RJ 486 B24 BARKER PRINCIPLES OF MENTAL HYGIENE APPLED TO THE MANAGEMENT OF CHILDREN PREDISPOSED TO NERVOUSNESS THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES Principles of Mental Hygiene applied to the Management of Children predisposed to Nervousness. By DR. LEWELLYS F. BARKER Professor of Medicine, Johns Hopkins University Published by THE NATIONAL COMMITTEE FOR MENTAL HYGIENE 50 Union Square, New York City 373 2, Publication No. 2 The National Committee for Mental Hygiene 50 UNION SQUARE, NEW YORK CITY President DR. LEWELLYS F. BARKER Treasurer Vice-Presidents Secretary MR. OTTO T. BANNARD DR. WILLIAM H. WELCH MR. CLIFFORD W. BEERS DR. CHARLES P. BANCROFT DR. GEORGE BLUMER. Chairman. Executive Comr PROF. RUSSELL H. CHITTENDEN. Chairman. Finance Committee DR. WILLIAM L. RUSSELL Chairman. Committee for Special Studies DR. THOMAS W. SALMON. In charge of Special Studies MEMBERS HARRY PRATT TUDSON, Chicago York Conn. York . : R, Albany :nneapolis ton Cambridge ,'ork ijton York i'ork DR. White Plains. K HURMAN, Ithaca - f ARR, New York KS, JR., New Haven nrk New York , Nordhoff, Cal. :ore ambridge rkeley, Cal. .ew York Cal. The Chief Object* of the National Committee for Mental Hygiene are : To work for the protection of the mental health of the public : to help raise the stan- dard of care for those threatened with mental disorder or actually ill; to promote the study of mental disorders in all their forms and relations and to disseminate knowledge concern- ing their causes, treatment and prevention; to obtain from every source reliable data regard- ing conditions and methods of dealing with mental disorders ; to enlist the aid of the Fed- eral Government so far as may seem desirable; to co-ordinate existing agencies and help organize in each State in the Union an allied, but independent Society for Mental Hygiene, similar to the existing Connecticut Society for Mental Hygiene. Inquiries regarding the work and requests for pamphlets issued by the organization should be addressed to Clifford W. Beers, Secretary, The National Committee for Mental Hygiene, Room 1914, No. 50 Union Square, New York City, or to Dr. Thomas W. Salmon at the same address. PRINCIPLES OF MENTAL HYGIENE APPLIED TO THE MANAGEMENT OF CHILDREN PREDISPOSED TO NERVOUSNESS. BY LEWELLYS F. BARKER, M.D. Professor of Medicine, Johns Hopkins University. Whether a person becomes nervous or not depends upon two great factors (a) the constitution which he inherits from his parents and through them from his ancestors generally; (b) the influences to which his body, especially his nervous system, is exposed during life and particularly during childhood. There will always be differences of opinion among serious students of the subject as to the relative importance of these two factors; some assume that heredity or nature is the all important factor; others maintain that this is relatively insignificant and that en- vironment or nurture accounts for everything; both views are one sided. Both nature and nurture are of fundamental import- ance and only by considering the two aspects of the subject fairly can sound ideas ever be arrived at. Heredity and environment overlap in one period of life ; during early childhood the individual is usually under the educational influence of his parents and exposed to their example. Doubtless much that is sometimes attributed to direct inheritance is really due to the influence after birth, of imitation of the parents. Where the heredity is notoriously bad it might be well, as Oppenheim ( I ) suggests, to protect children, who have the ill fortune to be born \ under such conditions, from the dangers of psychic infection in , the parental environment; such children taken away from home and placed under more favorable conditions would have a better chance of counteracting the faults of inheritance. In families in which nervous states prevail it is a matter of great interest to know in how far the nervous tendency can be Read at Baltimore, February 10, 1911, before the Public Health Conference of the Medical and Chirurgical Faculty of Maryland. 2 MENTAL HYGIENE overcome by educational means and especially to learn what to avoid because of its likelihood to injure the nervous system._Eyen in families in which no nervous taints exist in the parents or near relatives the children sometimes become nervous through faulty education and there, is a growing desire on the part of well informed people now-a-days to make sure that the means of education they provide for their children shall be such that the nervous system will be protected and strengthened rather than exposed to over-strain and injury. One fact which has become ever clearer as medical knowledge has advanced concerns the nutrition of_the ..child. Faulty feeding in infancy and early childhood may lead to such impoverishment of the tissues and such stunting of growth that the ill effects can never be recovered from in later life. A considerable proportion of the intellectual and moral inferiorities among our people is fairly attributable to imperfect nutrition at this early age. For- tunately the public is now being so thoroughly educated to the importance of breast feeding for infants and of liberal and suit- able diet during the early years of life, by family physicians and also through the excellent little manuals of Holt (2), Starr (3), Griffith (4) and others on the care and feeding of children that it is not necessary to dwell at length upon the subject. Plenty of good simple food, including milk, meat, vegetables and fruit, with avoidance of condiments, coffee, tea and alcohol is approved by all authorities. Many parents make the mistake of allowing the caprice of the child to influence its diet. We now know the foods that are suitable for children and, knowing these, the children should be provided with them in suitable amounts and should be required to eat of them, largely independent of choice. The child that learns to eat and digest all wholesome foods and who is not per- mitted to cultivate little food antipathies makes a good start and avoids one of the worst pit-falls of life with which medical men are very familiar, namely a finical anxiety concerning the effects of various foods, all too likely to develop into a hypochon- driacal state. There is a greater recognition now than formerly, also, of the MENTAL HYGIENE 3 fact that children should not be too tenderly brought up that a certain amount of judicious hardening of the body is desirable. While faddists and extremists in this direction fall into grievous errors, making their children go barefoot and barelegged in the snow and compelling the feeble, non-reacting child to take plunges in ice cold water, a still greater mistake is made by those who over-protect their children and who fail to accustom their bodies early to cool baths and to exercise in all sorts of weather. The child who is brought up in such a way that he is very sensitive to slight changes in temperature is bound to suffer from it sooner or later and everyone is familiar with those who grumble at the weather. If children be suitably dressed and are early accustomed to taking a cool bath in the morning and to walks out-of-doors every day, rain or shine and whether it be cold or warm, the skin and nervous system quickly acquire a tolerance for variations in temperature most desirable for health and for the feeling of well-being. An out-of-door life for children also leads them unconsciously to exercise their muscles more than is possible for the child who stays in-doors. Not only physicians but also laymen from the old Greek times to the present have been impressed with the import- ance of bodily exercise and harmonious muscular development for the welfare of the mind and of the nervous system. If we wish our children to be strong, energetic and courageous, if we desire to insure them against the nervous ills which follow in the wake of debility, inertia and timidity, we must see to it that all the muscles of their bodies are systematically and regularly exer- cised. For this purpose the plays of children are very important and the only child, deprived of the companionship of brothers and sisters, unless pains are taken to supply other playmates for him, is much to be pitied. Besides play, walking, running, rowing, riding, swimming, paddling and sailing are all desirable forms of bodily exercise. In cities, and especially during the school year, i systematic gymnastic exercises, calisthenics, have to be resorted to and where no suitable gymnastic exercises can be obtained, parents will do well to teach older children some forms of exer- cises to be taken in the early morning. One of the best of the 4 MENTAL HYGIENE various systems worked out is that of a Dane, one J. P. Miiller (5) who in his little book My System outlines a series of exercises which anyone may carry out in his own room without apparatus. These exercises are physiologically well devised and I can recom- mend them heartily, not only for older children but also for both men and women who have to compress the exercises of the day into a very short period. The exercises recommended in this country by Luther Gulick (6), by Tait MacKenzie (7) and others may also be mentioned. I would call your attention also to the works of Lagrange (8). An anxious mother will often ask to have her nervous child excused from regular exercises at school. This is usually a mistake, for nervous children even more than normal children, require systematic muscular exercises. It should, of course, be properly regulated and where there is any doubt as to the reliability of the supervision of such work at a school gymnasium, definite instructions should be obtained from the family physician as to the character and amount of exercises to be undertaken. While emphasis is thus laid upon suitable bodily exercise for children predisposed to nervousness a warning should be sounded against jjxcesses in sports like tennis, foot-ball, basket-ball and other games in which there is opportunity for competition or rivalry. Over-ambition in these directions is often most harmful both to the body and to the mind of the child and should be especially avoided where there is any neuropathic taint. >In addition to the hardening of the body, the education of the child should include measures which increase the resistance of the child against pain and discomforts of various sorts. Every child, therefore, should undergo a gradual process of "psychicj hardening" and be taught to bear with equanimity the pain and discomfort to which everyone sooner or later cannot help but be exposed. What I have said about clothing, cold baths, walking in all weather and at all temperatures, play and exercise in the open air, has a bearing on this point, for a child who has formed good habits in these various directions will have learned many lessons in the steeling of his mind to bear pain and to ignore small discomforts. MENTAL HYGIENE 5 Physicians who work among nervous cases realize how often the child who has been too much protected from pain becomes the victim of nervous break-down later in life. I have seen many a woman who could bear great sorrow or suffer without flinching the pain of childbirth who still had no tolerance for the little ills of life. In such cases it is the idea rather than the sensation from which the patient suffers and such abnormal ideas most frequently arise in those who have not learned in childhood to bear pain well or to adjust themselves without complaint to the disagreeable sensations and experiences which are essential to a normal bring- ing up. The boy who learns to tumble in a gymnasium, to stand the pain of boxing and fencing and wrestling and to keep his temper while engaging in these exercises will have subjected himself to a training which cannot help but stand him in good stead later on in life. One reason why women are more prone in later life to nervousness than men may lie in the lessened opportunity which girls have for bodily and psychic hardening in the games which they play and the life which they lead as children. Par- ticular care should be taken with young girls who show any ten- dency to nervousness to .see to it that not too much concession is made to their likes and dislikes. Nothing can be more harmful to them than the gratification of caprice. Especially when a child, shows a tendency to be nauseated by certain smells and tastes and ' to complain of noises or of sensitiveness to bright light ,the family physician should be consulted and, provided no actual disease of the sense organs or brain is responsible, the process of psychic hardening should at once be begun. Neglected, it is surprising to what vagaries such hypersensitive- ness may lead. A lady recently consulted me on account of a most distressing state, asking that "in the name of mercy and pity" she should be given some help and told how to overcome an obsession which distressed her. The sound of her husband chew- ing at table completely upset her and when he smoked, the noise made by the puffing of the smoke was torture to her; the creaking of her mother's shoes as she walked about the house made her most uncomfortable during a period of several months. 6 MENTAL HYGIENE Obviously the abnormal idea in such a case caused the suffering, not the sensory impulse itself. Another patient, a gentleman, who has had repeated nervous break-downs, told me that they always begin in the same way. After a night of insomnia he will suddenly become unable to bear a strong light and in lamp light he complains that he has a sensa- tion of pressure in the head and an inability to relax his limbs. He feels at such times as though he will lose his mind and that he must have some relief or he will have to end his life. In one of these attacks in early life, he stayed two years in a dark room and only at the end of that time would consent to remain in the light. Obviously here, too, it was not the sensation of light but the idea that the light would injure him which was the kernel of his condition. Examples like the two just mentioned could easily be multiplied but they will be sufficient to indicate the direction in which the psychopathic nervous system may easily tend. While in severe cases like these just referred to the patients undoubtedly started out in life with abnormal nervous systems, it is quite conceivable that a judicious hardening in early life might have prevented the later shipwreck. I cannot too strongly recommend, therefore, the acquisition of tolerance of disagreeable feeling-tones as early as practicable in life. / If children can be brought to behave normally in the presence / of the disagreeable feeling-tones just discussed, the task of W^ "' ' * - . .- " 4 educating them to control themselves in circumstances which tend f x to arouse the stronger feelings, emotions and passions will be made much easier. Parents and nurses are too little aw'are of the / dangers of allowing the emotions or passions to go unbridled. The / problem should be recognized and attempts at the beginning of its solution should be made in early infancy. If a young infant be kept in a normal routine, despite any emotional outbreak which it may manifest, an excellent start in the training of the emotions will have been made. If a child learns, that, by crying or by an exhibitiojn of temper, it can gain the thing which it thinks desirable, otherwise unattainable, a very bad start will have been made. Children should early be given to understand MENTAL HYGIENE 7 that they must control themselves before their desires will be gratified. How often has an indulgent mother given a child something it has asked for in order to stop its crying and to avoid a scene! It is hard to imagine anything, in the circumstances, worse for the child. If, instead, the mother had ignored the temper and told the child that it must say "please" and must wait a few moments after its temper has been controlled and the request has been made before the desire will be gratified, it would have been quickly possible to convince the child that it can get things by controlling itself rather than by emotional explosions. The substitution of self mastery for emotional outbreaks is easy / when begun early but very difficult, indeed, well nigh impossible, if begun late in life. Another mental attitude that bears watching is the craving of., the child_for sympathy. Parents are really unkind in yielding too much to such a craving. True kindness will teach the child to rely more upon self-help. Still another manifestation, common in children and fostered too often by the example of the parents, is vacillation. In one form of functional nervous disease indecision is a most prominent ~ symptom. Parents should see to it that children are not exposed to a pernicious example in this regard. While there are some children of the "hair-trigger" type who have to be taught delib- eration in the making of- decisions, there are more who have~a. tendency to doubt and indecision and who should be taught that it is better, after due consideration, to make a decision, even though it be wrong, and to stick to it, rather than to remain un- decided. The extent to which the fallacy of indecision may be carried is well manifested by some of the psychasthenic patients who apply to physicians for aid. Their indecision is often shown by the wa^ in which they make an appointment with the physician, making and breaking it several times or changing the hour repeatedly before finally appearing in his office. One of these patients told me that it sometimes took him hours to decide what clothes to put on for the day. Fortunately such pathological cases are uncom- mon but there is every gradation from the milder symptoms of 8 MENTAL HYGIENE vacillation to the outspoken and distressing indecision of the con- firmed psychasthenic. The old motto "When in doubt, act," should be kept in mind by parents who note a tendency to inde- cision in a child. The control of the stronger passions is for some easier than the mastery of ordinary irritation, and nervous children should, both by example and by precept, be taught how to stifle irritability whenever it arises. So few adults have learned how to meet the daily friction that there would seem but little chance as yet for the nervous child constantly exposed to a bad example. As an observant writer has said, "an important feature of the art of living consists in keeping the peace, the whole peace and nothing but the peace with those with whom one is thrown." If parents are prone, in their daily lives and especially within hearing of children, to blame the people who surround them or the people about whom they talk, they may often, quite uncon- sciously, sow the seeds of malevolence in young minds. Just as cheerfulness and kindliness are contagious, so, unfortunately, are moroseness, acerbity, churlishness and ill-will and the latter are mental states which are most harmful to the nervous system. It is entirely possible, with long training, practically to banish anger, worry, irritability and uncharitableness from one's life. You will be impressed with a passage in Arnold Bennett's book The Human Machine (9) which deals with the matter of blaming, of judging others, and emitting verdicts upon them. You may not agree with him but he will make you think, at least, when he says: "All blame, uttered or unexpressed, is wrong. I do not blame myself. I can explain myself to myself. I can invariably explain myself. If I forged a friend's name on a cheque I should explain the affair quite satisfactorily to myself. And instead of blaming myself I should sympathize with myself for having been driven into such an excessively awkward corner. Let me examine honestly my mental processes, and I must admit that my attitude towards others is entirely different from my attitude towards myself. I must admit that in the seclusion of my mind, though I say not a word, I am constantly blaming others because I am not happy. Whenever I bump up against an opposing personality and my MENTAL HYGIENE 9 smooth progress is impeded, I secretly blame the opposer. I act as though I had shouted to the world: "Clear out of the way, everyone, for I am coming!' Everyone does not clear out of the way. I did not really expect everyone to clear out of the way. But I act, within, as though I had so expected. I blame. Hence kindliness, hence cheerfulness, is rendered vastly more difficult for me. "What I ought to do is this ! I ought to reflect again and again, and yet again, that the beings among whom I have to steer, the living environment out of which I have to manufacture my happiness, are just as inevitable in the scheme of evolution; as I am myself ; have just as much right to be themselves as I have to be myself; are precisely my equals in the face of Nature; are capable of being explained as I am capable of being explained; are entitled to the same latitude as I am entitled to, and are no more responsible for their composition and their environment than I for mine. I ought to reflect again and again, and yet again, that they all deserve from me as much sympathy as I give to myself. Why not ? Having thus reflected in a general manner, I ought to take one by one the individuals with whom I am brought into frequent contact, and seek, by a deliberate effort of the imagina- tion and the reason, to understand them, to understand why they act thus and thus, what their difficulties are, what their explanation is, and how friction can be avoided. So I ought to reflect, morning after morning, until my brain is saturated with the cases of these individuals. Here is a course of discipline. If I follow it I shall gradually lose the preposterous habit of blaming, and I shall have laid the foundations of that quiet, unshakable self-possession which is the indispensable preliminary of conduct according to reason, of thorough efficiency in the machine of happiness." The growing child will nearly always find himself confronted by a sufficient number of disagreeable excitations to give him opportunity for the cultivation of emotional control. It is not desirable that life should be arranged otherwise for him ; it would be far from advantageous to him to be protected from everything tending to stir his feelings and emotions. Attempts to follow the io MENTAL HYGIENE founder of Buddhism in the idea of educating youth by suppress- ing desire and keeping the individual from the sight of suffering, care or sorrow, would lead to a race of weaklings insufficient for the struggle of life. Far better, as Ziehen (io) and Oppenheim recommend, purposely to expose the neuropathic child occa- sionally to opportunity for slight emotional outbreak in order that he may by a sort of "gymnastic" of the emotions gradually learn to be master of himself. The sensitive nervous system, if over-protected in the early years, suffers keenly when later on the principle of protection has, perforce, to give way to the principle of exertion. A lady of great refinement, who, owing to an illness which necessitated hospital treatment, was unpreparedly made aware of the world-pain which exists and of which she had previously known but little owing to her mode of life, once told me how the sudden contact with suffering humanity affected her. "I saw and heard so much that distressed me that all life seemed to be an open wound. ... I used to lie awake all night, thinking about what I had seen or heard or suspected during the day, and / thought I should go mad because I could do nothing to stem that rising tide of misery and corruption." Fortunately, she was made of excellent stuff and so profited by the chastening experience that, on recovery, she joined a group of enthusiastic social workers and now labors earnestly to improve human conditions in the city and state in which she lives. Especial care should be exercised to prevent disagreeable feel- ings and emotions becoming transformed into the more persistent moods. It is often better for an emotion to discharge itself in the form of some definite act and thus bring it to an end rather than through the partial suppression of it, have it last in the form of a disagreeable mood, for a considerable length of time. Pouting, sulkiness, harboring a grudge, or bearing malice, should be regarded as symptoms seriously to be considered and corrected, for if they be tolerated in the child, habits may be begun which will prepare the soil for the development, later in life, of the seeds of enmity and suspicion; the full grown plants are the persecutory ideas of the paranoid states. MENTAL HYGIENE 1 1 How to manage a child in a fit of temper has been much dis- cussed. When possible it is desirable to cut it short at the beginning. Some parents rejoice to see their children reveal a violent temper, and are glad that they can fly into a passion, turn red as a beet, clench the fists and attack the individual with whom they are angry. Such attacks if frequently repeated are very deleterious to the nervous system. Some parents try to stop them by petting or indulging the child, a kind of licensing of irritability which rarely, if ever, pays ; others threaten the child or corporally punish him ; a mistake, usually, in the other direction. As a rule, most may be accomplished by purpjosefully^igjioring the attack, perhaps isolating the child for a short period; in some cases a warm bath and the bed may be the best remedies! In older children the habit of giving way to temper may sometimes be broken by inculcating the conviction that one who loses his temper makes a fool of himself, loses his dignity and excites the disdain and contempt of his fellows : the horror of looking ridiculous, of making a donkey of one's self, may be a most powerful lever in conquering a tendency to attacks of fury. All children are easily frightened, but the child predisposed to nervousness, more easily than the healthy child, becomes the victim of abnormal fears or timidity. The Italian physiologist, Mosso, writing on "fear" (u) once said: "Every ugly thing told to the child, every shock, every fright given him, will remain like a minute splinter in the flesh, to torture him all his life long." In Greece and Rome the children were frightened with the lamias or female demons who would charm them and suck their blood, with the one-eyed Cyclops or with a black god, Mercury, who would come to carry them away. And this very pernicious error in education still prevails. The mother, the nurse, the maid and the servants still frighten the child with tales of the bogey-man, of goblins, or ogres, of wizards and of witches. How often is a child frightened to tears, its disposition spoiled and its life made a burden by tales, threats or tortures which make it timid and shrinking; sometimes fears are thus started which last through life. One must learn how to deal with the fear of being alone, the fear of the dark and the fear of thunder and lightning. Certain 12 MENTAL HYGIENE fears, common to childhood, are easily overcome, especially through the example of courage set by parent, nurse or teacher. In some instances, however, the fears are a symptom of disease and when there is doubt a physician should always be consulted. A young girl, recently brought to me, because of an unaccountable, persistent, and distressing fear of "burglars in the house," was found to be suffering from exophthalmic goitre ; on removal of a portion of the thyroid gland by Dr. Halsted the child rapidly improved and on last report was only occasionally troubled by the fear ; it seems probable that she will soon be entirely free from it. Children who suffer from "night terrors" often have adenoid growths in the nasopharynx ; on removal of the growth by a slight operation the "night terrors" disappear. In his book (12) entitled The Natural Way in Moral Training, Patterson DuBois emphasizes the importance of what he calls "nurture by atmosphere" by which he means the indirect educa- tion of the feelings and John Dewey (13) asserts that "The C feelings and sentiments are the most sacred and mysterious part . of the individual, and should always be approached and 'influenced ; indirectly :' " More can be accomplished by the setting of a good example in enthusiasms, depreciations, reverence, and admirations than by direct preaching. Let no one think, however, that lack of feeling, or a nature impoverished on the emotional side is desirable or that it protects against nervous disease. The elevating emotions, hope, joy, ex- pectation, love are constructive and are judiciously to be culti- vated; the depressing emotions despair, sorrow, regret and fear are damaging to the nervous system if long maintained. The highest feelings of all, including the religious, the ethical and the aesthetic inspire noble and useful conduct and in the education of nervous children these sentiments are to be favored in their development, in due degree, at a suitable age. It is a serious mistake to lead the young child into experiences that belong properly to a later age. When children under ten years of age are made to travel extensively, to visit museums and picture galleries, to attend the theatre and the opera, they are introduced to entertainment wholly unsuited to their time of life MENTAL HYGIENE 13 and which they, in their immaturity, are entirely unfitted to enjoy. Later on at an age when they should learn to know such things for the first time the attractiveness of novelty is wanting; they are cheated of the pleasures which normally should be theirs. As Oppenheim well puts it, a "child's childishness is its greatest asset." On the training of the religious, ethical and aesthetic feelings time will not permit me to speak, though I regard the topics of the greatest importance for the health of the nervous system. Certainly the cultivation of the love of nature, of truth, of good- ness, of beauty, and of humanity cannot help but strengthen the character and the will. The altruistic feelings, when they begin to appear, should be given opportunity for expression. Above all as a factor making for the health of the nervous system the joy of work (14) must be referred to. It is one of the greatest pleasures life offers ; moreover it compels concentra- tion of attention, and protects from all the dangers which attend upon idleness. "Education to idleness is education to nervous- ness." Overwork must be avoided; neither bodily or mental fatigue should be permitted in excess. Regular, systematic, en- joyable work, suited to the interests and powers of the worker, is the best tonic I know of. If the work can be in the country, rather than in the city, all the better, especially for those with nervous predisposition. The enjoyment of nature possible in the country, the opportunities for work in wood, field or garden and upon the river, keeping the worker much in the open air, exercis- ing his muscles, drawing his attention away from himself and fixing it upon things outside what conditions could be more favorable to the health and happiness of the nervous child. If the nervous children that we see in towns could be transplanted to villages and the country away from the din and bustle of the city, its restlessness, its haste and its feverish excitements, what a host of advantages would>accrue ! The schools are growing ever better in the country; in many country districts they are now excellent. The movement which began with the New School of Dr. Cecil Reddie (15) in Abbotsholme, England, and which has led to the Landerzichungsheime of Lietz (16) in the Harz and 14 MENTAL HYGIENE in Thuringen and of Triiper (17) near Jena should be followed and imitated in this country. In any case nervous children should not be sent to school too early; preferably they should start a year or even several years later than the normal child. And in the schools they should never be pushed ahead too fast; competition is dangerous for the nervous child. The mistaken ambition of parents who desire their children to head the class is often responsible for serious injury to health. Sleeplessness is always a danger signal. In children it is most often due to indigestion or to mental overstrain; occasionally to premature sexual excitations. If insomnia appear and especially if it persist, the parents should consult a physician. Medicine, psychology and pedagogy are all concerned in solving the problem presented by the nervous child. These sciences have already made great conquests; what the future may hold for them, who will attempt to foretell ? Let us avail ourselves of the knowledge we have, doing what we can to dispel the scepticism of the ignorant and at the same time avoiding the futile enthusiasm of those who believe they know all. REFERENCES. (1) OPPENHEIM (H.) Nervenleiden und Erziehung. Berlin, 1899. (2) HOLT (L. E.) The Care and Feeding of Children, 4th ed. D. Appleton & Co., New York. (3) STARR (L.) Hygiene of the Nursery, 4th ed. P. Blakis- ton's Son & Co., Philadelphia. (4) GRIFFITH (J. P. C.) The Care of the Baby, 2nd ed. W. B. Saunders, Philadelphia. (5) MULLER (J. P.) My System; Fifteen Minutes' Work a Day for Health's Sake. English Translation by G. M. Fox- Davies, New York, 1905. The Anglo-Danish Publishing Co., New York. (6) GULICK (L. H.) Ten Minutes Exercise for Busy Men. New York. MENTAL HYGIENE 15 (7) MACKENZIE (R. T.) Exercise in Education and Medi- cine. W. B. Saunders, Philadelphia. (8) LAGRANGE (F.) Physiology of Bodily Exercise. Trench & Co., London. Also, Les Mouvements methodiques et la "mecanotherapie" F. Alcan, Paris, France. (9) BENNETT (A.) The Human Machine. George H. Doran Co., New York. (10) ZIEHEN (T.) Hysteria und Neurasthenie. Article in Eulenburg's Real-Encyclopadie. (u) Mosso (A.) Fear. English Translation by E. Lough and F. Kiesow. Longmans, Green & Co., New York. (12) Du Bois (P.) The Natural Way in Moral Training. Four Modes of Nurture. Fleming H. Revell & Co., New York. (13) DEWEY (J.) Educational Creeds. (14) GROHMANN (A.) Technisches und Psychologisches in der Beschdftigung von Nervenkranken. Stuttgart, 1899. (15) REDDIE (C.) Abbotsholme. Rep. Roy. Com. on Second- ary Education. 1894. Also, his book Abbotsholme 1889-1899, or ten years work in an Educational Laboratory. London, 1900. (16) LIETZ (H.) Emlohstobba. Bilder aus dem Schulleben der Vergangenheit, Gegenwart oder Zukunft. Berlin, 1897. See also W. Frei's Lander siehungsheime, Leipzig, 1902. (17) TRUPER (J.) Das Ersiehungsheim und Jugendsanator- ium auf der Sophienhohe bei Jena. Langensolza. 1910. The Connecticut Society for Mental Hygiene PRESIDENT, DR. GEORGE BLUMER VICE-PRESIDENTS, HON. COSTELLO L1PPITT. HON. FRANK B. WEEKS TREASURER MR. VICTOR MORRIS TYLER CHAIRMAN OF EXECUTIVE COMMITTEE, DR. HENRY S. NOBLE MR. CLIFFORD W. BEERS, EXECUTIVE SECRETARY MISS JESSIE I. BELYEA, FIELD SECRETARY Kinds of Advice and Assistance given by the Social Service Department of The Connecticut Society for Mental Hygiene. 1. Advice and assistance to individuals who fear nervous or mental collapse, with a view to causing them to seek treatment promptly. 2. Advice and assistance to relatives and friends of patients suffering from nervous or mental disorders, whether under treat- ment in their own homes or in public or private hospitals. 3. Information regarding public and private hospitals in which cases of nervous and mental disorder are treated. 4. Advice regarding commitment to hospitals, viz., methods of procedure, the mental examination of the patient, voluntary com- mitment, commitment by Judges of Probate, cost, etc. 5. Advice regarding the management of the patient pending commitment with a view to avoiding harmful mismanagement at this critical period. 6. Advice regarding the best methods of transfering the patient from his home to the hospital. 7. Advice, and assistance when necessary, for the family of the patient while he is in the hospital, supplementing the advice of the hospital physicians who collaborate with the Society's social workers. 8. AFTER CARE. Advice and assistance to discharged patients (and those who recover at home), not only at the time of their recovery, but indefinitely if necessary, with a view to preventing relapse, and also in order that they may the more easily re-establish themselves in society and again become self-supporting. 9. ADVICE FOR EVERYBODY. Verbal and printed advice for those who desire information regarding the avoidable causes of mental disorder and the general principles of mental hygiene. All correspondence should be addressed to Miss Jessie I. Belyea, Field Secretary, or to Clifford W. Beers, Executive Secretary, Room 318, No. 39 Church Street, New Haven, Connecticut. Interviews may be arranged by telephone : Call 3008, New Haven. UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. Form L'J-Series 444 UC SOUTHERN REGIONAL LIBRARY FACILITY A 001 368 391 PLEA E DO NOT REMOVE THIS BOOK CARD 5 University Research Library