Chapter I: Certain Principles of General Biology (5)

According to certain experiments conducted in Rome by Professor Gosio, the light of the sun has an _intensive_ effect upon life. Living creatures reared in the solar light grow and mature _earlier_, but at the same time their life is shortened; that is, the cycle of life is more intense and more precocious; conversely, in the shade the cycle of life is slower, but of longer duration. A plant matures more quickly in the sun, but its stature is lower than that of a plant in the dark, which has grown far more slowly, but has become very tall and slender and lacking in chlorophyl. Similarly, as is well known, the women in tropical countries attain a precocious puberty, while conversely those of the North attain it tardily; and this fact must be considered in relation to the influence of the sun. A life passed wholly in the sunlight would be too intense; an organism that is exposed a few hours each day to the rays of the sun is invigorated; the interchange of matter (metabolism) is augmented; all the tissues are beneficially stimulated. For this reason sun baths are employed for paralytic and idiot children, and consist in exposing the body of the child, reclining upon its bed and with its head well protected, to the direct rays of the sun for several hours a day; this treatment is found to be most efficacious in giving _tone_ to the tissues and improving the general condition of the system.

_Variations in the Growth of Stature According to the Seasons._--One proof of the beneficent influence of heat and sunlight upon the growth of the organism, is afforded by the variations in the rate of growth according to the seasons. Every individual grows more in summer than in winter. Daffner gives the following figures relative to the increase in stature according to the seasons:

----------+-------+--------------------------+--------------------
| | Stature | Increase
Number of | Age in| in centimetres | in centimetres
subjects | years+--------+-------+---------+--------------------
| | October| April | October |Winter|Summer|Entire
| | | | | | | year
----------+-------+--------+-------+---------+------+------+------
12 | 11-12 | 139.4 | 141.0 | 143.3 | 1.6 | 2.3 | 3.9
80 | 12-13 | 143.0 | 144.5 | 147.4 | 1.5 | 2.9 | 4.4
146 | 13-14 | 147.5 | 149.5 | 152.5 | 2.0 | 3.0 | 5.0
162 | 14-15 | 152.5 | 155.0 | 158.5 | 2.5 | 3.5 | 6.0
162 | 15-16 | 158.5 | 160.8 | 163.8 | 2.3 | 3.0 | 5.3
150 | 16-17 | 163.5 | 165.4 | 167.7 | 1.9 | 2.3 | 4.2
82 | 17-18 | 167.7 | 168.9 | 170.4 | 1.2 | 1.5 | 2.7
22 | 18-19 | 169.8 | 170.6 | 171.5 | 0.8 | 0.9 | 1.7
6 | 19-20 | 170.7 | 171.1 | 171.5 | 0.4 | 0.4 | 0.8
----------+-------+--------+-------+---------+------+------+------

In the "Children's Houses," I require a record of stature to be made month by month in the case of every child, the measurement being taken on the day corresponding to the day on which he was born in the month of his birth; in addition to which I keep a record of the total annual increase.

The ages of these children vary between three and four years, and they all belong to the poorer social classes.

MONTHLY AVERAGE INCREASE IN STATURE
IN THE "CHILDREN'S HOUSES"
(In millimetres)

------------------------------+-------------------------
Cold months | Warm months
---------+---------+----------+-----+------+------------
December | January | February | May | June | July
4 | 3 | 4 | 7 | 8 | 8
---------+---------+----------+-----+------+------------

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.

I have had most eloquent experience of this in the "Children's
Houses" in the San Lorenzo quarter of Rome. This is the poorest
quarter in the city, and the children are the sons and daughters of
day labourers, who consequently are often out of work; illiteracy
is even yet incredibly frequent among the adults, so much so that
in a very high percentage of cases at least one of the parents is
unable to read. In these "Children's Houses" we receive little
children between the ages of three and seven, on a time schedule
that varies between summer, from nine to five, and winter, from
nine to four.

We have never served food in the school; the little ones, all of
whom live in their own homes, with their parents, have a half
hour's recess in which to go home to luncheon. Consequently we have
not _in any way influenced their diet_.

The pedagogic methods employed, however, are of such sort as to
constitute a gradual series of psychic stimuli perfectly adapted
to the needs of childhood; the environment stimulates each pupil
individually to his rightful psychic development according to his
subjective potentiality. The children are _free_ in all their
manifestations and are treated with much cordial affection.
I believe that this is the _first time_ that this extremely
interesting pedagogic experiment has ever been made: namely, to
_sow the seed_ in the consciousness of the child, leaving free
opportunity, in the most rigorous sense, for the spontaneous
expansion of its personality, in an environment that is _calm_, and
warm with a sentiment of affection and peace.

The results achieved were _surprising_: we were obliged to remodel
our ideas regarding child psychology, because many of the so-called
instincts of childhood did not develop at all, while in place of
them unforeseen sentiments and intellectual passions made their
appearance in the primordial consciousness of these children; true
_revelations_ of the sublime greatness of the human soul! The
intellectual activity of these little children was like a spring
of water gushing from beneath the rocks that had been erroneously
piled upon their budding souls; we saw them accomplishing the
incredible feat of despising _playthings_, through their insatiable
thirst for knowledge; carefully preserving the most fragile objects
of the lesson, the tenderest plants sprouting from the earth--these
children that are reputed to be vandals by instinct! In short, they
seemed to us to represent the childhood of a human race more highly
evolved than our own; and yet they are really the same humanity,
marvelously guided and stimulated through its own natural and free
development!

But what is still more marvelous is the astonishing fact that all
these children are so much improved in their general _nutrition_ as
to present a notably different appearance from their former state,
and from the condition in which their brothers still remain. Many
weakly ones have been organically strengthened; a great many who
were lymphatic have been cured; and in general the children have
gained flesh and become ruddy to such an extent that they look
like the children of wealthy parents living in the country. No one
seeing them would believe that these were the offspring of the
illiterate lower classes!

Well, let us glance over the notes taken upon these children at the
time when they first entered the school; for the great majority,
the same note was made: need of tonics. Yet not one of them took
medicine, not one of them had a change of diet; the renewed vigour
of these children was due solely to the _complete satisfaction_
_of their psychic life_. And yet they remain in school continually
from nine till five through eleven months out of the year! One
would say that this was an excessively long schedule; yet what
is still more surprising is that during all this period the
children are continually _busy_; and even more remarkable is the
report made by many of the mothers to the effect that after their
little ones have returned home they continue to busy themselves
up to the hour of going to bed; and lastly--and this seems almost
incredible--many of the little ones are back again at school by
half past eight in the morning, tranquil, smiling, as though
blissfully anticipating the enjoyment that awaits them during the
long day! We have seen small boys become profoundly observant of
their environment, finding a spontaneous delight in new sensations.
Their stature, which we measure month by month, shows how vigorous
the physiological growth is in every one of them, but particularly
in certain ones, whose blood-supply has become excellent.

Such results of our experiments have amazed us as an unexpected
_revelation_ of nature, or, to phrase it differently, as a
_scientific discovery_. Yet we might have foreseen some part of all
this had we stopped to think how our own physical health depends
far more upon happiness and a peaceful conscience than upon that
material substance, bread!

Let us learn to know _man_, sublime in his true reality! let us
learn to know him in the tenderest little child; we have shown
by experiment that he develops _through work, through liberty,
and through love_; hitherto, in place of these, we have stifled
the splendid possibilities of his nature with irrational toys,
with the slavery of discipline, with contempt for his spontaneous
manifestations. Man lives for the purpose of learning, loving and
producing, from his earliest years upward; it is from this that
even his bones get their growth and from this that his blood draws
its vitality!

Now, all such factors of physiological development are _suffocated_
by our antiquated pedagogic methods. We prevent, more or less
completely, the development of the separate personalities, in
order to keep all the pupils within the selfsame limits. The
perfectionment of each is impeded by the common level which it is
expected that all shall attain and make their limit, while the
pupils are forced to _receive_ from us, instead of producing of
their own accord; and they are obliged to sit motionless with their
minds in bondage to an iron programme, as their bodies are to the
iron benches.

We wish to look upon them as machines, to be driven and guided by
us, when in reality they are the most sensitive and the most superb
creation of nature.

We destroy divine forces by slavery. Rewards and punishments
furnish us with the needed scourge to enforce submission from these
marvelously active minds; we encourage them with rewards! to what
end? to winning the prize! Well, by doing so we make the child
lose sight of his real goal, which is knowledge, liberty and work,
in order to dazzle him with a prize which, considered morally,
is vanity, and considered materially is a few grains of metal.
We inflict punishments in order to conquer nature, which is in
rebellion, not against what is good and beautiful, not against the
purpose of life, but against us, because we are tyrants instead of
guides.

If only we did not also punish sickness, misfortune and poverty!

We are breakers-in of free human beings, not educators of men.

Our faith in rewards and punishments as _a necessary means_ to the
progress of the children and to the maintenance of discipline, is
a fallacy already exploded by experiment. It is not the material
and vain reward, bestowed upon a few individual children, that
constitutes the psychic stimulus which spurs on the multifold
expansions of human life to greater heights; rewards degrade the
grandeur of human consciousness into vanity and confine it within
the limits of egotism, which means perdition. The stimulus worthy
of man is the joy which he feels in the consciousness of his own
growth; and he grows only through the conquest of his own spirit
and the spread of universal brotherhood. It is not true that the
child is incapable of feeling a spiritual stimulus far greater
than the wretched prize that gives him an egotistical and illusory
superiority over his companions; it is rather that we ourselves,
because already degraded by egotism, judge these new forces of
nascent human life after our own low standards.

The small boys and girls in our "Children's Houses" are of their
own accord distrustful of rewards; they despise the little medals,
intended to be pinned upon the breast as marks of distinction, and
instead they actively search for objects of study through which,
without any guidance from the teacher, they may model and judge and
correct themselves, and thus work toward perfection.

As to punishments, they are depressing in effect, and they are
inflicted upon children who are already depressed!

Even in the case of those who are adult and strong, we know that it
is necessary to encourage those who have fallen, to aid the weak,
to comfort those who are discouraged. And if this method serves for
the strong, how much more necessary it is for lives in the course
of evolution!

This is a great reform which the world awaits at our hands: we must
shatter the iron chains with which we have kept the intelligence of
the new generations in bondage![29]

=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:

-----------------------------
Age |Stature | Index
----------+---------+--------
7 years | 111 | 56
8 years | 117 | 55
9 years | 122 | 55
10 years | 128 | 54
11 years | 132 | 53
-----------------------------

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).

---------------------------------------+------------------------------
Measurements | Age at which the
-------------------+-------------------+ measurements of
Of the child |Normal measurements| Vincenzo would
|at the age of seven| be normal
-------------------+-------------------+------------------------------
Stature, 0.870 m. | 1.10 m. |Three years, stature, 0.864 m.
Weight, 12.400 kg. | 20.16 kg. |Two years, weight, 12 kg.
Circumference of | 0.55 m. |Four years, circumference of
chest, 0.507 m. | | chest, 0.505 m.
Vital index, 59 | Vital index, 54 |Two years, vital index, 59.
-------------------+-------------------+------------------------------

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 foetus which results from a syphilitic conception lacks _vitality_, and often fails to complete the cycle of intrauterine life. But even granting that the foetus 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 foetus during the period of gestation--nevertheless a _predisposition_ to infection from the bacillus can be inherited.