Another factor of growth is

Electricity.—One of the most interesting discoveries of recent date is that of the influence of terrestrial electricity upon the growth of living organisms.

A series of experiments were made, by isolating cavies (a species of small Indian pig) from terrestrial electricity, and as a result they were found to be retarded in growth and to develop very imperfectly, much as though they had been suffering from rickets. In short, they manifested an arrest of organic development.

If, in electro-therapy, an electric current is applied to the cartilages of the long bones in children whose limbs have apparently been arrested in development, the result is a rapid increase in length, amounting to a luxuriant osteogenesis.

Since we know that the electric current can stimulate the nerve filaments and the fibres of the striped muscles when they have been rendered inactive from the effects of paresis or even of paralysis, we realise that electricity can exert an influence over the entire physiological life of an organism. We live not only upon nutriment, air, heat, and light, but also upon a mysterious, imperceptible force, that comes to us from the mother earth.

In addition to the biological potentialities which control the development of every individual, all living creatures owe something of themselves to their environment.

Space.—An empirical contention, without scientific value, but nevertheless of some interest, is that there is an ultimate relationship between the dimensions of living bodies and the territorial space, that is, the environment in which they are destined to live. In view of the innumerable varieties of living creatures, such an assertion would seem to be utterly unfounded. But as a matter of fact we see that while inorganic bodies can increase indefinitely in dimension, living creatures are limited in form and size. This fact undoubtedly has some primal connection with properties innate in corporeal life itself; in fact, in order to attain its appointed end, life requires the services of certain very small microscopic particles called cells. But the aggregations and combinations of cells in living organisms are also limited in their turn, and no matter how willingly we would attribute the greatest share of causation to biological facts, nevertheless, as always happens in life, we cannot wholly exclude environment.

Both animals and men that are bred on vast continents (Chinese, Russians) have tended to produce races of powerful and giant build: in islands, on the contrary, the men and the animals are of small size; it is sufficient merely to cite the men and the little donkeys of Sardinia, the small Irishmen who furnish jockeys for the race-track, and the small Irish horses or ponies that serve as saddle-horses for the children of the aristocracy the world over.

There is a harmony of associations, as between the container and the contained, between environment and life, notwithstanding that as yet science has not made serious investigations in regard to it.

Voltaire, in his Micromega, avails himself of this intuitive conception to create the material needed for his satire; he talks amusingly of the inhabitant of the planet Sirius, who was eight leagues in height and at four hundred years of age was still in school, while the inhabitant of Saturn was a mere pigmy in comparison, being scarcely a thousand rods tall—in fact, the inhabitants of Saturn could not be otherwise than pigmies in comparison, since Saturn is barely nine hundred times larger than the earth.

Gulliver makes use of similar standards in his Travels, which are read with so much delight by children.

Psychic Conditions.—Psychic Stimuli.—Accordingly many chemical and physical factors associated with the environment concur in aiding life in its development. From the light of the sun to the electricity of the earth, the whole environment offers its tribute to life, in order to cooperate in life's triumph. But, in the case of man, in addition to these widely different factors, there is still another distinctly human factor that we must take into consideration and that we may call the psychic stimulus of life: We may scientifically affirm the Bible statement that "man does not live by bread alone."

Without reverting to the basic physiological explanations of the emotions, as given by Lange and James, we may nevertheless assert that sensations of pleasure stimulate the renewal of bodily tissues and consequently promote health, happiness, and strength; while, on the contrary, painful events produce physiological effects depressing to the tone of the nervous system and to the metabolic activity of the tissues.

But it is precisely these metabolic phenomena that hold the key of life, and an organism in the course of evolution depends directly upon them. This problem concerns pedagogy in a very special way: when we have given food to the children in our schools, we have not yet completed our task of nourishing these children; for the phenomena of nutrition which take place in the hidden recesses of their tissues are very different from a simple intestinal transformation of aliments, and are influenced by the psychic conditions of the individual pupil.

Great workers not only need abundant nutriment, but they require at the same time a series of stimuli designed to produce "pleasure." The pleasures of life, necessary to human existence, include more than bread. In the history of social evolution there exist, side by side with the productions of labour, an entire series of enjoyments, more or less elevated, that constitute the stimului to production, and hence to evolution, and more profoundly still, to life itself.

The further man evolves and the more he produces, the more he ought to multiply and perfect his means of enjoyment.

Without stimuli, nutrition would grow less and less till it ended in death. Every-day experience in the punishment of criminals gives us proof of this. Confinement to a solitary cell is nothing else than a complete deprivation of psychic stimuli. The prisoner does not lack bread, nor air, nor shelter from the elements, nor sleep; his whole physiological life is provided for, in the strict material sense of the word. But the bare walls, the silence, the isolation from his fellow men in utter solitude, deprive the prisoner of every stimulus, visual, oral and moral.

The consequences are not merely a state of hopelessness, but a real and actual malnutrition leading to tuberculosis, to anemia, to death from atrophy. We may affirm that such a prisoner dies slowly of hunger due to defective assimilation; the solitary cell is the modern donjon, and far more cruel than the one in which Ugolino died within a few days, so much so that solitary confinement, being incompatible with life, is only of short duration.

Labour, love, and sensations apt to stimulate ideas, that is, to nourish the intelligence, are necessities of human life.

This is further proved by observations made regarding the development of puberty. Psychic stimuli may render such development precocious, and, on the contrary, their absence may retard it. Jean Jacques Rousseau relates in Émile that at Friuli he encountered young people of both sexes who were still undeveloped, although they were past the usual age and were strong and robust, and this he attributed to the fact that "owing to the simplicity of their customs, their imagination remained calm and tranquil for a longer time, causing the ferment in their blood to occur later, and consequently rendering their temperament less precocious."[27]

Recent statistical research confirms the intuitive observation of that great pedagogist; the women in the environs of Paris attain puberty nearly a year later than those who live in the city; and the same difference is observed between the country districts around Turin and those of the city itself.

All this goes to prove the fact of psychic influence upon physiological life: psychic excitation, experienced with pleasure, by developing healthy activities, aids the development of physical life.[28]

These principles must be taken under deep consideration when it comes to a question of directing the physiological growth of children. Fenelon relates a fable about a female bear who, having brought into the world an exceedingly ugly son, took the advice of a crow and licked and smoothed her cub so constantly that he finally became attractive and good-looking. This fable embodies the idea that maternal love may modify the body of the child, aiding its evolution toward a harmony of form by means of the first psychic stimuli of caresses and counsel.

Nature has implanted in the mother not only her milk, the material nourishment of her child, but also that absolutely altruistic love which transforms the soul of a woman, and creates in it moral forces hitherto unknown and unsuspected by the woman herself—just as the sweet and nourishing corpuscles of the milk were unknown to the red corpuscles of her blood. Accordingly, the nature of the human kind protects the species through the mother in two ways, which together form the complete nutrition of man: aliment and love. After a child is weaned, it obtains its aliment from its environment in more varied forms; and it also obtains from its environment a great variety of psychic stimuli, calculated not only to mould its psychic personality, but also to bring its physiological personality to its full development.

Pathological Variations.—Among the factors that may have a notable influence upon the stature are the pathological causes. Aside from those very rare occurrences that produce gigantism, it may be affirmed that pathological variations result in general in an arrest of development. In such a case it may follow that an individual of a given age will show the various characteristics of an individual of a younger age; that is, he will seem younger or more childish.

In such a case the stature has remained on a lower level than that which is normal for the given age; and this in general is the most obvious characteristic, because it is the index of the whole inclusive arrest of the physical personality. But together with the diminution of stature, various other characteristics may exist that also suggest a younger age; that is, the entire personality has been arrested in its development.

It follows, in school for example, that such pathological cases may escape the master's attention; he sees among his scholars a type that is apparently not abnormal, because it does not deviate from the common type, in fact is quite like other children; but when we inquire into its age, then the anomaly becomes evident, because the actual age of this small child is greater than his apparent age.

A principle of this sort announced in these terms is perhaps too schematic; but it will serve to establish a clear general rule that will guide us in our separate observations of a great variety of individual cases.

This form of arrested development was for the first time explained by Lasegue, who introduced into the literature of medicine or rather into nosographism, the comparative term of infantilism.

Infantilism has been extensively studied in Italy by Professor Sante de Sanctis, who has written notable treatises upon it. I have taken from his work Gli Infantilismi, the following table of fundamental characteristics necessary to constitute the infantile type.

1. Stature and physical development in general below that required by the age of the patient.
2. Retarded development or incomplete development of the sexual organs and of their functions.
3. Incomplete development of intelligence and character.

In order to recognise infantilism, it is necessary to know the dimensions and morphology of the body in their relation to the various ages, and to bear in mind that in young children sexual development either has not begun or is still incomplete.

Dimensions and Morphology of the Body at the Various Ages.—What we have already learned regarding stature will give us one test in our diagnosis of infantilism: the increase of stature and the transformations of type of stature concur in establishing the dimensions and the morphology of the body (See Stature, Types of Stature, Diagrams).

A sufferer from infantilism will have, for example at the age of eleven, a stature of 113 centimetres and a statural index of 56, while the average figures give:

Consequently, in such a case the eleven-year-old patient would have the appearance of a child of seven, not only in stature but also in the relative proportions of his body. (And if we examined him psychically, we should probably find his speech was not yet perfected, that he showed a tendency toward childish games, a mental level corresponding to the age of seven or thereabouts; in school the child would be placed in the first or second elementary grade.)

Accordingly the anthropological verdict of infantilism must not be based upon limits of measurement alone, but also upon the proportions of the body. Every age has its own morphology.

Now, such changes are found not only in the reciprocal relations between the bust and the limbs, but also between the various parts of the bust, as we shall see when we come to an analytical study of the morphology of the head, the thorax and the abdomen; the detailed anthropological examination of the individual patient will furnish us with further accompanying symptoms helpful in establishing a diagnosis. Further on we shall give a summarised table of the morphology of the body from year to year (laws of growth); and of the most notable and fundamental psychological characteristics of the different years of childhood; so that a teacher may easily derive from it at a glance a comprehensive picture that will aid in a diagnosis of the age, and hence of the arrest of development, in subjects suffering from infantilism.

Before entering upon the important question of pathogenesis in its relation to infantilism, I will reproduce a few biographic notes of infantile types, taken from various authorities:

Giulio B. was brought to the clinic because of his continued love for toys, notwithstanding his age. At seventeen and a half he retained the manners, the games and the language of a child of between ten and twelve. In appearance, he gave the impression of being between thirteen and fourteen, and was as well proportioned as a lad of that age. His stature was 1.45 meters (at thirteen the average stature is 1.40 m. and at fourteen it is 1.48 m.; while at seventeen it ought to be 1.67 m.) and his weight was 39 kilograms (at fourteen the weight is 40 k. and at seventeen it is 57 k.). His appearance was lively, intelligent, but on the whole childish. His genital organs were like those of a boy of twelve (Fig. 30). The patient understood all that was said to him, he could read, write and sing, but could not apply himself to any serious occupation; he did not read the papers, but would amuse himself by looking at pictures in illustrated books; he could play draughts, but was equally pleased when playing with children's toys. During his stay at the clinic he was several times punished for childish pranks: he filled his neighbour's chamber vessel with stones, and amused himself by making little paper boats and sailing them in the urine, etc. He was employed as a page at an all-night café; his age permitted him to perform this work forbidden to children, while his appearance rendered him fitted for the task. When questioned discreetly regarding his sexual functions, or rather his sexual incapacity, he understood at once, and expressed in a childish way his deep regret, because he had heard it said that "that was why they wouldn't let him serve in the army."

Vittorio Ch. Is twenty-two years old and looks about eight or ten. Stature 1.15 metres (average stature for the age of seven being 1.11 m.; for eight, 1.17 m.). Has no beard, nor any signs of virility; genital organs like those of a child. His intelligence is alert, but does not surpass that of a boy of ten. He speaks correctly, can read, write and sing; plays draughts, but does not disdain children's toys, and prefers looking at pictures in illustrated books to reading the daily papers. After the death of the patient, it was found, as a result of the autopsy, that the epiphyses of the long bones had not yet united with the diaphyses, and that the bones of the skull were still as soft as those of a child (Fig. 31).

Here is another case, taken from Moige:[30]

It is the case of a young working girl, presenting all the appearance of a child of twelve or fourteen; she had not yet attained puberty, although she was thirty years of age. No external sign gave evidence that she was undergoing the sexual transition that should give her womanhood. Her breasts were reduced to the mere nipple, as in infancy. Her voice was weak. This woman was hysterical and subject to frequent attacks of convulsions. Her mental condition remained infantile. She was gentle, docile, timid and apprehensive; she was destitute of coquetry or sense of shame.

Renato L.,[31] age twenty-nine; stature 1.30 m. (average stature at the age of ten, 1.28 m.; at eleven, 1.32 m.) weight, 32 kilograms (average weight, age of twelve, 31 k.). It appears from his history that he developed normally up to the age of nine, after which period an arrest of development occurred, both physical and psychic. An arrest of the genital organs dates back also to early childhood. His intelligence is that of a backward child; he has never been able to read or write, but can count up to 1000. He has never been able to learn a trade, but shows some talent for drawing.

His criminal instincts seem to be especially developed. He spends whole hours, turning over the leaves of popular illustrated novels, and whenever he comes across a picture representing a homicide or an assassination, he utters loud exclamations of delight. He has only one passion, tobacco, and only one object of adoration, Ravachol. Very violent, extremely irritable; when he is angry, he would kill someone, if, as he says, "he had the strength for it." Although, as a rule, he docilely obeys the orders given him, it is because he is "afraid of being scolded." His ideal is to be able some time to obtain refuge in the Hospice de Bicêtre.

From De Sanctis's work, Gli Infantilismi, I obtain the following data, that are very suggestive on the anthropological side, regarding a case of infantilism observed by the professor in his asylum-school for defective children, in Rome.

Vincenzo P., seven years of age. Father in good health and of good character. Mother small, thin, weak, underfed; has had nine children, of which five are living, all feeble. Vincenzo was born in due time, birth regular; had five wet-nurses; cut his teeth at the normal intervals; began to walk at the end of the second year and to speak at the end of the first. According to his mother, all went well until the fourth year. At this period, Vincenzo became very troublesome and ceased to "grow taller." Later on he was sent to the communal school, but the director of the school in the Via Ricasoli, seeing how undersized and backward he was, sent him to the Asylum-School for defective children.

In appearance the child is eurhythmic, excepting that the head appears a little too big in proportion to the rest of his body; but it is not of the hydrocephalic type (an infantile characteristic). He is slightly asymmetric, the postero-inferior portion of the right parietal bone being more depressed than that of the left (infantile plagiocephaly).

The bust is greatly developed in comparison with the lower limbs, which are unquestionably short. (The sitting stature was not taken, but this note, recorded from simple observation, reminds us of the enormous difference between the indices of stature at the age of two or three and at the age of seven: Index at two years=63; at three=62; at seven=56.)

But although we lack the index of stature, we may make use of the vital index, which is given by the proportion between the circumference of the chest and the stature, and consequently gives us an index of the morphology of the bust in its relation to the whole personality; thus we find that the vital index corresponds in the present case to that of a child of two, as is also true of the weight, so that we may deduce that the index of stature was probably about 62-63.

He shows no impairment as to external sensations; on the other hand, internal sensations, such as satiety, illness, etc., are blunted. His power of attention seems sufficient, both at play and in school and when questioned. Neither does his memory show anything abnormal. Emotionally, he is below the normal level; he says that he is afraid of thunder; occasionally he shows annoyance when disturbed; but it is equally certain that he never becomes angry, never turns pale and never blushes, as the result of any excitement. He is of an indifferent disposition and is passive in manner; he is good natured, or rather, a certain degree of apathy makes him appear so.

All things considered, his mental development may be described as that of a three-year-old child; only that he differs from children of that age in his lack of vivacity and in his complete development of articulate speech (it should be noted, in regard to the diagnosis of age made by so distinguished a psychologist as De Sanctis, that he judged the child to have a psychic development corresponding to the age of three years); while we, studying the general measurements of the body, determined that they correspond to three different ages, namely, two, three and four the average of which is precisely three; while the stature, which is the index of development of the body as a whole, corresponds almost exactly to that average of three years (0.870 m., 0.864 m.).

Pathogenesis of Infantilism.—At this point it might be asked: Why do we grow? We hide the mechanism of growth under very vague expressions: biological final causes, ontogenetic evolution, heredity. But, if we stop to think, such expressions are not greatly different from those which they have replaced: the divine purpose, creation.

In other words, a causal explanation is lacking. But positive science refuses to lose itself in the search after final causes, in which case it would become metaphysical philosophy. Nevertheless, it may pursue its investigations into the genesis of phenomena, whenever the results of experiments permit it to advance.

So it is in the case of growth; certain relatively recent discoveries in physiology have made it possible to establish relations between the development of the individual and the functions of certain little glands of "internal secretion." Now, the discovery of these relations is certainly not a causal explanation of the phenomenon of growth, but only a profounder analysis of it.

Hitherto, we have considered the organism in regard to its chief visceral functions: in speaking of macroscelia and of brachyscelia, we considered the different types in relation to the development of the organs of vegetative life and the organs of external relations: the central nervous system, the lungs, the heart, the digestive system. Our next step is to enter upon the study of certain little organs, which were still almost ignored by the anatomy and physiology of yesterday. These organs are glands which, unlike other glands (the salivary glands, the pancreas, the sudoriferous glands, etc.), are lacking in an excretory duct, through which the juices prepared for an immediate physiological purpose might be given forth; and in the absence of such excretory tubes, their product must be distributed through the lymphatic system, and hence imperceptibly conveyed throughout the whole organism.

One of these glands, the one best known, is the thyroid; but there are others, such, for example, as the thymus, situated beneath the sternum, or breast-bone, and much reduced in size in the adult; the pineal gland or hypophysis cerebri, situated at the base of the encephalon; the suprarenal capsules, little ear-shaped organs located above the kidneys. Up to a short time ago, it was not known what the functions of such glands were; some of them were regarded as atavistic survivals, because they are more developed in the lower animals than in man, and consequently were classed with the vermiform appendix as relics of organs which had served their functions in a bygone phylogenetic epoch and remain in man without any function, but on the contrary represent a danger through the local diseases that they may develop. The cerebral hypophysis was in ancient times regarded as the seat of the soul.

These glands are very small; the largest is the thyroid, which weighs between thirty and forty grams (1 to 1-3/5 oz.); the suprarenal glands weigh four grams each (about 60 grains); the hypophysis hardly attains the weight of one gram.

The importance of these glands began to be revealed when antiseptic methods rendered surgery venturesome, and the attempt was made (in 1882) to remove the thyroid gland. After a few weeks the patient operated on began to feel the effects of the absence of an organ necessary to normal life: effects that may be summed up as, extreme general debility; pains in the bones and in the head; an elastic swelling of the entire skin; enfeebled heart action, and anemia; and on the psychic side, loss of memory, taciturnity, melancholy. After the lapse of some time the patient showed such further symptoms as the shedding of the cuticle of the skin, whitening of the hair and facies cretinica.

But when Sick undertook to operate upon the thyroid of a child of ten, the deleterious effects of interrupting the above-mentioned function of the gland manifested itself in an arrest of development; at the age of twenty-eight the patient operated on by Sick was a cretin (idiotic dwarf) 1.27 metres tall (average stature at age of ten=1.28 m.). Since that time certain diseases have been recognised that call to mind the condition of patients who have undergone an operation for removal of the thyroid glands, and in which the subjects have suffered from hypothyroidea, or insufficient development of the thyroid.

Such individuals were characterised by nanism, solid edema of the skin, arrest of psychic development, and absence of development of puberty; this malady has taken its place in medical treatises under the name of myxedema; and, when serious, is accompanied by nanism and myxedematous idiocy. But in mild cases it may result in a simple myxedematous infantilism.

The other glands of internal secretion are also associated with the phenomena of growth. First in importance is the thymus which is found highly developed in the embryo and in the child at birth, and thereafter diminishes in volume, until it almost disappears after the attainment of puberty. In the psychological laboratories of Luciani, at Rome, the first experiments were conducted upon dogs, for the purpose of determining what alterations in growth would result as a consequence of the removal of the thymus. The dogs thus operated on were weak; furthermore they became atrophied, accompanied by roughness of the skin and changes in pigmentation. After this, experiments were made in the Pediatric Clinic at Padua, under the direction of Professor Cervesato, in the application of thymic organotherapy (that is, the use of animal thymus as medicine) with notable success in the case of atrophic children (infantile atrophy occurs in early infancy; this form is known popularly in Italy as the "monkey sickness." Nursing children become extremely thin, cease to grow in length, the little face becomes elongated and skeleton-like, and is frequently covered with a thick down).

Stoppato also obtained analogous results in infantile atrophy and anemia. Hence it is evident that the very rapid growth in the embryo is associated with the functional action of the thymus. And this is also true of the very rapid growth during the first years of a child's life.

The pituitary gland, or cerebral hypophysis, has also functions associated with the general nervous tone and trophism (or nourishment) of the tissues, and especially of the osseous system. There is a disease known as acromegalia (Marie's disease) which is characterised by an abnormal and inharmonic growth of the skeleton, especially in the limbs and the jaw; the hands and feet become enormously enlarged, while the jaw lengthens and thickens (an unhealthy formation on which the common people of Italy have bestowed the name of "horse sickness," because of the appearance assumed by the face). Such patients complain of general and progressive debility of their psychic activities. In such cases, an autopsy shows an alteration of the pituitary gland, often due to malignant tumors (sarcoma).

The suprarenal capsules also bear a relation to general trophism and particularly to the pigmentation of the skin. It was already noted by Cassan and Meckel that the negro races show a greater volumetric development of the suprarenal capsules; when in 1885 Addison for the first time discovered a form of disease associated with alterations of the suprarenal capsules, characterised by an intensely brown colouration of the skin (bronzed-skin disease), general debility of the nervous and muscular systems, progressive anemia and mental torpor; the malady ends in death. In the case of animals operated on for physiological experiments, not one of them has been able to survive.

Some interesting observations have been made by Zander on the connection between the development of the nervous system and the suprarenal glands. He found that there was an insufficient development of these glands in individuals having teratological (monstrous) mis-shapements of the brain, as in the case of hemicephalus (absence of one-half the brain), cyclops, etc.

There exists between all the ductless glands, or those of internal secretion, an organic sympathy: in other words, if one of them is injured the others react, frequently to the extent of assuming a vicarious (compensating) functional action.

What their functional mechanism is, that is, whether the secretions act as formative stimulants or enzymes, ferments of growth, or whether as antitoxins to the toxins elaborated by various organs in the process of regression, is a question still controverted and in any case cannot enter within the limits of our field.

It is enough for us to know that the general growth of the organism and its morphological harmony, depend not only as regards the skeleton, but equally in relation to the cutaneous system and its pigmentation, the development of the muscles, the heart, the blood, the brain, and the trophic functions of the nervous system, upon some formative and protective action of all these little glands of "internal secretion," with which are associated the psychic activities and even the life itself of each individual, as though within the embryonic crucible there must have been certain substances that acted by stimulating the genetic forces and directing the trophism of the tissues toward a predetermined morphology.

To-day it is held that even the mother's milk contains these formative principles, or enzymes, suited to stimulate the tissues of her own child in the course of their formation; consequently, it produces results which no other milk in all nature can replace.

Alterations in these glands of "internal secretion" may therefore produce an arrest of development—and, in mild cases, forms of infantilism. But the gland which in this connection is of first importance is the thyroid.

Now there is one form of arrest of the trophic rhythm of growth which may be due to hereditary causes effecting the formative glands (myxedematous infantilism), or to exceptional causes occurring in the individual himself in the course of formation, either at the moment of conception, or at some later moment, as may happen even during the period of infancy (dystrophic infantilism of various origin).

In all these cases, however, according to Hertoghe, the exceptional causes, deleterious to growth, would first of all exercise their influence upon the glands of internal secretion and especially upon the thyroid.

In order to make clear, in connection with such complex pathological problems, the cases which are important from the point of view of pedagogy and the school, let us divide them into:

Myxedematous infantilism, due to congenital insufficiency of the thyroid gland from hereditary causes, and

Dystrophic infantilism, associated with various causes deleterious to individual development—and acting secondarily upon the glands of internal secretion (syphilis, tuberculosis, alcoholism, malaria, pellagra, etc.).

Myxedematous infantilism is characterised by short stature, by excessive development of the adipose system, and by arrest of mental development (including speech). Such infantiles very frequently have a special morphology of the face, that suggests the mongol type, and characteristic malformations of the hands (little fingers atrophied). When treated with extracts of the thyroid glands of animals, they improve notably; they become thinner, they gain in stature, their mentality develops to the extent of permitting them to study and to work. Certain mongoloids treated by De Sanctis in the Asylum-School at Rome were improved to the point of being able to attend the high-school and therefore were restored to their family and to society as useful individuals—all of which are facts that are of singular importance to us as educators! Medical care working hand in hand with pedagogy may save from parasitism individual human beings who otherwise would be lost. We ought to be convinced from such evidence of the necessity of special schools for deficients, wholly separated from the elementary schools, and where medical care combined with a specially adapted pedagogic treatment may transform the school into a true "home of health and education." The plan of a "school with a prolonged schedule of hours," including two meals and a medical office, as was conceived and organised by Prof. Sante de Sanctis in Rome, has been proved to answer admirably to this social need; because without wholly removing the children from their families, and therefore without exposing them to the disadvantages of a boarding school, it provides them with all the assistance necessary to their special needs.

Dystrophic Infantilism.—Given a case of infantilism, discoverable by the teacher through the general measurements of the body and psychic examination, it is interesting to investigate the deleterious causes.

It may be the result of poisoning, as for example from alcohol. Alcohol has such a direct influence upon the arrest of development that in England jockeys are produced by making the lads drink a great deal of alcohol. Children who drink alcohol do not grow in stature, and similarly the embryo grows in a less degree when the mother indulges in alcohol during pregnancy; some Swiss women deliberately resort to this means, in order that a smaller child may lessen the pain of childbirth. But alcohol not only diminishes the stature, but destroys the harmony of the different parts; that is, in the development of the body it arrests both the volumetric and the morphological growth. Furthermore, alcohol produces in children an arrest of mental development. An acquaintance with this principle of hygiene should be looked upon by the teacher less as a piece of special knowledge than as a social duty. From the point of view of the educator, the fight against alcoholism should have no assignable limits! It would be vain for him to perfect his didactic methods in order to educate a child that drank wine or other still worse alcoholic liquors. It would be better if the efforts which he meant to dedicate to such educative work could be all turned to a propaganda directed toward the parents of such children, or toward the children themselves, to induce them to abstain from so pernicious a habit!

We may also consider in the category of poisonings certain chronic maladies which act upon the organism with special toxic (poisonous) effects. In the foremost rank of such maladies belongs

Syphilis.—This disease is ranked among the principal causes of abortion; in other words, the fœtus which results from a syphilitic conception lacks vitality, and often fails to complete the cycle of intrauterine life. But even granting that the fœtus survives and attains its complete development, the child after birth grows tardily, and very often remains an infantile. It is well known that syphilis has been transmitted to new-born infants at the time of birth, in consequence of which these infants may in turn transmit syphilis to their wet-nurses. In such cases they are really sick and need medical treatment from the hour of their birth. Just as in the adult patient, syphilis has several successive stages, an acute primary stage, with plain manifestations of hard ulcers, erythema diffused over the skin of the entire body, glandular infiltrations, etc., and then secondary and tertiary manifestations that eventually become chronic and exhibit almost imperceptible symptoms; so in the case of children, syphilis may be transmitted in various degrees of virulence. In the acute stage the result will be abortion or the child will be still-born, or else the new-born child will plainly exhibit ulcerations and erythema, but at other periods of the disease, the child may bear far less evident signs of its affliction, as for instance a special form of corrosion in the enamel of its teeth; the cervical pleiades or enlargement of certain little lymphatic glands like the beads of a rosary, distinguishable by touch in the posterior region of the neck; certain cranial malformations (prominent nodules on the parietal bones, Parrot's nodes); and in the child's whole personality an under-development in respect to its age. In cases like these the teacher's observations may be of real social value, because the child has shown no symptoms of such a nature as to cause the parents to have recourse to a physician, and it is the child's scholarship (using the word in the broad sense of the way in which the child reacts in the environment of school, the profit he derives from study, etc.) that may reveal an abnormal development to an intelligent teacher.

The first indication is a stature below what is normal at a given age. Such observations ought to be obligatory upon teachers who are in sympathy with the new ideas, for they alone can be the arbiters of the rising generations. It is being said on all sides, to be sure, with optimistic assurance that argues a deficiency of critical insight and common sense, that an adequate education of the mothers ought to enlighten all women in regard to the laws of growth in children and the abnormalities that are remediable. But of what class of mothers are we supposed to be speaking? Certainly not of the great mass of working women and illiterates! certainly not of the women who have been constrained to hard toil from childhood up, and later on condemned to abortion because of such unjust labor, while their spirit is brutalized and their memory loses even the last lingering notion of an alphabet! It will always be easier and more practical, in every way, to enlighten twenty-five thousand teachers regarding these principles than to enlighten many millions of mothers; not to mention that if we wished to enlighten these mothers in a practical way regarding the principles of the hygiene of generation, we should still have to invoke the services of that very class whose assigned task in society is precisely that of educating the masses!

The teacher can and should learn at least how to suspect the presence of hereditary syphilis in his pupils, in order to be able to invoke the aid of the physician, leaving to the latter the completion of the task, namely, the eventual cure. It is well known that iodide of potassium and its substitutes, especially if used at an early stage, can cure syphilitic children and therefore save innocent boys and girls from eventual definite arrest of development and from all the resultant human and social misery.

Another cause that is deleterious to development is

Tuberculosis.—Although it has now been demonstrated that tuberculosis is not hereditary, as an active disease—that is, we cannot inherit in our organism localised colonies of the tuberculosis bacillus, because the bacilli cannot pass through the placenta into the fœtus during the period of gestation—nevertheless a predisposition to infection from the bacillus can be inherited.

A predisposition which consists in a special form of weakened resistance of the tissues, rendering them incapable of immunity, and a skeletal formation which is distinguished by a narrowness of the chest, and a consequent smallness of lungs, which, being unable to take in sufficient air, constitute a locus minoris resistentiæ (locality of less resistance) to localisation of the bacilli. Now, since our environment is highly infected by the bacilli of tuberculosis, we must all necessarily meet with it, we must all have repeatedly received into our mouths and air passages Koch's bacilli, alive and virulent; and yet the strong organism remains immune, while the weak succumbs. Consequently those who are predisposed by heredity are almost fated to become tuberculous, and in this sense the malady presents the appearance of being truly hereditary. But such organic weakness in a child predisposed to tuberculosis is manifested not only by possible attacks of various forms of the disease localised in the glands (scrofula) or the bones, but also by a delayed development of the whole personality.

Now, the environment of school and the educative methods still in vogue in our schools, not only are not adapted to correct such a predisposition, but what is more, the school itself creates this predisposition! In fact, the sitting posture—or rather, that of stooping over the desk, to write—and the prolonged confinement in a closed environment, impede the normal development of the thorax and of all the physical powers in general. Many a work on pedagogic anthropology has already shown that the most studious scholars, the prize-winners, etc., have a wretched chest measure, and a muscular force so low as to threaten ruin to their constitutions.

Consequently, children who are predisposed to tuberculosis ought unquestionably to be removed from our schools and cared for and educated in favourable environments. While we are still impotent in the face of fatalities due to this deplorable disease, we are not ignorant of the means needed to save a predisposed child and transform him into a robust and resistant lad. Such knowledge, to be sure, was applied to mankind only as a second thought; for the first men to apply and then to teach such means of defence were the owners of cattle and the veterinaries. The owners of cattle discovered that if a calf was born of a tuberculous cow, it could be saved and become an excellent head of cattle, if only it was subjected to a very simple procedure; the calf must be removed from its mother and given over to be nursed by another cow in the open country; and it must remain in the open pastures for some time after it its weaned.

By taking similar precautions in the case of children, it has been shown that the son of a tuberculous woman, if entrusted to a wet-nurse in the open country, and brought up on an abundance of nourishing food until his sixth year in the freedom of the fields, can be made as robust as any naturally sound child. From this we get the principle of schools in the open air, or of schools in the woods, or on the sea-shore, for the benefit of weak, anemic children, predisposed to tuberculosis. Such a sojourn constitutes the "School-Sanatorium," the lack of which is so grievously felt by the parents of feeble children, and that might so easily be instituted in our mild and luxuriant peninsula, so rich in hillsides and sea-coast!

Malaria.—One of the chief causes of mortality and of biological pauperism in many regions of Italy is malaria. This scourge rages even to the very gates of Rome. The country folk of these abandoned tracts pine away in misery and at the same time in illiteracy, while their blood is impoverished by disease, and a notable percentage of the children are victims of arrested development.

These unfortunates, forgotten by civilisation, are destined to roam the fields, bearing with them, till the day of their death, a deceptive appearance of youth, and an infantile incapacity for work, an object-lesson of misery and barbarity! Among the means of fighting malaria, the spread of civilisation and the school ought to find a place. Even the quinine given freely by the government is distributed with difficulty among these unhappy people, brutalised by hunger and fever; and some message from civilisation ought to precede the remedy for the material ill. A far-sighted institution is that of Sunday classes founded by Signor Celli and his wife in the abandoned malarial districts. In these classes, the teachers from elementary schools give lessons every Sunday, spreading the principles of civic life, at the same time that they distribute quinine to the children.

If we stop to think that wherever malaria is beaten back, it means a direct conquest of fertile lands and of robust men, and hence of wealth, we must realise at once the immense importance of this sort of school and this sort of struggle, which may be compared to the ancient wars of conquest, when new territories and strong men constituted the prize of battles won, and the grandeur of the victorious nations.

Pellagra.—Pellagra is still another scourge diffused over many regions of Italy. It is well known that this disease, whose pathological etiology is still obscure, has some connection with a diet of mouldy grain. Pellagra runs a slow course, beginning almost unnoticed in the first year, with a simple cutaneous eruption, which the peasants sometimes attribute to the sun. The second year disturbances of the stomach and intestines begin, aggravated by a diet of spoiled corn; but it is usually not until the third year that pellagra reveals itself through its symptoms of great nervous derangements, with depression of muscular, psychic and sexual powers, together with melancholia, amounting to a true and special form of psychosis (insanity) leading to homicide, even of those nearest and dearest (mothers murdering their children) and to suicide.

This established cycle of the disease is not invariable. Instead of representing successive stages, these symptoms may often be regarded merely as representing the prevailing phenomena in various forms of pellagra; in any case, it constitutes a malady that runs a slow course during which the same patient is liable to many relapses. While the malady is running its course, the patients may continue their usual physiological and social life, and even reproduce themselves. So that it is not an infrequent case when we find mothers, suffering from pellagra, nursing an offspring generated in sickness and condemned to manifold forms of arrested development, both physical and mental.

Against a disease so terrible that it strikes the individual and the species, it is now a matter of common knowledge that there is an exceedingly simple remedy: it consists in a strongly nitrogenous diet (i.e. meat) and that, too, only temporarily. In fact, in the districts where the pellagra rages, various charitable organisations have been established, among others the economic kitchens for mothers, which by distributing big rations of meat effect a cure, within a few months, not only of the sick mothers but of their children as well.

The real battle against pellagra must be won through agrarian reforms: but in the meantime the local authorities could in no small degree aid the unhappy population with their counsel, by enlightening the peasants regarding the risks they run, as well as by informing them of the various forms of organised aid actually established in the neighbourhood and often unknown to the public or feared by them, because of the ignorance and prejudice with which they are profoundly imbued!

Pauperism, Denutrition, Hypertrophy.—We may define all the causes hitherto considered that are deleterious to growth, as toxical dystrophies, since not only alcohol, but the several diseases above discussed—syphilis, tuberculosis, malaria, pellagra—produce forms of chronic intoxication. But besides all these various forms of dystrophies, we may also cite cases of infantilism due purely to defective nutrition, and family poverty. Physiological misery may produce an arrest of growth in children.

But just as denutrition associated with pauperism (social misery, economic poverty, lack of nourishment) may cause an organism in course of development to arrest its processes of evolution through lack of material, the same result is equally apt to be produced by any one of a great variety of causes liable to produce organic denutrition, physiological poverty.

For example, too frequent pregnancies of the child's mother, which have resulted in impoverishing the maternal organism, causing deficiency of milk, etc.

Infant Illnesses.—In the same way, organic impoverishment is caused by certain maladies of the digestive system which impede the normal assimilation of nutritive matter: dysentery, for instance; and the effects may be still more disastrous if symptoms of this kind are accompanied by feverish conditions, as in typhus.

There are cases, however, in which the arrest of development is not to be attributed to some wasting disease, or to the denutrition resulting from it; but rather to some acute illness occurring in early childhood (pneumonia, etc.), after which the child ceased to progress in accordance with his former obviously normal development.

Anangioplastic Infantilism.—Another form of infantilism is associated with a malformation of the heart and blood-vessels, that is to say, the heart and aorta together with the entire circulatory system are of small dimensions; the calibre of the arteries is less than normal. In such a case the restriction of the entire vascular system and the scantiness of circulation of the blood constitute an impediment to the normal growth of the organism. Although in such cases the explanation of the cause of the phenomenon is purely mechanical, nevertheless such abnormality of the heart and veins is to be classed as a teratological (monstrous) malformation, determined by original anomalies of the ductless glands, similar to what is found in cases of cephalic and cerebral monstrosities.

In this form of infantilism the patient shows not only the usual fundamental characteristics already noted, but also symptoms of anemia as obstinate to all methods of treatment as chlorosis is; in addition to which they often show congenital malformations of the heart, in every way similar in their effects to valvular affections such as may result from pathological causes (chief of which are mitral and aortic stenosis, which consist of a stricture of the valves connected with the left ventricle of the heart).

Accordingly, children who show forms of mitral infantilism are inferior to their actual age not only in their whole psychosomatic appearance, but they are noticeably weak, pale and suffering from shortness of breath and disturbances of the circulation. In such cases, neither pedagogy nor hygiene can counteract the arrest of development; but it is well that the attention of teachers should be called to such cases, in order that cruel errors may be prevented, which would unconsciously do additional harm to individuals already burdened by nature with physiological wretchedness.

In conclusion: The normal growth of the organism is associated with the functional action of certain glands known as glands "of internal secretion," such as the thymus and thyroid, first of all, as well as the suprarenal capsules and the cerebral hypophysis.

This group of formative glands presides not only over the entire growth of the body, but also over the intimate modeling of its structure; so that a lesion or deficiency in any of them results not only in nanism and an arrest of mental development, but in various forms of general dystrophy.

That the organism is associated in the course of its transformations with the functional action of specific glands is shown by the development of puberty, which consists in a series of transformations of the entire organism, but is associated with the establishment of functional activity of glands that were hitherto immature: the genital glands (ovaries, testicles). These glands also are functionally in close sympathy with the entire group of formative glands: so much so that, if the glands of internal secretion are injured, the genital glands usually fail to attain normal development (infantilism). Now, the transformations which take place in the organism at the period of puberty might be produced at other periods if the functional action of the generative glands should show itself at a different epoch. That is, these transformations are not associated with the age of the organism, but with the development of specific glands. There are cases of the genital glands maturing at abnormal ages; or of local maladies that have hastened the appearance of the phenomena of puberty in children of tender years. A notable case is that described by Dr. Sacchi,[32] of a nine-year old boy, who had grown normally up to the age of five and a half, both in his physiological organism and in his psychic personality. At the age of five and a half, the child's father noticed a physical and moral alteration; the child's voice grew deeper, his character more serious, and the skeletal and muscular systems grew rapidly, while on certain portions of the body, as for example on the face, a fine down appeared. At the age of seven the child had attained a stature that was gigantic for his age; he was very diligent and studious and did not care to play with his comrades. At nine, he had a stature of 1.45 metres (the normal stature being 1.22), a weight of 44 kilograms (normal = 24); his muscles were highly developed, his powers of traction and compression being equal to those of a man; his chin was covered with a thick beard five centimetres long. When he was examined by a physician, the latter discovered a tumor in the left testicle. After an operation, the child lost his beard and regained his childish voice; his character became more timid and sensitive; he began once more to enjoy his comrades and take part in boyish games. His muscular force underwent a notable diminution.

Rickets.—It is important not to confound any of the various forms of infantilism with rickets. Rickets is a well-defined malady whose special point of attack is the osseous system in course of formation; but it leaves the nervous system and the genital system unimpaired. The sufferer from rickets may be a person of intelligence, capable of attaining the highest distinctions in art or in politics; he is normal in his genital powers, so that he is capable of normal reproduction, without, in many cases, transmitting any taint of rickets to his descendants.

Nevertheless this disease, like all constitutional maladies, occurs only in individuals who are weakly.

Among the characteristics of rickets, the one which assumes first importance is inferiority of stature in comparison with the normal man. In this connection I quote the following figures from Bonnifay:[33]

But together with diminution of stature there exist in rickets various deformities of the skeleton, especially in the bones of the cranium, in the vertebral column and in the frame of the thorax; although even the pelvis and the limbs have been known to show the characteristic deformities.

An objective knowledge of the first symptoms of rickets ought to be regarded as indispensable on the part of mistresses in children's asylums, and in any case to form an important chapter in pedagogic anthropology. For it is well known that in the early stages of rickets the child may be so guided in its growth as to save it from deformities of the skeleton, even though a definite limitation of the stature may not be prevented.

That is to say, that through the intervention of hygiene and pedagogy the rachitic child may be saved from becoming a cripple or a hunchback, and will simply remain an individual of low stature; with certain signs and proportions of the skeleton indicative of the attack through which he has passed. Even in very severe cases it is at least possible to minimize the deformity of the thorax and the curvature of the vertebral column.

The precursory signs of rickets in a child are: a characteristic muscular weakness, frequently accompanied by excessive development of adipose tissue, giving an illusory impression of abundant nutrition; delay in the development of the teeth and in locomotion, which from the very beginning may be accompanied by curvature of the long bones of the legs. The bregmatic fontanelle of the cranium closes later than at the normal period, and is larger than in normal cases, just as the entire cerebral cranium is abnormally developed in volume, while the facial portion remains small, especially in regard to the jaw bones.

One of the most salient characteristics, however, is the peculiar enlargement of the articular heads of the long bones, easily recognizable in the size of the wrists; the enlargement is also found in the extremities of the ribs, which at their points of union on each side of the sternum form a succession of little lumps, like the beads of a rosary. In conjunction with these characteristics, it is to be noted, at all ages, as appears from the figures given by Bonnifay, that there is a notable diminution of stature.

The treatment of rickets is medical and pedagogical combined. Children of this type should be removed from the public school, where the school routine might have a fatally aggravating effect upon the pathological condition of such children. In fact, gymnastics based upon marching and exercising in an erect position, together with a prolonged sitting posture, are likely to produce weaknesses of the skeleton and deformities, even where there are no symptoms of rickets!