Nervous children, prevention and management

Front matter

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Preface

SEVERAL years ago the author published in the Dietetic and Hygienic Gazette a short article, entitled "The Hygienic Management of Nervous Children," and in August, 19 lo, another paper in the Old Dominion Journal of Medicine and Surgery, on "The Hygiene of the Nervous System During Infancy and Childhood." During April, 191 1, he addressed the Federation of Mothers' Clubs in Richmond, Virginia, upon the same subject.

The papers as presented and published created considerable favorable comAient both from physicians and those interested in the training of children. The author, therefore, feels that the time has come when the subject should be more fully presented. It is his hope that this little book will be read with equal interest by the physician, the school teacher, the mother and the intelligent nurse. Such criticisms as are made in this book are sincere and the result of observation, and he hopes no offense will be taken. We live in an age when many hygienic and educational systems are being tried out and there is no system which can fit each individual case. It is not, therefore, his desire to promulgate any system but simply to give his readers as clear an understanding as possible of the fundamental principles underlying the rearing of children from a standpoint of their nervous and psychic development so that their knowledge and judgment will lead them not only to understand the child but to train it to avoid the neuro-psychopathic pitfalls which are found everywhere in its path.

In this work the writer has made free use of any book which he thought would be of service to him, and acknowledges his indebtedness to "many men of many minds."

Chapter I

the formation, physiology and psychology of the child's nervous system

Anatomy — Formation of Nerve Cells and Nerves — The Brain — ^The Spinal Cord — ^The Nerves. Physiology — ^The Function of the Neurons — ^The Function of the Brain — ^The Function of the Spinal Cord — ^The Function of the Nerves of Motion and Sensation — ^The Function of the Sympathetic Nerves. Psychology — Sensations — Perceptions — Memory — Attention — Judgment — Will — Emotions 17

Chapter II

Heredity — Specific Inheritance — Racial Characteristics — Familial Inheritance — Individual Inheritance — Disease Inheritance — Inherited Mental Caliber and Tendencies — Inherited Lack of Development — Maternal Impressions. Environment — Environmental Change of Characteristics — Environment of the Infant — Environment of the Child — Ideal Environment 28

Chapter III

the nervous and mental development of the child and its persojstality

Embryology — Infancy — Childhood — Mental Development — Education — Personality — Varieties of Personality 38

Chapter IV

Modes of Habit Forming — Influence of Inheritance on Habit — Bad Habits — Good Habits — Definition of Habit — Explanation of Habit — Correction of Bad Habits — ^The Crying and Fretting Habit — The Habit of Bed-Wetting— The Habit of Thumb-Sucking, etc. — ^The Habit of Biting the Nails— The Picking Habit— The So-Called Habit of Eye-Blinking and Grimacing — ^The Habit of Self-Abuse 47

Chapter V

Definition of Eugenics — The Necessity of Eugenics — Education of Children as to Whom They Should Marry. Sexual Hygiene — Sex As the Basis of Life — Sex Questions Traced from Birth — Sexual Shocks — What Sex Knowledge Should Be Given Children — Freud's Theory — Moral Obliquity — Abnormal Sexuality — Dreams — Certain Pathological Sexual Acts 59

Chapter VI The Cause And Prevention Of Nervousness In Children

Causes. Division into Inheritance, Environment and Acquisition — The End Result of Nervous Children — ^The Parents' Role — Habits — City Conditions — Syphilis — Acute Illnesses — In Regard to the Ductless Glands— The Pineal Gland— The Pituitary Gland— The Thyroid Gland— The

CONTENTS 9

Thymus Gland — ^The Suprarenal Glands. Prevention. Birth Injury — Clothing and Feeding — Medication — Punishment — Modesty — Sociability — Exercise — Effect of Acute Diseases — Schooling 73

Chapter VII The Training Of Nervous Children

Disposition of the Defective and Markedly Feebleminded Child — Candidates for Insanity — Toxemia — Extraneous Poisons — Hallucinations, Delusions and Illusions. The Nervous Child — Types — Environmental Misfits — The Role of the Teacher — The Role of the Physician — Difference in Training of the Boy and the Girl — Personality — Concerning Types of Personality — General Hygiene — Trained Supervision 89

Chapter VIII Defective And Feebleminded Children

Idiocy — Imbecility — Acquired Causes — Hereditary Factors — Stigmata of Degeneration — The Head — The Mouth — The Spine — ^The Pelvic Bones — The Genitals — The Eyes — Binet-Simon Test — Mental Age — Diagnosis of the Mental Age — Responsibility of Parents — Responsibilities of Communities, States and Nations 104

Chapter IX Certain Nervous And Mental Diseases Of Childhood

Brain Tumor — Brain Abscess — Brain Injury — Meningitis — Epilepsy — Little's Disease — Spinal Cord lo NERVOUS CHILDREN

Injury and Disease — Spinal Curvature — Infantile Paralysis — Friedreich's Ataxia — Erb's Paralysis or Birth Palsy — Chorea or St. Vitus' Dance — Neuralgia and Neuritis — Hysteria — Neurasthenia — Occupation Neurosis — Pseudo-Muscular Hypertrophy — Headache — ^Tetany — Diphtheritic Paralysis — Eye Defects. Paranoia — ^Tendencies Toward Paranoia in the Child — Dementia Praecox — ^Tendencies Toward Dementia Praecox — Manic-Depressive Insanity — ^Tendencies Toward Manic-Depressive Insanity 114

Chapter X

Puberty and Adolescence — Definition of Puberty — Of Adolescence — Puberty in the Male — Puberty in the Female — ^Adolescence in the Male — Adolescence in the Female — Plea for the Nervous Child 135

LIST OF ILLUSTRATIONS

facing page

Spastic Hemiplegia of the right arm and leg . . . .frontispiece

Feeble-minded girl of the imbecile class io6

Feeble-minded girl of the moron class U2

Posterior spinal curvature I20

Infantile paralysis of lower extremities 122 and 123

A case of pseudo muscular hypertrophy 128

Introduction

THE literature upon the hygiene of the nervous system during infancy and childhood is not as extensive as a subject of such peculiar importance deserves. What has been written is scattered through works on the various subjects of heredity, nervous diseases and insanity. Very recently there has been a great advance in the classification and training of feeble-minded children and in the study of the abnormal and criminal child.

Much good has also been accomplished in preventive medicine along dietetic and educational lines by those interested in the development of the bodies and minds of children. It is with hope of calling the attention of these workers, as well as others, to the necessity of careful consideration of what should be the normal nervous poise of a child, in order that they may better fit it to withstand the stress of modern life, that these chapters are written. When we contemplate that upon the development of the nervous system in the child depends most of that child's future happiness and usefulness, and possibly the peace of mind, health of body and the attainments of that child's posterity, through all the ages to come, we may appreciate the importance of its nervous hygiene. When we realize that we move and think and have our being by the action alone of our nervous system which makes our muscles contract, our brain store up memories or emit ideas and our blood circulate, we may realize the vastness of the subject with which we are dealing. We are just beginning to take a few definite steps to advance the hygiene of the nervous system in childhood at large, and we are awed at the enormous task before us, which includes a change in the whole present idea of rearing children in the home, and the rearrangement of their school and play life.

It has been said that "the education of a child begins one hundred years before its birth." I will paraphrase and say that the nervous status of the child began with civilization, or even before, and that to correct its nervous irregularities we must turn to nature for help rather than to ultra-scientific therapeutic measures. With the defect once established scientific measures are very valuable, but what we are now interested in, however, is to prevent neurotic development by the application of common sense. A child who is neurotic, whether this is inherent or acquired, needs especial management. The organic nervous diseases of childhood will be treated with chief regard to their recognition and prevention.

Chapter I The Formation, Physiology And

PSYCHOLOGY OF THE CHILD'S

NERVOUS SYSTEM

WE shall of necessity be very brief in outlining the important subjects of this chapter, referring the reader who wishes to go more deeply to the various special treatises and textbooks on anatomy, physiology and psychology. A general idea of these subjects, however, is essential before we can appreciate nervous children.

ANATOMY

Formation of Nerve Cells and Nerves. A cell contains a mass of substance known as protoplasm. This is surrounded by a cell membrane and contains a nucleus which in turn contains a nucleolus. Many cells are so small as only to be seen through a microscope. All life and growth takes place by the faculty of cells to divide and multiply. In the human being a specialized cell from the male, known as the spermatozoon, fecundates with a specialized cell of the female known as the ovum. This combined cell then divides and the divided cells grow and divide, which process is continued. As this division takes place, the cells begin to specialize and to throw out connections. Some go to make bone while others form skin, muscle, nerve tissue, and so on. The fetus is the outgrowth of the development of the cell, and the child of the fetus.

The nervous system is made up of nerve cells and their prolongations, which receive and transmit impulses. The short prolongations of a nerve cell are known as dendrons, while its more lengthy prolongation is called an axon. There may be many dendrons but only one axon to a cell. The nerve cell with all of its prolongations is known as the neuron. Groups of nerve cells are known as nerve centers. Bundles of axons are known as tracts within the brain and spinal cord, and as cranial and peripheral nerves elsewhere throughout the body. These axons end in fine terminal branches, arborizing with the dendrons of another nerve cell in the brain or spinal cord, or ending in muscle or skin in other parts of the body.

The Brain. The brain is an accumulation of neurons, the cells of which are grouped together in centers to form the gray matter and the dendrons of which form connections with other cells and centers, while bundles of axons form the nerve tracts or the white matter. These neurons are all held together by fine connective tissue.

ANATOMY 19

The brain is folded in upon itself to form lobes and convolutions, and consists of two hemispheres and a portion behind and below called the cerebellum, which is also divided into two hemispheres. The hemispheres of the brain, and also of the cerebellum, are connected together at their bases by communicating fibres. The brain is situated within the skull and is surrounded by three membranes. The center of the brain is hollow, due to its being folded in upon itself, and this open space is irregular and divided into compartments known as ventricles. These ventricles are filled with cerebro-spinal fluid, which also bathes the external brain surface. The brain structure is continued through an opening at the base of the skull to form the spinal cord and the ventricles are continued into a small opening in the center of the cord known as the central canal of the spinal cord. The brain at birth weighs about 384 grams, over 1,400 grams in the male adult and about 100 grams less in the female adult.

The Spinal Cord. The spinal cord consists of tracts of neurons continued from the brain, and of nerve cells and centers. The brain axons end in terminals in the cord, which, however, connect with the cell centers of the cord so that the nerve influence is continued. The spinal cord is also surrounded by three membranes and is situated in the bony canal of the spinal column and has the spinal canal running through its center. The spinal cord is bathed in cerebro-spinal fluid. In adult life it is

Diagram of Brain, showing approximate location of cortical brain centers.

PHYSIOLOGY 21

about 17 inches long. It ends shortly below where the last ribs join the spinal column, the distance varying according to age from about one to several inches.

The Nerves. Coming off from the brain and leading chiefly to various organs of the head and face are twelve pairs of cranial nerves. Coming off from the spinal cord are thirty-one pairs of nerves supplying the skin, muscles and other structures of our bodies. These, with their branches, are known as the peripheral nerves. Another set of nerves known as the sympathetic nerves run in ganglionated chains on the anterior aspect of the spinal cord. They also continue up into the brain. These sympathetic nerves supply blood vessels with nerves. The accumulations of nerve cells on this chain are known as ganglia. In supplying the various parts of the body, nerves divide into branches and collect together in places to form plexuses.

PHYSIOLOGY

The function of the neurons is to carry impulses to and from the brain. The sensory impulses ascend from the skin and mucous membranes through the sensory nerve fibres to the ganglia, or groups of cells, on their roots just before they enter the spinal cord, and are carried through the posterior columns of the cord by a series of neurons to their centers in the cortex of the brain, where they are appreciated as sensations. These sensory centers are connected by neurons with motor cortical cell centers. The motor centers, situated also in the cortex of the brain, send descending impulses through the anterior columns of the spinal cord by neurons whose axons by their terminals connect with cells in the anterior part of the spinal cord. Here other neurons begin which leave the cord at different levels by anterior nerve roots and form motor nerves whose axons terminate to supply motion to various muscle fibres. For instance, if we touch a hot stove with our hand an impulse travels up to the cortex of the brain through the sensory neurons where the sensation is appreciated. These sensory cortex centers are connected with the motor cells or centers which send down an impulse through the motor neurons to contract the muscles so that the hand is removed. There are other functions, such as the appreciation of the position of our limbs, the appreciation of weight by our muscle sense, etc., which are complicated and cannot here be described.

The function of the brain will only be spoken of in a few of its essentials. The anterior or front part of the brain has to do with intellectual development and here are the higher psychic centers. On the sides of the brain cortex are the centers for motion and sensation, while lower down than these are the centers for hearing, word appreciation and writing. The posterior lobes of the cortex contain the centers of vision. Most of the vital centers and centers of the cranial nerves are deep within

PHYSIOLOGY the brain near the base. The cerebellum is the chief organ of co-ordination of movement.

The function of the spinal cord is to receive through its neurons, which form its posterior columns, impulses of sensation from the body, and

Moron

Diagram of a sensory and a motor neuron, showing direction of impulses and their transmission through dendrons.

from the anterior columns, formed by the motor neurons of the brain and cord, to send out the nerve impulses of motion. The spinal cord also has certain centers which have to do with bladder and rectal control. It also has other functions more or less complicated; for instance, trophic control, which has to do with the nervous influence regulating the nutrition of parts.

The function of the nerves of sensation and motion is to supply the skin and mucous membranes with sensation and the muscles with motion and to aid in keeping up their nutrition. The function of the twelve cranial nerves is to supply the sense of sight, of smell, of taste and of hearing; to supply motion to the muscles of the face, eyes, throat and tongue; to supply sensation to these parts and through the pneumogastric nerve to supply sensation to the stomach and to regulate the heart action and respiration to some extent. One of the cranial nerves, the eleventh, helps to enable us to elevate the shoulder.

The function of the sympathetic nerves we know too little about, but we know that they have to do with the regulation of the heart, with the regulation of the tone of the blood vessels by making them contract and dilate, and that they exert an influence upon the glands and viscera of the body.

PSYCHOLOGY

Following chiefly Professor James, we will say that psychology is the explanation of consciousness; that is to say, the explanation of such things as sensations, emotions, reasonings, desires, judgments and many other attributes. It explains the things we learn as these come through our outer relation and are stored up and associated and become responsible for our thoughts and actions. As an example of a

PSYCHOLOGY 25

psychological process, a baby sees an orange and learns by degrees that It is round, has weight, is yellow, its peel is bitter, its taste is good and it is full of juice. Afterward, he desires an orange and delights in getting it. He begins to compare, and says such and such a thing is as cool and juicy as an orange, or as round as an orange, or the size and weight of an orange; in other words, he soon has knowledge of an orange.

Sensations. Various sensory nerve fibres have different functions and are only affected by certain stimuli. Thus, the optic nerve, the nerve of sight, is not affected by sound waves and we cannot hear with our eyes, nor taste with our skin nerve terminals. Practice and talent can make these special nerves more highly sensitized than in the average individual. Thus, certain people through highly organized sight and touch can engrave the Lord's Prayer on a gold dollar, others can tell different grades of tea by taste, others can distinguish sounds afar, while others who are blind can tell grades of cloth or read raised print through their touch, by what is known as perception.

Perception. When sensations are interpreted we call the result perception. For instance, in certain conditions a sensation can be felt as something, but without perception it cannot be understood, for example, as sharp or dull. Normally we can perceive that a pin Is sharp at the point and dull at the head. We can tell by perception from the feel or sight that an object is round or square or that a thing is sticky or smooth, and so on.

Sensations and perceptions are immediate and present. After they are past they are stored up in memory and become more vague. Imagination, thought and recollection may bring them up again. Many sensations and perceptions are complex ; thus, if an orange is dropped into our hand when we have our eyes closed we feel that it is round and cool and has a certain weight. This occurs through our tactile, thermal, muscular and joint senses.

Memory. Memory is the knowledge of a thing or fact which has been dormant or subconscious in our minds. When we recall and rehearse it in our minds it becomes recollection. When we take these memories and compare them, making a train of thought leading toward deductions, we are reasoning, and if these reasonings lead to discriminations we have judgment. Attention is fixing the mind, that is, our train of thoughts, on certain things. Thus we narrow our consciousness to the matter in hand. Conception is the formation in the mind of an idea or notion from facts, events and things. Imagination is the re-combination in the mind of sensations and perceptions till they appear fanciful. Thought is the act of meditation, and meditation is bringing up to consciousness mental impressions.

Will is the power of choosing with desire, volition and determination. Habit is caused by our nerve impulses going through certain pathways by association of sensations, memories, reasonings,

PSYCHOLOGY 27

judgments, will, etc. A habit once formed tends to keep up, and the effect our habits have on us in our adaptation to our environment, and on those with whom we come in contact, has much to do with our status, that is to say our limitations and capabilities. Habits may be broken, or one habit may be replaced by another, or new habits made because we are susceptible in regard to impressions on our nerves and nerve centers. We can be influenced by our own will or by the will of other people or by circumstance. However, habits may be so fixed that they diminish our attention to our performances of certain things until they become almost automatic and we are scarcely conscious of them.

An emotion is a state of mental feeling in which forms of excited sensibility are expanded and strengthened by the admixture of various peripheral or organic sensations. In other words, it is a mental feeling-complex. Most emotions may be traced to three primary emotions, fear, anger and desire. Complicated emotions may grow out of these, as terror out of fear, malice out of anger, and ambition out of desire. Many emotions are formed by a combination of these and other emotions.

In this chapter we have been very brief, and very superficial, but we have tried to lay a foundation of certain knowledge which will aid in the proper conception of some of the things to follow.

Chapter II Heredity And Environment

HOW much the attributes of our character and personality, both normal and abnormal, are due to inheritance and how much to environment is a hard question to answer. Characteristics often considered truly inherited, as, for instance, a talent for music, are so clearly affected by early association that it is difficult to say how much is inherited and how much acquired.

HEREDITY

Professor Adami says that the only conditions which are capable of being inherited are those which have told upon the nuclear material of the germ cells of either parent prior to or at the moment of fusion. Therefore, from the standpoint of histological anatomy, everything acting after this moment of fusion, that is, after the moment of conception, is considered acquired. He further divides conditions truly inherited into four classes : specific, racial, familial and individual.

Specific inheritance is shown by the law that features longest possessed by a given stock are the ones most impressed upon that stock and the least easily lost. For instance, a large, peculiarly-shaped nose may have been a characteristic of a certain family for generations. If this characteristic has been the one longest possessed by this particular family it will be the feature least easily lost.

Racial inheritance is too broad a subject to be attempted here except t6 point out that emigration modifies it to some extent, and I believe this is most true of those characteristics affecting the nervous system. For Instance, the characteristics of the Jewish race, although marked In this country, are, however, somewhat modified. This modification Is more apparent in certain changes In their personality than In their appearance. The burden of oppression being lifted, Jews are less subservient, less subject to hysteria and neurasthenia, more generous and less orthodox in their beliefs.

Familial inheritance is also a broad subject. We are all acquainted with the frequency of an hereditary similarity of form and feature. In families there is every reason to believe that this similarity may extend to the organs of the body and that the brain, liver, heart, lungs and other viscera, the bones, muscles, nerves and even the blood may be characterized more or less by this similarity. Also certain intellectual and other characteristics are, as we all know, frequently family traits.

Individual inheritance Includes, of course, all of the above classes but, at times, conditions peculiar to the parent as distinct from the family may appear in the child, and a property not observable In either parent may be seen in the child. The latter is ascribed by Adami to the interaction of the two parental germ plasms.

It is indeed fortunate that but few diseases are really inherited. These inherited diseases, or better conditions, are usually due to some malformation either gross or microscopical. For instance, a spinal cord disease known as Friedreich's ataxia is considered inherited and is due to the fact that certain cells in the spinal cord are never properly developed. Feeble-mindedness and idiocy are due to under-development or non-development of brain tissue. Even sick headaches, which are often seen in certain families, are probably due to abnormal brain cells, this abnormality being transmitted from parent to child. Apart from conditions just described, predisposition to disease may be inherited; thus a tuberculous mother may have a frail child predisposed to contract tuberculosis.

It is a well-known fact that certain diseases produce substances in the blood known as antigens or antibodies, which render the patient more or less immune. These antibodies are probably in some instances transmitted from the blood of the mother and may render the child less susceptible to certain diseases. A few diseases may be directly transferred from parent to child and the most important of these is syphilis. A syphilitic mother may have a child born with active manifestations of this disease and a syphilitic father may propagate certain toxins or poisons in the cells of the child which cause mental or physical changes in that child. It is even considered by some that the germ of syphilis itself may be transferred in this way.

Certain chronic conditions, often due to improper hygiene and nourishment in the ancestors, may give to the descendants arteries which harden early, kidneys and livers which functionate improperly and hearts in which the tone is not normal.

Mental caliber, artistic and scientific tastes and talents may be inherited, due to development of certain brain centers and convolutions. Emotional tendencies as fears, dare-devil bravery, morbid or cheerful dispositions, easily provoked laughter and tears, are probably the result of association, although an inherited instability of the nervous system may have a bearing upon most of these. It is perfectly conceivable that neurotic members of a neurotic family have inherited an underdeveloped or improperly developed nervous balance.

An inherited lack of development of the higher centers as a whole may cause such so-called functional, nervous diseases as some of the insanities, hysteria and the psycho-neuroses. Certain organic nervous diseases, as family muscular atrophy or family juvenile paralysis, are due to lack of development or premature atrophy of certain groups of cells, which lesions or anomalies, according to Adami and other authorities, are inherited. Diffuse underdevelopment of brain cells and centers may be inherited and result in such conditions as criminal tendencies, feeble-mindedness and idiocy.

Little or no attention should be paid to maternal impressions while the child is "in utero" as being the cause of maimed or deformed children. No sight, however horrible, can be impressed upon the developing fetus, as it would be entirely against all the laws of embryology and biology. Mothers who are known to have gone through the most harrowing and distressing experiences give birth to perfectly normal children, and the children born in times of massacres, wars and persecutions are as normal as those born during the "piping times of peace." When the converse is true and a monster, a maimed, a marked or a neurotic child is born of a mother who has received a shock during pregnancy, the character of which is of no consequence, the child's condition may always be ascribed to coincidence.

The taint of a bad heredity can hardly be appreciated. With its stealthy blighting hand it stigmatizes the human race for generation after generation, finding its way into every class of society, sapping the life blood of nations and putting a burden upon the fit which they are hardly able to bear. A great proportion of humanity is thus stigmatized and complete regeneration can only take place through prohibition of the marriage of defectives and the proper control of the defective classes when young. If we count back, for instance, our grandmothers for twenty-two generations, we will find that we have received an heredity influence from more than 2,000,000 females. This simply gives an idea of how closely the human race is related. Many families have been investigated in which there have occurred hundreds of defectives who have been absolutely dependent upon municipal support either as paupers or criminals, and who have cost their states millions of dollars in a few generations.

ENVIRONMENT

With the above brief insight into heredity we may approach the influence of environment in the development of the nervous characteristics of the child. Bearing the nervous system especially in mind, we may be led to believe that a nervous child born of a neurotic family, may, by change of environment, or what amounts to the same thing as far as the child is concerned, by bettering its environment, become less nervous. It is probable that a new-born babe of Norway if taken away from its parents to live in Italy would modify many of its inherited traits in this new environment. Just as the fair skin would become darker, the stolid bearing would tend to become flexible; thriftiness would probably be lost and it would become more emotional, more artistic, more graceful, more easily excited and perchance more neurotic.

A child comes into the world with its plans for existence drawn by heredity; in the dry dock of environment it assumes certain characteristics and these depend much upon the material used and the influence of the builders. A ship built in Japan by the same plan of one built in England would contain different wood, steel and even paint. In other words, although the same plan was followed, some Japanese characteristics would be worked into it. The fitness of the ship might be further altered by the builders of either country putting in here and there a bad piece of material or even wilfully destroying or changing some of the specifications of the plan, all of which would affect its sea-worthiness. So, with the child, disease might destroy a part of its fitness, gnarled and warped ideas imbued from those in charge of its rearing might change its plan and an individual destined by nature to battie with the storms and stand the stress of life may, because of environmental circumstance and influence, be rendered unfit.