2. Laryngismus stridulus (croup spasm).

3. Ch.o.r.ea.

K. Bronchi.

1. Asthma.

2. Bronchorrhoea (excessive secretion).

L. Bladder.

1. Incontinence.

2. Retention.

M. Urethra.

1. Spasmodic stricture.

N. Uterus.

1. Neuralgias.

2. Spasms.

O. v.a.g.i.n.a.

1. Vaginismus (painful spasm).

P. Heart.

1. Ch.o.r.ea.

2. Disturbance of rate.

3. Disturbance of rhythm.

Q. Secretory organs.

1. Decrease of secretion.

2. Modification of composition of secretion.

R. Absorptive organs.

S. Elaborative organs.

T. Respiratory organs. Other than those cited.

U. Excretory organs.

V. Reproductory organs.

Those of the genital organs only exist in precocious childhood, while still others occur, some occasionally, some very frequently.

Of the psychic neuroses, perhaps the commonest are the night terrors, which occur in ill-nourished children with great frequency. Hyperesthesia (or increased sensitiveness) is a starvation neurosis occurring especially in unrecognised scurvy. Variations of temperature, both increased and subnormal, occur in children suffering from evident in-nutrition.

Of the starvation neuroses, the commonest are muscular convulsions.

Naturally enough, any muscle or any group of muscles may be affected, and the manifestations may present all the varieties of convulsive movements to which muscles are liable. Probably no child whose nutrition is perfect ever has general convulsions except as the result of actual brain disease or at the onset of some infectious process where the convulsion takes the place of the initial chill of the adult. The so-called reflex convulsions occur only in children whose nutrition is below par. In a rickety child the slight irritation produced by an erupting tooth may be sufficient to weaken the mechanism which checks explosive action, just as in the same child it may be the determining cause of bronchorrhoea. In the healthy child teething can cause no such effect. Both these manifestations, the convulsions and the bronchorrhoea, are starvation neuroses. In such children many other trivial conditions may weaken the controlling mechanism.

In older children ch.o.r.ea, whatever be its cause, is evidently connected with the developmental process. The beneficial effects in ch.o.r.ea of absolute rest in bed and forced feeding are a matter of common observation. Dysphagia as a neurosis in children is uncommon. Vomiting and diarrhoea occur so frequently in infants from a wide variety of causes, that it is very difficult to say when they are merely starvation neuroses.

In rickets, diarrhoea often occurs, with no adequate explanation in the conditions present in the intestinal ca.n.a.l, and which is an essential feature of the disease itself.

Laryngismus stridulus is a very common manifestation of muscular starvation neurosis. Spasmodic asthma occurs in ill-nourished children.

Incontinence of urine in older children is often a starvation neurosis.

The younger the child the more rapid are its processes of growth. Hence in infants the results of defective nutrition are quickly manifested, and the curative effects of food arranged to supply the nutritive deficiencies also become apparent very soon. In older children with more stable tissues a defective food supply is longer borne without apparent effect; but, on the other hand, the beneficial effect of an antidotal diet becomes apparent only after a prolonged use.

The relatively simple diet of the infant makes it easy to discover the particular kind of food which is supplied in sufficient quant.i.ty, and makes the supply of the deficiency comparatively easy. But in older children with a more varied diet the defect is less readily discovered and less readily supplied.

The effects of climate, soil, and food in the production of degeneracy are first shown in the causation of general loss of nerve tone in the ancestor, often with special local expressions. This loss of nerve tone may show itself in the offspring by any type of degeneracy from nutritive defect to loss of moral tone.

CHAPTER IX

SCHOOL STRAIN

Like all factors of degeneracy, school strain evinces itself in a systemic nervous exhaustion manifest along lines of least resistance, as in the neuroses of Christopher. The first types of his neuroses are due to overstrain of certain territories related with memory, as contrasted with diminished use of the a.s.sociation fibres connecting these. As Schopenhauer has excellently observed, man is one-third intellect and two-thirds will, and much of this last two-thirds is the result of training. Capacity for training may be greater in one individual than another, because of inherited or congenital deficiencies. It is, as Sully[180] remarks, "a happy circ.u.mstance in healthy children that that most prolific excitant of fear, the presentation of something new and uncanny, is also provocative of curiosity, with its impulse to look and examine. A very tiny child, on first making acquaintance with some form of physical pain, as a b.u.mp on the head, will deliberately repeat the experience by knocking his head against something as if experimenting and watching the effect. A clearer case of curiosity overpowering fear is that of a child who, after pulling the tail of a cat in a bush and getting scratched, proceeded to dive into the bush again. Still more interesting here are gradual transitions from actual fear, before the new and strange, to bold inspection. The child who was frightened by her j.a.panese doll insisted on seeing it every day. The behaviour of one of these small persons on the arrival at the house of a strange dog, of a dark foreigner or some other startling novelty is a pretty and amusing sight. The first overpowering timidity, the shrinking back to the mother's breast, followed by curious peers, then by bolder outstretchings of head and arms, mark the stage by which curiosity and interest gain on fear, and finally leave it far behind. Very soon the small, timorous creatures will grow into bold adventurers. They will make playthings of the alarming animals and of the alarming shadows too. Later on still perhaps they will love nothing so much as to probe the awful mysteries of gunpowder."

In degenerate children, because of deficiencies of proper inter-a.s.sociation of the memory territories in the brain, healthy curiosity, and the instinct of sheltering are deficient, so that states of uncertainty, producing terror, result. These become permanent in after life, even when training as an adult is strongly antagonistic to them.

This is ill.u.s.trated, as Harriet C. B. Alexander has shown,[181] in George Eliot, who during childhood "suffered from a low general state of health and great susceptibility to terror at night, and the liability to have all her soul become a quivering fear," which remained during life. She had periods of depression and vertex headache, which latter gave place to sick headache, often attended with rheumatoid phenomena. "She was an awkward girl, reserved and serious far beyond her years, but observant, and addicted to the habit of sitting in corners and watching her elders."

Fear of the unknown in childhood, seemingly a reversion to the fear of the unknown of savages, tends, like it, to produce occult belief. Despite the German rationalism of George Eliot, such fear found utterance in her _Behind the Veil_, a mystically occult contrast with her novels and with the positivism which was her religion. Theoretically the philosophy of George Eliot should have destroyed much mysticism, yet as a survival of "night terrors" it came to the surface. A very vivid autobiographical narrative of night-terrors and similar nervous phenomena in the childhood of a distinguished man of letters will be found in Horatio Brown's _Life of John Addington Symonds_.

School over-pressure in certain respects checks, even in well-developed minds, the transition from the terror of the unknown of childhood into the calm of maturity. Morbid fears, imperative conceptions, and imperative acts which torture the individual during an otherwise healthy career unquestionably originate in the early periods of life.

Degenerate children, as Kiernan[182] remarks, early manifest decided neurotic excitability, and tend to neuroses at physiologic crises like the first and second dent.i.tion, and the onset and close of p.u.b.erty. Slight physical or mental perturbation is followed by sleeplessness, delirium, hallucinations, &c. Hyperaesthesia and excessive reaction to pleasant or offensive impressions exist. Vasomotor instability is present, pallor, blushing, palpitations or pre-cardial anxiety result from trivial moral or physical excitants. There is no precocity or aberration of the s.e.xual instinct. The disposition is irritable. The gra.s.shopper is a burden.

Psychic pain arises from the most trivial cause, and finds expression in emotional outbursts. Sympathies and antipathies are equally intense. The mental life swings between periods of exaltation and depression, alternating with brief epochs of healthy indifference. Egotism is supreme, and morality absent or perverted. This absence or perversion is often concealed under the guise of moral superiority, religiosity, or cant.

Vanity and jealous suspiciousness are common. The intellect and temper are exceedingly irregular. Monotonously feeble, scanty ideation pa.s.ses readily into seeming brilliance, even to the extent of hallucinations. But ideas are barren as a rule, because generated so rapidly as to destroy each other ere they pa.s.s into action. Energy fails ere aught can be completed.

The inability to distinguish between desires and facts produces seeming mendacity. The will in its apparent exuberance, its capricious energy, and innate futility, matches and distorts the one-sided talent or whimsical genius which may exist. The whole of this mental state may not be present.

The tendency to introspection, to morbid fear, to gloom, to hallucinations, to alternations of depression and exaltation, may occur in a degenerate child in whom has been otherwise preserved that secondary ego which is the latest and greatest acquirement of the race.

In the same cla.s.s, according to George Parkman,[183] an American alienist of more than eighty years ago, brilliant talents, astonishing facility of receiving and communicating ideas often appear suddenly at p.u.b.erty, especially in females, to be later followed by mediocrity, disappointment, and supineness.

These degenerate children have a tendency, as C. F. Folsom[184] remarks, to manifest aberrant tendencies at the periods of stress, which may, in Folsom's judgment, be congenital, or due to early interference with normal brain development. These show themselves in childhood and infancy by irregularity or disturbed sleep, irritability, apprehension, strange ideas, great sensitiveness to external impressions, high temperature, delirium or convulsions from slight causes, disagreeable dreams and visions, romancing, intense feeling, periodic headache, muscular twitching, capricious appet.i.te, and great intolerance of stimulants and narcotics. At p.u.b.erty developmental anomalies, and not infrequently perverted s.e.xual instincts, are observed in both s.e.xes. During adolescence there is often excessive shyness or bravado, always introspection and self-consciousness, and sometimes abeyance or absence of the s.e.xual instinct, which, however, is frequently of extraordinary intensity. The imitative and imaginative faculties may be quick. The affections or emotions are vehement but shallow. Vehement dislikes are formed, and intense personal attachments result in extraordinary friendships, which not seldom swing around suddenly into bitter enmity or indifference. The pa.s.sions are unduly a force in the character, which lacks will power. The individual's higher brain centres are not well inhibited, and he dashes about like a ship without a rudder, fairly well if the winds be fair and the seas be calm, but dependent on the elements for the character and the time of the final wreck. Invention, poetry, music, artistic taste, philanthropy, intensity, and originality, are sometimes of a higher order among these persons, but desultory, half-finished work and shiftlessness are much more common. With many of them concentrated, sustained effort, and attempts to keep them to it are impossible. Their common-sense perception of the relations of life, executive or business faculty and judgment are seldom well developed. The memory is now and then extraordinary. They are apt to be self-conscious, egotistic, and morbidly conscious. They easily become victims of insomnia, neurasthenia, hypochondria, neuroticism, hysteria, or insanity. They offend against the proprieties of life and commit crime with less cause or provocation than other persons. While many of them are among the most gifted and attractive people in their community, the majority are otherwise, and possess an uncommon capacity for making fools of themselves, and of being a nuisance to their friends and of little use to the world.

These conditions occur from heredity in degenerates, but, as Francis Warner[185] remarks, while "it is very common to see disordered conditions of the nervous system in children with defective construction of body, these nerve disturbances may also be seen in children with normal construction of body. Such signs result from the disorder, produced by special circ.u.mstances, aiding as well as producing defect which results from, or in the next generation becomes, defect in original construction.

Among the signs of fatigue in children is the slight amount of force expended in movement, often with asymmetry of balance in the body. The fatigued centres may be unequally exhausted; spontaneous finger twitches like those of younger children may be seen, and slight movements may be excited by noises. The head is often held on one side. The arms when extended are not held horizontally. Usually the left is lower. The face is no evidence of bodily nutrition. It may be well nourished, yet the body be thin. Three per cent. of the children seen in school are below par in nutrition. These children are of lower general const.i.tutional power. They tend to an ill-nourished condition under the stress of life, and many cases of mental excitement which, while they render them sharper mentally, militate against general nutrition."

Colin A. Scott has found corroborative evidences of similar effects of strain in the children of the New England and Illinois schools.

These systemic nervous exhaustions may, as W. S. Christopher, of Chicago, has shown (in remarks on neuroses already cited), take unexpected local directions, especially involving, in accordance with the general law of reversal, evolution or degeneracy checks on excessive action. Among the conditions produced by school strain of serious consequence in after-life are headaches, usually charged to anaemia or neurasthenia. These headaches, as Sachs,[186] of New York, has shown, usually appear after emotional excitement or fatiguing ordeal. There are other symptoms expressive of neurasthenia, such as slight tremor of the tongue and fingers and exaggeration of the deep reflexes, but, above all, the very persistent vertex headache, and the child's description of pressure or heat there. In children emotional conditions, school strain, rivalry between cla.s.s-mates, are as liable to produce neurasthenia as are the more serious struggles for existence in later life. These headaches may pa.s.s very readily at periods of stress into migraine. The vertigo characteristic of migraine is not rarely found in the neurasthenic headache of childhood. What is true of migraine is also true of epilepsy. The tremors, &c., accompanying neurasthenic headache become the convulsions of epilepsy. G. B. Fowler reports a case emphasising very clearly the position of Christopher. It was that of a seven-year-old boy of mushroom growth and hothouse culture.

He began every day before breakfast with an hour at Spanish, and until three in the afternoon was unceasingly occupied with French, German, music, and the ordinary school curriculum. This policy, initiated four years before, the pressure being gradually increased, had been maintained almost without interruption. The child had consequently developed into a sort of phonograph, capable of starting automatic expressions which afforded much entertainment to visitors, and gave the ambitious father great hope and comfort. Under such conditions it is not to be wondered at that something gave way, and, fortunately for the brain, it was the sphincter of the a.n.u.s. When this deplorable occurrence first took place the child was sharply reprimanded; the accident repeating itself, however, two or three times weekly, and later about once a day, more p.r.o.nounced measures were inst.i.tuted. The boy was often severely flogged, deprived of liberty, luxuries, &c., yet without avail. The lower bowel was perfectly normal. The sphincter was tight, grasped the finger with the usual firmness, and there were no sources of irritation about the a.n.u.s. The abnormal conditions under which the child had been living very naturally at the outset were the cause of the difficulty. Cessation of the punishment and release from books was ordered. The result was satisfactory. In three weeks the involuntary discharge became gradually less frequent, and finally ceased altogether.

Mental strain produces precisely similar effects on the nerve control of the stomach. All types of nervous disturbances of the stomach--merycism (cud-chewing), bulimia (ox appet.i.te), acoria (incapacity for getting enough)--result, as Ewald[187] has shown, from nerve strain, and increase this through auto-intoxication.

The sphincter of bladder often gives way, and is a very frequent expression of nervous exhaustion in the child, often increased by the effects of nerve strain on the kidneys, which do their work of purification imperfectly, while excreting nearly pure water. The enormous quant.i.ty of clear urine pa.s.sed during worry is a generally recognised expression of such strain. This nerve-strain interference with the purifying work of the kidneys leads to increased strain on the liver and other glands, whence result migraine, the uric acid states, rheumatisms, and the other perversions of nutrition. Nerve-strain on either liver, bowel, or other glands, has similar secondary effects on the kidneys. In part this is an organ degeneracy in function whereby man's liver and kidneys do the work of the sauropsidal liver and kidneys.

Among the nutritive disturbances resulting from nerve-strain is the fatty anaemia of Weir Mitch.e.l.l, the juvenile obesity of Fere and others. This is generally a.s.sociated with the uric acid states which so often result from school strain. The apparent improvement shown in increased weight leads to increased strain, and many of these fat victims of school over-pressure enter insane hospitals as p.u.b.erty lunatics.