and when the parents arrived, they showed less surprise than one would expect, for they knew the trouble the child had given in her bringing- INSANITY IN CHILDHOOD 159 up, and of a history of insanity or neurosis on the mother's or the father's side. Adolescent Insanity The idiot, the imbecile, and the feeble-minded remain for hfe in the condition of children or even of infants. But there are others who go farther than this. They grow up normally to adolescence ; and it is not until adolescence is reached that the heavy burdens of life are assumed and the conscious struggle for hfe begins. There are children in whom the early years of life may present nothing abnormal, some indeed showing promise of quite excep- tional mental ability ; yet as they approach ado- lescence, they manifest intellectual unrest, with sometimes alarming conduct, followed by perma- nent mental unrest. In the nursery and the school, the conditions of life are artificially simplified to adapt them to the simple minds of children, boys and girls ; but when the adolescent leaves school he goes, as we call it, " out into the world." He may not be compelled to earn his own hvehhood, but he comes into close relation with the infinite complexity of modern civilised society ; he is no longer schooled and tutored, but has to make his own decisions about serious affairs under the guidance of his 160 ABNORMAL CHILDREN own reason. His brain falls into disorder upon being confronted with problems with which it is unable to cope. Adolescent insanity is essentially the outcome of a neuropathic constitution. It is more common in the male sex than in the female. There is generally a history of defective heredity, a tendency to keep by themselves, or to be over- religious, a tendency to indulge in day-dreaming and immature philosophising. It affects the better educated and highly strung at the period of adolescence. Among the poorer classes, it is comparatively rare. Dementia Precox. The first chief sign is an inabihty to perform the usual work or mental tasks with the same correctness or facility as formerly. There is a lack of apphcation and a general inefficiency. Although there may be no apparent lack of endeavour or industry, there is a defect in attention and concentration, with mental powerlessness. All volition is inter- rupted, remittent, or spasmodic ; yet the comprehension is preserved. The memory is unimpaired. The memory of past events, especially of school knowledge, may be surprisingly good, even when the patient is very much deteriorated. Of course, when such patients have not used their knowledge for INSANITY IN CHILDHOOD 161 many years they forget part of it, but not more or less than does a normal person who has not exercised his mind on given things for a long time. But while there is the recollection of knowledge previously acquired, there is a curious weakness of judgment and loss of interest. The patients are silly, often constrained and affected in manner, they express many absurd ideas, and their beliefs are hkely to be mythical. There is also from time to time a tendency to fits of depression and despondency, or to argumenta- tiveness or irritability. Self-absorbed, uncon- cerned, apparently feeling neither joy nor sorrow, they often stare for hours into vacancy. Silly laughter without any appreciable cause is fre- quently seen. Periods of unprovoked anger are common. They are apathetic in the performance of their accustomed tasks, indifferent to the sorrows of their friends, and often either irritably obstinate and resistive, or utterly unresponsive to all efforts made to awaken their interest in things about them. Others may obey simple directions or requests, and many can be trained to do useful work in a routine way. The main underlying mental symptom is a progressive mental weakness and confusion. The patients appear to be aware of their mental disturbance and incapacity, but no regret, no 162 ABNORMAL CHILDREN care or fear for the future, for a moment dims their serenity. They become indifferent, stupid, foohsh, and improvident, and the will-power is affected either in the direction of a foolish obstinacy or a no less foolish facility. The course of this affection may be arrested at any stage after a few months or years ; but it always leaves behind it a permanent degree of mental incapacity, which lasts during the remainder of the patient's hfe. The mental powers are so enfeebled that most of these patients are totally incapacitated from ever again doing useful work, in spite of the fact that their memory and perception are almost un- impaired. Even in those cases which apparently do recover, careful examination will usually reveal some degree of mental enfeeblement which was not previously present. Many blasted careers, blighted prospects, and inexplicable life failures result from this disease. Paranoia. This is another form of insanity which occurs in young men at the period of adolescence. It starts with delusions of perse- cution, the patient believing himself to be the victim of circumstances. He is made to suffer either for wrongs he has committed or for the envy others feel towards him. He has, as a rule, been morose and exclusive. He feels that he INSANITY IN CHILDHOOD 163 is being observed by others ; that everyone notices a peculiarity in him ; that others can read and control his thoughts. Before long, he hears the voices of his enemies who are trying to ferret out his actions ; he stops up the keyholes and draws the bhnds of his windows. If his neighbours cannot get rid of him as speedily as they ^vish they put poison in his food, which he refuses to take. He sup- poses himself the victim of the police, of sociahsts, of a rehgious sect, who will endeavour to influ- ence him by electricity, through the telephone, by hypnotising him, or by forcing him to inhale all sorts of noxious vapours. There are characters who are prone to sus- picion, to mystery, and to dupHcity. Such persons do everything in an underhand way ; and, as they imagine everyone to act under the same motives as themselves, they are constantly on the watch to detect plots and devices, which in reahty do not exist. If adversity besets them for a time, the natural suspiciousness of character is exalted and sharpened to excessive activity ; they suspect everybody, they listen to every tale and gossip, and embitter their lives by suspicious fancies, till their best friends become as much the objects of suspicion as their known enemies. Every trifling circumstance is then converted 164 ABNORMAL CHILDREN into a confirmation of their apprehensions, and the mind is kept constantly on the stretch to hide its own thoughts, and to fathom the secret devices of others. They may start with a vague distrust, leading to the notions that others were more ready to do them harm than good, and becoming in the end, by being indulged in, a firm conviction that others were committed to an actual conspiracy to ruin or poison them, or to do them some other grievous injury. In the course of this mental disorder there are sure to arise delusions of grandeur. The patient imagines himself destined to fulfil some special mission. The whole basis is an intensified feeling of self-importance. They lead a dreamy, fan- tastic existence, brooding over sensations and discoveries, dream of air-castles of future might and greatness, they feel that they are destined for something important, greatly overestimate themselves, and have a tendency to a haughty personal bearing toward the vulgar crowd. Their false ideas are concerned with brilliant deeds, as poets, artists, discoverers, or social reformers ; and thus it may happen that their acquaintances, or those of them who are devoid of good judgment, may take the boy for a genius, just as, on the other hand, geniuses are INSANITY IN CHILDHOOD 165 often taken for fools. Such false geniuses generally have the capacity to criticise and tear down what exists, but they have not the same power to create as real geniuses have. The obstacles which such unfortunate youths en- counter among their rational fellow-beings they regard as manifestations of jealousy and rivalry, or of fear of their remarkable talents. CHAPTER X ABNORMAL HEADS OF CHILDREN AND THEIR SIGNIFICANCE In early life the diagnosis of the slighter forms of weak-mindedness is extremely difficult ; but, as development proceeds, the recognition becomes easier and the deeper grades are less difficult to discover. The general aspect of a backward child gives some clue to the amount of mental deficiency; for instance, the facial appearance, deformed ears, a highly arched palate may arouse suspicion ; but the only safe and scientific indication of mental weakness due to deficient development of the brain from birth, and not acquired by accident, is, in my opinion, the size and shape of the head. There are no two skulls nor two brains alike in their configuration, nor are the characters of any two individuals found exactly to correspond. When the brain conformation of several indi- viduals is similar, the talents and dispositions are similar ; and when the conformation is dif- ferent, the mental powers are different. 166 ABNORMAL HEADS OF CHILDREN 167 We may always observe that brothers and sisters who most resemble each other have heads similarly formed, and that children, whose heads resemble that of one or other parent, manifest the mental qualities of that parent. The skull represents for all practical purposes a true measure of the dimensions of the brain in all normal individuals. The brain is not made for the skull, but the osseous envelope is made to protect the brain, the brain being an object more essential to the end of nature than the skull. Every child is born with a tendency to that form of brain which it afterwards assumes. To allow of this, the brain of the foetus is not surrounded by any osseous substance, but by a transparent cartilaginous membrane, which becomes osseous simply for the protection of the brain. The skull yields to the brain as the latter augments in volume ; and since the skull enlarges in the same proportion as the brain increases in size, and this simultaneous growth continues so long as the brain grows, and the bones of the skull are very thin until the age of puberty, i.e. about a hne in thickness, we have in the outward form of the head the best indication of the size and shape of the brain. The frontal sinus, i.e. the cavity at the root of the nose which divides 168 ABNORMAL CHILDREN the two plates of the skull in adults, presents no difficulty, since it is non-existent or, at the most, of insignificant size in children. The head of a new-born child should be from 13 to 14 inches in circumference ; those of adults are found to vary from 22 to 23 inches. The head develops rapidly during infancy ; and by the time a boy arrives at school age, the cir- cumference should have reached 20 inches and in a girl 19 inches. The circumference of the head in boys should be : — At the end of the first year 17-5 inches ,, ,, second year 18-5 fifth year 19-5 ,, eight years of age . . 20-25 „ nine „ „ . . 20-5 „ ten „ „ . . 20-7 „ twelve „ „ . . 20-8 „ thirteen „ „ . .20-9 „ fourteen „ ,, . . 21-2 „ fifteen „ ,, . . 21-4 A feeble-minded boy will be half an inch, or, in severer cases, one or two inches below these figures, and will remain below throughout the period of growth. If the head is three inches under the average circumference for its age, the child will be an imbecile. It is a mistake, however, to trust to the cir- ABNORMAL HEADS OF CHILDREN 169 cumference alone, or even to the width of the head and the circumference, although the mis- take is made by many men who are regarded as experts on this subject. Circumference alone as a measure of the skull and its contents, is inadequate ; for the brain may grow in certain regions without affecting the circumferential measurement. The brain may be wide or narrow, deep or flattened, the shape of the entire mass will not give any clue to the intellectual endowment. We must compare the relative development of different regions in the same brain to come to a conclusion as to the mind and character of the child. The circumference of the brain gives no proof of the intellectual endowment of an individual ; for the brain may be developed chiefly in those regions — the lateral and posterior — which we have in common with animals, and be defective in the frontal region, i.e. the area of the frontal lobes. It is the development of the frontal lobes which distinguishes human from animal brains, and we know from other observations besides that of their size — from the effects of injuries and disease — that they are connected with the highest intellectual operations and moral acquisitions. A hoy may have a comparatively small head and yet be intelligent, if his liead he of normal size in the frontal region, 170 ABNORMAL CHILDREN and the deficiency is chiefly in the posterior region ; while a boy may have a large head (hydrocephalus or other disease excluded) and be mentally deficient, if the extraordinary development is chiefly in the posterior and lateral regions and the frontal is below the average. When the brain is too small, it is not dwarfed equally in all its parts. It is in the frontal regions, those parts which manifest the peculiarly human faculties, that the deficiency is most marked ; while the lateral and posterior parts of the brain are far less, if at all, affected. Given two boys with heads of identical shape and size in all regions except the frontal lobes, the boy with a larger anterior region will be the more intel- lectual of the two. Let me repeat that, as far as the intellect is concerned, it matters not whether the entire head be large or small, so long as the frontal area has large dimensions as compared with the rest ; and a defective development of the frontal area may be indicative of mental and moral idiocy, even though the remainder of the cerebral hemispheres has attained to normal growth. With increased mental work the frontal brain shows increased growth. The forehead, which in a newly born infant is perpendicular, or flattened ABNORMAL HEADS OF CHILDREN 171 backward, begins to protrude as soon as its life ceases to be purely vegetative, passed between sleeping and feeding, and it begins to take notice of the external world. As the child observes and begins to reason, the small, narrow, short forehead of the early months dilates in all directions and especially forward ; the frontal bone increases in convexity with the rapidly growing frontal lobes of the brain, and in rela- tion to the extensive knowledge he now acquires. Later on, these frontal parts get more balanced with the rest of the brain, and the little prodigy resumes his place among ordinary folk. The frontal lobes in man reach the greatest development in volume as compared to all animals. As we ascend the scale of animal intelhgence, so we find that in proportion to the rest of the brain the frontal lobes increase in size, until their surface measures one- third of the entire surface of the brain. The frontal lobes, even of the highest apes, reach in size only those of the lowest microcephalic idiot ; and as the other lobes of the brain in man and animals show no such disproportion, we may draw the inference that the frontal lobes contain those centres which are distinctly human, that is, the centres for the purely intellectual operations and moral sentiments. 172 ABNORMAL CHILDREN The frontal lobes, roughly speaking, lie in front of an imaginary plane held vertically upwards between the two external openings of the ears and another, held nearly horizontally, from the outer corners of the eyes to meet the first plane. To estimate the size of the frontal lobes, we do not look for " bumps " on the forehead ; but measure first of all the base of the skull on which the frontal lobes rest and the size of which changes the least, i.e. from the opening of the ear to the outer corner of the eye. This distance in an average boy at eight years of age should be 2j inches. Two and a quarter inches are still fair, but below that would make us seek for other evidences of deficiency. Boys above 2j inches frontal base, as a rule, do very well at school. Besides the size of the base from the opening of the ear to the outer corner of the eye, we must notice the height of the forehead, its width, as well as its shape. It will be seen, therefore, that the observation of the size and shape of the head is not so simple as is commonly believed. At the end of the chapter, we furnish a table of cranial measurements which will be found useful. The general measurement, circumference, length and width of the skull are not always sufficient to prove whether the brain is small or RATHER BROAD lll-AI KAiiiKK men lli;\l Aim K i.oNc, iii:\i [To f.uc f'M^- ,:,. I ABNORMAL HEADS OF CHILDREN 173 not. Each segment of the skull should be measured separately, from the prominence just in front of the opening of the ear (the tragus) to the same point on the other side : (1) at the level of the eyebrows ; (2) at the level of the frontal eminence ; (3) over the anterior f ontanelle ; (4) over the parietal eminences ; and (5) across the occipital protuberance. I have seen heads with normal circumference in which there was practically no forehead, but an unusual large back-head, similar to the conformation of animal skulls. Since it is the front portion of the brain which is identified with the intellectual develop- ment of the child, we can see the importance such measurements have upon the prognosis of a child's future. It would be too much to expect parents to take all these measurements, even if they could do so accurately ; but for anthropometrical purposes, no less will suffice. Anyone, however, can take the frontal measurement from one opening of the ear to the other across the lower part of the forehead just above the eyebrows, and the posterior measurement from one opening of the ear to the other across the most prominent part at the back of the head. Average school- boys at 7 years of age measure anteriorly 10 J inches and posteriorly 10^ inches. At 14 years 174 ABNORMAL CHILDREN of age, the intellectual region has developed so much that the anterior region measures 11 J inches as compared with 11 J inches posteriorly. The ratio between the anterior and posterior parts of the brain varies with the intellect. The more inteUigent boys have the larger anterior lobes. If the boys are backward the anterior brain does not develop to the same extent, as is seen by the following figures : — In boys in the lowest class, Standard I, at 7 years of age the ratio was found to be 10-5 : 10-8 inches ; but the boys of the same standard of 10 years of age had a ratio of 10-3 to 10-9 inches ; that is to say, the oldest boys in the same class have less anterior brain than their younger class- mates have. The same holds good for higher standards. For example, boys in Standard IV, of 9 years of age, had 10-8 inches anterior measurement and 10-9 posterior, but the boys 11 years of age had a ratio of 107 : 11 inches. The anterior measurements increase about I inch per year, from lOj inches average at 7 years of age to Hi inches at 14. Two boys may have heads of the same cir- cumference and be in the same class, but if one of them be older than the other, then the younger boy will be found to have the larger anterior brain. ABNORMAL HEADS OF CHILDREN 175 Not only is the circumference of the head of a feeble-minded child between 7 and 12 years of age about half an inch less than that of the normal child of the corresponding age and sex, and does this discrepancy get more marked as the child grows older (it may reach one inch or more at 15 years of age), but the ratio be- tween the anterior and posterior measure ments is even more significant. The anterior measurement of the brain in boys, passing up from Standard I to VII, increases at a greater rate than the posterior measurement, in accord- ance with the increase of their intellectual capacity, until the most intellectual boys average half an inch more anterior than posterior brain ; whereas backward boys frequently have more posterior than anterior brain. The differences in the mental powers of mem- bers of the same family arise wholly from the various degrees of development in the different cerebral parts. A high development of a par- ticular region, as compared to the rest of the brain, is associated with special mental powers of which the region in question is the essential basis. If the quantity of cerebral structure in particular regions be considerable, some related power or quality will, under ordinary circum- stances, be displayed with unwonted energy ; 176 ABNORMAL CHILDREN and in cases of great deficiency in volume of brain in the same region, the corresponding power or quahty will be only feebly mani- fested. When all the mental powers are equally moderate in their development and activity, the feelings and propensities, owing to the fact that they occupy the largest portion of the brain, will be in the ascendant. An equally-balanced head is a head which exhibits an equal proportion in the relative size of parts, and equal balance in the capability of the parts to execute the functions assigned to them in nature, with no innate tendency in any one particular direction more than another except that which circumstances may impart. It should also be borne in mind that if there exists a disproportion, ever so small, between the different parts of the brain, it will increase if left unchecked by fitting means. That which is by nature somewhat stronger than the rest becomes, through exercise of its function, and through neglect of exercising the functions of the other and smaller parts, far stronger, until it utterly dominates them. Hence any evil tendency that can be traced to malfor- mation of the brain, i.e. relative disproportion of its parts, should be checked in child- hood. ABNORMAL HEADS OF CHILDREN 177 It will be seen that we lay great stress on the relative proportion of the several parts of the brain as an indication of mental capacity. But not in every case where the size and shape of the brain are favourable will the mental operations be well performed, for there are other things which may impart unusual energy of function or injure the activity of the brain. The digestion, circulation of the blood, or other functions may be disordered, and exert an exciting or deteriorative influence on the brain, however well proportioned. These conditions must not be overlooked. Quahty of the brain is another factor in esti- mating activity. Another important factor in estimating activity is the excitability of the brain and nervous system. Quite normal people vary in tliis respect according to their temperament and constitution. 178 ABNORMAL CHILDREN Cranial Measurements to show the increase in the size of the head 1. Circumference. — From centre of forehead around the head — across the most promi- nent part of the occiput. 2. Occifito-Jrontal arch. — Longitudinal measure, from root of nose (glabella) over top of head to most prominent part of occiput. 3. Lower frontal arch. — From the opening of one ear (the tragus just in front of it) to the same point on the other side — across the root of the nose. 4. Middle frontal arch. — From the opening of one ear to the other — across the centre of the forehead. 5. Upper frontal arch. — From the opening of one ear to the other — across the frontal eminences. 6. Posterior frontal arch. — From the opening of one ear to the other — across anterior border-line of hair. 7. Anterior parietal arch. — From the opening of one ear to the other— vertically across head. 8. Posterior parietal arch. — From the opening of one ear to the other — across parietal eminences. ABNORMAL HEADS OF CHILDREN 179 9. Occipital arch. — From the opening of one ear to the other — across most prominent part of the occiput. 10. Cerebellar arch. — From the opening of one ear to the other — across nape of neck at j miction of occipital bone. IL Longitudinal diameter. — From root of nose to most prominent part of occiput. 12. Lower frontal diameter. — Between the two external angular processes of frontal bone at outer corner of eyes. 13. Upper frontal diameter. — Between the outer edges of the two frontal eminences. 14. Middle temporal diameter. — Between the most projecting portions of the two temporal bones in a vertical hue above the opening of the ears. 15. Posterior temporal diameter. — From a point just above and behind the mastoid pro- cess behind one ear to the same point on the other side. 16. Bi-parietal diameter. — Between the two parietal eminences. CHAPTER XI WHAT TO DO WITH OUR BOYS AND GIRLS THEIR EDUCATION AND CHOICE OF PURSUITS The first condition to the future success of a child is to have the necessary aptitudes. No amount of taking pains can atone for the lack of aptitude. The schools cannot fashion a great poet, a great painter, or a great musician, out of a lad who has no native capacity for literature or art. All that education does, or can do, is to improve the natural faculty ; it can never supply it. Even the moral qualities depend on innate tendencies. Whether a youth will have the ambition and perseverance neces- sary for intellectual supremacy, whether he will follow the path of virtue, dissipation, or vice, will depend at least as much on the organisation of his brain as on any subsequent training. Frequently there is not enough regard to in- dustry, energy, perseverance, self-reliance, force of character and the like, on which success in life chiefly depends. The only motive for 180 CHOICE OF PURSUITS 181 learning that is put before the boy is that of passing examinations ; and when that is with- drawn there is often no other to take its place. It is only the born student who has a love of learning, and too little is done to awaken and encourage that love in others. So long as examinations determine the rank- ing of pupils, and the belief is held that training the memory trains the mind, a tenacious memory will remain the most serviceable gift for a pupil to possess. Originahty will count for little, and may be positively detrimental in keeping up with his class. It is open to doubt whether the exceptionally gifted child can always reveal its power under this system of training, and whether the system is Hkely to fan a spark of genius or permit it to flicker out. There is certainly a great disproportion at the present day between the scarcity of adult genius and the high fre- quency of early promise. Examinations are chiefly memory tests and not tests of the reason- ing, imaginative, inventive, and creative facul- ties. Young men ^vith the mind of a Socrates or a Plato, a Shakespeare or a Victor Hugo, a Napoleon Buonaparte or a WelUngton, a Bis- marck or a William Pitt, a Darwin or a Pasteur, would have small chance of passing in the com- petition. 182 ABNORMAL CHILDREN Examinations are very ejficient to exclude incompetent persons, but are by no means sufficient to secure the choice of such as are competent and deserving. Originahty of thought is of httle help in most examinations, which rather require the assimilation of facts and of other men's opinions. The clever boy has generally more reflective talent than memory. Memory alone will not help a man at all. The dry facts and figures of the encyclopaedias should not have to be learned by heart, to serve as a mnemonic ballast to our brain; but we should be taught where to find them, in which pigeon-holes and hbraries, so that we can con- sult them when we need them. This is why tables and lexicons exist — not to be learned by heart. It is too often assumed that the general goodness of education is to be tested by the quantity of knowledge acquired, whereas it is to be much more truly tested by the capacity for using the knowledge — by the extent to which the knowledge gained has been turned into a faculty, so as to be available for the requirements of hfe and for purposes of independent investigation. The mind should not be crammed with things which cause intellectual indigestion, and are happily got rid of as soon as the necessity for remembering details about them is past ; but CHOICE OF PURSUITS 183 the child should be taught to observe systemati- cally, to record accurately, to compare, group, and infer justly, and to express cogently the results of these operations. This would advance him far and rapidly in the direction of plain, clear thinking. The preparation for scholarships dominates the education of the great majority of the cleverer boys who go to Universities, and indeed in some quarters it seems to be held that the chief duty of a schoolmaster, and the best test of his efficiency, is to make his boys win scholarships. The preparation for the scholarships, too, often means that about two years before the examination the boy begins to specialise, and from the age of sixteen does little else than the particular subject, be it mathematics, classics, or natural science ; then on entering the University, he spends three or four years studying the same subject before he takes his degree, when his real life-work ought to begin. The premature specialisation fostered by the preparation for these scholarships injures the student by depriving him of adequate literary culture. Speciahsation to some extent is necessary. A man cannot learn one thing by doing another. If the memory is trained, say, in arithmetic, it 184 ABNORMAL CHILDREN will not equally well respond in poetry, or if trained in Latin, it will not necessarily be equally good in history. The same applies to observa- tion, discrimination, and all the other mental powers. If we wish a boy to observe Stock Exchange prices, we must teach him to observe Stock Exchange prices, not teach him to be an observant half-back at football ; if we wish to make a girl into a neat housewife, we must teach her neat housewifery, not insist on neat arithmetic papers ; if we wish to make a boy accurate as a commercial traveller, it is not sufficient to make him accurate in Latin com- position ; if we wish to make him a loyal and intelligent citizen, we must teach him citizen- ship, and not merely demand that he be loyal and intelligent at cricket. There is also a widespread opinion that public schools are more concerned with s'ports than with anything else. They are the absorbing interests of the average public school boy ; he often thinks far too much of the athletic, and far too httle of intellectual, proficiency. It is not the time devoted to the playing of games that is wasted, but the talking and thinking of them when other things should be in his mind. The youth is, during his college course, constantly impressed through his surroundings with the CHOICE OF PURSUITS 185 idea that success is to be won rather by the body than by the mind ; that popularity is of more effect than culture ; and that learning may be disregarded for more showy and epheme- ral accomplishments. Games in their origin were good ; but, like most things that are over- organised, they have become a tyranny. In my opinion, there is too much sport and too little physical trainincj, by which I mean gym- nastic exercises for an all-round scientific, rational, and harmonious development of the human frame in accordance with physiological law. If some of the time devoted to sport were given, if not to gymnastics, at all events to manual training, it would serve the same pur- pose from a hygienic point of view, but prove a thousand times more useful. Speaking gener- ally, the public school boy who is deprived of his organised games or his organised sport fre- quently does not know how to occupy his leisure or how to find healthy amusement and exercise. There are, of course, many exceptions. In a good many schools it is possible for a boy to train his hands, eyes, and ears ; there are laboratories and workshops, and drawing and music are not entirely neglected. As regards the defects of both the pubhc schools and the Universities, it is not the ex- 186 ABNORMAL CHILDREN perts who are to blame. They have devised well- planned schemes of education, but there is little or no support of public opinion behind them. It is the general public which is satisfied with things as they are and feels no interest in re- modelling them. Reform will, no doubt, in time touch both secondary schools and Uni- versities ; but its progress must be slow, so long as the demand for it is confined to a com- paratively small circle, while public opinion is lukewarm or silent. The public has not risen to an interest in education for its own sake. There is too much wranghng about the rehgious teaching of young children in elementary schools, as if that were the entire education question. Parents are apt to attribute the breakdown of the health of a child to educational over-pressure, but the fault lies much more often in the want of suitable education. Subjects are crammed into a child's head for which he has no actual capacity. If it is true of normal children, it is still more true of nervous and backward children that they require individual training as much as possible. The material of which the child is made, the die in which his body is cast, the mental capacities inherent in him, his individual disposition and idiosyncrasy of temperament, — all these factors should compel a parent's CHOICE OF PURSUITS 187 thoughtful consideration. By selecting the calhng of a youth in accordance with his brain and mental organisation, and rendering him proficient in those studies or pursuits to which his qualifications and aptitudes inchne him, the world would be greatly benefited and the in- dividual himself rendered happier. For a man finds happiness in any work in proportion as it calls into exercise those natural faculties of his that are most vigorous or most developed, and in proportion to his acquired skill and excellence therein. Every system of education must be defective which has no reference to the characteristic talents of the scholar, who, though he may be a dunce in classics and slow of recollection, may possess a turn of mind which will some day lead him to great discoveries, and rank its pos- sessor amongst the eminent of mankind. There are no two children alike, not even brothers or sisters ; their individual pecuHarities are of the greatest importance for their future career and contentment. Their good points can be taken advantage of at an early stage in their life-history, and they can be guarded from the evil results of defects which may handicap them in life. The greatest folly which parents can commit 188 ABNORMAL CHILDREN is to force their children into caUings for which they have no aptitude. It is a step that can seldom be retracted with safety or advantage. If a normal boy tries to do the thing for which he is not adapted, he will fail to gain the two great keys to success : self-confidence and enthusiasm ; in a nervous boy, a mistake may destroy the health of the mind and tranquillity of the heart. A man always runs more risk if he spends his life doing uncongenial work, es- pecially if he has an innate craving for some- thing else. A square man in a round hole is much more likely to come to grief than one whose occupation fits his capacity. When we have to deal with a girl or young man, inheriting a nervous tendency, it will be of the utmost importance that the career chosen should be one fitted to their mental constitution, and that everything about them should be equally studied and regulated with the view of constantly ward- ing off the threatened evil. Precocious boys and brilliant boys with a spark of genius in them no doubt display special proclivities in their early years, and their appro- priate life-course is easily determined ; but im- mense numbers of average boys complete their school curriculum without having developed any predilections, and their parents and guardians CHOICE OF PURSUITS 189 are often puzzled to know how to employ them to the best advantage. Their schoolmasters offer but the vaguest and most untrustworthy suggestions, and the boys themselves, if they have any definite inclinations, have probably derived them from one of the " popular " novels rather than from a decisive bent of character or appre- ciation of their own powers. A boy goes to school at the age, say, of eight or nine. He has mastered the three R's, and must begin, in a certain degree, to specialise. As matters stand, the Kne on which he specialises is probably determined either by the father's taste and prejudice or by some external advan- tage he foresees in the boy adopting this or that profession, or by the schoolmaster's rough-and- ready diagnosis of the case, or by all these influences acting vaguely, blindly, blunderingly together. Negatively, at any rate, we can decide with some confidence, that he has no special turn for classics, or for mathematics, or for science, and so might save him from having to make the same discovery for himself after years of painful and wasted labour. Hitherto it was by experience only that parents and teachers got to know the capacities and the dispositions of their children, and the knowledge was frequently acquired too 190 ABNORMAL CHILDREN late to be of practical benefit. Within recent years, various branches of science have accumu- lated a sufficient number of facts and observa- tions to enable us to make a fairly correct diagnosis of the possibiHties of a child. The earlier we are able to recognise the innate dispositions, the sooner we can aid their right use and educate the child according to the pursuit for which he is best adapted, on the right choice whereof his future success and happiness depend. Many a little boy and girl have been made to toil in mathematics when there was no corresponding quality in the brain ; in music, when they could never sing a true note ; in language, when they had no linguistic power whatever ; and on the other hand, many great mathematicians, musicians, painters, and sculptors have been prevented, or at least delayed, from obtain- ing the position for which nature designed them. If every boy or girl were directed thus early to the subjects to which he or she is best suited, it would double the prosperity and material good of future generations and greatly enhance the happiness of the race, besides diminishing poverty and crime. The earlier we can diagnose the bent of a child, according to which we can shape his education, the better the prospects of THK STIDF.M 1 VI [To face fititic 190. CHOICE OF PURSUITS 191 that child. How many tears would be spared to children who are forced to learn subjects for which they are not by nature endowed, and how much vexation of spirit might the parent or teacher himself be spared ! Comparatively few youths would, I think, be baulked in the careers in which they are em- barked were their mental capacity for that which they are expected to perform correctly gauged beforehand. A man who is colour-blind is, from necessity, debarred from taking charge of railway signals ; yet over and over again does one see youths whose brain organisation fitted them for some other calling, forced into a calling for which they are not suited, and where they consequently must have to endure a martyr- dom for life, with not one gUmpse of a chance for distinction, or for anything more than a set rule of thumb performance of duties which are a daily cross and sorrow. As regards education of the children of the poor, I would say, " Find out what each child is capable of doing, that is to say, his actual aptitudes, teach him to succeed in these, and then you give him a means of hvehhood." If only our educators would remember that skilled labour, and not general education, is what is valuable.! 192 ABNORMAL CHILDREN Among the educated and richer classes the cry of : " What shall we do with our sons and daughters ? " is also heard. The question every parent whose sons and daughters choose uni- versity careers has to face is what is to become of them when their school and college days are over. The number of unemployed and poorly employed university graduates is increasing year by year. The various professions, and all the so-called higher callings, are invaded by a mass of young people who imagine they possess a faculty on the strength of what is called a " liberal education," which means that they have simply been '' crammed " up to pass a series of examinations. In consequence, every avenue of employment that is not mechanical, is overcrowded, and wages for intellectual labour are at their lowest ebb. The hardships of the born proletarian are small compared to the sufferings of those whose artificial education has rendered them ornamental, rather than useful; and who therefore, when deprived through mis- fortune of the means of independence, are quite unfitted to take part in the struggle for life. In this struggle, it is not only the morally or physically unfit that go down, it is also those who are morally refined and intellectually superior, if they have learned nothing that will gain them CHOICE OF PURSUITS 193 remunerative employment. It is the victims of artificial education who suffer. It is bad enough for the college man, but it is worse for the college girl. She goes up from her high school or her suburban home and passes the time pleasantly at Girton or Newnham or Lady Margaret's for the allotted space. She reads for her examination sedulously, she plays games, she makes charming friendships, she speciahses, perhaps, in mathematics, classics or history, and takes a good degree. And then she " goes down," to find herself only one of the many superfluous women. The knowledge, the " tone," the various interests she has acquired at college do not open many congenial avenues of occupa- tion to her. She may get married ; but the university graduate does not always want to marry, nor is she asked in marriage quite as much as her less cultured sister. The professions available for educated women are not numerous. There is teaching, and the college girl usually falls back on that ; but most of them are in the elementary schools where the higher culture is not needed. Perhaps the public service may offer her more extended opportunities in the future. Girls appear to be more ambitious than boys, and to attach more importance to the examina- 194 ABNORMAL CHILDREN tion itself, especially when it is competitive, hence they are more apt to overwork themselves. They become nervous and do not take sufficient rest, allowing their work to run into time that should be devoted to sleep. It is quite im- possible for girls to remain well in such circum- stances, and the strain often has serious results. Of course, sometimes the girls who break down were originally physically weak, but in many cases the collapse is due solely to overstrain. There are frequent complaints from teachers of want of vitality in these girls, as compared with girls who have not been pressed for examina- tions during their school years, and who generally approach their work with greater spirit and fresh- ness. The remedy would be that there should be no competitive examinations for girls under six- teen or even eighteen. This would result in a much stronger race of women, because the result of the strain not only interrupts and damages the school career of these girls, but also injures them afterwards, and in this connection " after- wards " is not a matter of personal but of national concern. CHAPTER XII THE MORAL EDUCATION OF CHILDREN Besides the intellectual gifts, the characters and dispositions of children require to be carefully studied and as carefully trained. Some are bold, others tiinid ; some frank, others reserved ; some rash, others cautious ; some forward, others retiring ; some active, others slow ; and so on, each requiring special treatment. For many children of a nervous temperament habits of system, order, punctuality, temperance, self- reliance, perseverance, and self-control may be their salvation in after-life. Of the errors committed in the management of early childhood, the two which are perhaps the most common may be said to arise from the tendency of human nature to go to one extreme while seeking to avoid the other. The first error consists in allowing the will of the child to have almost unhmited sway, and conse- quently permitting the unregulated and un- limited indulgence of every wish as it rises in the 195 196 ABNORMAL CHILDREN infant mind. The second and opposite error consists in substituting, on all occasions, the mother's feelings, inclinations, and judgment for those of the child, and regulating even the minutest and most unimportant details by a rigid adherence to rules, which is not less at variance with the spirit than destructive of the comfort and dispositions of the child. By the former of these methods, selfishness is so directly and systematically cultivated that in most instances the child becomes thoroughly " spoiled." By the latter the child finds itself so continually thwarted that its spirit is broken, and it is made to lead a hfe of fretting and wretchedness. A third error, far from uncommon among over-anxious mothers, consists in asking and acting upon the advice of every visitor who happens to cross the threshold. A child should be left free to feel and act according to its own inspirations, so long as its feelings and conduct are physically harmless and morally proper. But let the parent be at all times watchful and ready either to check, or give a better direction to, its activity when pru- dence requires it. Improper conduct and un- reasonable demands should at once be checked with a kind and gentle but firm hand, and the child be made to feel that the denial, being die- MORAL EDUCATION OF CHILDREN 197 tated by love, is unalterable by entreaty. In this way implicit obedience will soon be secured. To the young, the harsh or vacillating exercise of mere authority, unguided by reason and un- influenced by Idndly aft'ections, is as grating and disagreeable and as provocative of resistance as it is to the adult. It would serve no good purpose, even if we were able, to convert the infant into a puppet moved only by our will. A child thus discouraged from the free exercise of its own faculties and from placing the slightest reliance on its own caution and foresight, trained to act only at the bidding of another, will be found in after life to display a feebleness and indecision of character, in strong contrast with the prompti- tude and energy manifested by those who have been trained, from an early age, to think and act for themselves under the superintendence and correction, but not the dictation, of their natural guardians. The child has to learn to repress and overcome his desires. The more he yields to his impulses and appetites, the stronger and more exacting they become. We must check his desires and cravings dming his pHable youth, when good habits may still be formed and firmly implanted. Lack of disciphne in youth tends to self-indul- 198 ABNORMAL CHILDREN gence in later years. Resistance to over-active propensities would be facilitated with all the more success were the task of curbing them started earher ; and a suitable mental training commenced in infancy would ensure greater facility of action and more energy to the higher sentiments and intellectual powers, and render more vivid and accurate the knowledge of the fatal results of all immoral acts. Moral feehng should be developed by the practice of morahty, and the enactment of such scenes as awaken the feelings which are at their base, such as pity, sympathy, wonder, venera- tion ; and not merely through addressing our selves to the intellect alone by means of storing the mind with moral precepts. The example of his associates in the family, or out of it, is more potent in the formation of the child's character and habits than are all the precepts that are dinned into him. Parents sometimes wonder why the multiplied precepts which they bestow upon their children do not more powerfully influence their conduct. The fact is that the precepts in question go to form in the children's minds a fund of conventional opinions— those which they will use before the world — but the parent's own example, the thousand and one ways in which they practically manifest them- MORAL EDUCATION OF CHILDREN 199 selves, are subconsciously received by the children, and go to form the underlying character from which most of their actions spring. Hence the common maxim that example is better than precept. Precept strikes the consciousness, but example constantly present sinks into the subconsciousness. There is no fault of character in a boy or girl that may not be corrected, or at least rendered harmless, if right treatment be applied to it in time. Moral education must first of all remove all that cramps the soul of childhood. It must reahse that some children need hard work and could be saved by it, while others need rest and leisure ; some are spoihng for lack of kind- ness and some for lack of severity ; some need more control, some more freedom. Even the most powerful and deep-seated passions may be overcome or indeed rooted out, and that which naturally tended to evil may be made productive only of good. Those little displays of temper or passion in a child which, under a course of mismanagement or neglect, will produce self- will, rashness, wrong-headedness, may be so managed as to develop into energy, firmness, decision, guided by right reason. It often happens that strong passions are mistaken for strong will, and that an entirely wrong method 200 ABNORMAL CHILDREN of discipline is adopted to break the child's will, when what is really needed is to direct its mental action aright. Every wrong propensity may be finally sub- dued or considerably corrected, every right one may be assisted by additional motives and carried on to yet higher perfection. Even in the w^orst characters, some capacity for virtuous improvement, of which no vestige has yet been observed, may be discovered or drawn forth ; and upon the best, restraints may be employed against vicious inchnations which from the mere absence of opportunity have not hitherto been suspected. Moral education must aim at convincing the child that he is capable of good and making him beheve he has a strong will, and is master of himself, in order to impart to him the strength, and ultimately the habit, to exert his will and to govern himself. As the child grows up, he should be instructed as to his own character, the predominating elements of which furnish the motives for his conduct. We all have to live with ourselves, and it adds much to our comfort to be able to do so peacefully and on good terms. To know our weak points is to prevent other people playing on our weaknesses, and is quite as important a matter in life as to know our CLKvr-:R. \vi;i.i.-ni:ii.\\ i:n, ai'i-icciionai i-: (■im.i>Ki.N. I 7 .. /.I.-.- p.ige JO MORAL EDUCATION OF CHILDREN 201 strong points and how to make the most of them. Children require such moral education and character organisation as will fit them to deal with the practical affairs of life., and enable them to do well when actually launched upon the business of the world. Parents should remember that their children's lives will be a struggle, however comfortably off they may be. There will be the struggle against weakness and temptation, against sickness and misery, against shame and falseness of all sorts. There will be the struggle with the world, with open enemies, and Vvdth their imier selves. There are many persons passing for creditable and even distinguished members of their social group whose children enter on the difficulties of life almost entirely unprepared for the struggle to which they are to be exposed. Many a lad who might possibly have done well had he re- ceived practical training in the art of social existence becomes a " waster " through in- ability to appreciate the position in which he finds himself placed as he approaches manhood. With a little more worldly wisdom in our youth, knovrledge of the mainsprings of human nature, and adaptability to circumstances, how 202 ABNORMAL CHILDREN many errors we should have avoided, how many careers would have been successful that are now spoiled, how much misery we should have been saved ! But most of our boys and girls when they leave college are not aware that the real life's struggle is only beginning, are totally un- trained in the power to deal with the world, and cannot guard themselves against the " busi- ness " capacities of those with whom they come in contact, not to speak of the slyness of those who prey upon the ignorant. The need of moral culture is urgent. It is the intellect that receives the chief atten- tion, but not the feelings and propensities which are at least equally important to the future success and happiness. Unless in home and in school there be education of the moral sense and direction of sympathies, unless the formation of character accompany that of the intellect, education will be the evolution of selfishness, the steady arming of man against man, as if everyone carried his intellectual revolver. Moreover, by moral culture we do not mean the formation of character by the imposition of moulds and casts from without, but by carefully tending the many spontaneous and sensitive pro- cesses of growth within ; and such a discipHne of the primitive impulses as shall lead them to MORAL EDUCATION OF CHILDREN 203 do right, not by the restraint of conventional prohibitions and sanctions but by an internal and automatic repugnance to wrong-doing. To be successful, the child must have an extra- ordinary gift for some particular work and cer- tain character quahties. The child must not only have the capacity to learn, but his character must be so educated that he will have powerful motives to go on learning, and to apply the know- ledge he has acquired. Knowledge of itself is nothing without the capacity to apply it, and then it must be concentrated knowledge of one matter and not a weak versatility. Who are the men who make large fortunes but the men who exercise apph- cation in some narrow field of industry or specu- lation ? Without a paying speciality the gifted intellectual man may be in actual want, while a mediocre man with a special knack may make fame and millions. It is not possible to insist too strongly upon the necessity of definiteness of aim, steadiness of purpose, unity of object, gathering up all the powers into one special channel. However, fixed aim must not be mistaken for fixed idea, and concentration of energy and talent upon the object in view must not imply absolute disregard of every other. The exclusive cultivation of a 204 ABNORMAL CHILDREN single faculty would necessarily dwarf and wither all the rest. Ambition is one of the qualities necessary to induce industry in a child. It is the greatest motive power to achievement. But parents must not mistake ambition for capacity. Foohsh persons fancy that if a young man only starts in life with a sufficiently vehement desire to get to the top of the tree, he cannot fail. Thus many parents get disappointed. The father who en- tertains a vague and complacent conviction that he is rearing an archbishop, or a Lord Chancellor, or a great author, is often amazingly pleased ten years later to learn that his lad evinces a genius for book-keeping by double-entry and for mounting a high stool with punctuality. The child must be trained to employ its time methodically. Time is a commodity of which everyone is rich, but most are wasteful. If the idle are described as killing time, the successful man brings it to hfe. He never talks of " leisure " because he never has any. He has for every hour its proper task. One man will be found to accomplish in a day as much as another man accomplished in a week. Inquiry will show that the difference is due not so much to greater power of intellect, or great quickness or appre- hension, as to better application of time. MORAL EDUCATION OF CHILDREN 205 The man who values time is a punctual man, and the virtue of punctuality is essential to success in life. A man who keeps his time will keep his word ; in truth, he cannot keep his word unless he does keep his time. Again, to be unpunctual is wanting in tact, and tact is a most necessary quality even in boyhood. The talented man knows what to do, the tactful man knows also how to do it. A right use of time means, of course, a right use of opportunities. The man who is called lucky is usually the man who has a keener eye for opportunity than his fellows, and is better pre- pared than they to take advantage of it. Suc- cess in life depends largely on opportunities promptly utilised. Opportunity becomes in- visible to those who are doing nothing or looking somewhere else for it. It is the great worker, the man who is alert for chances, that sees and at once grasps his opportunities. In addition to the qualities already mentioned, the child must have enthusiasm for his work. He cannot do his work to perfection unless it is done with enthusiasm. Together with enthu- siasm goes optimism ; it is the greatest achiever in the world. Pessimism has never done any- thing but tear down and destroy what optimism has built up. Furthermore, the child must 206 ABNORMAL CHILDREN possess or acquire a contented spirit, and must be taught to depend on himself. These and many other forces of character must be trained. Some children, notwithstanding the best edu- cation, still prove a failure. Some have an im- perfect mental organisation that keeps them down ; others have vicious tendencies, are erratic, contrary, disobedient, or troublesome to an extreme. Seeing how little impression in general is made upon them by the ordinary and even the special processes of education, it is of interest to inquire if there are no other methods by which these deficiencies may in a measure be remedied, the vicious tendencies eradicated, and desirable moral qualities drawn out. Certainly there is one method, namely, the influence of " suggestion," which may be exerted for the development and improvement of mind and character with the best results. All children are open to suggestion. By this we mean that they show themselves perfectly docile to all the influences of those around them. All that they feel, all that they perceive, im- presses their minds and may become the start- ing-point of a habit that will last perhaps their whole life long. Suggestion may constantly be employed as a means of moral education and as a powerful modifier of hereditary tendencies, MORAL EDUCATION OF CHILDREN 207 It is especially useful in the moral education of nervously disposed children, because these are particularly impressionable and sensitive to impulses communicated to them by sugges- tion. Indeed in nothing has the admirable effect of suggestion been so manifest and striking as in the changes wrought in the character and habits of neglected, vicious, and criminal children in every grade of society. Imperfect capacities may be stimulated, a kleptomaniac may be restrained, or a case of habitual lying may be influenced ; evil habits may be uprooted, a mental force and moral sentiment induced, and a moral and useful character developed. Guiding ideas that will produce interest, enthusiasm, and noble passions may be introduced ; and high purpose and noble endeavour may be substituted in character for carnal propensities and sordid aims, worthy ideals for bestial standards, intel- lectual brilhance and hving interest for obtuse- ness and indifference. Habits of thought-con- centration may be made to take the place of habits of rambling, and nervousness, timidity, stammering, stuttering, and other speech defects overcome. Habitual indolence and disinclina- tion to exertion can be cured by suggestion, by exciting in them a real interest and motive, and 208 ABNORMAL CHILDREN teaching them to see the importance of their studies in relation to their future activity. How many parents and schoolmasters try to reform children by scolding and the threat of punishment, which frightens a delicate child and does harm to its nervous organisation, some- times for its Ufetime ! Where the usual medical treatment, moral influences, discipline, change of scene and companionships are of no avail, carefully directed " suggestion," if confidently persevered in, is sure to awaken intellectual per- ception, impart mental alertness, improve the memory conditions, and substitute self-reliance for diffidence and timidity. Children, as a rule, are more impressionable than adults, and the fulfilment of suggestions given to them is more pronounced and more permanent. Here the result of suggestion amounts practically to regeneration, moral per- versity not having become fixed by the indul- gence of years. In the training of children tactful suggestion has power to exalt both the intellectual and moral nature. Of course, even by suggestion we cannot produce a faculty that does not already exist potentially. Therefore those who practise it must first of all take stock of the existing character of the subject. There is still much prejudice existing against MORAL EDUCATION OF CHILDREN 209 the employment of " suggestion," although sug- gestion is at the root of all moral training. Sug- gestion does not necessarily imply " hypnotism," although if the patient can be sent to sleep the cure is hkely to be more rapid. As a rule, sug- gestion is applied in the waking or what is called the " somnolent " state ; but even when a hypnotic state is induced, the procedure is per- fectly harmless. The public have a wrong conception of hypnotism, derived chiefly from witnessing the popular entertainments in public halls and theatres by self-styled " professors," and are not aware that " suggestion-treatment " is practised now by qualified physicians all the world over and is simply a part of the greater psychotherapy, which is a science in itself and a legitimate branch of medicine. No one proposes that morality and virtue should be systematically inculcated by sugges- tion, any more than that the healthy person should be dosed with medicine. The normal child is naturally best left to the normal pro- cesses of moral education. But the abnormal child, the criminal, the mentally unbalanced, the morally unsound, all those on whom punish- ment and the ordinary methods of treatment have no effect, are we to let them drift to the workhouse, prison, or lunatic asylum ? 210 ABNORMAL CHILDREN An objection one often hears made by people is that moral reformation effected by suggestion treatment must be intrinsically worthless, since only that goodness which springs from within is possessed of any value. But it must not be forgotten that no one can be good unless he first wills to be so. Willing must always precede action. On the physical plane, for instance, we cannot perform so simple an action as the lifting of a limb until the brain, at the instigation of our desire, has first given the order. Similarly on the mental plane we must first want, or will to be good, before our moral muscles, so to speak, will carry out the order. Now suggestion does not make a child good in spite of himself, but merely arouses in him a desire to be good, and then leaves him to work out that desire for himself. We do not interfere with will itself as will, we merely change its direction. Suggestion cannot create goodness. It is already there in every individual, implanted in the soul from the beginning. All we do by sug- gestion is to bring that goodness to the surface. Children have sometimes perverse habits. By suggestion we bring these habits, done uncon- sciously, into the domain of consciousness ; and try to improve the moral invalid's character by MORAL EDUCATION OF CHILDREN 211 the teaching of self-restraint, which will con- tinue effective in the future. An example of inherent goodness in an appar- ently moralli/ iveak-mitided child is the following : Patient, a girl, thirteen years old, strange in her manner, bad-tempered, addicted to habitual falsehood and kleptomania, stealing money, sweets, and eatables. She struck other children and even her mother. She walked in her sleep, moved furniture about in her dream-state, and had to be guarded so as not to escape from the house. Patient was of good physique, had a quick, reliable memory, and was intellectually quite normal, only her moral quaHties were perverted. Suggestion treatment in addition to hygienic and medicinal measures was advised. She was a good subject and confessed her deeds, and after being reasoned with showed signs of repentance. She even expressed desire for regular study and occupation, and they being arranged in accordance with her wishes, sug- gestions were made restraining her inclination to falsehood, theft, and temper, and instilHng healthy ambitions to excel. This suggestive treatment was continued at intervals more and more prolonged, until she grew out of her per- versities and the somnambulism and abnormal habits were cured, 212 ABNORMAL CHILDREN Another example is the following, showing insubordination, indolence, and perverse habits in a boy : Patient, twelve years old, was disobedient and quarrelsome, obstinate, often mute when thwarted, at other times breaking out in violent attacks. Although so young he was given to perverse habits, and led other boys astray. For this reason he had to change school frequently, and his parents being unable to manage him, and fearing for his future, sought advice. There was nothing organically wrong, only his char- acter. I enacted a perfect process of re-educa- tion simply by suggestion, and had the pleasure to see him become a moral, obedient, diligent youth in a short space of time, when he was able to go back to school. Excellent reports were received. Sometimes it is not suggestion treatment that is wanted but hygienic measures. This may appear novel to some, yet there can be no doubt that the moral nature can often be influenced successfully by physical means. We will take a few moral states as examples. Some boys who are of flagging will and in- dolent are at the same time of " flagging nutri- tion " or suffering from some functional dis- turbance or impoverishment of the circulation. MORAL EDUCATION OF CHILDREN 213 The cure will lie in doing away with the con- ditions which prevent continued intellectual labour. Other boys suffer from irritabihty owing to profound exhaustion of the nervous system. It is the irritabihty of weakness, quite different to the anger of the full-blooded boy, who is always bellicose and masterful. His anger is due to high blood-pressure and consequent excess of nervous energy. It is obvious, therefore, that the anger dependent on the low state of the nervous system may be cured by means which will restore nervous tone, and the same happy state of affairs may be brought about in the plethoric boy by lowered dietary and measures calculated to reduce blood-pressure and excess of nervous force. My experience is that many of the unruly children are full-blooded, being as a rule fed to excess on meat and having a preference for animal food. I have seen a change of diet to milk, fish, and farinaceous food produce a marked improvement in regard to such children. Thus, to give only one example, I have come across a most striking manifestation of the destructive impulse in a httle girl, aged five years, who already showed homicidal impulses. The child had fits of temper, in which she would 214 ABNORMAL CHILDREN destroy anything, and be a danger to her play- mates. She would act thus impulsively without provocation, and had no recollection of her acts. Punishment had no effect. Her temper was hereditary in the family. I ascertained that the child had been started early on an animal diet and was given meat to excess ; her fits occurred an hour or so after her midday meal, and during her attacks she could not be trusted to be left alone because of the destruction she caused and of her attacks on other children. All the rest of the day she was perfectly normal, indeed an amiable little girl. By means of hygienic measures and a milk diet for a time, the child recovered completely. The preceding examples concern children of cultured, well-to-do parents. If a child goes wrong in such families, parents recognise that there may be some defect of the brain or its functions, and they seek advice. But such cases are far more common amongst the poor, chiefly on account of the overcrowded unhealthy sur- roundings. I have seen and treated quite a number of such children, whose parents were honest though poor, and anxious for the welfare of their offspring. But how many more must there be who, owing to the ignorance of otherwise well-meaning parents, are allowed to grow up MORAL EDUCATION OF CHILDREN 215 into criminals, and how many more who, con- taminated by the example of drunken or dis- honest fathers and mothers, have no chance at all in life ? Much might be done for the treat- ment of the degenerate and the reformation of juvenile criminals and offenders by a methodical use of the principles of " suggestion." Of course if we can certify them as " morally weak-minded " provision will be found for them in future under the Mental Deficiency Act, 1913. Such defectives will be placed under control either in a State Institution, if dangerous or violent, a Certified Institution provided by the local authorities, or in a certified home, approved home, or " private" house for one defective only. APPENDIX POINTS TO OBSERVE IN THE EXAMINATION OF MEN- TALLY DEFECTIVE CHILDREN OF SCHOOL AGE A PHYSICIAN called upon to certify a mentally defective school child should note carefully : 1. The family history. 2. The past personal history of the child, as to troubles at birth and infantile illnesses ; date of closure of fontanelles, of first teeth and second teeth ; the age at which the child began to sit up, walk, talk, and learned to control the bladder and bowels. 3. He should note the general health ; the muscular control, gait, carriage, manner, and conduct of the child. 4. He should note the heioht and weif^ht of the child and his bodily appearance ; examine the palate, teeth, etc., for stigmata of degenera- tion. 5. He should note the state of the eyes and ears, and test the senses of vision and hearing. 6. He should note the size and shape of the head for abnormalities in configuration. 217 218 ABNORMAL CHILDREN 7. He should note tlie condition of the skin, clothes, etc., for cleanliness, and whether the child can dress and undress without assistance. 8. He should test the ability of the child ; his powers of perception, memory, and reason ; the capacity for attention and concentration; the formation of ideas, judgment, power of combination, and deduction, and his power of expression, making allowance for age and lack of education. 9. He should note the educational attain- ments ; whether the child can read, write, has ideas of number, and can perform simple calcu- lations ; whether he can tell the time ; what is his power of application, and whether he can do useful work with or without supervision. 10. He should note whether the child has any knowledge of money, and whether he can be trusted with it. 11. He should observe the moral character of the child, the development of the affections, instincts, and ethical sentiments ; if passionate, quarrelsome, noisy, impulsive, cruel ; if proud, jealous, suspicious, acquisitive, immodest ; if truthful or deceitful, obstinate or obedient; if kind, affectionate, and open to suggestion ; if indolent, lazy, dull, stupid, awkward ; if talka- tive, cheerful, bold, reckless, or timid, reticent, APPENDIX 219 and seeking solitude ; if emotional, moody, capricious, sensitive, or fretful. 12. If the child is addicted to evil-doing the physician should note his method and motive and the use to which the child puts the results, to discover any mental defect ; for moral defect (vice or crime) alone is not certifiable unless the child exhibits some sisn of mental defect as well. INDEX Abnormal Heads, 166-179 Abnormality, Causes of, 1-28 Abortion, Injury through at- tempts at, 19 Act, Defective Children, 52 — Elementary Education, 52 — Mental Deficiency, 44, 46, 51, 52, 106, 215 Adenoids, 24, 64 Adolescent Insanity, 159 Affectation, 88-90 Ambition, 204 Anger, 60. 81, 82. 98, 113, 124, 161, 199, 213 Arithmetical Ability, 38, 41, 49, 110. 117, 129, 132, 183 Awkwardness, 138 Backward Children, 63-78, 134, 186 Binet's Tests, 64 Bragging, 88-90 Brain and Skull, Relation of, 167 Brooding, 110, 413, 148, 154, 155, 161, 164 Callousness, 91 Case of Ill-Temper, 213 Indolence and Perverse Habits, 212 Moral Weak-mindedness, 211 Somnambulism, 211 Vagabondage, 92, 102 Causes of Abnormality, 1-28 Insanity in Children, 145, 158 Character Defects in Children, 79-94, 199 Treatment of, 207 — Dispositions of Backward Children, 72 Feeble-minded, 47, 53 Idiots, 36 Imbeciles, 39 Morally Weak-minded, 98 Transmission of, 80 Choice of Pursuits, 180-194, 203 Chorea, 128-132 Clouded Consciousness, 105, 124 Compression of Head, 17, 36 Confusion, 161 Consanguineous Marriages, 9 Contentment, 206 Convulsions, 15, 21, 23, 47, 122, 134 Cranial Measurements, 32, 168. 172, 174, 178 Cranky Children, 148 Cretins, 33 Criminal Children, 95-106, 207, 209, 215 Cunningness, 87 Cupidity, 83 Cuttingof Teeth, 21, 23 Deceitfulness, 87 Defective Children Act, 52 Delayed Speech, 133 Delusions of Grandeur, 164 Persecution, 162 Dementia Praecox, 160 Depression, 113, 154, 161 Destructiveness, 82, 102, 113, 157, 158, 213 221 222 ABNORMAL CftlLDREN Development of Head, 168 — Mental, 47, 58 Diet Treatment, 82, 131, 213 Diseases, Febrile, 24 Drunkenness in Parents, 12, 105 Education, 180-194 — Act, 52 — by Suggestion, 206-212 — of Girls, 151, 154, 193 Sensitive Children, 27 Tainted Children, 152 — Faulty, 16, 26, 107, 117, 145, 180, 187 — Moral, 80, 94, 195-215 — Specialisation of, 183 Educational Overpressure, 129, 147, 150, 186, 194 Emotional Instability, 93, 113 Enthusiasm for Work, 76, 205 Epilepsy, 14, 15, 24, 35, 123 Examination of Mentally De- fective Children, 217 — System, Defects of, 77, 181, 182, 193 Examinations, Fear of, 147, 157 Excitability, Abnormal, 111 Faulty Education, 16, 26, 107, 117, 145, 180, 187 Fear, 26, 109, 207 — of Examinations, 147, 157 Febrile Diseases, 24, 36, 47 Feeble-minded Children, 30, 40- 58, 168, 175 Feeble-mindedness in Parents, 12 Feeding, Improper, 20-23, 63, 82, 121,213 Fidgetiness, 111, 138 Forcing of Intellect, 28, 110, 115, 117, 129, 146, 182, 194 Genius, 107, 117, 164, 181 Girls, Education of, 151, 154, 193 Greed, 61, 83 Growth of Head, 168 Gymnastics, 119, 185 Habit Spasms, 132 Head, Growth of, 168, 174 — Injury to, 14, 19, 25, 36, 39, 123, 145 — Measurements of, 32, 168, 172, 174, 178 — Pressure to, 17, 36 Headache, 139 Heads of Feeble-minded, 30, 32, 34, 168, 175 Heads, Abnormal, 106, 166-179 Heredity, 2-17, 63, 74, 80, 104, 105,106, 107.114,119,145, 147, 149, 150, 152 159, 160 Hydrocephalus, 31 Hygienic Conditions in Infancy, 25 — Measures, 212 Hypersensitive Children, 108, 146, 207 Hysteria, 94, 151 Idiocy, 28-39 Ignorance of Mothers, 19 Ill-Temper, 27, 60, 81-83, 98, 113, 123, 199, 211, 212. 213 Imbecility, 30, 39-45 Immorality, 99 Improper Feeding, 20-23, 63, 82, 121,213 Impudence, 88-90 Impulsiveness, 101, 124 Incontinence of Urine, 140 Inequality of Capacity, 68 Character Dispositions, 73 Infancy, Hygienic Conditions in, 25 Infantile Convulsions, 21, 23, 122 — Diarrhoea, 21 — Paralysis, 120 Injury to Head, 14, 19, 25, 36, 39, 123, 145 Insanity in Childhood, 145-165 Parents, 6 Insomnia, 110, 130, 148, 155, 167 INDEX 223 Instability, Emotional, 93, 113 I Intellect, Forcing of, 28, 110, ! 115,117. 129, 146,194 Irritability, 81, 82, 98, 113, 123, 130, 161, 199, 213 Jealousy, 61, 90, 110 Kleptomania, 86, 207, 211 Lack of Consideration for others, 91 Self-confidence. 75, 109 Self-restraint, 102 Lisping, 135 L3^ng, 87, 89, 99, 110, 207, 211 Luck and Opportunity, 205 Macrocephalics, 31 Mania in Children, 157 Manual Training, 118, 153, 185 Marriages between Cousins, 9 — of Tainted Persons, 8 Maternal Impressions, 16 Measurements of Head, 32, 168, 172, 174, 178 MelanchoUa, 113, 146, 154 Memory, 40. 48-50. 61, 69, 97, 129, 131, 160, 182, 183 Meningitis, 15, 120 Mental Capacity of Backward Children, 64 Feeble-minded, 47 Idiots, 36 Imbeciles, 39 Morally Weak-minded, 97 — Confusion, 161 — Deficiency Act, 44, 46, 51, 52, 106, 215 — Depression, 113, 154, 161 — Development of a Child, 47, 59 Mentally Defective, Statistics of, 1 How to Examine, 217 Method, Importance of, 76, 204 Microcephalics, 31 Migraine, 139 Mongolian Type of Idiocy, 35 Montessori Method, 108 Moody Children, 148, 161 Moral Education. 80, 94, 195-215 — Weak-mindedness, 53,95-106. 211.215 Morbid Impulses, 101 — Self -consciousness, 137, 155 — Shj-ness, 109. 137 Mother, Condition of Pregnant, 16 Mothers, Ignorance of, 19 Musical Sense, 33. 38.41, 49, 66, 117 Narrow-mindedness, 71. 97 Naughtiness, 113 Nervous Children, 106-120, 186, 188, 195, 207 — Disorders in Parents, 15, 104, 119 of Childhood, 121-144 Nishtmares, 110, 126 Night Terrors, 110, 125 Nutrition of Child, 20, 212 Obsessions, 114 Obstinacy, 91, 146, 161. 212 Operative Treatment, 25, 31, 145 Opportunity and Luck, 205 Paralysis, Infantile, 120 Paralytic Type of Idiocy, 36 Paranoia, 162 Parents, Drunkenness in, 12, 105 — Epilepsy m, 14 — Feeble-mindedness in, 12 — Insanity in, 6 — Nervous Disorders in, 15, 104, 119 — SyphiUs in, 15 Perceptive Faculties, 69 Persecution, Delusions of, 162 Perverse Habits, 212 Petit Mai, 124 Phobias, 113 Physical Exercises, 119, 185 Porencephalic Tj-pe of Idiocy, 36 Precocious Children, 28, 106-120. 147, 188 224 ABNORMAL CHILDREN Pregnancy, Condition during, 16 Pressure to Head, 17, 36 Prodigies, 114 Psychotherapy, 94 Puberty, Changes in, 93, 137, 150 Pubescent Insanity, 149 Pubhc School Education, 119, 153, 185 Punishment of Children, 27, 65, 97, 105. 113, 129, 132, 147, 156, 208 Pursuits, Choice of, 180-194, 203 Rachitic Type of Idiocy, 36 Reflective Faculties. 70 Restlessness, 111, 118, 129, 1.39, 148.155. 158 Rickets, 21, 120 Runaways, 92, 102 St. Vitus's Dance, 128 Self-abuse, 141, 145. 212 Self-consciousness, 137, 155, 157 Self-esteem, Exaggerated, 164 Sensitive Children, 108, 146, 207 Education of, 27 Sexual Enlightenment of Chil- dren, 142 Shyness, Morbid, 109, 137 Size of Head, 32, 168, 172, 174, 178 Skull and Brain, Relation of, 167 Sleeplessness, 110, 130, 148, 155, 157 Somnambulism, 127, 211 Special Schools, 46, 51 Specialisation of Study, 183, 189 Speech Defects, 30. 32, 36, 40, 42. 47, 112, 133-137 Spendthrifts, 101 Spoiled Children, 27, 146, 195, 190 Sports, Obsession of, 184 Stammering, 112, 135,207 Statistics of Mentally Defective, 1 Stealing Tendency, 83-87. 98, 100, 102. 211 Stubbornness, 91, 113 Suggestion in Education, 206-212 — Treatment, 128, 132, 137, 141 . 215 Suicide in Children, 156 Sulkiness, 98, 130 Surgical Operation for Idiocy, 31 Suspicious Nature, 163 Syphilis in Parents, 15 Tainted Persons, Marriage of, 8 — Children; Education of, 152 Teasing Tendency, 83, 98 Teeth, Cutting of, 21, 23 Tests of Feeble-mindedness, 64, 217 Thieving Tendency, 83-87, 98, 100, 102, 211 Thyroid Gland, Atrophy of, 33 Timidity, 26, 75, 108, 207 Training of Backward Children, 74 Feeble-minded Children, 50, 55 Idiots, 39 Imbeciles, 44 Morally Weak - minded Children, 106 Nervous Children, 118 Precocious Children, 118 Psychopathic Children, 152 — Manual, 118, 153, 185 — Moral, 80, 94, 195-215 — Physical, 185 Traumatic Idiocy, 36 Treatment of Character Defects, 94,211,212,213 Untruthfulness, 87-89, 99, 110, 142, 207, 211 Vagabondage, 92, 102 Vindictiveness, 81 Weak-mindedness, Moral, 53, 95-106,211,215 Youthful Criminals, 95-106, 207, 209, 215 PRINTED PY WM, BRENDON AND SON, LTD., PLYMOUTH, ENGLAND. 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