A text-book on hygiene and pediatrics from a chiropractic standpoint

THE BABY

Chiropractic has nothing to do with obstetrics, but the chiropractor should be informed on the subject of child hygiene. It must be remembered that our idea is not to substitute here for the services of the obstetrician, a food diet for the infant when the mother is unable to nurse her child. The proper application of Chiropractic will eventually enable the mother, who might otherwise be unable to do so, to nurse her baby.

The child is the most helpless of the animal kingdom and requires special attention. This must come through the observation of Nature’s laws and an educated adaptation by means of substituting the educated mind of the adult for that of the infant.

Feeding

The child that is normal will give little trouble since Nature has made provision for all processes necessary to maintain the normal functions of the body. In order that these processes be maintained it is necessary to have food, proper environment, and sufficient exercise. When the mother is able to nurse the babe the problem of nourishment is solved. If the mother is unable to nurse the child and if the condition which makes this impossible is of such long standing that adjustments will not get results on the mother within the nursing period of her child, then the question of baby food should be left to the obstetrician who can prescribe the proper diet.

If the child has difficulty in digesting the food, adjustments should be given to enable Innate to bring about the proper adaptation. The bottle fed baby will require more care than the breast fed baby. Special care must be exercised to keep the bottles and other receptacles in a proper sanitary condition. This can be done by boiling them. Great care must be taken that the nipples used on the bottle are not allowed to become sour and otherwise unhygienic.

Cows’ milk may be used for bottle fed babies, but the most rigid sanitary measures should be used in producing and delivering the milk. There are many baby foods on the market, but the prescribing of food for the bottle-fed baby does not come within the scope of the chiropractor. This should be left to the obstetrician who has specialized in this work. It is not within the scope of Chiropractic to prescribe the kind of food that a bottle-fed baby needs, but the chiropractor must realize the importance of the right kind of food and the necessity for a proper innate adaptation to the kind of food given. Proper feeding is necessary for normal development, although it alone will not insure proper growth and development. The digestive organs must work normally and there must be proper coördinate action between the glands of the body. For this proper balance to be maintained there must be a normal transmission of mental impulses to all parts of the body.

The child that is getting a properly balanced ration and still is not developing normally should receive immediate attention at the hands of a competent chiropractor. No phase of the chiropractor’s work brings such gratifying results as the care of infants and babies, yet in no other phase will he find so much to baffle him. If the child is unable to digest the food then adjustments should be given.

Sleep

The infant requires much sleep and for the first two or three days this sleep will be very deep. The ordeal of labor is very trying on the infant and in cases involving great labor difficulty the first sleep of the infant may be so profound that it may appear to be coma. This may last for several hours, but if there are no convulsions or contractures there is no occasion for alarm; otherwise, this might indicate an incoördination in the brain.

After this first deep sleep, and especially after the first month, the infant will not sleep so soundly, although the sleep will be quiet. The deep, heavy sleep of childhood will be observed after the second or third year. The healthy infant sleeps almost all the time during the first few weeks, usually from twenty to twenty-two hours out of twenty-four. After that and for the first six or eight months, he sleeps from sixteen to eighteen hours out of the twenty-four. The healthy infant a few weeks old will awaken only when disturbed or when hungry. A child one year of age should have at least fourteen hours of sleep and more would not be excessive. This sleep should be taken about twelve hours at night and the balance during the day. A child two years of age requires about the same amount. At four years, eleven to twelve hours may be sufficient. Up to six years of age the child should take a daily nap. Ten to eleven hours’ sleep is considered sufficient from the age of six to ten years. The youth up to sixteen or seventeen years of age should have not less than nine hours of sleep and even more will not be excessive.

The nervous mechanism of the infant is a very delicate organization and often the fond parents do the child an injustice by not giving due consideration to the environment surrounding him the first year of life. The greatest development of the brain takes place during the first two years. To have the proper development of the nervous system there must be a quiet environment and the elimination of anything that will excite the child or tend to create nervousness. If the child is unduly susceptible to noise and is irritable and nervous, cries out or is too easily startled, there is a cause for this and a very careful analysis should be given and the causative subluxations found and adjusted immediately. The nervousness may be due to some disorder such as gastric, intestinal indigestion, poor elimination or directly to a cervical subluxation.

Playing violently with the young child should not be indulged in. It is a common failing of parents to want the baby to make a good appearance and therefore he is often stimulated to laughter by means that are detrimental to his health. This should not be done.

Exercise

The need for exercise is quite apparent and this need is as great in the infant as in the adult. Proper exercise is important from the standpoint of hygiene and we will readily realize this when we observe the provisions which have been made in Nature to take care of this very important process. The child gets his exercise from the natural instincts in his nature to run and play. His curiosity performs an important function in this respect. This keeps him running about to investigate the things about him. This takes care of the child that is thrown in a natural environment where there is plenty of room for him to run and play indoors and out, but it does not take care of the infant and the child in the city or apartment who gets the proper amount of exercise only where there is special provision made for it.

The infant gets his exercise by kicking, therefore the clothing should not be too tight. If it is, it prevents this natural exercise which is an adaptation on the part of Innate Intelligence. It is advisable to place the nude baby on his back for a few minutes at a time, preferably following the bath. In this way he can kick to his heart’s content. Crying is another means of exercise open to the child. The lusty cry of the infant is an advantage enabling the expansion of the lungs and the exercising of the abdominal muscles, the diaphragm and other structures that would otherwise get very little exercise. Of course attention must be given the crying child to see that there is nothing wrong. The crying may be the result of pain or discomfort from the clothing, but it does not take a mother or nurse long to recognize the different cries.

The child gets a certain amount of exercise from the handling which he receives. A child that is left in the crib and does not get the proper handling will be fretful and will not do well. Of course the infant must not be handled roughly and at no time should he be disturbed from sleep. The child who is given opportunity to exert himself and who receives the proper exercise through handling will relish his milk, digestion will be normal, other things being equal, and in every way he will present a more healthful appearance.

Children old enough to creep will get a sufficient amount of exercise in this way. Precautions must be taken, however, that the child is not allowed to remain on the floor when there are drafts or when the floor is cold as it is likely to be in winter in homes that are not provided with furnace heat. It must be remembered that the child is very curious and is likely to get hurt unless properly protected. He should not be restrained in creeping and he should be permitted to spend some time romping on the floor each day. Children should not be encouraged to stand when too young since the weight of the body tends to produce bow-legs.

Outdoor exercise should be provided for the children at an early age. This should include every sort of exercise and play. It is an advantage to have systematic games, for this not only gives a regular amount of exercise but also has an influence on the mind of the child which will aid in forming regular and systematic habits of thought and action. In early childhood there need be no difference in the exercise of the two sexes. It is necessary only to regulate the amount of exertion for the more delicate children. In this respect competitive games may tend to stimulate children to play too hard in an effort to win. Especially is the delicate child likely to overdo since no child likes for other children to know that he is not as physically fit as his playmates. There are no objections from a hygienic standpoint, for the exercise to be sufficiently strenuous to produce muscular fatigue, but it must never be so strenuous or so prolonged as to produce muscular exhaustion. The exercise should develop all parts of the body. In this way there will be a symmetrical body development.

Playroom

In stormy weather and in winter time when children can not get outdoors they should get exercise indoors. In practically every home a room could be fitted up as a playroom or nursery. It need not be elaborate and could be a bedroom used for a playroom during the day. This room should be well lighted and not kept too warm. The right temperature is about 55° F. Since an abundance of light is necessary the room should not be on the north, for the direct rays of the sun are to be desired and some provision should be made to admit them. All drafts must be avoided, yet a sufficient amount of air must be admitted so as to prevent the air from becoming vitiated. The best method of accomplishing this is by means of ventilators placed in the windows. Occasionally the doors and windows should be opened and the room thoroughly aired. This should be done while the children are absent from the room.

The furniture in the playroom should be substantial and of such a character that it can easily be cleaned and kept in a sanitary condition.

Sleeping Rooms or Nurseries

When it is possible in a home a room should be set aside for the nursery. This room should be well lighted, properly ventilated, and the heat and humidity should be carefully regulated. This room is to be the chief home of the infant for the first few months. Therefore it should meet the needs of the infant. It should receive the direct rays of the sun during the day. No processes, such as preparation of food, or washing of diapers, for example, should be permitted in this room. As far as possible gas plates, heaters, or gas lights should be avoided.

The nursery should not be kept too warm. A temperature of 70° F. is proper during the day. During the first few weeks it should not be allowed to drop below 65° F. through the night. For children over two months of age the temperature during the night may go as low as 60° F. but not below 50° F.

It is more sanitary for the infant to have a separate bed. Both mother and babe will rest better and there will not be the tendency for the baby to nurse too frequently during the night. The infant should be placed in a crib without rockers. A basket or bassinet is very convenient and sanitary. The sides of the bassinet may be lined and this will prevent drafts and assist materially in keeping the baby warm. The pillow should be small and soft. It is advisable to change the position of the child occasionally while sleeping. It must be remembered that the child is unable to turn should he become cramped or should he become tired from lying in one position. The average mother knows how to take care of her child in a general way and nurses have had special training in this respect, but these simple necessities should not be beneath the notice of the chiropractor. Especially is this of importance in determining the cause of irritability in the infant. Attention must be given to skin irritation, especially resulting from carelessness in the changing of the diaper and in keeping the body of the child otherwise clean. It is not, however, the intention of the author to present in this text complete instruction in the care of infants except from the general viewpoint of hygiene. The chiropractor is not to be a nurse, but he must know the rules of hygiene since there are many conditions of infancy which result from a violation of these rules.

After the first week or two the infant should be taken out of doors if it is in the summer. The open air is healthful for the young children and they should be kept outdoors a part of each day. The eyes must be protected from the sun and the head from the wind. The child, of course, should be properly dressed for out of doors. At first the child must be kept out only a few minutes, since sufficient time must be allowed for adaptation to take place, or in other words, for the child to become accustomed to the change. Before children are taken out the first time it is well to get them accustomed to the change by opening the doors and windows of the room that there may be a gradual cooling of the temperature. The child born in the fall or winter must not be deprived of fresh air even though the weather will not permit the outside airing. The child may be dressed as for an outdoor airing, then the doors and windows opened. Great care must be exercised or the child will take cold.

Control of Bowels and Bladder

While the chiropractor will have little if anything to do in advising mothers how to train their children to answer the “call of Nature,” yet he should be familiar with methods that are suggested for such training and certainly he should recognize the importance from a hygienic standpoint of such regular habits. It might be stated here that the normal movement of the young infant’s bowels should be at least twice a day.

At a very early age children learn to evacuate the bowels when placed upon a nursery chair. This requires a great deal of patience and regularity on the part of the mother or nurse. Even at the early age of three months the child may be trained to such a degree that the napkin will seldom be soiled from the movements of the bowels. This saves an enormous amount of work and certainly is more pleasant for the child, and much more sanitary. There is, however, another advantage having the young child form this regular habit; it is very probable that a habit formed this early will be followed the entire life, and thus the tendency for the educated mind to neglect this very important innate function will be averted. The best time to place the child upon the nursery chair is immediately following feeding.

Training the child to empty the bladder at stated times is more difficult, although with patient and intelligent effort this may be accomplished. Many children at the age of one year are able to indicate when they desire to empty the bladder. This adds materially to the comfort of the child and certainly makes it very much easier to care for him. Some mothers are able to dispense with the diapers during the day by the time the child is a year old and some even at an earlier age. If there is no special effort put forth to train the child in this respect it will be necessary to keep him in diapers as late as two and a half years. After this age the child should have no difficulty in holding the urine during the night. If there is such difficulty adjustments should be given to correct the cause for the nocturnal enuresis.

Growth and Development

Since growth of the child is the best evidence of health, some attention should be given it and should there be any arrest in development the cause should be carefully determined. Arrested progress always indicates that something is wrong and therefore adjustments are needed. Although normal growth does not prove perfect health by any means, yet if the child is not growing and properly developing he is not enjoying proper health.

Weight

From observation made of a great number of cases by authorities the average weight for girls at birth is a little over seven pounds, while that of boys is about seven and a half pounds. Some weigh more, some less. There is a loss of weight the first three days, this being greatest the first day. After the third day the child begins gradually to increase in weight and by the tenth day will have gained all that was lost the first three days, reaching the birth-weight about the tenth day. The artificially fed babies gain more slowly, even though they may be perfectly healthy and vigorous. The greatest increase that is made in the weight of children the first year is during the first three months. Normally the average child will gain from five to six ounces each week during the first six months, but only about half this much the second six months. The data given here must be considered only as an average, no standard can be set, but the variation must be within certain limits, otherwise it will be indicative of abnormality.

During the first two years the weight of children is considered with reference to age, but after this it is studied with relation to height. This latter method is much more accurate. The age, however, must always enter into the consideration, for of two children of the same height but of different ages the older should be the heavier. There is much less variation in weight with reference to height than with reference to age. Normal weight differs with different individuals and is governed by various conditions so that a stated weight can not be decided upon as normal in all cases. The degree of deviation from the average weight that one may experience and still be within the normal range is a matter of opinion. If the weight of the child is more than 10% below the average for his height it is a fair indication that there is a lack of proper nutrition, either because he does not have proper food or because the tissues can not assimilate the nutrition due to interference with transmission. In a case of this kind the child should be carefully analyzed and adjusted. The disturbance may be in the digestive tract or due to an impairment in the serous circulation.

Children twelve years of age and over gain less regularly and more spasmodically. For this reason there will be a greater degree of variation at this age. The weight may fall as much at 12% below the average and still the child not be considered underweight, or as much as 20% above the average before being considered overweight. If an observation of the weight is to be of any value it must be made over a period of time. The important thing is to observe whether or not there has been a gain in weight over that period of time. Loss of weight over a period of time indicates that Innate is compelled to draw upon the physical in her processes and that there is no new material with which to replace the old. This is a warning from Innate that should be heeded. The following table will give the idea of the average weight for the given height of the child.

This table is based upon a general average taken from various authentic sources and is for the purpose of giving the chiropractor a general basis upon which to make observations in growing children. The average weight is given with relation to the average height and approximate age from the second to the sixteenth year of life inclusive.

Separate weights have not been given for boys and girls. The average weight of boys is about two pounds heavier than that of girls at the same age up to about the thirteenth year. From fourteen to sixteen years of age the average weight of girls is from three to ten pounds above that of boys. The greatest increase in the weight of girls takes place between the thirteenth and fourteenth year, while with boys this increase is between the sixteenth and seventeenth year.

The following table compiled by A. B. Hender, M. D., D. C., Ph. C., Dean of the Faculty of The Palmer School of Chiropractic, gives the average weight of the child from birth to one year of age. Dr. Hender has had years of experience as an obstetrician, and is well known to the chiropractic profession. These statistics are compiled by him from personal observation made of over 5,000 children, covering a period of over twenty-five years of active practice as an obstetrician.

Height

The same thing can be said about height as about weight of children. There is no standard, since there are so many variations to consider, but there is a general average. The average length of the infant at birth is about twenty and one-half inches. The average normal growth the first year is about nine inches. Growth in height of the child does not indicate much in the way of nutrition, since a child may grow in height and at the same time lose in weight. The greatest growth in height is made at the time of puberty. Girls begin this rapid growth about twelve years of age and will mature more rapidly than boys, since boys do not begin this rapid growth until the thirteenth or fourteenth year; but, in the fifteenth year the boys will be taller than the girls.

Growth in height is not retarded by malnutrition to the same degree as is weight. The average growth of the normal child during the second year is about four inches; for the third year a little less; for the fourth year still a little less, about three inches. Bowditch tells us that after the fifth year the average growth is about two inches a year up to the time of puberty.

THE SPECIAL SENSES

Sight

The eyes of the infant are very sensitive to the light and every effort is made by the child to avoid bright light and thus protect the eyes from glare; the eyes will innately close when a bright light is brought before them. For the protection of the infant’s eyes the room should be kept darkened for the first few weeks. A subdued light will usually attract the attention of an infant and as early as the sixth day the child may even turn the head in an effort to follow the light with the eyes.

It is not uncommon for the eyelids to remain partly separated during sleep and for the movement to be more or less irregular during the first few weeks of life. The muscles of the eyeballs do not always coördinate in their action. This often results in temporary strabismus when the infant is looking intently at an object. Perfect coördinate action is often as late as the third or fourth month.

Hearing

The hearing of the infant is very acute, although it is asserted that the child is unable to hear for the first twenty-four hours after birth. This is due to the absence of air in the middle ear. During the process of respiration air is gradually admitted to the middle ear and hearing becomes very acute, so much so that sharp noises will startle the child. For this reason the nursery should be so located that it may be as free as possible from noise. Noise is trying on the nervous system and should be avoided as far as possible. As early as two months of age the infant will turn his head in the direction of the noise.

Touch

Certain portions of the infant’s body are more sensitive than others. The tactile sensibility of the lips and tongue is highly developed. This facilitates the process of nursing. The forehead and external auditory meatus are more sensitive than other parts. This creates a necessity for protection of these parts. The child’s head should be covered, but not the face, when taken out of doors. Touch is less acute in the infant than in the older child.

The tongue of the young infant is very susceptible to temperature. He will show a dislike for the bottle if the milk is too hot or too cold.

Taste

At one time it was thought that the child at birth had no sense of taste, but now it is agreed that even at birth this sense is extremely acute. The newly born infant is unable to distinguish sweet, sour and bitter. The sucking movement is excited by the taste of sweet, some authorities believe. With bottle-fed babies a difference in the taste of the food will be quickly noticed and it is with difficulty that he can be induced to take anything that is distasteful such as sour or bitter substances. The child very early will show that he enjoys sweets.

Smell

The acuteness of this sense is not so easily determined in the infant, although there is sufficient evidence to warrant the conclusion that sense of smell exists from the beginning; however, the ability to detect different odors is not developed to any great extent until later in childhood. It is believed that the sense of smell plays an important part at the beginning in the child finding the mother’s breast.

SPEECH

The age at which the child begins to talk varies with individuals and also with circumstances and environment. Girls on the average will learn to talk earlier than boys; the average is about two months earlier. The average child begins to say such words as mamma and papa a little before one year of age. Other simple and easy words are learned until by the second year he is putting words together. How early a child learns to talk depends to a great extent upon the amount of time given him by adults in trying to teach him. The words that he learns depend largely on what is taught at the beginning. The reason for the average child learning to say papa first is largely due to the efforts of the mother who induces the child to say this word; then naturally an effort is made to get the child to say mamma and from this word attention is directed to any pets there may be in the family. Then the names of objects are learned. Verbs are usually next learned then adverbs and adjectives. Following these in order are the conjunctions, prepositions, and articles. Personal pronouns are the last to be learned.

Children who are permitted to associate with other children will usually learn to talk earlier than those who are reared alone. If the child has not learned to talk at two years of age he may be mentally deficient; or failure to talk may be the result of being deaf or some other incoördination of the vocal apparatus may exist. As soon as a child is discovered to be mute he should have immediate chiropractic attention. Many such cases are on record which show excellent results obtained through adjustments.

HEAD

The occipito-frontal measurement of the child at birth is from 13.52 inches to 13.90 inches. The most rapid growth of the head takes place during the first year. With the average child this growth is about four inches. For the first few months the growth is about half an inch per month. During the second year the circumference of the head increases only about one inch and for the next three years, about one and one-half inches. From this time until puberty, about five years, it increases only about half an inch. The head develops so rapidly so early in life that it appears to be all out of proportion for the body.

Sutures

In syphilitic infants or in premature birth, the cranial bones may be distinctly separated. This condition does not, however, necessarily prove that either exists for often subluxations are produced at the time of birth and these prevent the normal expression of Innate Intelligence in bringing about the adaptative processes necessary to close the sutures. This is an abnormal condition and should receive careful consideration at the hands of the chiropractor. Normally the main sutures ossify at about the end of the sixth month, although there may be some mobility at the end of the ninth month. If after this the sutures have not entirely ossified the child should be carefully examined for subluxations.

Fontanels

Under normal conditions the anterior fontanels should be completely closed at the age of one and a half years. If at the end of two years they have not completely closed it is abnormal and indicates cretinism, rickets or hydrocephalus. In case of hydrocephalus the sutures will be distinctly separated and the head will be enlarged. This condition may also obtain in rickets. When the fontanels are slow in closing the child should be very carefully analyzed and an effort made to find symptoms of other conditions which might be responsible for this abnormality. Most excellent results have been obtained from chiropractic adjustments in these cases. It is quite as objectionable for the fontanels to close too soon as it is for them to be too slow in closing and it may be much more serious. There are many cases on record in which the fontanels have been closed when the child was born. A case of this kind is ordinarily beyond the reach of Chiropractic. The closure of the fontanels during the first few weeks, or even at the middle of the first year, indicates microcephalus.

Normally the anterior fontanels should be completely closed about the eighteenth month, although it may be as late as the twenty-second month. In rachitic children it may be as late as the third year. In cretinism the fontanels may become very large and sometimes do not close until the eighth year. In hydrocephalus also the fontanels become very large, the head develops rapidly to an enormous size and this results in the spreading of the sutures. If these cases receive adjustments early enough in life, excellent results are obtained.

The posterior fontanel is very much smaller than the anterior and closes about the second month, normally.

Shape

In most cases the head of the infant is more or less compressed during labor. In hard labor it may be so greatly compressed that it gives the appearance of being deformed, but this apparent deformity soon disappears, usually from the third to the fifth week. Healthy children and especially good natured ones are sometimes neglected and permitted to lie in one position for such a length of time that the head becomes misshapen. Usually in such cases the child is placed on his back. This results in the flattening of the back of the head. This, however, may be easily corrected by changing the position of the child occasionally. These variations should not be mistaken for actual deformities of the head.

THORAX

The average chest measurement of the child at birth is from thirteen to thirteen and four-tenths inches; thus it is seen that at birth the circumference of the chest is about a half inch less than that of the head. The circumference of the abdomen is about equal to that of the chest. The transverse diameter is practically the same as that of the antero-posterior, but as time goes on and the child develops, the transverse diameter increases more rapidly until about ten years of age when the shape of the thorax becomes about the same as that of the adult. The diameter of the chest increases at the rate of about one inch per year until the average of thirty inches is reached at about the age of fifteen. During childhood the thorax should be carefully observed for deformities.

Subluxations in the upper dorsal region may result in faulty postures, which in turn will result in various deformities of the thorax. If this faulty posture is not corrected and the child is permitted to grow into adult life with the deformity, it can readily be seen that such deformity will become permanent. In such cases the dorsal subluxation should be adjusted early in life to overcome the faulty posture. Innate will then take care of this temporary deviation from the normal shape of the thorax. Deformities of the thorax often indicate Pott’s dis-ease, curvatures of the spine, rickets, emphysema, empyema and cardiac disturbances. In such cases a very careful analysis should be made and the subluxations adjusted to remove the cause of the condition to which the deformity is adaptative.

ABDOMEN

The abdomen of the infant is very large in comparison with its proportion in later childhood. Up to about two years of age the circumference is the same as that of the chest, after which the chest develops more rapidly and the abdomen gradually assumes the proportions of the adult. However, the abdomen remains proportionately large up to the age of puberty. Unless this fact is recognized by the practitioner, he may suspect an abnormal enlargement of the abdomen. There are conditions in which an enlargement of the abdomen is typical, such as in various intestinal disorders and especially in rickets. In rickets the abdomen becomes gradually extended and is known as pot belly, but with this there will be other symptoms of the dis-ease. If the abdomen seems abnormally large the chiropractor should carefully analyze the child to determine whether this is the result of some incoördination or whether it is simply an idiosyncrasy of the child.

WALKING

The age at which children are able to sit alone, stand and walk, varies greatly. Some infants walk as early as the tenth month, while others are as late as the eighteenth month. The average age at which children are able to walk alone is from thirteen to fifteen months. Other things being equal, the age at which a child walks has little significance. The first voluntarily directed movements of the child occur at about four months of age, sometimes a little earlier, when the child begins to make an effort to grasp objects which he sees about him.

At about four or five months of age the average child is able to hold the head erect when the body is properly supported. Between the seventh and eighth month the muscles have developed sufficiently for the child to sit erect by himself for a few minutes at a time. From this on, the child develops the sense of equilibrium very rapidly. Not later than nine months of age the child will indicate a tendency to stand and to bear the weight upon the feet. He may even be able to stand with a little assistance; then, in a very short time, if placed upon the floor he will show a tendency to pull himself up by a chair and stand alone. This is soon followed by the first steps and by the thirteenth month the child is walking alone freely.

Mechanical devices intended to assist the child in learning to walk are of little value and may be an actual detriment. If the child is normal, has the proper care and a reasonable environment, Nature will put him on his feet at the earliest possible moment without injury to the delicate structures of the body. If the child is extremely backward in learning to walk a careful analysis should be made to determine the reason. Rickets is a very common cause for backwardness in children, not only in walking but in other functions as well. If a child is backward in learning to walk he should not be urged, but the reason for this backwardness should be sought out and the cause adjusted.